Peds- Chapter 33& 34

5. The nurse is interviewing the caregiver of a 5-year-old child who has been admitted with bruises on the abdomen and thighs as well as additional bruises in various stages of healing. Which statement made by the caregiver might alert the health care team to the possibility of child abuse (child maltreatment)? A. "His brother just plays too rough with him." B. "My child goes to day care after school." C. "He just learned to ride his bicycle." D. "When he is in trouble I make him go to his room."

A. "His brother just plays too rough with him."

8. A group of pediatric nurses is discussing the diagnosis of Munchausen syndrome by proxy. Which statement most accurately describes this disorder? A. "It is seen when one person fabricates or induces illness in another to get attention." B. "The disorder occurs when a child is shaken by the arms or shoulders in a repetitive manner." C. "Children with this diagnosis often appear worried or fearful and have nightmares." D. "It happens when there is sexual contact between a child and a caregiver."

A. "It is seen when one person fabricates or induces illness in another to get attention."

2. A 3-year-old who has been attending preschool has been diagnosed with leukemia. The caregivers of this child ask the nurse what they can do to help their child feel secure. Which recommendation could the nurse make to these caregivers that would be helpful in making the child feel secure? A. "Let your child continue to attend preschool as much as possible." B. "Keep your child at home and spend as much one-on-one time with her as possible." C. "Keep your child out of school but invite some friends over for play dates." D. "Plan special outings with just the family during the time the child would normally have been at school."

A. "Let your child continue to attend preschool as much as possible."

21. The nurse is admitting a pediatric client for a common pediatric surgical procedure. When completing the domestic violence screening, which statements require clarification? Select all that apply. A. "My Dad yells a lot but never means it and doesn't hit anyone." B. "We stay out of Mom's way when she is in a bad mood." C. "I see my Dad drive by our new house to see who is here." D. "I love my parents even though they are divorced." E. "My Mom will hit my Dad when she is drunk but it doesn't hurt."

A. "My Dad yells a lot but never means it and doesn't hit anyone." C. "I see my Dad drive by our new house to see who is here." E. "My Mom will hit my Dad when she is drunk but it doesn't hurt."

10. The health care provider is unsure of physical symptoms and diagnosis of a pediatric client. The health care provider is prescribing diagnostic testing to determine possible poisoning by the parent. When the parent asks why laboratory work is being drawn, which response is best? A. "Since we have not found the cause of the illness yet, the health care provider has ordered more blood tests." B. "We are drawing laboratory work to rule out poison in the child's system." C. "I am not really sure at this time. I just saw it on the prescription sheet." D. "It is hospital policy to draw laboratory work daily to monitor the client status."

A. "Since we have not found the cause of the illness yet, the health care provider has ordered more blood tests."

6. The father of a 10-year-old who has recently been diagnosed with a terminal illness tells the nurse that his family had been working together for the previous year trying to get the 10-year-old and his 6-year-old sister to play better together and to share with each other. Which statement would be most appropriate for the nurse to tell the father regarding children and the diagnosis of an illness? A. "The younger child might believe that her anger at her brother caused his illness; she will need reassurance that she does not have that power." B. "The older child might believe that his sister's anger caused his illness; he will need reassurance that his sister does not have that power." C. "It will be important that the children learn to play well together while the older child is alive so that the younger child will have positive memories of the older child." D. "Both children are likely to be more cooperative and

A. "The younger child might believe that her anger at her brother caused his illness; she will need reassurance that she does not have that power."

8. A child who is dying becomes restless and fidgety, then becomes calm and peaceful. The caregivers feel hopeful that the child seems "better." Which statement would be the best for the nurse to tell the caregivers about this pattern? A. "This pattern is part of dying; the child's death is imminent." B. "This pattern is not unusual in a dying child and might happen over and over again." C. "This pattern suggests that the child is feeling more comfortable and has less distress from the illness." D. "This pattern is consistent with medication cycles; the fidgeting is caused by pain, and the calmness is a sign that the pain has been controlled with medicine."

A. "This pattern is part of dying; the child's death is imminent."

12. A toddler's older sibling has died. Which nursing response best addresses a toddler's concern about, "Where has my brother gone?" A. "Your brother is gone but is in a special place. We can think about him and remember the fun times." B. "Your brother has fallen asleep and is safe where he has gone. We look forward to seeing him again someday." C. "We do not know or understand where your brother has gone as we have never gone there. Many people say it is a wonderful place." D. "It is best to ask your Mommy where he is. She will explain it to you."

A. "Your brother is gone but is in a special place. We can think about him and remember the fun times."

17. The parents of a terminally ill child ask the nurse how to have a conversation about illness. Which is the most appropriate concept for the nurse to base the response? A. Be direct, using age-appropriate language the child can understand. B. Use metaphors that the child has heard from past stories. C. Relate to a favorite family member who has died. D. Use broad terms and general statements.

A. Be direct, using age-appropriate language the child can understand.

22. When evaluating a terminally ill client for pain relief following medication administration, which nursing assessments would be documented to support that the medication was effective? Select all that apply. A. Heart rate and respirations are within normal limits. B. The client is lying in a flexed position on the bed. C. The client is quietly sleeping on the parent's lap. D. The child is withdrawing from the environment. E. The client verbalizes a 1 on the analog pain scale.

A. Heart rate and respirations are within normal limits. C. The client is quietly sleeping on the parent's lap. E. The client verbalizes a 1 on the analog pain scale.

6. In caring for a child who has been admitted after being sexually abused, which intervention would be included in the child's plan of care? A. Observe for signs of anxiety. B. Weigh on the same scale each day. C. Encourage frequent family visits. D. Test the urine for glucose upon admission.

A. Observe for signs of anxiety.

24. The nurse is attempting to include family in the care of a hospitalized, terminally ill adolescent. Which interventions can be appropriately delegated to family members? Select all that apply. A. Provide mouth swabs for the family to moisten lips. B. Discuss the client's status with care options at the beside. C. Provide pillows to facilitate the repositioning for comfort. D. Keep a blood pressure cuff and stethoscope available at bedside. E. Supply sufficient disposable pads to be placed under the client as needed.

A. Provide mouth swabs for the family to moisten lips. C. Provide pillows to facilitate the repositioning for comfort. E. Supply sufficient disposable pads to be placed under the client as needed.

18. Which technique will best foster the initial communication between the nurse and a school-aged child recently told of a cancer diagnosis? A. Provide supplies for the child to draw a picture. B. Begin a conversation about the diagnosis with the parent. C. Sit quietly at the bedside until the child is ready to communicate. D. Offer age-appropriate board games, movies, or video games.

A. Provide supplies for the child to draw a picture.

10. A single parent of a dying child has told the nurse she would like to take care of her daughter at home. What would be best for the nurse to do to help the mother reach a decision that will be good for both the mother and the child? The nurse should: A. Put the mother in touch with the department of a hospital that can help her sort out the availability of home nursing care, insurance coverage, and respite care. B. Remind the mother that the number of staff people caring for the child in the hospital is unlikely to be duplicated at home, making the hospital a better choice. C. Validate her courageous idea and say that the staff at the hospital will always be available to answer her questions. D. Suggest that she look into a hospice residence, which is often a good alternative to caring for the child alone at home or having the child remain in the hospital.

A. Put the mother in touch with the department of a hospital that can help her sort out the availability of home nursing care, insurance coverage, and respite care.

25. Which communication strategies are appropriate when discussing the topic of death and dying with a terminally ill school-aged child? Select all that apply. A. Use the terms death and dying in the conversation. B. Listen to the child and accept the child's feelings. C. Tell the client that you know how hard this is. D. Consider the developmental level of the child. E. Say "I do not know" when unsure of an answer. F. Allow the health care provider to answer all questions.

A. Use the terms death and dying in the conversation. B. Listen to the child and accept the child's feelings. D. Consider the developmental level of the child. E. Say "I do not know" when unsure of an answer.

14. The nurse is providing client-centered support to an adolescent diagnosed with a terminal illness. Keeping the client's developmental stage in mind, which nursing intervention will best meet the client's needs? A. rearranging the medication schedule so the client can see a favorite sports team B. changing the client's room so the client can watch the busy outdoors C. limiting visits from friends at school to the client's birthday D. encouraging siblings to participate with client in hospital activities

A. rearranging the medication schedule so the client can see a favorite sports team

17. Which type of abuse is reported most quickly to the police? A. sexual assault B. incest C. neglect D. emotional abuse

A. sexual assault

25. A child is brought to the emergency department for evaluation. The caregiver states, "The child was running and tripped over the scooter on the sidewalk and landed on the left arm." The nurse assesses and records the findings (above). The nurse suspects child abuse (child mistreatment) and notifies the proper authorities. Which finding(s) will the nurse use to support this suspicion? Select all that apply. A. spiral fracture B. bruises on the knees C. bruises on the thighs D. abrasion on the left palm E. bruise on the upper back

A. spiral fracture C. bruises on the thighs E. bruise on the upper back

19. Which physical symptoms confirm that a child has been sexually abused or assaulted? Select all that apply. A. stained and bloody underclothing B. The child states that someone touched the breasts. C. inappropriate vaginal opening measurements D. suspicious actions of the caregiver E. sperm on body or clothes

A. stained and bloody underclothing C. inappropriate vaginal opening measurements E. sperm on body or clothes

16. The nurse is caring for a 4-year-old child with bruises on various areas of the body. Which parental statement does the nurse note as most suspicious? A. "The child plays aggressively with the siblings in the house." B. "The child plays tackle football at the local school. He has advanced skills." C. "The child bruises easily but was checked for a bleeding disorder." D. "The child is clumsy when running and playing with older siblings."

B. "The child plays tackle football at the local school. He has advanced skills."

4. In interacting for several days with a dying child, the nurse realizes that the child has not mentioned death. There are some dead flowers in a vase on the child's windowsill. The child looks at the flowers and says, "Did they die?" Which statement would be most appropriate for the nurse to make to give the child an opportunity to open up and talk about dying? A. "These flowers don't seem to be alive anymore. I'll take them away." B. "These flowers are dead now. What do you think it would be like to die?" C. "I'm going to throw these flowers in the trash, okay?" D. "Well, these flowers aren't very cheerful anymore. I'll get rid of them."

B. "These flowers are dead now. What do you think it would be like to die?"

19. A graduate nurse has provided care for a pediatric client who has died. Which statement to the family would require further discussion between the graduate nurse and the registered nurse (RN) mentor? A. "It is so hard to see you cry." B. "This reminds me of the time my aunt died." C. "I am very sorry of your loss. He was a great kid." D. "Please let me know if there is something I can do for you."

B. "This reminds me of the time my aunt died."

3. The nurse is caring for a child who has been a client in the pediatric unit for several weeks. The child has a terminal illness and is dying. The caregivers and the nurse are in the room when the child takes the last breath and dies. Which action by the nurse would be considered appropriate at this time? A. The nurse walks out of the room and calls the nursing supervisor and chaplain. B. The nurse tells the family that they share in the family's sadness and cries with them. C. The nurse maintains their professional demeanor and tells the caregivers that a staff person will be in to take the body soon. D. The nurse consoles the family members by hugging or rubbing their backs and then moves to a corner of the room to cry.

B. The nurse tells the family that they share in the family's sadness and cries with them.

11. When mentoring a graduate practical nurse (PN), which behavior would the registered nurse (RN) address if demonstrated by the PN in the care of a dying child? A. agreeing to pray with the client and family B. checking on the client and family once every shift C. assessing comfort measures needed by the client every hour D. providing bedding for the family to remain close to the client

B. checking on the client and family once every shift

20. The emergency room nurse is caring for a family who lost an adolescent in a violent car accident. Which initial nursing action best helps the family's grieving process? A. notifying the family's religious leader of the tragedy B. cleaning and making the deceased presentable to the family C. calling the funeral home to make arrangements for the body transfer D. presenting the family with the deceased's personal belongings

B. cleaning and making the deceased presentable to the family

20. Which is essential in working with caregivers who have been affected by abuse? A. knowing the legal system B. developing a therapeutic relationship C. providing details on social services in the community D. arranging family meetings to discuss issues

B. developing a therapeutic relationship

15. The nurse is caring for a young child whose parents have been charged with physical abuse. Which child reaction is noted as a result of the parental behavior? A. despondent and does not respond to questions B. fretful and shrinks away when approached C. aggressive and kicks and fights during the assessment D. cries frequently and stares at the nurse

B. fretful and shrinks away when approached

9. The caregivers of a dying 9-year-old boy are in his hospital room. Death is near and the child has drifted in and out of consciousness for several days. The caregivers are at two different stages of anticipatory grief and are arguing in whispers in the room. The best response in this situation would be for the nurse to: A. recognize that their differences are normal and leave them to their argument. B. interrupt their conversation, acknowledge that their feelings are valid, and let them know that the child can hear them and might be upset by their discord. C. interrupt their conversation, acknowledge that their feelings are valid, and ask them to leave the room. D. call a chaplain to come and speak with them.

B. interrupt their conversation, acknowledge that their feelings are valid, and let them know that the child can hear them and might be upset by their discord.

7. The nurse is caring for a small child who has been admitted with a diagnosis of abusive head trauma (shaken baby syndrome). Which condition or concern often occurs with shaken baby syndrome? A. edema to the arms and legs B. loss of vision and intellectual disability C. chronic infection and scarring D. reports of illness and nightmares

B. loss of vision and intellectual disability

14. A toddler is brought to the emergency department with burns on the feet and buttocks. The toddler is screaming in pain. The caregiver states that she did not know the bath water was so hot. What is the initial action completed by the nurse? A. assessment of the toddler B. notifying a health care provider C. completing injury documentation D. calling law enforcement

B. notifying a health care provider

22. Which adolescent behavior is most common if the parents have substance use problems? A. staying away from the house B. taking on adult responsibilities C. being clingy to teachers at school D. telling everyone of the parental issues

B. taking on adult responsibilities

1. The nurse is working with a group of caregivers who have dying children. Which statement made by one of the caregivers indicates that this caregiver is in the depression stage of anticipatory grief? A. "It is going to be hard for me when I can't hug my daughter anymore." B. "I've got to go into my office for a meeting. I'm sure my son will be fine while I'm gone." C. "I used to love playing board games with my son. Now that just makes me feel sad." D. "I'll be able to handle my child's dying if she can just live until her next birthday."

C. "I used to love playing board games with my son. Now that just makes me feel sad."

13. Which statement made by a participant at a workshop on sexual abuse needs further clarification from the group leader? A. "The difference between sexual abuse and sexual assault is the perpetrator." B. "Sexual abuse by a person of trust is the most damaging type." C. "Mostly low-income people commit sexual violence against children." D. "In cases of incest, the child rarely tells anyone else."

C. "Mostly low-income people commit sexual violence against children."

21. The nurse is discussing the principles of hospice care to the family of a terminally ill pediatric client. Which parental statement would the nurse clarify as a misconception? A. "My son will be assessed for pain relief." B. "We can participate in our religious practices." C. "My son will still receive aggressive treatments for a cure." D. "My son will have holistic nursing care meeting his needs."

C. "My son will still receive aggressive treatments for a cure."

16. When caring for a child who is dying, which statement by the child leads the nurse to believe that the topic of death needs to be discussed further? A. "I am going to a better place." B. "I do not want to leave my parents." C. "The bogeyman is going to come and fly me away." D. "I want to make a picture so my sister remembers me."

C. "The bogeyman is going to come and fly me away."

7. A young nurse has had no experiences of death in her own life. As a staff nurse, she finds herself dealing with young children who are terminally ill. She feels extremely uncomfortable facing these children and their caregivers. What is the best approach for the nurse to take in caring for these families? A. Focus on the physical needs of the client; the nurse's job is to care for those aspects of the child's needs. B. Ask another nurse to perform those tasks that involve discussions with the clients and their caregivers. C. Ask her supervisor to allow her to attend a seminar on dealing with the terminally ill and to recommend books and articles that will help her understand death better. D. Recognize that the bad thing is not happening to her, and face her responsibility to care for all of the needs of the client.

C. Ask her supervisor to allow her to attend a seminar on dealing with the terminally ill and to recommend books and articles that will help her understand death better.

11. The nurse on a pediatric unit is caring for a client who has been physically and emotionally abused. Which adjustment in care is most appropriate? A. Only draw laboratory work in the treatment room. B. Allow the nonabusive caregiver to remain with the client. C. Assign consistent nursing staff to the client when possible. D. Provide play and distraction techniques to relieve stress.

C. Assign consistent nursing staff to the client when possible.

2. A caregiver who works in the hospital brings his 9-year-old son to the emergency room with a spiral fracture of the tibia. The caregiver reports that the injury occurred when the boy's 5-year-old sister hit him with wooden bat. The injury is inconsistent with an impact and with the sister's strength. Which of the following would be appropriate for the nurse to do in this situation? A. Tell the caregiver that the story is not plausible and ask what really happened. B. Leave the treatment area and call the police. C. Leave the treatment area and call the social services department in the hospital. D. Let the hospital administrator know so that the hospital can take any necessary action.

C. Leave the treatment area and call the social services department in the hospital.

3. Which situation should the nurse explore for possible emotional abuse of the child by the caregiver? A. The caregiver of a 13-year-old reports, "Amy is really frustrating me. I've been late for work every day this week because she hasn't been ready to leave for school on time." B. The caregiver of a 16-year-old reports, "I couldn't believe that dinner wasn't ready when I got home from work last night. Jack knew it was his turn to cook." C. The caregiver of a 12-year-old reports, "I'm sorry we missed Jamal's appointment last week, but he was supposed to remind me to come." D. The caregiver of a 15-year-old reports, "Laia promised to earn the money to care for the dog if we got him, but she keeps turning down baby-sitting jobs to go out with her friends, and I have to add dog food to my already impossible budget."

C. The caregiver of a 12-year-old reports, "I'm sorry we missed Jamal's appointment last week, but he was supposed to remind me to come."

23. Which factor associated with the caring of a dying pediatric client is most often cited by nurses as presenting the greatest degree of difficulty? A. realizing that the clients have not lived much of their life B. caring for such families takes a high emotional toll C. being constantly reminded of their personal mortality D. addressing cultural difference in beliefs and practices

C. being constantly reminded of their personal mortality

18. Which is the primary physical sign of a child who the nurse suspects as being emotionally abused? A. poor hygiene B. fatigue C. delays in physical development D. inadequate medical care

C. delays in physical development

15. When considering a school-aged child, the nurse should anticipate which factor as playing an influential role in the development of the concept of death? A. social media B. video games C. family D. friends

C. family

1. A group of nurses is discussing child abuse (child maltreatment) and one nurse suggests that inadequate parenting skills may lead to child maltreatment. The nurse recognizes that sometimes child maltreatment occurs because the parent: A. is responding appropriately to the child's behavior. B. believes the child is intentionally trying to make him or her angry. C. may have unrealistic expectations of the child. D. works hard to provide for the family and feels unappreciated.

C. may have unrealistic expectations of the child.

23. The nurse has identified the outcome of improving parenting and coping skills in a caregiver who has shown past poor judgement in caring for the children. Which action promotes a positive image of his or her abilities? A. educating on positive parenting skills B. providing feedback on how to better cope with stressful situations C. providing a compliment when a caregiver does something well D. initiating a reward system when the parent accomplishes a goal

C. providing a compliment when a caregiver does something well

5. The nurse has recently started caring for a dying child. The nurse has not yet had a chance to discuss the family's beliefs with the child's caregivers. In the middle of the night, the child awakens and is frightened. She asks the nurse what the nurse's religious beliefs are about death. Which response would be appropriate? A. "I believe that good people, like you, go to heaven." B. "I don't have any religion but I don't think you should be scared of dying." C. "I like to keep my beliefs to myself. Are you having trouble sleeping?" D. "Most religions seem to believe that spirits live on after the body dies. What are you thinking about?"

D. "Most religions seem to believe that spirits live on after the body dies. What are you thinking about?"

4. The nurse is assisting with a physical exam on a child who has been admitted with a diagnosis of possible child abuse (child maltreatment). Which finding might alert the nurse to this possibility that the child may have been abused? A. The child has a fractured bone. B. The child has bruises on the knees and elbows. C. The child is hyperactive and angry. D. The child has a burn that has not been treated.

D. The child has a burn that has not been treated.

13. Which action by the nurse providing end-of-life care to a preschool-aged client best promotes comfort? A. positioning a favorite toy by the client's hand B. allowing a pet to visit and sit on the client's lap C. providing a warm bath and back massage before bed D. arranging for a bed to allow the parent to lie with the child

D. arranging for a bed to allow the parent to lie with the child

24. A mother brings a 23-month-old child for a well-child check. She apologizes, stating, "It's my allergies, not a cold, that is causing me to sniffle so much." The mother reports that the toddler seems "slower at doing things than my older children did." The nurse notices that the child sits in the mother's lap without fear or hesitation and responds to the her questions, but fails to looks at the mother's face when being spoken to. These behaviors are supportive of what additional assessment? A. autistic behaviors demonstrated by the child B. attention deficit hyperactive disorder (ADHD) characteristics demonstrated by the child C. indications of physical abuse of the child by the caregiver D. evidence of cocaine abuse by the caregiver affecting the child

D. evidence of cocaine abuse by the caregiver affecting the child

12. The school nurse observes an elementary school child arriving in the winter in shorts and a short sleeved shirt with no coat. The nurse would consider this as which type of abuse? A. physical abuse B. emotional abuse C. sexual abuse D. neglect

D. neglect

9. The nurse is assessing an infant diagnosed with abusive head trauma (shaken baby syndrome). Clinical manifestations of shaken baby syndrome affect which body system the most? A. musculoskeletal system B. cardiovascular system C. respiratory system D. nervous system

D. nervous system