In which order would the nurse perform the following actions to administer eardrops to a preschooler

What is the most important reason for administering a medication at the correct time?

To maintain the desired blood level of the medication

Administering a drug at the correct time helps to maintain the desired blood level of the drug. When giving a PRN medication, always check the last time it was given and clarify how much has been given during the past 24 hours.

An infant is to have a scalp-vein intravenous infusion begun. What is an advantage of this insertion site?

The scalp veins are easily visualized.

Peripheral IVs can be inserted in neonates and infants. The scalp veins are easily visualized, being covered only by a thin layer of subcutaneous tissue. These veins do not have valves, so the device may be inserted in either direction, although the preference would be in the direction of blood flow. Unless the are area has been numbed before the procedure, the child will feel the pain of insertion. Infiltration can occur at any site a peripheral catheter has been inserted. Glucose can be absorbed from any vein from which it is infusing.

The clinical nurse educator who oversees the emergency department in a children's hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children?

Having nurses check their math calculations with a colleague before administering a drug

Of all the problems that may contribute to an incorrect dose, the most common involve errors in math during dosage calculation. Dosage calculation can involve several steps, and a mathematical error can occur at each step. Documentation in multiple locations, rigorous assessment, and avoidance of IV administration are not practices that appreciably reduce the potential for incorrect doses.

The pediatric nurse is bringing the prescribed medication for a child but notes that the identification band is missing. The parents are at the bedside holding the child. What is the best method for identifying the child?

Ask the parents to tell you his or her name and date of birth.

The parents are the best resource for finding out the child's legal name and date of birth, which can be compared to the medical record. The child may use a nickname or other name, which cannot be verified with the medical record. It is not safe to leave any medication at the bedside. It is appropriate to get another identification band once the child has been properly identified. Refusing to give the medication is not appropriate if the nurse is able to identify the child correctly.

A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first

Administer the bronchodilator via a nebulizer

The nurse would first administer the bronchodilator to open the child's airway and facilitate breathing. Once the airway was open, the nurse could administer oxygen, if indicated. At this time, the child's saturation level is normal but it should be monitored. The nurse would then administer the antibiotic medication. The heart rate is within normal range for a child of this age (65 to 110 beats/minute); therefore, a cardiac monitor is not needed at this time.

If a medication is being administered by the otic route, it will be administered in which way?

Warmed to room temperature and dropped into the ear

Otic means ear. Be sure that the ear drops are at room temperature. If necessary, roll the container between the palms of your hands to help warm the drops. Using cold ear drops can cause pain and possibly vertigo or vomitting when they reach the eardrum. If the medication were to be placed in the rectum the instructions would say "for rectal use only." A opthalmic drug would be placed in the eye. Medications in a syringe could be for injection or a liquid for oral use.

A young child is prescribed pancreatic enzymes as part of his treatment plan for cystic fibrosis. The child has difficulty swallowing medications. After teaching the parents of a young child with cystic fibrosis about how to administer pancreatic enzymes, the parents demonstrate understanding by stating:

"We can open the capsule and sprinkle it on his cereal."

If the child has difficulty swallowing the pancreatic enzyme capsules, the parents can open the capsule and sprinkle the contents onto the child's cereal or applesauce. Dissolving the capsule in water or crushing it would be appropriate. The capsule does not contain liquid so there would not be any liquid to pour on the child's tongue.

A nursing student is administering medications to her client, Tommy, on a pediatric floor. What action by the student demonstrates a need for further instruction?

The student asks the client if he is Tommy before giving the medication.

Children cannot be depended on to give their correct names. Anxious to please, a preschooler might answer the question, "Are you Tommy Jones?" with "yes" even if he is not Tommy Jones. He also may agree with any other name you propose. The nurse needs to check the name band and compare it to the medication sheet and/or medical record.

A mother of a newborn brings her child to the well child clinic the week after birth. The mother asks the nurse if the child will get any "shots" at the next appointment. The best response from the nurse would be:

"Yes, your child will get 3 shots next time. They will be the polio vaccine (called IPV), Haemophilus influenza B vaccine (called Hib), and hepatitis B vaccine. They will be given in the thigh."

In older children, the deltoid muscle and the ventrogluteal are acceptable sites. For infants under walking age, use the vastus lateralis for IM injections

The nurse is administering 2 puffs of an albuterol sulfate inhaler to a 4-year-old. Which side effect would the nurse instruct the parent to most likely expect?

Increased heart rate and restlessness

The nurse instructs the parents on the side effects of the bronchodilator, albuterol sulfate. The side effect of this medication is restlessness, anxiety, fear, palpitations, and tremors. It is important for the parents to realize so they understand the actions of the 4-year-old. Once the bronchial tree is open, cough is decreased but mucous expectoration could increase. The medication does not cause drowsiness.

A neonate is to receive a hepatitis B vaccine within a few hours after birth. What is the best approach for the nurse to take when giving this medication?

Administer the medication in the neonate's vastus lateralis with a 25-gauge needle.

The vastus lateralis site is a safe choice for IM injections in a neonate. A 22- to 25-gauge needle is recommended for neonates, but the nurse must assess the neonate's size before determining needle size to use.The 25-gauge needle is recommended for neonates. The dorsogluteal site should not be used until school age. The deltoid muscle nor the dorsogluteal muscle is not a recommended IM site for neonates. These muscles should not be used until toddler age or older. The volume of the medication should not exceed 0.5 ml per injection until the child is preschool

A nurse is preparing a dose of insulin to give the client. Which action takes priority when preparing and administering this medication?

Double-check the dose with another RN before giving.

Insulin is a high-alert medication and the dosage must be checked with another RN before administering. All rights of medication administration should be adhered to. Insulin dosages come in units and the prescription is to administer a specific number of units, thus no calculations of dosages are needed. Insulin injections do not have to be witnessed. Insulin is not known for having adverse reactions, but it is always safe to ask the client if he or she has experienced any problems receiving insulin.

A child has been admitted to the hospital with a systemic infection in the blood. Which route will the nurse prepare for antibiotic administration for this client?

Intravenous antibiotics

With any systemic infection, the intravenous route of medication administration will be the most effective. The patient has been admitted to the hospital, and the nurse should prepare for IV administration. Intrathecal is not appropriate for antibiotics. IM and oral do not require admission to the hospital for administration.

Parents question the necessity of moving their preschooler from her room to another place to insert her IV line. The nurse explains:

the importance of avoiding unpleasant experiences in the child's room and bed in order for both to remain safe places.

The child's room and bed should be as nonthreatening and safe as possible. The child needs to feel secure in what is her space in an unfamiliar environment. The playroom also needs to remain a place of pleasure and security. Procedures are not done there. Distraction can be provided in places other than the playroom. The treatment room does have many supplies, and the hospital room lighting may not be optimal, but those are not the basic reasons why the child's room will not be used as the IV start location.

The primary health care provider prescribed ketoconazole for a child with ringworm. Which statement by the parents indicates the nurse needs to provider additional teaching on the prescription?

"I will wrap the skin tightly after applying the medication."

Ketoconazole is an antifungal used to treat tinea infections. The nurse would teach to avoid covering treated skin areas with tightly. The area needs to be able to allow air to circulate to the skin to limit side effects. All other statements indicate correct understanding.

A 4-year-old child is admitted to the hospital for surgery. Before the nurse administers medicine, the best way to identify the child would be to:

read the child's armband

A child may answer to the wrong name or deny his or her identity to avoid an unpleasant situation or if scared of the unknown. If the child is avoiding the situation he or she may fail to answer. Using the child's nickname is okay in conversation but it is not a legal identification of the child. To verify the correct identity the nurse should verify the child's armband and the correct name with the child's caregiver. Bar code scanning the child's armband would also be a correct method of identification.

The nurse is caring for a 10-year-old girl with cystic fibrosis who receives pancreatic enzymes. Which comment by a parent demonstrates understanding of the instructions regarding the medication?

"I should give the enzymes before each meal or snack."

The enzymes are necessary for appropriate digestion and absorption of food and nutrients. There is no interaction between enzymes and antibiotics. Large, malodorous stools are a sign of no pancreatic enzyme activity. Pancreatic enzymes must be given each time the child eats, usually in smaller doses for snacks than for meals.

The nurse is giving discharge instructions to a mother of a 3-month-old infant who will be receiving oral medication at home. Which of the following would the nurse include in the teaching plan?

Give the medication with a syringe and squirt a small amount at a time beside the tongue while holding the infant upright.

Infants should be given oral medications with a syringe. Squirt a small amount at a time onto the side of the tongue while holding the infant upright in order to prevent aspiration. Medications should never be mixed with an infant's formula or breast milk since this is their primary source of nutrition and the infant could develop an aversion to it. Infants should be positioned upright or with the head of the bed elevated when giving oral medications. Infants are obligatory nose breathers therefore holding shut the nose is contraindicated. Medication should be squirted beside the tongue.

A nurse is preparing a dose of insulin to give Billy, an 11-year-old boy. Which of the following actions would be most appropriate for the nurse to do when giving this medication?

Double check the dose with another registered nurse before giving it.

Insulin is a high alert medication, that is it has a high risk of causing harm when an error occurs. Therefore it must be checked with another registered nurse before it is given. Insulin is typically ordered as specific units, so no calculations are needed. Insulin injections do not have to be witnessed. Insulin can cause adverse reactions but this is not the main concern with administration.

A 12-month-old child weighing 11 lb has an order for gentamycin sulfate 13 mg IM q 36 hour. The pharmacy has 20 mg/2 mL on hand. How may milliliters would the infant receive, and what is the best site for the injection?

1.3 mL; vastus lateralis

For IM injections in infants, the mandatory site for administration is the vastus lateralis muscle of the anterior thigh. Use the lateral aspect rather than the medial portion because this site is not as tender and should cause less pain. 0.13 mg is incorrect, and both ventrogluteal and deltoid are not sites used with the toddler.

The nurse is giving discharge instructions to a parent of a 3-month-old infant. What is the best information to give the parent concerning oral medication administration?

Give the medication with a syringe and direct the liquid toward the posterior side of the mouth while holding the infant upright.

Infants should be given oral medications with a syringe. The liquid should be directed toward the posterior side of the mouth while the parent is holding the infant upright, to prevent aspiration. Medications should be given in small amounts and the infant should be allowed to swallow before administering more. Medications should never be mixed with an infant's formula or breast milk since this is the infant's primary source of nutrition. If the infant does not drink all the formula or milk there is no way to know if the entire dose of medication was ingested. Infants should be positioned upright or with the head of the bed elevated when giving oral medications. Infants are obligatory nose breathers so holding shut the nose is contraindicated.

The nurse enters the room to give a subcutaneous injection of insulin to a 6-year-old female diabetic client. Which of the following would be most appropriate for the nurse to do?

Ask the patient where she would like to have the nurse give the injection

Asking the patient to choose where to receive the injection gives a degree of control to the patient. Announcing that it is time for the medication does not give any sense of control to the child. Asking permission to give a medication to a child is not appropriate. A child should not be given the opportunity to decline a medication. It is not appropriate to tell a child not to cry during a painful procedure. The child should be given permission to yell out or cry if they feel the need to so.

Which technique should the nurse use to administer ear drops to a 4-year-old child?

Pull the pinna of the ear up and back.

A mother is told that her child will receive total parenteral nutrition. She asks the nurse what this means. The nurse bases her response on knowledge that total parenteral nutrition is:

administration of fluids, electrolytes, amino acids, lipids, dextrose, and minerals through an IV.

Total parenteral nutrition is an IV fluid that contains dextrose, amino acids, lipids, electrolytes, vitamins, and minerals through an IV. A peripheral IV might be used short term, but in most cases the fluid will be administered through a central IV line. TPN is not administered IM or through a nasogastric tube, and it includes more nutrients that those contained in Ringer's lactate

A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first?

Administer the bronchodilator via a nebulizer

he nurse would first administer the bronchodilator to open the child's airway and facilitate breathing. Once the airway was open, the nurse could administer oxygen, if indicated. At this time, the child's saturation level is normal but it should be monitored. The nurse would then administer the antibiotic medication. The heart rate is within normal range for a child of this age (65 to 110 beats/minute); therefore, a cardiac monitor is not needed at this time.

The nurse has prepared an IM injection to give a 13-year-old child. After some searching, the nurse locates the child in the playroom in front of a video game. Which action is best for the nurse to take?

Inform the child that it is time for an injection. Explain why the injection is needed and have the child move to the treatment room

Explaining the reason for a medication is appropriate for a 13-year-old child. The medication should not be given in the playroom. The playroom is a safe area for clients. Painful procedures should be done in a treatment room. Asking the child to take a break from the game sounds like the nurse is asking permission to give the medication. A child should not be given the opportunity to refuse a medicine.

The nurse is working to gain a preschooler's cooperation to swallow an oral medication. What would be the nurse's best approach?

ask if the child would like to take the medicine in a cup or through an oral syringe

The preschool age is when the child develops initiative. This is the sense that the child is helping. Thus, the nurse should allow the child ot participate in the medication task. The instructions and choices need to be simple. The nurse can ask if the preschooler would like to take the medicine in a cup or through an oral syringe. Medicine never should be compared to candy or any other foods. Doing so can present a safety problem if the child gets into the medication cabinet at home thinking he or she is getting candy. Children cannot be depended on to take medicine without supervision, so leaving the medication on the night stand would not only be ineffective it would also be dangerous. Bribing is ineffective. A preschooler is not going to do a task he or she does not like and the medication is needed to make the child well. The nurse should be gentle but firm in the administration of the medication.

A nurse is administering a liquid oral medication to a 5-month-old. Which nursing action provides the correct dosage? Select all that apply.

Using a medicine dropper
Gently restraining the child's arms and head
Administering the medicine such that it flows slowly into the child's mouth

In infants, oral medication can be given with a medicine dropper or a unit dose syringe (without a needle). The nurse would not choose a medicine cup for administration. Never give medicine with the child lying completely flat; otherwise, a child could choke and aspirate. Instead, gently restrain the child's arms and head by holding the child against your body with the head raised. A crying child is already opening the mouth for you; otherwise, gently open the mouth by pressing on the child's chin. Press the bulb of the medicine dropper or use the plunger of the syringe so that the fluid flows slowly into the side of the child's mouth. Be certain the end of the syringe or dropper rests at the side of the infant's mouth to help prevent aspiration.

The nurse is preparing to administer an IV antibiotic to a 10-year-old child. After calculating the recommended dose with the patient's weight, the nurse discovers the ordered dose exceeds the safe dose range in a pediatric drug reference. The medication has been given to the child at this dose for three days. Which of the following should the nurse's next action be?

Verify the dose with the prescribing practitioner

Medication calculations should always be checked before giving the dose. When a medication dose is found to be outside of the safe dose range, the dose should be verified with the prescribing practitioner. Doses that exceed the recommended range should always be verified, even if they have been given before. The parents did not prescribe this medication. Even if the medication had been given for three days, it does not make the dose correct. Calling the pharmacy can only verify if the dose is out of the safe range. The pharmacy did not prescribe the medication, nor do they know the medical background of the patient.

A toddler is ordered amoxicillin for bilateral otitis media. The mother complains that the child refuses to take the oral medication. The nurse knows that more education is needed when the mother states:

I will shake the medication well, and draw up the medication to the top of the syringe. My husband and I will hold the child down and force the medication down his throat.

The objective of administering oral medications is to administer the entire dose to the child while creating the least aversion to the medication as possible. No force should be used. Allowing the child to take the medication slowly from a medicine spoon or syringe is one way to reduce aversion.

The new graduate nurse is preparing to administer medication to a 4-year-old client. When would it be appropriate for the supervising nurse to intervene? The new graduate:

had two whole tablets to administer to the child.

Many children do not have enough coordination to swallow tablets or pills until they are 6 or 7 years of age. Therefore, the supervising nurse would need to intervene. The other actions are correct. The nurse should explain why the medication is being administered. Medications in children are dosed according to body weight (milligrams per kilogram) or body surface area (BSA) (milligrams per square meter). The vastus lateralis is a good location for an IM injection in a 4-year-old child.

The nurse is caring for a 12-year-old post-appendectomy client who weighs 86 pounds. The child has a temperature of 38.5ºC (101.3ºF). The nurse prepares to give the client a dose of oral Tylenol. The order reads "Tylenol 15mg/kg/dose every 4 to 6 hours PO PRN for fever or pain." How many milligrams of Tylenol should the nurse give the client?

587 milligrams

The child's weight must first be converted to kilograms by dividing 86 by 2.2. The result is 39.1 kilograms. Next, the 39.1 kilograms must be multiplied by 15 milligrams. This answer is 587 milligrams

The nurse is preparing to give a 4-month-old an oral medication. Which technique demonstrates the nurse's accurate knowledge of the infant's developmental level?

Position the infant upright, offer the infant a bottle of formula, remove the bottle and squirt the medication on the side of the tongue toward the cheek, then offer the infant the bottle again.

Proper medication administration for an infant includes the following: Position the infant upright, present a pleasant- or neutral-tasting substance to ensure that the child is awake and swallowing, give the medication slowly enough to allow the child to swallow and prevent any risk of aspirating, and give a pleasant-tasting "chaser." An infant should not be placed supine since this would increase the risk of aspiration. Medications should not be placed in a patient's staple food to avoid an aversion to the food in the future.

The nurse teaches the mother of a 2-year-old child how to instill antibiotic otic drops. The mother indicates understanding of the skill when she takes which action?

Pulls down and backward on the earlobe before instilling the drops.

The danger of fluid overload developing is a potential problem in the infant receiving an intravenous infusion. For which of the following would you observe?

Increased pulse rate and increased blood pressure

An increased fluid load puts excessive strain on the circulatory system, increasing pulse rate and blood pressure.

The nurse is preparing to administer a medication to a 5-year-old who weighs 35 pounds. The prescribed single dose is 1 to 2 mg/kg/day. Which is the appropriate dose range for this child?

16 to 32 mg

The nurse should convert the child's weight in pounds to kilograms by dividing the child's weight in pounds by 2.2 (35 pounds divided by 2.2 = 16 kg). The nurse would then multiply the child's weight in kilograms by 1 mg for the low end (16 kg × 1 mg = 16 mg) and then by 2 mg for the high end (16 kg × 2 mg = 32 mg).

The nurse is caring for an 8-year-old girl who requires medication that is only available in an enteric tablet form. The nurse is teaching the mother how to help the girl swallow the medication. Which statement indicates a need for further teaching?

"I can pinch her nose to make it easier to swallow."

The mother should be advised to never pinch the child's nose as it increases the risk for aspiration. The other statements are correct.

A nurse has just given otic medication instructions to the parents of a 12-year-old child. Which statement would indicate that the parents need further education concerning the medication?

"I will pull the outer ear down and back before administering the medication."

The proper technique to instill ear drops in a child older than age 3 involves pulling the pinna up and back. Otic medication should not be administered if it is cold. Cold medication may cause discomfort and produce vomiting or vertigo in the child. If an otic medication must be refrigerated, it should be warmed to room temperature in the palms of the hands. Proper otic administration technique involves holding the dropper 0.5 in (1.25 cm) above the ear canal and being careful not to touch the dropper to the ear to prevent contamination of the dropper with microorganisms. For children young than 3, the parent would pull the pinna down and back.

To give eardrops to a 4-year-old child, what would be the best technique to use?

Pull the pinna of the ear up and back.

Pulling the pinna upward and back straightens the ear canal in the child older than 3 years of age. To administer otic drops to a child younger than 3 years, the pinna would be pulled downward and back. Pressing the pinna of the ear forward or downward would occlude the ear canal.

The nurse is planning to provide a preschool-age client with an oral medication. Which approach should the nurse use to gain the child's cooperation?

Ask the child if a cup or oral syringe is preferred to take the medicine.

The child should be offered choices to provide a sense of control. Asking if a cup or oral syringe is preferred is the best approach for the nurse to use to gain the child's cooperation. Medicine should never be compared to chocolate. The child might eat a fatal amount of the medicine when unattended. Offering to play a game is bribing the child and should not be done. The medicine should not be left at the bedside stand. The child might forget to take it and another child might swallow it.

The nurse educator is teaching the class of nurses about infusion control in children. The nurse knows that more education is needed when the student nurse states:

"No special pumps are needed for the pediatric patient; I can use the same one that we use with adult patients."

Pediatric IV medications can be given directly into the IV tubing or via volume control chamber, syringe pump, or a volume control chamber. They are used to avoid overloading of the cardiopulmonary system. The amount of fluid meed to be monitored and accurately documented to avoid overloading the infant/child's circulation.

Which statement by the nurse is most likely to gain the cooperation of a young child?

"It's time for you to drink your medicine now."

It is best to state the request firmly to prevent resistance. Asking if the child wants to take the medicine will likely get a negative answer. Bribing the child with a treat is not appropriate because then every time the child takes medicine he will expect a treat. It is equally inappropriate to threaten children into taking medication.

The nurse is instructing a parent on administering ear drops to a 6-year-old. Which parental action demonstrates an understanding of teaching?

The parent has the child sit down and pulls the pinna upward and back

The nurse should pull the pinna upward and back for children 3 years of age and older. The nurse should pull the pinna downward and back for children younger than 3 years of age. Medication should not be instilled cold and should not be heated in the microwave. A 6 year old is not able to instill ear drops independently.

A child with gastroenteritis has been unable to keep oral medication down. What nursing intervention would be appropriate for this client?

Request an intravenous form of the medication.

Absorption is the transfer of the drug from its point of entry into the bloodstream, and vomiting and diarrhea interfere with absorption because the drug does not remain in the gastrointestinal tract long enough to be absorbed. Distribution is not affected by vomiting and diarrhea, as it involves movement of the drug through the bloodstream. Metabolism involves conversion of the drug into an active or inactive form, and is unaffected by gastroenteritis. Excretion is the elimination of the drug from the body, usually through the kidneys. This is also unaffected by vomiting and diarrhea.

A child is prescribed multiple intravenous medications. Which nursing action demonstrates the best practice to maintain medication safety?

Flush the intravenous line between each medication.

Two nurses are not necessarily needed to transcribe or review health care provider orders. Pharmacists review all pediatric medication orders for accuracy. Diluents and fluids should always be checked for compatibility with the medications. Thus, the best practice when giving multiple IV medications to a child is to flush the IV line between each medication.

The nurse is caring for a child who weighs 47 lb (21.3 kg). The medication prescribed for the child has a therapeutic dosage of 3 mg/kg/day. The medication prescribed is to be given every 6 hours. What is the total number of milligrams of medication the child will receive in one dose?

16 mg

Use the child's weight in kilograms. For the dosage of 3 mg/kg/day, the child will get 64 mg in one day ( 21.3 kg × 3 mg/kg/day = 64 mg/day). If the dose is to be given every 6 hours, that is 4 doses in 24 hours. Divide the total dose of 64 mg by 4 = 16 mg.

Mike, age 8, is going home on medication after surgery. The nurse is preparing to review the discharge instructions with the mother. What basic information and/or instructions should be given to her to continue the drug therapy at home? Select all that apply.

Generic and trade names of drugs
Description of the intended therapeutic drug effect
Schedule and duration of administration

A crucial step in administering pediatric drug therapy is educating the parents and other family members or caregivers, especially when the child returns home. Providing honest and detailed explanations and rationales helps reassure those caring for the child. The nurse should also provide age-appropriate explanations. Referring to books or imparting knowledge of the position papers will not help Mike's mother take care of her son at home.

The site most often used when administering a medication using the intradermal route is the

forearm.

Intradermal injections deposit medications just under the epidermis. They are most often used for tuberculosis screening and allergy testing. The forearm is the site most often used. The anterior thigh, lateral upper arms, and abdomen are the preferred sites for subcutaneous administration. The deltoid, vastus lateralis and the ventrogluteal are the preferred sited for intramuscular injections.

A 5-year-old child is to receive long-term IV antibiotics. The mother is concerned about what type of administration method will be used. Which medication administration route may be the most easily accepted?

A peripherally inserted central catheter (PICC) line in an antecubital space

If IV antibiotic therapy is going to be needed for an extended period of time a type of longer term device needs to be used as opposed to a peripheral IV. A peripheral IV would need to be changed often and the risks of dislodgement or inflammation are much greater. Pereipherally inserted central catheters are placed in the upper arm uder ultraound guidance. If maintained properly they can remained for many months. This means no IV sticks for the time the child would need IV therapy. It also leaves the hands free to use. A port must be surgically implanted into the child's chest. It can remain for many months or an extended period of time. This would not be warranted for a one-time treatment of antibiotic therapy. A Hickman catheter is inserted via sterile procedure by a surgeon. This catheter is placed near the heart and has an increased risk of infection. An intraosseous line is not a route for long-term administration. It is used for emergent situations.

The nurse is teaching a 14-year-old child on the proper use of a metered-dose inhaler to control symptoms of asthma. Which teaching points should the nurse include in these instructions? Select all that apply

Shake the canister before using.
Hold the breath for 5 to 10 seconds.
Activate the inhaler while taking a deep breath.

The nurse should instruct the child to shake the canister, exhale deeply, activate the inhaler while inhaling, take a long slow inhalation, and then hold the breath for 5 to 10 seconds. The child should be instructed to take only one puff at a time and to wait for 1 minute between puffs.

The nurse is providing discharge education to the parents of a 2-year-old who will be taking amoxicillin orally at home. The nurse would include which statement in the teaching?

"Use a dosing cap to measure the dosage."

When talking to parents about giving medicine, stress that if a medicine comes supplied with a dosing cap, it is best to use that to measure the correct dose (Pham et al., 2011). If there is no dosing cap, then an oral medicine syringe or dropper are the next best methods to measure liquid medicine because kitchen teaspoons are rarely exactly 5 ml. Antibiotics need to be taken for the full course, not until symptoms subside. Mixing the medication with a drink or in food makes it difficult to determine how much the child has taken if the child refuses to finish it all. Amoxicillin comes in a liquid form, so crushing the pills is not appropriate.

The nurse is preparing to administer an oral dose of metoclopramide to a 5-year-old child who weighs 40 lb (18.2 kg). The prescription reads metoclopramide 0.8 mg/kg/day to be given in 4 oral doses. How many milligrams of metoclopramide would the nurse give per dose?

3.65 mg per dose

To calculate the does, use the client's weight in kilograms. Multiply 0.8 mg by 18.2 kg, which equals 14.6 mg per day for the client's weight. Then, divide 14.6 mg by 4, the number of doses per day day, to arrive at 3.65 mg per dose.

A toddler requires 1.5 mL (.05 oz) of an antibiotic given intramuscularly (IM). How will the nurse administer this medication?

Divide the dose. Administer 0.75 mL (0.25 oz) IM in each vastus lateralis.

The recommended amount of solution a toddler should receive in one IM injection should not exceed 1 mL (0.33 oz). Dividing the dose is necessary even though two injections will cause additional stress. These could be given simultaneously by two nurses. Seeking an oral route could be explored, but may not be feasible. The manufacturer's directions regarding the amount of diluent should be followed to ensure safety.

The nurse is providing teaching for parents on how to administer ointment to their son's eyes. Which response indicates a need for further teaching?

"We should stand or sit behind him as he lies down."

It is usually easier to apply an eye ointment by facing the child directly. Eye drops are more easily administered by standing or sitting behind the child while the child reclines. The other statements are correct and support proper use of eye ointment.

A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should:

offer a choice between liquid and chewable medications, if possible.

Preschoolers are often uncooperative during drug administration. Strategies for enlisting cooperation include offering choices (e.g., between liquid medicines or chewable tablets) when feasible. This is preferable to forcibly administering a medication. Teaching is unlikely to influence a 3-year-old child's reluctance. A central IV line would not be a preferred strategy if oral medications are available.

Which action should the nurse take to ensure an intravenous infusion will be administered safely to an infant?

Add a calibrated fluid chamber to the line.

Overloading of IV fluid in infants can be prevented by use of fluid chambers, devices that allow only 50 to 100 ml of fluid into the drip chamber at a time. With these in place, even if the pump fails, only the amount of fluid in the drip chamber will be allowed to enter the child's circulation, not the entire contents of the bag suspended above the child's head. A large-bore needle will not ensure that intravenous fluids will be administered safely to an infant. Using a rolled pillowcase instead of a hard arm board also will not ensure that intravenous fluids will be administered safely to an infant. The height of the infusion bag will not ensure that fluids will be administered safely to an infant.

The nurse is caring for a child who weighs 42 lb (19 kg). The medication prescribed for the child has a therapeutic dosage range of 33 mg/kg/day to 48 mg/kg/day. The medication prescribed is to be given 3 times per day. Which dosage would be appropriate for the nurse to administer to this child in one dose?

250 mg

Use the child's weight in kilograms. The low dose of this medication would be 19 kg × 33 mg/kg/day = 627 mg, divided by 3 times per day equals 209 mg per dose. The high dose of this medication would be 19 kg × 48 mg/kg/day = 912 mg/day divided by 3 times per day equals 304 mg per dose. Halfway between these two dosages (304 mg - 209 mg = 95 mg, 95 mg ÷ 2 = 47.5 mg), equates to a dose of 250 mg per dose being appropriate.

A father believes his 2-year-old son is frightened by seeing an intramuscular (IM) medication injected into his thigh and requests that the child's "butt" be used. What will be the nurse's response?

"The muscle in his butt is not well enough developed to receive this injection until he has walked for 1 year."

Muscle development follows use, and 1 year of walking allows for full development of the gluteus and less likelihood of injury to the sciatic nerve. Since most children do little walking at 12 months, it is not likely the child has been walking for a year. The other explanations do not address muscle development or are inaccurate statements.

A nurse has just given instructions to the parents of a 12-year-old about administering a prescribed otic medication. Which statement by the parents would indicate the need for further education concerning the medication?

"I will make sure that I pull her outer ear down and back before administering the medication."

The proper technique to instill ear drops in a child over age 3 involves pulling the pinna of the ear up and back. Do not administer otic medication if it is cold. Cold medication may cause discomfort and produce vomiting or vertigo in the child. If an otic medication must be refrigerated, it should be warmed to room temperature in the palms of the hands. Proper otic administration technique involves holding the dropper one-half inch above the ear canal and being careful not to touch the dropper to the ear to prevent contamination of the dropper with microorganisms. For children under 3, pull the pinna up and back.

A 6-year-old client is prescribed to receive an oral antibiotic. What should the nurse do before giving the child this medication?

Check to see if the child can swallow pills.

Many children do not have enough coordination to swallow tablets or pills until they are 6 or 7 years of age. Children younger than 9 years of age often have difficulty swallowing tablets. This can make getting a child to agree to try an oral medication difficult. The nurse needs to check to see if the child can swallow pills before providing the oral medication. Drinking a glass of water before giving the medication will not determine if the child can swallow an oral medication. Giving the oral medication at the time of the next meal does not necessarily mean that the child will be able to swallow the oral medication. The nurse should not threaten to give the medication with an injection.

The nurse is caring for a toddler diagnosed with iron deficiency anemia and prescribed an iron supplement. What would the nurse include in the educational plan for the parents? Select all that apply.

Give the iron suppleiment with a liquid or food high in vitamin C (such as orange juice/oranges)

Iron suppliments may cause dark stools, so monitor for this as an expected finding

Iron suppliments are best given with a food or liquid high in vitamin C because it enhances iron absorption. The toddler's stools will be dark in color as this is an expected finding for a child taking iron suppliments. The child should avoid excess cow's milk because this tends to cause the child to consume too little iron and not be hungry for iron rich foods. High carbohydrates snacks and foods are typically low in iron, so the nurse would not encourage these types of foods. Bananas, peas and potatoes are high in potassium, not iron.

The nurse is preparing to give an oral medication to an 11-year-old client. Which of the following is the best approach for the nurse to take?

Allow independence from the parent in the process of medication administration.

Allowing a patient in middle childhood independence from the parent is an appropriate approach. Abstract rationales are too advanced for this age group and are better suited to adolescents. Allowing preparation through play is better suited to a child in early childhood. Introducing a bottle is better suited for an infant.

While working in the emergency room, the nurse receives a call that a 3-year-old child sustained extensive burns in a house fire. Assuming all of the following actions are included in the standing burn-care protocol, which action should be the nurse perform first?

Obtain a weight

A burn victim will require large amounts of fluid hydration to replace fluid losses. Obtaining a weight provides a base for calculating the fluid that will need to be replaced. Nasogastric tube placement and/or drinking milk are not actions to take at this point. Tetanus can be given later and is not critical to active management.

A parent must administer a medication in syrup form to a 2-month-old infant. The nurse suggests:

placing the medicine in an empty nipple without an attached bottle.

The young infant should naturally and easily suck the medicine through an empty nipple, getting the entire dose. Formula and rice cereal are essential foods for the infant and the desirability of them should not be altered by the taste of the medication. In addition, a 2-month-old is not developmentally ready for spoon feeding of rice cereal or medication from a medicine spoon.

The nurse is teaching a parent how to administer otic medications to her 4-year-old child. Which comment from the mother would indicate the need for further teaching?

"I will pull the pinna down and back."

If the child is older than 2 years of age, the parent should pull the pinna of the ear up and back. Ear drops must always be used at room temperature or warmed slightly because cold fluid may exacerbate pain and may also cause severe vertigo as it touches the tympanic membrane. The parent should turn the child or ask the child to turn onto his or her back, or use restraint as necessary, and then turn the child's head to one side and administer in the ear as prescribed.

Which technique should the nurse use to administer eardrops to a 4 year old child?

When administering ear drops to a 2 year old which action would be most appropriate?

How does the nurse pull the ear of an 8 year old patient when administering ear drops?