PEDS Chapter 21 Family Centered Care of the Child During Illness and Hospitalization

A 4-year-old child tells the nurse that a small bandage is needed at the site where the blood sample was drawn. Which is the best nursing intervention in this situation? 1 Applying a small bandage to the site 2 Asking why the child needs a bandage 3 Explaining why the blood sample is taken 4 Telling the child the bleeding will stop when the needle is removed

1 Preschoolers have poorly-defined bodily boundaries, so applying a bandage to the site from where the blood is drawn would be helpful in reducing the fear of bodily injury. Asking the child why a small bandage is needed would limit the conversation with the child and would not reduce the fear of bodily injury. Explaining to the child the reason for taking a blood sample in simple terms would be helpful for preparing the child for the procedure; however, it might not reduce the fear of bodily injury. Telling the child that the bleeding will stop once the needle is removed does help a little to relieve fear, but applying a small bandage would comfort the child.

What is the primary nursing goal for a hospitalized toddler? 1 Providing privacy 2 Encouraging parents to room in 3 Explaining procedures and routines 4 Encouraging contact with children of the same age

2 A toddler experiences separation anxiety when separated from the parents. As a means of avoiding this, the parents should be encouraged to room in. Explaining routines, encouraging contact with children of the same age, and ensuring privacy are helpful goals, but the primary goal for a hospitalized toddler is to prevent separation.

When caring for a school-age child, which interventions by the nurse help the child to become a cooperative and satisfied patient? Select all that apply. 1 Helping the child with a bed bath 2 Engaging the child in a new hobby 3 Allowing the child to choose a menu 4 Permitting age-appropriate board games 5 Ensuring complete bed rest for the child

2,3,4 Engaging the child in a new hobby helps to promote adjustment to physical restrictions in the hospital. The child cooperates with nursing care when allowed to exert a certain measure of control, such as choosing a menu. Age-appropriate board games help the child overcome boredom and depression. Routine nursing interventions, such as helping the child with a bed bath or ensuring complete bed rest, may be perceived as a threat to individual control, resulting in lack of cooperation or satisfaction.

It is important to consider the child's developmental understanding of death when working with that child. Which option is the preschool child's developmental stage? A. Children of this age believe their thoughts are sufficient to cause death. B. They are still very much influenced by remnants of magical thinking and are subject to feelings of guilt and shame. C. They have a deeper understanding of death in a concrete sense. D. They can perceive events only in terms of their own frame of reference—living.

A. Children of this age believe their thoughts are sufficient to cause death.

As the nurse caring for a culturally diverse population, it is important to understand cultural health beliefs of families. This can best be accomplished by: A. Asking the parents how their extended families feel about their child's illness B. Exploring the use of alternative medicines and therapies C. Understanding the parents' perception of the seriousness or severity of the illness or disability, as well as concerns and worries they have about the condition D. Acknowledging that language constraints may make it necessary for the health care team to make some decisions

C. Understanding the parents' perception of the seriousness or severity of the illness or disability, as well as concerns and worries they have about the condition

A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for Mommy. What is the best reply by the nurse? 1 "Mommy will be here after lunch." 2 "Mommy always comes back to see you." 3 "Mommy had to go home for a while, but she'll be here today." 4 "Your Mommy told me yesterday that she'd be here today about noon."

1 Because toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon to a familiar activity that takes place at that time. Telling the child that his mother always comes back to see him does not give the child any meaningful information about when his mother will visit. Noon is a meaningless concept for a toddler. Stating that his mother had to go home but will be back today does not provide the child with any meaningful information related to when she will actually visit.

What intervention by the nurse can help ease negative feelings and fear in a 5-year-old child being admitted to the hospital? 1 Preparing the child for the hospital experience 2 No intervention because children this age cannot be prepared 3 No intervention because preparation will increase the child's stress 4 Preparing the child for the potential negative effects of hospitalization

1 The best intervention the nurse can use to help decrease negative feelings and fear in a 5-year-old child being admitted to the hospital is to prepare the child for the hospital experience. A 5-year-old child can be prepared for hospitalization. Preparation will decrease, rather than increase stress. Preparing the child for the potential negative effects of hospitalization is not helpful and may likely increase the child's stress.

What are some environmental stressors for the child and family in the pediatric intensive care unit? Select all that apply. 1 Pain 2 Immobility 3 Constant lights 4 Sleep deprivation 5 Unfamiliar sounds

3,5 Environmental stressors for the child and family in the pediatric intensive care unit include unfamiliar sounds from monitors, telephones, suctioning, and other equipment and constant lights which disturb day and night rhythms. Pain, immobility, and sleep deprivation are physical stressors for the child in the pediatric intensive care unit.

What change does the nurse teach the parents to expect in their child after prolonged hospitalization? 1 Anger toward parents 2 Jealousy toward siblings 3 Repressed feeling of resentment 4 Regression in newly learned skills

4 After prolonged hospitalization, it is normal for children to exhibit regression in newly learned skills. Parents must deal with such attention-seeking behavior in a supportive manner to enable the child to assume prior levels of functioning. Siblings of the child are likely to express anger toward parents and jealousy toward the sick sibling over the extra care for the sick child. Older siblings often feel guilty and repress feelings of resentment against the parents and the sick sibling.

What is the most appropriate way for the nurse help a child feel empowered to cope during a painful procedure? 1 Apologizing for hurting the child 2 Coaching the child to hold her feelings inside 3 Telling the child that the pain will be over soon 4 Coaching the child in learning a skill that will distract the child

4 Coaching the child to learn a coping skill such as blowing the hurt away is a helpful way to reduce pain, fear, and anxiety and give the child a sense of control over the situation. Apologizing for hurting the child is a nice sentiment but not a helpful way to help the child feel empowered to cope during a painful procedure. Coaching the child to hold feelings inside is not therapeutic. Telling the child that the pain will be over soon disregards the child's concern and doesn't offer any coping skills.

The home care nurse is caring for a toddler who is on a ventilator via a tracheostomy tube. Which intervention does the nurse implement to promote freedom of movement for this patient? 1 Use a cardiorespiratory monitor. 2 Provide oxygen through nasal cannula. 3 Mount the ventilator to the wheelchair. 4 Use long tubing to connect the patient to the ventilator.

4 Designing creative home care strategies is essential for meeting the developmental needs of a patient. Toddlers need to be active for appropriate developmental activities. This can be facilitated by using long oxygen tubing. Long oxygen tubing for ventilation promotes freedom of movement in toddlers. A cardiorespiratory monitor is a device used for assessing the breathing pattern. Mounting a ventilator to a wheelchair provides freedom of movement in school-age children and adolescents. Providing oxygen through the nasal cannula is unnecessary for a child with a tracheostomy.

Which factors will influence self-care in the chronically ill hospitalized child? Select all that apply. 1 Child's level of interest 2 Child's physical ability 3 The parent doing all care 4 Child's developmental age 5 Child's interest in spirituality

1,2,4 Self-care depends on the developmental age of the child in order to help the child acquire age-appropriate competence. The nurse assesses the child's level of interest and physical ability to promote self-care. Having the parent do all the care will not encourage the patient to participate in self-care. Spiritual beliefs are assessed to understand how the child views the illness.

The nurse is preparing the family of a child for admission to an ambulatory setting for surgery. Which actions does the nurse take? Select all that apply. 1 Provides a tour of the facility 2 Provides discharge instructions 3 Provides a review of the day's events 4 Suggests items to bring to the facility 5 Acquaints the child with the surroundings

1,3,4,5 The nurse provides a tour of the facility to familiarize the family with the settings. The nurse provides a review of the day's events so that the family understands what to expect. The nurse suggests bringing items like blankets or toys to provide comfort for the child. The nurse acquaints the child with the surroundings to lessen the child's anxiety. Discharge planning begins upon admission; however, the nurse provides discharge instructions once the prescribed procedure or surgery is done.

The nurse working in an outpatient surgery center for children understands which concept? 1 Children's anxiety is minimal in such a center. 2 Waiting is not stressful for parents in such a center. 3 Families need to be prepared for what to expect after discharge. 4 Accurate and complete discharge teaching is the responsibility of the surgeon.

3 Discharge instructions should be provided in both written and oral form. They need to include normal responses to the procedure and when to notify the practitioner if untoward reactions are occurring. Although anxiety may be reduced because of the lack of an overnight stay, the child will still experience the stress associated with a medical procedure. The waiting period while the child is having the procedure is a very stressful time for families. Discharge teaching is a responsibility of both the surgeon and the nursing staff.

What is the major stressor of hospitalization for children from middle infancy throughout the preschool years? 1 Fear of pain 2 Loss of control 3 Separation anxiety 4 Fear of bodily injury

3 Separation anxiety is a major stressor for children from infancy through the preschool years. Fear of pain, fear of loss of control, and fear of bodily injury are all stressors associated with hospitalization, but none is the primary stressor in this age group.

The primary nursing goal for the hospitalized child younger than 5 years is to prevent which concern? 1 Discomfort 2 Sleep problems 3 Separation from parents 4 Changes in normal routine

3 The primary nursing goal in the care of a hospitalized child younger than 5 years of age is to prevent or minimize separation from parents or primary caregivers. Although preventing discomfort is important, the primary nursing goal is to prevent separation from parents or primary caregivers. Preventing sleep problems is a goal but not the primary nursing goal in this case. In this case it is impossible to prevent changes in normal routine and therefore this is not the primary nursing goal.

A student nurse asks a registered nurse how children sleep in the intensive care unit (ICU) and not become frightened with all the lights and noises. How does the registered nurse respond? 1 "We silence alarms at night." 2 "We turn down the light for 90 minutes at night." 3 "Bright lights and alarms are necessary for children in the ICU." 4 "We encourage parents to sit with their child as often as possible."

4 Parents should be encouraged to sit with their children in the ICU and touch their children as often as possible to comfort them, because the presence of parents reduces stress and anxiety in hospitalized children. Alarms should not be silenced, but should be turned as low as possible at night. The light should be kept dim during the night; it should not be turned down for 90 minutes. The alarms and lights are necessary because the children in ICU are sicker than the children in the pediatric unit; therefore, the lights and noise should be kept at minimum to allow for an uninterrupted sleep cycle for the children.

The nurse is caring for a child whose parents are unable to stay with the child for long hours. Which action by the nurse helps to ease the feelings of separation from home? 1 Surround the child with familiar items. 2 Move the child's bed toward the window. 3 Provide musical, visual, or tactile activities. 4 Allow the child to continue school lesso

1 If the parents cannot stay long, the nurse can allow familiar articles in the room to ease the feelings of separation from home. Favorite toys, photographs, and recordings of the family members provide comfort and reassurance. The nurse ensures sensory freedom for the child who has restricted physical movement by moving the bed toward the window or providing musical, visual, or tactile activities. The nurse helps the child to maintain a usual routine by allowing the child to continue school lessons.

What is a common experience of a sibling during a sister's or brother's illness or hospitalization? 1 Anger 2 Support 3 Detachment 4 Positive adaptation

1 Siblings tend to react to a sister's or brother's illness or hospitalization with anger and/or jealousy. Support, detachment, and positive adaptation are not as common as anger and jealousy.

What behavior does the nurse expect when caring for a preschool-age child admitted to the hospital? Select all that apply. 1 Develops trust in adults 2 Cries quietly for the parents 3 Tolerates brief periods of separation 4 Refuses to comply with the usual routines 5 Attempts to physically keep the parents near

1,2,3 Preschoolers are more secure independently. The preschooler may demonstrate subtle protest behaviors, such as crying quietly for the parents or continually asking when the parents will visit. Preschoolers are able to tolerate brief periods of separation, and they develop trust in adults who care for them. Toddlers, on the other hand, often demonstrate the stress of separation by refusing to comply with the usual routines of mealtime, bedtime, or toileting. They also demonstrate more goal-directed behaviors, such as attempting to physically keep the parents with them.

Which interventions by the nurse help the child and family to overcome fear and prepare for hospitalization? Select all that apply. 1 Have a common preparatory session for all families. 2 Allow the family and child to express their concerns. 3 Arrange short preparatory sessions for older children. 4 Use puppet shows or videos to explain hospital processes. 5 Orient the child and family to the hospital and its routines.

1,4,5 The nurse who answers all questions posed by the family helps them to deal with the stress of hospitalization. The fear of hospitalization is greatly reduced when the child and family are familiar with hospital routines and environment. Use of age-appropriate media such as puppet shows, books, or videos helps to teach children and their families what to expect during hospitalization. Unlike younger children, older children have a longer attention span and can tolerate longer preparatory sessions. Optimal preparation is when each child and family are provided with an individualized preparatory session.

A 3-year-old child who was left under the care of a babysitter is depressed and sad. The child is silent and keeps sucking the thumb all the time. In which stage of separation anxiety does the nurse place the child? 1 Denial 2 Protest 3 Despair 4 Detachment

3 The nurse identifies that the child is in the second stage of separation anxiety, which is despair. In this stage, the child would show depression and would not communicate with others. The child regresses to earlier behaviors such as thumb sucking, bed-wetting, or the use of a bottle. Denial is the other name for detachment and is the third stage in separation anxiety. In this stage the child shows interest in the surroundings, interacts with strangers, and appears happy. The child would cry, scream, and cling to the parents in the stage of protest, which is the first stage in separation anxiety. Detachment occurs after a prolonged separation from the parents where the child appears to be happy, but is not actually content.

What is the most common reaction of many parents to their child's hospitalization? 1 Relief 2 Anger 3 Helplessness 4 depression

3 Helplessness, fear, anxiety, and frustration are common responses of parents when a child becomes ill or is hospitalized. Relief, anger, and depression are not common reactions.

The nurse removes an intravenous (IV) needle from a toddler's hand and quickly covers the area with a bandage. Why is a bandage particularly important in this age group? 1 Because the bandage promotes independence 2 Because the bandage promotes freedom of movement 3 Because toddlers have poorly defined body boundaries 4 Because the bandage demonstrates respect to the child

3 Because toddlers have poorly defined body boundaries, applying a bandage after removal an IV needle helps allay the child's fear that the bleeding from the wound will not stop. The bandage does not promote independence; rather, it helps ease the toddler's fears. The bandage may promote freedom of movement, but this is not the reason that it is particularly important to toddlers. The bandage may demonstrate respect to the child, but it is particularly important in easing the toddler's fear of bodily injury.

A school-age child is at risk for infection and is placed in an isolation room. What does the nurse tell the child to prevent stress? 1 "You are not well and need special care." 2 "You need to stay in the room for some time." 3 "It is a magical room that will make you better." 4 "It is a special place that makes all the germs go away."

4 An isolation room affects the child's orientation of time and place and increases stress, so the nurse explains the purpose of keeping the child in the isolation room. The nurse can explain that the child needs to be in the room to get better, because it is a special place that will make the germs go away. This will alleviate the child's anxiety. The nurse does not say that the room is magical, because this may lead the child to imagine something unusual. The child is likely to view the isolation room as a punishment if the nurse says that the child needs to stay there for some time. Saying that the child is not well may make the child more anxious.

The nurse caring for a school-age child observes detachment behavior. Which intervention by the nurse helps to overcome the stage of detachment or denial? 1 Assign a primary nurse to care for the child. 2 Place the child with children of the same age group. 3 Assist the child with age-appropriate games or hobbies. 4 Talk to the child about the significance of the parents' visit.

4 Detachment behaviors are a result of separation anxiety. The nurse can help the child overcome this by maintaining the child's contact with the parents by talking about them and explaining the significance of their visits. Assigning a primary nurse allows individualized care and substitute support for the child but does not apply to separation anxiety. Placing the child with children of the same age group is known to be therapeutic and medically advantageous. Boredom is overcome by engaging the child in an age-appropriate game or hobby.

What is the primary goal of care coordination? 1 Providing timely care 2 Ensuring access to a variety of services 3 Reducing the financial cost of health care 4 Ensuring continuity across various settings

4 The primary goal of care coordination is to ensure continuity for the child and family across hospital, home, educational, therapeutic, and other settings. Other goals are to facilitate timely access to services and enhance child and family well-being. Receiving access to a variety of services and reducing financial costs are part of care coordination but not primary goals.

A nurse is caring for a 6-year-old child recovering from surgery in an outpatient setting. Which is the priority nursing intervention for this family at discharge? 1 Bagging all of their belongings before discharge 2 Getting the child back to socializing with friends 3 Placing a blanket and pillow in the car for comfort 4 Teaching parents when to notify the health care provider

4 The priority nursing intervention for this family is proper and complete discharge planning, including guidelines on when to call the practitioner regarding a change in the child's condition. Bagging all their belongings before discharge, getting the child back to socializing with friends, and placing a blanket and pillow in the car to keep the child comfortable on the drive home are not nursing priorities for this family.

A school-age child is admitted to the hospital for an extended duration. The nurse observes that the altered routine due to the hospital stay is causing inactivity in the child and lack of interest in the environment. What is the nurse's best action? 1 Provides the child's favorite food often during mealtimes 2 Spends maximum time with the child in the parents' absence 3 Asks the parents to bring the child's favorite toys from home 4 Writes a daily schedule of activities and leaves it in the child's room

4 To encourage activity and interest, a daily schedule minimizes the disruption of the child's routine that the child was used to before hospitalization. The nurse writes down the activities and leaves it in the child's room so that the child knows what is expected. Spending maximum time with the child in the parents' absence, suggesting that parents provide the child's favorite toys, and providing favorite foods at mealtimes are anxiety-relieving actions.

A nurse is caring for a 10-year-old child who has been hospitalized due to illness. Which play activity does the nurse provide for the child to reduce separation anxiety? 1 Providing sandboxes 2 Providing large blocks 3 Providing colorful toys 4 Providing reading material

4 The nurse should provide age-specific play material for hospitalized children. Playing is used to distract the children and provide recreation. A 10-year-old child should be provided with a book to read. Sandboxes, large blocks, and colorful toys would be best to help divert the attention of small children.

What are the different stages of separation anxiety in children? Select all that apply. 1 Protest 2 Despair 3 Approval 4 Regression 5 Detachment

1,2,5 Protest is the first stage of separation anxiety in children, in which the child cries and screams for the parent. The stage of despair follows, in which the child becomes sad and withdrawn, as the child is unable to cope with anxiety. The last stage is detachment, in which the child appears happy and forms new but superficial relationships to escape the emotional pain of separation from the parent. Approval and regression are not stages of separation anxiety.

The nurse is providing home care to a child from a Hispanic family. Which strategies does the nurse take while providing care? Select all that apply. 1 Uses culture-specific methods of teaching 2 Tells the family how they should view the illness 3 Does not interfere in the family's lifestyle choices 4 Learns about the family's communication patterns 5 Understands the spiritual and religious ideas of the family

1,3,4,5 The nurse respects the family's culture and does not interfere in their lifestyle choices. The nurse learns about the family's communication patterns, because they may use certain words differently. The nurse also understands their spiritual and religious ideas, because these shape their view of the illness. The nurse uses culture-specific methods of teaching, such as asking the family for return demonstration if they prefer or letting the family take written instructions to ensure that the family has understood the care process. The nurse does not provide personal opinions or judgments about their lifestyle and helps to maintain autonomy.

What is a common fear of hospitalized adolescents? 1 Pain 2 Altered body image 3 Restricted motor activity 4 Separation from material things

2 A common fear of hospitalized adolescents is the fear of altered body image. Injury, pain, disability, and death are viewed primarily in terms of how each affects an adolescent's perception of self in the present. Any change that differentiates the adolescent from peers is regarded as a major stressor. Pain is a concern because it affects body image, but adolescents have more self-control than do younger children when it comes to dealing with pain. Restricted motor activity is an issue if it affects the adolescent's body image. Adolescents are able to tolerate separation from their material things better than they can tolerate the fear of altered body image

Which of the following factors should a nurse consider when managing the pain of a terminally ill child? Select all that apply. A. Pain medications are given on an as-needed schedule, and extra doses for breakthrough pain are available to maintain comfort. B. Opioid drugs, such as morphine, are given for severe pain, and the dosage is increased as necessary to maintain optimum pain relief. C. Addiction is a factor in managing terminal pain in a child, and the nurse plays an important role in educating parents that their child may become addicted. D. Nurses often express concern that administering dosages of opioids that exceed those with which they are familiar will hasten the child's death; in the principle of double effect. E. In addition to pain medication, techniques such as music therapy, distraction, and guided imagery should be combined with medications to provide the child and family strategies to control pain.

A. Pain medications are given on an as-needed schedule, and extra doses for breakthrough pain are available to maintain comfort. B. Opioid drugs, such as morphine, are given for severe pain, and the dosage is increased as necessary to maintain optimum pain relief. D. Nurses often express concern that administering dosages of opioids that exceed those with which they are familiar will hasten the child's death; in the principle of double effect. E. In addition to pain medication, techniques such as music therapy, distraction, and guided imagery should be combined with medications to provide the child and family strategies to control pain.

Children with disabilities or chronic illness and their families may have different methods of coping than those of healthy children. Often they have a resilience that is to be admired. Which of these statements reflect ways that they foster this resilience? Select all that apply. A. Protect the child from having to learn about his or her disability or illness on a repeated basis. B. Develop relationships with other children and their families with similar circumstances to build support. C. The parents set long-term goals to create a sense of hope. D. Focus on the child's strengths and encourage independence. E. Accept that chronic illness is part of livin

B. Develop relationships with other children and their families with similar circumstances to build support. D. Focus on the child's strengths and encourage independence. E. Accept that chronic illness is part of living

What strategies can the nurse suggest to help the family of a 5-year-old child prepare for transportation home from the ambulatory setting? Select all that apply. 1 Have a blanket or pillow in the car. 2 Take a basin or plastic bag along in case of vomiting. 3 Wait to give the prescribed pain medication until the child returns home. 4 Ensure that they take all personal items home with them from the ambulatory setting. 5 Carry the written discharge information regarding potential side effects of pain medication with them.

1,2 4,5 Strategies that the nurse can suggest to help the family of a 5-year-old child prepare for transportation home from the ambulatory setting include having a blanket or pillow in the car, taking a basin or plastic bag with them in case of vomiting, ensuring that they take all personal items home with them from the ambulatory setting, and carrying the written discharge information regarding potential side effects of pain medication with them. It is better to suggest giving the prescribed pain medications before the child leaves the ambulatory setting than it is to wait to give the prescribed pain medication when the child returns home.

The nurse is discharging a young child from the hospital. The nurse instructs the parents to look for which child behaviors after hospital discharge? Select all that apply. 1 Anger toward parents 2 Jealousy toward others 3 Resistance to go to bed 4 Tendency to cling to parents 5 Demands for parents' attention

3,4,5 Young children's behaviors after hospital discharge include showing initial aloofness toward parents; this may last from a few minutes (most common) to a few days. This is frequently followed by dependency behaviors such as a tendency to cling to the parents, demanding the parents' attention, vigorous opposition to any separation (e.g., staying at preschool or with a babysitter). Other negative behaviors include new fears (e.g., nightmares), resistance to going to bed, night waking, withdrawal and shyness, hyperactivity, temper tantrums, food peculiarities, attachment to a blanket or toy, and regression in newly learned skills (e.g., self-toileting). Behaviors after hospital discharge for older children include negative behaviors, emotional coldness followed by intense, demanding dependence on parents, anger toward parents, and jealousy toward others (e.g., siblings).

The parents of a young child tell the nurse that they cannot stay with their daughter during hospitalization. What can the nurse say to the parents that will help the child adjust to their absence? 1 "Children just need their parents. Can't you find a way to be here?" 2 "It'll be fine. Just buy some new toys from the hospital gift store." 3 "Young children like new toys much better than they do older ones." 4 "At this age children often need the comfort and reassurance of familiar toys from home."

4 Parents should bring favorite items from home for the child. Young children associate inanimate objects with significant people, and they gain comfort and reassurance from these items. Because the parents are leaving the objects at the hospital, the preschooler knows that the parents will return. Trying to guilt the parents into staying with the child after they have already said that they cannot stay will not help the child or parent adjust to hospitalization. New toys will not serve the purpose of familiar toys and objects from home.

A nurse hears the sibling of a hospitalized child saying, "We are sick of mom always sitting with you in the hospital and taking care of you, because we have to stay with the neighbors. It's not fair." What would be the nurse's assessment of the situation? 1 The sibling is jealous. 2 The sibling feels dejected. 3 The sibling hates the child. 4 The sibling is immature and spoiled.

1 A sibling of the hospitalized child may experience stress, fear, loneliness, and worry. The sibling might also feel jealous about the care given by the parents to the ill child and might resent it. There is no evidence of the sibling feeling dejected or depressed. There is also no evidence that the sibling hates the hospitalized child. The parent or the nurse should explain to the sibling why the mother is with the hospitalized child, and the needs of the sibling should be addressed. The sibling cannot be considered immature or spoiled because of this behavior, because feeling jealous is not uncommon.

During which phase of separation anxiety is a toddler most likely to cling to the parent? 1 Protest 2 Inactivity 3 Depression 4 Regression to earlier behavior

1 During the protest phase of separation anxiety the toddler is most likely to cling to the parent. Inactivity is characteristic of the despair stage. Depression and sadness are characteristic of the despair phase. Regression to earlier behavior is also a characteristic of the despair phase.

The nurse is caring for a 10-year-old child who has been hospitalized for an extended period of time. Which intervention by the nurse can help to minimize threats to the child's development and prevent regression? 1 Encourage the child to resume schoolwork. 2 Allow participation in activities with elders. 3 Allow access to wireless technology devices. 4 Ensure that a ready supply of snacks is available.

1 School activities are essential for the child's development. The nurse can encourage the child to resume schoolwork as quickly as the child's health permits. Adolescents who require prolonged hospitalization have unique developmental needs and may not want to share space with younger children. A 10-year-old would prefer using the "playroom" than having access to wireless technology devices. Adolescent food habits are not restricted to three meals a day, and a ready supply of snacks must be made available to them.

Which intervention by the nurse helps to reduce separation anxiety in a child placed in isolation? 1 Move the bed to a window with open shades. 2 Introduce staff to the child after donning masks. 3 Allow close family members to visit with their pet. 4 Provide the child with favorite soft toys from home.

1 The child's environment can be manipulated by moving the bed to a window with open shades. This helps to orient the child to time and place, minimize boredom, and stimulate the senses. The child in isolation has restricted visitors, and no pets are allowed in order to minimize the spread of infection. Caregivers should allow the child to see their faces and introduce themselves before donning masks. This increases familiarity and creates a bond with caregivers in the isolated environment. The child should be provided with disposable toys or toys that can be disinfected after every use.

The nurse is providing care for a child transferred to an intensive care unit. Which interventions does the nurse include in the child's plan of care? Select all that apply. 1 Informs the parents that they can call the unit at any time 2 Monitors the child's siblings' reactions during visits 3 Asks visitors to avoid loud, abrupt noises or loud talking 4 Explains the child's condition to the parents in simple terms 5 Tells the parents to leave the child alone to reduce disturbance

1,2,3,4 The nurse informs the parents that they can call the unit at any time to alleviate their anxiety and to encourage them to participate in the child's care. The nurse monitors siblings' reactions when they visit so that they are not overwhelmed. The nurse asks visitors to avoid loud noises or talking to reduce stimulation in the environment and reduce stress. The nurse explains the child's condition to the parents in simple terms so that they understand what has happened to the child. The nurse encourages parental visits and does not tell them to leave the child alone.

The nurse is preparing a school-age child for hospitalization. Which strategies does the nurse utilize? Select all that apply. 1 Describes the different aspects of hospital stay 2 Provides miniature hospital equipment for the child 3 Ensures that the child pays attention to the information 4 Answers any questions the child has about hospitalization 5 Does not tell the child about any unpleasant upcoming procedures

1,2,3,4 The nurse provides miniature hospital equipment for the child so that the child is comfortable and becomes familiar with the procedures. The nurse describes the different aspects of the hospital stay so that the child understands what to expect. The nurse answers any questions that the child has so that the child is not confused or anxious about any aspect of the hospital stay. The nurse ensures that the child pays attention to the information and tailors the preparation program according to the child's attention span. The child is informed about every procedure that will be performed.

The parent of a 4-year-old patient who is being admitted to the hospital asks the nurse why the nurse is asking so many questions. Which responses by the nurse are most appropriate? Select all that apply. 1 "This will give you an opportunity to ask questions as well." 2 "It is something we are required to do for every child who is hospitalized." 3 "Knowing more about your child can help predict how the hospital stay will go." 4 "It will help us provide the best care by gaining more information about your child." 5 "We can try to minimize some of the changes your child will be going through by knowing your child's routines."

1,2,4,5 The nurse explains that the reason there are so many questions is so that the parents get an opportunity to clarify any concerns they have regarding the treatment and condition. The nurse explains that it is necessary to collect information from all children who are being hospitalized. It is also important to collect as much information as possible in order to plan the best care. Knowing more about the child and the child's routines will help to minimize some of the changes that the child will be experiencing. Information collected will not help t

The nurse is providing care to a school-age child in an ambulatory setting. What are the benefits of ambulatory care? Select all that apply. 1 Increased cost savings 2 Reduced chances of infection 3 Reduced time for preparation 4 No separation anxiety in the child 5 Minimized stressors compared to hospitalization

1,2,4,5 A child in ambulatory care experiences fewer stressors, because the hospital stay is brief. The child also does not face separation anxiety, because the child returns home immediately after the surgery or procedure. The brief stay at the hospital ensures that there are fewer chances of acquiring hospital infections. Ambulatory care also decreases cost because of the brief stay. When the time needed for child preparation is reduced, children may experience more stress due to not being thoroughly acquainted with the procedure.

The nurse engages a child in play activities during the child's hospital stay. Which benefits of play does the nurse expect in the child? Select all that apply. 1 Encourages interaction 2 Cures developmental delays 3 Lessens the stress of separation 4 Makes the child feel more secure 5 Helps to develop positive attitudes

1,3,4,5 Play helps the child feel more secure, because it helps to normalize the child's environment. It also encourages interaction when the child plays with others. Play lessens the stress of separation, because it reduces homesickness. It also helps to develop positive attitudes in the child, because the child learns to interact and share with others. Developmental delays are prevented, not cured, by engaging the child in activities that are developmentally appropriat

A 2-year-old child has just been admitted to the hospital with pneumonia. The child is crying and visibly upset. The nurse is beginning to perform the physical assessment when the mother asks, "Would it be better if I left the room?" Which response by the nurse is most appropriate? 1 "If you want to run to the coffee shop, that would be great!" 2 "I can perform the assessment while you hug the child on your lap." 3 "Yes, please—children usually stop crying after just a few minutes." 4 "Whatever you want to do is fine. I just need to get this assessment done."

2 A 2-year-old child will feel safer sitting on the parent's lap while the nurse performs the assessment. Telling the parent to leave is not a developmentally appropriate response; therefore, the nurse should not tell the parent to step outside or go get coffee. Letting the parent choose is not appropriate because the parent asked the nurse for guidance. p. 672

When caring for children, which child does the nurse recognize as having an increased risk for poor coping strategies? 1 A child who is visited frequently by the family 2 A child undergoing multiple invasive procedures 3 A sick school-age child who loves board games 4 A teenager who is given information about physical status

2 Frequent hospitalizations and multiple invasive procedures increase the risk for poor coping strategies. Supportive behavior such as frequent visits from the family helps the child cope. The sick school-age child who overcomes boredom and physical restriction in the hospital by playing board games is able to cope well. Adolescents rely on nurses for anticipatory preparation to decrease fear and anxiety. A teenager who is provided information about health status copes better while in the hospital.

The nurse is providing care to a preschool child. The parents have left familiar toys with the child because of their inability to stay in the hospital. What further actions can the nurse take to help the child adjust to separation from the parents? 1 Tell the child to say prayers often. 2 Teach self-care skills to the child. 3 Teach the child to use the call bell. 4 Place an identification band on the toy.

4 The nurse can place an identification band on the toy so that the child feels that the toy is experiencing the same treatment. Teaching self-care to the child does not reduce the child's anxiety if the child misses the family. Teaching the child to use the call bell is more effective for an older school-age child who wants to learn new things and gain autonomy. For a younger child the presence of the nurse is more important, because it provides comfort. The nurse does not interfere with the spiritual beliefs of the child by asking the child to pray. Instead the nurse can ask the parents to provide the child with video recordings of family activities.

Arrange the steps in the order in which they are executed by the nurse when preparing for the discharge and home care of a hospitalized child. 1. Teach skills per the teaching plan 2. Maintain a record of teaching 3. Provide written instructions 4. Evaluate return demonstration 5. Follow up with home visit or telephone call 6. Assess the family and home environment

6. Assess the family and home environment 1. Teach skills per the teaching plan 4. Evaluate return demonstration 2. Maintain a record of teaching 3. Provide written instructions 5. Follow up with home visit or telephone call The nurse starts preparing for hospital discharge and home care during the admission assessment. A thorough assessment of the family and home environment is done first. This helps to ensure that the family's emotional and physical resources are sufficient to manage the tasks of home care. A discharge teaching plan is prepared, and the family is taught the skills required for care of the child. The family and the child are asked to return demonstration of each skill before a new one is taught. A record of teaching that evaluates the skill learned is maintained. The family is provided with written instructions about the execution of these skills. The discharge is followed up with a telephone call or a home visit.

When caring for a 4-year-old with a disability, the nurse notes that while encouraging the child to take part in his care, the mother constantly gives into the child, allowing him to have his own way. What anticipatory guidance can the nurse give to promote normalization in this relationship? A. "Giving in" is not a detriment to the child when he or she has a disability and limitations. B. Explain that when parents establish reasonable limits, children are likely to develop independence that is appropriate for their age and achievement equal to their limitations. C. Advise the parent to wait to explain any procedure to the child until they are at the health care setting or just before the procedure to avoid unduly upsetting the child. D. Have the parent realize that it would be unfair to the siblings to expect similar rules to apply to all of the children in the family.

B. Explain that when parents establish reasonable limits, children are likely to develop independence that is appropriate for their age and achievement equal to their limitations.