Pediatrics Greater Lowell Technical College
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A 4-year-old begins to cry when his mother tells him it is time for his operation. The nurse understands this is an expected reaction because the preschooler is particularly fearful of:
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Invasive procedures
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Unfamiliar routines
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Loss of control
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Restricted mobility
Explanation
Correct Answer: (A) Invasive procedures
Preschoolers (ages 3–6) have a particular fear of bodily harm and invasive procedures. At this developmental stage, children have magical thinking and an incomplete understanding of body boundaries. They fear that their body can be "broken" or that parts will not work after a procedure. Surgery represents a major invasion of the body, which is the primary source of fear for preschool-aged children.
Why Other Options are Incorrect:
- B. Unfamiliar routines — While unfamiliar environments can cause anxiety, this is more characteristic of toddlers who rely heavily on routine and familiarity.
- C. Loss of control — Loss of control is more characteristic of the toddler stage, where autonomy is the central developmental theme.
- D. Restricted mobility — Restricted mobility is more distressing for toddlers and school-age children, not specifically preschoolers.
Which of the following strategies might the nurse use when administering oral medications to a young child?
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Offer the child fruit juice after the medication is swallowed
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Tell the child that the medication is candy
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Give the medication quickly if the child is crying
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Mix the medication with chocolate milk
Explanation
Correct Answer: (A) Offer the child fruit juice after the medication is swallowed
Offering fruit juice or a pleasant-tasting drink after medication is swallowed is an appropriate and safe strategy to improve medication compliance in young children. It helps wash away any unpleasant taste left by the medication and serves as a positive reinforcement that encourages cooperation with future medication administration.
Why Other Options are Incorrect:
- B. Tell the child that the medication is candy — This is dangerous and unethical. Telling a child medication is candy can lead to accidental overdose if the child seeks out and self-administers medication unsupervised, thinking it is a treat.
- C. Give the medication quickly if the child is crying — Administering medication to a crying child increases the risk of aspiration. The nurse should calm the child first before attempting medication administration.
- D. Mix the medication with chocolate milk — Mixing medication with a large volume of milk or food is not recommended because if the child does not finish the entire amount, the full dose is not received, leading to underdosing.
Children less than 5 years of age may not fully absorb time released oral medications due to:
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Constipation
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Immature kidney function
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Increased gastrointestinal motility
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Decreased gastric acidity
Explanation
Correct Answer: (C) Increased gastrointestinal motility
Young children have faster gastrointestinal motility compared to adults, meaning food and medications move through the digestive tract more quickly. Time-released medications are designed to dissolve and be absorbed slowly over time. With increased GI motility, these medications may pass through the gut before the full dose is absorbed, reducing their effectiveness.
Why Other Options are Incorrect:
- A. Constipation — Constipation would actually slow GI transit, potentially increasing absorption time, not reducing it.
- B. Immature kidney function — Kidney function affects drug elimination and excretion, not the absorption of oral medications from the GI tract.
- D. Decreased gastric acidity — While gastric acidity does affect some medications, it is not the primary reason for poor absorption of time-released formulations in young children.
Which of the following techniques may be used for pain management for a child having an intramuscular injection? Select all that apply:
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Use an 18-20g needle
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Distraction
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Hug position
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Opioid analgesics
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Administer as slowly as possible
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EMLA cream
Explanation
Correct Answer: (B) Distraction, (C) Hug position, (D) Opioid analgesics
These three techniques are appropriate pain management strategies for children receiving IM injections. Distraction redirects the child's attention away from the procedure, reducing perceived pain. The hug position provides comfort and security through parental closeness while also providing gentle immobilization. Opioid analgesics may be used for pain management when appropriate and prescribed.
Why Other Options are Incorrect:
- A. Use an 18-20g needle — An 18-20g needle is too large for children; a smaller gauge needle (22-25g) should be used to minimize pain and tissue trauma.
- E. Administer as slowly as possible — IM injections should actually be administered at a moderate, steady pace; injecting too slowly increases discomfort and pain for the child.
- F. EMLA cream — While EMLA cream is a topical anesthetic that can reduce pain, it requires application 60 minutes before the procedure to be effective, making it impractical for routine IM injections unless planned well in advance.
The nurse caring for an 8 year old boy is trying to encourage developmental growth. What activity can the nurse provide for the child to encourage his sense of industry?
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Provide the child with his homework his teacher sent for him
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Allow the child to choose what time to take his medications
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Allow the child to help with his dressing change
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Allow the child to assist with his bath
Explanation
Correct Answer: (A) Provide the child with his homework his teacher sent for him
According to Erikson's psychosocial theory, the developmental stage for school-age children (6–12 years) is Industry vs. Inferiority. During this stage, children develop a sense of competence and achievement through productive activities, particularly schoolwork and learning. Providing the child with his homework directly supports his sense of industry by allowing him to continue meaningful, goal-directed work even during hospitalization.
Why Other Options are Incorrect:
- B. Allow the child to choose what time to take his medications — This promotes autonomy and a sense of control, which relates more to Erikson's Autonomy vs. Shame and Doubt stage seen in toddlers.
- C. Allow the child to help with his dressing change — While participation in care can be beneficial, this is more related to fostering independence and cooperation rather than directly addressing the sense of industry through achievement.
- D. Allow the child to assist with his bath — Similar to option C, this encourages self-care and independence but does not specifically address the school-age child's need for productive, skill-building achievement that defines the industry stage.
The nurse is caring for a 3 week old infant with a surgical incision. Which of the following pain scales is appropriate for assessing her pain?
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Qualitative pain scale
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NIPS
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Wong Baker Faces scale
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Numeric pain scale
Explanation
Correct Answer: (B) NIPS
The Neonatal Infant Pain Scale (NIPS) is specifically designed for assessing pain in neonates and infants under 1 year of age. It evaluates behavioral and physiological indicators such as facial expression, cry, breathing patterns, arm and leg position, and state of arousal. Since a 3-week-old infant cannot self-report pain, an observational tool like NIPS is the most appropriate choice.
Why Other Options are Incorrect:
- A. Qualitative pain scale — This type of scale requires verbal communication and self-reporting, which a 3-week-old infant is incapable of.
- C. Wong Baker Faces scale — This scale is appropriate for children aged 3 years and older who can identify facial expressions that match their pain level; it is not suitable for neonates.
- D. Numeric pain scale — This scale requires the patient to assign a number to their pain and is used in older children and adults who can understand numerical concepts.
A parent tells the nurse, "I'm not sure how to give this medicine to my infant." How would the nurse teach the parent to administer an oral suspension?
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Use an oral syringe and place the medication in the side of the infant's mouth
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Pour the medication into a small cup and allow the infant to drink it
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Administer the medication with a dropper onto the back of the infant's tongue
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Place the medication in a nipple and have the infant suck the nipple
Explanation
Correct Answer: (A) Use an oral syringe and place the medication in the side of the infant's mouth
An oral syringe is the safest and most accurate method for administering liquid medications to infants. Placing the medication along the side of the infant's mouth — between the cheek and gum — allows the infant to swallow it safely and reduces the risk of choking or aspiration. This method also ensures accurate dosing, which is critical in infants.
Why Other Options are Incorrect:
- B. Pour the medication into a small cup — Infants cannot drink from a cup reliably, and this method does not ensure accurate dosing or safe administration.
- C. Administer with a dropper onto the back of the tongue — Placing medication at the back of the tongue increases the risk of gagging, choking, and aspiration in infants.
- D. Place the medication in a nipple — This method is unreliable because the infant may not consume the entire dose, leading to underdosing and inaccurate medication delivery.
The nurse is preparing to administer an intramuscular injection to an 8 month old infant. Which is the preferred site?
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Vastus lateralis
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Ventrogluteal
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Deltoid
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Dorsogluteal
Explanation
Correct Answer: (A) Vastus lateralis
The vastus lateralis (anterolateral thigh) is the preferred intramuscular injection site for infants and young children under 3 years of age. This muscle is well developed even at birth, has no major nerves or blood vessels nearby, and provides a large enough muscle mass for safe injection. It is the recommended site by both the CDC and nursing guidelines for this age group.
Why Other Options are Incorrect:
- B. Ventrogluteal — Although this is the preferred site for older children and adults, it is not recommended for infants under 7 months due to insufficient muscle development.
- C. Deltoid — The deltoid is too small and underdeveloped in infants to safely receive intramuscular injections.
- D. Dorsogluteal — This site is contraindicated in children under 3 years due to proximity to the sciatic nerve and underdeveloped gluteal muscles, posing a risk of nerve damage.
What can a nurse do to assist a pre-school child adjust to hospitalization?
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Encourage the child to personalize his or her space
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Make meal choices for the child
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Discourage social interaction with other patients on the unit
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Do not explain procedures in detail so as not to frighten the child
Explanation
Correct Answer: (A) Encourage the child to personalize his or her space
Allowing preschool children to personalize their hospital space with familiar items from home — such as photos, toys, or drawings — helps them feel a sense of control and security in an unfamiliar environment. This promotes emotional comfort and eases the adjustment to hospitalization by making the environment feel less threatening and more like their own.
Why Other Options are Incorrect:
- B. Make meal choices for the child — Preschoolers benefit from being given simple choices, such as what to eat, as this fosters a sense of autonomy and control. Making choices for them undermines this need.
- C. Discourage social interaction with other patients — Social interaction with peers is beneficial for preschoolers' emotional well-being and adjustment during hospitalization and should be encouraged, not discouraged.
- D. Do not explain procedures in detail — Age-appropriate explanations of procedures actually reduce fear and anxiety in preschoolers. Withholding information increases distrust and fear of the unknown.
The nurse is preparing to give a vaccination to a 2½ year old child. Which I.M. site should be used?
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Vastus medius muscle
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Ventrogluteal muscle
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Deltoid muscle
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Dorsogluteal muscle
Explanation
Correct Answer: (B) Ventrogluteal muscle
For children over 2 years of age, the ventrogluteal muscle is the preferred IM injection site. It is a large, well-developed muscle with no major nerves or blood vessels nearby, making it the safest and most reliable site for children in this age group. It provides adequate muscle mass and has the lowest risk of complications compared to other sites.
Why Other Options are Incorrect:
- A. Vastus medius muscle — The vastus lateralis (anterolateral thigh) is preferred for infants under 2 years; by 2½ years, the ventrogluteal site is more appropriate.
- C. Deltoid muscle — The deltoid is not sufficiently developed in a 2½ year old to safely receive IM injections and is generally used in older children and adults.
- D. Dorsogluteal muscle — This site is contraindicated in children under 3 years due to proximity to the sciatic nerve and underdeveloped gluteal muscles, posing a significant risk of nerve damage.
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