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.

Answer and Explanation

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.

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Correct Answer is C

Explanation

Choice A reason: Play dates maintain social contact but disrupt the 3-year-old’s preschool routine, which provides stability. Continuing preschool supports normalcy and security, making this less effective and incorrect compared to maintaining the familiar structure of school for a child with leukemia.

Choice B reason: Keeping the child home for one-on-one time may isolate her, reducing social interaction critical for a 3-year-old’s security. Preschool attendance fosters normalcy, making this overly restrictive and incorrect compared to supporting the child’s routine and social needs during leukemia treatment.

Choice C reason: Continuing preschool as much as possible maintains routine and social connections, fostering security for a 3-year-old with leukemia. This aligns with pediatric psychosocial care for chronic illness, making it the correct recommendation to help the child feel secure during her treatment.

Choice D reason: Special family outings are bonding but disrupt the 3-year-old’s preschool routine, which provides consistent security. Continuing school is more stabilizing, making this less consistent and incorrect compared to maintaining the child’s normal preschool environment to support her sense of security.

A. Repeat the signs and symptoms over and over until they seem to understand. B. Instruct them to treat the reaction as if it’s hypoglycemia, since this condition is more likely. C. Give the caregivers educational pamphlets and videos about diabetes. D. Suggest that the child wear an insulin pump for continuous insulin administration.

Correct Answer is B

Explanation

Choice A reason: Repeating symptoms may help but doesn’t provide immediate emergency guidance, risking delay in critical situations. Treating as hypoglycemia ensures rapid response, making this less practical and incorrect compared to a clear action plan for the caregivers’ concerns about diabetes emergencies.

Choice B reason: Instructing to treat unclear reactions as hypoglycemia prioritizes rapid glucose administration, which is safer and more urgent than mistreating hyperglycemia. This aligns with pediatric diabetes emergency protocols, making it the best initial response to ensure the child’s safety in potential crises.

Choice C reason: Providing pamphlets and videos educates long-term but doesn’t address immediate emergency response needs. Treating as hypoglycemia offers clear guidance, making this supplementary and incorrect compared to the urgent action needed to manage the caregivers’ fears about diabetes emergencies.

Choice D reason: Suggesting an insulin pump addresses insulin delivery, not symptom recognition or emergency response. Treating as hypoglycemia ensures safety in crises, making this irrelevant and incorrect compared to the immediate guidance needed for the caregivers’ concerns about handling diabetes emergencies.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A 3-year-old who has been attending preschool has been diagnosed with leukemia. The caregivers of this child ask the nurse what they can do to help their child feel secure. Which recommendation could the nurse make to these caregivers that would be helpful in making the child feel secure?

Correct Answer is C

Explanation

Correct Answer is B

Explanation

A young child has been admitted with a diagnosis of enterobiasis (pinworm infection). This child will most likely have a history of:

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