PrepUs for Pediatrics Chapter 30

The nurse is caring for a minor who wishes to sign the informed consent instead of the parents. In which situations would the nurse allow the adolescent to sign the consent? Select all that apply.

Adolescent is married. Adolescent is serving in the armed forces. There is an emergent or life-threatening situation. Legal emancipation has been documented. Minor is sexually active and seeking prenatal care Foster parents would be considered legal guardians, so they would be required to sign the consent form. In the other listed situations, the minor is considered emancipated and able to provide informed consent for health care needs.

A nursing student is learning how to insert and administer enteral feedings through a nasogastric (NG) tube. The student identifies the best way to check placement before each feeding as which of the following?

Aspirating stomach contents and checking pH Confirmation of placement by radiologic examination is the most accurate method of verifying placement and position of a feeding tube. Because of the risks of repeated radiation exposure, however, this procedure cannot be used before each feeding. The nurse should verify placement of the tube by aspirating stomach contents and checking the pH. Verifying position by inserting air into the feeding tube and listening for sounds in the stomach is now considered an unreliable method of checking for tube placement.

Following the repair of a cleft palate, the nurse places an 18-month-old child in restraints. The caregivers are with the child and will stay in the room at all times. Which type of restraints would the nurse most likely use for this child?

Elbow restraint An elbow restraint prevents the child from being able to bend the elbows and thus prevents the child from reaching or touching the face or head areas.

A 13-month-old is having a dressing changed on a packed leg wound. Which action from the parents should be encouraged by the nurse during the treatment?

Encourage the father to talk quietly to the child. The role of a parent during treatments and procedures should be one of support and comfort.

When an infant is scheduled for a painful procedure, what is the most important action by the nurse?

Help to soothe and comfort the baby before and after the procedure Infants undergoing procedures can experience pain. Thus, the important action is to help soothe and comfort the child before and after the procedure. The nurse should explain everything to the care provider, but the patient's comfort in this case is the highest priority.

A nurse is preparing to apply heat therapy to a client who has a back abscess. Heat has which of the following benefits? Select all that apply.

Increases circulation Promotes muscle relaxation Causes vasodilation Local application of heat increases circulation by vasodilation and promotes muscle relaxation, thereby relieving pain and congestion. It also speeds the formation and drainage of superficial abscesses.

A novice nurse is instructed to collect a urine specimen from a 3-week-old. Which method of collection would an experienced nurse suggest first?

Placing cotton balls in the diaper and squeezing out urine To collect a urine specimen from an infant, the nurse places cotton balls in the diaper and squeezes urine from the cotton ball. Catheterization is not recommended. A pediatric urine bag is used with older infants and toddlers. A midstream specimen would not be possible to collect in an infant.

A nurse working with a patient who has an elevated temperature notices that the child is beginning to shiver. Which of the following should the nurse do immediately?

Stop whatever intervention is being done to lower the temperature Removing clothing and excess covering from a child with a fever permits additional cooling through evaporation. If a child starts to shiver, whatever method is being used to lower the temperature should be stopped. Shivering indicates the child is chilling, which will cause the body temperature to increase.

The nurse needs to transport her preschool client to radiology for a chest X-Ray. Which transportation device would be most appropriate?

Wagon When transporting a child off the floor, the nurse needs to select the correct means of transportation based upon the child's age and developmental level. For a preschooler, a wagon would be the best choice for both safety and for enjoyment. A stretcher or wheelchair are both too large for such a young child and a crib is too small for them.

A pediatric nurse teaching a new mother how to hold the infant emphasizes the need to support which of the following? Select all that apply.

head back When a child is held he or she needs to be safe and feel secure. When holding an infant, always support the infant's head and back.

A preschool child has been admitted to the hospital. Which prescription should the nurse question?

tap water enema 500 mL Tap water is not used in enemas with children because, as it is not isotonic, it causes a rapid shift of fluid in body compartments, possibly leading to water intoxication. The nurse would want to question the health care provider about the prescription for a large tap water enema. The other prescriptions could be completed safely for a preschool child.

After inserting a nasogastric tube (NG) into a young child, how will the nurse tape the tube in place?

Below nose and to cheek The nurse will tape the tube below the nose and to the side of the cheek to avoid pressure on the naris, as also happens when taping to the forehead is done. Taping to the cheek and behind the ear will not stabilize the tube adequately. It will not be taped to the side of the mouth. A nasogastric tube enters the nose.

Colin, age 1, has been admitted for an injury on his head that requires sutures to be placed. He is crying and trying to sit up when he is placed on the examining table. To keep him safe during the procedure, the nurse would choose which method to restrain him?

Restrain him with a mummy restraint and release it as soon as the procedure is completed Restraints often are needed to protect a child from injury during a procedure or an examination, or to ensure the infant's or child's safety and comfort. A mummy restraint can be used for an infant or small child during a procedure. This device is a snug wrap that is effective when performing a scalp venipuncture, inserting a nasogastric tube, or performing other procedures that involve only the head or neck.

The nurse aspirates stomach contents before administering a nasogastric (NG) tube feeding. How will the nurse manage the aspirate? Select all that apply.

Return the aspirate to the stomach Determine the pH of the aspirate Record the amount of the aspirate Discarding the aspirate would deprive the child of both electrolytes and nutrients. The aspirate should not be discarded. The other measures are the ones to be used.

How will the nurse measure urine output in the hospitalized toddler who is partially potty trained?

Weigh the wet pull-up or diaper and subtract the weight of a dry diaper A toddler who is partially potty trained is likely to regress during the stress of hospitalization and need diapering. Subtracting dry weight in grams from wet weight reveals the number of milliliters of urine excreted. The other output measurement methods will not be accurate.

The nurse is caring for a child who has a gastrostomy tube in place. The nurse is about to give a feeding when it becomes evident that the tube is filled with dark brown fluid. The nurse's best action would be to:

report to the primary care provider that a complication may be occurring. A potential complication of gastrostomy tubes is that they may migrate through the pyloric valve into the duodenum and cause obstruction. Brown fluid suggests this has happened, because the tube is filled with feces. An alkaline pH suggests the complication has occurred, because bowel secretions are alkaline, while stomach secretions are acidic.

An infant is scheduled to have a painful procedure performed. Which nursing action provides the best support for the parents and infant?

Allow the parents to hold the infant during the procedure. It is important for the nurse to advocate for parents to remain in the procedure room to provide support to the infant. The parent may choose to hold the infant during a painful procedure, but it is best that the parent not restrain the procedure. Their role should be supportive and comforting, not one that causes pain. Having the parents remain outside the room leaves the infant without needed support. Infants experience pain but express it differently than adults.

The nurse instructs the mother of a preschool-aged child on the use of ibuprofen prescribed for a temperature. Which statement indicates that the teaching has been effective?

"I should give this medication with food." Because ibuprofen can cause gastrointestinal irritation, it should be given with food or fluids. The medication dosage should be measured by using the device supplied with the medication and not using a kitchen spoon. Fluids should be encouraged when taking this medication because renal failure can occur if the child becomes dehydrated. If the child complains of a stomachache while taking this medication, notify the health care provider. This could be an indication of an adverse effect.

A nurse is teaching a parent ways to reduce fever in a child. What statement made by the parent would require further education?

"I will give my child a tepid sponge bath to reduce the fever." Because of their ineffectiveness in reducing fever and associated discomfort, tepid sponge baths are no longer recommended for reducing fever.

The nurse needs to obtain a blood sample from a 7-year-old child. How should the nurse explain this procedure to the client?

"The doctor needs to look at your blood to see why you are sick; it will hurt for a second." The nurse should offer the child a simple explanation of the procedure such as, "The doctor needs to look at your blood to see why you are sick; it will only hurt for a second." The nurse needs to let the child know you understand how difficult it is to agree to the procedure. Saying that the procedure does not hurt is not being truthful. Asking the patient to hold still does not provide enough of an explanation about the venipuncture. Saying that the technician is going to draw the blood and that it will only hurt for a minute does not explain why the blood is needed.

A 4-year-old child is being prepared to undergo a bronchoscopy to remove an aspirated pea. The nurse knows that the parents need reteaching based on which statement?

"We will be able to take our child home immediately after the procedure is completed." The child will not leave immediately. Procedural complications are not common but may include compromise to the airway such as hemorrhage, pneumothorax, and airway edema. After the procedure, the nurse will need to continue to assess the child's respiratory function and airway patency. Postprocedure complications may include bronchospasm, stridor, desaturation, or respiratory distress. The nurse will observe children carefully the first time they drink after the procedure to assess that their gag reflex is intact and they do not choke. All of the other options are correct.

The nurse needs to provide instructions to a school-aged girl about how to obtain a clean catch midstream urine specimen. Which instructions are best?

Clean the labia from front to back, then void a small amount into the toilet before collecting in the cup. For girls, clean the labia from front to back using a cleansing pad or cotton balls saturated with the agency's designated cleaning solution. During the child's voiding, ask the parent to collect a "midstream" sample into a sterile container provided. It is unnecessary to catheterize a school age child to get a clean catch urine specimen. Urinating into the cup is part of the process, but it follows cleaning the labia and voiding a small amount in the toilet. A urine collection bag is used for infants, not school age children.

The nurse will apply which type of restraint for the infant recovering from cleft lip repair?

Elbow The reason for the restraint is to keep the infant from touching the lip and interfering with healing. The elbow restraint will do this while allowing all other movement. This device is the least restrictive while promoting safety. The other restraints would not be effective.

A nurse is starting an intravenous (IV) line in the antecubital fossa of a small child. What restraint would be best for the nurse to use to maintain patency of the IV?

Elbow restraint Elbow restraints are wrapped around the child's arm and tied securely to prevent the child from bending the elbow. They are often made of muslin or other materials in two layers. Pockets wide enough to hold tongue depressors are placed vertically in the width of the fabric. The top flap folds over to close the pockets. Care must be taken to ensure that the elbow restraints fit the child properly.

How will the nurse properly collect and care for the child's 24-hour urine specimen?

Empty each void into a designated container that keeps the urine cool The 24-hour urine collection is cumulative over this time period and is sent to the laboratory when complete. The urine is kept cool to keep the bacterial count to a minimum. Sterile collection procedures are not needed. Hydration of the child should reflect the youngster's norm. Pushing clear fluids is not necessary.

A school-aged child appears to be very brave about having blood drawn, but at time of venipuncture he begins to cry and pulls away. Which response would best demonstrate an understanding of his needs?

"It's okay to cry; I know having your blood tested hurts." Acknowledging that a procedure is painful helps a child to feel a sense of control.

A 6-year-old has just returned to his room after a spinal tap. What could the nurse do to make this unpleasant procedure less memorable for the child?

Give him a little toy that he has been wanting. Children given a treat or small toy after an uncomfortable procedure tend to remember the experience as not totally bad. The nurse should never say that any patient will not have to go through an uncomfortable experience again. Saying the child was brave when maybe he was not could foster mistrust in the nurse.

The nurse is caring for an 11-year-old admitted with a respiratory condition. The child requires occassional administration of low-flow oxygen. Which of the following methods of oxygen administration would likely be used for this child?

Nasal prongs Depending on the child's age and oxygen needs, many different methods are used to deliver oxygen. Nasal prongs or a nasal cannula are used appropriately for an 11-year-old child, especially if the child has modest needs for supplementation.

A nursing instructor is discussing oxygen therapy with a group of pediatric nursing students. Which of the following statements made by one of the students indicates a need for further teaching?

Oxygen should be removed immediately upon receiving the physician's order to stop therapy. Oxygen should be weaned or removed slowly.

The nurse is caring for a client needing oxygen. Many forms of oxygen delivery can be used. Which of the following is the most difficult to manage the oxygen concentration?

Oxygen tent It is most difficult to manage the oxygen concentration in a tent because it is opened frequently.

A pediatic client is having difficulty breathing. Which nursing intervention is appropriate for this client?

Provide oxygen as needed to maintain oxygen saturation above 93% The nurse would provide oxygen to increase oxygen saturation as needed for this child. A decrease in oxygen saturation will cause the child to have an increase in the work of breathing. The positioning does not promote an open airway. Having family members leave the room could increase the child's anxiety, which would worsen the respiratory status. Continuing to monitor the child provides no assistance or relief.

An older school-aged child is taught to apply warm, nonsterile compresses to an inflamed area on one leg. Which suggestion by the nurse will increase the effectiveness and safety of the child's self-care?

Set a timer for not longer than 20 minutes as a removal reminder Applying the compress for 20 minutes is the safe and therapeutic method. More lengthy application reverses the desired vasodilation. A microwave should not be used to heat the compress owing to the risk for uneven heating and burns. A hot water bottle increases the risk for burns.

An adolescent is scheduled to have the present gastrostomy tube replaced with a gastrostomy button. What advantage of the button over the tube will the nurse emphasize?

The button will be smaller and less visible when not in use. The button is a skin level device that is not visible under clothing when not in use. It is accessed easily with a special tube. Residual is aspirated and flushing regularly done. Replacement is needed on a regular basis. The button is more expensive than a simple gastrostomy tube.

A child has returned to the unit after having a lumbar puncture. Which instructions are important for the nurse to provide the parents and child?

The child will need to remain flat to prevent a headache. After a lumbar puncture, remind children to remain quiet and with their head flat to help prevent a post dural puncture headache. Typically, children will not be fearful of staff nor will the child be up ambulating until later. The procedure should not need to be repeated in 24 hours.

A child has been admitted to the pediatric unit with diarrhea. The nurse must collect a stool specimen for ova and parasites. The nurse knows that the proper procedure must be followed for detection of the ova and parasites. The proper procedure includes:

Transport the stool specimen to the laboratory promptly. The stool specimen must go to the laboratory immediately so that it does not have to be redone. Refrigeration destroys ova and parasites. Urine should not be in contact with the stool, and the stool needs to be in a clean container. Stools are collected from diapers as well as bedpans.

The nurse notes that parents accompanying their child for a procedure appear tense and nervous. What intervention by the nurse will best assist the young child to relax?

Use measures to reduce the parents' anxiety. Reducing the parents' anxiety will also reduce the child's anxiety. Anxious parents transmit their anxiety to the child and are less effective in providing support. The other nursing interventions are helpful, but relaxed parents are the key.

A pediatric nurse is preparing to use a jacket restraint with a client. After making sure it is the correct size and applying the jacket, the nurse will secure the ties to which of the following?

bed frame Jacket restraints are used to secure the child from climbing out of bed or a chair. Ties must be secured to the bed frame, not the side rails, so that the jacket is not pulled when the side rails are moved up and down.

A nurse will explain to a child's caregiver any procedure that is to be done. What is the primary reason for this explanation?

It helps to reduce anxiety. Although it is a patient's right to know everything about his or her care, in this case the caregiver is not the patient. Communication helps to develop rapport and trust, but the main purpose of explaining procedures to the caregiver of a child is to reduce anxiety. Doing this also will help decrease the child's anxiety.

A child is reporting pain where an IV infiltrated his hand earlier in the shift. The doctor orders warm compresses to the right hand every 4 hours. What precautions would the nurse implement for this client?

Limit treatments to 20 minutes at a time. Warm compresses are used to increase circulation to an area of the body and to promote pain relief. For a child having warm compresses, the length of each session is a maximum of 20 minutes to prevent skin damage. Towels used in warm compresses are never heated in a microwave because of uneven heating. Parents are not to apply compresses because the nurse needs to assess the skin before and after the treatment. Gauze is not a good material for compresses; it does not hold heat well.

If a urine specimen for analysis is ordered for an 8-month-old girl, which intervention would you use?

Place a urine collector on her just prior to feeding. Most infants void following a feeding, so placing a urine collector just before a feeding will usually allow a urine specimen to be obtained.

Which intervention should the nurse use when collecting a urine specimen from an 8-month-old client?

Place a urine collector on the baby just prior to feeding An infant who has not been toilet trained cannot be expected to urinate on command so a collecting device must be attached to the genitalia to collect their next voiding. Most infants void shortly after a feeding, so if the collector is applied just before a regular feeding, voiding will probably result soon afterward. Remove the collector as soon as the infant voids and transfer the specimen to a specimen cup by cutting a bottom corner of the bag. Waiting an hour after a feeding might not produce the needed urine for the specimen. It would be difficult to obtain a clean-catch specimen from a baby. It is inappropriate to send a saturated diaper to the laboratory for a urine specimen.

`The nurse is administering a prescribed bolus gavage feeding. Which action would be incorrect in performing this procedure?

Verify placement by auscultating for sounds in the stomach when air is inserted. Auscultating for sounds when air is injected into the stomach is no longer considered recommended for verifying tube placement because it has been found unreliable as a confirmation of position.

A nurse is preparing to insert a nasogastric (NG) tube in an infant. How will the nurse determine the appropriate length of tubing to use for the infant?

Measure from the tip of the child's nose to the earlobe down to the tip of the sternum. The nurse determines the length of tubing to use by measuring from the tip of the child's nose to the earlobe, and from the earlobe down to the tip of the sternum.

A parent calls the nurse in the emergency department and reports giving a tepid bath to decrease temperature in a feverish child. The parent states the child is shivering and wants to know if this means the bath was effective. What is the best response by the nurse?

"Shivering means the child is chilling, which will cause the body temperature to increase." If a child begins to shiver, whatever method is being used to lower the temperature should be stopped. Shivering indicates the child is chilling, which will cause the body temperature to increase.

A child is prescribed several diagnostic procedures. How can the nurse advocate for this client?

Advocate for procedures to be separated to allow time for food and rest. Whenever possible, try to arrange time for meals, rest, and play between procedures to prevent fatigue. If food or fluid is restricted, then it is best to decrease time between procedures. It is best for the parent to accompany the child to the procedures, but if the parent is not able to, then it is optimal to have the nurse present. Painful procedures might be done under moderate sedation, but not all procedures will require general anesthesia.

The nurse is reinforcing teaching with a group of caregivers regarding steps that can be taken to lower a child's elevated temperature. Which action would the nurse include in the discussion? Select all that apply

Encourage fluids. Administer acetaminophen. Lower the room temperature. Methods used to reduce fever include maintaining hydration by encouraging fluids and administering acetaminophen. Keep room environment cool. Dress the child in lightweight clothing. Because of their ineffectiveness in reducing fever and the discomfort they cause, tepid or lukewarm sponge baths are no longer recommended for reducing fever.

The nurse is reinforcing teaching with a group of caregivers regarding steps that can be taken to lower a child's elevated temperature. Which action would the nurse include in the discussion? Select all that apply.

Lower the room temperature. Administer acetaminophen. Encourage fluids. Methods used to reduce fever include maintaining hydration by encouraging fluids and administering acetaminophen. Keep room environment cool. Dress the child in lightweight clothing. Because of their ineffectiveness in reducing fever and the discomfort they cause, tepid or lukewarm sponge baths are no longer recommended for reducing fever.

Parents asks the nurse why their premature infant is receiving a feeding through the mouth rather than the nose. What is the best explanation by the nurse?

Newborns are obligate nose breathers so nasogastric may obstruct their breathing. Whether enteral catheters should be passed through the nares or the mouth is controversial. Because newborns are obligate nasal breathers, passing a catheter through the nose may obstruct their breathing space, and repeated insertion of a nasal gastric tube can cause inflammation and obstruction of the nose; thus most tubes are inserted orally in small infants. Orogastric insertion can also decrease the possibility of striking the vagal nerve in the back of the throat and causing bradycardia, whereas nasogastric tubes increase the possibility of striking the vagal nerve.

The doctor orders a urinalysis on a 15-month-old toddler. The mother states that the child is not potty trained. What is the best way for the nurse to collect the specimen?

Place a urine collection bag on the child after cleaning off the perineum. In patients that are not potty trained, the best method for collecting a urine specimen is to place a urine collection bag on the child and wait for them to void. The doctor did not order a urine culture, so a catheterized urinalysis is not needed and would be traumatic for the child. Trying to catch urine from a voiding toddler is nearly impossible and aspirating urine out of the diaper is not the best approach or one that ensures the best results.

A young preschooler who has been playing in the hospital playroom needs transportation to the imaging department. What conveyance will the nurse choose?

Wagon The best choice is the wagon. It is familiar to the child, is nonthreatening, and continues the playroom fun. The other, more adult-like methods may be used to transport children as condition and treatment regimens require

The nurse is caring for a breastfed infant hospitalized for gastroenteritis. What method can be used to most accurately measure intake?

Weigh the infant before and after feeding and subtract weight. Intake in breastfed infants is merely recorded as breastfed for however many minutes. If it is necessary to estimate the amount more closely than this, an infant can be weighed before and after a feeding. The difference in weight (measured in grams) is calculated to establish the number of milliliters of breast milk ingested (1 g = 1 ml). Weighing the infant before and after feeding is the most accurate method for strict intake. Therefore, it is possible to get an accurate intake measurement. Comparing to a bottlefed infant is inaccurate and therefore not correct.

A child is to receive an IV. The nurse knows that the first step in initiating the procedure is to:

verify the physician's order. The first step before beginning the procedure is to verify the physician's order. The other steps are necessary but are not the first step

The nurse is about to place a gastrostomy tube in an infant. After gathering the supplies, which is the first step in the procedure?

Explain the procedure to the parents. The procedure should be explained to the parents first. The nurse then proceeds with hand washing and commences the procedure.