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A parent brings a 12-month-old infant into the emergency department and tells the nurse that the infant is allergic to peanuts and was accidentally given a cookie with peanuts in it. The infant is dyspneic, wheezing, and cyanotic. The health care provider has prescribed a dose of epinephrine to be administered. The infant weighs 24 lb. How many milligrams of epinephrine should be administered?
- A. 0.11 to 0.33 mg
- B. 0.011 to 0.3 mg
- C. 1.1 to 3.3 mg
- D. 11 to 33 mg
Correct Answer: B
Rationale: The correct dose of epinephrine to use in the emergency management of an anaphylactic reaction is 0.001 mg/kg up to a maximum of 0.3 mg, giving a range of 0.011 to 0.3 mg using a weight of 11 kg (24 lb).
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An infant has been diagnosed with an allergy to milk. In teaching the parent how to meet the infants nutritional needs, the nurse states that
- A. Most children will grow out of the allergy.
- B. All dairy products must be eliminated from the childs diet.
- C. It is important to have the entire family follow the special diet.
- D. Antihistamines can be used so the child can have milk products.
Correct Answer: A
Rationale: Approximately 80% of children with cows milk allergy develop tolerance by the fifth birthday. The child can have eggs. Any food that has milk as a component or filler is eliminated. These foods include processed meats, salad dressings, soups, and milk chocolate. Having the entire family follow the special diet would provide support for the child, but the nutritional needs of other family members must be addressed. Antihistamines are not used for food allergies.
What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)?
- A. Discourage the parents from making a last visit with the infant.
- B. Make a follow-up home visit to the parents as soon as possible after the childs death.
- C. Explain how SIDS could have been predicted and prevented.
- D. Interview the parents in depth concerning the circumstances surrounding the childs death.
Correct Answer: B
Rationale: A competent, qualified professional should visit the family at home as soon as possible after the death. Printed information about SIDS should be provided to the family. Parents should be allowed and encouraged to make a last visit with their child. SIDS cannot always be prevented or predicted, but parents can take steps to reduce the risk (e.g., supine sleeping, removing blankets and pillows from the crib, and not smoking). Discussions about the cause only increase parental guilt. The parents should be asked only factual questions to determine the cause of death.
The nurse is discussing the management of atopic dermatitis (eczema) with a parent. What should be included?
- A. Dress infant warmly to prevent chilling.
- B. Keep the infants fingernails and toenails cut short and clean.
- C. Give bubble baths instead of washing lesions with soap.
- D. Launder clothes in mild detergent; use fabric softener in the rinse.
Correct Answer: B
Rationale: The infants nails should be kept short and clean and have no sharp edges. Gloves or cotton socks can be placed over the childs hands and pinned to the shirt sleeves. Heat and humidity increase perspiration, which can exacerbate the eczema. The child should be dressed properly for the climate. Synthetic material (not wool) should be used for the childs clothing during cold months. Baths are given as prescribed with tepid water, and emollients such as Aquaphor, Cetaphil, and Eucerin are applied within 3 minutes. Soap (except as indicated), bubble bath oils, and powders are avoided. Fabric softener should be avoided because of the irritant effects of some of its components.
What is an appropriate action when an infant becomes apneic?
- A. Shake vigorously.
- B. Roll the infants head to the side.
- C. Gently stimulate the trunk by patting or rubbing.
- D. Hold the infant by the feet upside down with the head supported.
Correct Answer: C
Rationale: If an infant is apneic, the infants trunk should be gently stimulated by patting or rubbing. If the infant is prone, turn onto the back. Vigorous shaking, rolling of the head, and hanging the child upside down can cause injury and should not be done.
What may a clinical manifestation of failure to thrive (FTT) in a 13-month-old include?
- A. Irregularity in activities of daily living
- B. Preferring solid food to milk or formula
- C. Weight that is at or below the 10th percentile
- D. Appropriate achievement of developmental landmarks
Correct Answer: A
Rationale: One of the clinical manifestations of children with FTT is irregularity or low rhythmicity in activities of daily living. Children with FTT often refuse to switch from liquids to solid foods. Weight below the fifth percentile is indicative of FTT. Developmental delays, including social, motor, adaptive, and language, exist.