Pediatrics/Maternity Ch 38

8. What intervention should the nurse implement when a 5 year old tells the nurse, "I need a Band-Aid" after having an injection. a. Apply a Band-Aid. b. Ask why he/she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show he/her that the bleeding has already stopped.

ANS: A Children in this age-group still fear that their insides may leak out at the injection site, even if the bleeding has stopped. Provide the Band-Aid. No explanation should be required.

2. When a preschool child is hospitalized without adequate preparation, what is the child may likely see hospitalization as? a. Punishment b. Threat to child's self-image c. An opportunity for regression d. Loss of companionship with friends

ANS: A If a toddler is not prepared for hospitalization, a typical preschooler fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds. Threat to child's self-image and loss of companionship with friends are reactions typical of school-age children. Regression is a response characteristic of toddlers when threatened with loss of control.

19. A previously "potty-trained" 30-month-old child has reverted to wearing diapers while hospitalized. The nurse should reassure the parents based on what knowledge concerning regressive behaviors? a. Regression is seen during hospitalization. b. Developmental delays occur because of the hospitalization. c. The child is experiencing urinary urgency because of hospitalization. d. The child was too young to be "potty-trained."

ANS: A Regression is expected and normal for all age-groups when hospitalized. Nurses should assure the parents this is temporary and the child will return to the previously mastered developmental milestone when back home. This does not indicate a developmental delay. The child should not be experiencing urinary urgency because of hospitalization and this would not be normal. Successful "potty-training" can be started at 2 years of age if the child is ready.

7. Latasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What intervention will help an 8 year old most in adjusting to a hospital admission? 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.

ANS: A School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for experiences that are unavoidable. The nurse should refer to the child by the preferred name. Telling the child about all of the limitations of visiting does not help him/her adjust to the hospital. At the age of 8 years, the child and parents should be oriented to the environment.

1. 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

ANS: A The major stress for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age-group.

4. A 10 year old, who needs to have another intravenous (IV) line started, keeps telling the nurse, "Wait a minute," and, "I'm not ready." How should the nurse interpret these requests? 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.

ANS: A This school-age child is attempting to maintain control. The nurse should provide the girl with structured choices about when the IV will be inserted. This can be characteristic behavior when an individual needs to maintain some control over a situation. The child is trying to have some control in the hospital experience. None of the other options accurately interprets the child's statement.

2. What is an age-appropriate nursing intervention to facilitate psychologic adjustment for an adolescent expected to have a prolonged hospitalization? (Select all that apply.) a. Encourage parents to bring in homework and schedule study times. b. Allow the adolescent to wear street clothes. c. Involve the parents in care. d. Follow home routines. e. Encourage parents to bring in favorite foods.

ANS: A, B, E Encouraging parents to bring in homework, street clothes, and favorite foods are all developmentally appropriate approaches to facilitate adjustment and coping for an adolescent who will be experiencing prolonged hospitalization. Involving parents in care and following home routines are important interventions for the preschool child who is in the hospital. Adolescents do not need parents to assist in their care. They are used to performing independent self-care. Adolescents may want their parents to be nearby, or they may enjoy the freedom and independence from parental control and routines.

1. A child has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and the child's condition is beginning to stabilize. When speaking with the parents, the nurses should expect which stressors to be evident? (Select all that apply.) a. Unfamiliar environment b. Usual day-night routine c. Strange smells d. Provision of privacy e. Inadequate knowledge of condition and routine

ANS: A, C, E Intensive care units, especially when the family is unprepared for the admission, are a strange and unfamiliar place. There are many pieces of unfamiliar equipment, and the sights and sounds are much different from a general hospital unit. Also, with the child's condition being more precarious, it may be difficult to keep the parents updated and knowledgeable about what is happening. Lights are usually on around the clock, seriously disrupting the diurnal rhythm. There is usually little privacy available for families in intensive care units.

4. A child is being discharged from an ambulatory care center after an inguinal hernia repair. Which discharge interventions should the nurse implement? (Select all that apply.) a. Discuss dietary restrictions. b. Hold any analgesic medications until the child is home. c. Send a pain scale home with the family. d. Suggest the parents fill the prescriptions on the way home. e. Discuss complications that may occur.

ANS: A, C, E The discharge interventions a nurse should implement when a child is being discharged from an ambulatory care center should include dietary restrictions being very specific and giving examples of "clear fluids" or what is meant by a "full liquid diet." The nurse should give specific information on pain control and send a pain scale home with the family. All complications that may occur after an inguinal hernia repair should be discussed with the parents. The pain medication, as prescribed, should be given before the child leaves the building, and prescriptions should be filled and given to the family before discharge.

5. A 6 year old, hospitalized again because of a chronic illness, is told by school-age siblings that, "We are sick of Mom always sitting with you in the hospital and playing with you. It is not fair that you get everything and we have to stay with the neighbors." What is the nurse's best assessment of the cause of the siblings' resentment? 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 the patient's illness and needs.

ANS: B Siblings experience loneliness, fear, worry, anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These are not uncommon responses by normal siblings. There is no evidence that the family has maladaptive coping or that the siblings lack understanding.

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

ANS: B A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible. Maintaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents. Contact with same-aged children would not substitute for having the parents present.

12. Which situation poses the greatest challenge to the nurse working with a child and family? a. Twenty-four-hour observation b. Emergency hospitalization c. Outpatient admission d. Rehabilitation admission

ANS: B Emergency hospitalization involves: (1) limited time for preparation both for the child and family, (2) situations that cause fear for the family that the child may die or be permanently disabled, and (3) a high level of activity, which can foster further anxiety. Although preparation time may be limited with a 24-hour observation, this situation does not usually involve the acuteness of the situation and the high levels of anxiety associated with emergency admission. Outpatient admission generally involves preparation time for the family and child. Because of the lower level of acuteness in this setting, anxiety levels are not as high. Rehabilitation admission follows a serious illness or disease. This type of unit may resemble a home environment, which decreases the child's and family's anxiety.

21. A nurse in the emergency department is assessing a 5-year-old child with symptoms of pneumonia and a fever of 102° F. Which intervention can the nurse implement to promote a sense of control for the child? a. None, this is an emergency and the child should not participate in care. b. Allow the child to hold the digital thermometer while taking the child's blood pressure. c. Ask the child if it is OK to take a temperature in the ear. d. Have parents wait in the waiting room.

ANS: B The nurse should allow the child to hold the digital thermometer while taking the child's blood pressure. Unless an emergency is life threatening, children need to participate in their care to maintain a sense of control. Because emergency departments are frequently hectic, there is a tendency to rush through procedures to save time. However, the extra few minutes needed to allow children to participate may save many more minutes of useless resistance and uncooperativeness during subsequent procedures. The child may not give permission, if asked, for a procedure that is necessary to be performed. It is better to give choices such as, "Which ear do you want me to do your temperature in?" instead of, "Can I take your temperature?" Parents should remain with their child to help with decreasing the child's anxiety.

3. A nurse plans therapeutic play time for a hospitalized child. Which are the benefits of therapeutic play? (Select all that apply.) a. Serves as method to assist disturbed children b. Allows the child to express feelings c. The nurse can gain insight into the child's feelings d. The child can deal with concerns and feelings e. Gives the child a structured play environment

ANS: B, C, D Therapeutic play is an effective, nondirective modality for helping children deal with their concerns and fears, and at the same time, it often helps the nurse gain insights into children's needs and feelings. Play and other expressive activities provide one of the best opportunities for encouraging emotional expression, including the safe release of anger and hostility. Nondirective play that allows children freedom for expression can be tremendously therapeutic. Play therapy is a structured therapy that helps disturbed children. It should not be confused with therapeutic play.

15. During the first 4 days of hospitalization, an 18 month old cried inconsolably when his/her parents left and he/she refused the staff's attention. Now the nurse observes that the child appears to be "settled in" and unconcerned about seeing his/her parents. How should the nurse interpret this change in behavior? a. The child has successfully adjusted to the hospital environment. b. The child has transferred their trust to the nursing staff. c. The child may be experiencing detachment, which is the third stage of separation anxiety. d. Because the child is "at home" in the hospital now, seeing his mother frequently will only start the cycle again.

ANS: C Detachment is a behavioral manifestation of separation anxiety. Superficially it appears that the child has adjusted to the loss and transferred his trust to the nursing staff. Detachment is a sign of resignation, not contentment. Parents should be encouraged to be with their child. If parents restrict visits, they may begin a pattern of misunderstanding the child's cues and not meeting his needs.

14. What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of intravenous (IV) antibiotics cries, screams, and resists having the IV restarted? a. Exit the room and leave the child alone until he stops crying. b. Tell the child big boys and girls "don't cry." c. Let the child decide which color arm board to use with the IV. d. Administer a narcotic analgesic for pain to quiet the child.

ANS: C Giving the preschooler some choice and control, while maintaining boundaries of treatment, supports the child's coping skills. Leaving the child alone robs the child of support when a coping difficulty exists. Crying is a normal response to stress. The child needs time to adjust and support to cope with unfamiliar and painful procedures during hospitalization. Although administration of a topical analgesic is indicated before restarting the child's IV, a narcotic analgesic is not indicated.

11. The nurse is caring for an adolescent hospitalized after 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."

ANS: C Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status; friends' visiting is an important aspect of hospitalization for an adolescent and would be very reassuring. Adolescents may welcome the opportunity to be away from their parents. The separation from siblings may produce reactions from difficulty coping to a welcome relief.

18. A school-age child, admitted for intravenous antibiotic therapy for osteomyelitis, reports difficulty in going to sleep at night. Which intervention should the nurse implement to assist the child in going to sleep at bedtime? a. Request a prescription for a sleeping pill. b. Allow the child to stay up late and sleep late in the morning. c. Create a schedule similar to the one the child follows at home. d. Plan passive activities in the morning and interactive activities right before bedtime.

ANS: C Many children obtain significantly less sleep in the hospital than at home; the primary causes are a delay in sleep onset and early termination of sleep because of hospital routines. One technique that can minimize the disruption in the child's routine is establishing a daily schedule. This approach is most suitable for noncritically ill school-age and adolescent children who have mastered the concept of time. It involves scheduling the child's day to include all those activities that are important to the child and nurse, such as treatment procedures, schoolwork, exercise, television, playroom, and hobbies. The school-age child with osteomyelitis would benefit from a schedule similar to the one followed at home. Requesting a prescription for a sleeping pill would be inappropriate, and allowing the child to stay up late and sleep late would not be keeping the child in a routine followed at home. Passive activities in the morning and interactive activities at bedtime should be reversed; it would be better to keep the child active in the morning hours and plan quiet activities at bedtime.

13. What is the primary disadvantage associated with outpatient and day facility care? a. Increased cost b. Increased risk of infection c. Lack of physical connection to the hospital d. Longer separation of the child from family

ANS: C Outpatient and day facility care do not provide extended care; therefore, a child requiring extended care must be transferred to the hospital, causing increased stress to the child and parents. Outpatient care decreases cost and reduces the risk of infection. Outpatient care also minimizes separation of the child from family.

9. Emma, age 3 years, is being admitted for about 1 week of hospitalization. The parents of a 3 year old being admitted tell the nurse that they are going to buy their child "a lot of new toys to help during the hospital." The nurse's reply should be based on an understanding of comfort measures for that age-group? a. New toys do 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.

ANS: C Parents should bring favorite items from home to be with the child. Young children associate inanimate objects with significant people; they gain comfort and reassurance from these items. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive.

17. A nurse is preparing to complete an admission assessment on a 2-year-old child who is sitting on the parent's lap. Which technique should the nurse implement to complete the physical examination? a. Ask the parent to place the child in the hospital crib. b. Take the child and parent to the examination room. c. Perform the examination while the child is on the parent's lap. d. Ask the child to stand by the parent while completing the examination.

ANS: C The nurse should complete the examination while the child is on the parent's lap. For young children, particularly infants and toddlers, preserving parent-child contact is the best means of decreasing the need for or stress of restraint. The entire physical examination can be done in a parent's lap with the parent hugging the child for procedures such as an otoscopic examination. Placing the child in the crib, taking the child to the examination room, or asking the child to stand by the parent would separate the child from the parent and cause anxiety.

20. The nurse needs to take a blood pressure on the child playing in the playroom. Which is the appropriate procedure for obtaining the blood pressure? a. Take the blood pressure in the playroom. b. Ask the child to come to the exam room to obtain the blood pressure. c. Ask the child to return to his or her room for the blood pressure, then escort the child back to the playroom. d. Document that the blood pressure was not obtained because the child was in the playroom.

ANS: C The playroom is a safe haven for children, free from medical or nursing procedures. The child can be returned to his or her room for the blood pressure and then escorted back to the playroom. The examination room is reserved for painful procedures that should not be performed in the child's hospital bed. Documenting that the blood pressure was not obtained because the child was in the playroom is inappropriate.

16. A 14-year-old boy is being admitted to the hospital for an appendectomy. Which roommate should the nurse assign with this patient? a. A 4-year-old boy who is first day postappendectomy surgery. b. A 6-year-old boy with pneumonia. c. A 15-year-old boy admitted with a vaso-occlusive sickle cell crisis. d. A 12-year-old boy with cellulitis.

ANS: C When a child is admitted, nurses follow several fairly universal admission procedures. The minimum considerations for room assignment are age, sex, and nature of the illness. Age-grouping is especially important for adolescents. The 14-year-old boy being admitted to the unit after appendectomy surgery should be placed with a noninfectious child of the same sex and age. The 15-year-old child with sickle cell is the best choice. The 4-year-old boy who is postappendectomy is too young, and the child with pneumonia is too young and possibly has an infectious process. The 12-year-old boy with cellulitis is the right age, but he has an infection (cellulitis).

10. The nurse is doing a prehospitalization orientation for a 7 year old, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that he/she will not be able to talk until the endotracheal tube is removed. What is the assessment of this explanation? a. It is unnecessary. b. It is the surgeon's responsibility. c. It is too stressful for a young child. d. It is an appropriate part of the child's preparation.

ANS: D This is a necessary part of preoperative preparation that will help reduce the anxiety associated with surgery. If the child wakes and is not prepared for the inability to speak, she will be even more anxious. It is a joint responsibility of nursing, medical staff, and child life personnel. This is a necessary component of preparation that will help reduce the anxiety associated with surgery.

3. 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

ANS: D When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurp individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that lessen their control and power. Infants, toddlers, and preschoolers, although affected by loss of power are not as significantly affected as are school-age children.