CAQ: Pediatric Hospitalization
How should a nurse respond to parents who are concerned about separation anxiety in their 15-month-old toddler? 1 "This is an expected developmental reaction." 2 "You may be spending too much time with your child." 3 "It might be helpful to leave your child with someone once in a while." 4 "Toddlers who have separation anxiety may have difficulty when they start school."
1- "This is an expected developmental reaction." Understanding that separation anxiety is an expected developmental occurrence will be reassuring to the parents. Commenting that the parents may be spending too much time with their child is a value judgment and does not address this expected stage of development. Giving advice is not therapeutic and does not address the child's separation anxiety. There is no connection between separation anxiety in a 15-month-old child and difficulty starting school.
On the third day of a 2-year-old toddler's hospitalization the nurse notes that the child, who had been screaming and crying inconsolably, has begun to regress and is now lying quietly in the crib with a blanket. What stage of separation anxiety has developed? 1 Denial 2 Despair 3 Mistrust 4 Rejection
1-Denial The second stage of separation anxiety is despair, in which the child is depressed, lonely, and uninterested in the surroundings. The third stage of separation, denial or detachment, occurs later as hospitalization becomes prolonged. The child is suffering from separation anxiety, which does not include a stage of mistrust or of rejection.
Which parental statement regarding the use of car safety seats for a toddler-age child indicates the need for further education by the nurse? 1 "I should follow the manufacturer instructions regarding use." 2 "I should allow my child to ride unrestrained for short car trips." 3 "I should allow my child to have a toy for quiet play while in the car." 4 "I should encourage my child to help attach the buckles."
2- "I should allow my child to ride unrestrained for short car trips." Toddler-age children should never be allowed to ride in a motor vehicle unrestrained, even for short car trips. This statement indicates the need for further education. The parental statements regarding following manufacturer instructions, allowing the child to have a toy for quiet play, and encouraging the toddler to assist with buckles all indicate correct understanding.
Two 3-year-old clients are playing together in a hospital playroom. One is working on a puzzle, and the other is stacking blocks. Which type of play are these children participating in based on this scenario? 1 Solitary play 2 Parallel play 3 Associative play 4 Cooperative play
2-Parallel play Parallel play is when two or more children play together, each engaute ging in his or her own activities. Solitary play is when a child plays alone. Infants' play style is described as solitary. Cooperative play is when children demonstrate the ability to cooperate with others and to play a part in order to contribto a unified whole. The school-age child participates in cooperative play.Associative play is characterized by children interacting in groups and participating in similar activities.
The nurse is providing education to the parents of a preschool-age client who is experiencing a severe fear of the dark. Which treatment option should the nurse share with the parents during the teaching session? 1 Prescription medication 2 Electroconvulsive therapy 3 Intensive therapy sessions 4 Repetition of brave statements
4- Repetition of brave statements Repetition of brave statements is a treatment option that the nurse should share with the parents of a preschool-age client who experiences severe fear of the dark. Prescription medication, electroconvulsive therapy, and intensive therapy sessions are not appropriate treatment options for the nurse to share with this client's parents.
What is the most common cause of death among adolescents? 1 Suicide 2 Homicide 3 Accidents 4 Substance abuse
3-Accidents Accidents are the most common cause of death in adolescents; approximately 74% of all adolescent deaths are caused by accidents. Suicide is the third leading cause of death in adolescents. Homicide is the second leading cause of death in adolescents. Death by substance abuse affects 30% of adolescents.
According to Freud's theory, in what order do the stages of child development occur? 1..Anal 2..Oral 3..Genital 4..Oedipal 5..Latency
Freud's theory sets forth five stages of child development. The oral stage (stage 1) spans the period from birth to 12 to 18 months. The anal stage (stage 2) occurs between the ages of 18 months and 3 years. The Oedipal stage (stage 3) occurs between 3 and 6 years of age. The latency stage (stage 4) occurs between the ages of 6 and 12 years. Finally, the genital stage (stage 5) lasts from puberty through adulthood.
The nurse educates the parents of a toddler-age client regarding play and toys appropriate for this stage of development. Which parental responses indicate correct understanding of the information presented? Select all that apply. 1 "We should expect our child to participate in parallel play." 2 "We should provide our child with finger paints to foster creativity." 3 "We should allow our child to watch as much television as she wants." 4 "We should provide our child with toys that foster her imagination, such as a doll." 5 "We should provide our child with toys so that we are able to finish household chores."
1-"We should expect our child to participate in parallel play." 2-"We should provide our child with finger paints to foster creativity." 4-"We should provide our child with toys that foster her imagination, such as a doll." The toddler-age client should participate in parallel play, use finger paints to foster creativity, and play with dolls to foster imagination. The toddler-age client should not be allowed to watch as much television as he wants. The toddler-age child should not be provided toys as a substitute for interaction with parents.
A home health nurse is caring for school-aged children in a family that is economically deprived. Which characteristic is most common to those living in poverty? 1 Open expression of anger 2 Long-term feeling of powerlessness 3 Willingness to postpone gratification 4 Compliance with health recommendations
2- Long-term feeling of powerlessness People living in poverty feel powerless because they do not have the buying power or social status to effect change. Their anger is covert and not direct; in addition, the anger rarely resolves their situation, resulting in feelings of powerlessness and hopelessness. Economically deprived people are less likely to postpone gratification because they focus on the present, not the future. Health recommendations may be misunderstood, confusing, or perceived as of little value and are frequently ignored.
The nurse is providing anticipatory guidance to the parents of a child who has a difficult temperament. Which statement should the nurse include in the teaching session with these parents regarding their child's temperament? Select all that apply. 1 "Your child will develop predictable habits." 2 "Your child will benefit from a bedtime routine." 3 "Your child is open to change and adapts easily." 4 "Your child is likely to adapt slowly to the new daycare setting." 5 "Your child will display intense emotions, including those associated with happiness."
2-"Your child will benefit from a bedtime routine." 4-"Your child is likely to adapt slowly to the new daycare setting." 5-"Your child will display intense emotions, including those associated with happiness." Children who are classified as having a difficult temperament will benefit from a bedtime routine, will likely adapt slowly to a new daycare setting, and will display intense emotions, including those associated with happiness. The child who is classified as easy will develop predictable habits and will be open to change and adapt easily.
Which teaching point regarding safety should the nurse include in the instructions for the parents of a school-age client who is a latchkey child? 1 "Consider getting a pet for your child." 2 "Plan play dates for your child to attend on afternoons you are not home." 3 "Teach your child not to display the keys used to enter the home after school." 4 "Provide structured activities for your child to complete while they are home alone."
3- "Teach your child not to display the keys used to enter the home after school." Teaching the child not to display the house keys used to enter the home after school is a safety teaching point the nurse should include in the teaching session. Planning for play dates on afternoons the parent will not be home is an important point to emphasize in regards to after-school activities. Getting a pet is a teaching point directed towards decreasing the child's loneliness while home alone. Providing structured activities for the child is an important point to emphasize regarding after-school activities, not safety.
Based on Erikson's theory of development, what should the nurse suggest to a mother of a toddler who harshly disciplines her child? 1 "Your behavior may induce a feeling of isolation in your child." 2 "You need to establish a sense of trust or the child may lose trust in you." 3 "Your child needs support and love or may develop feelings of shame and doubt." 4 "You need to control the child's impulses or the child may suffer guilt and frustration."
3- "Your child needs support and love or may develop feelings of shame and doubt." According to Erikson, a child of 2 years old is in the autonomy versus sense of shame and doubt stage. The nurse should counsel the mother that harshly disciplining her child may lead to a feeling of shame and doubt. The intimacy versus isolation stage leads to a feeling of isolation in young adults. A feeling of mistrust can be seen in infants less than 1 year of age. Guilt and frustration can be seen in preschoolers in the stage of initiative versus guilt.
Which should the nurse anticipate for a 5-year-old client related to play? Select all that apply. 1 Solitary play 2 Parallel play 3 Dress-up play 4 Team sport play 5 Cooperative play
3-Dress-up play 5-Cooperative play The 5-year-old preschool-age client would be expected to participate in dress-up play due to the preoccupation with magical thinking and the beginnings of cooperative play. Solitary play is expected for the infant and toddler. Parallel play is expected for the toddler and young preschool-age client. Team sport play is expected for the school-age client.
When teaching a class about parenting, the nurse asks the participants what they do when their toddlers have a temper tantrum. Which statement demonstrates one father's understanding of the origin of temper tantrums? 1 After a temper tantrum he disciplines his child by restricting a favorite food or activity. 2 When a temper tantrum begins he isolates and ignores his child until the behavior improves. 3 During a temper tantrum he partially gives in to his child before the tantrum becomes excessive. 4 He tries to prevent a temper tantrum by allowing his child to choose between two reasonable alternatives.
4- He tries to prevent a temper tantrum by allowing his child to choose between two reasonable alternatives. This parent's action gives his child more control by allowing the child to make a decision. This demonstrates an understanding of what the toddler can and cannot do safely. Toddlers are too young to understand that a restrictive type of punishment is a response to the temper tantrum; it may lead to more frustration and anger. Although tantrums as attention-getting devices largely must be ignored, isolating the child will produce feelings of rejection and insecurity. Partially giving in to the child may lead to the development of more manipulative tactics because the action brought a degree of success initially.
What is the best room assignment for a 5-year-old child admitted with injuries that may be related to abuse? 1 In an isolation room 2 With a friendly older child 3 With a child of the same age 4 In a room near the nurses' desk
4- In a room near the nurses' desk A child who exhibits signs of abuse needs close supervision, especially when members of the family visit. The child requires close monitoring and should not be left alone. There is no indication that this child needs to be placed in an isolation room for the sake of infection control. An older child who exhibits signs of friendliness may be threatening to this child. Placement with a child of the same age may be desirable from a developmental level, but it does not meet the child's safety needs.
A nurse is making room assignments on the pediatric unit. Who is the best choice of roommate for a 10-year-old boy with juvenile idiopathic arthritis? 1 An 11-year-old girl with colitis 2 A 10-year-old boy with asthma 3 A 10-year-old girl with a fractured femur 4 An 11-year-old boy who has undergone splenectomy
4-An 11-year-old boy who has undergone splenectomy An 11-year-old boy who has undergone a splenectomy is an appropriate roommate. Ten-year-old boys prefer the company of children of the same sex and age group; also, the child should avoid stressful situations that may increase the likelihood of an exacerbation. Same-sex roommates are more desirable for companionship and will better satisfy the desire for boy/girl separateness of this age group. Children with asthma may have severe respiratory difficulties; this may be too stressful for the child who needs rest.
A nurse is admitting a 4-year-old child to the pediatric unit and making plans to help the child adjust to the unit. The nurse understands that a 4-year-old child's greatest fear related to hospitalization is a fear of what? 1 Bodily harm 2 Lack of control 3 Loss of independence 4 Separation from mother
1- Bodily Harm The psychosexual development of a preschooler is focused on the fear of invasive procedures. Hospitalization threatens the toddler's autonomy more than it does the preschooler's. The adolescent may be threatened with the loss of independence when hospitalized. Separation from the mother is most critical during infancy and toddlerhood.
An adolescent girl is concerned about her body image after amputation of a leg for bone cancer. After the nurse has obtained the girl's consent, what nursing action is most therapeutic? 1 Encouraging her peers to visit 2 Keeping her lower body covered 3 Placing her in a room by herself 4 Limiting her visitors to the family
1- Encouraging her peers to visit Peer acceptance is crucial during this period; friends must have the opportunity to accept the client with one leg. Concealment does not help the adolescent or others accept the loss. Isolating the adolescent will increase feelings of alienation and being different. An adolescent needs to relate to and be accepted by peers as well as family.
A toddler has frequent temper tantrums. The parents ask a nurse how to limit this acting-out behavior. What should the nurse recommend? 1 Ignore the tantrum whenever possible. 2 Restrain the child whenever a tantrum begins. 3 Move the child to a quiet area as soon as a tantrum begins. 4 Visit the clinic to request medication to control the tantrum.
1- Ignore the tantrum whenever possible. Ignoring the temper tantrum as long as the child is not causing self-harm avoids reinforcement of the behavior. The parents should remain nearby to provide a sense of security. Restraining the child will probably worsen the behavior associated with the tantrum. Moving the child to a quiet area may be impossible; tantrums often involve lying on the floor, kicking, and screaming loudly. Medication is not the treatment of choice.
Which stage of Erikson's theory would the nurse explain describes the development of a preschooler? 1 Initiative versus guilt 2 Trust versus mistrust 3 Identity versus role confusion 4 Autonomy versus sense of shame and doubt
1- Initiative versus guilt According to Erikson's theory, the initiative versus guilt stage is applicable to preschoolers between the ages of 3 to 6 years. The trust versus mistrust stage gives details about an infant from birth through the age of 1 year. The identity versus role confusion stage is seen during puberty. The autonomy versus a sense of shame and doubt stage describes the growth and development of a toddler.
The nurse is providing care to a preschool-age client of Asian descent during a scheduled health maintenance visit. The family speaks fluent English. Which assessment strategies should the nurse implement with the child and family based on the current data? Select all that apply. 1 Using open-ended questions 2 Avoiding prolonged eye contact 3 Phrasing questions in a neutral manner 4 Asking all questions directly to the interpreter 5 Asking several questions for time management purposes
1- Using open-ended questions 2- Avoiding prolonged eye contact 3- Phrasing questions in a neutral manner Open-ended questions should be used as frequently as possible during a health history interview. This is especially important for a family of Asian descent who tend to answer "yes" or anticipate the answer the nurse wants to hear. Direct or prolonged eye contact is often seen as a sign of disrespect when assessing a family of Asian descent. Phrasing questions in a neutral manner decreases the risk of the family anticipating the answer the nurse wants to hear, which often occurs for clients of Asian descent. Since the family speaks fluent English, there is no need to engage the services of an interpreter unless the family requests it. If an interpreter was used, the nurse would direct the questions directly to the family. One question should be asked at a time during the assessment process.
A nurse plans to talk to the parents of a toddler about toilet training. What should the nurse tell the parents is the most important factor in the process of toilet training? 1 Parents' attitude about it 2 Child's desire to remain dry 3 Child's ability to sit still on the toilet 4 Parents' willingness to work at the toilet training
1-Parents' attitude about it The parents' attitude, approach, and understanding of the child's physical and psychologic readiness are essential to letting the child proceed at his or her own pace with appropriate parental intervention. A child's desire to remain dry is not the major motivation for toilet training. Although the child's ability to sit still on the toilet is definitely a factor, it is not a major one. The parents' willingness to work at the toilet training is, of course, a factor, but the major factor is the child, who is strongly influenced by the parents' attitudes and approach.
In which stage of development are food choices affected by such factors as peer acceptability and sociability, possibly resulting in malnutrition or chronic illness? 1 Midlife 2 Infancy 3 Childhood 4 Adolescence
4-Adolescence During adolescence, parental influence diminishes and the adolescent bases food choices on peer acceptability and sociability. These choices can result in such chronic illnesses as diabetes and obesity. Midlife adults are more mature than adolescents in making food choices and are less susceptible to the influence of factors that can lead to malnutrition or chronic illness. Infants depend on human milk, the preferred form of nutrition for all infants. Children establish lifelong eating habits during the first 3 years of life. Infants and children are too young to make food choices that are affected by peer acceptability and sociability.
