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Please help answer these questions Simulation Day 2 -Simulation 4 Pre-simulation Quiz 1.A 1-year-old patient is drooling and gagging following nasogastric tube insertion. Which intervention would be most appropriate? Report this finding to the physician immediately Reassure the father that this is normal because of the irritation from the tube in the patient’s throat Suction the patient’s mouth and reassess Remove the tube and plan for re-insertion 2.A nurse is completing an assessment of a child with a nasogastric tube prior to medication administration. While preparing the medication, the nurse notes that the tape securing the tube is loose and that the tube has moved about 6 cm. The nurse’s next intervention should be to: re-tape the tube and continue with medication administration. check the pH of the gastric contents by aspirating some from a syringe. prepare for reinsertion of the gastric tube. administer the medication orally instead, if the child is able to swallow. 3.Which signs and symptoms are most suggestive of liver involvement in a child with an acetaminophen overdose? Nausea and vomiting Sweating, pallor, and tachycardia Elevated PT and PTT and complaints of right upper quadrant pain An acetaminophen level of 18 mcg/mL 4.A nurse receives an order for an initial dose of N-acetylcysteine 1400 mg by mouth for a 10-kg child who presented to the emergency department 1 hour after ingesting of an unknown amount of acetaminophen. The nurse should: prioritize administering the medication as ordered to the patient. question the order as the dose ordered is not within the safe range. question the order as the dose ordered is sub-therapeutic. question the order as the child is likely to refuse to drink the medication. 5.What is the most important teaching priority in the prevention of unintentional ingestion in a toddler? Knowledge of how to access poison control (1800-222-1222) Proper storage of medications and hazardous products Ensuring that the child knows the difference between safe and unsafe products Storing products that are dangerous at counter level or lower 6.Gastric lavage is contraindicated in all of these cases except: a child who presents to the emergency department 4 hours after ingestion of acetaminophen. a child who presents to the emergency department 30 minutes after ingestion of a sustained-release blood pressure medication. a child who does not have a protected airway. an adolescent who presents to the emergency department after drinking 3 beers. 7.A 2-year-old toddler should be in which of Erickson’s developmental stages? Autonomy vs. shame and doubt Trust vs. mistrust Industry vs. accomplishment Sensorimotor vs. preoperational 8.When administering oral N-acetylcysteine to a 2-year-old patient, what is an appropriate technique the nurse can utilize? Asking the toddler if he would like to take the medication Asking the toddler if he would like the medication mixed with apple or grape juice Putting the medication in a large cup for the toddler Telling the mother she needs to force the toddler to drink all of the medication 9. Following reinsertion of the nasogastric tube, x-ray results indicate that the tip of the tube is located in the stomach. The nurse anticipates an order to: administer medications through the nasogastric tube. advance the nasogastric tube 1 cm. pull back the nasogastric tube 2 cm. discontinue the nasogastric tube and administer oral medications. 10.How often should the nurse assess Johnny’s peripheral IV site infusing dextrose 5% in ½ normal saline with 2 mEq potassium chloride per 100 mL at 41 mL/hour? Once a shift Every 5 hours and PRN Every 15 minutes Every 1 hour 11.When preparing to discharge Johnny from the hospital, which statement from Johnny’s mother would best indicate an understanding of the discharge instructions? “I have the number to poison control by my phone.” “Johnny can never take acetaminophen again.” “We have all the medications and other potentially hazardous substances locked in cupboards out of Johnny’s reach.” “Johnny can’t drink anything for 24 hours following the removal of the tube from his stomach.” 12.A nurse notices that Johnny is jaundiced and is having right upper quadrant pain. The nurse should be concerned that: Johnny has a low platelet count. Johnny is developing an overwhelming hospital-acquired infection. Johnny’s acetaminophen ingestion is causing hepatic involvement. Johnny’s kidneys are failing. 13.A nurse is reviewing Johnny’s laboratory results and sees that his initial acetaminophen level was 212 mcg/mL. This finding is consistent with: a toxic level of acetaminophen in the serum. a therapeutic level of acetaminophen in the serum. a high level of acetaminophen in the serum. a low level of acetaminophen in the serum. 14.Johnny’s mother is concerned after finding Johnny’s stool to be very black. Which statement should the nurse provide to Johnny’s mother? “I will get an order to check the stool for blood.” “This is a result of Johnny’s liver being sick.” “This is an expected finding from the charcoal that was administered in the emergency department.” “This might mean that Johnny also ingested iron pills.” 15.Johnny has had an episode of emesis, has not had a wet diaper in 5 hours, and has a capillary refill greater than 3 seconds. Which intervention might the nurse anticipate the physician to order next? Changing Johnny’s NPO status and encouraging fluids Increasing Johnny’s maintenance fluid rate Administering a bolus of a crystalloid at 20 mL/kg Requesting a blood pressure assessment for Johnny 16.Which number represents the daily maintenance fluid requirement for a 20-lb child? 909 mL 1000 mL 90 mL 800 mL

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