EVOLVE - ch. 39 (pediatric variations)

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?

A. Taking his blood pressure when a parent is there to comfort him.
B. Telling him that this procedure will help him get well faster.
C. Explaining to him how the blood flows through the arm and why the blood pressure is important.
D. Permitting him to handle equipment and see the dial move before putting the cuff in place.

Permitting him to handle equipment and see the dial move before putting the cuff in place.

The parent's presence will be helpful, but it will not alleviate fear of the unknown. This is not a true statement, and the child will not be able to understand the relationship between blood pressure and feeling better. Such an explanation is too complex for this age group. This is the best approach for a preschooler. It allows the child to play out the experience ahead of time.

It is time to give a 3-year-old boy his medication. Which approach is MOST likely to receive a positive response?

"It is time for your medication now. Would you like water or apple juice afterward?"
"Would not you like to take your medicine?"
"You must take your medicine, because the doctor says it will make you better."
"See how nicely this boy took his medicine? Now take yours."

"It's time for your medication now. Would you like water or apple juice afterward?"

This statement provides the child with a structured choice with two acceptable options. Posed as a question, this approach allows the child the option to say "no." This statement can elicit negative behavior from the child; the nurse is abdicating responsibility to the doctor. Encouraging competition is not appropriate for this age group.

The nurse is doing preoperative teaching with a child and his parents. The parents say that he is "dreading the shot" for premedication. The nurse's response should be based on the knowledge that:
A. preanesthetic medication can only be given intramuscularly.
B. in children the intramuscular route is safer than the intravenous (IV) route.
C. the child will have no memory of the injection because of amnesia.
D. preanesthetic medication should be "atraumatic," using oral, existing intravenous, or rectal routes.

preanesthetic medication should be "atraumatic," using oral, existing intravenous, or rectal routes.

Preanesthetic medicines can be given in a variety of routes other than intramuscular. The IV route is preferable. The muscle may be sore following the injection. The necessity of premedication is being investigated. If necessary, numerous drug regimens and routes exist.

A 10-year-old female child requires daily medications for a chronic illness. Her mother tells the nurse that she is always nagging her to take her medicine before school. What is the MOST appropriate nursing action to promote the child's compliance?

A. Establishing a contract with her, including rewards
B. Suggesting time-outs when she forgets her medicine
C. Discussing with her mother the damaging effects of nagging
D. Asking the child to bring her medicine containers to each appointment so they can be counted

Establishing a contract with her, including rewards

For school-age children, behavior contracting associated with desirable rewards is an effective method for achieving compliance. Time-outs should be used only if the behavioral contracting is not successful. Although nagging is not an effective strategy, the nurse needs to assist the mother in problem solving rather than criticize the actions. Monitoring the medicine supply may be tried if the contracting is not successful.

A 7-year-old female child 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:
A. relief of discomfort.
B. reassurance that illness is temporary.
C. prevention of secondary bacterial infection.
D. prevention of life-threatening complications.

relief of discomfort.

This is the primary reason for treating a fever with pharmacologic or environmental interventions. Treatment does not provide reassurance that illness is temporary. Fever-reducing medications (acetaminophen and ibuprofen) do not have antibacterial actions and may inhibit the fever-enhancing effects on the immune system. Fever-reducing medications (acetaminophen and ibuprofen) do not have antibacterial actions and may inhibit the fever-enhancing effects on the immune system.

Standard Precautions for infection control include that:

A. gloves are worn any time a patient is touched.
B. needles are capped immediately after use and disposed of in a special container.
C. gloves are worn to change diapers when there are loose or explosive stools.
D. masks are needed only when caring for patients with airborne infections.

gloves are worn to change diapers when there are loose or explosive stools.

Gloves are not indicated unless there is potential for contact with body substances. Needles should not be recapped. They should be immediately disposed of in a rigid, puncture-proof container. This situation has the greatest risk for exposure to body substances. Masks are a component of transmission-based precautions and not Standard Precautions.

The nurse is preparing a plan to teach a mother how to administer 1½ teaspoons of medicine to her 6-month-old child. The nurse should recommend using:

A. a household measuring spoon.
B. a regular silverware teaspoon.
C. a paper cup measure in 5-mL increments.
D. a plastic syringe (without needle) calibrated in milliliters.

a plastic syringe (without needle) calibrated in milliliters.

Household measuring spoons can be used if other more precise devices are not available. A dinner table utensil is not acceptable because household teaspoons vary greatly in size. A paper cup does not contain calibration for the additional 2.5 ml that is needed. This offers the most accurate measurement. The nurse should teach the mother to give the child 7.5 ml of the medication.

Several types of long-term central venous access devices are used. A benefit of using an implanted port (e.g., Port-a-cath) is that it:

A. is easy to use for self-administered infusions.
B. does not need to pierce the skin for access.
C. does not need to limit regular physical activity, including swimming.
D. cannot dislodge from the port, even if child plays with port site.

does not need to limit regular physical activity, including swimming.

The port has to be accessed with a special needle. Because the port is totally under the skin, a needle must be used to access the port. Because this device is totally under the skin, there are no activity limitations for the child. The port site is under the skin, so there is nothing for the child to play with.

The nurse observes erythema, pain, and edema at a child's intravenous (IV) site with streaking along the vein. What should the nurse do FIRST?

A. Immediately stop the infusion.
B. Check for a good blood return.
C. Ask another nurse to check the IV site.
D. Increase the intravenous (IV) drip for 1 minute and recheck.

Immediately stop the infusion.

This describes an extravasation/infiltration. The IV must be stopped to prevent further damage to the child. A blood return suggests that the IV catheter is still within the vein, but the description here is a definition of an infiltrated IV. The site can be checked after the IV is stopped. The IV drip should not be increased. It will add additional fluid to the child's tissue.

The best explanation for why pulse oximetry is used on young children is that it:

A. is noninvasive.
B. is better than capnography.
C. is more accurate than arterial blood gases.
D. provides intermittent measurements of O2.

is noninvasive.

Pulse oximetry is a noninvasive method to determine oxygen saturation. Capnography measures carbon dioxide exhalation. It does not reflect oxygen perfusion. It is less invasive and easier to test than arterial blood gases. It provides continuous or intermittent measurements of oxygen saturation.

When is bronchial (postural) drainage generally performed?

A. Immediately before all aerosol therapy
B. Before meals and at bedtime
C. Immediately on arising and at bedtime
D. Thirty minutes after meals and at bedtime

Before meals and at bedtime

It is more effective after other respiratory therapy, such as bronchodilators or nebulizer treatments. The most effective time for bronchial drainage is before meals and at bedtime. The procedure should be done 3 to 4 times each day. When drainage is done after meals, it may cause the child to vomit.

The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. What should be the NEXT action by the nurse?

A. Notifying the surgeon
B. Performing oral intubation
C. Trying to insert a larger-size tube
D. Trying to insert smaller-size tube

Trying to insert smaller-size tube

Notify the surgeon after the emergent situation is handled. Oral intubation is done if a tube cannot be inserted. A larger tube would cause trauma to the trachea. A smaller size tube should be available. This will keep the stoma open until further action can be taken.

A neonate had corrective surgery 3 days ago for esophageal atresia. The nurse notices that after the child receives his gastrostomy feeding, there is often a backup of formula feeding into the tube. As a result, the nurse should:

A. position the child in a supine position after feedings.
B. position the child on his or her left side after feedings.
C. leave the gastrostomy tube open and suspended after feedings.
D. leave the gastrostomy tube clamped after feedings.

leave the gastrostomy tube open and suspended after feedings.

The child should be positioned on the right side with head elevated at approximately 30 degrees. The child should be positioned on the right side with head elevated at approximately 30 degrees. The formula is backing up into the tube because of the delayed emptying. By keeping the tube open to air, the buildup of pressure on the operative site will be prevented. Leaving the tube clamped will create pressure on the operative site.

Informed consent is valid when: (Select all that apply.)

A. universal consent is used.
B. it is completed only for major surgery.
C. a person is over the age of majority and competent.
D. information is provided to make an intelligent decision.
E. the choice exercised is free of force, fraud, duress, or coercion.

a person is over the age of majority and competent. Correct
information is provided to make an intelligent decision. Correct
the choice exercised is free of force, fraud, duress, or coercion. Correct

The age of majority is usually 18 years. The term competent is defined as possessing the mental capacity to make choices and understand their consequences. Enough information is provided so that the person can make an intelligent decision. The person giving consent does so voluntarily; that is, freely without coercion, any form of constraint, force, fraud, duress, or deceit. Universal consent is not sufficient. Informed consent must be obtained for each surgical or diagnostic procedure. Informed consents must be obtained for major and minor surgery, diagnostic tests, medical treatments, release of medical information, postmortem examination, removal of a child from the health care provider against medical advice, and photographs for medical, educational, or public use.

When caring for a child with an intravenous (IV) infusion, the most appropriate nursing interventions are to (Select all that apply.)

A. use an infusion pump with a microdropper to ensure the prescribed infusion rate.
B. check IV fluids and infusion rate with another licensed professional.
avoid restraining the child to prevent undue emotional stress.
C. observe the insertion site frequently for signs of infiltration.
D. change the insertion site every 24 hours.

use an infusion pump with a microdropper to ensure the prescribed infusion rate.
check IV fluids and infusion rate with another licensed professional.
observe the insertion site frequently for signs of infiltration.

An infusion pump with a microdropper is recommended for IV infusions in pediatrics to ensure the correct amount is infused and checked at least every 1 to 2 hours to ensure that the desired rate is infused. IV fluids and infusion rates should be checked with another licensed professional to ensure right fluids and correct infusion rate based on the pediatric age and weight. The nurse is responsible for close observation at least every 1 to 2 hours to ensure the system remains intact and the infusion site remains free of redness, edema, infiltration, or irritation. Soft restraints may be required at times in pediatrics to ensure the IV site is protected. IV infusion sites do not need to be changed every 24 hours unless a problem is found with the site. Frequent changes expose the pediatric patient to significant trauma.