When initiating a peripheral intravenous (IV) infusion on an infant, what action should the nurse take?
Apply soft restraints to all four extremities.
Assess the dorsal surface of the feet for an IV site.
Instruct parents to sing or croon to the infant.
Select a site that is least restrictive to the infant.
The Correct Answer is D
Choice A rationale
Applying soft restraints to all four extremities of an infant is not typically recommended when initiating a peripheral intravenous (IV) infusion. Restraints can cause distress and may not be necessary for the procedure.
Choice B rationale
While the dorsal surface of the feet can be used as an IV site, it is not typically the first choice for infants. The veins in the feet can be difficult to access and the location can be inconvenient for the infant.
Choice C rationale
Instructing parents to sing or croon to the infant can be comforting and may help soothe the infant during the procedure. However, this action alone does not directly facilitate the successful initiation of an IV infusion.
Choice D rationale
Selecting a site that is least restrictive to the infant is the most appropriate action when initiating a peripheral IV infusion. This can make the procedure less distressing for the infant and allow for easier movement after the IV is in place.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["1.3"]
Explanation
Step 1: First, convert the child’s weight from pounds to kilograms. Since 1 pound is approximately 0.45 kilograms, an 18-pound child weighs about 8.16 kilograms (18 pounds × 0.45 kg/pound).
Step 2: Next, calculate the total daily dosage of amoxicillin. The prescribed dosage is 25 mg/kg/day. Therefore, the total daily dosage is 204 mg/day (8.16 kg × 25 mg/kg).
Step 3: Since the medication is to be administered in two divided doses every 12 hours, each dose should be half of the total daily dosage. Therefore, each dose is 102 mg (204 mg/day ÷ 2).
Step 4: Finally, calculate the volume of the suspension to be administered for each dose. The label on the bottle reads, “Amoxicillin for Oral Suspension, USP 400 mg per 5 mL.”. Therefore, each milliliter of the suspension contains 80 mg of amoxicillin (400 mg/5 mL). To administer a dose of 102 mg, the nurse should administer approximately 1.275 mL (102 mg ÷ 80 mg/mL). If rounding is required, round to the nearest tenth.
Therefore, the nurse should administer 1.3 mL for each dose.
Correct Answer is A
Explanation
Choice A rationale
When caring for a child in balanced suspension skeletal traction using a Thomas splint and Pearson attachment to the right femur, the most important intervention for the nurse to implement is monitoring peripheral pulses and sensation in the right leg. This is crucial because the traction places tension on the bones, which can result in nerve or vascular damage. Changes in peripheral pulses and sensation can indicate potential complications, such as compromised blood flow or nerve compression, which need immediate attention to prevent further damage.
Choice B rationale
While cleansing pin sites as prescribed is important for infection prevention, it is not the most critical intervention in the context of assessing vascular and neurologic status.
Choice C rationale
Assessing skin for redness and signs of tissue breakdown is important for skin care and preventing pressure ulcers, but it is secondary to monitoring peripheral pulses and sensations when the child is in traction.
Choice D rationale
Changing position every 2 hours is a standard nursing practice to prevent pressure ulcers and provide comfort, but it does not take precedence over monitoring circulation and sensation in the affected limb.
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