Peds midterm

An infant's mother does not visit her in the hospital for 3 days. The infant cries relentlessly for her during this time and then becomes extremely quiet and withdrawn. This reaction best indicates

development of a sense of despair.

The nurse is using blowing bubbles during a procedure with a child as an alternative pain-management technique. What type of alternative pain management is this considered?

distraction

The nurse is caring for a preschooler who knows she is dying. Her reaction to her impending death is most likely to be demonstrated through:

fear of being separated from her parents

To be an effective nurse with a female child who is dying, it is first necessary to:

identify your own reactions and feelings about death

According to Erikson, the psychosocial task of adolescence is developing:

identity

The feeling of guilt that the child "caused" the disability or illness is especially critical in which child?

Preschooler

The nurse is caring for a 5-year-old who is receiving daily antibiotic injections due to a wound infection. Which toy provides the most therapeutic play?

play syringe and doll

The psychologic effects of being obese during adolescence include:

poor body image

A 5-year-old is diagnosed with acute otitis media. Which nursing intervention would be a priority?

relief of pain

What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years?

separation anxiety

A school-aged child's parents are very upset about having to leave her alone in the hospital. How would you respond to their concern?

"If you can't stay, visiting as often as possible is the next best thing."

An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to:

Encourage parents to room in.

The nurse comes into the room of a child who was just diagnosed with a chronic disability. The child's parents begin to yell at the nurse about a variety of concerns. The nurse's best response is:

"Being angry is only natural."

The nurse is talking to the parent of a 13-month-old child. The mother states, "My child does not make noises like 'da' or 'na' like my sister's baby, who is only 9 months old." Which statement by the nurse would be most appropriate to make?

"I am going to request a referral to a hearing specialist."

The parents of a newborn say that their toddler "hates the baby . . . he suggested that we put him in the trash can so the trash truck could take him away." The nurse's best reply is:

"That is a normal response to the birth of a sibling. Let's look at ways to deal with this.

While hospitalized, a school-age child began sleepwalking. The nurse teaches the parents how to handle sleepwalking once the child is discharged. Which statement indicates that this teaching has been effective?

"We should wake the child up gently and return the child to bed."

A 9-year-old boy who is blind is admitted to the hospital. When serving him a meal in bed, which statement would be most appropriate to increase his self-esteem?

"You have a sandwich on your plate, a glass of milk to your right, and an apple to your left."

A 3-year-old girl is admitted to the hospital for treatment of cellulitis of the right thigh. She is accompanied by her parents, who appear to be upset and frightened. Which question would be most effective in eliciting information concerning the parents' understanding of why their daughter is being admitted to the hospital?

"You seem concerned; do you have questions about your child's admission?"

A child having myringotomy tubes placed asks, "How and when will the tubes be removed?" What is your best response?

"the tubes remain in place for 6-12 months until they come out by themselves"

The intravenous infusion line infiltrates on a child who is terminally ill, and his mother tells you that the nursing care in this hospital is the worst she has ever seen. What is your best response to her?

"you seem angrier today than before. Is something going on?"

Kimberly's parents have been using a rearward-facing, convertible car seat since she was born. The parents should be taught that most car seats can be safely switched to the forward-facing position when the child reaches which age?

2 years

The nurse is doing a prehospitalization orientation for Kayla, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that Kayla will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is:

An appropriate part of the child's preparation.

The nurse is preparing to conduct a health history with the parents of a preschool-age child admitted for an appendectomy. Which questions should the nurse plan to use to learn more about the child's ability to manage pain? (Select all that apply.) A. "How do you know when your child is in pain?" B. "Are you concerned about addiction to pain medication?" C. "Does your child use pain as a control mechanism?" D. "How does your child usually react to pain?" E. "What do you do for your child when your child is hurting?"

A. "How do you know when your child is in pain?" D. "How does your child usually react to pain?" E. "What do you do for your child when your child is hurting?"

The nurse plans to apply EMLA cream to decrease the pain of an injection. What would be the best technique

A. Apply it at least 1 hour before the procedure

The nurse is planning care for a school-age child being admitted to the hospital for a chronic illness. Which hazards of hospitalization for children will the nurse use to plan this patient's care? (Select all that apply.) A. Losing control over the environment B. Unsure of acceptable behavior C. Experiencing physical discomfort and pain D. Meeting new people E. Being separated from family, school, and friends

A. Losing control over the environment B. Unsure of acceptable behavior C. Experiencing physical discomfort and pain E. Being separated from family, school, and friends

What would be most effective in helping promote initiative and nutritional health for a preschooler? a. Giving the child a high carbohydrate snack after preschool. b. Praising the child for cleaning his large plate of food. c. Allowing the child to spread soft cheese on crackers. d. Encouraging the child to cut up small pieces of apple for a snack

Allowing they child to spread soft cheese on crackers

A 3-year-old girl is admitted to the hospital for eye surgery. You provide her with a doll and syringe for therapeutic play. She sticks the doll in the eye with the syringe and says, "You won't watch TV again when I tell you not to!" What is your best response to this?

Ask her if she thinks having surgery is punishing her.

A child is playing in the playroom. The nurse needs to take a blood pressure on the child. Which is the appropriate procedure for obtaining the blood pressure?

Ask the child to return to his or her room for the blood pressure, then escort the child back to the playroom.

The nurse is helping the parents explain to a toddler the need to go to the hospital for a tonsillectomy. When explaining the procedure to the child, which phrase should the nurse and parents avoid using?

B. "The bad tissue will be cut out of your throat.

The nurse is caring for an infant who will have surgery. What type of pain assessment would the nurse use?

B. Observation of facial and body actions

The nurse working in pediatrics is aware of the special needs of children related to pain assessment. What is the highest priority for the nurse to consider when completing a pain assessment?

C. Developmental age of child

A group of boys ages 9 and 10 years have formed a "boys-only" club that is open to neighborhood and school friends who have skateboards. This should be interpreted as:

Characteristic of social development of this age.

The teaching plan for the parents of a 3-year-old child with amblyopia ("lazy eye") should include what instruction?

Cover the "good" eye completely with a patch

A 6-year-old girl has a fractured left leg and has been crying. She denies having any pain while continuing to lie still without movement of the extremity. What should the nurse anticipate as the reason for this behavior?

D. She received an injection last time she was in the emergency room

The nurse is discussing with a parent group the importance of fluoride for healthy teeth. The nurse should recommend that the parents:

Determine whether water supply is fluoridated.

Which intervention will encourage a sense of autonomy in a toddler with disabilities?

Encourage independence in as many areas as possible.

The nurse is assessing a preschool-age child who is being hospitalized for the first time for a surgical procedure. The child expresses the desire to go home and is scared. Which nursing diagnosis should the nurse identify as appropriate for the child at this time?

Fear related to being away from home for first time

Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by:

Guilt and anger.

Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, "We are sick of Mom always sitting with you in the hospital and playing with you. It isn't fair that you get everything and we have to stay with the neighbors." The nurse's best assessment of this situation is that:

Jealousy and resentment are common reactions to the illness or hospitalization of a sibling.

A 9-year-old girl often comes to the school nurse complaining of stomach pains. Her teacher says that she is completing her schoolwork satisfactorily, but lately she has been somewhat aggressive and stubborn in the classroom. The school nurse should recognize this as:

Signs of stress.

A terminally ill child is awake at 2 AM and continues to put on the call light. What should the nurse do regarding this child's behavior?

Sit with the child until sleep comes

A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. The nurse should explain that:

Terminally ill children know when they are seriously ill.

The nurse is completing the teaching for parents of a toddler recovering from a fracture. Which outcome should the nurse identify to help determine if teaching has been effective?

The child waits for the parent to assist before walking down a set of stairs.

A 10-year-old boy develops bacterial conjunctivitis of the right eye. The eye is inflamed and drains a thick, yellow discharge. An important measure you would want to teach him is:

To clean the discharge away from the inner to outer canthus

What is helpful to tell a mother who is concerned about preventing sleep problems in her 2-year-old child?

Use a night-light in the child's room.

Which statement by a parent about a child's conjunctivitis indicates that further teaching is needed? a. "After taking the antibiotic for 24 hours, my child can return to school." b. "I'll have separate towels and washcloths for each family member." c. "I'll notify my doctor if the eye gets redder or the drainage increases." d. "When the eye drainage improves, we'll stop giving the antibiotic ointment."

When the eye drainage improves, we'll stop giving the antibiotic ointment.

The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which statement made by the caregivers best indicates a common aspect of the diet and nutrition of the preschool child? a. "My child is so picky and eats the same thing every day for days of end!" b. "Our child gets into food jags where she will only one food all day long." c. "My husband is insistent that our 5-year-old not eat any snacks so that he will eat all of his meals at mealtime." d. "My 4-year-old east as much as my adolescent does every day."

a. "My child is so picky and eats the same thing every day for days of end!"

Which interventions should the nurse plan when caring for a child with a visual impairment (select all that apply)? a. Describe the placement of the eating utensils on the meal tray. b. Touch the child upon entering the room before speaking. c. Identify noises for the child. d. Keep items in the room in the same location. e. Always use color to describe something to a child who has been blind since birth.

a. Describe the placement of the eating utensils on the meal tray. c. Identify noises for the child. d. Keep items in the room in the same location.

A nurse is instructing a nursing assistant on techniques to facilitate lipreading with a hearing-impaired child who lip-reads. Which techniques should the nurse include (select all that apply)? a. Speak at eye level. b. Keep sentences short. c. Speak words in a loud tone. d. Stand at a distance from the child. e. Use facial expressions while speaking.

a. Speak at eye level. b. Keep sentences short. e. Use facial expressions while speaking.

What should the nurse identify as major fears in the preschool child who is hospitalized with a chronic illness (select all that apply)? a. mutilation b. altered boby image c. being left alone d. bodily injury e. separation from peer group

a. mutilation c. being left alone d. bodily injury

When teaching a mother about amblyopia, it would be most important to explain that:

amblyopia is correctable if the child is properly treated before 6 years of age

Conscious sedation is a pain-management technique that is used with children. During conscious sedation for a preschooler, which action would be most important?

assess vital signs frequently, bc they can become depressed

Nursing students are reviewing information about preschooler growth and development. The students demonstrate understanding of the information when they identify which of the following as a common fear during this period? Select all that apply. a. Fear pf independence b. Fear of mutilation c. Fear pf abandonment d. fear of separation e. Fear of the dark

b. Fear of mutilation c. Fear of abandonment d. fear of separation e. Fear of the dark

The role of the peer group in the life of school-age children is that it:

b. Provides them with security as they gain independence from their parents.

What describes a toddler's cognitive development at age 20 months? a. Searches for an object only if he or she sees it being hiddenb. Realizes that "out of sight" is not out of reach b. Realizes that "out of sight" is not out of reach c. Puts objects into a container but cannot take them out d. Understands the passage of time such as "just a minute" and "in an hour"

b. Realizes that "out of sight" is not out of reach

The nurse is using a postoperative pain management scale to determine if a newborn recovering from emergency surgery is experiencing pain. Which observations indicate that the child is experiencing level 3 pain this time? (Select all that apply.) A. Baby is grimacing B. High-pitched cry C. Baby falls asleep for short periods and then wakes up crying D. Heart rate elevated to greater than 20% over the baseline E. Baby has not fallen asleep

b. high pitch cry d. heart rate elevated to greater than 20% over the baseline e. baby has not fallen asleep

A parent asks the nurse about how to respond to negativism in toddlers. The most appropriate recommendation is to:

c. Reduce the opportunities for a "no" answer.

The parent of a 4-year-old son tells the nurse that the child believes "monsters and the boogeyman" are in his bedroom at night. The nurse's best suggestion for coping with this problem is to: a. Insist that the child sleep with his parents until the fearful phase passes. b. Tell the child frequently that monsters and the boogeyman do not exist. c. Suggest involving the child to find a practical solution such as a night-light. d. Help the child understand that these fears are illogical.

c. Suggest involving the child to find a practical solution such as a night-light.

A nurse plans therapeutic play time for a hospitalized child. Which are the benefits of therapeutic play (select all that apply)? a. Gives the child a structured play environment b. Serves as method to assist disturbed children c. The nurse can gain insight into the child's feelings d. The child can deal with concerns and feelings e. Allows the child to express feelings

c. The nurse can gain insight into the child's feelings d. The child can deal with concerns and feelings e. Allows the child to express feelings

The most common type of hearing loss, which results from interference of transmission of sound to the middle ear, is called:

conductive

Which behavior is not normally demonstrated in the 8-year-old child? a. Understands that pouring liquid from a small to a large container does not change the amount b. Understands that his or her point of view is not the only one Correctc. Engages in fantasy and magical thinking d. Enjoys telling riddles and silly jokes

d. Engages in fantasy and magical thinking

A 4-year-old boy is hospitalized with a serious bacterial infection. He tells the nurse that he is sick because he was "bad." The nurse's best interpretation of this comment is that it is: a. Suggestive of maladaptation. b. Suggestive of excessive discipline at home. c. A sign of stress. d. Common at this age.

d. common at this age

A nurse is teaching adolescent boys about pubertal changes. The first sign of pubertal change seen with boys is: a. Voice deepens. b. Facial hair. c. Scrotal enlargement. d. Testicular enlargement.

d. testicular enlargement

A school-aged child needs 5 units of regular insulin administered. She is in the playroom when you are ready to give the injection. Your best action would be to

tell her to come outside the playroom for the injection.

A mother asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the mother?

the frequency of otitis media is reduced in breast-fed infants

The nurse is caring for an infant born with a congenital anomaly. Which of the following factors is likely to have the most influence on the mother's ability to cope with the infant's handicap?

the parents' amount of support