Question 1

What is an important nursing consideration when performing a bladder catheterization on a young boy?

Accepted Answer

A)  Use clean technique, not Standard Precautions. 
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 anesthetic lubricant is absorbed. 
A)  Use clean technique, not Standard Precautions. 
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 anesthetic lubricant is absorbed.

Question 2

Frequent urine testing for specific gravity and glucose are required on a 6-month-old infant.How should the nurse collect small amounts of urine for these tests?

Accepted Answer

A)  Apply a urine-collection bag to the 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. 
A)  Apply a urine-collection bag to the 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.

Question 3

A 2-year-old child comes to the emergency department demonstrating signs of dehydration and hypovolemic shock.Which best explains why an intraosseous infusion is started?

Accepted Answer

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. 
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.

Question 4

What important consideration in providing atraumatic care should the nurse consider when preforming a venipuncture on a 6-year-old child?

Accepted Answer

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 equipment to be used before procedure. 
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 equipment to be used before procedure.

Question 5

What critical information should the nurse incorporate into care when using restraints on a child?

Accepted Answer

A)  Use the least restrictive type of restraint. 
B)  Tie knots securely so they cannot be untied easily. 
C)  Secure the ties to the mattress or side rails. 
D)  Remove restraints every 4 hours to assess skin. 
A)  Use the least restrictive type of restraint. 
B)  Tie knots securely so they cannot be untied easily. 
C)  Secure the ties to the mattress or side rails. 
D)  Remove restraints every 4 hours to assess skin.

Question 6

MATCHING
The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube.

-Step five

Accepted Answer

A) Lubricate the nasogastric tube with water-soluble lubricant. 
B) Tape the nasogastric tube securely to the child's face. 
C) Check the placement of the tube by aspirating stomach contents. 
D) Place the child in the supine position with head slightly hyperflexed. 
E) Insert the nasogastric tube through the nares.
F)Measure the tube from the tip of the nose to the earlobe to the midpoint between the xiphoid process and the umbilicus. 
A) Lubricate the nasogastric tube with water-soluble lubricant. 
B) Tape the nasogastric tube securely to the child's face. 
C) Check the placement of the tube by aspirating stomach contents. 
D) Place the child in the supine position with head slightly hyperflexed. 
E) Insert the nasogastric tube through the nares.
F)Measure the tube from the tip of the nose to the earlobe to the midpoint between the xiphoid process and the umbilicus.

Question 7

After collecting blood by venipuncture in the antecubital fossa,what intervention should the nurse implement in order to assure control of any bleeding?

Accepted Answer

A)  Keep arm extended while applying a bandage to the site. 
B)  Keep arm extended, and apply pressure to the site for a few minutes. 
C)  Apply a bandage to the site, and keep the arm flexed for 10 minutes. 
D)  Apply a gauze pad or cotton ball to the site, and keep the arm flexed for several minutes. 
A)  Keep arm extended while applying a bandage to the site. 
B)  Keep arm extended, and apply pressure to the site for a few minutes. 
C)  Apply a bandage to the site, and keep the arm flexed for 10 minutes. 
D)  Apply a gauze pad or cotton ball to the site, and keep the arm flexed for several minutes.

Question 8

MATCHING
The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube.

-Step one

Accepted Answer

A) Lubricate the nasogastric tube with water-soluble lubricant. 
B) Tape the nasogastric tube securely to the child's face. 
C) Check the placement of the tube by aspirating stomach contents. 
D) Place the child in the supine position with head slightly hyperflexed. 
E) Insert the nasogastric tube through the nares.
F)Measure the tube from the tip of the nose to the earlobe to the midpoint between the xiphoid process and the umbilicus. 
A) Lubricate the nasogastric tube with water-soluble lubricant. 
B) Tape the nasogastric tube securely to the child's face. 
C) Check the placement of the tube by aspirating stomach contents. 
D) Place the child in the supine position with head slightly hyperflexed. 
E) Insert the nasogastric tube through the nares.
F)Measure the tube from the tip of the nose to the earlobe to the midpoint between the xiphoid process and the umbilicus.

Question 9

Which nursing action is the most appropriate when applying a face mask to a child prescribed oxygen therapy?

Accepted Answer

A)  Set the oxygen flow rate at less than 6 L/min. 
B)  Make sure the mask fits properly. 
C)  Keep the child warm. 
D)  Remove the mask for 5 minutes every hour. 
A)  Set the oxygen flow rate at less than 6 L/min. 
B)  Make sure the mask fits properly. 
C)  Keep the child warm. 
D)  Remove the mask for 5 minutes every hour.

Question 10

The nurse is planning how to best prepare a 4-year-old child for some diagnostic procedures.What guideline should the nurse consider when preparing a preschooler for a diagnostic procedure?

Accepted Answer

A)  Planning for a short teaching session of about 30 minutes. 
B)  Telling the child that procedures are never a form of punishment. 
C)  Keeping equipment out of the child's view. 
D)  Using correct scientific and medical terminology in explanations. 
A)  Planning for a short teaching session of about 30 minutes. 
B)  Telling the child that procedures are never a form of punishment. 
C)  Keeping equipment out of the child's view. 
D)  Using correct scientific and medical terminology in explanations.

Question 11

When administering a gavage feeding to a school-age child,the nurse should implement what intervention to assure safety?

Accepted Answer

A)  Lubricate the tip of the feeding tube with Vaseline to facilitate passage. 
B)  Check the placement of the tube by inserting 20 mL of sterile water. 
C)  Administer feedings over 5 to 10 minutes. 
D)  Position the child on the right side after administering the feeding. 
A)  Lubricate the tip of the feeding tube with Vaseline to facilitate passage. 
B)  Check the placement of the tube by inserting 20 mL of sterile water. 
C)  Administer feedings over 5 to 10 minutes. 
D)  Position the child on the right side after administering the feeding.

Question 12

MATCHING
The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube.

-Step four

Accepted Answer

A) Lubricate the nasogastric tube with water-soluble lubricant. 
B) Tape the nasogastric tube securely to the child's face. 
C) Check the placement of the tube by aspirating stomach contents. 
D) Place the child in the supine position with head slightly hyperflexed. 
E) Insert the nasogastric tube through the nares.
F)Measure the tube from the tip of the nose to the earlobe to the midpoint between the xiphoid process and the umbilicus. 
A) Lubricate the nasogastric tube with water-soluble lubricant. 
B) Tape the nasogastric tube securely to the child's face. 
C) Check the placement of the tube by aspirating stomach contents. 
D) Place the child in the supine position with head slightly hyperflexed. 
E) Insert the nasogastric tube through the nares.
F)Measure the tube from the tip of the nose to the earlobe to the midpoint between the xiphoid process and the umbilicus.

Question 13

MATCHING
The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube.

-Step three

Accepted Answer

A) Lubricate the nasogastric tube with water-soluble lubricant. 
B) Tape the nasogastric tube securely to the child's face. 
C) Check the placement of the tube by aspirating stomach contents. 
D) Place the child in the supine position with head slightly hyperflexed. 
E) Insert the nasogastric tube through the nares.
F)Measure the tube from the tip of the nose to the earlobe to the midpoint between the xiphoid process and the umbilicus. 
A) Lubricate the nasogastric tube with water-soluble lubricant. 
B) Tape the nasogastric tube securely to the child's face. 
C) Check the placement of the tube by aspirating stomach contents. 
D) Place the child in the supine position with head slightly hyperflexed. 
E) Insert the nasogastric tube through the nares.
F)Measure the tube from the tip of the nose to the earlobe to the midpoint between the xiphoid process and the umbilicus.

Question 14

What nursing action is appropriate for specimen collection?

Accepted Answer

A)  Follow sterile technique for specimen collection. 
B)  Sterile gloves are worn if the nurse plans to touch the specimen. 
C)  Use Standard Precautions when handling body fluids. 
D)  Avoid wearing gloves in front of the child and family. 
A)  Follow sterile technique for specimen collection. 
B)  Sterile gloves are worn if the nurse plans to touch the specimen. 
C)  Use Standard Precautions when handling body fluids. 
D)  Avoid wearing gloves in front of the child and family.

Question 15

The advantages of the ventrogluteal muscle as an injection site in young children include which of the following? (Select all that apply.)

Accepted Answer

A)  Less painful than vastus lateralis 
B)  Free of important nerves and vascular structures 
C)  Cannot be used when child reaches a weight of 20 lbs 
D)  Increased subcutaneous fat, which increases drug absorption 
E)  Easily identified by major landmarks 
A)  Less painful than vastus lateralis 
B)  Free of important nerves and vascular structures 
C)  Cannot be used when child reaches a weight of 20 lbs 
D)  Increased subcutaneous fat, which increases drug absorption 
E)  Easily identified by major landmarks

Question 16

What information should the nurse include when teaching parents how to care for a child's gastrostomy tube at home?

Accepted Answer

A)  Never turn the gastrostomy button. 
B)  Clean around the insertion site daily with soap and water. 
C)  Expect some leakage around the button. 
D)  Remove the tube for cleaning once a week. 
A)  Never turn the gastrostomy button. 
B)  Clean around the insertion site daily with soap and water. 
C)  Expect some leakage around the button. 
D)  Remove the tube for cleaning once a week.

Question 17

MATCHING
The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube.

-Step six

Accepted Answer

A) Lubricate the nasogastric tube with water-soluble lubricant. 
B) Tape the nasogastric tube securely to the child's face. 
C) Check the placement of the tube by aspirating stomach contents. 
D) Place the child in the supine position with head slightly hyperflexed. 
E) Insert the nasogastric tube through the nares.
F)Measure the tube from the tip of the nose to the earlobe to the midpoint between the xiphoid process and the umbilicus. 
A) Lubricate the nasogastric tube with water-soluble lubricant. 
B) Tape the nasogastric tube securely to the child's face. 
C) Check the placement of the tube by aspirating stomach contents. 
D) Place the child in the supine position with head slightly hyperflexed. 
E) Insert the nasogastric tube through the nares.
F)Measure the tube from the tip of the nose to the earlobe to the midpoint between the xiphoid process and the umbilicus.

Question 18

A 3 year old has a 102° F fever associated with a viral illness that has not responded to acetaminophen.The nurse's action should be based on what knowledge about fevers in children?

Accepted Answer

A)  Fevers such as this are common with viral illnesses. 
B)  Seizures are common in children when antipyretics are ineffective. 
C)  Fever over 102° F indicates greater severity of illness. 
D)  Fever over 102° F indicates a probable bacterial infection. 
A)  Fevers such as this are common with viral illnesses. 
B)  Seizures are common in children when antipyretics are ineffective. 
C)  Fever over 102° F indicates greater severity of illness. 
D)  Fever over 102° F indicates a probable bacterial infection.

Question 19

What procedure is recommended to facilitate a heelstick on an ill neonate to obtain a blood sample?

Accepted Answer

A)  Apply cool, moist compresses. 
B)  Apply a tourniquet to the ankle. 
C)  Elevate the foot for 5 minutes. 
D)  Wrap foot in a warm washcloth. 
A)  Apply cool, moist compresses. 
B)  Apply a tourniquet to the ankle. 
C)  Elevate the foot for 5 minutes. 
D)  Wrap foot in a warm washcloth.

Question 20

MATCHING
The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube.

-Step two

Accepted Answer

A) Lubricate the nasogastric tube with water-soluble lubricant. 
B) Tape the nasogastric tube securely to the child's face. 
C) Check the placement of the tube by aspirating stomach contents. 
D) Place the child in the supine position with head slightly hyperflexed. 
E) Insert the nasogastric tube through the nares.
F)Measure the tube from the tip of the nose to the earlobe to the midpoint between the xiphoid process and the umbilicus. 
A) Lubricate the nasogastric tube with water-soluble lubricant. 
B) Tape the nasogastric tube securely to the child's face. 
C) Check the placement of the tube by aspirating stomach contents. 
D) Place the child in the supine position with head slightly hyperflexed. 
E) Insert the nasogastric tube through the nares.
F)Measure the tube from the tip of the nose to the earlobe to the midpoint between the xiphoid process and the umbilicus.

Exam 39: Pediatric Variations of Nursing Interventions

What is an important nursing consideration when performing a bladder catheterization on a young boy?

Frequent urine testing for specific gravity and glucose are required on a 6-month-old infant.How should the nurse collect small amounts of urine for these tests?

A 2-year-old child comes to the emergency department demonstrating signs of dehydration and hypovolemic shock.Which best explains why an intraosseous infusion is started?

What important consideration in providing atraumatic care should the nurse consider when preforming a venipuncture on a 6-year-old child?

What critical information should the nurse incorporate into care when using restraints on a child?

MATCHING The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube. -Step five

After collecting blood by venipuncture in the antecubital fossa,what intervention should the nurse implement in order to assure control of any bleeding?

MATCHING The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube. -Step one

Which nursing action is the most appropriate when applying a face mask to a child prescribed oxygen therapy?

The nurse is planning how to best prepare a 4-year-old child for some diagnostic procedures.What guideline should the nurse consider when preparing a preschooler for a diagnostic procedure?

When administering a gavage feeding to a school-age child,the nurse should implement what intervention to assure safety?

MATCHING The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube. -Step four

MATCHING The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube. -Step three

What nursing action is appropriate for specimen collection?

The advantages of the ventrogluteal muscle as an injection site in young children include which of the following? (Select all that apply.)

What information should the nurse include when teaching parents how to care for a child's gastrostomy tube at home?

MATCHING The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube. -Step six

A 3 year old has a 102° F fever associated with a viral illness that has not responded to acetaminophen.The nurse's action should be based on what knowledge about fevers in children?

What procedure is recommended to facilitate a heelstick on an ill neonate to obtain a blood sample?

MATCHING The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube. -Step two

21st Century Maternity Nursing

The Family, culture, spirituality, and Home Care

Assessment and Health Promotion

Reproductive System Concerns

Infertility, contraception, and Abortion

Genetics, conception, and Fetal Development

Anatomy and Physiology of Pregnancy

Nursing Care of the Family During Pregnancy

Maternal and Fetal Nutrition

Assessment of High-Risk Pregnancy

High-Risk Perinatal Care: Preexisting Conditions

High-Risk Perinatal Care: Gestational Conditions

Labor and Birth Processes

Maximizing Comfort for the Laboring Woman

Fetal Assessment During Labor

Nursing Care of the Family During Labor and Birth

Labor and Birth Complications

Postpartum Physiologic Changes

Nursing Care of the Family During the Postpartum Period

Transition to Parenthood

Postpartum Complications

Physiologic and Behavioral Adaptations of the Newborn

Nursing Care of the Newborn and Family

Newborn Nutrition and Feeding

The High-Risk Newborn

21st Century Pediatric Nursing

Family, social, cultural, and Religious Influences on Child Health Promotion

Developmental and Genetic Influences on Child Health Promotion

Communication and Physical Assessment of the Child and Family

Pain Assessment and Management in Children

The Infant and Family

The Toddler and Family

The Preschooler and Family

The School-Age Child and Family

The Adolescent and Family

Impact of Chronic Illness, disability, or End-Of-Life Care for the Child and Family

Impact of Cognitive or Sensory Impairment on the Child and Family

Family-Centered Care of the Child During Illness and Hospitalization

The Child With Respiratory Dysfunction

The Child With Gastrointestinal Dysfunction

The Child With Cardiovascular Dysfunction

The Child With Hematologic or Immunologic Dysfunction

The Child With Cancer

The Child With Genitourinary Dysfunction

The Child With Cerebral Dysfunction

The Child With Endocrine Dysfunction

The Child With Musculoskeletal or Articular Dysfunction

The Child With Neuromuscular or Muscular Dysfunction

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