PrepUs for Pediatrics Chapter 29

Caregivers of a hospitalized toddler are being given safety instructions upon admission to the pediatric floor. Which action by the caregiver would be most important to the toddler's safety?

Keep the crib side rails up at all times. Many toddlers are climbers and are always curious. So side rails must be kept fully up at all times, except when direct care is being provided. If side rails are down, the nurse or caregiver must keep a hand firmly on the child. Providing a call button to a toddler is not a good idea since the child will be pushing it all the time. Beds and cribs are kept at the lowest setting to minimize the possibility of injury if the child does fall out.

A preschool teacher calls the hospital and wants to introduce the concept of a hospital to her preschool class in case they ever get sick and need to be admitted. What resources could the child life specialist provide for this group to aid in their learning? Select all that apply.

Let the children lie in the beds, use the call lights and practice being a patient. Provide a room for the class with hospital gowns, masks and equipment used on children. Tour the hospital, including the playrooms on the pediatric floors. Preschoolers are curious and love to manipulate the equipment used at the hospital. By making admission to the hospital less frightening for them, they will adjust better if they have to be admitted. Mentioning people not leaving the hospital indicates they died; this is scary to the children and inappropriate for this session. Children are never allowed to play with needles or syringes - it is too dangerous.

A school-aged child is in isolation at the hospital and her family members ask what they can do to help the child feel less lonely. What would the nurse suggest to this family? Select all that apply.

Have the child's classmates send cards to the child. Have parents bring the child's electronic game system. Draw a smile on the nurse's mask before entering the room. Being in isolation causes a child to feel lonely and depressed. Parents are encouraged to visit and bring items from home that the child likes to play with, such as a gaming system. Having classmates send cards makes the child feel that he or she is not forgotten. Since wearing a gown and mask may frighten a young child, doing something as simple as drawing a smile on the nurse's mask helps the child relax and often brings laughter.

A 5-month-old is hospitalized for dehydration. What can the nurse make with items found on the unit for an activity to distract the child?

A mobile using gauze and tongue blades For an infant, the nurse could make a mobile from gauze and tongue blades. The other options are for older children.

A 5-year-old scheduled for surgery in the morning wakes at 2 am and asks the nurse for something to eat and drink. What should the nurse tell this client?

That not having food or drink before surgery will prevent an upset stomach Children may better understand why they are NPO if they are told that food and drink are being withheld to prevent an upset stomach. During general anesthesia food and drink are withheld to prevent vomiting and aspiration, but a young child will not comprehend this information.

The nurse is caring for a preoperative pediatric client. What would it be best for the nurse to do with this client?

Determine how much the child knows and is capable of understanding. The nurse must determine how much the child knows and is capable of learning in order to best prepare the child for surgery. Keeping terminology at the child's and caregivers' level of understanding is important when doing teaching. Teaching the therapeutic plan is important, but it has to be done on the level of the child's and caregivers' knowledge and build on what they already know. The child going to surgery will be NPO, but the nurse needs to know on what level to teach the child the reason for this.

Which intervention is most important in assuring a child's cooperation and reducing his or her fear during an emergency room visit?

Having the parent stay with the child The most effective way to enlist a child's cooperation and reduce his or her stress in an emergency room visit is to have the parent remain with the child and comfort him or her.

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 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.

The nurse is caring for a 7-year-old boy who needs his left leg immobilized. What is the priority nursing intervention?

Explain to the boy that he must keep his leg very still. An explanation about the desired goal is necessary and appropriate for a 7-year-old child to understand what is required. In many cases, this will be all that is needed. Explaining that a restraint will be applied if the boy cannot hold still will likely be perceived as a threat or punishment. All alternative measures need to be tried before the use of restraints. Enlisting the assistance of the child life specialist is not a priority.

The nurse is caring for a 10-year-old girl who is in an isolation room. Which intervention would be a priority intervention for this child?

Provide age-appropriate toys and games. Children in this setting may experience sensory deprivation due to the limited contact with others and the use of personal protective equipment such as gloves, masks, and gowns. The nurse should stimulate the child by playing with her with age-appropriate toys/games. Reducing noise would be appropriate for sensory overload. The nurse should encourage the family to visit often, introduce himself or herself before entering the room, and allow the child to view his or her face before applying a mask.

A nurse asks a 5-year-old to use a color scale during a pain assessment. The nurse gives the child crayons and the child picks a red crayon to indicate the pain level. This indicates that the child is experiencing which level of pain?

most pain The color scale is used in children to assess pain. Yellow represents no pain, while the darkest color or red represents the most pain. The child selects the color that represents the amount of pain felt.

The nurse is caring for a preschooler who requires postsurgical breathing exercises. Which approach will best elicit the child's cooperation?

"Let's see who can blow these cotton balls off the table first." 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 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 approaches a client room and notes a sign stating the client is in droplet isolation. Which precautions would be appropriate for this client?

Gown, gloves and mask A client in droplet isolation has a disease that is spread by coughing and sneezing; anyone entering the room needs protection from the infected droplets. Droplet isolation requires a gown, mask and gloves for all people who enter come in contact with the client room.

A school-aged child needs to have an IV started. Where would be the best place for the nurse to perform this procedure?

In a treatment room All treatments are performed in a treatment room so the child's room remains a "safe zone" for the child. By maintaining the client's room as a safe place, the child is reassured that that nothing bad will happen when he or she is in the room. Procedures are never performed in public places such as a playroom to maintain the child's privacy. Distractions are provided in the treatment room.

The nurse is caring for several families in the home care setting. What additional team member will the nurse have available to assist in the home setting?

Unlicensed assistive personnel There are many health care team members who care for a child in the home setting. The nurse will likely have a home care assistant who is unlicensed but trained in helping with activities not requiring a license. The child would have access to the other options, but not in the home setting.

The nurse caring for a 6-month-old infant can best reduce the stress of hospitalization by:

supporting the parent in his or her presence and caregiving 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 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?

"Are you wondering about anything related to your tonsillectomy?" 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.

The pediatric nurse is caring for a child who is recovering after abdominal surgery several days ago. After the child's sutures are removed, the child asks the nurse, "Will my insides fall out now?" How should the nurse respond?

"Your insides are healed and the cut you see on the outside is not what it looks like inside." Children are often fearful that their insides will "fall out" when sutures are removed. The nurse should ease the child's fears and tell him or her that the wound has healed from the inside and that the child's insides will not fall out. The remaining answer choices are not correct as these do not address the child's fear.

The pediatric nurse is caring for a group of children. Which clinical situation will the nurse identify as being a safety concern?

Sleepy mother holding sleeping child at the child's bedside Safety is the priority for the pediatric nurse. The nurse should not allow a sleepy family member to hold a sleeping child because the family member may accidentally drop the child. Friction toys should not be allowed when supplemental oxygen is used; and a rubber ball would not be considered a friction toy. The infant who can stand should be placed in a crib with the top on it to prevent climbing out and an infant in a crib should have all railings in the up position.

The nurse is caring for a preschool aged child following abdominal surgery. Of the following nursing actions, which is the highest priority?

The nurse uses pain assessment tools. Pain is a concern of postoperative patients in any age group. Most adult patients can verbally express the pain they feel, so they request relief. However, infants and young children cannot adequately express themselves and need help to tell where or how great the pain is.

The nurse is caring for a hospitalized toddler who is prescribed bedrest. Which item(s) would the nurse recognize as appropriate for the toddler? Select all that apply.

Boxes to put toys in and/or take out toys Stacking blocks or small boxes to stack Nursery rhymes or sing-along songs on tape Hospitalized toddlers on bedrest benefit from toys that can be interacted with and that are age appropriate. Examples would be stacking boxes, blocks, and sing-along-songs or nursery rhymes. Small piece puzzles, coins, token, and marbles are a choking risk for the toddler. Fine print books and magazines are not age appropriate and would not be of interest to a toddler.

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?

Children this age often show regressive behaviors and have nightmares following hospitalization due to fear of another separation. 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.

A preschooler is admitted to the pediatric floor for dehydration and is frightened. Which nursing intervention would be least effective in alleviating the child's anxiety?

Explain all procedures using medical terminology. Using medical terminology will ensure that the child will not understand what is happening and only increase his or her anxiety. Allowing touching of equipment, assigning the child to the same nurse and encouraging caregivers to stay with the child all help alleviate anxiety and reduce the child's fears

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?

Remove one restraint at a time on a regular basis to check for skin irritation. Removing one restraint at a time provides for control of both hands. A long-sleeve shirt under the elbow restraints also protects 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 nurse is caring for a 10-year-old boy who is in traction. The boy has a nursing diagnosis of deficient diversional activity related to confinement in bed that is evidenced by verbalization of boredom and lack of participation in play, reading, and schoolwork. What would be the best intervention?

Enlist the aid of a child-life specialist. The nurse should enlist the aid of a child-life specialist to provide suggestions for appropriate activities. Offering the child reading materials or encouraging him to complete his homework would most likely be met with resistance as he has already verbalized his boredom and disinterest in play, reading, and schoolwork. The parents could offer the child life specialist ideas about the boy's likes and dislikes; however, the child life specialist could offer expertise in assisting hospitalized children.

Health care providers follow transmission-based precautions when caring for children with documented pathogens or children suspected of having highly transmissible pathogens. Which of the following are included in transmission-based precautions?

Airborne precautions Droplet precautions Contact precautions For clients documented or suspected of having highly transmissible pathogens, health care providers must follow transmission-based precautions. These precautions are in addition to the standard precautions. Transmission-based precautions include three types: airborne precautions, droplet precautions, and contact precautions.

The nurse is caring for an 8-year-old boy hospitalized for a bone marrow transplant. His parents are in and out of his room throughout the day. Which behaviors of the child would alert the nurse that he is in the second stage of separation anxiety?

He sits quietly and is uninterested in playing and eating. Separation anxiety consists of three stages—protest, despair, and detachment. In the protest stage, the child reacts aggressively to separation and exhibits great distress by crying, expressing agitation, and rejecting others who attempt to offer comfort. In the despair phase the child displays hopelessness by withdrawing from others, becoming quiet without crying, and exhibiting apathy, depression, lack of interest in play and food, and overall feelings of sadness. In the detachment stage the child shows interest in the environment, starts to play again, and forms superficial relationships with the nurses and other children. If the parents return, the child ignores them. A child in this phase of separation anxiety exhibits resignation, not contentment.

A 3-year-old who has just been admitted with pneumonia needs to have an intravenous (IV) line inserted for antibiotic therapy. What is the best nursing action?

Take the patient to the treatment room to have the IV inserted. Treatments should be performed in a treatment room, not in the child's room. Using a separate room to perform procedures promotes the concept that the child's bed is a safe place. Having the mother hold the child is helpful but not the best action in this case. It is very difficult for mother to hold her child still while the child is in pain and it is a negative emotional experience for the mother. Telling the patient that it will feel like a bee sting would only make the child more apprehensive and it is also not being truthful to the child.

The nurse suspects that an infant is experiencing pain postoperatively. What behaviors would validate this suspicion? Select all that apply.

Knees flexed Facial grimacing Rigid body posture An infant in pain will display physical cues to the nurse to indicate that he or she is in pain. Those include facial grimacing, knees drawn up, crying that is not easily consolable, acting active and fussy, stiffened posture, and elevated vital signs (heart rate and blood pressure). A heart rate of 100 bpm is normal for a child this age.

What can a nurse do during an emergency admission to alleviate some of the child's and family's fears/anxieties over the situation? Select all that apply.

Ask the family members health history questions while the child is being initially treated. Place an identification bracelet on the child, explaining that this will help the hospital staff know who he or she is at all times. Remain calm, explaining procedures to both the family and the client in a caring manner. Children who undergo an emergency admission to the hospital are often frightened and anxious, so the nurse needs to provide education about everything done to the child. Explaining the reason for the identification bracelet, involving the family in providing client information (if they cannot remain with the child), and describing what is being done to the child all help alleviate anxiety and fear in both parents and the child.

The nurse is preparing a hospitalized 7-year-old girl for a lumbar puncture. Which actions would help reduce her stress related to the procedure? Select all that apply.

Pretend to perform the procedure on her doll. Teach her the steps of the procedure. Introduce her to the health care personnel. Useful techniques for reducing stress in children include the following: perform nursing care on stuffed animals or dolls and allow the child to do the same, teach the child the steps of the procedure or inform him or her exactly what will happen during the hospital stay, introduce the child to the health care personnel with whom he or she will come in contact, avoid the use of medical terms, allow the child to handle some equipment, show the child the room where he or she will be staying, explain the sounds the child may hear, and let the child sample the food that will be served.

On the first postoperative day, a 4-year-old chld who was hospitalized for an emergency appendectomy has begun to cry relentlessly, will not let the nurse touch him or her, and keeps asking for the parent. The pediatric nurse is aware that this client is in which stage of separation?

Protest Separation anxiety is very real for the hospitalized child who is separated from parents or caretakers. Separation anxiety has three stages.This child is displaying symptoms of the first stage of separation, which is protest. The child reacts aggressively, cries and exhibits great distress. The child rejects others who would attempt to provide care or comfort. The second stage is despair. During this stage the child dispalys hopelessness, is quiet without crying and lacks any interest in play or food. The third stage is denial. During this phase the child is detached and has formed coping mechanisms to avoid any further emotional pain. Grief is not a stage of separation anxiety.

The nurse is caring for a 10-year-old child admitted for a surgical procedure to be done the next day. The nurse takes the child to a special area in the playroom and lets the child "start" an IV on a stuffed bear. This is an example of:

therapeutic play. Therapeutic play is a play technique used to help the child have a better understanding of what will be happening to him or her in a specific situation. It is nondirected and focuses on helping the child cope with feelings and fears. Positive reinforcement is offering praise for doing well so that the good behavior will happen again. Play therapy or emotional outlet play is used for the child to act out or dramatize life stressors. An age-related activity would be one where the play was directed to the ability of the child's age, such as a toddler stacking blocks.The 10-year-old child would have the capability to start the IV on the bear, but a toddler or preschooler would not.

A 6-year-old child will be hospitalized for a surgical procedure. How can the nurse best ease the stress of hospitalization for this child?

Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital. The best way to ease the stress of hospitalization is to ensure that the child has been well prepared for the hospital experience. Not only is the child's fear reduced but also the child has a better ability to cope. Preparation allows the child a better understanding of what's happening to him or her. Good preparation allows the child to see a hospital room, handle medical equipment and gain an understanding of procedures and hospital sounds. Another child would only give explanations from his or her point of view and that child may describe a negative experience. The child's favorite toy or blanket should come with the child to the hospital as a comfort to the child, but that does not prepare the child for hospitalization.

A 10-year-old is scheduled for an appendectomy in 6 hours. The child is placed on NPO status and wants to know why he cannot have anything to eat or drink. What is the best explanation by the nurse?

"We cannot give you anything to eat or drink before your procedure because we do not want you to get an upset stomach." Children may better understand why they are NPO if they are told that food and drink are being withheld to prevent an upset stomach.

A nurse is caring for a child on transmission-based precautions. What interventions can the nurse provide to prevent the child from feeling socially isolated? Select all that apply.

Encourage family members to spend time with the child and help them with maintaining precautions. Make sure the child understands the isolation precautions are not a punishment. Arrange to spend extra time in the room when performing treatments and procedures. The child must not think that being in a room alone is a punishment. The nurse should arrange to spend extra time in the room when performing treatments and procedures. While in the room, he or she might read a story, play a game, or just talk with the child, rather than going quickly in and out of the room. The nurse also should encourage family caregivers to spend time with the child and help them with gowning and other necessary precaution procedures so that they become more comfortable.

A nurse is admitting a 7-year-old child to the pediatric unit of the hospital. While the nurse is showing the child and parents the room and explaining where things are, the child becomes upset and frightened. What is the best action by the nurse?

Go slowly with the acquaintance process. The child who reacts with fear to well-meaning advances and who clings to the caregiver is telling the nurse to go slowly with the acquaintance process. The child who knows that the caregiver may stay is more quickly put at ease. To provide security for the child and to provide family-centered care, it is the responsibility of the nurse to form good partnerships with families. Asking the family to leave the room in this situation would only frighten the child more. The nurse should never provide false reassurance. Telling the child there is nothing to be afraid of or nothing will hurt him or her are promises the nurse cannot make to the child.

The nurse is preparing a postsurgical care plan for an infant girl 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?

Place the infant in a room close to the nurses' station. 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. That 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.

Which approach by the nurse best demonstrates the correct way to prepare a Hispanic child for a planned hospital admission?

Allow the child to put on surgical attire and "operate" on a doll to teach what will be happening. Allowing the child to put on surgical attire lets him or her see that hospital equipment is "not scary" and prepares the child for what will be seen on the day of surgery. Both the child and parents should be encouraged to ask questions. Honesty is the most important part of the program, so the nurse would never tell the child that the procedure will be painless because even the best care by the nurse may not eliminate all pain. Assuming that the family only speaks Spanish is inappropriate and could be considered profiling and rude. The nurse needs to determine the family's preference of language.

The pediatric nurse would use standard precautions in caring for which client on her floor?

An adolescent who has a broken arm Standard precautions involve avoidance of handling blood or body fluids from a client and involve use of personal protective equipment (PPE). In this case, with a fracture, there is minimal risk of exposure to body fluids so the nurse would wear gloves only. The other three clients would be in transmission-based precautions: airborne precautions for the toddler with chicken pox; contact precaution for the infant with diarrhea, or droplet precautions for the child with pertussis.

The nurse is preparing a family to visit their child, who has been admitted to the pediatric intensive care unit (PICU) following a motor vehicle accident. What actions by the nurse would reduce the family's anxiety? Select all that apply.

Ask the parents what the doctor has told them to ensure their understanding. Provide written information about visiting hours. Prepare the family for what the child will look like when they first visit. Parents need preparation for visiting their child in the PICU to help them and the child adjust to this serious medical situation. Providing information on visiting hours, following up on information provided to them by the physician, and preparing the family for the child's appearance (especially following a traumatic accident) will serve to reduce the family's anxieties. The nurse never tells family members that a child will be fine, nor would the nurse discourage toys or stuffed animals, which can provide emotional security.

The nurse is caring for a child who has been hospitalized for 6 days and whose caregivers are unable to stay with the child. The child cried most of the day for the first 3 days but now is quiet and withdrawn. This behavior in the child is an example of which stage of separation?

Despair Children often go through three characteristic stages of response to separation: protest, despair, and denial. When the caregiver does not appear, the child enters the second stage of despair. The child withdraws, is quiet without crying, is apathetic and depressed. The child has little interest in food or play and fails to react with health care personnel when they administer medications or perform procedures which are painful. Protest, denial and depression are not forms of separation anxiety.

A 5-year-old child is scheduled for hospitalization in 2 weeks. Which is the best intervention to help ease the stress of hospitalization in this child?

Encourage the family to participate in the child-life program. Many hospitals have a child-life program to make hospitalization less threatening for children and parents. The best way to ease the stress of hospitalization is to ensure that the child has been well prepared, and this can be done with such a program. The other options will help relieve some stress, but the child-life program is the best all-inclusive intervention. Having the parent explain the situation may not be best because the parents may be anxious also and they will not be able to perceive the situation from a child's perspective.

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 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.

When a child is hospitalized and must be away from the caregiver, the child goes through stages of response to the separation. The child who cries and refuses to let the nurse or anyone else provide comfort and is continually looking out the door to see if the caregiver is returning is in which stage of separation?

Protest Children often go through three characteristic stages of response to the separation: protest, despair, and detachment. During the first stage (protest), the young child cries, often refuses to be comforted by others, and constantly seeks the primary caregiver at every sight and sound. Despair is the second stage of separation. In this stage the child withdraws, is quiet without crying and becomes apathetic. Anger and denial are not included in stages of separation.

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. Play a game while in the room. Spend extra time to talk while in the room. 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. Quickly exiting the room and providing cluster care will increase social isolation and may make the child feel punished.

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?

Use of a highly structured format 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.