Question 1

A 2-year-old child comes to the emergency department with dehydration and hypovolemic shock.What statement best explains why an intraosseous infusion is started?

Accepted Answer

In situations in which rapid establishment of systemic access is vital and venous access is hampered such as peripheral circulatory collapse and hypovolemic shock,intraosseous infusion provides a rapid,lifesaving alternative.The procedure is painful,so both local and systemic analgesia are given.Antibiotics could be given when vascular access is obtained.Long-term central venous access is time-consuming,and intraosseous infusion is used in an emergency situation.

Question 2

What should the nurse do when caring for a child with an intravenous infusion?

Accepted Answer

The nursing responsibility for intravenous therapy is to calculate the amount to be infused in a given length of time,set the infusion rate,and monitor the apparatus frequently,at least every 1 to 2 hours,to make certain that the desired rate is maintained,the integrity of the system remains intact,the site remains intact (free of redness,edema,infiltration,or irritation),and the infusion does not stop.A minidropper (60 drops per millilitre)is the kind of recommended intravenous tubing in pediatrics.The intravenous site should be protected,and this may require soft restraints on the child.Insertion sites do not need to be changed every 24 hours; this should only happen if a problem is found with the site.Frequent change exposes the child to significant trauma.

Question 3

Which guideline is most appropriate for intramuscular administration of medication in school-age children?

Accepted Answer

The needle should be inserted quickly in a dart-like motion at a 90-degree angle,unless contraindicated.Inject medication slowly.Allow skin preparation to dry completely before skin is penetrated.Place the child in a lying or sitting position.

Question 4

In preparing to give "enemas until clear" to a young child,the nurse should select which of the following?

Accepted Answer

Isotonic solutions should be used in children,and saline is the solution of choice.Plain water is not used.This is a hypotonic solution and can cause rapid fluid shift,resulting in fluid overload.Oil-retention enemas will not achieve the "until clear" result.Fleet enemas are not advised for children because of the harsh action of the ingredients.The osmotic effects of the Fleet enema can result in diarrhea,which can lead to metabolic acidosis.

Question 5

When giving liquid medication to a crying 10-month-old infant,which approach minimizes the possibility of aspiration?

Accepted Answer

Administer the medication with a syringe without needle placed alongside of the infant's tongue.The contents are administered slowly in small amounts,allowing the child to swallow between deposits.Medications should be given slowly to avoid aspiration.The medication should be mixed with only a small amount of food or liquid.If the child does not finish drinking/eating,it is difficult to determine how much medication was consumed.Essential foods also should not be used.Holding the child's nasal passages shut increases the risk of aspiration.

Question 6

An appropriate method for administering bitter oral medications to an infant or small child is to mix them with which one of the following?

Accepted Answer

Mix the drug with a small amount (about 1 teaspoon)of a sweet-tasting substance.This will make the medication more palatable to the child.If the child does not finish drinking/eating what they are given,it is difficult to determine how much medication was consumed.Medication should not be mixed with essential foods and milk.The child may associate the altered taste with the food and refuse to eat it in the future.

Question 7

It is important to make certain that sensory connectors and oximeters are compatible since wiring that is incompatible can cause which one of the following?

Accepted Answer

It is important to make certain that sensor connectors and oximeters are compatible.Wiring that is incompatible can generate considerable heat at the tip of the sensor,causing second- and third-degree burns under the sensor.A low voltage is used,which should not present risk of electrocution.Pressure necrosis can occur from the sensor being attached too tightly,but this is not a problem of incompatibility.

Question 8

The nurse must suction a child with a tracheostomy.Which intervention should the nurse include?

Accepted Answer

Suctioning should require no longer than 5 seconds per pass,otherwise the airway may be occluded for too long.If the child is able to cough up secretions,suctioning may not be indicated.The catheter should have a diameter one-half the size of the tracheostomy tube.If it is too large,it might block the child's airway.The child is allowed to rest for 30 to 60 seconds after each aspiration to allow oxygen tension to return to normal.Then the process is repeated until the trachea is clear.

Question 9

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?

Accepted Answer

The TPN infusion rate should not be increased or decreased without the practitioner being informed,because alterations in rate can cause hyperglycemia or hypoglycemia.

Question 10

What is one advantage of the ventrogluteal muscle as an injection site in young children?

Accepted Answer

The advantages of the ventrogluteal muscle are that it is less painful,free of important nerves and vascular structures,and easily identifiable.The major disadvantage is health professionals' lack of familiarity with it,and controversy over whether the site can be used before weight bearing.The fact that it cannot be used when a child is 9 kg (20 lbs)or more and that is has increased subcutaneous fat are disadvantages of the ventrogluteal muscle as an injection site in young children.

Question 11

The nurse is teaching a mother how to perform chest physiotherapy and postural drainage on her 3-year-old child,who has cystic fibrosis.What should the nurse instruct her to do when performing percussion?

Accepted Answer

For postural drainage and percussion,the child should be dressed in a light shirt to protect the skin and placed in the appropriate postural drainage positions.The chest wall is struck with a cupped-hand,not a flat-hand position.The procedure should be done over the rib cage only.Positioning precedes the percussion.

Question 12

When teaching a mother how to administer eyedrops,where should the nurse tell her to place them?

Accepted Answer

The nurse should show her how to pull down the lower lid,forming a small conjunctival sac.The solution or ointment is applied to this area.The medication should not be administered directly on the eyeball.

Quiz 45: Pediatric Variations of Nursing Interventions