ch 18 and Ch 19

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.) Unfamiliar environment Usual day-night routine Strange smells Provision of privacy 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 with many pieces of unfamiliar equipment. The sights and sounds are much different from those of 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. p 554

Samantha, age 5 years, tells the nurse that she "needs a Band-Aid" where she had an injection. Which is the best nursing action? Apply a Band-Aid. Ask her why she wants a Band-Aid. Explain why a Band-Aid is not needed. Show her that the bleeding has already stopped.

ANS: A Children at this age group still fear that their insides may leak out at the injection site. Provide the Band-Aid. No explanation should be required. The nurse should be prepared to apply a small Band-Aid after the injection. p 563

Matthew, age 18 months, has just been admitted with croup. His parent is tearful and tells the nurse, "This is all my fault. I should have taken him to the doctor sooner so he wouldn't have to be here." Which is appropriate in the care plan for this parent who is experiencing guilt? Clarify misconception about the illness. Explain to the parent that the illness is not serious. Encourage the parent to maintain a sense of control. Assess further why the parent has excessive guilt feelings.

ANS: A Guilt is a common response of parents when a child is hospitalized. They may blame themselves for the child's illness or for not recognizing it soon enough. The nurse should clarify the nature of the problem and reassure parents that the child is being cared for. Croup is a potentially serious illness. The nurse should not minimize the parent's feelings. It would be difficult for the parent to maintain a sense of control while the child is seriously ill. No further assessment is indicated at this time; guilt is a common response for parents. p 567

A nurse is interviewing the parents of a toddler about use of complementary or alternative medical practices. The parents share several practices they use in their household. Which should the nurse document as complementary or alternative medical practices? (Select all that apply.) a. Use of acetaminophen (Tylenol) for fever b. Administration of chamomile tea at bedtime c. Hypnotherapy for relief of pain d. Acupressure to relieve headaches e. Cool mist vaporizer at the bedside for "stuffiness"

ANS: B, C, D When conducting an assessment, the nurse should inquire about the use of complementary or alternative medical practices. Administration of chamomile tea at bedtime, hypnotherapy for relief of pain, and acupressure to relieve headaches are complementary or alternative medical practices. Using Tylenol for fever relief and a cool mist vaporizer at the bedside to reduce "stuffiness" are not considered complementary or alternative medical practices. p 560

During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his parents left him, and he refused the staff's attention. Now the nurse observes that Eric appears to be "settled in" and unconcerned about seeing his parents. The nurse should interpret this as which statement? a. He has successfully adjusted to the hospital environment. b. He has transferred his trust to the nursing staff. c. He may be experiencing detachment, which is the third stage of separation anxiety. d. Because he is "at home" in the hospital now, seeing his mother frequently will only start the cycle again.

ANS: C Detachment is a behavior manifestation of separation anxiety. Superficially it appears that the child has adjusted to the loss. 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. p 554

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 non-critically 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. p 562

A child is playing in the playroom. The nurse needs to obtain a child's blood pressure. 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 play room 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 exam 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. p 566

What is a common initial reaction of parents to illness or injury and hospitalization in their child? a. Anger b. Fear c. Depression d. helplessness

ANS: D Recent research has identified common themes among parents whose children were hospitalized, including feeling an overall sense of helplessness, questioning the skills of staff, accepting the reality of hospitalization, needing to have information explained in simple language, dealing with fear, coping with uncertainty, and seeking reassurance from caregivers. Anger or guilt is usually the second reaction stage. Fear, anxiety, and frustrations also are common feelings. Parents may finally react with some form of depression related to the physical and emotional exhaustion associated with a hospitalized child. p 557

Which age group should the pediatric nurse recognize as being vulnerable to events that lessen their feeling of control and power? Infants Toddlers Preschoolers 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 to different extents by loss of power, are not as significantly affected as are school-age children. p 556

Which is an effective strategy to reduce the stress of burn dressing procedures? a. Give the child as many choices as possible. b. Reassure the child that dressing changes are not painful. c. Explain to the child why analgesics cannot be used. d. Encourage the child to master stress with controlled passivity.

ANS: A Children who understand the procedure and have some perceived control demonstrate less maladaptive behavior. They respond well to participating in decisions and should be given as many choices as possible. The dressing change procedure is painful and stressful. Misinformation should not be given to the child. Analgesia and sedation can and should be used. Encouraging the child to master stress with controlled passivity is not a positive coping strategy. p 572

Four-year-old Brian appears to be upset by hospitalization. Which is an appropriate intervention? Let him know it is all right to cry. Give him time to gain control of himself. Show him how other children are cooperating. Tell him what a big boy he is to be so quiet.

ANS: A Crying is an appropriate behavior for the upset preschooler. The nurse provides support through physical presence. Giving the child time to gain control is appropriate, but the child must know that crying is acceptable. The preschooler does not engage in competitive behaviors. p 556

When a preschool child is hospitalized without adequate preparation, how does the child often react to the hospitalization? Sees it as a punishment A threat to child's self-image An opportunity for regression 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. Attributing the hospitalization to punishment for real or imagined misdeeds is a reaction typical of toddler and school-age children when threatened with loss of control. p 554

A child with autism spectrum disorder (ASD) is admitted to the hospital with pneumonia. The nurse should plan which priority intervention when caring for the child? Maintain a structured routine and keep stimulation to a minimum. Place child in a room with a roommate of the same age. Maintain frequent touch and eye contact with the child. Take the child frequently to the playroom to play with other children.

ANS: A Providing a structured routine for the child to follow is a key in the management of ASD. Decreasing stimulation by using a private room, avoiding extraneous auditory and visual distractions, and encouraging the parents to bring in possessions the child is attached to may lessen the disruptiveness of hospitalization. Because physical contact often upsets these children, minimum holding and eye contact may be necessary to avoid behavioral outbursts. Children with ASD need to be introduced slowly to new situations, with visits with staff caregivers kept short whenever possible. The playroom would be too overwhelming with new people and situations and should not be a priority of care. p 547

A previously "potty-trained" 30-month-old child has reverted to wearing diapers while hospitalized. The nurse should reassure the parents that this is normal because of which reason? 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. p 564

Latasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. Which will help her most in her adjustment to the hospital? Explain hospital schedules to her, such as mealtimes. Use terms such as "honey" and "dear" to show a caring attitude. Explain when parents can visit and why siblings cannot come to see her. 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 those experiences that are unavailable. The nurse should refer to the child by the preferred name. Explaining when parents can visit and why siblings cannot come to see her is telling the child all of the limitations, not helping her adjust to the hospital. At the age of 8 years, the child should be oriented to the environment along with the parents. p 556

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute" and "I'm not ready." The nurse should recognize this as which description? This is normal behavior for a school-age child. The behavior is not seen past the preschool years. The child thinks the nurse is punishing her. The child has successfully manipulated the nurse in the past.

ANS: A The 10-year-old girl is attempting to maintain control. The nurse should provide the girl with structured choices about when the IV will be inserted. Telling the nurse "Wait a minute" and "I'm not ready" can be characteristic behavior when an individual needs to maintain some control over a situation. p 562

A nurse is caring for four patients; three are toddlers and one is a preschooler. Which represents the major stressor of hospitalization for these four patients? Separation anxiety Loss of control Fear of bodily injury Fear of pain

ANS: A The major stressor 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. p 554

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.) Discuss dietary restrictions. Hold any analgesic medications until the child is home. Send a pain scale home with the family. Suggest the parents fill the prescriptions on the way home. 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. p 570

A child is being admitted to the intensive care unit (ICU) and the parents are with the child. Which creates stressors for children and parents in ICUs? (Select all that apply.) Equipment noise Privacy Caring behavior by the nurse Unfamiliar smells Sleep deprivation

ANS: A, D, E The ICU can create physical and environmental stressors for children and their families. Equipment noise (monitors, suction equipment, telephones, computers), unfamiliar smells (alcohol, adhesive remover, body odors), and sleep deprivation all are stressors found in the ICU. Privacy as opposed to no privacy and a caring nurse as opposed to unkind or thoughtless comments from staff help reduce the stressors of the ICU. p 572

A nurse is instructing a nursing assistant on techniques to facilitate lipreading with a hearing-impaired child who lip reads. Which techniques should the nurse include? (Select all that apply.) Speak at eye level. Stand at a distance from the child. Speak words in a loud tone. Use facial expressions while speaking. Keep sentences short.

ANS: A, D, E To facilitate lipreading for a hearing-impaired child who can lip read, the speaker should be at eye level, facing the child directly or at a 45-degree angle. Facial expressions should be used to assist in conveying messages, and the sentences should be kept short. The speaker should stand close to the child, not at a distance, and using a loud tone while speaking will not facilitate lipreading. p 547

Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which areas with onset before age 3 years? (Select all that apply.) Language as used in social communication Parallel play Gross motor development Growth below the 5th percentile for height and weight Symbolic or imaginative play Social interaction

ANS: A, E, F These are three of the areas in which autistic children may show delayed or abnormal functioning: language as used in social communication, symbolic or imaginative play, and social interaction. Parallel play is typical play of toddlers and is usually not affected. Gross motor development and growth below the 5th percentile for height and weight are usually not characteristic of autism. p 547

What is an appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler? Provide for privacy Encourage parents to room in Explain procedures and routines 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. Encouraging contact with children the same age would not substitute for having the parents present. p 557

Which is an important consideration for the nurse when changing dressings and applying topical medication to a child's abdomen and leg burns? a. Apply topical medication with clean hands. b. Wash hands and forearms before and after dressing change. c. If dressings adhere to the wound, soak in hot water before removal. d. Apply dressing so that movement is limited during the healing process.

ANS: B Frequent hand and forearm washing is the single most important element of the infection-control program. Topical medications should be applied with a tongue blade or gloved hand. Dressings that have adhered to the wound can be removed with tepid water or normal saline. Dressings are applied with sufficient tension to remain in place but not so tightly as to impair circulation or limit motion. p 562

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." Which is the nurse's best assessment of this situation? a. The siblings are immature and probably spoiled. b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. c. Family has ineffective coping mechanisms to deal with chronic illness. d. The siblings need to better understand their sister's illness and needs.

ANS: B Siblings experience loneliness, fear, and worry, as well as anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. There is no evidence that the family has maladaptive coping mechanisms. p 568

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. p 571

A nurse plans therapeutic play time for a hospitalized child. What are the benefits of 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 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. p 565

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 should be expected about separation anxiety? "I wish my parents could spend the night with me while I am in the hospital." "I think I would like for my siblings to visit me but not my friends." "I hope my friends don't forget about visiting me." "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, so friends visiting are an important aspect of hospitalization for an adolescent. Most adolescents do not need a parent to spend the night during hospitalization and sometimes view the hospitalization as a welcome event. Adolescents would be more concerned about friends visiting than siblings. Adolescents want visitors to keep control and maintain social status among their group of peers. p 556

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 of which concept? New toys make hospitalization easier. New toys are usually better than older ones for children of this age. At this age, children often need the comfort and reassurance of familiar toys from home. 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 people who are significant in their lives. The favorite items will comfort and reassure the child. Because the parents left the objects, the preschooler knows the parents will return. 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. p 565

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

ANS: C The nurse should complete the exam 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 exam room, or asking the child to stand by the parent would separate the child from the parent and cause anxiety. p 562

A 14-year-old boy is being admitted to the hospital for an appendectomy. Which roommate should the nurse assign with this patient? A 4-year-old boy post-appendectomy surgery A 6-year-old boy with pneumonia A 15-year-old boy admitted with a vasoocclusive sickle cell crisis 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 post-appendectomy 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). p 567