Tess is a 5-year-old client who must receive an IV infusion of antibiotics. She is anxious, resistant, and wiggly. To keep her safe during the time the IV is in place, the nurse would choose which method to restrain her?
Allow her caregiver to hold her during the time the IV is in place.
Restrain her with a mummy restraint and loosen and rewrap it every 3 hours.
Use a clove-hitch restraint to keep her arm still and loosen it every 2 hours.
Restrain her on a papoose board and release her as soon as the IV is in place.
The Correct Answer is C
Choice A reason: Caregiver holding may comfort but is unreliable for keeping a wiggly 5-year-old still, risking IV dislodgement. A clove-hitch restraint ensures arm stability while allowing some movement, making this less safe and incorrect for maintaining IV security during antibiotic infusion in a resistant child.
Choice B reason: Mummy restraints are excessive for an IV, restricting the whole body and potentially distressing a 5-year-old. A clove-hitch restraint targets the arm, balancing safety and comfort, making this overly restrictive and incorrect for the specific need to secure the IV site in this scenario.
Choice C reason: A clove-hitch restraint secures the arm, preventing IV dislodgement in a resistant 5-year-old while allowing some movement. Loosening every 2 hours ensures circulation, aligning with pediatric nursing safety standards for IV therapy, making it the correct method for ensuring safety during infusion.
Choice D reason: A papoose board is used for short procedures, not prolonged IV infusions, and releasing immediately negates its purpose. A clove-hitch restraint maintains IV security over time, making this impractical and incorrect for ensuring safety during the antibiotic infusion period for the child.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Forming clay vases requires fine motor skills but may lack the complexity to engage an 8-year-old’s cognitive and creative abilities. A model plane offers a challenging, age-appropriate task, making this less stimulating and incorrect for the developmental needs of an 8-year-old in the playroom.
Choice B reason: Stacking blocks is too simplistic for an 8-year-old, better suited for younger children developing basic motor skills. A model plane engages advanced dexterity and problem-solving, making this insufficiently challenging and incorrect for the cognitive level of an 8-year-old in the hospital.
Choice C reason: Assembling a model plane suits an 8-year-old’s fine motor skills, concentration, and interest in complex tasks. This project aligns with developmental stages for school-aged children, promoting engagement and skill-building, making it the best choice for the playroom activity for the child.
Choice D reason: Building a sandcastle is creative but less structured than a model plane, which challenges an 8-year-old’s dexterity and focus. Sandcastles may be less engaging for hospitalized children, making this incorrect compared to the structured, skill-based task of model plane assembly in the playroom.
Correct Answer is A
Explanation
Choice A reason: Wearing personal clothes, connecting with friends, and interacting with peers with similar illnesses fosters normalcy and emotional well-being in a 12-year-old. This aligns with pediatric psychosocial care for chronic illness, making it the correct action to help the preteen thrive during hospitalization.
Choice B reason: Making all decisions excludes the 12-year-old from care involvement, undermining autonomy and coping. Encouraging personal expression and peer connection supports thriving, making this disempowering and incorrect compared to fostering independence and emotional health in a chronically ill preteen in the hospital.
Choice C reason: Focusing on limitations discourages confidence and resilience, hindering a 12-year-old’s adaptation to chronic illness. Promoting normalcy through clothes and social interaction is more supportive, making this negative and incorrect for helping the preteen thrive during their hospital stay with a chronic condition.
Choice D reason: Strict behavioral rules may provide structure but do not address emotional and social needs like personal expression and peer support. Encouraging normalcy fosters thriving, making this less impactful and incorrect compared to actions promoting psychosocial well-being in a hospitalized 12-year-old with chronic illness.
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