Peds Exam 2
Mark, age 6 years, is hospitalized for intravenous antibiotic therapy. He eats very little on his "regular diet" trays. He tells the nurse that all he wants to eat is pizza, tacos, and ice cream. Which of the following is the best nursing action?
Request these favorite foods for him.
When describing organ donation to the family of a dying child, what would the nurse include in the discussion?
Tell them that their cultural and religious beliefs will be considered
The nurse is administering acetaminophen PRN to a 9-year-old child on the pediatric ward of the hospital. Which answers reflect nursing actions that follow the rules of the 'eight rights' of pediatric medication administration? Select all that apply.
The nurse checks the documented time of the last dosage administered. The nurse calculates the dosage according to the child's weight. The nurse explains the therapeutic effects of the medication to the child and parents.
The nurse is preparing to administer an intramuscular injection to an 8-month-old infant. Which site would the nurse select?
Vastus lateralis
A 5-year-old child returns from the pediatric intensive care unit after abdominal surgery. The orders state to monitor vital signs every 2 hours. On assessment, the nurse observes that the child's heart rate is 20 beats/min less than it was preoperatively. The nurse's next action is to:
recheck the pulse and blood pressure in 15 minutes
A child, age 7 years, has a fever associated with a viral illness. She is being cared for at home. The nurse should recognize that the principal reason for treating fever in this child is:
relief of discomfort.
An 11-month-old hospitalized boy is restrained because he is receiving intravenous (IV) fluids. His grandmother has come to stay with him for the afternoon and asks the nurse if the restraints can be removed. The nurse's best response is which of the following?
"That is fine as long as you are with him."
The nurse is providing teaching for the mother of an infant who receives all of his nutrition through a tube. The nurse is reviewing interventions to promote growth and development. Which response from the mother indicates a need for further teaching?
"We need to keep feeding time very quiet."
The parents of a child with a developmental disability tell the nurse that they feel guilty because they sometimes find themselves feeling sad and wondering how their child would be without the disability. Which response by the nurse best shows empathy and encourages the parents to vent their feelings?
"I can only imagine how hard it is for you. You should know that it is common for parents to have these feelings when having a child with special needs."
The parents of a child receiving total parenteral nutrition ask the nurse why their child must have their blood glucose monitored so frequently since they are not diabetic. What is the best response by the nurse?
"It is important to monitor the blood glucose level because the solution has a high concentration of carbohydrates that convert to glucose."
The nurse is caring for children who are receiving IV therapy in the hospital setting. For which children would a central venous device be indicated?
A child who is receiving chemotherapy for leukemia
A nurse must do a venipuncture on a 6-year-old child. Which of the following is an important consideration in providing atraumatic care?
Show child equipment to be used before procedure.
The nurse is preparing to administer insulin to a diabetic child. Which would be the recommended route for this administration? (REd)
Subcutaneous
When describing the differences affecting the pharmacokinetics of drugs administered to children, which would the nurse include?
Topical drugs are absorbed more quickly in young children than adults.
A bone marrow biopsy will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. The nurse should recognize that this:
may help the child relax.
A 14-year-old is hospitalized with cystic fibrosis. Appropriate documentation of his breakfast is:
one pancake, eggs, and 240 ml OJ.
Parents are being taught how to feed their infant using the newly placed gastrostomy tube (G-tube). Essential information includes:
position the infant on the right side during and after the feeding.
The nurse is caring for a special needs infant. Which intervention will be most important in helping the child reach her maximum developmental potential?
Directing her parents to an early intervention program
The nurse is administering immunizations to children in a neighborhood clinic. What is the most frequent route of administration? (Red)
Intramuscular
The nurse has just collected blood by venipuncture in the antecubital fossa. What should the nurse do next?
Keep the child's arm extended, and apply pressure to the site for a few minutes.
The nurse is explaining to the student nurse the therapeutic effects of total parenteral nutrition (TPN). What accurately describes the use of TPN?
It is a highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals.
The nurse is caring for a child who is receiving total parenteral nutrition (TPN) for failure to thrive. Which nursing action might the nurse take to prevent complications from this therapy?
Use occlusive dressings and chlorhexidine-impregnated sponge dressings.
Which would be least appropriate to include in the discharge plan for a medically fragile child?
Encouraging passive caregiving
A 7-year-old boy has reentered the hospital for the second time in a month. Which intervention is particularly important at this time?
Assessing his parents&coping abilities
The nurse is caring for a 6-year-old child who has multisystem trauma due to a motor vehicle accident. The child is receiving total parenteral nutrition (TPN). What is a recommended nursing intervention for children on TPN?
Initially, check blood glucose levels frequently, such as every 4 to 6 hours, to evaluate for hyperglycemia
Guidelines for intramuscular administration of medication in school-age children include which of the following? (Red)
Insert needle quickly, using a dartlike motion.
A 4-year-old is admitted to outpatient surgery for removal of a cyst on her back. Her mother puts the hospital gown on her, but the child is crying because she wants to leave on her underpants. The most appropriate nursing action is which of the following?
Allow her to wear her underpants.
The nurse is providing home care for the family of an 8-year-old boy who is dying of leukemia. Which action will be most supportive to the parents of the child?
Being patient with parental indecision
The nurse is providing home care for a 1-year-old girl who is technologically dependent. Which intervention will best support the family process?
Creating schedules for therapies and interventions
The nurse caring for a 6-year-old patient enters the room to administer an oral medication in the form of a pill. The dad at the bedside looks at the pill and tells the nurse that his daughter has a hard time swallowing pills. Which of the following is the best response by the nurse?
Call the pharmacy and ask if the pill can be crushed.
What would the nurse include in the plan of care for a dying child with pain?
Changing the child position frequently but gently
Using knowledge of child development, which of the following is the best approach when preparing a toddler for a procedure?
Demonstrate on a doll how the procedure will be done.
The nurse is caring for a toddler with special needs. Which developmental tasks related to toddlerhood might be delayed in the child with special needs?
Developing language and motor skills
The nurse is preparing a 9-year-old boy before obtaining a blood specimen by venipuncture. The child tells the nurse he does not want to lose his blood. Which of the following is an appropriate approach by the nurse?
Discuss with him how his body is always in the process of making blood.
The nurse gives an injection in a patient's room. How should the nurse dispose of the needle?
Dispose of syringe and needle in a rigid, puncture-resistant container in patient's room.
A nurse has just administered medication via an orogastric tube. What is the priority nursing action following administration? ( RED)
Flush the tube.
When providing care to a dying child and his family, which would be most important?
Focusing on the family as the unit of care
The advantages of the ventrogluteal muscle as an injection site in young children include which of the following?
Free of significant nerves and vascular structures
The nurse is caring for families with vulnerable child syndrome. Which situation would be most likely to predispose the family to this condition?
Having an infant who is reluctant to feed properly
When teaching a mother how to administer eye drops, where should the nurse tell her to place them?
In the conjunctival sac when the lower lid is pulled down
A 2-year-old child is being admitted to the hospital for possible bacterial meningitis. When preparing for a lumbar puncture, the nurse should do which of the following?
Prepare child for conscious sedation being used for the procedure.
The nurse is providing palliative care for a 9-year-old boy in hospice. Which is unique to hospice care for children?
Prolonging treatment that might possibly help
The nurse caring for young children in a hospice setting is aware of the following statistics related to the occurrence of death in children. Which statement accurately reflects one of these statistics?
Congenital defects and traumatic injuries are the more common causes of diseases leading to death.
A child who has cystic fibrosis is admitted to the pediatric unit with methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse recognizes that in addition to a private room, the child is placed on the following precautions:
Contact.
The nurse is caring for an 8-year-old girl who requires medication that is only available in an enteric tablet form. The nurse is teaching the mother how to help the girl swallow the medication. Which statement indicates a need for further teaching?
"I can pinch her nose to make it easier to swallow."
The nurse is providing teaching on how to administer nasal drops. Which response by the parents indicates a need for further teaching?
"She needs to remain still for at least 10 minutes after administration."
A child has a central venous access device for intravenous (IV) fluid administration. A blood sample is needed for a complete blood count, hemogram, and electrolytes. The appropriate procedure is to:
withdraw a blood sample equal to the amount of fluid in the device, discard, and then withdraw the sample needed.
The mother of a 7-year-old boy with autism tearfully reports feeling as if she is not qualified to care for her child. Which initial action by the nurse is most appropriate?
Recognize the mother positive accomplishments in caring for her child.
A child is admitted to the hospital with a spinal cord injury resulting in paralysis below the level of the waist. When should the nurse begin planning with the parents for rehabilitation placement for this child after acute hospitalization?
As soon after the patient is admitted as possible
Frequent urine tests for specific gravity are required on a 6-month-old infant. Which of the following is the most appropriate way to collect small amounts of urine for these tests?
Aspirate urine from cotton balls inside diaper with a syringe without needle.
The nurse is caring for a 5-year-old boy who is terminally ill. Which intervention would best meet the needs of this dying child?
Assure the child that he did nothing wrong.
The nurse is determining the amount of IV fluids to administer in a 24-hour period to a child who weighs 40 kg. How many milliliters should the nurse administer?
1,900 mL
The nurse is reviewing the Adolescent Health Transition Project's recommended schedule for transition planning. According to the schedule, at what age should the nurse explore health care financing for young adults?
17 years old
The practitioner has ordered a liquid oral antibiotic for a toddler with otitis media. The prescription reads 1 1/2 tsp four times per day. What should the nurse consider in teaching the mother how to give the medicine?
A hollow-handled medication spoon is advisable, and the medication should be equally spaced while the child is awake.
The nurse is caring for infants having the condition failure to thrive (FTT). Which infants would be at risk for this condition? Select all that apply.
A newborn baby with tetralogy of Fallot An infant with a cleft palate An infant born to an impoverished mother An infant with bronchopulmonary dysplasia
The nurse is meeting with the parents of a 7-year-old boy with Down syndrome. The child mother reports an interest in hippotherapy. The child father reports that this seems to be a waste of money. The parents then ask the nurse for additional information. What information may be included in the nurse response? Select all answers that apply.
A variety of conditions including Down syndrome have used hippotherapy with success. Self-esteem may be improved with hippotherapy. The benefits of hippotherapy are both physical and psychological.
The nurse is administering a liquid medication to a 3-year-old using an oral syringe. Which action would be most appropriate?
Allow the child time to swallow the medication in between amounts.
The nurse is helping a 20-year-old woman transition to adult care. Which would be the most important role of the nurse following a successful transition?
Consultant
A 10-year-old child requires daily medications for a chronic illness. Her mother tells the nurse that the child continually forgets to take the medicine unless reminded. Which of the following is the most appropriate nursing action to promote adherence to the medication regimen?
Establish a contract with her, including rewards.
A nurse is caring for a 14-year-old with a gastrostomy tube. The girl has skin breakdown and irritation at the insertion site. Which would be the most appropriate method to clean and secure the gastrostomy tube?
If any drainage is present, use a presplit 2 × 2 and place it loosely around the site.
The nurse is teaching the student nurse the factors that affect the pharmacodynamics of the drugs they are administering. What is a factor affecting this property of drugs?
Immature body systems
The nurse is weighing an underweight infant diagnosed with failure to thrive (FTT) and notes that the baby does not make eye contact and is less active than the other infants. What would be a probable cause for the FTT related to the infant's body language?
Maternal abuse
The nurse is administering a crushed tablet to an 18-month-old infant. What is a recommended guideline for this intervention?
Mix the crushed tablet with a small amount of applesauce.
The nurse is caring for a 14-year-old girl with special health needs. What is the priority intervention for this child?
Monitoring for compliance with treatment
An appropriate method for administering oral medications that are bitter to an infant or small child would be to mix them with which of the following?
One teaspoon of something sweet-tasting such as jam
The nurse is teaching a group of parents with premature infants about the various medical and developmental problems that may occur. The nurse determines that additional teaching is needed when the group identifies what as a problem?
Peptic ulcer
The nurse needs to take the blood pressure of a preschool boy for the first time. Which action would be best in gaining his cooperation?
Permit him to handle equipment and see the cuff inflate and deflate before putting the cuff in place.
The nurse is caring for a 12-year-old child who is on fall precautions secondary to seizures. Which of the following of the following interventions should be included in the child's care plan? Select all that apply.
Place call light and desired items within reach. Have child wear appropriate size gown and nonskid footwear
The parents of an 11-year-old boy who is dying from cancer are concerned that he is not eating. Which intervention would serve both the parents& and child& needs?
Serving small meals of things the child likes
The nurse is caring for a 4-year-old girl with special care needs in the hospital. Which intervention would have the most positive effect on this child?
Taking her on an adventure down the hall
The nurse is caring for a preschool child who is receiving palliative care for end-stage cancer. What would be the focus of age-appropriate interventions for this child?
Teaching the child that death is not punishment
The student nurse is preparing to administer eye drops to a 2-year-old child. Which actions indicate the need for additional instruction? Select all that apply.
The nurse holds the medication bottle 3 inches from the child's nurse during administration. C) The child is instructed to look down during the instillation of the medication in the eyes. E) The child is turned so the medication flows toward the outer corner of the eye.
The nurse notes that a child with swallowing difficulty is receiving a continuous tube feeding. The child is very active and the feeding frequently gets interrupted because the tube becomes disconnected. What should the nurse discuss with the physician about the tube feeding?
The nurse should ask the physician if the patient could receive bolus rather than continuous tube feedings.
The nurse is caring for a child involved in an automobile accident whose family has been informed that the child is brain dead. What teaching might the nurse provide the family regarding organ donation?
The nurse should explain that written consent is necessary for the organ donation.
A physician orders a medication dosage that is above the normal dosage. The nurse administers the medication without questioning the dosage. What error did the nurse make? (RED)
The nurse violated one of the "rights" of medication administration.
The nurse is reviewing the therapist documentation in the medical record of an assigned client who has cerebral palsy. The therapist has noted the parents may be experiencing vulnerable child syndrome. Which observation of the family unit best supports this potential diagnosis?
The parents report they feel their child requires more therapy than the care team has indicated will be needed.
The nurse is looking into the Individuals with Disabilities Education Improvement Act of 2004 to help provide resources for a client with multiple chronic diseases. What are mandates of this legislation? Select all that apply.
This federal law allows each state to define "developmental disability" differently. An evaluation of the child's physical, language, emotional, and social capabilities is performed to determine eligibility. The goal is to maintain a natural environment, so most services occur in the home or day care center.
The parents of a child with physical and developmental special needs state, & We wish our child could get some kind of educational experience.& How should the nurse respond?
This must be difficult for you. Let talk with the social worker to see what programs are available for your child.
After administering eye drops to a child, the nurse applies gentle pressure to the inside corner of the eye at the nose for which reason?
To ensure the medication stays in the eye
The nurse is preparing to administer medication to a child with a gastrostomy tube in place. What is a recommended guideline for this procedure? Select all that apply.
Verify proper tube placement prior to instilling medication. Crush tablets and mix with warm water to prevent tube occlusion. Open up capsules and mix the contents with warm water. Flush the tube with water after administering medications.
A critically ill child has hyperthermia. The parents ask the nurse to give an antipyretic such as acetaminophen. The nurse should explain that antipyretics:
are of no value in treating hyperthermia.
Verification of the placement of a nasogastric tube before each use is best accomplished by:
aspiration of stomach contents.
A 7-year-old is identified as being at risk for skin breakdown. The nursing care plan for this child includes:
ensuring that nutritional intake meets requirements.
A 16-year-old girl comes to the pediatric clinic for information on birth control. The nurse knows that before this young woman can be examined, consent must be obtained from:
herself
A priority intervention for an infant with a temporary colostomy for Hirschsprung disease is:
protecting skin around the colostomy.
A child needs to drink 1 L of GoLYTELY in preparation for a computed tomographic scan of the abdomen. To encourage the child to drink, the nurse should:
use little cups and make a game to reward him for each cup he drinks.
A toddler is being sent to the operating room for surgery at 9 AM. As the nurse prepares the child, the priority intervention is:
verifying that the child and procedure are correct
