Chapter 33: Caring for Children in Diverse Settings

The nurse is caring for a 3-year-old child who is hospitalized for pneumonia. When considering his developmental age and need for security, which statement by the nurse after an invasive procedure would be most helpful? "You acted like such a big boy." "I know you are glad that is over." "See, I told you it would be ok." "I am proud of how you were such a good boy."

"I am proud of how you were such a good boy." Toddlers and preschoolers may attribute illness and hospitalization a punishment for wrong deeds or misbehavior. Communicating to them that they are "good" and well behaved is beneficial. Calling them a "big boy" while flattering will not have the same impact as alleviating fears of misbehavior for this age group. While they are likely relieved the procedure is over, saying it is not helpful. Telling them you explained they would be "ok" is not of benefit.

The nurse is caring for a preoperative pediatric client. What would it be best for the nurse to do with this client? Explain how the therapeutic plan can be used in preparing the child for surgery. Keep the child away from any food or drinks to ensure the child is NPO. Teach technical terminology to the caregivers so they will understand what is being said postoperatively. Determine how much the child knows and is capable of understanding.

Determine how much the child knows and is capable of understanding. The nurse must determine how much the child knows and is capable of learning in order to best prepare the child for surgery. Keeping terminology at the child's and caregivers' level of understanding is important when doing teaching. Teaching the therapeutic plan is important, but it has to be done on the level of the child's and caregivers' knowledge and build on what they already know. The child going to surgery will be NPO, but the nurse needs to know on what level to teach the child the reason for this.

A 12-year-old client is hospitalized. Which finding will the nurse expect while providing care to this client? inability to understand explanation uncomfortable during genital assessment refusal of treatments separation anxiety

uncomfortable during genital assessment The nurse would expect discomfort with genital assessment as school-age children are often quite uncomfortable with any type of sexually related examination or care. Modesty is well developed and privacy is important. Around age 11, children are able to understand explanations regarding their care and illnesses. Separation anxiety is not a concern during this time since children this age are generally used to being away from parents. Preschool-age clients are most likely to refuse treatments due to the disruption in their normal routines.

The mother of a 4-year-old returns to the hospital after being away for 3 days. She is anxious and excited to be back; however, the toddler turns his back to her and scoots away as she attempts to pick him up. Which response should the nurse prioritize in this situation? "His distrust is normal and may have lingering effects, but you should touch and soothe him as much as possible." "His distrust is abnormal. It may or may not go away in a day or two; we will just have to wait and see." "Now that he has seen that you have returned he will feel better, but you should leave the room for a few minutes to help him feel in control." "He is probably just tired from the many tests run while you were away."

"His distrust is normal and may have lingering effects, but you should touch and soothe him as much as possible." Three characteristic, consecutive stages of response to separation have been identified: protest, despair, and denial. In the denial stage, the child begins taking interest in his or her surroundings and appears to accept the situation. However, the damage is revealed when the caregivers do visit: the child may turn away from them, showing distrust and rejection. It may take a long time before the child accepts them again; even then remnants of the damage may linger. The child may always have a memory of being abandoned at the hospital.

A nurse is educating the parents on how to help their 10-year-old daughter deal with an extended hospital stay due to surgery, followed by traction. Which response indicates a need for further teaching? "I should not tell her how long she will be here." "She will watch our reactions carefully." "She will be sensitive to our concerns." "We must prepare her in advance."

"I should not tell her how long she will be here." Parents who do not tell their child the truth or do not answer the child's questions confuse, frighten, and may weaken the child's trust in them. The other statements are effective forms of communication.

The nurse is educating the parents of a 7-year-old boy scheduled for surgery to help prepare the child for hospitalization. Which statement by the parents indicates a need for further teaching? "It is best to wait and let him bring up the surgery or any questions he has." "We should visit the hospital and go through the preadmission tour in advance." "We should talk about going to the hospital and what it will be like coming home." "It is a good idea to read stories about experiences with hospitals or surgery."

"It is best to wait and let him bring up the surgery or any questions he has." It is important to be honest and encourage the child to ask questions rather than wait for the child to speak up. The other statements are correct.

A new home health care nurse asks her preceptor for some hints to help establish a good relationship with her pediatric clients and their families. What is the best response by the preceptor? "Always talk in a loud voice. This will make sure the family hears everything you say." "Address the child and parents by their first names. It will make it seem less formal." "Make sure you find out things that the child is interested in. This will give you things to talk about." "Be sure to speak with the families away from the child. This will keep the child from being scared of you."

"Make sure you find out things that the child is interested in. This will give you things to talk about." Being interested in the child's activities is a way to establish a trusting relationship in home care. Addressing caregivers formally, not by the first names unless otherwise instructed, including the child in the conversation and speaking in a soft, calm voice are other ways to help establish a trusting relationship.

A nurse is preparing to admit a child for a tonsillectomy. How should the nurse establish rapport? "Let's take a look at your tonsils." "Tell me about your cute stuffed dog." "Are you scared about having your tonsils out?" "Do you understand why you are here?"

"Tell me about your cute stuffed dog." The nurse should start the initial contact with children and their families as a foundation for developing a trusting relationship. Asking about a favorite toy would be a good starting point. The nurse should allow the child to participate in the conversation without the pressure of having to comply with a request or undergo any procedures.

The nurse is working with a group of caregivers of children in a community setting. The topic of hospitalization and the effects of hospitalization on the child are being discussed. Which statement made by the caregivers supports the most effective way for children to be educated about hospitals? "My wife brought home several books about hospitalization and surgery, and she and I are reading them to our son." "The school nurse set up posters and displays showing pictures of what the inside of a hospital looked like, and we made sure our daughter saw the display." "Our next door neighbor was sick and died in the hospital. We explained to our son that usually babies are born and people get well in hospitals." "We are going to take our child to an open house at the hospital so she can see the pediatric unit."

"We are going to take our child to an open house at the hospital so she can see the pediatric unit." One factor in how children deal with hospitalization is the amount of preparation and the type of preparation they have been given prior to being hospitalized. A child's lack of understanding and experience with illness, hospitals, and hospital procedures increases his or her anxiety. Anything parents can do to prepare the child will decrease this anxiety. Families are encouraged to help children develop a positive attitude about hospitals from an early age. The family should avoid negative attitudes about hospitals and should help the child understand that not all experiences will be good. Some hospitals have regular open house programs for healthy children. Children may attend with parents or caregivers or in an organized community or school group. Anytime the child can visually see the hospital and physically touch furniture, equipment, etc. a positive experience can occur. Showing pictures in a book, seeing posters, and talking about the experience are also effective if a tour of the hospital is not available, but these do not replace the actual experience.

A mother in the outpatient setting is explaining how she plans to prepare her 5-year-old for hospital admission. What remark indicates the parent requires additional teaching? "We told him to use his manners and behave like a big, brave boy." "We found several books for him at the library that talk about being in the hospital." "We have a date to visit pediatrics and tour their department." "We watched a program for kids on public television about being in the hospital."

"We told him to use his manners and behave like a big, brave boy." Expecting manners and brave "big-boy" behavior is unrealistic. The child's coping skills are not yet well developed. Expressing true feelings should be allowed. The other preparations are helpful and promote understanding of the experience.

The nurse is caring for a preschooler who is hospitalized with a suspected blood disorder and receives an order to draw a blood sample. Which approach is best? "I need to remove a little blood." "We need to put a little hole in your arm." "Why don't you sit on your mom's lap?" "I need to take some blood."

"Why don't you sit on your mom's lap?" It is best to include the families whenever possible so they can assist the child in coping with their fears. Preschoolers fear mutilation and are afraid of intrusive procedures. Their magical thinking limits their ability to understand everything, requiring communication and intervention to be on their level. Telling the child that we need to put a little hole in their arm might scare the child.

A nurse is caring for a 6-year-old boy hospitalized due to an infection requiring intravenous antibiotic therapy. The child's motor activity is restricted and he is acting out, yelling, kicking, and screaming. How should the nurse respond to help promote positive coping? "Would you like to read or play video games?" "Let me explain why you need to sit still." "Your medicine is the only way you will get better." "Do I need to call your parents?"

"Would you like to read or play video games?" Distraction with books or games would be the best remedy to provide an outlet to distract the child from his restricted activity. The other responses would be unlikely to affect a change in the behavior of a 6-year-old.

The nurse is documenting the child's intake. The child ate 4 cups of ice during this shift. How many cups of fluid did the child ingest? ½ cup of fluid 2 cups of fluid 1 cup of fluid 4 cups of fluid

2 cups of fluid Ice is approximately equivalent to half the same amount of water, which in this instance would be 2 cups of fluid.

Which approach by the nurse best demonstrates the correct way to prepare a Hispanic child for a planned hospital admission? Allow the child to put on surgical attire and "operate" on a doll to teach what will be happening. Tell the child that the procedure will not hurt because we have "magic medicine." Discourage questions so as to not frighten the child. Since the family is Hispanic, all preparation needs to be in Spanish.

Allow the child to put on surgical attire and "operate" on a doll to teach what will be happening. Allowing the child to put on surgical attire lets him or her see that hospital equipment is "not scary" and prepares the child for what will be seen on the day of surgery. Both the child and parents should be encouraged to ask questions. Honesty is the most important part of the program, so the nurse would never tell the child that the procedure will be painless because even the best care by the nurse may not eliminate all pain. Assuming that the family only speaks Spanish is inappropriate and could be considered profiling and rude. The nurse needs to determine the family's preference of language.

The nurse is caring for a 6-year-old client who is prescribed to cough and deep breathe following surgery. Which nursing action is best for this client? Arrange for respiratory therapy to do coughing and deep breathing exercises with the child. Blow a pinwheel and bubbles with the child. Have the parents encourage the child to cough and deep breathe every 2 hours. Teach the child to use an incentive spirometer.

Blow a pinwheel and bubbles with the child. The nurse will have the child blow bubbles and a pinwheel to accomplish the prescription as these actions are most like play. These actions will encourage and engage the child and are likely to be accepted and even enjoyed. All of the measures have potential to get the child to cough and deep breathe to some extent, but blowing bubbles and a pinwheel is best for the client's age.

The nurse is caring for a technology-dependent school-aged child in his home. Which action best builds a trusting relationship? Changing the date and time of the child's physical therapy to fit the family schedule. Talking with the brother of the child who feels ignored. Encouraging the parents to join a support group. Discussing care and treatment with the parent and child together.

Discussing care and treatment with the parent and child together. To build a trusting relationship with the family, the nurse must remember the child is both the client and a family member. He needs to be included in all discussions. Encouraging parents to join a support group and talking with the sibling of the ill child who feels ignored are important and supportive activities. Changing the date and time of a therapy session to fit the family schedule is a case management activity. These are important elements of family-centered home care, but are not meant specifically to build trust.

A nurse is inspecting the surgical dressing on a school-age child and notes that there is bloody drainage on it. What actions should the nurse take? Change the dressing, initial it, then chart it. Draw a circle around the drainage with a permanent marker, recording the date and time on it. Reinforce the dressing and tape it down securely. Remove the dressing and keep it to show the physician.

Draw a circle around the drainage with a permanent marker, recording the date and time on it. If the nurse notes bloody drainage in a surgical dressing, the nurse should draw a line around the drainage with a marker, and record the time and date on it. That way, if further bleeding occurs, there will be evidence of the amount of additional drainage there is and the time frame of the drainage.

A preschooler is admitted to the pediatric floor for dehydration and is frightened. Which nursing intervention would be least effective in alleviating the child's anxiety? Explain all procedures using medical terminology. Encourage a caregiver to stay with the child when possible. Allow the child to handle the blood pressure cuff before using it. Assign the child to the same nurse each day.

Explain all procedures using medical terminology. Using medical terminology will ensure that the child will not understand what is happening and only increase his or her anxiety. Allowing touching of equipment, assigning the child to the same nurse, and encouraging caregivers to stay with the child all help alleviate anxiety and reduce the child's fears.

The school nurse is caring for an 8-year-old boy with asthma. What is most likely to be part of the child's Individualized Health Plan? Making a monthly report of the child's asthma episodes to his physician. Giving the child his prescribed asthma medications. Helping the child modify his physical activity requirements. Storing the child's asthma inhaler in the health office.

Helping the child modify his physical activity requirements. Assisting the child in modifying the physical activity required of him is most likely to be part of the Individualized Health Plan. The nurse would record asthma episodes but probably not make a monthly report to the physician. The nurse would assist the 8-year-old with his medication regimen to promote self-care rather than administering the medications to him. The child should have ready access to his inhaler. It would not be stored in the health office.

Caregivers of a hospitalized toddler are being given safety instructions upon admission to the pediatric floor. Which action by the caregiver would be most important to the toddler's safety? Keep the crib side rails up at all times. Show the child how to push the nurse call button. If side rails are down, never be more than 3 feet away from the child. Keep the crib at the highest setting so the nurse can assess the child easily.

Keep the crib side rails up at all times. Many toddlers are climbers and are always curious. So side rails must be kept fully up at all times, except when direct care is being provided. If side rails are down, the nurse or caregiver must keep a hand firmly on the child. Providing a call button to a toddler is not a good idea since the child will be pushing it all the time. Beds and cribs are kept at the lowest setting to minimize the possibility of injury if the child does fall out.

The nurse has been assigned to care for a child who is on transmission-based precautions. This nurse has not cared for this child before. Which action would be the best way to help the child feel comfortable with the nurse? Ask the parent to introduce the new nurse. Remind the child that her caregivers will be in to visit soon. Let the child see the nurse's face before the mask is put on. Read to the child for a few minutes before starting care.

Let the child see the nurse's face before the mask is put on. If masks or gloves are part of the necessary precautions, the child may experience even greater feelings of isolation. Before putting on the mask, the nurse should allow the child to see his or her face; this process will help the child easily identify the nurse. Being introduced by the parents may be effective but is not likely to be possible. Reading to the child, or explaining that the caregiver will visit soon, are appropriate actions but are not the best ways to help the child feel less isolated and more comfortable with the nurse in the isolation setting.

A 10-year-old boy who had an appendectomy had expressed worry that following the procedure he would have lots of pain. Two days after the procedure the child is claiming he is having no pain. Which nursing intervention should the nurse prioritize when assessing this child? Ask him to show you his pain level using the color pain scale. Observe him for physical signs which might indicate pain. Tell him to let you know if he begins to feel pain. Explain to his caregiver that his pain level shows he is getting better quickly. SUBMIT ANSWER

Observe him for physical signs which might indicate pain. Nursing judgment is in order. Some children may try to hide pain because they fear an injection or because they are afraid that admitting to pain will increase the time they have to stay in the hospital. To use the color scale, a child younger than 7 is given crayons ranging from yellow to red or black. Yellow represents no pain; the darkest color (or red) represents the most pain. The child selects the color that represents the amount of pain he or she feels. The most appropriate pain scale to use with this child would be the 1 to 10 (with 10 being the worst pain) or the faces scale.

The nurse is preparing a postsurgical care plan for an infant girl located on a general hospital unit that only occasionally admits children. To ensure the infant's safety, what should the nurse include in the plan? Ask the family to stay with the infant at all times. Place the infant in a room close to the nurses' station. Place the infant in a room with an ambulatory adolescent. Put the infant in a carrier and bring her to the nurses' station.

Place the infant in a room close to the nurses' station. The infant will need close monitoring, and having the child nearby will promote frequent checks and awareness of her status. Family cannot be required to stay at all times. That may be impossible for some. One client should never be responsible for another. The infant is the nurses' responsibility. Putting the infant in a carrier and bringing her to the nurses' station is not safe.

The nurse is caring for a 10-year-old child who is in a contact isolation room. Which intervention would be appropriate for this child? Provide age-appropriate toys and games. Put on a mask prior to entering the room. Reduce noise as much as possible. Discourage visitors from entering the room.

Provide age-appropriate toys and games. Children in this setting may experience sensory deprivation due to the limited contact with others and the use of personal protective equipment such as gloves and gowns. The nurse should stimulate the child by playing with the child using age-appropriate toys and games. Reducing noise would be appropriate if the child was experiencing sensory overload. The nurse should encourage the family to visit often and introduce oneself before entering the room. A mask is not needed for contact isolation.

The nurse is reviewing a job description of a school nurse. Which activity would the nurse question? Provide immunizations to students. Educate students on health promotion activities, such as bike and car safety. Provide training and education to other staff on CPR, first aid, and other health issues. Providing emergency first aid care.

Provide immunizations to students. School nurses typically don't administer vaccines to children. They act as a liaison between the child and various health care provider and other community agencies. Training staff and students on topics such as first aid, CPR, and health promotion activities, and providing emergency first aid are examples of activities of the school nurse.

A 6-year-old with leukemia is placed on reverse isolation. What nursing actions could prevent depression and loneliness in this client? Select all that apply. Do all nursing tasks at one time. Read a story while in the room. Spend extra time to talk while in the room. Quickly exit the room when possible. Play a game while in the room.

Spend extra time to talk while in the room. Read a story while in the room. Play a game while in the room. A child on isolation is subject to loneliness, which can be prevented by arranging to spend extra time in the room during treatments. Also, while in the room the nurse might read a story, play a game, or just talk to the child. Quickly exiting the room and providing cluster care will increase social isolation and may make the child feel punished.

A nurse is caring for an 18-month-old girl undergoing traction therapy in a rehabilitation unit. The nurse understands that the girl is in the second phase of separation anxiety when she observes what behavior? The girl acts extremely agitated. The child exhibits signs of anger. The toddler is quiet, looks sad, and is disinterested in playing. The toddler cries inconsolably. The girl ignores her.

The toddler is quiet, looks sad, and is disinterested in playing. Despair is the second phase of separation anxiety. During this phase the child appears hopeless, depressed, and apathetic. Exhibiting signs of anger and agitation or crying inconsolably all indicate the first phase of separation anxiety called protest. Denial or detachment is the third phase of separation anxiety. The child uses this to protect against further emotional pain. When parents return the child will ignore them and, instead, has formed superficial relationships with other caretakers. This third stage is seen infrequently when family-centered care is in place.

A 15-year-old boy asks numerous questions about recovery from anesthesia and typical behaviors of someone awakening from sedation. The nurse interprets the concern of this teen to be: anxiety related to the surgical procedure itself. about a change in body image. adequacy of postsurgical pain control. about his ability to control his own behavior.

about his ability to control his own behavior. These questions point to anxiety about how the teen may act while he has limited control of his behaviors. It is likely he does not want to appear "stupid, babyish, or uncool." All the other factors are typical adolescent concerns that may surface during the hospital stay.

The nurse who wishes to be as supportive as possible to the hospitalized preschool-age child makes great effort to avoid threatening the 4-year-old's: body integrity. verbal skills. creativity. food preferences.

body integrity. Preschoole-age children are very concerned about physically intrusive procedures. They lack understanding of the way the body works and feel extremely threatened by all that could possibly cause bodily harm. Preschoolers are creative, have useful verbal skills, and often have very particular food preference. All of these characteristics and abilities should be recognized and supported by the nurse, but are not as anxiety-producing when threatened as is body integrity.

The nurse is reviewing a client's chart and notes that the child is in droplet precautions for pneumonia. What protection would she need to take in caring for the child? handwashing and gloves mask and handwashing gown, handwashing and gloves gown, gloves, and mask

gown, gloves, and mask For droplet precautions, the nurse needs to wear a mask, gown, and gloves for client care since the transmission is airborne and is spread through contact with secretions from the mouth, nose, and lungs when a client sneezes or coughs.

The nurse is assigned to care for a 7-year-old child following hernia repair. When will the nurse begin to plan for the client's discharge? the morning after the client's surgical procedure after a home health nurse is consulted the day the health care provider writes the discharge prescription immediately upon the client's admission to the unit

immediately upon the client's admission to the unit The nurse will begin planning for the client's discharge immediately upon admission to the unit. Planning for the child's discharge and care at home begins early in the hospital experience and should start upon admission. The nurse would assess the family's resources and knowledge to determine what education and referrals they may need. The nurse should not wait until a later point to begin teaching or planning. A home health consultation may or may not be prescribed.

What will the nurse view as best maintaining normalcy in the life of a 10-year-old boy who is experiencing a lengthy hospitalization? Choosing the time of his bath or shower watching daytime television writing down his oral intake on the day and evening shifts keeping up with his schoolwork playing board games with the child life specialist

keeping up with his schoolwork A school-ager is exactly that—someone whose life is centered around school. Doing school and homework assignments is part of his usual day when not hospitalized. Watching daytime TV is not. Choosing the time hygiene activities occur provides him some control, while tracking his oral intake is an opportunity to participate in his care. Playing board games with the child life specialist is an age-appropriate activity that provides distraction. These support him developmentally but do not normalize his day, as does keeping up with school assignments. It will be easier for him to return to the classroom and feel more in step with his peers by doing this.

Parents are concerned because their 18-month-old will eat only when they feed him. They report he was independent with feeding at home but is unwilling in the hospital. The nurse considers this behavior: ritualism. egocentrism. regression. negativism.

regression. This is regression caused by the stress of hospitalization. The child feels threatened and moves back to a more secure stage of development. Egocentrism is a thought pattern of toddlers not expressed in this manner. Negativism is a control mechanism and uses the power of "no" to assert autonomy. Instead, this toddler is exhibiting increased dependency. Ritualism is reassuring to toddlers, creating sameness and predictability. Ritualism is not being expressed here.

A nurse is using a doll to explain what will be done when starting an intravenous (IV) line on a 4-year-old child. What type of play is this? play therapy parallel play interactive play therapeutic play

therapeutic play Play is a very important part of nursing care. Therapeutic play is nondirected and focuses on helping the child cope with feelings and fears. It helps the child deal with the challenges of illness and hospitalization. Therapeutic play is a technique to help children better understand what will be happening to them in a specific situation. For instance, the child who will have an IV line started before surgery might be given the materials and encouraged to "start" an IV on a stuffed animal or doll. Emotional play or play therapy is play that allows the child to act out stressors or dramatize real-life stressors. For example, to relieve anger a child may be given something to pound. Interactive play is where children play together cooperatively. Parallel play is where toddlers play side by side but not together.

The nurse is working with a child-life specialist to assist a young preadolescent who is preparing for treatment for cancer. Which technique will the nurse and specialist prioritize to assist this child in better understanding what will be happening in the treatment of the cancer? onlooker play cooperative play therapeutic play play therapy

therapeutic play Therapeutic play is a play technique used to help the child better understand what will be happening to him or her in a specific situation. For instance, the child who will be having an IV started before surgery might be given the materials and encouraged to "start" an IV on a stuffed animal or doll. By observing the child, you can often note concerns, fears, and anxieties the child might express. Therapeutic play helps the child express feelings, fears, and concerns. The other types of play will not accomplish this goal.

A nurse is caring for a young child who has been hospitalized in a facility that is located several hours from the child's home. The child has not seen his parents in three weeks. When they arrive to visit, the child ignores them. The nurse is aware that this is common in which stage of separation anxiety? first stage second stage third stage fourth stage

third stage During the third stage of separation anxiety, the child shows interest in the environment, starts to play again, and forms superficial relationships with the nurses and other children. If the parents return, the child ignores them. In the first phase, the child reacts aggressively to this separation and exhibits great distress by crying, expressing agitation, and rejecting others who attempt to offer comfort. In the second phase of separation anxiety, the child displays hopelessness by withdrawing from others; becoming quiet without crying; and exhibiting apathy, depression, lack of interest in play and food, and overall feelings of sadness. There is no fourth phase of separation anxiety.

A nurse with no pediatric experience has been transferred to a pediatric unit to work for the day. Which comment by the nurse indicate knowledge of developmental considerations when providing hygiene needs to a 3-month-old infant? "I will be sure to only leave the infant for a very short time if I forget anything during the bath." "I think the baby is old enough for me to use the bathtub if I am careful." "I plan on using a sponge bath to bathe the infant." "I need to find the talcum powder to use after the bath."

"I plan on using a sponge bath to bathe the infant." A 3-month-old would require a sponge bath or tub bath to bathe because he or she cannot sit unaided. Talcum powder is not suggested for infants. A bathtub can be used for toddlers or older. No child should ever be left alone during bathing for any length of time.

The nurse is speaking to a hospitalized child's parent about ways to encourage good nutrition while the child is hospitalized and after discharge. Which statement by the parent would indicate the need for further education? "I will bring his favorite sippy cup from home to use." "I will make the menu choices for my child so I make sure he is getting a balanced diet." "I will make sure my husband or I are here for all meals." "I will make sure we always have ice chips in the room for him to suck on."

"I will make the menu choices for my child so I make sure he is getting a balanced diet." Offering the child choices and allowing the child to choose what he or she wants from the menu helps to promote nutrition. Having family present for meals, using familiar objects such as sippy cups and offering ice chips as fluid intake are all additional ways to promote nutrition in hospitalized children.

The nurse is providing teaching for the parents of an 8-year-old girl who has undergone surgery. The nurse emphasizes the importance of maintaining adequate hydration. Which response by the mother would indicate a need for further teaching? "I should offer her small amounts of fluid frequently." "I will remind her that she will need an IV if she does not drink." "Ice chips count as fluid intake. One cup of ice equals a half-cup of water." "Anything that melts at body temperature is counted as a fluid."

"I will remind her that she will need an IV if she does not drink." The child is likely to view an IV both as frightening and as punishment. Intravenous fluids should be seen as therapy. Threats such as this should not be used to achieve compliance with eating or drinking. The other statements show understanding.

The home health nurse is caring for a child requiring ongoing home health care for a chronic disease. The family shares with the nurse, "We don't think we can financially afford to keep our child at home. We have explored all options, but we know we are going to have to find a long-term care facility for our child. We feel so guilty but we have to provide for our other children too." What is the best response from the nurse? "The home setting is so much better than any long-term care setting. Maybe you can rethink your decision." "You have done everything you could for your child. You have to move on." "Are you sure you have looked at all options? Maybe I can give you some ideas for maintaining home care." "It must be a very difficult decision for you. Why don't I give the case manager a call to give you some assistance with finding a facility."

"It must be a very difficult decision for you. Why don't I give the case manager a call to give you some assistance with finding a facility." The nurse must be supportive and empathetic of the parents' decision for long-term care and assist with exploring possible resources. Involving the case manager gives the parents additional assistance in carrying out this difficult task. Questioning the parents' decision will cause the parents to feel guilty. Telling them they have to move on offers no support.

The nurse is caring for a preschooler who requires postsurgical breathing exercises. Which approach will best elicit the child's cooperation? "You will need to cooperate. Otherwise, you might not feel better." "Do you want to play a breathing exercise game with me?" "Let's see who can blow these cotton balls off the table first." "You need to do the breathing or you could get pneumonia."

"Let's see who can blow these cotton balls off the table first." Any intervention should be developmentally appropriate, and play can often serve as a vehicle for care. Turning breathing exercises into a game is likely to engage the preschooler. Telling the child he needs to do breathing exercises or he will develop another illness or not feel better is not likely to impress the young child. Connecting the two events in a meaningful way is beyond his cognitive ability. Asking if the child "wants" to play a breathing game is an open invitation for a "No" answer.

The telephone triage nurse answers the call from a stay-at-home father of an infant; the father is unable to describe clearly the signs and symptoms the child displays but keeps saying, "She doesn't act like herself," and "Things with her are just not right." The best response by the nurse is: "Please call again in 2 hours and describe her symptoms then." "Is there another caretaker available that I can talk with?" "Please bring the child to the clinic to be seen. You seem concerned." "Try very hard to answer my questions. I will repeat them."

"Please bring the child to the clinic to be seen. You seem concerned." Telephone triage is useful in responding to many concerns and helping parents provide appropriate care. It is not meant to function as a gatekeeper discouraging parents from having a child seen. If a parent is very concerned, the nurse needs to listen and the child should be examined. The other responses do not accomplish this. With the vagueness of the father, asking if someone else was present to describe the symptoms was reasonable, just not the best answer.

The nurse is preparing to provide hygiene care to the scalp of a pediatric client. Which action will the nurse complete first? Thoroughly comb the client's hair Follow hospital procedures for hair care Assess the client's scalp and hair Apply shampoo to the client's hair after wetting

Assess the client's scalp and hair Before providing hygiene care to the client's scalp, the nurse would first assess the scalp and hair. The nurse would then proceed with providing hygiene care to the client. The nurse should ask the client's usual procedure and follow, if possible. It is appropriate to apply shampoo after wetting the hair and to comb hair.

A mother of a recently discharged preschooler calls the pediatric floor that provided care to her child a week ago. She reports that the child is having elimination accidents, temper tantrums and is waking up at night with nightmares. How should the nurse respond to the mother's concerns? Recommend that she sternly tell the child to quit acting out or he will be punished. Reassure her that this is typical behavior following a traumatic event and she needs to pay more attention to him. Children this age often show regressive behaviors and have nightmares following hospitalization due to fear of another separation. The entire family needs to spend more time with the child, directing their attention to him.

Children this age often show regressive behaviors and have nightmares following hospitalization due to fear of another separation. Preschoolers who have been hospitalized often show regression, have temper tantrums, or have nightmares following their discharge. The family is advised to be understanding but not dote on the child. Discipline should remain consistently firm and loving and parents should reward positive behavior.

A nurse is admitting a 7-year-old child to the pediatric unit of the hospital. While the nurse is showing the child and parents the room and explaining where things are, the child becomes upset and frightened. What is the best action by the nurse? Keep on showing and explaining to the parents and do not include the child. Tell the child that there is nothing to be afraid of and that nobody will hurt the child during hospitalization. Ask the parents to leave the room while explaining procedures to the child. Go slowly with the acquaintance process.

Go slowly with the acquaintance process. The child who reacts with fear to well-meaning advances and who clings to the caregiver is telling the nurse to go slowly with the acquaintance process. The child who knows that the caregiver may stay is more quickly put at ease. To provide security for the child and to provide family-centered care, it is the responsibility of the nurse to form good partnerships with families. Asking the family to leave the room in this situation would only frighten the child more. The nurse should never provide false reassurance. Telling the child there is nothing to be afraid of or nothing will hurt him or her are promises the nurse cannot make to the child.

The father of a 5-year-old child reports that he uses a series of local urgent care centers for routine care. What is the greatest concern about this practice? These facilities are not well versed in the care of children. It is difficult to have continuity of care with these practices. Seeking routine care at this type of facility often will not be covered by health insurance. The cost of using these options for medical treatment is excessive.

It is difficult to have continuity of care with these practices. The American Academy of Pediatrics discourages children and families from using urgent care centers or the emergency department for routine care, since it is difficult to provide coordinated, comprehensive family-centered care consistent with a "medical home" concept.

A preschool teacher calls the hospital and wants to introduce the concept of a hospital to her preschool class in case they ever get sick and need to be admitted. What resources could the child life specialist provide for this group to aid in their learning? Select all that apply. Tell the children that hospitals are places for sick people to come and sometimes they don't leave. Let the children lie in the beds, use the call lights and practice being a patient. Tour the hospital, including the playrooms on the pediatric floors. Provide a room for the class with hospital gowns, masks and equipment used on children. Offer to let them see and play with the injection equipment such as syringes and needles.

Provide a room for the class with hospital gowns, masks and equipment used on children. Tour the hospital, including the playrooms on the pediatric floors. Let the children lie in the beds, use the call lights and practice being a patient. Preschoolers are curious and love to manipulate the equipment used at the hospital. By making admission to the hospital less frightening for them, they will adjust better if they have to be admitted. Mentioning people not leaving the hospital indicates they died; this is scary to the children and inappropriate for this session. Children are never allowed to play with needles or syringes - it is too dangerous.

The nurse encourages the staff of a medically fragile day care center to also accept children with no medical needs. What is the advantage of requesting these children be accepted? The children in the community will have additional day care options. The children will learn acceptance and develop peer relationships. The medically fragile children will have role models in his or her environment. The diversity of health needs will allow for sharing of resources.

The children will learn acceptance and develop peer relationships. Medically fragile day care centers are an option for parents of medically fragile children who would not be able to attend traditional day care centers. The staff at a medically fragile day care center allows children with multiple and complex health conditions to be cared for outside the home while the parents are at work. By accepting children without health care needs, all the children develop peer relationships and acceptance of others. Medical resources would not be needed for those children without health care needs and all the children have the opportunity for role modeling, not just those without medical needs.

The nurse is caring for a 7-year-old boy in a body cast. He is shy and seems fearful of the numerous personnel moving in and out of his room. How can the nurse help reduce his fear? Write the name of his nurse on a board and identify all staff on each shift, every day. Tell him not to worry; explain that everyone is here to care for him. Encourage the boy's parents to stay with him at all times to reduce his fears. Remind the boy he will be out of the hospital and going home soon.

Write the name of his nurse on a board and identify all staff on each shift, every day. The best approach would be to write the name of his nurse on a small board and then identify all staff members working with the child (each shift and each day). Reminding the boy he will be going home soon or telling him not to worry does not address his concerns or provide solutions. Encouraging the boy's parents to stay with him at all times may be unrealistic and may place undue stress on the family.

The pediatric nurse would use standard precautions in caring for which client on her floor? a toddler with chickenpox an adolescent who has a broken arm a child who is diagnosed with pertussis an infant with diarrhea

an adolescent who has a broken arm Standard precautions involve avoidance of handling blood or body fluids from a client and involve use of personal protective equipment (PPE). In this case, with a fracture, there is minimal risk of exposure to body fluids so the nurse would wear gloves only. The other three clients would be in transmission-based precautions: airborne precautions for the toddler with chickenpox; contact precaution for the infant with diarrhea, or droplet precautions for the child with pertussis.

The nurse is establishing a long-term relationship with a child who will be seeking treatment for cancer. What is the most important factor in this relationship? determining appointment times for meetings establishing a timeline for the relationship establishing trust setting goals for the relationship

establishing trust Each of the elements listed is a part of a relationship for a child who will be involved in an extended relationship with a health care team. Establishment of trust is most important as it provides a foundation for the relationship to move forward in a positive manner.

A child seeing his health care provider in a clinic is diagnosed with dehydration caused by vomiting and diarrhea for the past 3 days. The health care provider asks the nurse to arrange for admission of the client to the hospital for rehydration therapy. When contacting the admission's department, to which hospital unit will the nurse plan on requesting the child be admitted? pediatric rehabilitation unit special procedures pediatric unit emergency pediatric unit general inpatient pediatric stay unit

general inpatient pediatric stay unit For IV rehydration, the client should be admitted to a general inpatient pediatric unit. The child has already been assessed by the health care provider so an emergency department visit is not warranted. A special procedures unit would be for procedures such as a bone marrow biopsy or endoscopy procedure. A rehabilitation unit would be for a child who has been in the hospital and is requiring further care, such as after a spinal cord injury.

Which intervention is most important in assuring a child's cooperation and reducing his or her fear during an emergency room visit? having the parent stay with the child offering the child a popsicle for being good providing distractions for the child during all procedures allowing the child to draw and color while in the emergency room

having the parent stay with the child The most effective way to enlist a child's cooperation and reduce his or her stress in an emergency room visit is to have the parent remain with the child and comfort him or her.

A nurse who has worked in a variety of settings over the past several years is trying to determine what setting she would most like to work in now. The nurse is very organized, works well in an autonomous environment, and prefers one-on-one care. Which setting would best fit this nurse's needs? health department physician's office school nurse home health

home health Home health would provide the most autonomy (which requires being organized), and takes place in the client's home, giving one-on-one care. All areas of nursing require organization in order to provide efficient care. A physician's office would likely provide the least amount of autonomy since the physician is always present, as well as other office staff. The health department nurse and the school nurse would favor an autonomous person, but there is still more direct supervision than with home health nursing.

The nurse is preparing to start an intravenous (IV) line on a stable pediatric client in the hospital. Which location is most appropriate for the nurse to use for this procedure? the child's hospital room the unit's playroom the pediatric treatment room room selected by the client

the pediatric treatment room The nurse would perform procedures on stable pediatric clients in the pediatric treatment room. Using a separate room to perform procedures promotes the concept that the child's room is a "safe" place. The other "safe" place for a child in the hospital is the playroom and should not be used for any procedures or medication administrations. The client would not be allowed to select a location as the client may select one's room or the playroom.

The nurse is caring for several families in the home care setting. What additional team member will the nurse have available to assist in the home setting? unlicensed assistive personnel an emergency medicine provider an infectious disease specialist surgical care interns

unlicensed assistive personnel There are many health care team members who care for a child in the home setting. The nurse will likely have a home care assistant who is unlicensed but trained in helping with activities not requiring a license. The child would have access to the other options, but not in the home setting.

In a preadmission visit, a 9-year-old girl says she is afraid her tonsillectomy will hurt too much. Which statement by the nurse would be best to help the child feel more comfortable and less afraid? "I'm sure you are worried about the pain, but lots of people have tonsillectomies and they're fine after a few days." "It won't hurt too much, so there is nothing to worry about. Besides, you need to be brave for the younger ones." "There's nothing to worry about. You will forget about the pain because you can have all the ice cream and pudding you want." "I understand that you're worried. It will hurt for only a few days; we'll give you something to help stop the pain when you need it."

"I understand that you're worried. It will hurt for only a few days; we'll give you something to help stop the pain when you need it." In a successful preadmission visit, children's feelings are explored and validated. The children are told that some things will hurt but that doctors and nurses will do everything they can to make the pain go away. Honesty must be central to any discussion of this kind. The other responses do not take seriously the child's concerns and fears.

The parents of a 10-year-old child tell the nurse they are nervous about their child being discharged to home. The parents state, "We trust you all so much that we are afraid to go home and have home health care. Do you think our child will do as well at home?" What would be the best response by the nurse? "It's scary going home but it is the best place for both you and your child." "Your child is at a much higher risk for infection in the hospital, so being home is a much better option." "Home care nurses are very qualified to give care to your child. You have nothing to worry about." "I understand your anxiety, but being at home helps your child's growth and development. The home care nurses will be there to support you."

"I understand your anxiety, but being at home helps your child's growth and development. The home care nurses will be there to support you." Caring for children at home not only improves their physical health but also allows for adequate growth and development while keeping them within their family. They are in a familiar environment with the comfort and support of family, which leads to improved care and quality of life. Reassuring the parents that the home care nurses will be there to support them further is necessary to help ease their anxiety.

The nurse has applied a restraint to the child's right wrist to prevent the child from pulling out an intravenous line. Which assessment findings ensure that there is proper circulation to the child's right arm? Select all that apply. Capillary refill is less than 2 seconds in upper extremities bilaterally. Fingers are pink and warm bilaterally. Lungs are clear throughout. Radial pulses are easily palpable bilaterally. Bowel sounds are present in all four quadrants.

Capillary refill is less than 2 seconds in upper extremities bilaterally. Fingers are pink and warm bilaterally. Radial pulses are easily palpable bilaterally. It is important to assess the child's peripheral vascular circulation especially when the child has a restraint placed on an extremity. Capillary refill, color, temperature, and pulses are appropriate to assess to ensure that the child's peripheral vascular circulation has not been compromised.

The nurse is caring for a toddler on a pediatric unit and plans to initiate safety precautions according to the child's developmental level. What safety measure(s) will the nurse add to the child's care plan? Select all that apply. Avoid leaving small objects that can be swallowed in the toddler's reach. Leave the toddler in the appropriately sized bed only when an adult is present in the room at all times. Instruct the toddler to call the nurse or caregiver with the call button when help is needed. Keep crib side rails up with overhead crib protection intact when the toddler is in the crib. Keep the bed in a low position with the side rails up when the nurse is not in the room and the toddler is in the bed.

Keep crib side rails up with overhead crib protection intact when the toddler is in the crib. Leave the toddler in the appropriately sized bed only when an adult is present in the room at all times. Avoid leaving small objects that can be swallowed in the toddler's reach. Nursing considerations for safe, developmentally appropriate care include keeping the crib side rails up with overhead crib protection intact when the toddler is in the crib, never leaving a toddler alone in the room unless secured in the crib, using a bed only for the older toddler who has an adult present in the room at all times and avoiding leaving small objects that can be swallowed or are harmful in the crib or bed. Instructing the toddler to call the nurse or caregiver when help is needed would be developmentally appropriate for the preschooler, not the toddler. Leaving the child alone in the room in bed with the bed in a low position and the rails up is appropriate for the preschooler, not the toddler.

The nurse is preparing to discharge a 5-year-old child from the hospital who will require dressing changes to a wound at home. The parents have been taught the appropriate wound care measures during the stay in the hospital. Which action by the parents assures the nurse that learning occurred? The parents voice understanding of aseptic technique. The parents have performed the wound care and dressing change with the nurse's supervision the last 2 days prior to discharge. The parents have made a list of instructions to remind them of the requirements of the dressing change. The parents have helped the nurse provide wound care every day of the child's hospitalization.

The parents have performed the wound care and dressing change with the nurse's supervision the last 2 days prior to discharge. Demonstration of wound care is the best way to evaluate if the parents are knowledgeable of the procedure. Voicing understanding and listing the steps does not assure the nurse that learning has occurred. Helping the nurse with wound care is beneficial when initially learning the procedure, but does not ensure the ability to perform the procedure independently.

The school nurse is orienting a new nurse to the position in an elementary school. The new nurse displays understanding of the position with which comment(s)? Select all that apply. "We will administer most of the immunizations children at this age require." "I will be doing a lot of health screening, like vision and scoliosis testing." "I worked on a unit that specialized in the care of autoimmune clients, so that will benefit me in this position." "I will need to stay up-to-date on my emergency first aid skills in case they are needed." "I will need to obtain my CPR instructor license."

"I will be doing a lot of health screening, like vision and scoliosis testing." "I will need to obtain my CPR instructor license." "I will need to stay up-to-date on my emergency first aid skills in case they are needed." "I worked on a unit that specialized in the care of autoimmune clients, so that will benefit me in this position." Health screenings the school nurse provides include vision, hearing, and scoliosis. The school nurse will need to obtain a CPR instructor license because the school nurse often certifies the staff in CPR. The school nurse provides emergency first aid and provides medication administration and monitoring of students with diabetes. The school nurse also works with today's diverse school population, which includes students with chronic conditions such as asthma, serious allergies, physical disabilities, and attention-deficit/hyperactivity disorder. The school nurse will not administer but will educate on immunizations.

The nurse is talking with the parents of a 6-month-old girl hospitalized with a respiratory infection. The parents state, "Since our child is so young it will be easier for her to cope with us being at work all day." How should the nurse respond? "I love babies so much that I will be happy to give her extra attention when you both are at work." "Is there a familiar person in your child's life who might be able to spend time with her while you're at work?" "I am sure she will be just fine when you both are at work." "Just be prepared for her to show signs of separation anxiety if one of you isn't going to stay with her."

"Is there a familiar person in your child's life who might be able to spend time with her while you're at work?" By 5 to 6 months of age, infants have developed an awareness of self as separate from mother. As a result, infants of this age are acutely aware of the absence of their primary caregiver and become fearful of unfamiliar persons. If the parents must both be at work, a familiar person to be with the child would be beneficial. Telling the parents the child will be fine may be instilling false hope. "Just be prepared for her to show signs of separation anxiety..." is not supportive and may cause the parents to feel guilty. "...I will be happy to give her extra attention when you both are at work" may be making promises that the nurse can't keep, and the nurse is still a stranger to the child.

A few days after discharge, the parent of an 8-year-old calls the pediatric clinic, expressing concern about the child's behavior now that she is home. The child has been treating her siblings badly and using inappropriate language. Which suggestion should the nurse prioritize to this caregiver as an appropriate way to handle this situation? "Respond to her behavior in a firm, loving, consistent way." "Children often feel guilty for the attention they've taken away from their siblings and act out as a way of earning the attention." "Coming home is a difficult adjustment. Warn your daughter that you expect her to begin to behave better over the next few weeks." "Tell her you don't like her behavior and have her stay in her room until she can be nicer to her siblings."

"Respond to her behavior in a firm, loving, consistent way." The return home may be a difficult period of adjustment for the entire family. The older child may demonstrate anger or jealousy of siblings. The family may be advised to encourage positive behavior and to avoid making the child the center of attention because of the illness. Discipline should be firm, loving, and consistent. The child may express feelings verbally or in play activities. The family may be reassured that this is not unusual.

The nurse in the pediatric surgeon's office has just completed preoperative teaching to a child and the parents. Which comments by the parents indicate that the parents understood the preoperative teaching? Select all that apply. "We are going to read this book that the surgeon gave us to our child several times before the surgery." "Our child loves to draw and color. We are going to get some coloring books about being in the hospital." "So that we don't make our child worry too much, we will wait until the night before the surgery to talk about it." "We are going to call the hospital to see if we can make a visit before the surgery date." "It will be good for our child's sister to hear about the surgery and how the period after surgery will be."

"We are going to read this book that the surgeon gave us to our child several times before the surgery." "It will be good for our child's sister to hear about the surgery and how the period after surgery will be." "We are going to call the hospital to see if we can make a visit before the surgery date." "Our child loves to draw and color. We are going to get some coloring books about being in the hospital." Parents are instrumental in preparing children by reviewing the materials that are given, answering questions, and being truthful and supportive. The more ways the experience is discussed the better the hospitalization and surgical experience will be. Not talking about the surgery until the night before it is scheduled will lead the child to be wondering and fearing the unknown.

A 12-year-old child is being discharged from the hospital. The nurse provide discharge instructions to: the parent. the child. the child and the parent. the parent and a neighbor.

the child and the parent. When providing discharge instructions, it is best for the nurse to provide instructions to the parent and one other person. Since the child is old enough to understand basic instructions and he/she is the person involved, providing instructions to both of them would be best. The nurse would also provide a phone number for them to call back if they get home and have any questions.

The nurse is caring for a 13-year-old who is hospitalized for management of his recently diagnosed diabetes. The child has been withdrawn, and when asked she reports she is "just tired of being sick". What action by the nurse will be of the greatest benefit to helping the child with this concern? Ask one of the parents to stay with her at all times. Encourage the child to participate in planning her daily care. Encourage the child to call her friends on the phone. Provide books and magazines of interest to her.

Encourage the child to participate in planning her daily care. When teens face illness they are also faced with a loss of control and independence. Activities that foster her involvement and encourage her to participate in care will work to reduce these feelings related to loss of control. Interacting with friends by phone will be helpful but will not establish feelings of control. Parents are encouraged to spend the night but this will not promote a sense of control. Providing books and magazines will offer diversion but will not promote feelings of control.

A team of nurses has been chosen to devise a program to help educate children and their families about the hospital and being hospitalized. Which activity should the nurses plan to best achieve this goal? Work with the local library to provide resources (books, pamphlets, or DVDs) explaining the admission process and hospitalization, which the families can check out and view together. Plan an open house and invite the families of the community to come tour the hospital. Offer guided tours to an organized group such as Boy Scouts or Girl Scouts. Ask the school nurse to do a presentation to groups of schoolchildren about what it is like to be in the hospital.

Plan an open house and invite the families of the community to come tour the hospital. The first choice should be working with the family and caregivers with the open house. The family and caregivers have the most important role in educating children about hospitals and hospitalization. The child trusts and feels safer most often with the caregiver. During a tour of the hospital, a room is set aside where children can handle equipment, try out call bells, try on masks and gowns, have their blood pressure taken to feel the squeeze of the blood pressure cuff, and see a hospital pediatric bed and compare it with their bed at home. The caregivers can reinforce what the child has seen in the home setting. Not all children are involved in an organized group such as Boy Scouts or Girl Scouts. The library could be a potential source; however, with many homes now having internet access, the same materials may be viewed online. This can reinforce what the child saw at the open house.

The nurse is preparing discharge teaching for a child and the caregivers after a week of hospitalization. Which activity should the nurse prioritize in this plan? Ensure the caregiver has assistance to handle the complex treatments at home. Provide written instructions which can be taken home to read and follow. Begin the teaching sessions just prior to the child leaving the facility. Plan to review information and procedures with the family caregivers before discharge.

Plan to review information and procedures with the family caregivers before discharge. Shortly before the child is discharged from the hospital, it is important to review information and procedures with the family caregivers. The nurse should not wait until the client is almost out the door before starting discharge training. Depending on the training, it can begin shortly after admission. Not all families will need home health care to assist with transitioning from the hospital to the home setting. Written instructions may not always be appropriate if the family cannot read the literature or if it is not in their native language. The best option is to spend time with the family, demonstrating what needs to be done and observing them performing the various treatments.

A 6-year-old child will be hospitalized for a surgical procedure. How can the nurse best ease the stress of hospitalization for this child? Tell the parents to bring toys for the child from home. Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital. There is no way to adequately prepare a child for an impending hospitalization. Have another child talk with the child to be hospitalized.

Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital. The best way to ease the stress of hospitalization is to ensure that the child has been well prepared for the hospital experience. Not only is the child's fear reduced but also the child has a better ability to cope. Preparation allows the child a better understanding of what's happening to him or her. Good preparation allows the child to see a hospital room, handle medical equipment and gain an understanding of procedures and hospital sounds. Another child would only give explanations from his or her point of view and that child may describe a negative experience. The child's favorite toy or blanket should come with the child to the hospital as a comfort to the child, but that does not prepare the child for hospitalization.

The toddler needs elbow restraints to keep his hands away from a facial wound. What will the nurse do to best ensure their safe use? Choose restraints long enough to fit closely under the arm and extend over the wrist. Remove one restraint at a time on a regular basis to check for skin irritation. Apply lotion to the skin prior to putting on the restraints. Have the parent check for equal warmth bilaterally in his hands and fingers.

Remove one restraint at a time on a regular basis to check for skin irritation. Removing one restraint at a time provides for control of both hands. A long-sleeve shirt under the elbow restraints also protects the skin, and is a better choice than lotion since lotion will soften the skin and not be protective. The restraints should not extend into the axilla. Movement would create pressure and irritation. The parent can help monitor the restraints, but the nurse is responsible for the safety of their use.

A 3-year-old who has just been admitted with pneumonia needs to have an intravenous (IV) line inserted for antibiotic therapy. What is the best nursing action? Tell the patient that it will feel like a bumble bee sting when inserted. Tell the patient to stay with the mother in his room while the IV is inserted. Take the patient to the treatment room to have the IV inserted. Inform the patient's mother that she can stay in the room and hold the child while the IV is inserted.

Take the patient to the treatment room to have the IV inserted. Treatments should be performed in a treatment room, not in the child's room. Using a separate room to perform procedures promotes the concept that the child's bed is a safe place. Having the mother hold the child is helpful but not the best action in this case. It is very difficult for mother to hold her child still while the child is in pain and it is a negative emotional experience for the mother. Telling the patient that it will feel like a bee sting would only make the child more apprehensive and it is also not being truthful to the child.

The hospital nurse is providing discharge instructions to the caregivers of a 10-year-old child with a new prosthetic limb. Which finding will cause the nurse to contact the primary health care provider? The child was diagnosed with hypothyroidism as an infant. The child's white blood cell (WBC) count is 9,000/mm3 (9 x 109/L). The child's blood pressure is 115/75 mm Hg. The child is being discharged home with the caregiver.

The child is being discharged home with the caregiver. The nurse would question the child with a new prosthetic limb being sent home immediately from the hospital. Sending the child to a rehabilitation unit is best to facilitate usage of the prosthetic limb. The care in a rehabilitation unit involves an interdisciplinary approach that assists the child to reach his or her potential and achieve developmental skills. A diagnosis of hypothyroidism in infancy would not be concerning to the use of a prosthetic. The WBC and blood pressure are both within normal range for a client of this age. The normal WBC is 5,000 to 10,000 mm3 (5 to 10 x 109/L) and blood pressure range is 95-120/55-76 mm Hg.

The following assessments are gathered from an 8-year-old pediatric client returning from surgery. Which information would need to be reported to the physician promptly? axillary temperature of 99°F (37.2°C) heart rate of 82 anuria for 7 hours pain rating of 4

anuria for 7 hours Lack of urinary output for more than 6 hours needs to be reported to the physician because inadequate urinary output may indicate urinary retention, dehydration, or inadequate blood flow to the kidneys. All other data are within normal limits.

The nurse is caring for a hospitalized toddler who is prescribed bedrest. Which item(s) would the nurse recognize as appropriate for the toddler? Select all that apply. fine-print books or magazines to read boxes to put toys in and/or take out toys stacking blocks or small boxes jigsaw puzzle with pieces 1/2 in (1.25 cm) or smaller coins, small tokens, or marbles to organize and sort nursery rhymes or sing-along songs on tape

boxes to put toys in and/or take out toys stacking blocks or small boxes nursery rhymes or sing-along songs on tape Hospitalized toddlers on bedrest benefit from toys that can be interacted with and that are age-appropriate. Examples would be stacking boxes, blocks, and sing-along-songs or nursery rhymes. Small piece puzzles, coins, tokens, and marbles are a choking risk for the toddler. Fine-print books and magazines are not age-appropriate and would not be of interest to a toddler.

The nurse is caring for an 18-month-old boy hospitalized with a gastrointestinal disorder. The nurse knows that the child is at risk for separation anxiety. The nurse watches for behaviors that indicate the first phase of separation anxiety. For which behavior should the nurse watch? crying and acting out losing interest in play and food exhibiting apathy and withdrawing from others embracing others who attempt to comfort him

crying and acting out Children in the first phase, protest, react aggressively to this separation, and reject others who attempt to comfort the child. The other behaviors are indicators of the second phase, despair.

On the first postoperative day, a 4-year-old child who was hospitalized for an emergency appendectomy has begun to cry relentlessly, will not let the nurse touch him or her, and keeps asking for the parent. The pediatric nurse is aware that this client is in which stage of separation? protest denial grief despair

protest Separation anxiety is very real for the hospitalized child who is separated from parents or caretakers. Separation anxiety has three stages. This child is displaying symptoms of the first stage of separation, which is protest. The child reacts aggressively, cries, and exhibits great distress. The child rejects others who would attempt to provide care or comfort. The second stage is despair. During this stage the child displays hopelessness, is quiet without crying, and lacks any interest in play or food. The third stage is denial. During this phase, the child is detached and has formed coping mechanisms to avoid any further emotional pain. Grief is not a stage of separation anxiety.

The nurse is talking with the parents of a hospitalized child who has three siblings at home being cared for by the grandparents. The main idea the nurse wants the parents to understand is that the siblings may experience: stress equal to that of the affected child. guilt, believing they caused their brother's or sister's illness. resentment toward the parents. jealousy toward their ill brother or sister.

stress equal to that of the affected child. Research indicates sibling stress is often equal to that of the hospitalized child, and parents are often unaware that this is the case. The feelings of jealousy, resentment, guilt, insecurity, and more all add to the stress level of the siblings. The effect of each can be mitigated or compounded based on the child's particular developmental level.

The charge nurse is planning staffing on a pediatric unit. Which client will the charge nurse assign to the registered nurse? the 6-year-old client admitted yesterday for oral rehydration following a mild gastrointestinal disorder the 12-year-old client with a urinary tract infection taking oral antibiotics the 8-year-old client recovering from an appendectomy who is ambulating the 1-year-old client with a respiratory disorder prescribed oxygen therapy

the 1-year-old client with a respiratory disorder prescribed oxygen therapy The charge nurse would assign the RN to the most unstable client, which is the client with a respiratory disorder who is only 1 year of age. According to Child Health USA 2010, diseases of the respiratory system account for the majority of hospitalizations in children younger than 5 years of age, indicating this is a common occurrence. All other clients are stable and could be cared for by licensed practical nurses at this time.