Chapter 35: Key Pediatric Nursing Interventions: Question 4 See full question 32s Report this Question A child needs a peripheral IV start as well as a venous blood sample for a laboratory test. The nurse will take what action? You Selected: Make sure the laboratory specimen is drawn prior to placing the IV access device. Correct response: Coordinate placing the peripheral IV and the lab blood draw. Explanation: Coordinate the IV placement and lab blood draw to minimize the number of venipunctures for the child. Gaining venous access for each purpose separately does not do this and is not necessary. Having a well-hydrated child makes venous access easier, but oral hydration will take some time, thus delaying needed treatment. Question 5 An infant is scheduled to have a painful procedure performed. Which nursing action provides the best support for the parents and infant? You Selected: Have the parents remain outside the room while the procedure is occurring. Correct response: Allow the parents to hold the infant during the procedure. Explanation: 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 infant during 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. Question 9 See full question 30s ] A child will be receiving a gastrostomy tube for long-term gastrostomy feedings. The surgeon is inserting a gastrostomy button. What are the advantages of the button placement? Select all that apply. more desirable cosmetically simple to care for less skin irritation than a tube shorter duration of tube insertion higher flow of enteral feeding Correct response: Explanation: For long-term gastrostomy feedings, a gastrostomy button may be inserted. Some advantages of buttons are that they are more desirable cosmetically, are simple to care for, and cause less skin irritation. They also are less conspicuous and allow the child to be more active and mobile. Whether the gastrostomy placement is a tube or a button does not affect the length of time the child will need the device. The G button does not change the flow of the enteral feeds. Question 5 See full question 1m 46s Report this Question A 4-year-old child is admitted to the hospital for surgery. Before the nurse administers medicine, the best way to identify the child would be to: You Selected: ask the child to state his or her name. Correct response: read the child's armband. Explanation: A child may answer to the wrong name or deny his or her identity to avoid an unpleasant situation or if scared of the unknown. If the child is avoiding the situation he or she may fail to answer. Using the child's nickname is okay in conversation but it is not a legal identification of the child. To verify the correct identity the nurse should verify the child's armband and the correct name with the child's caregiver. Bar code scanning the child's armband would also be a correct method of identification. Question 6 See full question 31s Report this Question The mother of a 9-year-old girl calls the physician's office complaining that her daughter continues to vomit soon after being given an oral amoxicillin capsule for her strep throat. The nurse recognizes that the child's vomiting will interfere with which pharmacokinetic process? You Selected: Distribution Correct response: Absorption Explanation: Drug absorption (transfer of the drug from its point of entry in the body into the bloodstream) is influenced by the route of administration as well as by the concentration and acidity of the drug. Vomiting and diarrhea, frequent symptoms of childhood illnesses, interfere with absorption because a drug does not remain in the gastrointestinal tract long enough to be absorbed. Distribution refers to the movement of the drug through the bloodstream to a specific site of action. Metabolism involves conversion of the drug into an active form (biotransformation) or an inactive form (inactivation). Excretion is the elimination of raw drug or drug metabolites, a process that largely prevents properly administered drugs from becoming toxic. Question 1 See full question 2m 30s Report this Question A nurse is providing care for a child diagnosed with beta-thalassemia. The child requires a blood transfusion of packed red blood cells (PRBCs). The health care provider has prescribed a transfusion volume of 10 ml/kg. The child weighs 37 lb (16.8 kg). How many milliliters should the nurse infuse? Your response: 1.68 Correct response: 168 Explanation: The nurse will use the client's weight in kilograms and multiply by the prescribed milliliters/kilogram 16.8 kg × 10 ml PRBCs = 168 mLl Question 4 See full question 4m 48s Report this Question A health care provider has prescribed hydroxyurea 20 mg/kg to a child as part of a treatment regimen for sickle cell disease. The child weighs 27 lb (12.2 kg). How many milligrams should the nurse administer? Your response: 1.6393442623 Correct response: 244 Explanation: The nurse will use the client's weight in kilograms and multiply by the prescribed milligrams per kilogram. 12.2 kg × 20 mg/kg = 244 mg Question 4 See full question 4m 48s Report this Question A health care provider has prescribed hydroxyurea 20 mg/kg to a child as part of a treatment regimen for sickle cell disease. The child weighs 27 lb (12.2 kg). How many milligrams should the nurse administer? Your response: 1.6393442623 Correct response: 244 Explanation: The nurse will use the client's weight in kilograms and multiply by the prescribed milligrams per kilogram. 12.2 kg × 20 mg/kg = 244 mg Question 3 See full question 31s Report this Question An IV device needs to be removed from a school-aged child. Which instruction by the nurse is bestto provide atraumatic care for this procedure? You Selected: "Would you like your parent to hold your other hand?" Correct response: "Would you like to help remove the tape from the IV?" Explanation: For a school-aged child, the nurse needs to openly discuss the procedure with the child at an age-appropriate level and to offer the child a sense of control over the situation. Thus, the nurse should explain what will occur and enlist the child’s help in the removal of the tape or dressing. This provides the child with a sense of control over the situation and also encourages his or her cooperation. The procedure may be slightly uncomfortable and the nurse should be honest about that with the child. This statement, however, could cause the child to have increased anxiety. It is better to let the child participate in the event and not make the child afraid. Asking the child to participate also says to the child that the discomfort will be minor. Asking the child if he or she wants the parent to hold the other hand can provide a sense of security, but it does not provide the child with a sense of control. The offer of a colorful band-aid is good, but this does not offer support during the procedure, only afterward. Question 10 See full question 25s Report this Question A parent informs the nurse about having a hard time getting her 6-year-old child to take the liquid medication at home. Which would be the best suggestion for the nurse to offer the parent to help correct this concern? You Selected: Tell the parent to say calmly, "Can you drink this for me?" Correct response: Tell the parent to state firmly, "It's time for you to drink your medicine." Explanation: The best guideline for the parent to help in getting a child to take the liquid medication is to state firmly, "It's time to take your medication." Asking or pleading with the child does not work. Firmness is required. The child can be, however, allowed to choose what liquid to use to help swallow the medication. This helps with self-esteem and independence. The parent should also be honest about the taste of the medication. Adults also should never refer to medicine as candy. If a child happens to like a particular medicine, he or she may help themselves to it, and consuming too much can be fatal. Question 3 See full question 1m 24s Report this Question A toddler requires 1.5 ml of an antibiotic given intramuscularly (IM). How will the nurse administer this medication? You Selected: Administer the antibiotic IM in the rectus femoris. Correct response: Divide the dose. Administer 0.75 ml IM in each vastus lateralis. Explanation: The recommended amount of solution a toddler should receive in one IM injection should not exceed 1 ml. Dividing the dose is necessary even though two injections will cause additional stress. These could be given simultaneously by two nurses. Seeking an oral route could be explored, but may not be feasible. The manufacturer's directions regarding the amount of diluent should be followed to ensure safety. Question 6 See full question 29s Report this Question A child with gastroenteritis has been unable to keep oral medication down. What nursing intervention would be appropriate for this client? You Selected: Hold all medications until the vomiting stops. Correct response: Request an intravenous form of the medication. Explanation: Absorption is the transfer of the drug from its point of entry into the bloodstream, and vomiting and diarrhea interfere with absorption because the drug does not remain in the gastrointestinal tract long enough to be absorbed. Distribution is not affected by vomiting and diarrhea, as it involves movement of the drug through the bloodstream. Metabolism involves conversion of the drug into an active or inactive form, and is unaffected by gastroenteritis. Excretion is the elimination of the drug from the body, usually through the kidneys. This is also unaffected by vomiting and diarrhea. Question 7 See full question 40s Report this Question A nurse is educating the parents how to administer daily oral medication to their 5-yearold boy. Which response indicates a need for further teaching? You Selected: “We checked that the medicine can be mixed with yogurt or applesauce.” Correct response: “He needs to take his medicine or he will lose a privilege.” Explanation: The nurse should emphasize that the parents should never threaten the child in order to make him take his medication. It is more appropriate to develop a cooperative approach that will elicit the child’s cooperation since he needs ongoing, daily medication. The other statements are correct. Question 2 See full question 54s Report this Question The nurse is caring for a child prescribed ophthalmic drops. Place the steps in the order the nurse will complete them when administering the ophthalmic medication to the child. Use each option once. You Selected: Place the child in the supine position, slightly hyperextending the neck with the head lower than the body Instruct the child to gently close the eyes Retract the lower conjunctival sac Place the prescribed number of drops into the lower eyelid Wipe any excess medication from the skin Correct response: Place the child in the supine position, slightly hyperextending the neck with the head lower than the body Retract the lower conjunctival sac Place the prescribed number of drops into the lower eyelid Instruct the child to gently close the eyes Wipe any excess medication from the skin Explanation: After performing the rights of medication administration, the nurse would place the child in the supine position, slightly hyperextending the neck with the head lower than the body. Next, the nurse would retract the lower eyelid and instill the drops. The child would then gently close the eyes and the nurse would remove any excess medication. Question 8 See full question 26s Report this Question A medical/surgical nurse has been floated to the pediatric unit. Which action by the float nurse would require the pediatric nurse to intervene? You Selected: requesting the pediatric nurse to double-check calculations Correct response: asking the child his or her name prior to giving medications Explanation: To prevent errors, the nurse should never ask children their names for identification. This action would require the pediatric nurse to intervenes. Instead, nurses must read or scan the bar code on clients' identification arm bands and compare them with the medication sheet or electronic record. It is important to include both the parents and child in teaching about a medication. Calculating pediatric doses is not something medical/surgical nurses do on a regular basis, so it would be appropriate for the float nurse to have a pediatric nurse double-check the calculations. Question 1 See full question 41s Report this Question The nurse knows additional teaching is needed if a parent makes which comment? You Selected: "I keep refrigerated medications on the highest shelf." Correct response: "I keep the medications in a drawer under papers." Explanation: The nurse would need to provide additional teaching if the medication is kept in a drawer under papers, as children are curious and will look inside drawers that are not locked. It is best to teach parents to keep medication in a locked drawer or cabinet. Keeping it in a high cabinet is also appropriate. Refrigerated medications should be kept on the highest shelf in the refrigerator. Question 5 See full question 35s Report this Question A child is receiving intravenous fluids for dehydration. The nurse notes coarse breath sounds and increased pulse and blood pressure. What does the nurse do first? You Selected: Assess intake, output, and weight. Correct response: Discontinue the IV infusion. Explanation: Signs of fluid overload are those of congestive heart failure and include coarse breath sounds, increased pulse rate, and increased blood pressure. These are not symptoms of extravasation because this would be swelling of fluid around the IV site. The nurse would need to stop the IV infusion, then assess weight, intake, and output. The nurse would then contact the health care provider. Chapter 37: Nursing Care of the Child with an Infectious or Communicable Disorder: Question 2 See full question 23s Report this Question The nurse is caring for a child admitted to the hospital for sepsis. Which assessment finding is the most concerning? You Selected: white blood cell count 18,000/mm3 Correct response: urine output of 10 ml over 3 hours Explanation: Children with sepsis will show alteration in temperature, heart rate, respiratory rate, and white blood cell count. Septic shock with organ dysfunction is more serious and can be manifested by decreased urine output. Question 3 See full question 15s Report this Question Nursing students are learning about the infectious process. They correctly identify the first stage of an infectious disease to be which period? You Selected: Prodromal period Correct response: Incubation period Explanation: Infection occurs when an organism invades the body and multiplies, causing damage to the tissue and cells. The infectious process goes through four stages. The incubation period is the first stage of the infectious disease. It is the time between the invasion of an organism and the onset of symptoms of infection. The prodromal period is the time from the onset of nonspecific symptoms to specific symptoms, for example, cold/flu-like symptoms before Koplik spots occur in measles. The illness is the time during which symptoms of the specific illness occur. The convalescent stage is the time when the acute symptoms disappear. Question 6 See full question 15s Report this Question What is the leading cause of neonatal sepsis and death? You Selected: cytomegalovirus infection Correct response: Group B streptococcus Explanation: Sepsis is a systemic overresponse to infection. It is very serious and can produce septic shock and death. In infants under the 3 months of age the most causative agents are group B streptococcus, Escherichia coli, Staphylococcus aureus, enteroviruses, and the herpes simplex virus. Any time a febrile, ill-appearing neonate is seen, a full septic work-up is done. Neonates have the poorest outcomes from sepsis. Neisseria meningitidis is one cause of sepsis in older children. The Epstein-Barr virus is a herpes virus that causes mononucleosis. The cytomegalovirus is a common herpes virus. It is spread through bodily fluids and is not necessarily a concern unless the person is immunocompromised or is pregnant. Question 7 See full question 17s Report this Question A nurse practitioner suspects that a child has scarlet fever based on which assessment finding? You Selected: An enanthematous rash Correct response: Red, strawberry tongue Explanation: The characteristic assessment finding that distinguishes scarlet fever from other disorders is the appearance of the red, strawberry tongue. Sore throat, an enanthematous and exanthematous rash, and white exudate on the tonsils are also seen with scarlet fever, but it is the strawberry tongue that helps to confirm the diagnosis Question 10 See full question 47s Report this Question A nursing instructor is teaching the students about the standard and transmission-based precautions. What type of precautions require placing a client in an isolated room with limited access, wearing gloves during contact with the client and all body fluids or contaminated items, wearing two layers of protective clothing, and avoiding sharing equipment between clients? You Selected: Droplet precautions Correct response: Contact precautions Explanation: Contact precautions means placing the client in an isolation room with limited access, wearing gloves during contact with the client and all body fluids, wearing two layers of protective clothing, limiting movement of the client from the room, and avoiding sharing equipment between clients. Standard precautions are used with every client. They involve good handwashing and the use of gloves for client contact. Airborne precautions are used for diseases where small particles are dispersed in the air. They require that the client be in a negative-pressure room and, in addition to standard personal protective equipment, the mask should be N95 or higher. Varicella would need airborne precautions. Droplet precautions are used for diseases such as pertussis, which produce large droplets. They require standard precautions plus a surgical mask, preferably with a face shield. Question 1 See full question 58s Report this Question A school-aged child is recovering from varicella. The parent calls the school nurse and states, "my child is feeling much better" and asks when the child can return to school. What information does the nurse provide the parent? You Selected: "Your child may return to school when a health care provider has given written permission." Correct response: "Your child may return to school when all of the lesions have crusted over." Explanation: Varicella is a highly communicable disease. It is spread via airborne transmission or by direct contact with the nasopharyngeal secretions of an infected person. Varicella is communicable from 1 to 2 days before the rash occurs until all the vesicles have crusted over. The nurse would be correct in telling the parent the child cannot return to school, even though the child is feeling better, until all the vesicles have crusted over. The child does not have to be free of lesions. Being free of fever does not make the child less communicable. The child would not need a permission slip from the health care provider unless this is a specific requirement by the child's school district. Question 3 See full question 27s Report this Question The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first? You Selected: a child diagnosed with measles experiencing photophobia and coryza Correct response: a child with erythema infectiosum experiencing fatigue and confusion Explanation: A child with erythema infectiosum experiencing fatigue and confusion is showing signs of decreased oxygenation, possibly related to aplasia of erythrocytes caused by the virus. A child with signs and symptoms of decreased oxygenation should be seen first. Nausea and malaise are symptoms of chicken pox. A child with herpes simplex will most likely report pain an pruritis. Signs and symptoms of measles include photophobia and coryza. Question 10 See full question 26s Report this Question After teaching a class to a group of nursing students about reporting infectious diseases to the Centers for Disease Control and Prevention, the instructor determines a need for additional discussion when the students identify which infection as being reportable: You Selected: Lyme disease Correct response: pinworm Explanation: Pinworm infections are not required to be reported. Gonorrhea, Lyme disease, and pertussis are all reportable infectious diseases. Question 3 See full question 24s Report this Question A nurse is assessing a neonate with sepsis. The nurse understands that most commonly the cause involves: You Selected: enterovirus. Correct response: bacteria. Explanation: Neonatal sepsis can be caused by viruses such as herpes simplex or enteroviruses and by protozoa (e.g., oxoplasma gondii). However, bacteria are typically the culprits. Question 4 See full question 33s Report this Question A young client in the clinic has a rash, cough, and fever that the parent says spiked on day 5 of the rash. The client also had conjunctivitis. What illness would the nurse expect the health care provider to diagnose? You Selected: Scarlet fever Correct response: Measles Explanation: Measles are diagnosed based on the symptoms. Measles is a viral illness. The prodromal period includes 2 to 4 days of rising fevers, cough, coryza, and conjunctivitis. Following this, Koplik spots develop followed by an erythematous maculopapular rash. The rash starts on the head and spreads downward and outward. Rubella, also viral, begins with the rash starting first and the child will have a low-grade fever. Scarlet fever is a bacterial illness generally occurring after strep throat. It is accompanied by high fevers and a generalized rash over the entire body. Varicella is also caused by a virus but the rash differs in that it has fluid-filled vesicles. Question 8 See full question 29s Report this Question A child has been diagnosed with hookworm. The nurse is teaching the parent about the treatment for the condition. Which statement made by the parent confirms that further education is needed? You Selected: "My child can play outside bare footed when treatment is done." Correct response: "My child can play outside bare footed when treatment is done." Explanation: Hookworms are found in soil, especially in areas with warmer climates. They enter the body through the skin, pores and hair follicles. The treatment is with the drug albendazole. The duration is from 7 to 14 days of treatment. Most importantly, besides medication, good handwashing and sanitation practices are needed. Children should wear shoes and not go barefoot outside since the worms can enter through the soles of the feet. The worms attach themselves to the walls of the small intestine where they feed and reproduce. This can cause anemia. The child's diet should include foods high in iron or iron supplements. All children who are suspected or at high risk should be evaluated for hookworms. Question 2 See full question 19s Report this Question A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease? You Selected: Mumps Correct response: Mumps Explanation: Mumps is an infectious disease with a primary symptom of a swollen parotid gland. It is a contagious disease spread by droplets. The child is contagious 1 to 7 days prior to the onset of the swelling and 4 to 9 days after the onset of the swelling. Pertussis is a respiratory disorder that causes severe paroxysmal coughing, which produces a whooping sound. Measles is recognized by Koplik spots in the mouth and the classic maculopapular rash that starts on the head and spreads downward. Scabies is a skin condition where lice lay eggs under the skin. The rash is very pruritic and is seen on the hands, feet, and folds of the skin. Question 6 See full question 41s Report this Question A 6-month-old boy is brought to the doctor's office with a high fever. The physician diagnoses the child as having a viral infection of some kind and recommends acetaminophen to reduce the fever. After 3 days, the mother returns with the child. The fever is gone, but a rash of discrete, rose-pink macules approximately 2 to 3 mm and flat with the skin surface appears. Which condition should the nurse suspect? You Selected: Roseola Correct response: Roseola Explanation: Roseola begins with a high fever; after 3 or 4 days, the fever falls abruptly and a distinctive rash of discrete, rose-pink macules approximately 2 to 3 mm in size and flat with the skin surface appears. With rubella, after the 1 to 5 days of prodromal signs, a discrete pink-red maculopapular rash begins on the face, then spreads downward to the trunk and extremities. On the third day, the rash disappears. Measles feature Koplik spots (small, irregular, bright-red spots with a blue-white center point), which appear on the buccal membrane. Chickenpox is marked by a low-grade fever, malaise, and, in 24 hours, the appearance of a distinctive rash. Varicella lesions first begin as a macula, then progress rapidly within 6 to 8 hours to a papule, then a vesicle that becomes umbilicated and then forms a crust. Question 8 See full question 33s Report this Question A young client arrives at the clinic with a rash on the trunk and flexor surfaces of the extremities. The parent informs the nurse that the rash started a day before on the exterior surfaces of the extremities; 2 days before, the child had a really bad rash on the face. The health care provider diagnoses the child with erythema infectiosum. The nurse tells the parent that this is also known as: You Selected: pityriasis rosea. Correct response: fifth disease. Explanation: Erythema infectiosum is also known as "fifth disease." It starts with a fever, headache, and malaise. One week later, a rash appears on the face. A day later, the rash appears on the extensor surfaces of the extremities. One more day later, the rash appears on the trunk and flexor surfaces of the extremities. Pityriasis rosea is a skin rash that begins with a large spot on the chest, abdomen, or back that is followed by a pattern of small lesions. It is self-limiting and can be treated with steroid creams. Rosacea is a chronic inflammatory skin condition that causes redness to the face. An enterovirus infection can many times cause the same symptoms as the common cold or it can include the respiratory system. It is contagious. Question 5 See full question 18s Report this Question The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions? You Selected: “The lesions should eventually form soft crusts that drain.” Correct response: “We need to make sure that he washes his hands frequently.” Explanation: The child with varicella needs to wash his hands frequently with antibacterial soap to reduce bacterial colonization. A cool bath with soothing colloidal oatmeal may help the skin discomfort. Alcohol would be too drying to the skin. Acetaminophen, not aspirin, should be used to reduce fever. The lesions should eventually crust over. Soft crusts with drainage may suggest an infection. Question 7 See full question 57s Report this Question The nurse is discussing fever with the parents of a child who is in the emergency department with a temperature of 101°F (38.3°C). Which statement by a parent indicates an understanding of fevers and their management in the ill child? You Selected: “We’ve had to wake him up in the night to give him more medicine to reduce his temperature.” Correct response: “Fevers can be beneficial because they can slow down the growth of the bacteria or virus that may be causing the infection.” Explanation: Fevers can be protective and can help the body fight the infection. Fevers slow down bacterial or viral growth. Mismanaging fevers include inappropriate dosing of antipyretics, awakening a child at night to administer antipyretics, and using cold water or sponging the child with alcohol to reduce the temperature. Question 6 See full question 17s Report this Question A nursing instructor has presented a class on the stages of an infectious disease to a group of students and asks the students to place the stages in their proper sequence from beginning to end. Place the stages in their proper sequence. You Selected: Incubation Prodrome Illness Convalescence Correct response: Incubation Prodrome Illness Convalescence Explanation: An infectious disease begins with incubation, then progresses to the prodrome stage, then to illness, and finally to convalescence.
