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Flashcards in Chapter 45 Deck (32)
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1

What should the nurse consider when having consent forms signed for surgery and procedures on children?
a.
Only a parent or legal guardian can give consent.
b.
The person giving consent must be at least 18 years old.
c.
The risks and benefits of a procedure are part of the consent process.
d.
A mental age of 7 years or older is required for a consent to be considered “informed.”

C
The informed consent must include the nature of the procedure, benefits and risks, and alternatives to the procedure. In special circumstances such as emancipated minors, consent can be given by someone younger than 18 years without the parent or legal guardian. A mental age of 7 years is too young for consent to be informed.

2

The nurse is planning how to prepare a 4-year-old child for some diagnostic procedures. Which guideline should be included to prepare this preschooler?
a.
Plan for a short teaching session of about 30 minutes.
b.
Tell the child that procedures are never a form of punishment.
c.
Keep equipment out of the child’s view.
d.
Use correct scientific and medical terminology in explanations.

B
Preschoolers may view illness and hospitalization as punishment, so always state directly that procedures are never a form of punishment. Teaching sessions for this age group should be 10 to 15 minutes in length. Demonstrate the use of equipment and allow the child to play with miniature or actual equipment. Explain the procedure and how it affects the child in simple terms.

3

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

A
In this case, it is appropriate for the child to leave her underpants on. This allows her some measure of control during the foot surgery. The mother should not be required to make the child more upset. Katie is too young to understand what hospital policy means, so this explanation would not help her.

4

Using your knowledge of child development, what is the best approach to prepare a toddler for a procedure?
a.
Avoid asking the child to make choices.
b.
Demonstrate the procedure on a doll.
c.
Plan for the teaching session to last about 20 minutes.
d.
Show the necessary equipment without allowing child to handle it.

B
Prepare toddlers for procedures by using play. Demonstrate on a doll, but avoid using the child’s favourite doll because the toddler may think the doll is really “feeling” the procedure. In preparing a toddler for a procedure, allow the child to participate in care and help whenever possible. Teaching sessions for toddlers should be about 5 to 10 minutes. Use a small replica of the equipment and allow the child to handle it.

5

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

A
The parents’ preferences for assisting, observing, or waiting outside the room should be assessed, as well as the child’s preference for parental presence. The child’s choice should be respected. If the mother and child are agreeable, the mother is welcome to stay. An appropriate substitute for the mother is necessary only if the mother does not wish to stay. Support must be offered to the child regardless of parental presence.

6

The emergency department nurse is cleaning multiple facial abrasions on 9-year-old Mike. His mother is present. He is crying and screaming loudly. What should the nurse do?
a.
Ask him to be quieter.
b.
Have his mother tell him to relax.
c.
Tell him it is okay to cry and scream.
d.
Suggest that he talk to his mother instead of crying.

C
The child should be allowed to express feelings of anger, anxiety, fear, frustration, or any other emotion. The child needs to know that it is all right to cry. There is no reason for him to be quieter. He is upset and needs to be able to express his feelings.

7

In some genetically susceptible children, anaesthetic agents can trigger malignant hyperthermia. In addition to an increased temperature, what is one early sign of this disorder?
a.
Apnea
b.
Bradycardia
c.
Muscle rigidity
d.
Decreased blood pressure

C
Early signs of malignant hyperthermia include tachycardia, increasing blood pressure, tachypnea, mottled skin, and muscle rigidity. Apnea is not a sign of malignant hyperthermia. Tachycardia, not bradycardia, is an early sign of malignant hyperthermia. Increased, not decreased, blood pressure is characteristic of malignant hyperthermia.

8

The nurse is caring for an unconscious child. Skin care should include which of the following?
a.
Avoiding use of pressure reduction on the bed.
b.
Massaging reddened bony prominences to prevent deep tissue damage.
c.
Using a draw sheet to move the child in bed to reduce friction and shearing injuries.
d.
Avoiding rinsing skin after cleansing with mild antibacterial soap to provide a protective barrier.

C
A draw sheet should be used to move the child in the bed or onto a gurney to reduce friction and shearing injuries. Do not drag the child from under the arms. Bony prominences should not be massaged if reddened, as deep tissue damage can occur. Pressure-reduction devices should be used instead. The skin should be cleansed with mild, non-alkaline soap or soap-free cleaning agents for routine bathing.

9

Which of the following is an appropriate intervention to encourage food and fluid intake in a hospitalized child?
a.
Force the child to eat and drink to combat caloric losses.
b.
Discourage participation in non-eating activities until caloric intake is sufficient.
c.
Administer large quantities of flavoured fluids at frequent intervals and during meals.
d.
Give high-quality foods and snacks whenever the child expresses hunger.

D
Small, frequent meals and nutritious snacks should be provided for the child. Favourite foods such as peanut butter and jelly sandwiches, fruit yogurt, cheese, pizza, and macaroni and cheese should be available. Forcing a child to eat only results in rebellion and reinforces the behaviour as a control mechanism. Large quantities of fluid may decrease the child’s hunger and further inhibit food intake.

10

Kimberly, age 3 years, has a fever associated with a viral illness. Her mother calls the nurse, reporting a fever of 38°C even though she had acetaminophen 2 hours ago. What knowledge should the nurse’s response be based upon?
a.
Fevers such as this are common with viral illnesses.
b.
Seizures are common in children when antipyretics are ineffective.
c.
Fever over 38°C indicates greater severity of illness.
d.
Fever over 38°C indicates a probable bacterial infection.

A
Most fevers are of brief duration, have limited consequences, and are viral. There is little evidence to support the use of antipyretic drugs to prevent febrile seizures. Neither the increase in temperature nor its response to antipyretics indicates the severity or etiology of infection.

11

What should the nurse do when giving a child with hyperthermia a tepid water or sponge bath?
a.
Add isopropyl alcohol to the water.
b.
Direct a fan on the child in the bath.
c.
Stop the bath if the child begins to chill.
d.
Continue the bath for 5 minutes.

C
Environmental measures such as sponge baths can be used to reduce temperature if tolerated by the child, and if they do not induce shivering. Shivering is the body’s way of maintaining the elevated set point. Compensatory shivering increases metabolic requirements above those already caused by the fever. Ice water and isopropyl alcohol are inappropriate, potentially dangerous solutions. Fans should not be used because of the risk of the child developing vasoconstriction, which defeats the purpose of the cooling measures. Little blood is carried to the skin surface, and the blood remains primarily in the viscera to become heated. The child should be placed in a tub of tepid water for 20 to 30 minutes.

12

The nurse approaches a group of school-age patients to administer medication to one child named Sam Hart. What should the nurse do to identify the correct child?
a.
Ask the group, “Who is Sam Hart?”
b.
Call out to the group, “Sam Hart?”
c.
Ask each child, “What’s your name?”
d.
Check the patient’s identification name band.

D
The child must be correctly identified before the administration of any medication. Children are not totally reliable in giving correct names on request; identification bracelets should always be checked. Asking the group to identify the child, calling out the child’s name, and asking each child to give their name are not acceptable ways to identify a child. Older children may exchange places, give an erroneous name, or choose not to respond to their name as a joke.

13

The nurse wore gloves during a dressing change. What should the nurse do after removing the gloves?
a.
Wash hands thoroughly.
b.
Check the gloves for leaks.
c.
Rinse gloves in a disinfectant solution.
d.
Apply new gloves before touching the next patient.

A
When wearing gloves, the nurse should thoroughly wash his or her hands after removing them because both latex and vinyl gloves fail to provide complete protection. Gloves should be disposed of after use, and hands should be thoroughly washed again before new gloves are applied.

14

The nurse gives an injection in a patient’s room. What should the nurse do to dispose of the needle?
a.
Dispose of the syringe and needle in a rigid, puncture-resistant container in the patient’s room.
b.
Dispose of the syringe and needle in a rigid, puncture-resistant container in an area outside of the patient’s room.
c.
Cap the needle immediately after giving the injection and dispose it in the proper container.
d.
Cap the needle, break it from the syringe, and dispose it in the proper container.

A
All needles (uncapped and unbroken) should be disposed of in a rigid, puncture-resistant container located near the site of use. Consequently these containers should be installed in the patient’s room. The uncapped needle should not be transported to an area distant from use.

15

An 8-month-old infant is restrained to prevent interference with the intravenous infusion. What should the nurse do?
a.
Remove the restraints once a day to allow movement.
b.
Keep the restraints on constantly.
c.
Keep the restraints secure so infant remains supine.
d.
Remove restraints whenever possible.

D
The nurse should remove the restraints whenever possible. When parents and/or staff are present, the restraints can be removed, and the intravenous site protected. Restraints must be checked and documented every 1 to 2 hours and should be removed for range of motion on a periodic basis. The child should not be securely restrained in the supine position because of the risk of aspiration.

16

A venipuncture will be performed on a 7-year-old girl. She wants her mother to hold her during the procedure. What should the nurse recognize about this request?
a.
It is unsafe.
b.
It may help the child relax.
c.
It is against hospital policy.
d.
It is unnecessary because of the child’s age.

B
Both the mother’s preference for assisting, observing, or waiting outside the room and the child’s preference for parental presence should be assessed. The child’s choice should be respected. The mother’s presence will most likely help the child through the procedure. If the mother and child are agreeable, the mother is welcome to stay. Her familiarity with the procedure should be assessed, and potential safety risks identified. Hospital policies should be reviewed to ensure that they incorporate family-centred care.

17

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

C
To obtain small amounts of urine, use a syringe without a needle to aspirate urine directly from the diaper. If diapers with absorbent material are used, place a small gauze dressing or cotton balls inside the diaper to collect the urine, and aspirate the urine with a syringe. For frequent urine sampling, a collection bag would be too irritating to the child’s skin. Taping a small medicine cup to the inside of the diaper is not feasible; the urine will spill from the cup. Diapers with superabsorbent gels absorb the urine, so there is nothing to aspirate.

18

What is one important nursing consideration when performing a bladder catheterization on a young boy?
a.
Use a clean technique, not routine practices.
b.
Insert 2% lidocaine lubricant into the urethra.
c.
Lubricate catheter with water-soluble lubricant such as K-Y Jelly.
d.
Delay catheterization for 20 minutes while anaesthetic lubricant is absorbed.

B
The anxiety, fear, and discomfort experienced during catheterization can be significantly decreased by preparing the child and parents, selecting the correct catheter, and using the appropriate insertion technique. Generous lubrication of the urethra before catheterization and using lubricant containing 2% lidocaine may reduce or eliminate the burning and discomfort associated with this procedure. Catheterization is a sterile procedure, and routine practices for body-substance protection should be followed. Water-soluble lubricants do not provide appropriate local anaesthesia. Catheterization should be delayed only 2 to 3 minutes to provide sufficient local anaesthesia for the procedure.

19

The Allen test is performed as a precautionary measure before which procedure?
a.
Heel stick
b.
Venipuncture
c.
Arterial puncture
d.
Lumbar puncture

C
The Allen test assesses circulation in the radial, ulnar, or brachial arteries before arterial puncture.

20

A nurse must do a venipuncture on a 6-year-old child. What is one important element of providing atraumatic care?
a.
Use an 18-gauge needle if possible.
b.
If not successful after four attempts, have another nurse try.
c.
Restrain the child only as needed to perform venipuncture safely.
d.
Show the child the equipment to be used before the procedure.

C
Restrain the child only as needed to perform the procedure safely; use therapeutic hugging. Use the smallest-gauge needle that permits free flow of blood. A two-try-only policy is desirable, in which two operators each have only two attempts. If insertion is not successful after four punctures, alternative venous access should be considered. Keep all equipment out of sight until it is used.

21

An appropriate method for administering bitter oral medications to an infant or small child is to mix them with which one of the following?
a.
A bottle of formula or milk
b.
Any food the child is going to eat
c.
About a teaspoon of a sweet-tasting substance, such as jam or ice cream
d.
Large amounts of water to dilute medication sufficiently

C
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.

22

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

A
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.

23

Which guideline is most appropriate for intramuscular administration of medication in school-age children?
a.
Inject the medication as rapidly as possible.
b.
Insert the needle quickly, using a dart-like motion.
c.
Penetrate the skin immediately after cleansing the site, before it has dried.
d.
Have the child stand, if possible, and if he or she is cooperative.

B
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.

24

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

A
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.

25

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?
a.
It is less painful for small children.
b.
Rapid venous access is not possible.
c.
Antibiotics must be started immediately.
d.
Long-term central venous access is not possible.

B
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.

26

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

D
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.

27

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?
a.
Hyperthermia
b.
Electrocution
c.
Pressure necrosis
d.
Burns under the sensors

D
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.

28

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?
a.
Cover the skin with a shirt or gown before percussing.
b.
Strike the chest wall with a flat-hand position.
c.
Percuss over the entire trunk anteriorly and posteriorly.
d.
Percuss before positioning for postural drainage.

A
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.

29

The nurse must suction a child with a tracheostomy. Which intervention should the nurse include?
a.
Encourage the child to cough to raise the secretions before suctioning.
b.
Select a catheter with a diameter three-fourths as large as the diameter of the tracheostomy tube.
c.
Ensure that each pass of the suction catheter takes no longer than 5 seconds.
d.
Allow the child to rest after every five times the suction catheter is passed.

C
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.

30

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?
a.
200 mL
b.
300 mL
c.
350 mL
d.
400 mL

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