ch 11: nursing considerations for the hospitalized child

15) The nurse is working with an adolescent client who will be admitted to the hospital in two days. Which nursing approach is most appropriate to prepare this client for hospitalization? 1. Have teens who have had similar experiences talk to the adolescent about hospitalization. 2. Provide an opportunity for the child to talk with an adult who has had a similar experience. 3. Teach parents what to expect so the information can be shared with the adolescent. 4. Provide an opportunity for the teen to try on surgical attire

Answer: 1 Explanation: 1. Adolescents benefit from a different approach than younger children when being prepared for hospitalization. Written materials, anatomically correct dolls, and talking to peers who have had similar experiences are all appropriate for the adolescent. The adolescent should be taught first-hand what to expect during the hospitalization. Dressing up in surgical attire is appropriate for the younger child. page ref: 233

6) The nurse is working with a school-age child who is hospitalized. Which action by the nurse will promote a sense of industry in this child? 1. Allow the child to assist with her care. 2. Encourage parents to participate in the child's care. 3. Give the child a detailed scientific explanation of the illness. 4. Speak to the child in a high-pitched voice.

Answer: 1 Explanation: 1. Allowing the child to participate in her care will decrease the sense of loss of control and increase a sense of industry. While parents can certainly participate in their child's care, it does not increase the child's sense of control. School-age children in general will not understand detailed scientific explanations. Change in voice tone is appropriate when talking to very young children. page ref: 225-227

11) The nurse is working with a hospitalized preschool-age child. The nurse is planning activities to reduce anxiety in this child. Which action by the nurse is the most appropriate? 1. Provide the child with a doll and safe medical equipment. 2. Read a story to the child. 3. Use an anatomically correct doll to teach the child about the illness. 4. Talk to the child about the hospitalization

Answer: 1 Explanation: 1. Therapeutic play is a means of anxiety reduction in the hospitalized child. Allowing the child to play with safe medical equipment is an age-appropriate method through which the child can express her feelings, thereby reducing anxiety. Anatomically correct dolls are not age appropriate. Reading a story to the child does not allow for expression of feelings. Talking to the child may be beneficial, but it does not allow for active release of frustration and anxiety as active play does. page ref: 235

17) The nurse is providing care to a preschool-age client who was admitted to the medical-surgical unit after an acute asthma attack. Which interventions foster a family-centered focus to client care? Select all that apply. 1. Discussing rooming in with the parents of the client 2. Allowing the client to "cry it out" after the parents leave for the evening 3. Providing comfort items from home, such as a blanket 4. Maintaining strict visitation for the family 5. Discussing what to expect during the hospital stay

Answer: 1, 3, 5 Explanation: 1. Family-centered care principles that are used in the hospital setting include rooming in, providing comfort items from home, and discussing what to expect. Allowing the child to "cry it out" and maintaining strict visitation for the family are not family-centered principles. page ref: 230-231

18) Match the behaviors with its stage of separation anxiety the child may exhibit. A. Protest B. Despair C. Denial 1. Withdrawal or compliant behavior 2. Appearance of being happy and content with everyone 3. Clinging to parents 4. Lack of protest when parents leave 5. Screaming and crying 6. Sadness

Answer: 1/B, 2/C, 3/A, 4/C, 5/A, 6/B 1. Despair 2. Denial 3. Protest 4. Denial 5. Protest 6. Despair Explanation: The stages of separation anxiety include: Protest-Screaming, crying, clinging to parents, and may resist attempts by other adults to comfort them. Despair-Sadness, quiet, appear to have "settled in," withdrawal or compliant behavior, and crying when parents return. Denial-Lack of protest when parents leave, appearance of being happy and content with everyone, show interest in surroundings, and close relationships not established. Page Ref: 227

19) The child was just transferred to the postanesthesia unit (PACU) and report given. The nurse has performed baseline vital signs, the child is stable and pain is under control. What should the nurse do next? 1. Document 2. Allow the parents to visit the child 3. Discharge the child 4. Look for signs of infection 5. Offer clear liquids

Answer: 2 Explanation: 1. This is not the next task the nurse should perform. 2. If the child is stable and pain is under control, the nurse should allow the parents to visit with the child. 3. The child has just come to the PACU, the normal amount of time in the PACU is at least one hour. 4. The vital signs and operative area will be monitored throughout the child's time in PACU. 5. The child has just been transferred to PACU, the child will be offered liquids when fully awake. Page Ref: 224

1) The parents of a critically injured child wish to stay in the room while the child is receiving emergency care. Which action by the nurse is the most appropriate? 1. Escort the parents to the waiting room and assure them that they can see their child soon. 2. Allow the parents to stay with the child. 3. Ask the physician if the parents can stay with the child. 4. Tell the parents that they do not need to stay with the child.

Answer: 2 Explanation: Parents should be allowed to stay with their child if they wish to do so. This position is supported by the Emergency Nurses Association and is a key aspect of family-centered care. page ref: 227-228

2) The charge nurse on a hospital unit is developing plans of care related to separation anxiety. The charge nurse recognizes that which hospitalized child at highest risk to experience separation anxiety when parents cannot stay? 1. 6-month-old 2. 18-month-old 3. 3-year-old 4. 4-year-old

Answer: 2 Explanation: While all of these children can experience separation anxiety, the young toddler is at highest risk. Toddlers are the group most at risk for a stressful experience when hospitalized. Separation from parents increases this risk greatly page ref: 224

12) The nurse needs to administer a medication to a preschool-age child. The medication is only available in tablet form. Which action by the nurse is the most appropriate? 1. Place the tablet on the child's tongue and give the child a drink of water. 2. Break the tablet in small pieces and ask the child to swallow the pieces one by one. 3. Crush the tablet and mix it in a teaspoon of applesauce. 4. Crush the table and mix it in a cup of juice

Answer: 3 Explanation: A 4-year-old is not mature enough to swallow a pill or pieces of a pill. The medication should be crushed and mixed with a very small amount of food, not juice page ref: 234

7) The nurse is caring for a client in the pediatric intensive-care unit (PICU). The parents have expressed anger over the nursing care their child is receiving. Which nursing intervention is most appropriate based on the situation? 1. Ask the physician to talk with the family. 2. Explain to the parents that their anger is affecting their child so they will not be allowed to visit the child until they calm down. 3. Acknowledge the parents' concerns and collaborate with them regarding the care of their child. 4. Call the chaplain to sit with the family.

Answer: 3 Explanation: Hospitalization of the child in a pediatric intensive-care unit is a great stressor for parents. If the parents feel that they are not informed or involved in the care of their child, they may become angry and upset. Calling the physician or chaplain may be appropriate at some point, but the nurse must assume the role of supporter in this situation to promote a sense of trust. Telling the parents that they cannot visit their child will only increase their anger page ref: 227-229

4) A preschool-age client is seen in the clinic for a sore throat. In this child's mind, what is the most likely causative agent for the sore throat? 1. Was exposed to someone else with a sore throat. 2. Did not eat the right foods. 3. Yelled at his brother. 4. Did not take his vitamins

Answer: 3 Explanation: Preschool-age children understand some concepts of being sick but not the cause of illness. They are likely to think that they are sick as a result of something that they have done. They will frequently view illness as punishment. A child of this age does not yet understand that he can become sick from exposure to someone else who is sick. The other two answers, while not causes of sore throat, can be factors in some illnesses but are beyond the thinking of a 4-year-old. page ref: 226-227

8) A toddler recently diagnosed with a seizure disorder will be discharged home on an anticonvulsant. Which action by the mother best demonstrates understanding of how to give the medication? 1. Verbalizing how to give the medication 2. Acknowledging understanding of written instructions 3. Drawing up the medication correctly in an oral syringe and administering it to the child 4. Observing the nurse draw up the medication and administering it to the child.

Answer: 3 Explanation: Verbalization of how to give the medication and acknowledging understanding of written instructions are methods that might be used, but they do not actually demonstrate understanding. Observing the nurse draw up and administer the medication may be used in the teaching process. The best way for the mother to demonstrate understanding is to actually draw up and give the medication. page ref: 234

13) A child is being discharged from the hospital after a 3-week stay following a motor vehicle accident. The mother expresses concern about caring for the child's wounds at home. She has demonstrated appropriate technique with medication administration and wound care. Which nursing diagnosis is the priority in this situation? 1. Knowledge Deficit of Home Care 2. Altered Family Processes Related to Hospitalization 3. Parental Anxiety Related to Care of the Child at Home 4. Risk for Infection Related to Presence of Healing Wounds

Answer: 3 Explanation: While all of the diagnoses might have been appropriate at some point, the current focus is the mother's anxiety about caring for the child at home. The priority of the nurse is relieving this anxiety. page ref: 244-245

16) The nurse is providing care to a school-age client who is admitted to the hospital after a motor vehicle accident. Which interventions are appropriate to prepare this client and family for their hospital stay? Select all that apply. 1. A hospital tour 2. A health fair brochure 3. An orientation to the unit 4. An age-appropriate explanation of procedures 5. A child life program consultation

Answer: 3, 4, 5 Explanation: Interventions that are appropriate for this client and family are those that occur as the result of an unplanned hospital admission. The nurse would orient the client and family to the unit and provide age-appropriate explanation for all procedures. It is also appropriate for the nurse to consult with the child life program. A hospital tour and a health fair brochure are appropriate interventions for a planned hospitalization. page ref: 230-231

3) A group of children on one hospital unit are all suffering separation anxiety. Which child is experiencing the despair stage of separation anxiety? 1. Does not cry if parents return and leave again 2. Screams and cries when parents leave 3. Appears to be happy and content with staff 4. Lies quietly in bed

Answer: 4 Explanation: Children in the despair stage appear sad, depressed, or withdrawn. A child who is lying in bed might be exhibiting any of these. Screaming and crying are components of the protest stage. The young child who appears to be happy and content with everyone is in the denial stage, as is the child who does not cry if parents return and leave again. page ref: 225-226

10) A young school-age client is in the playroom when the respiratory therapist arrives on the pediatric unit to give the child a scheduled breathing treatment. Which action by the nurse is the most appropriate? 1. Reschedule the treatment for a later time. 2. Show the respiratory therapist to the playroom so the treatment may be performed. 3. Escort the child to his room and ask the child-life specialist to bring toys to the bedside. 4. Assist the child back to his room for the treatment but reassure the child that he may return when the procedure is completed.

Answer: 4 Explanation: Procedures should not be performed in the playroom. Scheduled respiratory treatments should be performed on time; however, the child should be allowed to return to the playroom as soon as the procedure is completed. page ref: 235

14) An infant has been NPO for surgery for 4 hours and does not have an intravenous line. The nurse receives a call from the operating room with the information that the surgery has been postponed due to an emergency. Which action by the nurse is the most appropriate? 1. Feed the infant 4 ounces of formula. 2. Reassure the parents that it will not be much longer before surgery. 3. Allow the parents to feed the infant an ounce of oral rehydration solution. 4. Call the physician to see if the infant needs to have an intravenous line started

Answer: 4 Explanation: The infant who is NPO is at high risk for dehydration. The nurse does not know how much longer it will be before surgery. The nurse cannot independently make the decision to feed the infant. Feeding the infant could further postpone the surgery, should an operating room become available sooner than expected. It is best to keep the infant NPO and consult the physician to see if an intravenous line is needed. page ref: 235-238

5) The charge nurse is concerned with reducing the stressors of hospitalization. Which nursing intervention is most helpful in decreasing the stressors for the toddler-age client? 1. Assign the same nurse to the toddler as much as possible. 2. Let the child listen to an audiotape of the mother's voice. 3. Place a picture of the family at the bedside. 4. Encourage a parent to stay with the child

Answer: 4 Explanation: While all of the interventions are appropriate for the hospitalized toddler, presence of a parent is most important. Separation from parents is the major stressor for the hospitalized toddler. page ref: 224-225

9) The nurse must perform a procedure on a toddler. Which technique is the most appropriate when performing the procedure? 1. Ask the mother to restrain the child during the procedure. 2. Ask the child if it is okay to start the procedure. 3. Perform the procedure in the child's hospital bed. 4. Allow the child to cry or scream

Answer: 4 Explanation: While the toddler will need to be restrained, the parent should not be the one to do this. The nurse should avoid giving the child a choice if there is no choice. The treatment room should be utilized for the procedure so that the hospital bed remains a safe place. The child should be allowed to cry or scream during the procedure page ref: 235