Homework Lance
MULTIPLE CHOICE
1. Which should the nurse use to prepare liquid medication in volumes less than 5 milliliters?
a.
Calibrated syringe
b.
Paper measuring cup
c.
Plastic measuring cup
d.
Household teaspoon
ANS: A
To ensure accuracy, a calibrated syringe without a needle should be used to prepare a liquid dosage less than 5 milliliters. Paper and plastic measuring cups are not calibrated for liquid volumes less than 5 milliliters. A household teaspoon is not accurate enough to measure small amounts of medication.
DIF: Cognitive Level: Application REF: p. 303
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
2. Which food choice is appropriate to mix with medication?
a.
Formula or milk
b.
Applesauce
c.
Syrup
d.
Orange juice
ANS: B
To prevent the child from developing a negative association with an essential food, a nonessential food such as applesauce is best for mixing with medications. Formula and milk are essential foods in a child’s diet. Medications may alter their flavor and cause the child to avoid them in the future. Syrup is not used to mix with medications because of its high sugar content. Orange juice is considered an essential food; therefore, the nurse should not mix medications with it.
DIF: Cognitive Level: Application REF: p. 303
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
3. Which physiological difference would affect the absorption of oral medications administered to a 3-month-old infant?
a.
More rapid peristaltic activity
b.
More acidic gastric secretions
c.
Usually more rapid gastric emptying
d.
Variable pancreatic enzyme activity
ANS: D
Pancreatic enzyme activity is variable in infants for the first 3 months of life as the gastrointestinal system matures. Medications that require specific enzymes for dissolution and absorption might not be digested to a form suitable for intestinal action. Infants up to 8 months of age tend to have prolonged motility. The longer the intestinal transit time, the more medication is absorbed. The gastric secretions of infants are less acidic than in older children or adults. Gastric emptying is usually slower in infants.
DIF: Cognitive Level: Comprehension REF: p. 300
OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity
4. Which factor should the nurse remember when administering topical medication to an infant?
a.
Infants require a larger dosage because of a greater body surface area.
b.
Infants have a thinner stratum corneum that absorbs more medication.
c.
Infants have a smaller percentage of muscle mass compared with adults.
d.
The skin of infants is less sensitive to allergic reactions.
ANS: B
Infants and young children have a thinner outer skin layer (stratum corneum), which increases the absorption of topical medication. A similar dose of a topical medication administered to an infant compared with an adult is approximately three times greater in the infant because of the greater body surface area. The smaller muscle mass in infants affects site selection for injected medications. The young child’s skin is more prone to irritation, making contact dermatitis and other allergic reactions more common.
DIF: Cognitive Level: Application REF: p. 300
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
5. What is the appropriate nursing response to a parent who asks, “What should I do if my child cannot take a tablet?”
a.
“You can crush the tablet and put it in some food.”
b.
“Find out if the medication is available in a liquid form.”
c.
“If the child can’t swallow the tablet, tell the child to chew it.”
d.
“Let me show you how to get your child to swallow tablets.”
ANS: B
A tablet should not be crushed without knowing whether it will alter the absorption, effectiveness, release time, or taste. Therefore telling the parent to find out whether the medication is available in liquid form is the most appropriate response. A chewed tablet may have an offensive taste, and chewing it may alter its absorption, effectiveness, or release time. Forcing a child, or anyone, to swallow a tablet is not acceptable and may be dangerous.
DIF: Cognitive Level: Application REF: p. 303
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
6. What is the maximum safe volume that an infant (aged 1 to 12 months) can receive in an intramuscular injection?
a.
0.25 milliliter
b.
0.5 milliliter
c.
1 milliliter
d.
1.5 milliliters
ANS: C
The maximum volume of medication for an intramuscular injection to an infant is 1 mL. The neonate should receive no more than 0.5 mL per intramuscular injection. 1.5 milliliters is not appropriate for an infant. It is appropriate for an intramuscular injection to a child 3 to 14 years of age.
DIF: Cognitive Level: Comprehension REF: p. 306
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
7. Which muscle would the nurse select to give a 6-month-old infant an intramuscular injection?
a.
Deltoid
b.
Ventrogluteal
c.
Dorsogluteal
d.
Vastus lateralis
ANS: D
The vastus lateralis is not located near any vital nerves or blood vessels. It is the best choice for intramuscular injections for children younger than 3 years of age. The deltoid muscle is not used for intramuscular injections in young children. The ventrogluteal muscle is safe for intramuscular injections for children older than 18 months. The dorsogluteal muscle does not develop until a child has been walking for at least 1 year.
DIF: Cognitive Level: Comprehension REF: pp. 305-306
OBJ: Nursing Process Step: Planning MSC: Physiological Integrity
8. The nurse is planning to administer an intramuscular injection to a 13-year-old child. What is the maximum volume of medication that can be injected into the ventrogluteal site?
a.
0.5 to 1 milliliter
b.
1 to 1.5 milliliters
c.
1.5 to 2 milliliters
d.
2 to 2.5 milliliters
ANS: C
The maximum volume of medication for an intramuscular injection to an older child (6 to 14 years) is 1.5 to 2.0 milliliters. 0.5 to 1.4 milliliters are acceptable volumes to inject, but they are not the maximum. 2 to 2.5 milliliters exceeds the amount that can be safely injected into one site for a 13-year-old child.
DIF: Cognitive Level: Comprehension REF: pp. 305-306
OBJ: Nursing Process Step: Planning MSC: Physiological Integrity
9. Which parameter should guide the nurse when administering a subcutaneous injection?
a.
Do not give injections in edematous areas.
b.
Attach a clean 1-inch needle to the syringe.
c.
The maximum volume injected into one site is 2 milliliters.
d.
Do not pinch up tissue before inserting the needle.
ANS: A
Subcutaneous injections should never be given in areas of edema because absorption is unreliable. A short (no more than 5/8 inch) needle should be used to deposit medication into subcutaneous tissue. Volumes for subcutaneous injections are small, usually averaging 0.5 milliliters. The skin is pinched up for a subcutaneous injection to raise the fatty tissue away from the muscle.
DIF: Cognitive Level: Application REF: p. 306
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
10. Which action is correct when administering ear drops to a 2-year-old child?
a.
Administer the ear drops straight from the refrigerator.
b.
Pull the pinna of the ear back and down.
c.
Massage the pinna after administering the medication.
d.
Pull the pinna of the ear back and up.
ANS: B
For children younger than 3 years, the pinna, or lower lobe, of the ear should be pulled back and down to straighten the ear canal. Medication should be at room temperature because cold solutions in the ear will cause pain. The tragus of the ear should be massaged to ensure the drops reach the tympanic membrane. For a child 3 years or older, the pinna is pulled up and back.
DIF: Cognitive Level: Application REF: p. 309
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
11. A nurse is preparing to start a continuous IV infusion on a child. The nurse selects a Buretrol (volume-control) attachment as part of the IV tubing set-up. The main purpose for selecting a Buretrol attachment is to:
a.
avoid fluid overload.
b.
aid in measuring intake.
c.
administer antibiotics.
d.
ensure adequate intravenous fluid intake.
ANS: A
A volume-control device such as a Buretrol or an infusion pump allows the nurse to set a specific volume of fluid to be given in a specific period of time (usually 1 hour) and decreases the risk of inadvertently administering a large amount of fluid. Although the use of a volume-control device allows for accurate measurement of intake, the primary purpose for using this equipment is to prevent fluid overload. Medications such as antibiotics can be administered with a volume-control device; however, this is not the primary purpose.
DIF: Cognitive Level: Application REF: pp. 312-313
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
12. Which is the most important nursing action before discharge for a mother who is apprehensive about giving her child insulin?
a.
Review the side effects of insulin with the mother.
b.
Have the mother verbalize that she knows the importance of follow-up care.
c.
Observe the mother while she administers an insulin injection.
d.
Help the mother devise a rotation schedule for injections.
ANS: C
It is important that the nurse evaluate the mother’s ability to give the insulin injection prior to discharge. Watching her give the injection to the child will give the nurse an opportunity to offer assistance and correct any errors. Although reviewing side effects is important, this could be done over the phone or by the pharmacist when the medication is picked up. Having the mother verbalize her knowledge of the importance of follow-up care is important but not directly relevant to the mother’s concern. Helping the mother devise a rotation schedule for injections is important but not as important as having the mother demonstrate the procedure.
DIF: Cognitive Level: Application REF: p. 315
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
13. A nurse has just initiated an intravenous piggyback of gentamicin (Garamycin). What is the best time for a trough serum level to be measured?
a.
Just before the next dose
b.
When the infusion is finished
c.
One hour after the medication is administered
d.
Depends on the specific medication
ANS: A
The medication trough is the level at which the serum concentration is lowest. Trough levels are usually obtained just before the next medication dose. The serum concentration would be increasing as the infusion finishes. This is not the concentration trough. The peak concentration, or the concentration after the medication has been distributed, varies according to the specific medication. Trough is always the lowest just before the next medication dose.
DIF: Cognitive Level: Application REF: p. 300
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
14. A nurse should routinely ask a colleague to double-check a medication calculation and the actual medication before administering which medications?
a.
Antibiotics
b.
Acetaminophen
c.
Anticonvulsants
d.
Anticoagulants
ANS: D
The nurse should ask another nurse to check the dosage calculation and the medication before administering anticoagulants. The nurse always double-checks a dosage calculation, but it is not necessary to have a second nurse check the medication before administering antibiotics, acetaminophen, or anticonvulsant medications.
DIF: Cognitive Level: Comprehension REF: p. 302
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
15. Which nursing action is correct when administering heparin subcutaneously?
a.
Insert the needle with the bevel up at a 15-degree angle.
b.
Insert the needle into the skin at a 45-degree angle.
c.
Inject the needle into the tissue on the upper back.
d.
Massage the injection site when the injection is complete.
ANS: B
For a subcutaneous injection, the nurse would pinch the skin and inject at a 45-degree angle. Inserting the needle with the bevel up at a 15-degree angle is the technique used for an intradermal injection. The upper back is used for intradermal injections. The nurse would not massage the site after administering heparin.
DIF: Cognitive Level: Application REF: p. 306
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
16. Which indicates that a school-age child is using a metered-dose inhaler correctly?
a.
The child uses his inhaled steroid before the bronchodilator.
b.
The child exhales forcefully as he squeezes the inhaler.
c.
The child holds his breath for 10 seconds after the first puff.
d.
The child waits 10 minutes before taking a second puff.
ANS: C
After a puff, the child should hold his breath for about 10 seconds or until he counts slowly to 5. If one of the child’s medications is an inhaled steroid, it should be administered last. The child should inhale slowly as the inhaler is squeezed or depressed. The child does not need to wait this long to take a second puff of medication. He can take a second puff after holding his breath for 10 seconds.
DIF: Cognitive Level: Analysis REF: p. 310
OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity
17. Which step is appropriate when using EMLA cream before intravenous catheter insertion?
a.
Rub a liberal amount of cream into the skin thoroughly.
b.
Cover the skin with a gauze dressing after applying the cream.
c.
Leave the cream on the skin for 1 to 2 hours before the procedure.
d.
Use the smallest amount of cream necessary to numb the skin surface.
ANS: C
The cream should be left in place for a minimum of 1 hour and up to 2 hours. The EMLA cream should not be rubbed into the skin. After the cream is applied to the skin surface, it is covered with a transparent occlusive dressing. The nurse would use a liberal amount of EMLA cream.
DIF: Cognitive Level: Application REF: p. 311
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
18. A child is receiving intravenous fluids. How frequently should the nurse assess and document the condition of the child’s intravenous site?
a.
Every hour
b.
Every 2 hours
c.
Every 4 hours
d.
Every shift
ANS: A
The nurse assesses and documents an IV site at least every hour for signs and symptoms of infiltration and phlebitis. The nurse should assess a child’s IV site more frequently than every 2 to 4 hours or every shift. Serious complications could occur during this time interval.
DIF: Cognitive Level: Application REF: p. 312
OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity
19. What is the hourly maintenance fluid rate for an intravenous infusion in a child weighing 19.3 kilograms?
a.
19 milliliters
b.
45 milliliters
c.
61 milliliters
d.
95 milliliters
ANS: C
The formula for calculating daily fluid requirements is 0 to 10 kg: 100 mL/kg/day; 10 to 20 kg: 1000 mL for the first 10 kg of body weight plus 50 mL/kg/day for each kg between 10 and 20. To determine an hourly rate, divide the total milliliters per day by 24.
DIF: Cognitive Level: Application REF: p. 313
OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity
20. The nurse administering an IV piggyback medication to a preschool child should take which action?
a.
Dilute the medication in at least 20 milliliters and infuse over at least 15 minutes.
b.
Flush the IV tubing before and after the infusion with normal saline solution.
c.
Inject the medication into the IV catheter using the port closest to the child.
d.
Inject the medication into the IV tubing in the direction away from the child.
ANS: A
Medications given by IV piggyback are diluted in at least 20 milliliters of IV solution and administered over at least 15 minutes. When administering medications by IV piggyback, the nurse flushes the tubing after the medication has infused, usually with 16 to 20 milliliters of IV solution. The nurse is using the IV push method when injecting medication into the IV tubing using the port closest to the child. The IV retrograde method involves clamping the IV tubing below the injection port and injecting medication into the tubing in a direction away from the child, causing it to flow into the tubing above the injection port.
DIF: Cognitive Level: Application REF: p. 313
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
21. What nursing action is indicated when a child receiving a unit of packed red blood cells complains of chills, headache, and nausea?
a.
Continue the infusion and take the child’s vital signs.
b.
Stop the infusion immediately and notify the physician.
c.
Slow the infusion and assess for cessation of symptoms.
d.
Start a dextrose solution and stay with the child.
ANS: B
If a reaction is suspected, as in this case, the transfusion is stopped immediately and the physician is notified. If the child is displaying signs of a transfusion reaction, the transfusion cannot continue. Dextrose solutions are never infused with blood products because the dextrose causes hemolysis. This action does not address the blood infusion.
DIF: Cognitive Level: Analysis REF: p. 315
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
22. What is the best action for the nurse to take when giving medications to a 3-year-old child?
a.
Tell the child to take the medication “right now.”
b.
Tell the child to take the medication or he will have to get a shot.
c.
Allow the child to choose fruit punch or apple juice when giving the medication.
d.
Tell the child that another child his age just took his medication like a “good boy.”
ANS: C
Realistic choices allow the child to feel some control. Direct confrontation typically results in a “no” response. Threatening a child with a shot is inappropriate. Comparisons are not helpful in getting a child to cooperate.
DIF: Cognitive Level: Application REF: p. 301
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
MULTIPLE RESPONSE
1. Which are advantages of using an Electronic Medical Record System (EMR) for medication administration to children? Select all that apply.
a.
Eliminates the need to perform the six rights of medication administration
b.
Reduces medication errors
c.
Is a cost effective means of medication administration
d.
Improves communication of patient medication lists
e.
Improves communication of patient allergies
ANS: B, D, E
One of the major reasons for the increasing use of computer systems such as patient electronic medical records (EMRs) is to reduce medication errors. EMRs, which include electronic medication administration records (EMARs), can improve communication of patient medication lists and other information such as allergies between different healthcare providers working in the same facility or in other settings. These systems do not replace the responsibility of physicians and nurses for clear and complete medication orders, accurate dose calculations, and correct administration of medications to children. The systems are not more cost effective than administering medications without the use of a computer scanning system.
DIF: Cognitive Level: Analysis REF: p. 303
OBJ: Nursing Process Step: Planning MSC: Physiological Integrity
SHORT ANSWER
1. You need to administer ibuprofen, 120 mg, to your 4-year-old patient. Ibuprofen comes in liquid form in a dose of 100 mg/5 mL. How many milliliters will you give?
ANS:
6
6 mL
5 mL = x mL
100 mg 120 mg
100 x = 600; x = 6.0 mL.
DIF: Cognitive Level: Analysis REF: p. 303
OBJ: Nursing Process Step: Planning MSC: Physiological Integrity
2. You need to administer ceftriaxone sodium to your 3-year-old patient who weighs 33 pounds. The physician’s order states that you should administer ceftriaxone sodium 50 mg/kg once a day. How many milligrams will you prepare?
ANS:
750750 mg
33 lbs ´ 0.4536 = 15 kg; 15 ´ 50 = 750 mg.
DIF: Cognitive Level: Analysis REF: p. 313
OBJ: Nursing Process Step: Planning MSC: Physiological Integrity
3. Calculate the daily maintenance fluid 24-hour total requirement for a child weighing 21.5 kg.
ANS:
1530
1530 mL
1500 mL/day + 20 mL/kg/day for each additional kg over 20 kg. 1500 + 30 = 1530.
DIF: Cognitive Level: Application REF: p. 303
OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity
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