Pre-School EAQ
A 3-year-old child is hospitalized with nephrotic syndrome. The child has oliguria and generalized edema. What factor does the nurse identify that will have the greatest effect on the child's adjustment to hospitalization? 1 Lack of parental visits 2 Inability to select a variety of foods 3 Response of peers to the edematous appearance 4 Willingness to participate in cooperative play activities
1 Lack of parental visits Hospitalization is traumatic to the preschooler because of separation from significant family members. When parents are unable to visit, the nurse should make arrangements with the parents for daily contact. Preschoolers are not interested in food; children with nephrotic syndrome often have decreased appetites. Preschoolers are not concerned about attitudes of peers; it is too early in their social development to have this concern. Massive edema results in easy fatigability and a lack of interest in play.
A nurse is trying to involve a hospitalized preschooler in therapeutic play. Why is this so important? 1 The child can work out ways of coping with fears. 2 It provides an opportunity to accept the hospital situation. 3 The child can forget the reality of the situation for a little while. 4 It provides an opportunity to meet other children on the pediatric unit.
1 The child can work out ways of coping with fears. Because their ability to express feelings verbally is limited, preschool children act out their feelings in play. Acceptance of hospitalization will not occur until the child has coped with fears. The child needs to cope with feelings rather than forget them. Therapeutic play does not necessarily involve other children.
A nurse is teaching the parents of a 3-year-old child with a diagnosis of cystic fibrosis about their child's special needs. What statement indicates that the parents need further teaching about the issues related to cystic fibrosis? 1 "We'll have to air-condition the whole house." 2 "We'll have to move to a very warm climate." 3 "Our child will be taking pancreatic enzymes with meals." 4 "Our child will need skin care after each bowel movement."
2 "We'll have to move to a very warm climate." Hot climates are contraindicated for children with cystic fibrosis because sweating precipitates excessive loss of sodium chloride. Air conditioning is advisable because it will keep the child from sweating. Pancreatic enzymes are essential to aid digestion of nutrients so they can be absorbed by the intestinal mucosa. After passage of the feces associated with this disorder, the perianal area may become inflamed if it is not adequately cleaned.
A nurse accompanies a 3-year-old child to the pediatric unit's playroom. The toddler seems reluctant to select a toy or activity. Which toy is most appropriate for the nurse to offer as a means of fostering creativity? 1 Plastic animal 2 Molding clay 3 Pencil and paper 4 Simple video game
2 Molding clay Three-year-olds are entering the developmental stage of creative and imaginative play; using clay to make shapes enhances their creativity and improves their fine motor coordination. A plastic animal will probably be a boring toy for a 3-year-old child; a plastic animal is more appropriate for a 6- to 12-month-old child. A 3-year-old is too young to manipulate a pen or a pencil and may cause a self-injury or an injury to others. Pens and pencils should not be left in a playroom. A 3-year-old does not have the cognitive ability or the fine motor coordination to play even simple video games.
A preschool-age boy has been restricted to bedrest since being admitted to the hospital. As he begins to recover, he becomes interested in playing. In light of his developmental level and activity restriction, what should the nurse provide for him? 1 Television viewing time 2 Squeaky stuffed animals 3 Little cars and a shoebox garage 4 Simple three- or four-piece wooden puzzles
3 Little cars and a shoebox garage Little cars and a shoebox garage allow an active preschooler to move within restrictions and encourages use of the imagination. Unless carefully selected, many television shows are inappropriate and uninteresting for a 4-year-old. Although a 4-year-old may still cling to a security toy, it will not stimulate the child's imagination. Simple three- or four-piece wooden puzzles may provide the child with rest, but this activity is too simple for a child of this age and will not promote development.
When a nurse brings a dinner tray to a 4-year-old child hospitalized with pneumonia, the child says, "I'm too sick to feed myself." What is the best response by the nurse? 1 "Try to eat as much as you can." 2 "You can eat later when you feel better." 3 "Wait a few minutes, and I will be back to help you." 4 "You're really not that sick, and I'm sure you can feed yourself."
3 "Wait a few minutes, and I will be back to help you." A few minutes will be enough time for the child to begin self-feeding. The nurse should provide both physical and emotional support because the child's request for help indicates regression and the need for dependence during a period of stress. Telling the child to eat as much as he or she can does not provide the child with the help that may be needed. It may be a while until the child feels better; in the meantime, adequate nourishment to foster healing is needed. Telling the child that he or she is not that sick and can feed himself could cause stress, feelings of guilt, and embarrassment.
The parents of a 3½ -year-old tell the nurse that their child has become a "picky eater" and has not gained much weight. How should the nurse respond? 1 "This is not expected; your child may be sick." 2 "This is a fast growth period; you need to give your child vitamins." 3 "Your child is growing slower; preschoolers don't have large appetites." 4 "Preschoolers enjoy gifts; offer a reward when your child eats an entire meal."
3 "Your child is growing slower; preschoolers don't have large appetites." A period of slow growth is an expected occurrence. Growth slows after the first year of life, and preschoolers and toddlers eat less. Telling the parents the child may be sick may be alarming to the parents; decreased appetite does not necessarily indicate illness. Offering rewards for meals encourages manipulative behavior by the child.
Which type of play behavior does a preschooler exhibit? 1 Parallel play 2 Solitary play 3 Organized play 4 Associative play
4 Associative play Preschoolers engage in associative play, where they play with each other. Toddlers engage in parallel play, where they play beside each other without interacting. Infants engage in solitary play, where they play by themselves. School-age children engage in organized play.
A 3-year-old child is to receive a liquid iron preparation. What should the nurse teach the mother regarding this medication? 1 Monitor the stools for diarrhea. 2 Administer the iron at least an hour before meals. 3 Avoid giving the child orange juice with the iron preparation. 4 Have the child drink the diluted iron preparation through a straw.
4 Have the child drink the diluted iron preparation through a straw. A liquid iron preparation may stain tooth enamel; therefore it should be diluted and administered through a straw. Constipation, rather than loose stools, often results from the administration of iron. As a means of helping prevent gastric irritation, iron should be given with food. To improve absorption, iron may be given with orange juice.
A preschooler is to have a peripheral intravenous catheter inserted. How can the nurse make the experience minimally traumatic for the child? 1 By applying an epidermal analgesic before the procedure 2 By telling the child that the procedure will not cause pain 3 By having the parents leave the room during the procedure 4 By describing the procedure several hours before the catheter is inserted
1 By applying an epidermal analgesic before the procedure Topical analgesics are used to make catheter insertion less uncomfortable. Telling the child that the procedure will not cause pain is not truthful; even with the application of a topical analgesic there may be some discomfort. The presence of the parents may provide a sense of security and help the child cope with the procedure. Although a brief explanation is necessary to prepare the child for the procedure, it should be given just before the procedure is performed; several hours is too long for the child to wait.
A nurse is caring for a 4-year-old child with just-diagnosed cystic fibrosis. The child has been passing loose, bulky, foul-smelling stools and is in the third percentile for weight. What is the best explanation of the growth failure? 1 Impaired digestion and absorption because of the lack of pancreatic enzymes 2 Dyspnea and shortness of breath, which cause anorexia and disinterest in food 3 Increased bowel motility and diarrhea, which lead to inadequate absorption of nutrients 4 Pulmonary obstruction, which cause an oxygen deficit and inadequate tissue nourishment
1 Impaired digestion and absorption because of the lack of pancreatic enzymes Obstruction of the pancreatic duct and the absence of enzymes (e.g., trypsin, amylase, and lipase) to aid fat digestion and absorption lead to wasting of tissues and failure to thrive. Currently it is recommended that children with cystic fibrosis consume 150% to 200% of the calories recommended for their body weight. Despite dyspnea and shortness of breath, when feeling well these children have voracious appetites; the difficulty involves poor digestion and malabsorption of fats and fat-soluble vitamins. Increased bowel motility and diarrhea are not associated with cystic fibrosis. The pulmonary disease process leads to localized respiratory dysfunction, not to retarded physical growth.
A nurse is caring for a preschooler who is being prepared for surgery. What does the nurse expect to have the most influence on the child's response to hospitalization? 1 Fear of separation 2 Fear of bodily harm 3 Belief in death's finality 4 Belief in the supernatural
2 Fear of bodily harm Fear of mutilation is typical of preschoolers because they have vague views of body boundaries. Toddlers are more likely to fear separation from parents. Preschoolers do not view death as final. Although preschoolers do indulge in magical thinking, they have not yet developed the concept of supernatural beliefs.
