BRiska guide simple version S3 Q3

Questions and Answers

What is the maximum volume of fluid that should be administered in a single IM injection site?

3 mL

0.5 mL

1 mL (correct)

2 mL

Which of the following is NOT a contraindication for taking a rectal temperature?

Diarrhea

Constipation

Ear Infection (correct)

GI bleeding

What is the preferred IM injection site for children?

Deltoid

Vastus lateralis (correct)

Dorsogluteal

Ventrogluteal

Which of the following is NOT a reason to use an infusion pump?

To administer large volumes of fluids quickly Signup and view all the answers

Which of the following is a common sign of dehydration in infants?

Sunken fontanel Signup and view all the answers

What is the recommended approach to communicating with a school-aged child about a medical procedure?

Be honest and use a doll or teddy bear to demonstrate Signup and view all the answers

What is the primary goal of palliative care?

To make the patient as comfortable as possible Signup and view all the answers

Which of the following is NOT a characteristic of the overprotective parent?

They may encourage the child to be independent Signup and view all the answers

At what age do we typically start taking a child's blood pressure?

2-3 years old Signup and view all the answers

What is the recommended way to prevent SIDS?

Lay the infant on their back on a firm mattress Signup and view all the answers

A child is scheduled to receive the MMR vaccine. They are on corticosteroids. Which action should the nurse take?

Withhold the MMR vaccine and consult with the healthcare provider. Signup and view all the answers

A child presents for a well-child visit and is due for the MMR vaccine. The child's mother reports the child has been experiencing a low-grade fever for the past two days. Which of the following is the most appropriate action for the nurse to take?

Defer the MMR vaccine until the child is fever-free. Signup and view all the answers

A child presents for the MMR vaccine. The child has a history of severe allergic reactions to vaccines. Which of the following actions is most appropriate?

Withhold the MMR vaccine and consult with the healthcare provider. Signup and view all the answers

A child has received the MMR vaccine and develops a fever of 103 degrees Fahrenheit 3 days later. The child also has a rash. Which of the following nursing actions is most appropriate?

Consider this a normal reaction and monitor the child closely. Signup and view all the answers

A child is due for the MMR vaccine. The child's mother reports that the child had a severe reaction to the previous MMR vaccine. Which of the following is the most appropriate action for the nurse to take?

Withhold the MMR vaccine and consult with the healthcare provider. Signup and view all the answers

A child presents for the MMR vaccine. The child's mother reports that the child has been crying for 3 hours straight. Which of the following is the most appropriate action for the nurse to take?

Administer the MMR vaccine after consulting with the healthcare provider. Signup and view all the answers

When interviewing an adolescent, what should the nurse prioritize?

Providing privacy and respecting the adolescent's autonomy. Signup and view all the answers

A child is receiving ear drops. The child is 5 years old. Which of the following nursing actions is most appropriate?

Pull the ear up and back. Signup and view all the answers

What is a key consideration when assigning a room to an adolescent patient?

The adolescent's need for privacy and age-appropriate surroundings. Signup and view all the answers

A child is receiving nose drops. Which of the following nursing actions is most appropriate after administering the nose drops?

Have the child tilt their head back for 30 seconds to 1 minute. Signup and view all the answers

Which of the following is an appropriate strategy for obtaining a urine sample from a diapered child?

Applying a u-bag to collect urine. Signup and view all the answers

When a preschooler expresses fear of leaking bodily fluids, what is the most appropriate nursing action?

Providing reassurance and allowing the child to use a bandaid. Signup and view all the answers

A child is receiving eye drops. The child is 7 years old. Which of the following nursing actions is most appropriate?

Pull the lower eyelid down and instill the drops into the conjunctival sac. Signup and view all the answers

A child is due for their MMR vaccine. The child's mother reports that the child is immune-compromised. Which of the following is the most appropriate action for the nurse to take?

Withhold the MMR vaccine and consult with the healthcare provider. Signup and view all the answers

What is the most important aspect of supporting an adolescent dealing with a terminal illness?

Providing a non-threatening environment for expressing emotions. Signup and view all the answers

How should the nurse approach the assessment of a toddler who is apprehensive about the physical exam?

Offer choices and allow the toddler to participate in the process. Signup and view all the answers

What is the most effective way to ensure a child understands a medical procedure?

Employing age-appropriate language and therapeutic play. Signup and view all the answers

Which of the following is a common concern for an adolescent hospitalized for a serious illness?

Worries about body image and self-esteem. Signup and view all the answers

When providing care for a dying child, the nurse should prioritize which of the following?

Providing emotional support to the child and family. Signup and view all the answers

What is a crucial aspect of nursing care when working with families of dying children?

Understanding the family's cultural views on death and dying. Signup and view all the answers

A 16-year-old patient is hospitalized for a serious illness. Which of the following nursing interventions is most appropriate to address the adolescent's primary psychosocial concern?

Encourage the adolescent to express their feelings in a safe environment. Signup and view all the answers

What are typical normal side effects of vaccinations in children?

Redness, swelling, and low-grade fever Signup and view all the answers

Which of the following is considered an abnormal reaction to vaccinations that should be reported?

Fever higher than 104°F Signup and view all the answers

What should be done if a child has had a severe allergic reaction to vaccines previously?

Give the vaccines separately and with caution Signup and view all the answers

What precautions should be taken for a child who is immune compromised when considering vaccinations?

They should avoid all vaccinations since their immune system is suppressed Signup and view all the answers

When administering ear drops to a child over 3 years old, how should the ear be pulled?

Up and back Signup and view all the answers

What should be done after installing nose drops in a child?

Keep the child's head back for 30 seconds to 1 minute Signup and view all the answers

Which of the following is NOT a reason to postpone vaccine administration?

Child has a mild cold Signup and view all the answers

How long after receiving a vaccine might a delayed reaction, such as rash, occur in a child?

10-12 days after administration Signup and view all the answers

A 3-year-old child presents with a fever of 104°F. The child's parents are concerned about the high temperature. How should the nurse approach the situation?

Assess the child for other symptoms and educate the parents on the importance of monitoring the child's temperature and seeking medical attention if the fever persists or worsens. Signup and view all the answers

A 7-year-old child is scheduled for a blood draw. The child is anxious and expresses fear about the procedure. What is the most effective approach to address the child's anxiety?

Explain the procedure using simple language and provide the child with a visual representation, such as a doll or picture, to demonstrate what will happen. Signup and view all the answers

A nurse is caring for a 16-year-old patient who is nearing the end of life. The patient's parents are struggling to cope with the situation. Which of the following nursing interventions would be most appropriate?

Provide the parents with accurate information about the patient's condition and prognosis, addressing their concerns openly and honestly. Signup and view all the answers

A 4-year-old child is admitted to the hospital after a car accident. The child's parents are constantly by their side, but the child becomes increasingly clingy and anxious. How should the nurse approach the situation?

Recognize the child's anxiety as a normal response to hospitalization and reassure the parents that it is perfectly acceptable for them to stay by their child's side. Signup and view all the answers

A nurse is caring for a newborn who has a sunken fontanel. What is the most likely cause of this finding?

Dehydration. Signup and view all the answers

A 10-year-old child is admitted to the hospital for an appendectomy. The child's parents are very protective and hesitant to allow the child to participate in activities like playing games or interacting with other children. How should the nurse approach the situation?

Offer the parents support and resources, such as play therapists or child life specialists, to help them understand the importance of play and socialization for hospitalized children. Signup and view all the answers

A nurse is providing education to a new mother on SIDS prevention. Which of the following instructions should be emphasized?

Position the infant on their back in a firm crib with no loose bedding. Signup and view all the answers

A nurse is caring for a 13-year-old patient who has been hospitalized for a prolonged period. The patient expresses frustration and anger about being confined to the hospital. How should the nurse respond?

Acknowledge the patient's feelings and provide them with opportunities to express their frustration and anger in a safe and healthy way. Signup and view all the answers

What is the most important psychological response for a nurse to understand when caring for a dying child?

The grieving process stages must be recognized Signup and view all the answers

Which age group typically does not fully comprehend that death is permanent?

Children under 5 Signup and view all the answers

Which of the following interventions is most appropriate for an adolescent expressing anger about their diagnosis?

Facilitating a safe space to express emotions Signup and view all the answers

In pediatric nursing, what should be prioritized during the hospitalization of a preschooler fearful of bodily injury?

Allowing creative play to help them process fear Signup and view all the answers

To assist a toddler in coping with a medical procedure, which strategy should the nurse employ?

Offering them choices to encourage autonomy Signup and view all the answers

What is a common misconception adolescents might have regarding their hospitalization?

Their body image will not be impacted Signup and view all the answers

What is a key consideration for nurses when assigning rooms to patients of different age groups?

Age, illness, and acuity must all be balanced Signup and view all the answers

What aspect of communication is vital when interviewing an adolescent about sensitive topics?

Ensure privacy and comfort for the adolescent Signup and view all the answers

What is imperative for nurses to do while discussing death with children?

Adapt explanations based on the child's developmental level Signup and view all the answers

During which stage of grief is a dying child likely to express frustration and emotional outbursts?

Anger Signup and view all the answers

Study Notes

Vaccine Side Effects and Reactions

Normal side effects include inflammation signs: redness, swelling, warmth, pain, fever, lethargy, and irritability indicating an immune response.
Adverse reactions warrant reporting: rash, fever exceeding 104°F, fever lasting over three days, total loss of function, prolonged high-pitched crying, recurrent fever, and spreading red streaks.
Normal delayed reactions to MMR vaccine include fever developing 10-12 days later and rash appearing 2-3 days post-vaccination.
Contraindications for vaccination include history of severe reactions, allergies, immune compromise, and current corticosteroid treatment.

Medication Administration Techniques

Nose Drops: Use mummy restraints if necessary. After administration, keep the child's head tilted back for 30-60 seconds.
Ear Drops:
- For children <3 years: pull ear down and back.
- For children >3 years: pull ear up and back. Keep child on unaffected side for about 5 minutes.
Eye Drops: Administer drops into the lower conjunctival sac as with adults.
IM Injections: Use a 25-gauge needle; maximum volume per site is 1 mL, with vastus lateralis as the preferred site.

Hydration and Vital Signs

Wet diapers indicate hydration; infants may have a sunken fontanel when dehydrated.
Normal temperature may reach 105°F in children up to 5 years due to poor temperature regulation.
Blood pressure monitoring begins at 2-3 years; earlier if cardiac abnormalities exist.
Pain management is essential. Administer medications for reported pain regardless of the child's appearance.

Developmental Assessments and Parent Interaction

Monitor head circumference above ears and brows for growth assessment.
Evaluate scoliosis in children aged 6-12 through visual inspections and standardized testing.
For communication with parents and children, always provide anticipatory guidance and explain potential regression after hospitalization.
Encourage supportive parenting and active participation in a child's care to foster independence.

Psychological and Grief Considerations

Understand and respect Kubler-Ross's five stages of grief: denial, anger, bargaining, depression, acceptance.
Preschoolers may perceive death as fantasy until the age of 9-10, when the permanence of death becomes clearer.
Therapeutic play can be used to explain medical procedures and alleviate anxiety in children.

Safety and Emergency Protocols

In case of poisoning, collect information about ingested substances, active ingredients, quantities, timing and child's symptoms.
Adolescent safety risks include driving, firearms, and substance experimentation. Education and privacy during discussions about sensitive topics are crucial.

Interviewing Techniques

When interviewing adolescents, ensure privacy and ask for consent regarding parental presence.
Gather subjective data like chief complaints with open-ended questioning techniques to facilitate communication.
Maintain appropriate room assignments based on age, illness, and acuity to ensure safety and comfort.

Routine Health Screenings

For infants, assess head-to-toe starting at the feet; consider rectal temperature if fever is present.
Encourage toddlers' choices during visits to foster cooperation; assess preschool, school-aged, and adolescents with considerations for privacy and sensitive discussions.
Urine sampling techniques differ based on age: use U-bag for diapered infants and straight catheterization for sterile samples.

Vaccine Side Effects and Reactions

Normal side effects include inflammation signs: redness, swelling, warmth, pain, fever, lethargy, and irritability indicating an immune response.
Adverse reactions warrant reporting: rash, fever exceeding 104°F, fever lasting over three days, total loss of function, prolonged high-pitched crying, recurrent fever, and spreading red streaks.
Normal delayed reactions to MMR vaccine include fever developing 10-12 days later and rash appearing 2-3 days post-vaccination.
Contraindications for vaccination include history of severe reactions, allergies, immune compromise, and current corticosteroid treatment.

Medication Administration Techniques

Nose Drops: Use mummy restraints if necessary. After administration, keep the child's head tilted back for 30-60 seconds.
Ear Drops:
- For children <3 years: pull ear down and back.
- For children >3 years: pull ear up and back. Keep child on unaffected side for about 5 minutes.
Eye Drops: Administer drops into the lower conjunctival sac as with adults.
IM Injections: Use a 25-gauge needle; maximum volume per site is 1 mL, with vastus lateralis as the preferred site.

Hydration and Vital Signs

Wet diapers indicate hydration; infants may have a sunken fontanel when dehydrated.
Normal temperature may reach 105°F in children up to 5 years due to poor temperature regulation.
Blood pressure monitoring begins at 2-3 years; earlier if cardiac abnormalities exist.
Pain management is essential. Administer medications for reported pain regardless of the child's appearance.

Developmental Assessments and Parent Interaction

Monitor head circumference above ears and brows for growth assessment.
Evaluate scoliosis in children aged 6-12 through visual inspections and standardized testing.
For communication with parents and children, always provide anticipatory guidance and explain potential regression after hospitalization.
Encourage supportive parenting and active participation in a child's care to foster independence.

Psychological and Grief Considerations

Understand and respect Kubler-Ross's five stages of grief: denial, anger, bargaining, depression, acceptance.
Preschoolers may perceive death as fantasy until the age of 9-10, when the permanence of death becomes clearer.
Therapeutic play can be used to explain medical procedures and alleviate anxiety in children.

Safety and Emergency Protocols

In case of poisoning, collect information about ingested substances, active ingredients, quantities, timing and child's symptoms.
Adolescent safety risks include driving, firearms, and substance experimentation. Education and privacy during discussions about sensitive topics are crucial.

Interviewing Techniques

When interviewing adolescents, ensure privacy and ask for consent regarding parental presence.
Gather subjective data like chief complaints with open-ended questioning techniques to facilitate communication.
Maintain appropriate room assignments based on age, illness, and acuity to ensure safety and comfort.

Routine Health Screenings

For infants, assess head-to-toe starting at the feet; consider rectal temperature if fever is present.
Encourage toddlers' choices during visits to foster cooperation; assess preschool, school-aged, and adolescents with considerations for privacy and sensitive discussions.
Urine sampling techniques differ based on age: use U-bag for diapered infants and straight catheterization for sterile samples.

Vaccine Side Effects and Reactions

Normal side effects include inflammation signs: redness, swelling, warmth, pain, fever, lethargy, and irritability indicating an immune response.
Adverse reactions warrant reporting: rash, fever exceeding 104°F, fever lasting over three days, total loss of function, prolonged high-pitched crying, recurrent fever, and spreading red streaks.
Normal delayed reactions to MMR vaccine include fever developing 10-12 days later and rash appearing 2-3 days post-vaccination.
Contraindications for vaccination include history of severe reactions, allergies, immune compromise, and current corticosteroid treatment.

Medication Administration Techniques

Nose Drops: Use mummy restraints if necessary. After administration, keep the child's head tilted back for 30-60 seconds.
Ear Drops:
- For children <3 years: pull ear down and back.
- For children >3 years: pull ear up and back. Keep child on unaffected side for about 5 minutes.
Eye Drops: Administer drops into the lower conjunctival sac as with adults.
IM Injections: Use a 25-gauge needle; maximum volume per site is 1 mL, with vastus lateralis as the preferred site.

Hydration and Vital Signs

Wet diapers indicate hydration; infants may have a sunken fontanel when dehydrated.
Normal temperature may reach 105°F in children up to 5 years due to poor temperature regulation.
Blood pressure monitoring begins at 2-3 years; earlier if cardiac abnormalities exist.
Pain management is essential. Administer medications for reported pain regardless of the child's appearance.

Developmental Assessments and Parent Interaction

Monitor head circumference above ears and brows for growth assessment.
Evaluate scoliosis in children aged 6-12 through visual inspections and standardized testing.
For communication with parents and children, always provide anticipatory guidance and explain potential regression after hospitalization.
Encourage supportive parenting and active participation in a child's care to foster independence.

Psychological and Grief Considerations

Understand and respect Kubler-Ross's five stages of grief: denial, anger, bargaining, depression, acceptance.
Preschoolers may perceive death as fantasy until the age of 9-10, when the permanence of death becomes clearer.
Therapeutic play can be used to explain medical procedures and alleviate anxiety in children.

Safety and Emergency Protocols

In case of poisoning, collect information about ingested substances, active ingredients, quantities, timing and child's symptoms.
Adolescent safety risks include driving, firearms, and substance experimentation. Education and privacy during discussions about sensitive topics are crucial.

Interviewing Techniques

When interviewing adolescents, ensure privacy and ask for consent regarding parental presence.
Gather subjective data like chief complaints with open-ended questioning techniques to facilitate communication.
Maintain appropriate room assignments based on age, illness, and acuity to ensure safety and comfort.

Routine Health Screenings

For infants, assess head-to-toe starting at the feet; consider rectal temperature if fever is present.
Encourage toddlers' choices during visits to foster cooperation; assess preschool, school-aged, and adolescents with considerations for privacy and sensitive discussions.
Urine sampling techniques differ based on age: use U-bag for diapered infants and straight catheterization for sterile samples.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the normal and abnormal side effects of vaccines, including signs of inflammation and adverse reactions that need to be reported. It also discusses delayed reactions in children.