PEDS: Chapter 29: Hospitalized Child

Question 15 of 20 A young child has been admitted to the hospital and is displaying signs of the second stage of separation response. Which behavior by the child demonstrates this stage? The child: begins to take interest in the surroundings and accepts the situation. cries loudly, refusing to be comforted by others. refuses to engage with the caregivers. lies in the bed, looking at the wall.

Correct response: lies in the bed, looking at the wall. Explanation: In the second stage of the separation response, despair, the child is apathetic and listless. In the first stage of separation, protest, the child cries loudly and latches onto the caregiver, refusing to let others hold them. In the third stage of separation, denial, the child appears to be accepting of his circumstances and shows interest in his environment but rejects the primary caregivers.

Question 20 of 20 The nurse is caring for a 3-year-old child at an outpatient pediatric clinic. The child asks her mother, "What is a hospital?" Which statement by the child's mother requires additional teaching? "It is where mommies go to have babies." "It is where sick people go sometimes." "Sometimes people go there to get a boo boo fixed." "Doctors and nurses work there to help people who are sick or with boo boo's."

Correct response: "It is where mommies go to have babies." Explanation: It is important that the child understands that hospitals are more than just a place where mommies go to have babies. The child should be told that it is a place where sick people go sometimes, where "boo boo's" are fixed, and where doctors and nurses work.

Question 10 of 20 A nurse realizes that a child's hospitalization is stressful for the family for which reasons? Select all that apply. Disruption in family life A child-life program Guilt about the illness The illness's treatment Past experiences of illness and hospitalizations Cause of the illness

Correct response: Cause of the illness The illness's treatment Guilt about the illness Past experiences of illness and hospitalizations Disruption in family life Explanation: The child's family suffers stress for several reasons: the cause of the illness, its treatment, guilt about the illness, past experiences of illness and hospitalizations, disruption in family life, and the threat of the child's long-term health. A child-life program helps to make hospitalizations less threatening for children and their parents.

Question 11 of 20 On the first postoperative day, a 4-year-old who was hospitalized for an emergency appendectomy has begun to cry relentlessly, will not let the nurse touch her, and keeps asking for her mother. The pediatric nurse is aware that this patient is in which stage of separation? Protest Denial Grief Despair

Correct response: Protest Explanation: The patient is in the first stage of separation, which is protest. The second stage is despair, and the third stage is denial. Grief is not a stage of separation.

Question 9 of 20 An adolescent is scheduled for outpatient arthroscopic surgery on his knee next week. As part of preparing him for the procedure, which action would be most appropriate? Providing detailed explanations of the procedure at least a week in advance of the procedure Discussing the events with the adolescent and his mother upon arrival the morning of the procedure Answering the adolescent's questions with simple answers, encouraging him to ask the surgeon Encouraging the parent to stay with the adolescent as much as possible before the procedure

Correct response: Providing detailed explanations of the procedure at least a week in advance of the procedure Explanation: The adolescent needs a detailed explanation about the procedure at least 7 to 10 days beforehand. Waiting until the morning of the procedure would be inappropriate. However, information could be clarified and additional questions could be answered at this time. Having the parent stay with the adolescent is something that the adolescent would need to decide; he may or may not want a parent present. Referring the adolescent to the surgeon for his questions is inappropriate and ignores the adolescent's desire for control and information.

Question 17 of 20 A novice pediatric nurse learns about the care provided in the pediatric unit. Which action(s) will the nurse demonstrate in regards to care in the pediatric unit? Select all that apply. Serve the child's food outside of his room. Encourage family members to stay at the child's bedside during procedures. Strictly enforce visiting hours to encourage rest. Encourage the child to wear his own clothes. Transport the child to the treatment room for any procedures.

Correct response: Transport the child to the treatment room for any procedures. Serve the child's food outside of his room. Explanation: Children admitted to the pediatric unit are encouraged to wear their own clothing, as appropriate. Meals are often served outside the child's room. Treatments are always provided in a treatment room, ensuring that the child's room is a "safe" place. Family and visitors are encouraged to visit and stay with the child often, which means visiting hours are not always enforced. Because procedures are always performed in a procedure room, the nurse will not encourage family members to stay at the client's bedside during procedures.

Question 2 of 20 The nurse caring for a 6-month-old infant can best reduce the stress of hospitalization by: keeping the infant warm and dry. providing opportunity for nonnutritive sucking. holding and rocking the infant. supporting the parent in his or her presence and caregiving.

Correct response: supporting the parent in his or her presence and caregiving. Explanation: 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.

Question 4 of 20 An adolescent would benefit from being out of his hospital room. What can the nurse do to promote this? Select all that apply. Challenge the adolescent to a video game in the recreation area. Invite the adolescent to meet with other teens for lunch in a common space. Encourage the teen to investigate the playroom. Suggest the adolescent visit other areas within the hospital that are away from the pediatric unit.

Correct response: Invite the adolescent to meet with other teens for lunch in a common space. Challenge the adolescent to a video game in the recreation area. Explanation: 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.

Question 1 of 20 Microorganisms are sometimes spread by what is called a vehicle. Of the following, which would fit into this category of transmission? Select all that apply. Microorganisms spread by food Microorganisms spread by water Microorganisms spread by mosquitoes Microorganisms spread by direct contact Microorganisms spread by blood

Correct response: Microorganisms spread by food Microorganisms spread by water Microorganisms spread by blood Explanation: Microorganisms are spread by contact (direct, indirect, or droplet), vehicle (food, water, blood, or contaminated products), airborne (dust particles in the air), or vector (mosquitoes, vermin) means of transmission.

Question 19 of 20 The public health nurse is choosing to focus community education for parents of young children about awareness of the hospital. When is the best time to educate the children about the hospital? When the children are capable of understanding basic functions of community resources When the children are capable of understanding death and dying When the children begin to recognize emergency workers When the children begin to show interest in emergency vehicles

Correct response: When the children are capable of understanding basic functions of community resources Explanation: The best time to educate the children about awareness of the hospital is when the children are capable of understanding the basic function of community resources. Children do not fully understand death and dying until later in childhood and it is not necessary to know in order for younger children to understand hospitals. Showing interest and recognizing emergency workers and vehicles does not mean the children are capable of understanding the function of the hospital.

Question 2 of 20 The nurse is admitting a 14-year-old girl for a tonsillectomy and is preparing her for the procedure. Which of the following is the best statement or question? "Some of the sounds in the hospital can be scary." "Are you wondering about anything related to your tonsillectomy?" "Are you feeling scared about the surgery?" "I have your discharge instructions for you."

Correct response: "Are you wondering about anything related to your tonsillectomy?" Explanation: For a 14-year-old girl, the best approach would be to ask an open question so that concerns, lack of understanding, or a need for information can be determined. Asking if the teen feels "scared" may get a "yes" or "no" response, which may or may not be honest depending on what the teen expects of herself or believes others expect of her. An adolescent is often reluctant to admit fear. Mentioning scary hospital sounds provides no information and is inappropriate developmentally. Introducing discharge instructions needs to come later after other needs are met. Some discharge information is covered during admission since tonsillectomy is usually day surgery.

Question 18 of 20 A mother of a recently discharged preschooler calls the pediatric floor that provided care to her child a week ago. She reports that the child is having elimination accidents, temper tantrums and is waking up at night with nightmares. How should the nurse respond to the mother's concerns? Reassure her that this is typical behavior following a traumatic event and she needs to pay more attention to him. Children this age often show regressive behaviors and have nightmares following hospitalization due to fear of another separation. The entire family needs to spend more time with the child, directing their attention to him. Recommend that she sternly tell the child to quit acting out or he will be punished.

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

Question 14 of 20 A mother is scheduled for rooming-in with her infant prior to discharge from the hospital. The nurse realizes that rooming-in is done for what purpose? To allow the infant to bond with the parent Take overall care of the infant in the hospital Allow the caregiver to practice treatments and procedures that will be necessary once the infant is home Reduce the cost of the hospital stay since rates for rooming-in are less

Correct response: Allow the caregiver to practice treatments and procedures that will be necessary once the infant is home Explanation: Rooming-in allows parents and caregivers the opportunity, under nursing supervision and guidance, to provide care and perform treatments that will be necessary after discharge. There is no reduction of cost for rooming-in. The caregivers do not take over care of the child and the infant is already bonded to the parent.

Question 16 of 20 A nurse is inspecting the surgical dressing on a school-age child and notes that there is bloody drainage on it. What actions should the nurse take? Draw a circle around the drainage with a permanent marker, recording the date and time on it. Change the dressing, initial it, then chart it. Reinforce the dressing and tape it down securely. Remove the dressing and keep it to show the physician.

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

Question 6 of 20 The nurse is caring for a 4-year-old girl who has been hospitalized for over a week with severe burns. Which would be a priority intervention to help satisfy this preschool child's basic needs? Encourage friends to visit as often as possible. Explain necessary procedures in simple language that she will understand. Allow her to make choices about her meals and activities as much as permitted. Suggest that a family member be present with her 24 hours a day.

Correct response: Explain necessary procedures in simple language that she will understand. Explanation: Preschoolers fear mutilation and are afraid of intrusive procedures since they do not understand the body's integrity. They interpret words literally and have an active imagination; therefore, procedures should be demonstrated and/or explained in simple terms. Adolescents typically do not experience separation anxiety from being away from their parents; instead, their anxiety comes from being separated from friends, and therefore encouraging friends to visit is a priority intervention. Toddlers are especially susceptible to separation anxiety and would benefit from a family member being present as much as possible. School-age children are accustomed to controlling self-care and typically are highly social; they would benefit from being involved in choices about meals and activities.

Question 18 of 20 The nurse is planning care for a child who is admitted to the hospital requiring isolation due to the risk of organism transmission. The nurse determines the child's diagnosis is powerlessness related to separation. Which action(s) will the nurse implement in response to the child's nursing diagnosis? Select all that apply. Maintain a schedule of activities the child enjoys Encourage the child to plan the timing of meals and snacks, as appropriate Encourage the child to perform exercises as appropriate to the child's condition Suggest to the child's mother to have classmates send the child notes Ensure nursing interventions allow for frequent contact with the child

Correct response: Maintain a schedule of activities the child enjoys Encourage the child to plan the timing of meals and snacks, as appropriate Explanation: A child admitted to the pediatric unit is at risk for separation anxiety and distress, especially if the child must be maintained in an isolation environment. It is important that the nurse collaborates with the child, involving him or her in the plan of care. Maintaining a schedule of activities the child enjoys and encouraging the child to plan the timing of meals and snacks, as appropriate are methods that best encourage collaboration with the child in response to the child's powerlessness related to environmental isolation precautions. Suggesting the child's classmates send notes and ensuring frequent contact with the child are interventions appropriate in response to the child's isolation; however, these actions do not encourage the collaboration of the child and are not most appropriate. Encouraging the child perform exercises is appropriate for diversional activity related to isolation; however, this does not allow the child the feeling of being in control of his or her own care and is not the most appropriate action.

Question 13 of 20 A nurse is admitting a 7-year-old to the hospital. The child's parents will be unable to stay with him. What can the nurse do to help the child meet his developmental, emotional, and intellectual needs? Make a referral to the child-life program. Provide constant one-on-one care for the child. Allow the child to interact with other children on the unit. Tell the parents that one of them will have to stay with the child.

Correct response: Make a referral to the child-life program. Explanation: Many hospitals have a child-life program to make hospitalization less threatening for children and their parents. These programs are usually under the direction of a child-life specialist whose background is in psychology and early childhood development. This person works with nurses, physicians, and other health team members to help them meet the developmental, emotional, and intellectual needs of hospitalized children.

Question 12 of 20 What is the primary purpose for rooming-in on pediatric units? Helping with basic care Being there for the child when the nurse is busy Assisting the nurse during staff shortages Providing security and stability

Correct response: Providing security and stability Explanation: The primary caregiver's role when rooming-in is to provide security and stability for the child. Nurses should avoid creating a situation in which they appear to expect primary caregivers to perform as health care technicians. Caregivers can help care for their children, but this is not their primary role in the hospital.

Question 7 of 20 The nurse is caring for an 8-year-old girl who requires numerous venipunctures and injections daily. The nurse understands that the child is exhibiting signs of sensory overload and enlists the assistance of the child-life specialist. What should the therapeutic play involve to best deal with the child's stressors? Sewing puppets with needles Wooden hammer and pegs Puppets and dolls Drawing paper and crayons

Correct response: Sewing puppets with needles Explanation: The nurse understands that the child may benefit from supervised needle play to assist the child undergoing frequent blood work, injections, or intravenous procedures. The child life specialist can determine what form of therapeutic play is best, but the nurse can recommend interventions based on his or her knowledge of the specific child.

Question 6 of 20 A 6-year-old with leukemia is placed on reverse isolation. What nursing actions could prevent depression and loneliness in this client? Select all that apply. Read a story while in the room. Spend extra time to talk while in the room. Do all nursing tasks at one time. Play a game while in the room. Quickly exit the room when possible.

Correct response: Spend extra time to talk while in the room. Read a story while in the room. Play a game while in the room. Explanation: A child on isolation is subject to loneliness, which can be prevented by arranging to spend extra time in the room during treatments. Also, while in the room the nurse might read a story, play a game, or just talk to the child. The other options will increase social isolation and may make the child feel punished.

Question 5 of 20 Development should continue during hospitalization. What play activities will the nurse choose for toddlers to accomplish this? Select all that apply. Stacking blocks Batting balloons Pulling a toy train Watching a mobile Putting together a large-piece puzzle

Correct response: Stacking blocks Pulling a toy train Putting together a large-piece puzzle Explanation: 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.

Question 8 of 20 After teaching a group of students about therapeutic play, the instructor determines that additional teaching is needed when the students identify what as a characteristic of therapeutic play? Dramatization of emotions Expression of feelings Use of a highly structured format Focus on coping

Correct response: Use of a highly structured format Explanation: Therapeutic play is nondirected play, focused on helping the child cope with feelings and fears. Real-life stressors and emotions can be acted out or dramatized, allowing the child to express his or her feelings.

Question 3 of 20 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: creativity. verbal skills. food preferences. body integrity.

Correct response: body integrity. Explanation: 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 are not as anxiety-producing when threatened as is body integrity.