NUR 411 Practical Exam #1
Discuss safety considerations for administering oral medications to infants and children,
including considerations for administering crushed medications. - answer- Importance of
using very small amounts of water (5 mls or less) with crushed meds
Discuss best methods for administering meds to a 3 year old. - answer- Emphasizing
that the child may want to "help at this age" and that if you hold them down giving the
medication will only be more difficult.
· How would you assess that an NG is safe to use in a pediatric patient? - answer
Measure or confirm the length of the NG and assess how it is secured with every
feeding. This is documented in the hospital chart every shift. Initial steps after
placement including recording length, pH testing, auscultation and Abdominal x-ray.
Most NG tube have centimeter markings so the number recorded in the chart is the
number where the NG exits the nare. If measuring with a paper tape measure, confirm
whether the previous measurement was performed by measuring the length of the tube
to the hub or including the hub. Below is an example of an NG with centimeter
markings.
Describe rationale for cefazolin - answerCefazolin is being used as a prophylactic
antibiotic to prevent infection due to surgery.
Describe considerations for administering IV medications to children - answerSyringe
pumps provide a more precise rate of infusion than a volume control device. Peds are at
an increased risk for fluid volume overload.
Discuss IV site care for children. - answerPediatric veins are small, fragile, and easily
irritated. IV site should be examined hourly for signs of inflammation (warm, red, tender)
or infiltration (cool, blanched, or puffy). Always use appropriate hand hygiene and
cleaning measures (scrub the hub) prior to administering medications.
What information should the nurse include when teaching the parents about vitamin K?
Which site would the nurse explain is the most appropriate for injection of the vitamin K?
- answer- A newborn's GI tract is sterile after delivery and requires bacteria (normal
flora) to produce vitamin K. Vitamin K is essential for all humans to clot their own blood.
When the NB has had feedings it begins to produce this normal flora about day 8.
Vitamin K is necessary to prevent bleeding for the NB.
- Common bleeding concerns in a newborn are from circumcision (late bleeding) and
head trauma/intracranial hemorrhage (early bleeding).
- The vitamin K shot prevents both of these things. Ideally, Vitamin K should be
administered within 1-2 hours after birth or before the patient is transferred to
postpartum care or discharged home
, - Give as IM injection at a 90-degree angle into the middle third of the vastus lateralis
muscle (the upper outer thigh muscle).
What purpose would the nurse share with the parent for administering neonatal eye
prophylaxis after birth? - answer- Erythromycin 0.5% (sometimes tetracycline 1%) is
used to prevent neonatal blindness secondary to gonorrhea (gonococcal ophthalmia
neonatorum).
- Prophylaxis for any ocular infections that may result in blindness in the newborn (from
what I am aware of, gonorrhea is the only proven infection that causes this).
- This antibiotic ointment is recommended to be given to all newborns (vaginal or c/s)
and is required by state law (but can still be declined and is very commonly declined by
patients when educated on the risks/benefits and when adequately screened in
antepartum period or at low risk of STIs).
- Sidenote: Current research suggests that this will be changed fairly soon because we
have the ability to recognize eye infections and adequately treat them. When eye ppx
first began, there weren't as many options for treating versus preventing ocular
infections. Science/medicine has caught up and considering antibiotic resistance, this
recommendation will likely be changed soon.Prophylaxis for any ocular infections that
may result in blindness in the newborn. Exposure to STI during delivery is the most
common cause of preventable blindness. This antibiotic ointment is given to all
newborns and is required by state law, all vaginal or C/S births must receive eye
prophylaxis.
You are taking care of a newborn that is awaiting abdominal surgery for a congenital
anomaly and is NPO. The newborn has an NG to suction. There is an order to replace
the NG output ml for ml with NS. At noon your patient had 30 mls of output. What do
you need to set the IV pump rate at to replace this volume over the next 4 hours? -
answer- The pump should be set for 7.5ml/hr with a limit of 30 ml so that it beeps when
the replacement is finished. This ensures that the baby does not receive fluids that are
not ordered and reminds the nurse to remeasure the output and reprogram the pump for
the next four hours.
30mL / 4 hrs = 7.5 ml/hr
How is a baby monitored pre-delivery? - answer- Students understanding that low risk
patients are monitored intermittently q30m in the 1st stage of labor and q5-15m in the
2nd stage is important - continuous is not evidence based for this population
Why should you have the patient empty her bladder before you assess the fundus? -
answerComfort and so that you get a good assessment of the position as a full bladder
displaces the uterus
What factors should you identify for hemorrhage risk in a client who is immediate
postpartum? - answer- Tone - the uterus is not clamping down/involuting (can be related
to MgSO4 use, shoulder dystocia, infection) - MOST PPH IS RELATED TO TONE - A
displaced uterus is more apt to bleed so keeping bladder empty decreses the risk for
bleeding
Discuss safety considerations for administering oral medications to infants and children,
including considerations for administering crushed medications. - answer- Importance of
using very small amounts of water (5 mls or less) with crushed meds
Discuss best methods for administering meds to a 3 year old. - answer- Emphasizing
that the child may want to "help at this age" and that if you hold them down giving the
medication will only be more difficult.
· How would you assess that an NG is safe to use in a pediatric patient? - answer
Measure or confirm the length of the NG and assess how it is secured with every
feeding. This is documented in the hospital chart every shift. Initial steps after
placement including recording length, pH testing, auscultation and Abdominal x-ray.
Most NG tube have centimeter markings so the number recorded in the chart is the
number where the NG exits the nare. If measuring with a paper tape measure, confirm
whether the previous measurement was performed by measuring the length of the tube
to the hub or including the hub. Below is an example of an NG with centimeter
markings.
Describe rationale for cefazolin - answerCefazolin is being used as a prophylactic
antibiotic to prevent infection due to surgery.
Describe considerations for administering IV medications to children - answerSyringe
pumps provide a more precise rate of infusion than a volume control device. Peds are at
an increased risk for fluid volume overload.
Discuss IV site care for children. - answerPediatric veins are small, fragile, and easily
irritated. IV site should be examined hourly for signs of inflammation (warm, red, tender)
or infiltration (cool, blanched, or puffy). Always use appropriate hand hygiene and
cleaning measures (scrub the hub) prior to administering medications.
What information should the nurse include when teaching the parents about vitamin K?
Which site would the nurse explain is the most appropriate for injection of the vitamin K?
- answer- A newborn's GI tract is sterile after delivery and requires bacteria (normal
flora) to produce vitamin K. Vitamin K is essential for all humans to clot their own blood.
When the NB has had feedings it begins to produce this normal flora about day 8.
Vitamin K is necessary to prevent bleeding for the NB.
- Common bleeding concerns in a newborn are from circumcision (late bleeding) and
head trauma/intracranial hemorrhage (early bleeding).
- The vitamin K shot prevents both of these things. Ideally, Vitamin K should be
administered within 1-2 hours after birth or before the patient is transferred to
postpartum care or discharged home
, - Give as IM injection at a 90-degree angle into the middle third of the vastus lateralis
muscle (the upper outer thigh muscle).
What purpose would the nurse share with the parent for administering neonatal eye
prophylaxis after birth? - answer- Erythromycin 0.5% (sometimes tetracycline 1%) is
used to prevent neonatal blindness secondary to gonorrhea (gonococcal ophthalmia
neonatorum).
- Prophylaxis for any ocular infections that may result in blindness in the newborn (from
what I am aware of, gonorrhea is the only proven infection that causes this).
- This antibiotic ointment is recommended to be given to all newborns (vaginal or c/s)
and is required by state law (but can still be declined and is very commonly declined by
patients when educated on the risks/benefits and when adequately screened in
antepartum period or at low risk of STIs).
- Sidenote: Current research suggests that this will be changed fairly soon because we
have the ability to recognize eye infections and adequately treat them. When eye ppx
first began, there weren't as many options for treating versus preventing ocular
infections. Science/medicine has caught up and considering antibiotic resistance, this
recommendation will likely be changed soon.Prophylaxis for any ocular infections that
may result in blindness in the newborn. Exposure to STI during delivery is the most
common cause of preventable blindness. This antibiotic ointment is given to all
newborns and is required by state law, all vaginal or C/S births must receive eye
prophylaxis.
You are taking care of a newborn that is awaiting abdominal surgery for a congenital
anomaly and is NPO. The newborn has an NG to suction. There is an order to replace
the NG output ml for ml with NS. At noon your patient had 30 mls of output. What do
you need to set the IV pump rate at to replace this volume over the next 4 hours? -
answer- The pump should be set for 7.5ml/hr with a limit of 30 ml so that it beeps when
the replacement is finished. This ensures that the baby does not receive fluids that are
not ordered and reminds the nurse to remeasure the output and reprogram the pump for
the next four hours.
30mL / 4 hrs = 7.5 ml/hr
How is a baby monitored pre-delivery? - answer- Students understanding that low risk
patients are monitored intermittently q30m in the 1st stage of labor and q5-15m in the
2nd stage is important - continuous is not evidence based for this population
Why should you have the patient empty her bladder before you assess the fundus? -
answerComfort and so that you get a good assessment of the position as a full bladder
displaces the uterus
What factors should you identify for hemorrhage risk in a client who is immediate
postpartum? - answer- Tone - the uterus is not clamping down/involuting (can be related
to MgSO4 use, shoulder dystocia, infection) - MOST PPH IS RELATED TO TONE - A
displaced uterus is more apt to bleed so keeping bladder empty decreses the risk for
bleeding
