NUR351 Pediatrics F23

The nurse is teaching about skin care for atopic dermatitis. Which statement by the parent indicates that further teaching may be necessary?

• “I will use Vaseline to moisturize my child’s skin.”

• “A hot bath will soothe my child’s itching when it is severe.”

• “I will buy cotton rather than wool or synthetic clothing for my child.”

• “I will apply a small amount of the prescribed cream after the bath.”

Answer explanation

Hot baths should be avoided, as they are more dehydrating to the skin. Warm baths are preferred, followed by patting the child dry and rubbing on a small amount of prescribed cream, than a liberal amount of fragrance free moisturizer. Avoid wool clothing.

The nurse is caring for a child with acute otitis media. The child weighs 22 lb. The medication order reads: amoxicillin 160 mg PO every 8 hours. Amoxicillin is supplied as 200 mg/5 mL. How many milliliters will the nurse administer? Round to the nearest whole number.

Answer explanation

Order: amoxicillin 160 mg PO every 8 hours

Supply: amoxicillin 200 mg/5 mL

1. 160 mg/x = 200 mg/5 mL

2. cross multiply

200x = (160 x 5 mL)

200x = 800 mL

3. divide both sides by 200

200x/200 = 800 mL/200

4. x = 4 mL

The nurse is caring for an infant in the pediatric unit who has a very red rash in the diaper area, with red lesions scattered on the abdomen and thighs.

What is the priority nursing intervention?

• Administer griseofulvin with a fatty meal.

• Institute contact isolation precautions.

• Apply topical antibiotic cream.

• Apply topical antifungal cream.

Answer explanation

An angry red rash with satellite lesions is typical of diaper candidiasis. Topical antifungal preparations are indicated.

The nurse is caring for orthopedic children who are in the postoperative period following spinal fusion. What is the most appropriate activity to delegate to unlicensed assistive personnel?

• Ambulate the children twice daily to promote mobility.

• Encourage commode use to promote bowel function.

• Provide diversionary activities, as the children must stay flat on their backs.

• Assist with log-rolling the children every 2 hours.

Answer explanation

Frequent position changes promote, Resp, GI and GU functioning, in the well child who has had spinal fusion, the appropriate method of changing position is by log-rolling to avoid flexing the spine. The nurse also has the opportunity to assess the spinal bandage for drainage or bleeding when the child is log-rolled.

Urine ouput: 210 mL in 12 hours. Patient weight: 10.1 kg

Calculate the toddlers urine output in mL/kg/hr.

Is this output normal or abnormal for a Toddler?

• Yes, it is normal

• No, it is abnormal

Answer explanation

210 mL/10.1 kg/ 12 hours = 1.73

Normal output should be 2-3 mL/kg/hr

Which situation would cause the nurse to become concerned about possible hearing loss?

• A 12-month-old who babbles incessantly, making no sense

• An 8-month-old who says only “da”

• A 3-month-old who startles easily to sound

• A 3-year-old who drops the letter “s”

Answer explanation

Infants should be babbling at the age of 8 months. Lack of babbling is an indicator of possible hearing loss.

Which of these factors contributes to infants’ and children’s increased risk for upper airway obstruction as compared with adults?

• Underdeveloped cricoid cartilage and narrow nasal passages.

• Small tonsils and narrow nasal passages.

• Cylinder-shaped larynx and underdeveloped sinuses.

• Underdeveloped cricoid cartilage and smaller tongue.

Answer explanation

Infants and children have smaller nasal passages than adults, thus making obstruction with mucous more common. The funnel shape of the larynx due to underdevelopment of the cricoid cartilage places children less than 10 years old at increased risk of airway obstruction in the event of edema or mucous production.

A toddler has moderate respiratory distress, is mildly cyanotic, and has increased work of breathing, with a respiratory rate of 40.

What is the priority nursing intervention?

• Airway maintenance and 100% oxygen by mask.

• 100% oxygen and pulse oximetry monitoring.

• Airway maintenance and continued reassessment.

• 100% oxygen and provision of comfort.

Answer explanation

Priorities of care for the child with respiratory distress are to clear the airway and provide O2 supplementation.

The nurse is caring for a child with acute asthma. The child weighs 37½ pounds. The medication order reads: methylprednisolone 20 mg IV twice a day. The Pediatric Dosage Handbook provides a recommended dose for acute asthma of 1 to 2 mg/kg/day in two divided doses.

Is the ordered dose safe?

• Yes, it is safe

• No, it is not safe

Answer explanation

Child weight: 37.5 lb = 17.05 kg

Order: methylprednison 20 mg IV twice a day

Safe Dose: 1-2 mg/ kg/day in 2 doses

1. 2 mg/ 17.05 kg/ day in 2 doses

2. 34.1 mg per day in 2 doses

4. 34.1 / 2

5. 17.05 mg/dose

6. 17.05 mg safe is < 20 mg ordered

7. Ordered dose is NOT safe

A 5-month-old infant with RSV bronchiolitis is in respiratory distress. The baby has copious secretions, increased work of breathing, cyanosis, and a respiratory rate of 78.

What is the most appropriate initial nursing intervention?

• Attempt to calm the infant by placing him in his mother’s lap and offering him a bottle.

• Alert the physician or nurse practitioner to the situation and ask for an order for a stat chest radiograph.

• Suction secretions, provide 100% oxygen via mask, and anticipate respiratory failure.

• Bring the emergency equipment to the room and begin bag-valve-mask ventilation.

Answer explanation

Priorities of care for the child with respiratory distress are to clear the airway and provide O2 supplementation. Children who experience respiratory distress often deteriorate very quickly, and the nurse must be prepared in the even of respiratory failure or arrest.