Pediatric Primary Care for the Advanced Practice Nurse (D119)

Correct Answer C. Have a parent stay with the child during the procedure.

Explanation

For a 3-year-old child who is fearful of painful procedures, having a parent stay with them during the procedure provides emotional support and comfort. This strategy reduces anxiety and helps the child feel more secure. It also promotes trust between the child, their family, and the healthcare team. The other options either do not address the child's fear effectively or could worsen the child's distress.

Why other options are wrong

A. Tell the child about the procedure ahead of time so they know what to expect.

While preparing a child for a procedure is important, 3-year-olds may not fully comprehend complex explanations. Overloading them with information may increase their anxiety, as they might focus on what they fear rather than understanding what to expect.

B. Cluster invasive procedures whenever possible.

While clustering procedures may reduce the number of times a child is subjected to painful interventions, it can also increase anxiety and make the child more fearful of the next procedure. Spacing out procedures with time for reassurance and recovery is often better for reducing stress.

D. Use mummy restraints during painful procedures.

Mummy restraints, while sometimes necessary for safety, can increase the child's fear and distress. This technique can be seen as punitive or frightening and may further traumatize the child, worsening their fear of future procedures. It should only be used if absolutely necessary and after considering less invasive approaches.

Correct Answer D. 18-20 hours

Explanation

Newborns, including 2-week-old infants, typically sleep between 16 to 20 hours a day. Sleep is crucial for their growth and development during the first few weeks of life. If the infant is sleeping 18-20 hours, it is within the normal range. Parents should be reassured that this is typical for infants in this age group.

Why other options are wrong

A. 10-12 hours

This amount of sleep is not typical for a 2-week-old infant, as they typically need much more sleep for proper development. This amount of sleep is more appropriate for older children or adults.

B. 12-15 hours

This is also less than the typical range for a 2-week-old infant. At this age, infants generally need more sleep, so 12-15 hours would be insufficient.

C. 15-18 hours

Although this is close, it is slightly lower than the typical sleep range for a 2-week-old infant. The optimal amount of sleep for infants in this age group is generally 18-20 hours.

Correct Answer C. Unintentional injuries and homicide

Explanation

Unintentional injuries, including motor vehicle accidents, drowning, and falls, are the leading cause of death due to injuries in children aged 1 to 4. Homicide can also be a significant factor in this age group. These types of injuries are often preventable, which is why they are a focus in public health efforts.

Why other options are wrong

A. Pneumonia

While pneumonia is a common cause of morbidity and mortality in infants and young children, it is not the leading cause of death due to injury in the 1- to 4-year-old age group.

B. Poverty

Poverty is a social determinant of health that can influence health outcomes, but it is not a direct cause of death due to injury. However, it can contribute to increased risk factors for injury, such as unsafe living conditions.

D. Heart disease

Heart disease is generally not a major cause of death in young children, including those aged 1 to 4. Most heart-related issues leading to death in children are congenital or related to genetic conditions rather than injuries.

Correct Answer D. Perform the venipuncture in the child's room.

Explanation

Performing the venipuncture in the child's room ensures that the child is in a familiar environment, which can help reduce anxiety. It also allows for the presence of the child's parents or guardians, who can offer comfort and reassurance. In addition, performing the procedure in the child’s room may reduce the fear of unfamiliar spaces.

Why other options are wrong

A. Allow the child to select the IV site.

While it is important to involve the child in their care, allowing them to select the IV site may not be practical or feasible. The nurse should assess the best site based on the condition of the veins, not leave it to the child’s decision-making, as they may not understand the implications for their treatment.

B. Consider using veins in the scalp or the foot.

Veins in the scalp or foot are typically reserved for infants or very young children. In a 9-year-old child, veins in the arms or hands are generally preferred for IV insertion due to greater vein stability and accessibility. These sites are more appropriate for a child of this age.

C. Ask the child's parents to leave the room.

It is typically better to allow the parents to remain with the child, as their presence can provide emotional support and comfort. Asking the parents to leave could increase the child's anxiety, making the procedure more stressful for both the child and the healthcare provider.

Correct Answer C. Accidental death

Explanation

Accidental death is the leading cause of death in children aged 1 to 4 in the United States. Common causes include motor vehicle accidents, drowning, and falls. While congenital anomalies and respiratory tract illnesses are significant health concerns, they do not represent the leading cause of death for this age group.

Why other options are wrong

A. Premature birth

Premature birth is a leading cause of death in infants, but not in children aged 1 to 4. This is more relevant in the neonatal period.

B. Congenital anomalies

Congenital anomalies are a leading cause of death in infants, but by the age of 1, these causes decrease as children grow older and are more likely to experience accidental deaths.

D. Respiratory tract illness

Respiratory tract illness is a common cause of morbidity in young children, but it is not the leading cause of death in this age group.

Correct Answer B. 2

Explanation

The prescribed dose is 500 mg, and each capsule contains 250 mg. To determine how many capsules are needed per dose, divide the prescribed dose by the amount in each capsule:

500 mg ÷ 250 mg = 2 capsules.

Therefore, the nurse should administer 2 capsules per dose.

Why other options are wrong

A. 1

One capsule would only provide 250 mg, which is less than the prescribed dose of 500 mg. Therefore, this is not the correct amount.

C. 3

Three capsules would provide 750 mg, which exceeds the prescribed 500 mg dose. This is too much for the child and should be avoided.

D. 4

Four capsules would provide 1,000 mg, which is far more than the prescribed dose of 500 mg. Administering this amount would result in an overdose.

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 B. 2mg and 1ml

Explanation

First, calculate the dose: The patient weighs 22lbs, which is approximately 10kg (22 ÷ 2.2 = 10).

The ordered dose is 0.2mg/kg.

0.2mg × 10kg = 2mg.

So, the total dose needed is 2mg.

Next, calculate how many mL of Morphine to administer:

The Morphine is packaged at 2mg/mL.

To administer 2 mg, you need to give 1mL.

Why other options are wrong

A. 0.2mg and 1ml

This answer underestimates the required dose for a 10kg child. The correct dose is 2mg, not 0.2mg.

C. 2mcg and 1ml

This answer uses the wrong unit of measurement. The correct dose should be in milligrams (mg), not micrograms (mcg).

D. 1mg and 2ml

This answer administers a dose lower than required. The correct dose should be 2mg, and with the concentration of 2mg/mL, the volume to administer is 1mL.

Correct Answer

C. Nocturnal emissions

Explanation

Nocturnal emissions, commonly known as "wet dreams," typically occur during late adolescence as part of normal sexual maturation. This is a natural way for males to ejaculate during sleep, and it is important for nurses to provide anticipatory guidance to prepare males for this common pubertal change. These emissions are typically a normal part of puberty and signify an increase in sexual maturation.

Why other options are wrong

A. Reddening of the scrotum

Reddening of the scrotum is not a typical pubertal change. While the scrotum may undergo changes in size and texture, reddening is not a common occurrence during puberty and does not require specific anticipatory guidance.

B. Breast enlargement

Breast enlargement, or gynecomastia, is more common in males during early adolescence and is not typically seen in late adolescence. By late adolescence, any breast enlargement usually resolves. Therefore, anticipatory guidance for this change is not usually necessary at this stage.

D. Lengthening of the penis

Penile lengthening typically occurs earlier in puberty, usually during mid-adolescence. While some minor growth may continue into late adolescence, it is not the most significant or expected change at this stage, making it less relevant for anticipatory guidance.