Chapter 38: Family-Centered Care of the Child During Illness and Hospitalization NCLEX
A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for mommy. The nurse's best reply is: A. "Mommy will be here after lunch." B. "Mommy always comes back to see you." C. "Your mommy told me yesterday that she would be here today about noon." D. "Mommy had to go home for a while, but she will be here today."
A (Because toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon by linking the arrival time to a familiar activity that takes place at that time. Saying that the child's mother will always return does not give the child any information about when his mother will visit. Twelve noon is a meaningless concept for a toddler. Saying generally that the child's mother will visit does not give the child specific information about when his mother will visit.)
Olivia, age 5 years, tells the nurse that she "needs a Band-Aid" where she had an injection. The best nursing action is to: a. Apply a Band-Aid. b. Ask her why she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show her that the bleeding has already stopped.
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.)
A child has recently been admitted to the hospital. The child's parents have not yet arrived at the hospital. What behavior is the child exhibiting that leads the nurse to believe the child is exhibiting the stage of protest? The child: A. Screams and hits the nurse. B. Is withdrawn from others. C. Has the habit of bed-wetting. D. Sits in a corner with a toy.
A (Children often undergo separation anxiety when they are separated from their parents. This separation anxiety manifests in different stages such as protest, despair, and detachment. Protest is the first stage of separation anxiety, during which the child screams, cries, or hits the other person for separating him or her from the parents. After this stage, the child enters the stage of despair, where the child begins to withdraw from others and stay depressed. During this stage, the child starts wetting the bed and sucking the thumb because of fear and anxiety. After the stage of despair, the child enters the stage of detachment. The child starts interacting with strangers and takes an increased interest in the surroundings or sits in a corner and plays with a toy.)
When a preschool child is hospitalized without adequate preparation, the nurse should recognize that 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.
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.)
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: 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."
A (Regression is seen during hospitalization.)
Latasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What will help her most in her adjustment to the hospital? 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.
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 her adjust to the hospital. At the age of 8 years, the child and parents should be oriented to the environment.)
A child is scheduled for a tonsillectomy and is afraid of the surgery. The child asks the nurse, "Will I need another operation when I have a sore throat again?" Which response should the nurse give to the child? A. "Once your tonsils are taken out, you will not need the surgery again." B. "You will need to repeat the surgery when you have another infection." C. "You will need to have another surgery when you turn 14 years old." D. "Once your tonsils are fixed, you will not have any more sore throats."
A (The child does not have enough knowledge about the tonsillectomy. Therefore the child may have fear about the surgery. The nurse should explain to the child that once the tonsils are removed, they do not need "fixing" again. It helps relieve the child's fear about the operation, and the child may feel comfortable. Once the tonsillectomy has been done in the child, a second operation is not required after another throat infection. There will actually not be a need for repeating the operation at any age. The child needs to be instructed that there may be other sore throats in the future. However, the child needs to be reassured that future sore throats will not require surgery.)
The nurse is preparing to administer a vaccine to a child. The child is refusing to take the vaccination because of fear of bleeding. What should the nurse do in this situation? A. Tell the child he or she can pick the bandage color. B. Tell the child bleeding will stop in a few seconds. C. Request a staff member sit beside the child. D. Give a favorite toy to the child for distraction.
A (The child is refusing to take vaccination because of fear of bleeding and pain. The nurse should ask the child to select the color of the bandage to be used. This reassures the child and will make him or her feel better. Even if the nurse tells the child that the bleeding will stop when the needle is removed, it does little to help relieve the child's fear. The nurse should not scold the child in a firm tone because the child may get frightened. Giving a favorite toy to the child for playing is not helpful for relieving the fear. A favorite toy may help the child sleep at night. Requesting a staff member sit beside the child may not be helpful for relieving the child's fear. It may be needed to help hold the child still during a procedure.)
A child is hospitalized for treatment of the flu. Once the child's parents leave, the child starts crying, looks for parents, attempts to leave, refuses to take medicine, hits other children, and breaks toys. What should the nurse conclude from the child's behavior? The child is in the: A. Protest stage. B. Despair stage. C. Denial stage. D. Detachment stage.
A (The child's behavior indicates that the child is in the protest stage of separation anxiety. The child is less able to cope with separation because of stress from the illness and wants to stay with the parents. The child expresses anger indirectly by showing behavioral changes. These behavioral changes are observed in the protest stage of separation anxiety. In the despair stage, the child appears less active, depressed, and uninterested in play and refuses to eat food. The denial stage is also called the detachment stage. In this stage the child is interested in the surroundings, plays with others, and forms new but superficial relationships with others.)
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
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.)
The nurse is obtaining the admission history of a recently admitted adolescent. The nurse notes the patient requires help inserting contact lenses. Under which functional health pattern should the nurse record this observation? A. Activity-exercise pattern B. Cognitive-perceptual pattern C. Nutrition-metabolic pattern D. Health perception-health management pattern
A (The nurse records the admission history of the patient in terms of different functional health patterns. This helps in documenting all the required information about the patient. The patient requires help inserting his or her contact lenses. This implies that the patient needs support to perform an activity. The nurse should record this information under the activity-exercise pattern. The cognitive-perceptual pattern recognizes the cognitive development in the child and includes information such as defects in vision, hearing, or grading in the school. The nutrition-metabolic pattern is used in the assessment of nutrition in the patient, food allergies, and food intake habits. The health perception-health management pattern reports the medication and the health history of the child.)
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 that: 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.
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.)
What are the various guidelines that the nurse has to follow for the admission of a child into the hospital? Select all that apply. A. Apply an identification band on the child's wrist. B. Obtain the nursing admission history of the child. C. Specimens for lab tests should not be taken. D. Orient the parents about the inpatient facilities. E. Hospital regulations should not be disclosed.
A, B, D (The nurse has to follow a few guidelines while admitting the child to the hospital. The nurse should apply an identification band on the child's wrist. This helps in providing appropriate care to the child. The nurse should take the nursing admission history in order to help to identify needs of the child. The nurse should explain to the parents as well as the child about the inpatient facilities. This would make them comfortable within the hospital. Specimens should be collected and may even be ordered for other specimens upon admission. The nurse should orient the parents and the child about the hospital regulations and schedules like visiting hours and food timings.)
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.
A, B, E (Encourage parents to bring in homework and schedule study times. Allow the adolescent to wear street clothes. Encourage parents to bring in favorite foods.)
The nurse plans to assess the role-relationship pattern in a child. Which questions should the nurse ask the parents? Select all that apply. A. "Does the child have any security objects at home?" B. "How do you handle discipline problems at home?" C. "Have you ever noticed that your child sweats a lot?" D. "How does your child usually handle disappointments?" E. "Have any major changes in the family occurred lately?"
A, B, E (For assessing the role-relationship pattern in the child, the nurse should ask the parents about any security objects the child may have at home that provide comfort, discipline problems of the child, and family changes. From this information, the nurse can understand the relationship between the parents and the child. Information about sweating gives an idea about the elimination pattern in the child. Information about the disappointment handling potential of the child gives an idea about the child's coping-stress tolerance pattern.)
A hospitalized child is being released for home health care. What suggestions should the nurse provide to prepare the family for transporting the child home? Select all that apply. A. Take a basin in case of vomiting B. Avoid using the restraint system C. Keep a blanket and pillow in the car D. Discourage the use of a straw for drinking fluids E. Administer prescribed pain medication before leaving
A, C, E (The parents should use a basin or plastic bag for managing vomiting in the child. A blanket and pillow should be kept in the car to provide comfort. Pain medication can be administered before leaving to provide a pain-free journey home. The use of a car safety restraint system should be encouraged for the child's safety. Also, the use of a straw for drinking fluids should be encouraged except for children with oral facial surgeries.)
Ryan has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and Ryan'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
A, C, E (Unfamiliar environment Strange smells Inadequate knowledge of condition and routine)
The nurse is discharging a young child from the hospital. The nurse should instruct the parents to look for which posthospital child behaviors? Select all the apply. A. Tendency to cling to parents B. Jealousy toward others C. Demands for parents' attention D. Anger toward parents E. New fears such as nightmares
A, C, E (Young children's posthospital behaviors include: They show initial aloofness toward parents; this may last from a few minutes (most common) to a few days. This is frequently followed by dependency behaviors: tendency to cling to parents; demands for parents' attention; vigorous opposition to any separation (e.g., staying at preschool or with a babysitter). Other negative behaviors include: new fears (e.g., nightmares); resistance to going to bed, night waking; withdrawal and shyness; hyperactivity; temper tantrums; food peculiarities; attachment to blanket or toy; regression in newly learned skills (e.g., self-toileting). Posthospital behaviors for older children include negative behaviors: emotional coldness followed by intense, demanding dependence on parents; anger toward parents; jealousy toward others (e.g., siblings).)
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.
A, C, E (a. Discuss dietary restrictions. c. Send a pain scale home with the family. e. Discuss complications that may occur.)
An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to: a. Provide for privacy. b. Encourage parents to room in. c. Explain procedures and routines. d. Encourage contact with children the same age.
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.)
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.
B (Allow the child to hold the digital thermometer while taking the child's blood pressure.)
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
B (Emergency hospitalization)
The nurse works in a pediatric unit. Which child would have an increased vulnerability to the stresses of hospitalization? A. A female child B. A child with a difficult temperament C. A child with an average intelligence D. A child older than 6 years of age
B (Hospitalization is a stressor in children and so they may react differently to it. Certain children are more susceptible to the stressful effects of hospitalization than others. Children who have difficult temperament may not readily adjust with the unfamiliar environment of the hospital. These children may experience adverse effects of hospitalization. Female children are able to withhold stress more when compared to male children and thus are less likely to experience stressors. Children with average intelligence may be able to understand their condition and the importance of hospitalization and thus may be more adaptable. Children with lower IQ would not understand the purpose of hospital admission and thus would be extremely stressed due to hospitalization. Children who are older than 6 years of age have developed the maturity to understand their condition and the purpose of hospitalization. Thus, they would be more adaptable to their condition, and experience less stress related to hospitalization.)
Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? A. Inactivity B. Clings to parent C. Depressed, sad D. Regression to earlier behavior
B (In the protest phase, the child aggressively responds to separation from parents (such as clinging to a parent). Inactivity is characteristic of despair. Depression and sadness are characteristics of despair. Regression to earlier behavior is characteristic of despair.)
The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, "Do it later, O.K.?" The nurse should: A. start the IV line because allowing the child to manipulate the nurse is bad. B. start the IV line because unlimited procrastination results in heightened anxiety. C. postpone starting the IV line until the child is ready so that the child experiences a sense of control. D. postpone starting the IV line until the child is ready so that the child's anxiety is reduced.
B (Intravenous antibiotics are a priority action for the nurse. A short delay may be possible to allow the child some choice, but a prolonged delay only serves to increase the anxiety. The nurse should start the IV line, recognizing that the child is attempting to gain control. If the timing of the IV line start was not essential for the start of IV antibiotics, postponing might be acceptable. The child may never be ready. The anxiety is likely to increase with prolonged delay.)
The nurse has been assigned to the pediatric respiratory unit. What is the preliminary requirement for the nurse to evaluate improvement in the respiratory function of the child with treatment? A. The child's feedback B. The baseline data C. The parents' opinion D. The primary health care provider's opinion
B (It is impossible to evaluate the improvement in the respiratory function of the child without having any baseline data. The child's feedback provides only subjective assessment. Evaluation of respiratory system function requires formal knowledge of the respiratory system assessment. Therefore, parent opinion is not reliable for improvement in the child's respiratory function. Evaluation of the improvement in the respiratory function requires objective assessment. Obtaining the primary health care provider's opinion is a type of subjective assessment.)
The nurse is teaching the nursing students about functions of play in the hospital. Which statement made by the nursing student indicates the need for further teaching? "Play: A. Can lessen the stress of separation from the family." B. Makes the child nervous in a strange environment." C. Helps the child develop a positive attitude for others." D. Provides an expressive outlet for the child's creative ideas."
B (Play is one of the most important aspects of a child's life and one of the most effective tools for managing stress. It is helpful for the child to relieve stress. It is also essential for the child's mental, emotional, and social well-being. Play does not make the child anxious in an unfamiliar environment. It helps the child feel more secure in a strange environment. Play lessens the stress of separation from the family because the child is busy. During play, the child communicates with others, which helps develop a positive attitude toward others. It also stimulates thinking in the child by allowing the child to express creative ideas.)
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." The nurse's best assessment of this situation is that: 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 their sister's illness and needs.
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.)
The nurse is assessing a child's level of self-care. The nurse documents a rating of II for dressing and grooming. What can be inferred from this rating? The child: A. Is independent on all aspects of personal care. B. Depends on the supervision of another person. C. Needs to use equipment or another adaptive device. D. Requires direction from a person and uses equipment.
B (The self-care scale can be used for rating the functional self-care abilities of the child. The score ranges from 0 to IV. If the child is scored a II, this implies that the child requires assistance or supervision from another person. A child who is independent with activities of daily living would receive a 0. A score of I implies that the child requires equipment or a device for self-care. A score of III implies that the child requires assistance or supervision from another person and equipment or a device. A score of IV implies that the child is totally dependent and does not participate.)
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
B, C, D (Allows the child to express feelings)
The nurse is explaining the health care bill of rights for children to parents and children in a pediatric ward. What key information does the nurse discuss with the group? Select all that apply. A. Quality health care B. Economic assistance C. Respect and personal dignity D. Making choices and decisions E. Complex information
B, C, D (The bill of rights emphasizes the quality of health care to the children and explains that children and teens should be treated with respect and dignity. The bill also states that children have the right to make choices and decisions in their health care. Children have right to get emotional support from the health care professionals. Children cannot always expect economic assistance from the hospital. The nurse need not explain complicated information such as pathologic process of the disease to the child since the child will not be able to understand. Such information should be provided to the caregivers of the child.)
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"
B, C, D (b. Administration of chamomile tea at bedtime c. Hypnotherapy for relief of pain d. Acupressure to relieve headaches)
When admitting a child to the inpatient pediatric unit, the nurse should assess for which risk factors that can increase the child's stress level associated with hospitalization? Select all that apply. A. Mild temperament B. Lack of fit between parent and child C. Below-average intelligence D. Age E. Gender
B, C, D, E (Risk factors for increased stress level of a child to illness or hospitalization: "Difficult" temperament; Lack of fit between child and parent; Age (especially between 6 months and 5 years old); Male gender; Below-average intelligence; Multiple and continuing stresses (e.g., frequent hospitalizations).)
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.
C (Create a schedule similar to the one the child follows at home.)
The nurse is educating a group of parents and children in the pediatric ward about the benefits of ambulatory care. What benefits does the nurse discuss with the group? Select all that apply. A. Improved care B. Increased cost-saving C. Reduced chances of infection D. Ambulatory care is lesser challenging E. Minimum stressors of hospitalization
B, C, E (Ambulatory care is associated with an increased cost-saving as compared to hospital admissions, since there are no admission-related costs. Ambulatory care is associated with lesser chances of acquiring infections due to limited exposure to health care facilities. Ambulatory care is devoid of the stressors of hospitalization. There is deficient care due to the absence of qualified medical person for supervision. Ambulatory care is more challenging when compared to hospitalization as the child and the parents need to rely mostly on themselves for providing care to the child.)
The nursing student is caring for a child admitted to the hospital. The nursing student asks the nurse instructor, "How can we keep the child's routine habits while he is in the hospital?" What would be the best response by the nurse instructor? Select all that apply. "Ask the parents: A. "About the use of any herbal therapies." B. "When the child goes to sleep at night." C. "What foods the child prefers to eat." D. "How the child's grades are in school." E. "Which toy the child plays with at home."
B, C, E (The nurse should assess the child's usual health habits at home to promote a more normal environment in the hospital. This includes the child's sleep-rest, nutritional-metabolic, and activity-exercise patterns. The nurse would assess the sleep-rest pattern by asking when the child goes to sleep at night. Assessing the nutritional-metabolic pattern would include asking about food preferences. The nurse should also ask what toy the child plays with at home as part of the activity-exercise pattern. These will help the nurse plan individualized care for the child. History about herbal and complementary therapy helps in preventing drug-drug interaction and severe adverse effects.)
After assessment, the nurse notices that a child is in the detachment stage of separation anxiety. Which behavioral changes would the nurse observe in the child? Select all that apply. A. Refuses to eat, drink, or get out of the bed B. Shows an increased interest in the surroundings C. Tries to leave the hospital to find the parents D. Begins to form new relationships with others E. Interacts with strangers or familiar caregivers
B, D, E (Detachment is the third stage of separation anxiety. It is also referred to as the denial stage. In this stage the child begins to take an interest in the surroundings. The child also forms new but superficial relationships with others and becomes more interested in interacting with strangers or familiar caregivers. The child's behavior indicates that the child has finally adjusted to the loss of the parents. This is a serious stage because reversal of the potential adverse effects is less likely to occur after detachment. Refusing to eat, drink, and get out of bed are characteristics of the despair stage of separation anxiety. Attempting to leave the hospital to find the parents is observed in protest stage of separation anxiety.)
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 post-appendectomy 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
C (A 15-year-old boy admitted with a vaso-occlusive sickle cell crisis.)
A child who has undergone orofacial surgery is getting discharged. The nurse teaches the parents about how to safely transport the child on the way home. Which statement made by the parents indicates a need for additional teaching? "We should: A. Have a blanket and pillow for our child for the car ride home." B. Have a plastic bag for our child in case of nausea and vomiting." C. Use a cup with a lid and a straw for giving fluids to our child." D. Make sure our child has pain medication before discharge."
C (Children who undergo orofacial surgery should not use a straw for drinking fluids because it can damage the surgical site. Therefore the parents should not use cup with a lid and a straw for giving fluids to the child. The parents should bring a blanket and pillow for the child in the car so that the child can sit or sleep properly. Parents should bring a plastic bag, which will be helpful if the child becomes nauseated or vomits. The parents should give prescribed pain medication to the child before leaving the facility for relieving pain.)
During the assessment of a child, the nurse finds that the child is inactive, depressed, sad, and uncommunicative; refuses to eat; and generally lacks interest in everything around her. What should the nurse interpret from this assessment? The child is in the: A. Denial stage. B. Protest stage. C. Despair stage. D. Detachment stage
C (From this assessment, the nurse interprets that the child is in the despair stage. This is the second stage of separation anxiety. In the despair stage, the child appears less active, depressed, and uninterested in play or food. In this stage the child's physical condition may deteriorate from refusing to eat, drink, or get out of bed. The denial stage is the third stage of separation anxiety. In the denial stage, the child is more interested in the surroundings, plays with others, and forms new but superficial relationships with others. In the protest stage, the child reacts aggressively, cries, screams, and searches for the parents with the eyes. Detachment is the third stage of separation anxiety. It is also called denial.)
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 of the following? 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.
C (He may be experiencing detachment, which is the third stage of separation anxiety.)
Why does the nurse ask the parents of a hospitalized child to bring the child's blanket from home? A. To alleviate any fears in the child B. To decrease any allergic reactions C. To provide comfort for the child D. To keep the child warm at night
C (If the parents cannot stay with the child in the hospital, the nurse may ask the parents to leave an article such as a blanket or toy from home. This is because young children associate such inanimate objects with significant people, and they gain comfort and reassurance from these possessions. When a child is frightened, the nurse should provide physical contact to ease the child. If the child is allergic to the linens at the hospital, it would be the hospital's responsibility to find alternative bedding. There are plenty of blankets available in the hospital, so the parents would not bring the blanket to keep the child warm.)
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
C (Lack of physical connection to the hospital)
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.
C (Let the child decide which color arm board to use with the IV.)
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 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."
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.)
Emma, 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 that: a. New toys 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.
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.)
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.
C (Perform the exam while the child is on the parent's lap.)
The nurse develops a plan of care based on the information documented in a child's admission assessment. The nurse instructs the health care team that they should not leave the room until the child falls asleep. What information documented under the self-perception-self-concept pattern would necessitate this nursing intervention? The child has: A. Nightmares. B. Disturbed sleep patterns. C. A fear of sleeping alone. D. The habit of bed-wetting.
C (The child has fear of sleeping alone in the room. This information is usually noted under the self-perception—self-concept pattern of the nursing history. The nurse tries to comfort the child's fear of sleeping alone by being present until the child falls asleep. Nightmares can be managed by comforting the child and preventing specific fears. Nightmares and disturbed sleep may be brought on by hospitalization and may improve once the child adapts himself or herself to the new environment. Bed-wetting is common in younger children but needs further evaluation in older children.)
The nurse is caring for a child with cancer. What should the nurse ask the child's parents about in order to obtain information about the child's coping-stress tolerance pattern? A. "How do you both handle discipline problems at home?" B. "Have you ever noticed if your child has many friends?" C. "How does your child usually handle disappointment?" D. "Who will be staying with your child at the hospital?"
C (The nurse should ask the child's parents about how the child usually handles disappointment. This can help the nurse understand the coping-stress tolerance pattern of the child. It is also helpful for identifying stressors in the child. It is important to know how discipline problems are managed in the child. This helps to know about the child and parent role-relationship pattern. When the nurse asks about the child's friends, it is to assess the child's role and relationship patterns outside the home. The nurse can understand the role and relationship pattern between the parents and child after knowing who will stay in the hospital with the child.)
The nurse is assessing the functional self-care level of a child and determines that the child requires the assistance of a caregiver for general hygiene and dressing. How would the nurse rate the child? A. 0 B. I C. II D. IV
C (The nurse should rate the child as a II (two) because the child requires assistance of a caregiver for general hygiene and dressing. A grading of 0 (zero) is given to the child who is capable of taking full self-care. A grading of a I (one) is given to the child who requires the use of equipment or a device for self-care. A child who is totally dependent and does not participate in self-care would be rated a IV (four).)
The nurse is caring for a child with an influenza viral infection. The child is anxious because the parents are unable to stay with the child. What should the nurse do to relieve the child's anxiety? The nurse should: A. Not maintain any eye contact with the child. B. Not speak with the child about missing the parents. C. Use the phone to let the child talk with the parents. D. Use a laptop to allow the child and parents to talk
C (The nurse should use a telephone to maintain contact between the child and parents so that the child can feel comfortable. It helps relieve the child's anxiety. The nurse should maintain eye contact and gently touch the child to establish rapport. The nurse should talk with the child about the parents and family to prevent detachment of the child from the parents. The nurse should not use a laptop to contact the child and parents. The laptop may not be compatible with medical equipment, and use may be restricted in certain areas.)
The nurse gets out finger painting materials made from wallpaper paste for a child. After reviewing the child's medical record, the nurse decides to get out crayons and a coloring book instead. What information did the nurse find in the nursing history? The child: A. Is on a salt-restricted diet. B. Has lactose intolerance. C. Has an allergy to wheat. D. Is allergic to beetroot.
C (The painting materials made from wallpaper paste may contain wheat. If the paint comes in contact with the child's skin, it can cause an allergic reaction. Therefore the nurse changes the activity. The child who is on a salt-restricted diet need not worry about salt being in the paint. A patient is placed on salt restriction to prevent water retention, not because of an allergy. The child who is lactose intolerant cannot ingest dairy products. Beetroot is used as natural dyes in paintings; however, the wallpaper paste does not contain beetroot extract.)
A child is playing in the playroom. The nurse needs to take a blood pressure on the child. 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.
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 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.)
A child is hospitalized for a chronic illness. Initially, the child showed symptoms of depression but later started interacting with others. What does the nurse infer from the patient's behavior? The child is: A. Content with the care provided. B. Showing improved social skills. C. Getting used to the surroundings. D. Detached from both parents.
D (Hospitalized children undergo depression when they are separated from their parents. As they go through the stages of separation anxiety, children eventually detach from their parents and develop new and shallow relationships. Children interact with others and develop new relationships as a result of resignation, not contentment. Children who are detached begin to show increased interest in their surroundings. They are also not developing their social interaction skills. Children try not to think about the separation; hence, they start developing new interactions.)
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
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.)
