Chapter 33 exam 3
The nurse is educating the parents of a 7-year-old boy scheduled for surgery to help prepare the child for hospitalization. Which statement by the parents indicates a need for further teaching?
"It is best to wait and let him bring up the surgery or any questions he has." It is important to be honest and encourage the child to ask questions rather than wait for the child to speak up.
The nurse is preparing to admit a 4-year-old who will be having tympanostomy tubes placed in both ears. Which strategy is most likely to reduce the child's fears of the procedure?
"Let me show you how tiny these tubes are." The nurse needs to describe the procedure and equipment in terms the child can understand. For a 4-year-old, a simple explanation along with the chance to touch and feel the tiny tubes would be best
A nurse is using a doll to explain what will be done when starting an intravenous (IV) line on a 4-year-old child. What type of play is this?
therapeutic play -Play is a very important part of nursing care. Therapeutic play is nondirected and focuses on helping the child cope with feelings and fears. It helps the child deal with the challenges of illness and hospitalization. Therapeutic play is a technique to help children better understand what will be happening to them in a specific situation. For instance, the child who will have an IV line started before surgery might be given the materials and encouraged to "start" an IV on a stuffed animal or doll.
The nurse is caring for a 10-year-old child admitted for a surgical procedure to be done the next day. The nurse takes the child to a special area in the playroom and lets the child "start" an IV on a stuffed bear. This is an example of:
therapeutic play. Therapeutic play is a play technique used to help the child have a better understanding of what will be happening to him or her in a specific situation.
The nurse is working with a group of caregivers of children in a community setting. The topic of hospitalization and the effects of hospitalization on the child are being discussed. Which statement made by the caregivers supports the most effective way for children to be educated about hospitals?
"We are going to take our child to an open house at the hospital so she can see the pediatric unit." One factor in how children deal with hospitalization is the amount of preparation and the type of preparation they have been given prior to being hospitalized. A child's lack of understanding and experience with illness, hospitals, and hospital procedures increases his or her anxiety.
A 6-year-old with leukemia is placed on reverse isolation. What nursing actions could prevent depression and loneliness in this client?
-Spend extra time to talk while in the room. -Read a story while in the room. -Play a game while in the room. A child on isolation is subject to loneliness, which can be prevented by arranging to spend extra time in the room during treatments. Also, while in the room the nurse might read a story, play a game, or just talk to the child
The nurse is preparing to provide hygiene care to the scalp of a pediatric client. Which action will the nurse complete first?
Assess the client's scalp and hair Before providing hygiene care to the client's scalp, the nurse would first assess the scalp and hair. The nurse would then proceed with providing hygiene care to the client
Caregivers of a hospitalized toddler are being given safety instructions upon admission to the pediatric floor. Which action by the caregiver would be most important to the toddler's safety?
Keep the crib side rails up at all times. Many toddlers are climbers and are always curious. So side rails must be kept fully up at all times, except when direct care is being provided.
A 10-year-old boy who had an appendectomy had expressed worry that following the procedure he would have lots of pain. Two days after the procedure the child is claiming he is having no pain. Which nursing intervention should the nurse prioritize when assessing this child?
Observe him for physical signs which might indicate pain. Nursing judgment is in order. Some children may try to hide pain because they fear an injection or because they are afraid that admitting to pain will increase the time they have to stay in the hospital.
The toddler needs elbow restraints to keep his hands away from a facial wound. What will the nurse do to best ensure their safe use?
Remove one restraint at a time on a regular basis to check for skin irritation. Removing one restraint at a time provides for control of both hands. A long-sleeve shirt under the elbow restraints also protects the skin, and is a better choice than lotion since lotion will soften the skin and not be protective.
The charge nurse is planning staffing on a pediatric unit. Which client will the charge nurse assign to the registered nurse?
the 1-year-old client with a respiratory disorder prescribed oxygen therapy The charge nurse would assign the RN to the most unstable client, which is the client with a respiratory disorder who is only 1 year of age
A mother in the outpatient setting is explaining how she plans to prepare her 5-year-old for hospital admission. What remark indicates the parent requires additional teaching?
"We told him to use his manners and behave like a big, brave boy." Expecting manners and brave "big-boy" behavior is unrealistic. The child's coping skills are not yet well developed. Expressing true feelings should be allowed. The other preparations are helpful and promote understanding of the experience.
A nurse is caring for a 6-year-old boy hospitalized due to an infection requiring intravenous antibiotic therapy. The child's motor activity is restricted and he is acting out, yelling, kicking, and screaming. How should the nurse respond to help promote positive coping?
"Would you like to read or play video games?" Distraction with books or games would be the best remedy to provide an outlet to distract the child from his restricted activity. The other responses would be unlikely to affect a change in the behavior of a 6-year-old.
Which approach by the nurse best demonstrates the correct way to prepare a Hispanic child for a planned hospital admission?
Allow the child to put on surgical attire and "operate" on a doll to teach what will be happening. Allowing the child to put on surgical attire lets him or her see that hospital equipment is "not scary" and prepares the child for what will be seen on the day of surgery. Both the child and parents should be encouraged to ask questions. Honesty is the most important part of the program, so the nurse would never tell the child that the procedure will be painless because even the best care by the nurse may not eliminate all pain.
A nurse is caring for an 18-month-old girl undergoing traction therapy in a rehabilitation unit. The nurse understands that the girl is in the second phase of separation anxiety when she observes what behavior?
The toddler is quiet, looks sad, and is disinterested in playing. Despair is the second phase of separation anxiety. During this phase the child appears hopeless, depressed, and apathetic. Exhibiting signs of anger and agitation or crying inconsolably all indicate the first phase of separation anxiety called protest. Denial or detachment is the third phase of separation anxiety. The child uses this to protect against further emotional pain. When parents return the child will ignore them and, instead, has formed superficial relationships with other caretakers. This third stage is seen infrequently when family-centered care is in place.
A 12-year-old client is hospitalized. Which finding will the nurse expect while providing care to this client?
uncomfortable during genital assessment The nurse would expect discomfort with genital assessment as school-age children are often quite uncomfortable with any type of sexually related examination or care. Modesty is well developed and privacy is important.
The nurse has applied a restraint to the child's right wrist to prevent the child from pulling out an intravenous line. Which assessment findings ensure that there is proper circulation to the child's right arm? Select all that apply.
-Capillary refill is less than 2 seconds in upper extremities bilaterally. -Fingers are pink and warm bilaterally. -Radial pulses are easily palpable bilaterally. It is important to assess the child's peripheral vascular circulation especially when the child has a restraint placed on an extremity. Capillary refill, color, temperature, and pulses are appropriate to assess to ensure that the child's peripheral vascular circulation has not been compromised.
The pediatric nurse would use standard precautions in caring for which client on her floor?
an adolescent who has a broken arm Standard precautions involve avoidance of handling blood or body fluids from a client and involve use of personal protective equipment (PPE). In this case, with a fracture, there is minimal risk of exposure to body fluids so the nurse would wear gloves only
The nurse is working with a child-life specialist to assist a young preadolescent who is preparing for treatment for cancer. Which technique will the nurse and specialist prioritize to assist this child in better understanding what will be happening in the treatment of the cancer?
therapeutic play Therapeutic play is a play technique used to help the child better understand what will be happening to him or her in a specific situation. For instance, the child who will be having an IV started before surgery might be given the materials and encouraged to "start" an IV on a stuffed animal or doll. By observing the child, you can often note concerns, fears, and anxieties the child might express. Therapeutic play helps the child express feelings, fears, and concerns. The other types of play will not accomplish this goal.
The parents of an adolescent recently diagnosed with cancer voice concern about how both the adolescent and the younger siblings ages 7, 10, and 12 are dealing with the disease. What advice can be offered by the nurse? Select all that apply
-Encourage family counseling. -Encourage counseling for the adolescent diagnosed with cancer. -Openly talk about the disease and related treatments with all the children in the family. A serious health diagnosis impacts all members of the family. It is important to have open lines of communication including the affected adolescent and siblings. Counseling for the affected adolescent and siblings regardless of age is helpful. Changes
The nurse suspects that an infant is experiencing pain postoperatively. What behaviors would validate this suspicion? Select all that apply.
-knees flexed -facial grimacing -rigid body posture An infant in pain will display physical cues to the nurse to indicate that he or she is in pain. Those include facial grimacing, knees drawn up, crying that is not easily consolable, acting active and fussy, stiffened posture, and elevated vital signs (heart rate and blood pressure).
The nurse is caring for a hospitalized toddler who is prescribed bedrest. Which item(s) would the nurse recognize as appropriate for the toddler?
-nursery rhymes or sing-along songs on tape -stacking blocks or small boxes -boxes to put toys in and/or take out toys Hospitalized toddlers on bedrest benefit from toys that can be interacted with and that are age-appropriate. Examples would be stacking boxes, blocks, and sing-along-songs or nursery rhymes. Small piece puzzles, coins, tokens, and marbles are a choking risk for the toddler
The nurse is caring for a preoperative pediatric client. What would it be best for the nurse to do with this client?
Determine how much the child knows and is capable of understanding. The nurse must determine how much the child knows and is capable of learning in order to best prepare the child for surgery.
A nurse is admitting a 7-year-old child to the pediatric unit of the hospital. While the nurse is showing the child and parents the room and explaining where things are, the child becomes upset and frightened. What is the best action by the nurse?
Go slowly with the acquaintance process. The child who reacts with fear to well-meaning advances and who clings to the caregiver is telling the nurse to go slowly with the acquaintance process. The child who knows that the caregiver may stay is more quickly put at ease. To provide security for the child and to provide family-centered care, it is the responsibility of the nurse to form good partnerships with families.
The nurse is caring for an 18-month-old boy hospitalized with a gastrointestinal disorder. The nurse knows that the child is at risk for separation anxiety. The nurse watches for behaviors that indicate the first phase of separation anxiety. For which behavior should the nurse watch?
crying and acting out Children in the first phase, protest, react aggressively to this separation, and reject others who attempt to comfort the child. The other behaviors are indicators of the second phase, despair.
The nurse is preparing a postsurgical care plan for an infant girl located on a general hospital unit that only occasionally admits children. To ensure the infant's safety, what should the nurse include in the plan?
Place the infant in a room close to the nurses' station. The infant will need close monitoring, and having the child nearby will promote frequent checks and awareness of her status.
The hospital nurse is providing discharge instructions to the caregivers of a 10-year-old child with a new prosthetic limb. Which finding will cause the nurse to contact the primary health care provider?
The child is being discharged home with the caregiver. The nurse would question the child with a new prosthetic limb being sent home immediately from the hospital. Sending the child to a rehabilitation unit is best to facilitate usage of the prosthetic limb. The care in a rehabilitation unit involves an interdisciplinary approach that assists the child to reach his or her potential and achieve developmental skills.
A 6-year-old child will be hospitalized for a surgical procedure. How can the nurse best ease the stress of hospitalization for this child?
Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital. The best way to ease the stress of hospitalization is to ensure that the child has been well prepared for the hospital experience. Not only is the child's fear reduced but also the child has a better ability to cope. Preparation allows the child a better understanding of what's happening to him or her. Good preparation allows the child to see a hospital room, handle medical equipment and gain an understanding of procedures and hospital sounds
The nurse is caring for a preschooler who is hospitalized with a suspected blood disorder and receives an order to draw a blood sample. Which approach is best?
"Why don't you sit on your mom's lap?" It is best to include the families whenever possible so they can assist the child in coping with their fears. Preschoolers fear mutilation and are afraid of intrusive procedures. Their magical thinking limits their ability to understand everything, requiring communication and intervention to be on their leve
The telephone triage nurse answers the call from a stay-at-home father of an infant; the father is unable to describe clearly the signs and symptoms the child displays but keeps saying, "She doesn't act like herself," and "Things with her are just not right." The best response by the nurse is:
"Please bring the child to the clinic to be seen. You seem concerned.
The nurse is caring for an 11-year-old girl preparing to undergo a magnetic resonance imaging (MRI) scan. Which statement would best help prepare the girl for the test and decrease anxiety
"The machine makes a very loud rattle; however, headphones will help." The nurse should acknowledge that an MRI is loud and briefly describe the noises the machine makes. Then, the nurse should immediately offer a solution: headphones. Telling the girl she won't hear a sound is untrue.
The nurse is providing care for a hospitalized child who is scheduled to receive morning medications. Place the statements in order that the nurse will state them, beginning with what the nurse will say first during the medication administration. Use all options.
-"Hello, I am going to be your nurse for today." -"It is time for you to take your morning medications." -"Would you like your medicine before or after your mom helps you take a bath?" -"You are doing great today. Would you like to play a game now?" Nursing care for a hospitalized child typically occurs in four phases: introduction, building a trusting relationship, decision-making phase, and providing comfort and reassurance. After introductions, the nurse should let the child know it is time to take his or her medication, and then can offer the child a choice to take medications before or after the bath (or other appropriate choice). Lastly, the nurse should provide comfort and reassurance by offering to play a game with the child.
A nurse caring for a 5-year-old who had abdominal surgery yesterday is trying to teach the child how to take deep breaths. The best way that the nurse can accomplish this is by:
using a pinwheel. Postoperative care for children includes coughing, turning, and deep breathing every 2 hours. A useful and fun way to teach deep breathing to a child is by using a pinwheel. Pursed-lip breathing does not help in deep breathing. It is used for a client with chronic obstructive pulmonary disease who take shallow breaths.
A school-aged child is in isolation at the hospital and her family members ask what they can do to help the child feel less lonely. What would the nurse suggest to this family? Select all that apply.
-Have the child's classmates send cards to the child. -Have parents bring the child's electronic game system. -Draw a smile on the nurse's mask before entering the room. Being in isolation causes a child to feel lonely and depressed. Parents are encouraged to visit and bring items from home that the child likes to play with, such as a gaming system. Having classmates send cards makes the child feel that he or she is not forgotten.