Chapter 21: The Child's Experience of Hospitalization

31. What are the stages of separation anxiety in the toddler? A. Protest, despair, and denial B. Denial, dependence, and submission C. Protest, sadness, and despair D. Despair, anxiety, and regression

ANS: A Rationale: The major tasks of adolescence include establishing an identity, separating from family, initiating intimacy, and developing career choices for economic independence. Erikson identifies the major task of this group as identity versus role confusion. Emancipation is a critical element in the establishment of identity.

19. An 8-year-old child will be hospitalized for several weeks in skeletal traction to treat a fractured femur. What does the nurse realize immobilization in this age-group can generate feelings of in planning care of this child? a. Loss of control b. Altered body image c. Shame and guilt d. Fear of bodily harm

ANS: A Forced dependency in the hospital, such as immobilization, can result in a feeling of loss of control and loss of security.

7. A hospitalized toddler was drinking from a cup at home but now refuses to drink from anything except his favorite bottle. What is the most likely reason for this behavior? a. He is dealing with the anxiety of hospitalization by regressing. b. He is demonstrating attention-seeking behaviors because of an overabundance of attention in the hospital. c. He is attempting to refocus the attention of the adults around him to avoid further painful procedures. d. He is exhibiting normal behavior for his age, as children often stop new behaviors after they believe they have mastered them.

ANS: A Hospitalization is frustrating for toddlers. They show their displeasure when illness restricts satisfaction of their desires. It is not unusual for a toddler who was drinking from a cup to refuse it in the hospital.

23. The nurse is preparing to start an IV on an infant admitted to the pediatric unit. What intervention is appropriate for the nurse to implement? a. Involve the parents. b. Provide a simple explanation to the child. c. Let the child examine the equipment. d. Suggest coping techniques.

ANS: A It is appropriate to involve the parents when performing a procedure on an infant. Providng a simple explanation, letting the child examine the equipment, and suggesting coping techniques are not appropriate interventions for an infant.

41. What is the drug of choice for the relief of mild to moderate pain in infants and children? A. Acetaminophen B. Ibuprofen C. Fentanyl D. Naloxone

ANS: A Rationale: Acetaminophen is commonly used for the relief of mild to moderate pain in infants and children

18. What statement by the parent of a hospitalized toddler leads the nurse to determine the parent understands a hospitalized toddler's need for transitional objects? a. "This stuffed animal makes him feel secure." b. "He insisted on bringing this dirty old blanket with him." c. "I'm going to buy him a big stuffed animal from the gift shop." d. "I'd like to get him some toys from the playroom."

ANS: A The use of a transitional object such as a blanket or a favorite toy promotes security.

21. The nurse shares the information and timelines recorded on the interdisciplinary outline of care for a child. What is this document? a. Clinical pathway b. Comprehensive nursing care plan c. Holistic care approach d. Incorporated cost analysis

ANS: A This document is the clinical pathway, which is a broad outline of interdisciplinary plan of care with specific timelines.

2. A 2-year-old child has been crying constantly for his mother since he was hospitalized 3 days ago. What does this behavior suggest? a. The toddler feels abandoned by his mother. b. The child still has not adjusted to his hospitalization. c. The child is not separated from his mother often. d. There is a poor mother-child bond.

ANS: A Unless toddlers are extremely ill, their grief and sense of abandonment during hospitalization are obvious.

25. What will the nurse include when documenting the discharge of a pediatric patient? (Select all that apply.) a. Time of discharge b. Adult(s) accompanying the child and the relationship to the child c. Condition of the child d. Method of transportation e. Instructions that were given to physician

ANS: A, B, C, D Information that should be included in the discharge note include time of discharge, adults accompanying the child and relationship to child, condition of the child, and method of transportation. It should also be documented that instructions were given to parents.

26. The nurse suggests to parents that they use the outpatient surgical center for their child's upcoming surgery. What advantage(s) does this type of facility have to offer? (Select all that apply.) a. Lower cost b. Less incidence of health care-associated infections c. Reduction of parent-child separation d. Ample time for recuperation at the facility e. Decreased emotional impact of illness

ANS: A, B, C, E All options listed are advantages of outpatient services with the exception of recuperating at the facility.

39. Which are appropriate interventions to improve a child's hospitalization, regardless of age? Select all that apply. A. Provide recuperation at home when possible. B. Provide a cheerful, casual atmosphere. C. Provide a flexible schedule. D. Provide a roommate who is age-appropriate. E. Provide for rooming in for parents. F. Provide activities that are developmentally appropriate.

ANS: A, B, C, E, F Rationale: It is not best practice to provide a roommate for hospitalized children. The other interventions listed provide benefit to the hospitalized child.REF: Page 475

28. What information will the nurse include when taking a developmental history? (Select all that apply.) a. Previous experience with hospitalization b. Cultural needs c. History of illness d. Allergies e. Child's nickname

ANS: A, B, E The developmental history has information about the child and the child's developmental and cultural needs and personal preferences. The information relative to history of illness or allergies would be covered in the medical history.

29. The nurse is preparing to obtain a throat culture on a toddler patient. What interventions are appropriate for the nurse to implement? (Select all that apply.) a. Model desired behavior. b. Instruct patient not to yell. c. Use distractions. d. Explain the procedure in detail. e. Encourage the child to ask questions.

ANS: A, C Whenever possible the parent should be involved in the preparation for and initiation of a treatment or procedure, and the child should be prepared according to his or her developmental level. For a toddler, model the behavior desired (i.e., opening the mouth), tell the child it is okay to yell if the treatment or procedure is uncomfortable, and use distractions. Explaining the procedure in detail and encouraging questions are appropriate interventions for an older child.

27. What are the basic fears of a young child being hospitalized? (Select all that apply.) a. Separation b. Permanent scarring c. Pain d. Cost e. Body intrusion

ANS: A, C, E Small children all share the same basic fears relative to hospitalization, which are separation from family, pain, and body intrusion or mutilation.

8. A nurse encourages a school-age child to draw a picture after a painful procedure. What is the best rationale for this nursing intervention? a. Attempting to re-establish rapport b. Providing a way for the child to express his feelings c. Encouraging quiet play d. Distracting the child from thinking about the pain

ANS: B After treatments, the nurse should encourage children to draw and talk about their drawings or to act out their feelings through puppet play.

16. When a 2-year-old returns to her hospital room following a diagnostic procedure, her parents are not available, and the child is crying loudly. Which technique is most appropriate to alleviate the child's distress? a. Rock the child gently to sleep. b. Play with the child using pop-up toys. c. Role play with the child to act out her feelings. d. Ask the child to draw a picture about her feelings.

ANS: B Distractions such as blowing bubbles, looking through a kaleidoscope, and playing with pop-up toys may help reduce anxiety and pain.

13. The mother of a hospitalized toddler states, "He cries when I visit. Maybe I should just stay away." What is the nurse's best response? a. "Perhaps you are right. He only gets upset when you have to leave." b. "It is important that you are here. This is a common reaction in children when they are separated from their parents." c. "It might be easier for your child if you would stay with him, but this decision is up to you." d. "We take good care of him and he seems fine when you are not here."

ANS: B During the second stage of separation anxiety (despair), the child is quiet, is not crying, and is sad and depressed. The child will revert to protest when the parent arrives for a visit.

20. The nurse explains to the parents of a hospitalized child that their child will receive fentanyl for an upcoming procedure. What advantage of fentanyl will the nurse explain? a. It is specifically designed for children. b. It has a rapid onset. c. It is nonaddicting. d. It has a long duration.

ANS: B Fentanyl is a drug useful for all ages because of its rapid onset and brief duration.

42. What statement about discharge planning for the pediatric patient is true? A. Continues after discharge B. Begins upon admission C. Is initiated by the pediatrician's office D. Begins when the parents are ready

ANS: B Rationale: Preparation for the patient's discharge ideally begins on admission, because the goal of hospitalization is to return a healthier and happier child to the parents

40. A hospitalized toddler requests a bottle for his juice, although he has been drinking from a cup at home. What instructions should the nurse provide to the parents? A. Encourage the child to use a straw. B. Praise appropriate behavior and ignore regressions. C. Redirect him and remind him he is a big boy who drinks from a cup. D. Distract him and provide the juice in a cup.

ANS: B Rationale: Regression should not be punished. Nurses can guide parents to praise appropriate behavior and ignore regressions. When the child is free of the stress that caused the regression, praise will motivate the achievement of appropriate behavior.

33. The best way to minimize separation anxiety in the hospital infant is to A. Explain routines carefully B. Encourage parents to room-in C. Provide age-appropriate roommate D. Provide an age appropriate toy

ANS: B Rationale: Rooming-in is highly desirable. When rooming-in is impossible, consistent caregivers should be assigned to care for the child and the parents.

34. Which statement by the parent of a hospitalized 4 year-old child indicated an understanding of the child's needs? A. "I am going to buy him a box of new toys to keep him busy while in the hospital." B. "I am going to bring some of his favorite toys from home for him to play with while he's in the hospital." C. "I'm glad there is a television in the room for him to watch all day." D. "I will stay every day and till he falls asleep and then I will go home."

ANS: B Rationale: The use of a transitional object, such as a blanket or a favorite toy from home, promotes security.

1. Which child would have the most difficulty in coping with separation from parents because of hospitalization? a. 3-month-old child b. 16-month-old child c. 4-year-old child d. 7-year-old child

ANS: B Separation anxiety occurs after age 6 months and is most pronounced in the toddler.

15. Which nursing action would facilitate rapport with a child and the child's parents during the admission process? a. Direct the parents to undress the child. b. Answer questions in a calm and matter-of-fact way. c. Perform assessments and ask questions as quickly as possible. d. Express concern about the seriousness of the child's condition.

ANS: B The nurse tries not to appear rushed. A matter-of-fact attitude must be maintained regardless of the child's condition.

3. Which statement best corresponds to a preschooler's understanding of hospitalization? a. "A germ made me get sick." b. "I got sick because I was mad at my brother." c. "My tonsils are sick and they have to come out." d. "I have a cast because I broke my leg."

ANS: B The preschooler may feel guilty, particularly if an accident happens as a result of mischief on his or her part.

10. The mother of a 3-year-old tells the nurse that she will be in to visit tomorrow around 12:00 PM. The next morning, the child asks the nurse, "When is my mommy coming?" What is the nurse's best response? a. "Your mommy will be here around noon." b. "Your mommy will be here when you have lunch." c. "Mommy will be here very soon." d. "Your mommy is coming in 4 hours."

ANS: B The toddler and preschooler do not understand time yet. They understand time relationships through activities in their experience, such as naptime and mealtimes.

24. The pediatric nurse is caring for child that weighs 15 kilograms and calls the physician for an order for Acetaminophen for pain control. What is the maximum amount of medication per dose the nurse anticipates ordering? a. 100 mg b. 150 mg c. 225 mg d. 250 mg

ANS: C Acetaminophen is commonly used for the relief of mild to moderate pain in infants and children. The maximum dose is 15 mg/kg/dose for infants and children, with a maximum of 5 doses in 24 hours.

22. The anxious parent asks if there is a danger of her 2-year-old child becoming addicted to the opioid pain reliever. What is the nurse's most helpful response? a. "Although this drug is addictive, the doctor monitors the dose very carefully." b. "Don't worry. Addicted children are very easy to wean off the drug." c. "Addiction is rare in children when opiates are given for pain." d. "Addictive behaviors are easy to assess. The drug will be stopped if that happens."

ANS: C Addiction is rare in children.

5. The nurse must make a room assignment for a 16-year-old with cystic fibrosis. Which roommate would be the most appropriate for this patient? a. A 4-year-old child who had an appendectomy b. A 10-year-old child with sickle cell disease in vaso-occlusive crisis c. A 15-year-old with type 1 diabetes mellitus d. To assign the adolescent to a private room

ANS: C Adolescents usually do better in rooms with one or more roommates than in single rooms. The adolescent would do best with a roommate who is closest to his or her age and also lives with a chronic illness.

11. A 13-year-old girl has been hospitalized for the past week. When discussing the girl's feelings about her illness, what would the nurse expect the girl to express as her biggest concern? a. Invasive procedures b. Loss of control c. Appearance d. Separation from her boyfriend

ANS: C Illness during early adolescence (12 to 15 years) is seen mainly as a threat to body image.

14. What should the nurse, preparing to collect an admission history from parents who have recently emigrated from Russia, keep in mind? a. Eye-to-eye contact is considered disrespectful. b. Touching the child's head means the nurse is superior. c. Smiling is inappropriate in a serious situation. d. Staring is a sign of the nurse's rudeness.

ANS: C In Russia, a smile indicates happiness and is inappropriate in a serious or sad situation.

4. The parents of a hospitalized toddler are upset because she seems more interested in her toys when they come to visit her. In which stage of separation anxiety is the toddler? a. Protest b. Despair c. Denial d. Attachment

ANS: C In the stage of denial or detachment, the child appears to deny the need for the parents and becomes uninterested in their visits.

9. What is the best suggestion by the nurse when parents ask, "When is the best time to begin to prepare a 5-year-old for surgery and hospitalization?" a. "As soon as the surgery is scheduled" b. "About 2 weeks before surgery" c. "About 4 days before surgery" d. "On the night before admission to the hospital"

ANS: C Parents should prepare children for procedures and hospitalization a few days in advance.

32. Assessment of pain is considered a fifth vital sign to be documented by the nurse. The nurse understands that pain in infants? A. Cannot be reliably assessable B. Will not be remembered by the infant C. Can be assessed by observation of behavior D. Is usually caused by fear and anxiety

ANS: C Rationale: In infants, pain may be assessed according to a behavior scale that includes tightly closed eyes, clenched fists, and a furrowed brow.

35. A 4 year-old hospitalized child wets his bed. The parents tell the nurse and the child was completely toilet trained. What should the nurse understand? A. The parents are denying a problem exists. B. The child may be developmentally delays. C. The child may be experiencing regression. D. The child is probably "punishing" the parents.

ANS: C Rationale: Regression is the loss of an achieved level of functioning that previously had been successful to a past level of behavior.

30. Parents are preparing their child for admission to the pediatric unit for minor surgery. What should they expect to see when visiting the pediatric unit? (Select all that apply.) a. Nurses wearing all white b. Formal atmosphere c. Availability of a playroom d. Dim lighting e. Colored bedding

ANS: C, E The children's hospital unit differs in many respects from adult divisions. The pediatric unit or hospital is designed to meet the needs of children and their parents. A cheerful, casual atmosphere helps to bridge the gap between home and hospital and is in keeping with the child's emotional, developmental, and physical needs. Nurses wear colorful uniforms, and colored bedspreads and wagons or strollers for transportation provide a more homelike atmosphere. The physical structure of the unit includes furniture of the proper height for the child, soundproof ceilings, and color schemes with eye appeal. Most pediatric departments include a playroom.

36. Which of the following can be a result of acetaminophen toxicity? A. Gastrointestinal distress B. Cerebral impairment C. Decreased urinary output D. Liver failure

ANS: D Rationale: Acetaminophen toxicity involves liver failure.

38. What pain indicator rated on a 1-to-10 scale can be used with nonverbal children? A. PICIC B. Wong-Baker scale C. Nomogram D. FLACC

ANS: D Rationale: The FLACC scale is a pain indicator that can be used with nonverbal children and is rated on a scale of 0 to 2 for each observation, with 10 being the highest level of pain.

37. The pediatric nurse is discharging a 3-year-old patient of Asian descent. When explaining the discharge instructions to the patient's parents, the nurse notices they are not making eye contact. What factor should be considered by the nurse to be accurate about this situation? A. The parents are not paying attention. B. The parents have a language barrier. C. The parents do not understand the information. D. The parents may consider eye contact to be disrespectful.

ANS: D Rationale: The parents may consider eye contact to be disrespectful. In the United States, eye-to-eye contact with the person with whom one is communicating is considered a show of respect and attention. In some Asian cultures, however, eye-to-eye contact is seen as disrespect

6. The parents of a hospitalized 9-month-old infant ask if their preschool child may visit his younger sibling. What understanding would assist the nurse most in formulating a response? a. Preschool children can be disruptive in the hospital environment. b. Seeing his younger sibling would probably frighten the preschooler and thus should be avoided. c. The sibling could view the infant from the doorway but not enter the room to prevent the spread of microorganisms. d. The preschooler needs to visit his infant sister to reassure himself that she is all right.

ANS: D Siblings are affected by a child's hospitalization. Their ability to cope is influenced by their age, experience, and intactness of the family.

12. The nurse notices that the mother of a child with cerebral palsy corrects and redoes many of the things the nurse does for her child. What is the nurse's most appropriate response to this mother? a. "Would you like to do all of your child's care?" b. "I'm doing the very best job that I can with your child." c. "Why don't you go have a cup of coffee? You are going to be exhausted if you don't take a break." d. "I'd love for you to share with me some of the special things you do for your child."

ANS: D The person who cares daily for the child with a chronic illness can provide information that will best guarantee continuity of care between the home and the hospital.

17. A 4-year-old begins to cry when his mother tells him it is time for his operation. The nurse understands this is an expected reaction. On which particular fear of the preschooler does the nurse base this understanding? a. Loss of control b. Restricted mobility c. Unfamiliar routines d. Invasive procedures

ANS: D The preschool-age child is afraid of bodily harm, particularly invasive procedures.