Question

A nurse is providing teaching to the caregiver of an infant who has a prescription for digoxin. Which of the following instructions should the nurse include?

Answer 1

Correct Answers:

Give the correct dose of medication at regularly scheduled times.

Rationale :

🔹When teaching the parent of an infant prescribed digoxin, the most critical instruction is to administer the medication exactly as prescribed at the scheduled times. 🔹Digoxin has a narrow therapeutic index, meaning that small deviations in dosage or timing can easily lead to toxicity or subtherapeutic effects. 🔹 Toxicity can manifest with symptoms such as vomiting, bradycardia, and poor feeding. 🔹Although side effects like vomiting should be reported, the nurse's primary teaching must emphasize the importance of accurate dosing and timing. 🔹This promotes effective management of the infant's cardiac condition and prevents adverse outcomes.

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Answer 2

Correct Answers:

Administer analgesics on a schedule.

Rationale :

✅ Children recovering from a tonsillectomy experience significant throat pain, which can interfere with oral intake, rest, and overall recovery. ✅ Administering analgesics on a schedule, rather than on an as-needed basis, maintains consistent pain control, preventing the child from reaching a high level of discomfort that could lead to crying, poor hydration, or hemorrhage. ✅ Routine analgesia ensures better cooperation with oral fluids, which is essential to prevent dehydration and facilitate healing. ✅ Supine positioning increases the risk of aspiration, and acidic beverages like orange juice can cause stinging pain in the throat postoperatively.

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Answer 3

Correct Answers:

Ensure that the medication is at room temperature.

Rationale :

✅ When administering otic medications to infants, it's essential to follow the proper technique to prevent discomfort and ensure effective delivery. ✅ Warming the medication to room temperature prevents vertigo and nausea, which can occur if cold drops are instilled into the sensitive inner ear. ✅ While proper ear canal alignment (pulling the pinna downward and backward for infants) is critical, the phrasing in the third option ("straight back") is anatomically imprecise for infants, making it incorrect.

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Answer 4

Correct Answers:

Calculate the safe dosage.
Offer juice after the medication.
Ask the toddler to pick a toy to hold during administration.

Rationale :

✅ Safe and effective medication administration in toddlers requires both clinical accuracy and developmentally appropriate techniques. The nurse must calculate the correct dose based on weight to avoid under- or overdosing. ✅ Offering a reward like juice after administration helps manage the unpleasant taste and promotes cooperation. ✅ Providing a choice, such as letting the child select a toy, incorporates atraumatic care principles by giving the child a sense of control, which reduces fear and resistance. ✅Having a parent present is often helpful but does not replace proper patient identification or nurse accountability in administering the medication.

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Answer 5

Correct Answers:

Perform a tape test.

Rationale :

🔸Enterobius vermicularis (pinworm) infection commonly causes perianal itching, particularly at night. 🔸The most accurate diagnostic method is the tape test, in which clear adhesive tape is applied to the perianal area upon waking, before bathing or using the bathroom. 🔸 This test captures eggs laid by the female pinworm overnight. Stool cultures and occult blood testing are not useful for diagnosing pinworms. 🔸 Prompt diagnosis enables treatment with antihelminthic medications, and the test should be repeated for accuracy if clinical suspicion remains high.

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Answer 6

Correct Answers:

Develop a professional support system.
Take time off from work.
Remain in contact with the family after their loss.

Rationale :

✅ Develop a professional support system Nurses caring for dying children often face emotional strain, and having a professional support system—such as peer support, counseling services, or debriefings—can help them process grief, reduce burnout, and maintain emotional resilience. ✅ Take time off from work Taking scheduled time off allows the nurse to recover emotionally, reflect on experiences, and return to patient care with a clear mind and renewed strength, preventing compassion fatigue. ✅ Remain in contact with the family after their loss Remaining in appropriate contact with the family, such as through condolence letters or follow-up calls, fosters closure for both the family and nurse and supports the grieving process within professional boundaries.

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Answer 7

Correct Answers:

"Oseltamivir should be given within 48 hours of onset of symptoms."

Rationale :

✅ Oseltamivir (Tamiflu) is an antiviral medication that is most effective when started within 48 hours of influenza symptom onset. ✅ It inhibits neuraminidase, a viral enzyme required for replication and release, thereby reducing symptom duration and severity. ✅ It can still be used after 48 hours in certain high-risk or hospitalized clients, but early initiation remains the standard. ✅ Zanamivir is used in older children, and amantadine and rimantadine are no longer recommended due to widespread resistance.

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Answer 8

Correct Answers:

Place the child in an upright position.
Administer bronchodilators.
Monitor oxygen saturation.

Rationale :

🔥Place the child in an upright position An upright position promotes optimal lung expansion and gas exchange, reducing the work of breathing and improving comfort in a child experiencing an asthma exacerbation. 🔥Administer bronchodilators Bronchodilators like albuterol rapidly relieve bronchospasm by relaxing airway smooth muscles, which is essential in acute asthma management to restore airflow and reduce wheezing. 🔥Monitor oxygen saturation Continuous monitoring of oxygen saturation ensures the child is maintaining adequate oxygenation and helps the nurse determine whether interventions are effective or if further escalation of care is needed.

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Answer 9

Correct Answers:

Empty the bladder completely with each void.
Wear cotton underpants.
Wipe the perineal area from front to back.
Avoid bubble baths.
Watch for manifestations of infection.

Rationale :

✅ Encourage the child to empty the bladder completely Urine retention fosters bacterial growth. Encouraging full bladder emptying helps eliminate residual urine and lowers the risk of recurrent urinary tract infections. ✅ Recommend cotton underwear Cotton is breathable and absorbs moisture, which helps reduce perineal irritation and bacterial growth, both of which are risk factors for UTIs. ✅Teach the child to wipe from front to back Wiping front to back prevents the transfer of bacteria from the rectal area to the urethra, significantly decreasing the risk of introducing pathogens into the urinary tract. ✅Advise to avoid bubble baths Bubble baths often contain fragrances and chemicals that can irritate the urethra, increasing the risk of UTIs, especially in young girls. ✅Observe for signs of infection Early recognition of symptoms such as dysuria, urgency, or fever ensures prompt diagnosis and treatment, minimizing complications from untreated infections.

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Answer 10

Correct Answers:

Initiate oral rehydration therapy.

Rationale :

✅ In children with mild to moderate dehydration due to diarrhea, the first-line treatment is oral rehydration therapy (ORT) with a balanced solution like Pedialyte. ✅ ORT is safe, effective, and non-invasive, restoring fluid and electrolyte balance without the complications of IV therapy. ✅ It’s best administered in small, frequent sips to avoid vomiting. ✅ NPO status is not indicated unless the child is actively vomiting or severely dehydrated. ✅ Chicken broth is not recommended due to its high sodium and low carbohydrate content, which can worsen electrolyte imbalance.

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RN Medsurg Nurs 228

No.

1 : A nurse is providing teaching to the caregiver of an infant who has a prescription for digoxin. Which of the following instructions should the nurse include?

2 : A nurse is caring for a child in the postoperative period following a tonsillectomy. Which of the following actions should the nurse take?

3 : A nurse is caring for an infant who needs Otic medication. Which of the following is an appropriate action for the nurse to take?

4 : A nurse is preparing to administer medication to a toddler. Which of the following actions should the nurse take? (Select all that apply.)

5 : A nurse is caring for a child who is suspected to have Enterobius vermicularis. Which of the following actions should the nurse take?

6 : A nurse often cares for children who are dying. Which of the following actions should the nurse take to maintain professional effectiveness? (Select all that apply.)

7 : A nurse is teaching a group of guardians about influenza. Which of the following information should the nurse include in the teaching?

8 : A nurse is planning care for a child who has asthma. Which of the following interventions should the nurse include in the plan of care? (Select all that apply)

9 : A nurse is teaching a parent of a child who has a urinary tract infection (UTI). Which of the following should the nurse include in the teaching? (Select all that apply.)

10 : A nurse is caring for a child who has had watery diarrhea for the past 3 days. Which of the following actions should the nurse take?

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