Lecture 1

Kimberly, age 3 years, is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding that: a. New toys make hospitalization easier. b. New toys are usually better than older ones for children of this age. c. At this age children often need the comfort and reassurance of familiar toys from home. d. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

c

A mother tells a nurse that her 22-month-old child says "no" to everything. When scolded, the toddler becomes angry and starts crying loudly. But then quickly runs to her mother's arms to be held. How does the nurse best interpret the toddler's behavior? a. The toddler is not effectively coping with stress. b. The toddler's need for attention is not being met. c. This is normal behavior for a child is around the age of 2 years. d. This behavior suggests the need for psychological therapy.

c

A nurse is teaching the parents of a 5-year-old child who requires daily oral medication how to administer it. Which of the following responses indicates a need for further teaching? a. "I should never refer to the medicine as candy." b. "We should never bribe our child to take the medicine." c. "He needs to take his medicine or he will lose a privilege." d. "We checked that the medicine can be mixed with yogurt or applesauce."

c

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to: a. Ask her why she wants to know. b. Determine why she is so anxious. c. Explain in simple terms how it works. d. Tell her she will see how it works as it is used.

c

An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to: a. Provide for privacy. b. Encourage parents to room in. c. Explain procedures and routines. d. Encourage contact with children the same age.

b

A 6-month-old infant is admitted to the peds unit for a 21-day course of antibiotic therapy. His parents can only visit on weekends. Which action indicates that the charge nurse understands the infant's emotional needs? a. The charge nurse places the infant in a 4-bed unit. b. The charge nurse places the infant in a room away from other children. c. The charge nurse assigns the infant to a different nurse each day. d. The charge nurse assigns the infant to the same nurse as often as possible.

d

A nurse is teaching a parent how to apply EMLA cream for the child who is frightened about having blood work performed at his healthcare provider's office after discharge from the hospital. The nurse knows the teaching is effective when the mother states, a. "I will apply the cream at least 20 - 30 minutes prior to arrival at the doctor's office." b. "I will massage the area where the cream is applied until it is all absorbed." c. "I will remove the bandage and rinse off any excess cream after 20 - 30 minutes." d. "I will apply the cream from the wrist to the shoulder on one arm only."

a

A nurse observes parents playing with their 10-month-old daughter. Which behavior indicates that the infant is developing object permanence? a. She looks for the toy that her parents hid under the blanket. b. She returns the play blocks to the same spot on the table. c. She recognizes that a ball of clay is the same object even when it is flattened. d. She bangs two cubes in her hands and throws them to the floor.

a

A nurse should expect a child at age 3 years to be able to perform which of the following actions? a. Ride a tricycle b. Tie shoelaces c. Roller skate d. Jump rope

a

Cecie, age 5 years, tells the nurse that she "needs a Band-Aid" where she had an injection. The best nursing action is to: a. Apply a Band-Aid. b. Ask Cecie why she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show Cecie that the bleeding has already stopped.

a

Four-year-old JJ appears to be upset by hospitalization. An appropriate intervention is to: a. Let JJ know that it is all right to cry. b. Give JJ time to gain control of himself. c. Show JJ how other children are cooperating. d. Tell JJ what a big boy he is to be so quiet.

a

It is time to give 3-year-old Markie's medication to him. Which approach is most likely to receive a positive response? a. "It's time for your medication now, Markie. Would you like water or apple juice afterward?" b. "Are you ready to take your medicine now, Markie?" c. "You have to take your medicine Markie, because the doctor says it will make you better." d. "See how nicely Andie took his medicine? Now it's your turn."

a

Jannie, a 10-year-old child needs to have another IV line started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." The nurse should recognize that: a. This is normal behavior for a school-age child. b. This behavior is usually not seen past the preschool years. c. The child thinks the nurse is punishing her. d. The child has successfully manipulated the nurse in the past.

a

Natasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What will help her most in her adjustment to the hospital? a. Explain hospital schedules such as mealtimes. b. Use terms such as "honey" and "dear" to show a caring attitude. c. Explain when parents can visit and why siblings cannot come to see her. d. Orient her parents, because she is young, to her room and hospital facility.

a

The nurse is assessing a 9 month-old infant for a well-baby check-up. Which of the following observations would be of most concern? a. The infant does not sit unsupported. b. The mother has not given him finger foods. c. The infant cries when the mother leaves. d. The infant cannot say "Mama" when he wants his mother.

a

. When administering an IM injection to an infant, the nurse should use which site? a. Dorsogluteal b. Vastus lateralis c. Deltoid d. Ventrogluteal

b

A term neonate weighs 7.5 lbs. (3 kg) at birth. The parents ask the nurse how much the child should weigh when he is 1-year-old. What is the best response by the nurse? a. 16 lbs. (7.33 kg) b. 22 lbs. (10 kg) c. 28 lbs. (12.7 kg) d. 32 lbs. (14.5 kg)

b

Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, "We are sick of Mom always sitting with you in the hospital and playing with you. It isn't fair that you get everything and we have to stay with the neighbors." The nurse's best assessment of this situation is that: a. The siblings are immature and probably spoiled. b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. c. The family has ineffective coping mechanisms to deal with chronic illness. d. The siblings need to better understand their sister's illness and needs.

b

An adolescent just had surgery and has a dressing on his abdomen. Which question should the nurse expect the patient to ask initially? a. "Did the surgery go OK?" b. "Will I have a big scar?" c. "What complications can I expect?" d. "When can I go back to school?"

b

For an 8-month-old infant, the nurse should plan to provide which toy to promote the infant's cognitive development? a. Blocks to stack b. Jack-in-the-box c. Small rubber ball d. Play gym strung across the crib

b

The nurse is assessing the pain level of an infant. Which of the following findings is not a typical physiologic indicator of pain? a. Decreased oxygen saturation b. Decreased heart rate c. Palmar sweating d. Plantar sweating

b

The nurse is preparing to assess the postsurgical pain level of a 6-year-old. The child has appeared unwilling or unable to accurately report his pain level. Which of the following assessment tolls would be most appropriate for this child? a. FACES Pain Rating Scale b. FLACC Behavioral Scale c. OUCHER Pain Rating d. Visual Analog and Numerical Scales

b

The nurse performs all of the following steps when administering an intramuscular injection to a 3-year-old except a. Clean the site with an antiseptic before administration of the medication. b. Insert the needle at a 45-degree angle. c. Position the child to relax the muscle. d. Have two adults restrain the child when giving the intramuscular injection.

b

What is an important consideration for the nurse who is communicating with a very young child? a. Speak loudly, clearly, and directly. b. Use transition objects such as a doll. c. Disguise own feelings, attitudes, and anxiety. d. Initiate contact with the child when a parent is not present.

b

Which age group is most concerned with body integrity? a. Toddler b. Preschooler c. School-age child d. Adolescent

b rational a. Toddler (This age group has other concerns such as being afraid of the nurse and medical equipment or of being "hurt.") b. Preschooler (This age group is most concerned about body integrity. They are afraid if the nurse or provider "sticks a hole in them" to start an IV or "cuts them open" during surgery that their inside parts will come out. That is why this age group likes bandaids and bandages so much. They believe that will fix the hole or cut in their skin and maintain body integrity. c. School-age child (This group has more concerns about loss of body function and loss of control.) d. Adolescent (This age group is concerned about scars not about the skin being open and blood, fluids, organs, cells coming out of their body.)

When providing nursing care to a preschooler, the nurse should remember that the child's major fear relates to: a. Separation from the parent. b. Unfamiliar experiences. c. Intrusive procedures d. Separation from friends.

c

The mother of a 11-month-old infant expresses concern about the effect of frequent thumb sucking on her child's teeth. After the nurse teaches her about this issue, which response by the mother indicates that the teaching has been effective? a. "Thumb sucking should be discouraged at 12 months." b. "I'll give my baby a pacifier so she won't use her thumb." c. "Sucking is important to my baby girl." d. "I'll wrap the thumb in a bandage."

c Rationale: A is incorrect because there is no reason that an infant should stop sucking at 12 months. Sucking is one way that infants soothe, comfort, and calm themselves. The age that a child should stop sucking their thumb is when they are old enough that other children would tease them or their secondary teeth begin to erupt. B is incorrect because it is OK for an infant or toddler to suck on their thumb, fingers, fist, arm, toes or any body part. C is correct because sucking is important for an infant at 11 months old. They still have that need to suck on a pacifier, thumb, bottle or breast. D is incorrect because wrapping a bandage around the thumb is a choking hazard. It will not prevent the infant from sucking on their thumb.

Which of the following opioid pain medications is not recommended for children because as the metabolite accumulates, the seizure threshold of the child is lowered? a. Codeine b. Fentanyl c. Methadone d. Meperidine

d

What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain

a

Which of the following is the best method to perform a physical assessment on a toddler? a. From abdomen to toes, then the head b. From least to most intrusive c. From head to toe d. Distally to proximally

b

When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as: a. Punishment for bad behavior b. A threat to the child's self-image c. An opportunity for regression d. Loss of companionship with friends

a

When introducing hospital equipment to a preschooler who seems afraid, the nurse's approach should be based on which principle? a. The child may think the equipment is alive. b. The child is too young to understand what the equipment does. c. Explaining the equipment will only increase the child's fear. d. One brief explanation is enough to reduce the child's fear.

a

A 9-year-old child needs to have another intravenous (IV) line started. The child keeps telling the nurse, "Wait a minute," and "I'm not ready." The nurse should recognize that: a. This is normal behavior for a school-age child. b. This behavior is usually not seen past the preschool years. c. The child thinks the nurse is confused about the procedure. d. The child has successfully manipulated health care providers in the past.

a

The nurse is providing postsurgical care for a 5-year-old. The nurse knows to avoid which of the following questions when assessing the child's pain level? a. "Would you say that the pain you are feeling is sharp or dull?" b. "Would you point to the cartoon face that best describes your pain?" c. "Would you point to the spot where your pain is?" d. "Would you please show me which picture best describes your hurt?"

a Rational: a. "Would you say that the pain you are feeling is sharp or dull?" (A 5-year-old child has difficulty describing how pain feels. They just know that it "hurts" and they want that feeling to go away.) b. "Would you point to the cartoon face that best describes your pain?" (A 5-year-old may be able to use the FACES scale or a simple scale with 3-5 different faces using no pain to a lot of pain. Children of this age typically choose either the face representing a pain level of zero or of 10. They usually cannot distinguish different levels of pain. So they usually do not choose the faces in the middle of the scale.) c. "Would you point to the spot where your pain is?" (The nurse would definitely ask the child to point to where the pain is located. This is easier for the child than verbally stating where the pain is located.) d. "Would you please show me which picture best describes your hurt?" (The rationale for this distractor is the same as for distractor "b.")

. A 14-month-old is admitted to the peds unit with a diagnosis of diarrhea. Which characteristics would the nurse expect the toddler to demonstrate if he is developing normally? Select all that apply. a. Strong hand grasp b. Tendency to hold one object while looking for another c. Recognition of familiar voices and smiles in recognition d. Presence of Moro reflex e. Weight that has tripled since his birth f. Closed anterior fontanel

a, b, c, e

When the nurse interviews an adolescent, it is especially important to: a. Focus the discussion on the peer group. b. Allow an opportunity to express feelings. c. Emphasize that confidentiality will always be maintained. d. Use the same type of language as the adolescent.

b

Which behavior by a preschool child indicates to the nurse that the child is in the appropriate stage of growth and development? a. He cries in protest when his mother leaves. b. He asks for a bandage after having blood drawn. c. He's upset about having a scar after surgery. d. He wants to know why his friends do not visit.

b

A nurse is teaching the parents of a 6-month-old infant about age-specific growth and development. Which statement is true regarding infant development? Select all that apply. a. A 6-month-old infant has trouble holding objects. b. A 6-month-old infant usually roll from prone to supine and supine to prone positions. c. A teething ring is appropriate for a 6-month-old infant. d. Head lag is commonly noted in infants at age 6 months. e. Lack of visual coordination usually resolves by age 6 months.

b, c, e

The nurse is assigned to care for a 14-year-old child who is hospitalized in traction for serious leg fractures after an automobile accident. The parents ask the nurse to avoid administering analgesics to their child to help prevent him from becoming addicted. What response by the nurse is indicated? a. "We can talk with the physician to see about reducing the amount of medications given to reduce the potential for addiction." b. "If there is no history of drug abuse in the family there should be no increased risk for the development of addiction." c. "Administering medications to manage complaints of pain is not going to cause addiction." d. "Your child is too young to experience drug addiction."

c

The nurse is caring for a 6-year-old boy hospitalized due to an infection requiring IV antibiotic therapy. The child's motor activity is restricted and he is acting out, yelling, kicking and screaming. Which of the following responses by the nurse would help promote positive coping? a. "Your medicine is the only way you will get better." b. "Let me explain why you need to sit still." c. "Would you like to read or play video games?" d. "Do I need to call your parents?"

c

The nurse is caring for a 7-year-old boy in a body cast. He is shy and seems fearful of the numerous personnel in and out of his room. How can the nurse help reduce his fear? a. Remind the boy he will be out of the hospital and going home soon. b. Encourage the boy's parents to stay with him at all times to reduce his fears. c. Write the name of his nurse on a board and identify all staff on each shift, every day. d. Tell him not to worry and explain that everyone is here to care for him.

c

The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which statement by the adolescent would be expected about separation anxiety? a. "I wish my parents could spend the night with me while I am in the hospital." b. "I think I would like for my siblings to visit me but not my friends." c. "I hope my friends don't forget about visiting me." d. "I will be embarrassed if my friends come to the hospital to visit."

c

Because of their striving for independence and productivity, which age group of children is particularly vulnerable to events that may lessen their feeling of control and power? a. Infants b. Toddlers c. Preschoolers d. School-age children

d

The nurse is doing a prehospitalization orientation for Diana, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that she will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is: a. Unnecessary. b. The surgeon's responsibility. c. Too stressful for a young child. d. An appropriate part of the child's preparation.

d

The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique might be most helpful? a. Suggest that the child keep a diary. b. Suggest that the parent read fairy tales to the child. c. Ask the parent if the child is always uncommunicative. d. Ask the child to draw a picture.

d

The nurse is performing preoperative teaching with a child and the parents. One of the parents say that the child is "dreading the shot" for premedication. The nurse's response should be based on the knowledge that: a. Pre-anesthetic medication can only be given intramuscularly. b. In children, the intramuscular route is safer than the intravenous (IV) route. c. The child will have no memory of the injection because of the effects of anesthesia. d. Pre-anesthetic medication should be "atraumatic," using oral, existing intravenous, or rectal routes.

d

The nurse is performing the initial morning assessment for a 9-year-old child. The vital signs are: Temperature- 98.2 orally; Heart rate - 70, Respirations - 24, Blood pressure - 100/60. Based on these findings, the nurse should a. Initiate a code b. Contact the rapid response team c. Notify the physician stat d. Continue with the initial assessment

d

The nurse is preparing to admit a preschool child for a tonsillectomy. How should the nurse establish rapport? a. "Let's take a look at your tonsils." b. "Do you understand why you are here?" c. "Are you scared about having your tonsils out?" d. "What's your cute stuffed dog's name?"

d

The nurse needs to take Junior's blood pressure for the first time. Which action would be best in gaining this preschool-age child's cooperation? a. Taking Junior's blood pressure when a parent is there to comfort him b. Telling Junior that this procedure will help him get well faster c. Explaining to Junior how the blood flows through the arm and why the blood pressure is important d. Permitting Junior to handle equipment and see the dial move before putting the cuff in place.

d

You are caring for a preschooler who is hospitalized with a suspected blood disorder & receives an order to draw a blood sample. Which of the following would be the best way to approach the child for this procedure? a. "I need to take some blood." b. "We need to put a little hole in your arm." c. "I need to remove a little blood." d. "Why don't you sit on your mom's lap?"

d