Infant care and Pain Management guide with Q&A

Infant care and Pain Management guide with Q&A What is the best action for the nurse to take when initiating contact with a toddler for the first time? -Ask the toddler to point to where it hurts. -Tell the child your name and that you are the nurse. -Call the child by name while picking up the toddler. -Kneel in front of the toddler and speak softly. - ANSWER Kneel in front of the toddler and speak softly. The toddler perceives the nurse as a stranger. A more positive interaction occurs when the toddler perceives the meeting in a nonthreatening way. Placing oneself at the toddler's eye level and speaking softly can be less threatening for the child. A 14-year-old is brought to the emergency department after a biking accident. How should the nurse interact with the adolescent? -Furnish rewards for cooperation during procedures. -Have the parents remain with the adolescent at all times. -Provide clear explanations while encouraging questions. -Limit the number of choices to be made by the adolescent. - ANSWER Provide clear explanations while encouraging questions. Adolescents are capable of abstract thinking and understand explanations, so the opportunity to ask questions should be provided. Since an adolescent's modesty should be respected, the presence of the parents at the bedside should be a choice made by the adolescent. An adolescent's ability to think abstractly engages problem-solving, therefore the 14-year-old should be allowed to verbalize decisions about their care. A 4-year-old is brought to the emergency department with a laceration on the right foot. Which action should the nurse implement to help the child cope with the emergency department experience? -Avoid the use of bandages to keep wounds open to air. -Remind the preschooler how big children should act. -Give the child some time after explaining procedures. -Avoid using jargon, such as "shot," when giving care - ANSWER Avoid using jargon, such as "shot," when giving care Using positive terms and avoiding words (jargon) that the child may perceive in a frightening way can assist the child cope with the emergency department experience. The nurse is caring for a 9-year-old female child who asks, "What does it mean when a girl says they started their period?" How should the nurse respond? -Ask the child whether she was sexually abused. The charge nurse is planning the placement of a child for admission from the emergency department with respiratory compromise of unknown origin. What is the best bed placement for this child's admission? - ANSWER Single room close to the nurse's station, and away from any other children with respiratory issues This child needs to be isolated until diagnosis of the underlying cause for the respiratory compromise. Then, the child can share a room with another child with the same infection. Close to the nurse's station is preferred since the child will require close observation. While the double room is available now, there is no guarantee that the bed will not be needed. An 18-month-old child returns to the unit following a cardiac catheterization with a cannulated femoral artery site. Which action will the nurse include when teaching the parents about immediate post-procedure care? - ANSWER Show the parents how to hold the child with the extremity extended. The extremity should be extended to prevent trauma to the femoral catheterization site. Options A and D increase the risk for complications and are contraindicated. Option C is not necessary. Only the extremity that was catheterized requires immobilization. A 2-year-old child with trisomy 21 (Down syndrome) is brought to the clinic for a routine evaluation. Which assessment finding suggests the presence of a common complication often experienced by those with Down syndrome? - ANSWER Presence of a systolic murmur Congenital heart disease occurs in 40% to 50% of children with trisomy 21 (Down syndrome). Defects of the atrial or ventricular septum that create systolic murmurs are the most common heart defects associated with this congenital anomaly. Options B, C, and D are not recognized as common complications of trisomy 21. When administering a gavage feeding to a school-age child, which action should the nurse implement? -Administer feedings over 5 to 10 minutes. -Position the child on the right side after administering the feeding. -Check the placement of the tube by inserting 20 mL of sterile water. -Lubricate the tip of the feeding tube with petroleum jelly to facilitate passage. - ANSWER Position the child on the right side after administering the feeding. The child should be positioned on the right side with the head of the bed elevated 30 degrees after administering the feeding to facilitate gastric emptying and prevent gastric reflux. Gavage feedings should be given to allow slow gastric filling over 15 to 30 minutes. When caring for a child who is in the paroxysmal stage of pertussis, which intervention should the nurse implement to support the child's nutritional needs? -Provide small, frequent meals. -Increase protein intake. -Maintain a liquid diet. -Offer the child a regular diet. - ANSWER Provide small, frequent meals. The paroxysmal stage of pertussis is characterized by coughing with vomiting. Frequent small meals are vomited less often than larger meals. An 8-year-old boy who was recently diagnosed with diabetes mellitus is admitted to the intensive care unit with diabetic ketoacidosis (DKA). Which nursing action has the highest priority? -Place on a cardiac monitor. -Initiate an intravenous infusion. -Collect a specimen for serum electrolytes. -Obtain fingerstick glucose. - ANSWER Initiate an intravenous infusion. The priority for a child with DKA, an emergency life-threatening situation, is to obtain venous access for administration of fluids, electrolytes, and insulin. The child should be placed on a cardiac monitor and have serum electrolytes and glucose levels obtained, but not before initiating venous access. When assessing a preschooler, which finding warrants further assessment by the nurse? -Able to ride a tricycle. -Talks about an imaginary friend. -Dresses independently. -Gains 2 pounds (0.9 kg) in 12 months. - ANSWER Gains 2 pounds (0.9 kg) in 12 months. Preschool children gain an average of 5 pounds (2.3 kg) per year. Therefore, a gain of 2 pounds (0.9 kg) is less than half of the expected weight gain and should be investigated further. Which clinical finding should the nurse expect a child with nephrosis to exhibit? -Elevated blood pressure. -Blood-tinged urine. -Elevated temperature. -Urine protein 3+ to 4+. - ANSWER Urine protein 3+ to 4+. In nephrosis, renal tubules become permeable to proteins, causing massive proteinuria. The low birthweight (LBW) infant requires a neutral thermal environment. Which action should the nurse implement? -Use wool blankets for covers. -Avoid using disposable diapers. -Maintain a temperature-controlled, high-humidity atmosphere. -Continue cool oxygenation via a hood. - ANSWER Maintain a temperature-controlled, high-humidity atmosphere A temperature-controlled neutral thermal environment with high humidity provides adequate warmth so the LBW infant can maintain a normal core temperature with minimum oxygen consumption and caloric expenditure. LBW infants are especially vulnerable to temperature instability since they are usually premature and neurologically have difficulty maintaining their temperature. Their skin has not matured enough to provide adequate protection from heat and water loss. A high-humidity atmosphere in an incubator contributes to body homeostasis by reducing evaporative heat loss and insensible water loss. The three primary methods for maintaining a neutral thermal environment are the use of an incubator, a radiant warmer, and an open bassinet with cotton blankets. Microenvironments for humidification can include items such as food-grade plastic bags or plastic wrap, humidified reservoirs for incubators, and humidified plastic heat shields covered with plastic wrap. The nurse is caring for an irritable, lethargic 18-month-old child who swallowed several over-the-counter (OTC) antihistamine tablets an hour ago. Which intervention should the nurse implement? -Initiate gastric lavage. -Administer naloxone. -Give a dose of ipecac syrup. -Encourage oral intake of water or milk. - ANSWER Initiate gastric lavage. Gastric lavage should be implemented within 2 hours of ingestion to ensure gastric removal of a noncorrosive substance, such as an OTC antihistamine. A 2-year-old is receiving care in the emergency department (ED) for a deep laceration on the head. What action should the nurse implement to facilitate the child's cooperation? -Allow the child to hold a favorite toy or blanket. -Direct the parents to remain outside the treatment room. -Keep the child physically restrained during nursing care. -Let the child decide whether to sit up or lie down for procedures. - ANSWER Allow the child to hold a favorite toy or blanket. Allowing a child to hold a favorite toy or blanket provides familiarity and comfort that should facilitate the child's cooperation during treatment. Parents should remain with the child to calm and reassure the child who may perceive the ED environment as threatening. When assessing the breath sounds of an 18-month-old child who is crying, what action should the nurse take? -Ask the parent to quiet the child so breath sounds can be auscultated. -Auscultate and document breath sounds, noting that the child was crying at the time. -Document that the assessment was not available because the child was crying. -Allow the child to initially play with the stethoscope, and distract the child during auscultation. - ANSWER Allow the child to initially play with the stethoscope, and distract the child during auscultation. Engaging the child with an interesting activity, such as playing with the stethoscope before its use, often distracts the child long enough to stop crying so that breath sounds can be auscultated accurately. The community health nurse teaches the parents of school-age children about the need for fluoride as part of a dental health program. Which statement by the parents indicates that they understand the teaching? -"Excessive amounts of fluoride will make teeth turn brittle and yellow." -"Having our children brush with fluoride toothpaste is not effective." -"Use of fluoride in water is mostly effective during initial tooth formation." -"Dental caries can be prevented through fluoridation of public water." - ANSWER "Dental caries can be prevented through fluoridation of public water." While teaching a parenting class to new parents the nurse describes the needs of infants and toddlers regarding discipline and limit setting. What is the most important reason for implementing such parenting behaviors? - ANSWER They provide the child with a sense of security The parents of a newborn infant with hypospadia are concerned about when the surgical correction should occur. What information should the nurse provide? - ANSWER Repairs typically should be done before the child is potty trained