[C_K_GrodeckLPN]

I have several Pediatric Nursing questions that I need to have answered to fill out a form for Ped. Homecare employment. Are these right?

1. A 6 day old infant who has a resp. rate of 70, pulse of 180 & a slight nasal flaring is to be given an oral medication. Which acton is to be taken first?

a. Attempt to give the neonate a small amt. of H2O
b. Check the last PaO2 reading
c. Suction the neonate's trachea

I think it's "b". It doesn't say that the neonate has a tracheostomy.

2. Because of a normal fear that 3 y/o children are likely to have, which of these actions should the nurse take after an IM medication?

a. Remind the child when the next injection will be given
b. Review the procedure that just took place
c. Place a small bandage over the injection site

I say "c" because children are afraid of pain & bleedig & a bandage will help the "boo-boo".

3. Which of these statements explains why school-age children are typically compliant in terms of taking medication?

a. They fantasize negative outcomes is they do not comply
b. They tend to be like their peers
c. They are anxious to please authourity figures

I say "a". Possibly "c". Not sure.

4.Children on glucocorticoid therapy are at risk for development of:

a. Hematological disorders
b. Deafness
c. Infections

I say "c".

5. You are caring for a 3 y/o with a tracheostomy. He had exhibited S/Sx f a URI for 2 days. Albuterol nebulizer Tx's have been ordered q 4 hrs prn wheezing. Last dose 4 hrs ago. He is wheezing, his O2 Sats are 94% on R/A & his heart rate is 220 bpm. What would you do first?

a. Phone the PSA Clinical Coordinator
b. Give Albuterol & follow the heart rate closely
c. Reassess respiratory status & heart rate in 2 hrs.

I say "b". His heart rate is slightly up, probably due to the Albuterol, & his Sats are WNL

6. Your 6 month old client is on Amoxicillin for otitis media. The order reads (125mg/5cc) 2.4 cc po TID X 10 days. She is due for her dose now. How would you administer it?

a. Add it to a four ounce bottle you are about to feed her
b. Add the medicationonly to a nipple, allow her to take all of the medication
c. Wait two hours after the feed to administer

Is it "c"? Is she being fed now?

[janfrn]

Interesting questions.

1. Why is a 6 day old baby in respiratory distress? A resp rate of 70 is high, and I'd be reluctant to give anything by mouth to a neonate with tachypnea without assessing the cause due to the risk for aspiration. To check a PaO2 you'd be doing an arterial or capillary blood gas. There isn't enough information in the scenario to suggest that. So I would pick "C" because you can suction the baby's oro- or naso-pharynx and distal trachea with a suction catheter. Infants are obligate nose breathers and often respiratory dostress is secondary to nasal congestion or upper airway secretions. A clear airway may often improve the distress, bring the heart and resp rates down and decrease iritability.

2. "C"

3. "A" is a good choice, although "C" is also applicable.

4. "C" again.

5. I'm not sure I'd give the neb right away. A heart rate of 220 in a 3 year old is not a slight elevation ('normal' being around 100 at rest). It likely is a side-effect of the albuterol, but still, 220 is pretty fast. Pushing it even higher wouldn't be my first choice. Sats of 94% in room air are good enough and I'd wait awhile (maybe not 2 hours) and reassess. So once again, I'd pick "C".

6. This one is definitely "B". If you mix the med in a bottle of formula or juice, what happens if they don't finish the bottle? How much did they get? This is an antibiotic, one that can be given with food so that's not the issue; aren't there enough problems with antibiotic-resistant bugs out there without adding to the problem? The easiest way to get an infant to take an oral med is to put it in a nipple and let them 'drink' it. I put a little bit of the med into a nipple and wait until they've started ucking to put more in. If it's something that tastes bad, you could mix it in a very small amount of formula and give it the same way; you want her to take ALL of the med... THEN you could feed her. If she's hungry.

Interested to see what others think.

[Annony RN]

I'm a little thrown by 1 also. I'd definitely suction her nose. Agree with Jan about the PaO2 although every now and then run into nurses who think that's interchangeable with "pulse ox" or SpO2. So I guess I'd choose B. (BTW- I see no reason for a 6day old to be home with a trach so I'm sure they mean via OP/NP route)

#5... hmmm... I'd like to know more about this kid. 94% means nothing to me. I've seen 94%, wheezing, and OK and I've seen 94%, wheezing, but copensating with high RR and accessory muscles and really in need of help. Since I personally very well might be putting in a call to his MD and suggesting Xopenex... I think I'd pick answer A. Keep in mind in home care, in the real world, you go by personal history... you know what this kid can handle and what he can't. You know what is normal for him that is panic stage in other kids. You know what meds he's been on before or in the hospital. You have mom or dad putting in their 2 cents... which you ignore in some families and heed in others.

Agree with #6... by the way has anyone seen the new medicine dosin bottles? http://www.reliadose.com/about.cfm Looks nifty!

If your agency test is anything like the ones I've taken... your clinical co-ordinator will go over all the ones you had wrong and say she personally agrees with your answer and the question was bad, LOL.

[C_K_GrodeckLPN]

Originally Posted by Annony RN

I'm a little thrown by 1 also. I'd definitely suction her nose. Agree with Jan about the PaO2 although every now and then run into nurses who think that's interchangeable with "pulse ox" or SpO2. So I guess I'd choose B. (BTW- I see no reason for a 6day old to be home with a trach so I'm sure they mean via OP/NP route)

#5... hmmm... I'd like to know more about this kid. 94% means nothing to me. I've seen 94%, wheezing, and OK and I've seen 94%, wheezing, but copensating with high RR and accessory muscles and really in need of help. Since I personally very well might be putting in a call to his MD and suggesting Xopenex... I think I'd pick answer A. Keep in mind in home care, in the real world, you go by personal history... you know what this kid can handle and what he can't. You know what is normal for him that is panic stage in other kids. You know what meds he's been on before or in the hospital. You have mom or dad putting in their 2 cents... which you ignore in some families and heed in others.

Agree with #6... by the way has anyone seen the new medicine dosin bottles? http://www.reliadose.com/about.cfm Looks nifty!

If your agency test is anything like the ones I've taken... your clinical co-ordinator will go over all the ones you had wrong and say she personally agrees with your answer and the question was bad, LOL.

Thanks for all the input.. I checked with my Clinical Coordinator of the agency I am currently working for P/T. I'm sending off the application & the test questions to the other agency tomorrow. I'll keep everyone updated as to the results.:studyowl: