San Jacinto College - RNSG 2201

Chapter 20: Pediatric Variations of Nursing Interventions Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition

MULTIPLE CHOICE

1)Which should the nurse consider when having consent forms signed for surgery and procedures on children?

1. 1. Only a parent or legal guardian can give consent.
   2. The person giving consent must be at least 18 years old.
   3. The risks and benefits of a procedure are part of the consent process.
   4. A mental age of 7 years or older is required for a consent to be considered “informed.”

2. The nurse is planning to prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this prescholar should included which action?
   1. Plan for a short teaching session of about 30 minutes.
   2. Tell the child that procedures are never a form of punishment.
   3. Keep equipment out of the child’s view.
   4. Use correct scientific and medical terminology in explanations.

3. Katie, 4 years old, is admitted to outpatient surgery for removal of a cyst on her foot. Her mother puts the hospital gown on her, but Katie is crying because she wants to leave on her underpants. What is the most appropriate nursing action?
   1. Allow her to wear her underpants
   2. Discuss with her mother why this is important to Katie
   3. Ask her mother to explain to her why she cannot wear them
   4. Explain in a kind, matter-of-fact manner that this is hospital policy

4. Using knowledge of child development, which is the best approach when preparing a toddler for a procedure?
   1. Avoid asking the child to make choices.
   2. Demonstrate the procedure on a doll.
   3. Plan for the teaching session to last about 20 minutes.
   4. Show necessary equipment without allowing the child to handle it.

5. The nurse is preparing a 12-year-old girl for a bone marrow aspiration. The girl tells the nurse she wants her mother with her “like before.” What is the most appropriate nursing action?
   1. Grant her request
   2. Explain why this is not possible
   3. Identify an appropriate substitute for her mother
   4. Offer to provide support to her during the procedure

6. The emergency department nurse is cleaning multiple facial abrasions on a 9-year-old child whose mother is present. The child is crying and screaming loudly. What is the best nursing action?
   1. Ask the child to be quieter

1. 2. Have the child’s mother give instructions about relaxation
   3. Tell the child it is okay to cry and scream
   4. Remove the mother from the room

7. In some genetically susceptible children, anesthetic agents can trigger malignant hyperthermia. The nurse should be alert in observing that, in addition to an increased temperature, what is an early sign of this disorder?
   1. Apnea
   2. Bradycardia
   3. Muscle rigidity
   4. Decreased blood pressure

8. The nurse is caring for an unconscious child. Skin care should include which action?
   1. Avoid use of pressure reduction on bed.
   2. Massage reddened bony prominences to prevent deep tissue damage.
   3. Use draw sheet to move child in bed to reduce friction and shearing injuries.
   4. Avoid rinsing skin after cleansing with mild antibacterial soap to provide a protective barrier.

9. What is an appropriate intervention to encourage food and fluid intake in a hospitalized child?
   1. Force the child to eat and drink to combat caloric losses.
   2. Discourage participation in non-eating activities until caloric intake is sufficient.
   3. Administer large quantities of flavored fluids at frequent intervals and during meals.
   4. Give high-quality foods and snacks whenever the child expresses hunger.

10. A 6-year-old child is hospitalized for intravenous (IV) antibiotic therapy. He eats little on his “regular diet” trays. He tells the nurse that all he wants to eat is pizza, tacos, and ice cream. Which is the best nursing action?
    1. Request these favorite foods for him.
    2. Identify healthier food choices that he likes.
    3. Explain that he needs fruits and vegitabels.
    4. Reward him with ice cream at the end of every meal that he eats.

11. A 3-year-old child has a fever associated with a viral illness. Her mother calls the nurse, reporting a fever of 102° F even though she had acetaminophen 2 hours ago. The nurse’s action should be based on which statement?
    1. Fevers such as this are common with viral illnesses.
    2. Seizures are common in children when antipyretics are ineffective.
    3. Fever over 102° F indicates greater severity of illness.
    4. Fever over 102° F indicates a probable bacterial infection.

12. A critically ill child has hyperthermia. The parents ask the nurse to give an antipyretic such as acetaminophen (Tylenol). What should the nurse explain about antipyretics?
    1. They may cause malignant hyperthermia
    2. They may cause febrile seizures
    3. They are of no value in treating hyperthermia
    4. They are of limited value in treating hyperthermia

13. Tepid water or sponge baths are indicated with hyperthermia in children. What is the priority nursing action?
    1. Add isopropyl alcohol to the water.
    2. Direct a fan on the child in the bath.
    3. Stop the bath if the child begins to chill.
    4. Continue the bath for 5 minutes.

14. The nurse approaches a group of school-age patients to administer medication to Sam Hart. What should the nurse do to identify the correct child?
    1. Ask the group, “Who is Sam Hart?”

1. 2. Call out to the group, “Sam Hart?”
   3. Ask each child, “What’s your name?”
   4. Check the patient’s identification name band

15. The nurse wore gloves during a dressing change. What should the nurse do after the gloves are removed?
    1. Wash hands thoroughly
    2. Check the gloves for leaks
    3. Rinse gloves in disinfectant solution
    4. Apply new gloves before touching the next patient

16. The nurse gives an injection in a patient’s room. The nurse should perform which intervention with the needle for disposal?
    1. Dispose of syringe and needle in a rigid, puncture-resistant container in the patient’s room.
    2. Dispose of syringe and needle in a rigid, puncture-resistant container in an area outside of the patient’s room.
    3. Cap needle immediately after giving injection and dispose of in a proper container.
    4. Cap needle, break from syringe, and dispose of in a proper container.

17. A mother calls the outpatient clinic requesting information on appropriate dosing for

over-the-counter medications for her 13-month-old who has symptoms of an upper respiratory tract infection and fever. The box of acetaminophen says to give 120 mg q4h when needed. At his 12-month visit, the nurse practitioner prescribed 150 mg. What is the nurse’s best response?

1. 1. “The doses are close enough; it doesn’t really matter which one is given.”
   2. “It is not appropriate to use dosages based on age because children have a wide range of weights at different ages.”
   3. “From your description, medications are not necessary. They should be avoided in children at this age.”
   4. “The nurse practitioner ordered the drug based on weight, which is a more accurate way of determining a therapeutic dose.”

18. An 8-month-old infant is restrained to prevent interference with the IV infusion. How should the nurse appropriately care for this child?
    1. Remove the restraints once a day to allow movement.
    2. Keep the restraints on constantly.
    3. Keep the restraints secure so the infant remains supine.
    4. Remove restraints whenever possible.

19. A venipuncture will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. What information should the nurse include in her response to the child?
    1. It is unsafe.
    2. It is helpful to relax the child.
    3. It is against hospital policy.
    4. It is unnecessary because of child’s age.

20. A 2-year-old child is being admitted to the hospital for possible bacterial meningitis. When preparing for a lumbar puncture, what is the nurse’s best action?
    1. Prepare child for conscious sedation during the test.
    2. Set up a tray with equipment the same size as for adults.
    3. Reassure the parents that the test is simple, painless, and risk free.
    4. Apply EMLA to the puncture site 15 minutes before the procedure.

21. Frequent urine testing for specific gravity and glucose are required on a 6-month-old infant. Which is the most appropriate way to collect small amounts of urine for these tests?
    1. Apply a urine-collection bag to the perineal area.
    2. Tape a small medicine cup to the inside of the diaper.
    3. Aspirate urine from cotton balls inside the diaper with a syringe.
    4. Aspirate urine from a superabsorbent disposable diaper with a syringe.

22. Which is an important nursing consideration when performing a bladder catheterization on a young boy?
    1. Clean technique, not standard precautions, is needed.
    2. Insert 2% lidocaine lubricant into the urethra.
    3. Lubricate catheter with water-soluble lubricant such as K-Y Jelly.
    4. Delay catheterization for 20 minutes while anesthetic lubricant is absorbed.

23. The Allen test is performed as a precautionary measure before which procedure?
    1. Heel stick
    2. Venipuncture

1. 3. Arterial puncture
   4. Lumbar puncture

24. The nurse must do a heel stick on an ill neonate to obtain a blood sample. What action is recommended to facilitate blood flow?
    1. Apply cool, moist compresses.
    2. Apply a tourniquet to the ankle.
    3. Elevate the foot for 5 minutes.
    4. Wrap the foot in a warm washcloth.

25. The nurse has just collected blood by venipuncture in the antecubital fossa. Which should the nurse do next?
    1. Keep the arm extended while applying a bandage to the site.
    2. Keep the arm extended, and apply pressure to the site for a few minutes.
    3. Apply a bandage to the site, and keep the arm flexed for 10 minutes.
    4. Apply a gauze pad or cotton ball to the site, and keep the arm flexed for several minutes.

26. A nurse must do a venipuncture on a 6-year-old child. What is an important consideration in providing atraumatic care?
    1. Use an 18-gauge needle if possible.
    2. If not successful after four attempts, have another nurse try.
    3. Restrain the child only as needed to perform venipuncture safely.
    4. Show the child equipment to be used before the procedure.

27. What is an appropriate method for administering oral medications that are bitter to an infant or small child?
    1. Mix in a bottle of formula or milk.
    2. Mix with any food the child is going to eat.
    3. Mix with a small amount (1 teaspoon) of a sweet-tasting substance such as jam or

ice cream.

1. 4. Mix with large amounts of water to dilute medication sufficiently.

28. When liquid medication is given to a crying 10-month-old infant, which approach minimizes the possibility of aspiration?
    1. Administer the medication with a syringe (without needle) placed along the side of the infant’s tongue.
    2. Administer the medication as rapidly as possible with the infant securely restrained.
    3. Mix the medication with the infant’s regular formula or juice and administer by bottle.
    4. Keep the child upright with the nasal passages blocked for a minute after administration.

29. Which is the preferred site for intramuscular injections in infants?
    1. Deltoid
    2. Dorsogluteal
    3. Rectus femoris
    4. Vastus lateralis

30. Guidelines for intramuscular administration of medication in school-age children include which action?
    1. Inject medication as rapidly as possible.
    2. Insert needle quickly, using a dart like motion.
    3. Penetrate skin immediately after cleansing site, before skin has dried.
    4. Have child stand, if possible, and if child is cooperative.

31. Several types of long-term central venous access devices are used. Which is considered an advantage of a Hickman-Broviac catheter?
    1. No need to keep exit site dry
    2. Easy to use for self-administered infusions
    3. Heparinized only monthly and after each infusion
    4. No limitations on regular physNicUaRlSaIcNtGivTitBy.,CiOnMcluding swimming

32. When teaching a mother how to administer eye drops, where should the nurse tell her to place them?
    1. In the conjunctival sac that is formed when the lower lid is pulled down
    2. Carefully under the eye lid while it is gently pulled upward
    3. On the sclera while the child looks to the side
    4. Anywhere as long as drops contact the eye’s surface

33. A 2-year-old child comes to the emergency department with dehydration and hypovolemic shock. Which best explains why an intraosseous infusion is started?
    1. It is less painful for small children.
    2. Rapid venous access is not possible.
    3. Antibiotics must be started immediately.
    4. Long-term central venous access is not possible.

34. What should the nurse do when caring for a child with an intravenous infusion?
    1. Use a macrodropper to facilitate reaching the prescribed flow rate.
    2. Avoid restraining the child to prevent undue emotional stress.
    3. Change the insertion site every 24 hours.
    4. Observe the insertion site frequently sign of for infiltration.

35. What is a nursing consideration related to the administration of oxygen in an infant?
    1. Humidify oxygen if the infant can tolerate it.
    2. Assess the infant to determine how much oxygen should be given.
    3. Ensure uninterrupted delivery of the appropriate oxygen concentration.
    4. Direct oxygen flow so that it blows directly into the infant’s face in a hood.

36. It is important to make certain that sensory connectors and oximeters are compatible. What can incompatible wiring cause?
    1. Hyperthermia
    2. Electrocution
    3. Pressure necrosis
    4. Burns under sensors

37. The nurse is teaching a mother how to perform chest physical therapy and postural drainage on her 3-year-old child, who has cystic fibrosis. How should the nurse instruct the mother?
    1. Cover the skin with a shirt or gown before percussing.
    2. Strike the chest wall with a flat-hand position.
    3. Percuss over the entire trunk anteriorly and posteriorly.
    4. Percuss before positioning for postural drainage.

38. The nurse must suction a child with a tracheostomy. What is the appropriate technique?
    1. Encourage the child to cough to raise the secretions before suctioning.
    2. Select a catheter with diameter three-fourths as large as the diameter of the

tracheostomy tube.

1. 3. Ensure each pass of the suction catheter should take no longer than 5 seconds.
   4. Allow the child to rest after every five times the suction catheter is passed.

39. How should the nurse administer a gavage feeding to a school-age child?
    1. Lubricate the tip of the feeding tube with Vaseline to facilitate passage.
    2. Check the placement of the tube by inserting 20 ml of sterile water.
    3. Administer feedings over 5 to 10 minutes.
    4. Position the patient on the right side after administering feeding.

40. A child is receiving total parenteral nutrition (TPN; hyperalimentation). At the end of 8 hours, the nurse observes the solution and notes that 200 ml/8 hr is being infused rather than the ordered amount of 300 ml/8 hr. The nurse should adjust the rate so that how much will infuse during the next 8 hours?
    1. 200 ml
    2. 300 ml
    3. 350 ml
    4. 400 ml

41. In preparing to give “enemas until clear” to a young child, the nurse should select which solution?
    1. Tap water
    2. Normal saline
    3. Oil retention
    4. Fleet solution

42. The nurse is doing a pre-hospitalization orientation for a 7-year-old child who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that she will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is:

1. 1. unnecessary.
   2. the surgeon’s responsibility.

1. 3. too stressful for a young child.
   4. an appropriate part of the child’s preparation.

MULTIPLE RESPONSE

1. The advantages of the ventrogluteal muscle as an injection site in young children include which considerations? (Select all that apply.)
   1. Less painful than vastus lateralis
   2. Free of important nerves and vascular structures
   3. Cannot be used when child reaches a weight of 20 pounds
   4. Increased subcutaneous fat, which increases drug absorption

1. 5. Easily identified by major landmarks

2. A nurse is caring for a child in droplet precautions. Which instructions should the nurse give to the unlicensed assistive personnel caring for this child? (Select all that apply.)
   1. Wear gloves when entering the room.
   2. Wear an isolation gown when entering the room.
   3. Place the child in a special air handling and ventilation room.
   4. A mask should be worn only when holding the child.
   5. Wash your hands upon exiting the room.

COMPLETION

1. A child with congestive heart failure is placed on a maintenance dosage of digoxin (Lanoxin). The dosage is 0.07 mg/kg/day, and the child’s weight is 7.2 kg. The physician prescribes the digoxin to be given once a day by mouth. Each dose will be                             milligrams. (Record your answer below using one decimal place.)

2. A physician’s prescription reads, “ampicillin sodium 125 mg IV every 6 hours.” The medication label reads, “1 g = 7.4 ml.” A nurse prepares to draw up          milliliters to administer one dose. (Round your answer to two decimal places.)

SHORT ANSWER

1. A 6-month-old infant is admitted to the pediatric unit with respiratory syncytial virus (RSV). The nurse places the infant on strict intake and output. The infant is in a size #2 diaper and the dry weight is 24 g. At the end of the shift, the infant has had two diapers with urine. One diaper weighed 56 g and one weighed 65 g. What is the total milliliter output for the shift? (Record your answer as a whole number below.)

OTHER