Pediatric Primary Care for the Advanced Practice Nurse (D119)

Correct Answer

A. Explain the procedure using simple language.

Explanation

Preschool-age children are often able to understand simple, clear explanations of what will happen during a procedure. Using simple language helps reduce their fear by making the process more understandable and predictable. This approach is effective in reducing anxiety and fostering a sense of control in the child, which can make the experience less frightening.

Why other options are wrong

B. Perform the procedure without any explanation.

Performing the procedure without explanation may increase the child's anxiety and fear, as they won't know what to expect. Children are more likely to feel frightened if they are unaware of what is happening to them. Explaining the procedure is essential to easing their concerns.

C. Ask the child to leave the room during the procedure.

Asking the child to leave the room could make them feel abandoned and more anxious. Children generally benefit from having their parents or caregivers nearby, and involving them in the procedure can help reduce fear and provide comfort.

D. Use medical jargon to describe the procedure.

Using medical jargon can confuse and overwhelm a preschool-age child, potentially increasing their anxiety. Simple, non-threatening language is more appropriate for this age group to help them understand and feel more at ease.

Correct Answer A. Coolness of the client’s left forearm, pitting edema at the insertion site

Explanation

Infiltration occurs when IV fluid leaks into the surrounding tissue instead of staying within the vein. Coolness and pitting edema at the insertion site are classic signs of infiltration. The fluid causes swelling and discomfort, leading to a change in temperature at the site, with the area becoming cooler than the rest of the skin. This is due to the body’s response to the non-vesicant fluid leaking into the tissues.

Why other options are wrong

B. Erythema along the path of the vein

Erythema (redness) along the path of the vein usually indicates phlebitis, which is inflammation of the vein, not infiltration. Infiltration typically does not cause redness along the vein but rather swelling and coolness around the insertion site.

C. Bruising around the insertion site

Bruising around the insertion site can occur from trauma to the vein or surrounding tissues, but it is not a specific sign of infiltration. Bruising is more commonly associated with venipuncture or accidental injury rather than the leakage of fluid into the tissue.

D. Pitting edema in the client’s ankles

Pitting edema in the ankles is a sign of fluid retention and can indicate systemic issues such as heart failure or kidney problems. This is unrelated to infiltration at the IV site, which would typically cause localized swelling around the insertion site rather than generalized edema.

Correct Answer A. 2 tablets

Explanation

To calculate how many tablets are needed, divide the prescribed dose (1g) by the dose per tablet (250 mg).

1g = 1000 mg

1000 mg ÷ 250 mg = 4 tablets

Therefore, the correct answer is 4 tablets.

Why other options are wrong

C. 0.5 tablet

A half tablet would only provide 125 mg, which is far less than the prescribed 1000 mg (1g). Therefore, this is incorrect.

D. 0.25 tablet

A quarter tablet would only provide 62.5 mg, which is also far less than the prescribed dose of 1000 mg. Therefore, this is incorrect.

B. 4 tablets

This is the correct option, providing the prescribed dose of 1000 mg (1g).

Correct Answer A. 7.5 mL

Explanation

The order is for 0.5 g, which is equal to 500 mg (since 1 g = 1000 mg). The solution contains 250 mg per 5 mL, so to administer 500 mg, the nurse would need:

500 mg250 mg * 5 mL = 7.5mL

Thus, 7.5 mL of the solution should be prepared to administer the correct dosage.

Why other options are wrong

B. 10 mL

To administer 500 mg, the nurse would need 7.5 mL, not 10 mL. This amount would result in giving more than the required dosage.

C. 5 mL

5 mL of solution contains only 250 mg of the drug, which is less than the required 500 mg.

D. 2.5 mL

2.5 mL would only provide 125 mg, which is much lower than the required 500 mg dosage.

Correct Answer C. Seizures, 25 mL

Explanation

Phenobarbital is commonly used to manage seizures, and the ordered dose is 0.2 g, which is equivalent to 200 mg. Given that the available concentration is 80 mg per 10 mL, the nurse must calculate how much to administer. To find the correct volume, divide the required dose (200 mg) by the concentration (80 mg/10 mL), which equals 25 mL. Therefore, the nurse should administer 25 mL of the solution to deliver the correct dose.

Why other options are wrong

A. CHF, 30 mL

Phenobarbital is not used as a primary treatment for Congestive Heart Failure (CHF). The correct dose is intended for managing seizures, not CHF. Additionally, the volume calculated for CHF is incorrect based on the given dose of 200 mg.

B. Stroke, 25 mL

While phenobarbital may be used in certain neurological conditions, it is not the first-line treatment for stroke. The correct indication here is for seizures, not stroke. The dose of 25 mL is correct for seizures but irrelevant for stroke management.

D. NSTEMI, 30 mL

Phenobarbital is not used to treat Non-ST-Elevation Myocardial Infarction (NSTEMI). This option is unrelated to the condition being treated with Phenobarbital, and the volume of 30 mL is not appropriate based on the required dose.

Correct Answer D. Give the child a stuffed animal.

Explanation

At 2 years of age, children are often comforted by familiar objects like stuffed animals. Giving the child a stuffed animal can provide comfort and distraction, helping the child manage separation anxiety during the parent's absence. It is an appropriate intervention to calm the child during a tantrum.

Why other options are wrong

A. Call the parent to return to the child's room.

Calling the parent to return to the child's room can reinforce separation anxiety and does not help the child learn to cope with being away from the parent. It is more beneficial for the child to be distracted with a comfort item rather than immediately having the parent return.

B. Leave the child alone in the room for 5 min.

Leaving the child alone may increase their distress and feelings of abandonment. At this developmental stage, children need reassurance and comfort rather than isolation, which could escalate their anxiety.

C. Inform the child that her parents will be back in 2 hr.

At 2 years old, children do not have the cognitive ability to understand the concept of time, especially in terms of hours. Telling the child their parents will be back in 2 hours may only confuse or upset them further.

Correct Answer D. Iron-fortified cereal

Explanation

The American Academy of Pediatrics recommends introducing iron-fortified cereals as the first solid food for infants. Iron-fortified rice cereal is usually recommended because it is easy to digest and has a low risk of causing allergies. It is important to begin with an iron source since the infant's iron stores from birth typically deplete around 6 months of age.

Why other options are wrong

A. Pureed vegetables

Although vegetables are an appropriate food to introduce later, they are not recommended as the first solid food. It is essential to start with an iron-rich cereal.

B. Rice cereal

While rice cereal is often suggested, it is typically iron-fortified rice cereal that should be used. Regular rice cereal alone lacks the iron needed for the infant's development.

C. Mashed bananas

Mashed bananas can be introduced after cereals, but they are not the best first solid food. Bananas are often used after the introduction of iron-rich foods to ensure that the infant gets necessary nutrients like iron.

Correct Answer: 100

Explanation

To administer 50 mL over 30 minutes, you need to calculate the rate in mL/hour:

To administer 50 mL in 30 minutes, that means in 1 hour (double the time), the nurse will need to administer 100 mL.

(50 mL / 30 minutes) × 60 minutes = 100 mL/hour.

Why other options are wrong

A. 25

This is incorrect because administering 25 mL/hour would result in the medication being delivered too slowly and not in the correct amount within 30 minutes.

C. 50

This is incorrect because delivering 50 mL/hour would administer the medication in 1 hour, not the desired 30 minutes.

D. 30

This is incorrect because administering 30 mL/hour would result in too slow an infusion rate, taking too long to deliver the medication.

Correct Answer B. Children at this age often test boundaries; this behavior is typically a normal part of development.

Explanation

It is common for children around the age of 5 to test boundaries and exhibit aggressive behavior. This is a normal part of their emotional and social development as they learn to express themselves and interact with peers. However, the behavior should be monitored, and the child should be taught appropriate ways to express emotions.

Why other options are wrong

A. Aggressive behavior is uncommon at this age and should be addressed immediately.

While aggression may be concerning, it is not uncommon at this age. Most children experience frustration and testing of limits. The behavior can be addressed with appropriate guidance, but it is not necessarily an urgent issue.

C. Aggressive behavior is a sign of a serious psychological issue that needs professional intervention.

Aggressive behavior at this age does not automatically indicate a serious psychological issue. It is usually a normal phase of development. However, if the behavior becomes persistent or extreme, it might warrant further evaluation.

D. This behavior indicates that the child is not receiving enough discipline at home.

Aggressive behavior is not always a reflection of a lack of discipline. Children may act out for various reasons, including frustration or difficulty with social skills. Discipline should be applied appropriately, but this behavior is typically not due to a lack of parental discipline.