Pediatric nursing

Pediatric Nursing Clinical Case Study
Pediatric Variations of Nursing Interventions
The pediatric nurse is giving care to a group of four patients of various ages. The nurse needs to perform a number of procedures and needs to modify procedures based on the patients’ ages and developmental stages.
Answer the following questions and give the rationale:

1. The nurse is preparing to administer penicillin G (Bicillin) to a school-age child. What action should the nurse take to determine that the bevel of the needle is in the correct place?
a) Check the bottom of the syringe for blood after aspirating.
b) Evaluate the ease with which the needle was inserted.
c) Ensure that the needle was inserted at a 90-degree angle.
d) Check the top of the syringe for blood while aspirating.

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Answer: _________________________________________________________________________________

Rationale: _______________________________________________________________________________

2. A toddler has a small-bore tube for tube feeding and requires a medication in suspension form. Which action by the nurse is the most important preventive action to maintain patency of the tube?
a) Flushing after the medication with an adequate amount of fluid
b) Dissolving all tablets completely in warm water before giving them
c) Checking for placement by aspiration of the small-bore tube
d) Elevating the head of the toddler’s bed at least 45 degrees

Answer: _____________________________________________________________________________________

Rationale: __________________________________________________________________________________

3. The nurse is trying to get a preschooler to eat after having nothing by mouth (NPO) for several days postoperatively. The child has been experiencing nausea. What approaches should the nurse try? Select all that apply.
a) Allow the parents to feed the child.
b) Encourage the child to eat the same amount of food as he or she did preoperatively.
c) Serve food that the child chooses.
d) Cover the plate with a variety of food.
e) Cut sandwiches into small shapes.
f) Avoid giving cookies or sweet drinks.

Answer: _____________________________________________________________________________________

Rationale: __________________________________________________________________________________

4. An enema is to be given to a 6-year-old to prepare her for an examination of the lower bowel. What type and amount of enema solution would the nurse anticipate administering?
a) 200 mL of a prepackaged Fleet’s
b) 300 mL of tap water
c) 400 mL of normal saline
d) 500 mL of mineral oil

Answer: _____________________________________________________________________________________

Rationale: __________________________________________________________________________________

The Child with Cerebral Dysfunction

The charge nurse in the pediatric neurologic intensive care unit is reviewing the change-of-shift report for several of the patients.

The first patient is a 28-month-old toddler who has been on life support for 2 days after a submersion injury. The vehicle in which he was riding flipped over and landed upside down in a shallow lake. The toddler was submerged for approximately 6 minutes. He was resuscitated at the accident site within 10 minutes after being rescued and transferred to the pediatric intensive care unit.

5. The charge nurse is assessing some of the information obtained during the hourly routine. Which assessment data would provide some indications of a good outcome?
a) The pupils react sluggishly but equally, and the child’s toes move when tickled.
b) The heart rate is regular, and the child lies quietly when his endotracheal tube is suctioned.
c) The body temperature has been 97 to 98 degrees, and the lung sounds are clear.
d) The oxygen saturation level is 98%, and the blood gases are within normal limits.

Answer: _____________________________________________________________________________________

Rationale: __________________________________________________________________________________

6. The second patient is a 4-year-old girl with suspected Reye syndrome who is almost comatose since admission during the night. The nurse caring for this child is preparing to assist with the primary diagnostic test for this disease. What equipment and supplies should the nurse have available?
a) A lumbar puncture tray and betadine
b) A liver biopsy tray and abdominal x-ray
c) Several blood tubes of various colors and a butterfly needle
d) A bone marrow tray and a hollow-core needle

Answer: _____________________________________________________________________________________

Rationale: __________________________________________________________________________________

7. The parents ask the nurse caring for their daughter what could have caused this sudden terrible illness. What information would be most appropriate for the nurse to share with the parents?
a) “How children get Reye syndrome is not well understood, but there is a connection between having a viral illness such as chickenpox or the flu and treating the fever with aspirin or a medication with aspirin in it.”
b) “There is a direct correlation between bacterial infections and the use of acetaminophen (Tylenol) in children who acquire Reye syndrome because Tylenol can harm the liver even in healthy children.”
c) “When a child gets immunizations and then gets a viral infection, regardless of how slight, the immune system cannot handle it, and because the liver is used to purify toxins, the liver function becomes impaired.”
d) “The measles virus can lie dormant in the body for a period of time. When a child gets the measles–mumps–rubella vaccine, it can awaken the sleeping virus, which can then attack the liver and the brain.”

Answer: _____________________________________________________________________________________

Rationale: __________________________________________________________________________________

8. A 3½-year-old child in the neurologic intensive care unit has had years of severe seizures and is being treated with a ketogenic diet. Which dinner tray would be appropriate for the nurse to serve to the child?
a) Cheeseburger on a bun, French fries, and a vanilla milkshake
b) Pepperoni pizza, watermelon cubes, and lemonade
c) Chopped hot dogs in baked beans, a biscuit, and fruit punch
d) Fried eggs with bacon, cheese cubes, and iced tea

Answer: _____________________________________________________________________________________

Rationale: __________________________________________________________________________________

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