ThePoint Chapter 33 NCLEX Review Questions Maternity and Pediatric Nursing

b. regression Rationale: 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.

Parents are concerned because their 18-month-old will not 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: a.egocentrism b. regression c. negativism d. ritualism

a. discussing care and treatment with the parent and child together Rationale: 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 parent 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.

The nurse is caring for a technology-dependent school-age child in his home. Which action builds a trusting relationship? a. discussing care and treatment with the parent and child together b. changing the date and time of the child's physical therapy to fit the family schedule c. talking with the brother of the child who feels ignored d. encouraging the parents to join a support group

c. scheduling intravenous and respiratory therapy services needed by the child Rationale: Coordinating healthcare services such as IV and respiratory therapy is one of the case manager's functions. Helping a family member learn to preform a procedure belongs to the teaching role. Checking cleanliness of the home is part of assessing resources during discharge planning. Establishing eligibility for a Medicaid waiver is advocacy and resource management.

The nurse is providing home care for a 4-year-old client with a chronic respiratory illness. What would be a case management activity? a. assessing the cleanliness of the home b. teaching the grandparent how to do chest physiotherapy c. scheduling intravenous and respiratory services needed by the child d. establishing eligibility for a Medicaid waiver

b. scheduling respite care of the child with a child care provider Rationale: Scheduling the respite care is case management since it involves coordinating healthcare services. Teaching PROM and AROM skills to the parents helps them meet their child's physical care needs with the nurse assuming a teaching role. Finding ways to get homework to the child by working with parents and the child promotes the development of a trusting relationship. The nurse is providing direct care (not case management) in doing the complex sterile dressing changes.

The nurse is providing home care for an 8-year-old client who is dependent on a ventilator. What is a part of case management for the child and family.? a. teaching the parents how to do passive range of motion and active range of motion with their child b. scheduling respite care of the child with a child care provider c. problem solving with the parents and child ways to get the child's homework when the child is unable to attend school d. doing complex sterile dressing changes the child requires

a. "I will remind my child about needing an IV if my child does not drink." Rationale: The child is likely to view and 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 nurse is providing teaching for the parents of an 8-year-old client who has undergone surgery. The nurse emphasizes the important of maintaining adequate hydration. Which response by the parent would indicate a need for further teaching? a. "I will remind my child about needing an IV if my child does not drink." b. " Ice chips count as fluid intake. One cup of ice equals a half-cup of water." c. "Anything that melts at body temperature is counted as a fluid." d. " I should offer my child small amounts of fluid frequently."

c. stress equal to that of the affected child Rationale: 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 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 siblings may experience: a. resentment toward the parents b. jealously toward their ill brother or sister c. stress equal to that of the affected child d. guilt, believing they caused their brother's or sister's illness

c. helping the child modify physical activity requirements Rationale: Assisting the child in modifying the physical activity required is most likely to be a part of the individualized health plan. The nurse would record asthma episodes but probably not make a monthly report to the healthcare provider. The nurse would assist the 8-year-old with the medication regimen to promote self-care rather than administering the medications to the child. The child should have ready access to the inhaler. It would not be stored in the health office.

The school nurse is caring for an 8-year-old client with asthma. What is most likely to be a part of the child's individualized health plan? a. making a monthly report of the child's asthma episodes to the healthcare provider storing the child's asthma inhaler in the health office c. helping the child modify physical activity requirements d. giving the child the prescribed asthma medications

c. perineal and indwelling catheter care Rationale: School-agers are often quite uncomfortable with any type of sexually related examination or care. Modesty is well developed and privacy important. The nurse should handle perineal and catheter care in a sensitive manner. Teaching the parent to provide this care is helpful. The abdominal dressing change may cause the school-ager some concern but can be done discreetly, as can listening to breath and bowel sounds and changing hospital gowns

The 10-year-old client is hospitalized for bladder surgery will be most stress when nurses provide which care? a. abdominal dressing change b. change of the hospital gown c. perineal and indwelling catheter care d. auscultation of breath and bowel sounds.

b. about the ability to control one's own behavior Rationale: These questions point to anxiety about how the adolescent may act while having limited control of one's behaviors. It is likely the client does not want to appear "stupid, babyish, or uncool." All other factors are typical adolescent concerns that may surface during the hospital stay.

A 15-year-old client asks numerous questions about recovery from anesthesia and typical behaviors of someone awakening from sedation. The nurse interprets the concern of this adolescent to be: a. anxiety related to the surgical procedure itself b. about the ability to control one's own behavior c. adequacy of post surgical pain control d. about a change in body image

a. include the adolescent in a hospital tour for incoming clients, b. invite the adolescent to meet with other teens for lunch in a common space, d. challenge the adolescent to a video game in the recreation area Rationale: A video game in the "recreation area" is more appealing than investigating the "playroom." If only one activity space is available, avoid calling it the playroom to school-agers and teens. Arranging for teens to spend time together and socialize over lunch may stimulate appetites and new supportive friendships. Suggesting the adolescent leave the unit may not be safe based on his knowledge of the hospital or his condition. Doing so accompanied would be appropriate. If physically able, the adolescent will benefit from the social activity of being on the hospital tour; the staff member giving the tour will be able to keep an eye on participants.

An adolescent would benefit from being out of his hospital room. What can the nurse do to promote this? Select all that apply. a. include the adolescent in a hospital tour for incoming clients b. invite the adolescent to meet with other teens for lunch in a common space c. suggest the adolescent visit other areas within the hospital that are away from the pediatric unit d. challenge the adolescent to a video game in the recreation area e. encourage the teen to investigate the playroom

b. pulling a toy train, c. putting together a large-piece puzzle, and e. stacking blocks Rationale: Pulling a toy train encourages movement and the development of gross motor skills important to the toddler. Stacking blocks and putting together a puzzle uses fine motor skills and an understanding of shapes and space and are stimulating cognitively. Watching a mobile is appropriate for infants and may be unsafe if the toddler could reach it. Balloons are inappropriate in the hospital setting (latex sensitivity) and are an aspiration risk. Mylar balloons may be considered safe, although attached long strings or ribbons are not.

Development should continue during hospitalization. What play activities will the nurse choose for toddlers to accomplish this? Select all that apply. a. watching a mobile b. pulling a toy train c. putting together a large-piece puzzle d. batting balloons e. stacking blocks

b. supporting the parent in his or her presence and caregiving Rationale: All the actions by the nurse would be helpful in reducing stress. However, the 6-month-old infant, who prefers his parents to other caregivers, will be stressed the least by having that person available to provide basic care and give comfort.

The nurse caring for a 6-month-old infant can best reduce stress of hospitalization by: a. holding and rocking the infant b. supporting the parent in his or her presence and caregiving c. keeping the infant warm and dry d. providing opportunity for nonnutritive sucking

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

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

What will the nurse view as best maintaining normalcy in the life of a 10-year-old child who is experiencing a lengthy hospitalization? a. writing down the oral intake in the day and evening shift b. playing board games with the child life specialist c. choosing the time of one's bath or shower d. keeping up with schoolwork

b. blow a pinwheel and bubbles with the child Rationale: All of the measures have potential to get the child to cough and deep breath to some extent. The most playful and familiar methods of bubbles and a pinwheel will accomplish the most since they are likely to be accepted and even enjoyed.

A 6-year-old needs to cough and deep breathe following surgery. To accomplish this, the nurse will: a. arrange for respiratory therapy to do coughing and deep breathing exercises with the child b. blow a pinwheel and bubbles with the child c. instruct the parents to remind the child to cough and deep breathe every 2 hours d. teach the young school-ager to use an incentive spirometer

a. rehabilitation unit Rationale: The care in a rehabilitation unit involves an interdisciplinary approach that assists the child to reach his or her potential and achieve developmental skills. General inpatient unit stays for children are shorter and involve more acute conditions. The pediatric intensive care unit (PICU) specializes in caring for children in crisis. Isolation rooms are used for situations involving the risk for infection.

A child with a new prosthetic limb needs extensive care to learn how to use the prosthesis. Which unit or facility is best equipped to provide this care? a. rehabilitation unit b. isolation unit c. pediatric intensive care unit d. inpatient stay unit

c. "We told our child to use manners and behave like a big, brave child." Rationale: Expecting manners and big, brave 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.

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

a. place the infant in a room close to the nurses' station Rationale: 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. This 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 preparing a post surgical care plan for an infant 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? a. place the infant in a room close to the nurses' station b. put the infant in a carrier and bring her to a nurses' station c. ask the family to stay with the infant at all times d. place the infant in a room with an ambulatory adolescent

a. ask the client and/or family about any preferences in hair care or for usual procedures used Rationale: Due to the child's ethnicity, the hair is likely to require certain care measures. Often products are used to lubricate the hair and make it easier to handle. Wet hair is easier to comb and a wide-tooth comb is helpful. The family can bring any special preparations needed.

The nurse is providing hair care for a black 10-year-old client hospitalized with a painful disorder. What should the nurse do first? a. ask the client and/or family about any preferences in hair care or for usual procedures used b. use commercial detangling solutions prior to brushing c. dry the hair before combing d. condition the hair before shampooing

c. remove one restraint at a time on a regular basis to check for skin irritation Rationale: Removing one restraint at a time provides for control of both hands. A long-sleeve shirt under the elbow restraints also protect 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.

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? a. have the parent check for equal warmth bilaterally in his hands and fingers b. choose restraints long enough to fit closely under the arm and extend over the wrist c. remove one restraint at a time on a regular basis to check for skin irritation d. apply lotion to the skin prior to putting on the restraints

c. engage the parent in therapeutic hugging Rationale: Often therapeutic hugging will calm a child and keep the youngster still for a procedure. Asking the child to calm down or telling the child everyone is trying to help will not assist the child adequately for the child to be able to cooperate. Alternate measures should be tried before using a restraint, and the least restrictive type of restraint should be used. A mummy restraint is quite restrictive.

The nurse is preparing a 4-year-old child for a lumbar puncture. The child is extremely fearful and crying. The nurse needs to quickly gain the child's cooperation so the procedure can move forward as ordered. Which approach by the nurse would be best to be used? a. tell the child everyone is trying to help b. apply a mummy restraint c. engage the parent in therapeutic hugging d. explain to the child that she must calm down

d. body integrity Rationale: Preschoolers are very concerned about physically intrusive procedures. They lack understanding of the way in which 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 they do not produce the level of anxiety a preschooler feels when body integrity is threatened.

The nurse who wishes to be as supportive as possible to the hospitalized preschooler makes great effort to avoid threatening the 4-year-old's: a. food preferences b. creativity c. verbal skills d. body integrity

a. "Please bring the child to the clinic to be seen. You seem concerned." Rationale: 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 other responses do not accomplish this. With the vagueness of the parent, asking if someone else was present to describe the symptoms was reasonable, just not the best answer.

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

c. the client is quiet, looks sad, and is disinterested in playing Rationale: 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 return the child will ignore them and, instead, has formed superficial relationships with other caretakers. This third stage is seen frequently when family-centered care is in place.

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

a. ask the dietician to visit the child to help determine foods the child prefers, c. encourage the child to eat several smaller meals instead of fewer larger meals, d. assist the child to choose from the facility menu foods they like, and e. if approved by the healthcare provider, allow the parents to bring food from home for the child Rationale: Ensuring the child receives food preferences and rewarding the child with praise can help in increasing the intake when hospitalized. Children should never be forced or punished for not eating as this can cause an aversion for food that carries beyond the hospital stay into the home environment.

The nurse is caring for a 9-year-old child on an inpatient pediatric unit that is admitted for an extended stay. The child continually refuses meals. What can the nurse do to help increase the child's intake? Select all that apply. a. ask the dietician to visit the child to help determine foods the child prefers b. tell the child that their play time will be shortened is they don't eat c. encourage the child to eat several small meals instead of fewer larger meals d. assist the child to choose from the facility menu foods they like e. if approved by the healthcare provider, allow the parents to bring food from home for the child