practice questions #5

Based on concepts related to the normal growth and development of children, which child would have the most difficulty with separation from family during hospitalization? a. A 5-month-old infant b. A 15-month-old toddler c. A 4-year-old child d. A 7-year-old child

A 15 month old toddler Separation is the major stressor for children hospitalized between ages 6 and 30 months. Infants younger than 6 months of age will generally adapt to hospitalization if their basic needs for food, warmth, and comfort are met. Although separation anxiety occurs in hospitalized preschoolers, it is usually less obvious and less serious than that experienced by the toddler. The school-age child is accustomed to separation from parents. Although hospitalization is a stressor, the 7-year-old child will have less separation anxiety than a 15-month-old toddler.

The home health care nurse is working with a family with three children, one of whom has a chronic condition. What statement by a parent indicates that goals for a primary nursing diagnosis have been met? a. "We take turns going to soccer practice with our other two kids." b. "Each sibling has one night when he or she is in charge so we can go out." c. "We are looking into local support groups for parents." d. "We can't afford home health care, so one of us will quit our job."

ANS: A The family that is demonstrating good ability to balance the needs of all family members is meeting an important goal for the diagnosis Interrupted Family Processes. The other siblings may not want to be "in charge" for an entire evening, but that does not show good balance. Looking into support groups and having to quit a job also do not demonstrate that a goal for this diagnosis is being met.

The parents of a chronic illness say, "Living with this disease is really hard; it's not fair." What response by the nurse is best? a. "Tell me about what is hard for you." b. "I know exactly how you must feel." c. "I know a local support group for families." d. "I am going to ask the grief counselor to meet with you."

ANS: A The first step in supporting families and helping them deal with chronic sorrow is to listen to and recognize their pain. Each individual's perception of a situation is different. A nurse can never know exactly how parents feel about having a child with a chronic illness. The family may welcome involvement in a support group or meeting with a counselor, but that should not be the first action.

The traditional areas of school health nursing that are still prevalent in many school systems include which of the following? (Select all that apply.) a. Health screening b. Emergency care c. Intensive care d. Communicable disease management e. Health care advice

ANS: A, B, D, E Health screening such as vision, hearing, and growth checks can provide information about problems that may affect the child's ability to learn. School nurses are often the first to provide care for children experiencing an unintentional injury, either on the playground or in the school building. The nurse must assess children for illnesses that may be transmitted to other children and provide care and isolation until a parent can pick up the child from school. The school nurse can be a source of referral for families in need of health care services. Intensive care is provided in the hospital.

What are age-appropriate nursing interventions to facilitate psychological 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.

ANS: A, B, E Completing homework during study time, allowing the teen to wear street clothes, and encouraging parents to bring favorite foods are all age appropriate. Involving parents in care and following home routines are important interventions for the preschool child who is in the hospital. Adolescents do not need parents to assist in their care. They are used to performing independent self-care. Adolescents may want their parents to be nearby, or they may enjoy the freedom and independence from parental control and routines.

Which should a nurse identify as common chronic illnesses of childhood? (Select all that apply.) a. Reactive airway disease (asthma) b. Respiratory syncytial virus (RSV) c. Cerebral palsy d. Diabetes mellitus e. Human immunodeficiency virus infection (HIV)

ANS: A, C, D, E A chronic illness is defined as a condition that is long term, does not spontaneously resolve, is usually without a complete cure, and affects activities of daily living. Reactive airway disease (asthma), cerebral palsy, diabetes mellitus, and HIV are all chronic illnesses that may occur during childhood. RSV is a virus that is highly contagious and causes bronchiolitis and pneumonia in children. It does not cause chronic illness.

A 3-year-old child cries, kicks, and clings to the father when the parents try to leave the hospital room. What is the nurse's best response to the parents about this behavior? a. "Your child is showing a normal response to the stress of hospitalization." b. "Your child is not coping effectively with hospitalization." c. "Parents should stay with children during hospitalization." d. "You can avoid this if you leave after your child falls asleep."

ANS: A- "Your child is showing a normal response to the stress of hospitalization." the child is exhibiting a healthy attachment to the father. The child's behavior represents the protest stage of separation and does not represent maladaptive behavior. This response places undue stress and guilt on the parents. Leaving when the child is asleep will foster mistrust.

Which is the most developmentally appropriate intervention when working with the hospitalized adolescent? a. Encourage peers to call and visit when the adolescent's condition allows. b. Encourage the adolescent's friends to continue with their daily activities; the adolescent has concrete thinking and will understand. c. Discourage questions and concerns about the effects of the illness on the adolescent's appearance. d. Ask the parents how the adolescent usually copes in new situations.

ANS: A- encourage peers to call and visit when the adolescent's condition allows The peer group is important to the adolescent's sense of belonging and identity; therefore separation from friends is a major source of anxiety for the hospitalized adolescent. Adolescents should have advanced beyond concrete thinking. In addition, hospitalized adolescents may be upset if their friends continue with daily activities without them. Communication, interacting, and meeting with friends will be important. Questions and concerns should be encouraged regarding the adolescent's appearance and the effects of illness on appearance. How the adolescent copes should be asked directly of the adolescent.

. Which nursing action is the most appropriate when applying a face mask to a child for oxygen therapy? a. The oxygen flow rate should be less than 6 L/min. b. Make sure the mask fits properly. c. Keep the child warm. d. Remove the mask for 5 minutes every hour.

ANS: B A properly fitting face mask is essential for adequate oxygen delivery. The oxygen flow rate should be greater than 6 L/min to prevent rebreathing of exhaled carbon dioxide. Oxygen delivery through a face mask does not affect body temperature. A face mask used for oxygen therapy is not routinely removed.

What is the appropriate nursing response to a parent who asks, "What should I do if my child cannot take a tablet?" a. "You can crush the tablet and put it in some food." b. "Find out if the medication is available in a liquid form." c. "If the child can't swallow the tablet, tell the child to chew it." d. "Let me show you how to get your child to swallow tablets."

ANS: B A tablet should not be crushed without knowing whether it will alter the absorption, effectiveness, release time, or taste. Therefore telling the parent to find out whether the medication is available in liquid form is the most appropriate response. A chewed tablet may have an offensive taste, and chewing it may alter its absorption, effectiveness, or release time. Forcing a child, or anyone, to swallow a tablet is not acceptable and may be dangerous.

In which age-group does the child's active imagination during unfamiliar experiences increase the stress of hospitalization? a. Toddlers b. Preschoolers c. School-age children d. Adolescents

ANS: B Active imagination is a primary characteristic of preschoolers. A toddler's primary response to hospitalization is separation anxiety. School-age children experience stress with loss of control. Adolescents experience stress from separation from their peers.

Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by which response? a. Denial b. Anger c. Social reintegration d. Acceptance of child's limitations

ANS: B After the initial shock has worn off, families often respond to a chronic illness diagnosis with anger. Social reintegration and acceptance may or may not ever occur but if they do it is the culmination of the grief process.

Which action by the nurse indicates that the correct procedure has been used to measure vital signs in a toddler? a. Measuring oral temperature for 5 minutes b. Counting apical heart rate for 60 seconds c. Observing chest movement for respiratory rate d. Recording blood pressure as P/80

ANS: B Apical pulse measurement when the child is quiet for 1 full minute is the preferred method for measuring vital signs in infants and children ages 2 years and younger. A child younger than 6 years may not be able to hold a thermometer under the tongue. The respiratory rate should be auscultated on the quiet infant or young child for 1 full minute. The nurse should be able to auscultate the blood pressure of a toddler, so this would not be the correct way to document it.

Kelly, age 8 years, will soon be able to return to school after an injury that resulted in several severe, chronic disabilities. What action by the school nurse is most appropriate? a. Recommend that Kelly's parents attend school at first to prevent teasing. b. Prepare Kelly's classmates and teachers for changes they can expect. c. Refer Kelly to a school where the children have chronic disabilities similar to hers. d. Discuss the fact that her classmates will not accept her as they did before.

ANS: B Attendance at school is an important part of normalization for Kelly. The school nurse should prepare teachers and classmates about her condition, abilities, and special needs. A visit by the parents can be helpful, but unless the classmates are prepared for the changes, it alone will not prevent teasing. Kelly's school experience should be normalized as much as possible. Children need the opportunity to interact with healthy peers, as well as to engage in activities with groups or clubs composed of similarly affected persons. Children with special needs are encouraged to maintain and reestablish relationships with peers and to participate according to their capabilities.

9. Why is observation for 24 hours in an acute-care setting often appropriate for children? a. Longer hospital stays are more costly. b. Children become ill quickly and recover quickly. c. Children feel less separation anxiety when hospitalized for 24 hours. d. Families experience less disruption during short hospital stays.

ANS: B Children become ill quickly and recover quickly; therefore they can require acute care for a shorter period of time. A child's state of wellness, rather than cost, determines the length of stay. Separation anxiety is primarily a factor of the stage of development, not the length of hospital stay. Family disruption is a secondary outcome of a child's hospitalization; it does not determine length of stay.

What corresponds to a 5-year-old child's understanding of death? a. Loss of a caretaker b. Reversible and temporary c. Permanent d. Inevitable

ANS: B Children in early childhood (2 to 7 years old) view death as reversible and temporary. Loss of a caretaker corresponds to the infant/toddler understanding of death. The school-age child and adolescent understand that death is permanent. The adolescent understands death not only as permanent but also inevitable.

How can chronic illness and frequent hospitalizations affect the psychosocial development of a toddler? a. They can create a distortion or differentiation of self from parent. b. They can interfere with the development of autonomy. c. They can interfere with the acquisition of language, fine motor, and self-care skills. d. They can create feelings of inadequacy.

ANS: B Chronic illness may interfere in the development of autonomy, which is the major psychosocial task of the toddler. The infant with a chronic illness may have distortion of differentiation of self from parents. Chronic illness with frequent hospitalizations can inhibit the acquisition of language, motor, and self-care skills in the preschool-age child. Feelings of inadequacy and inferiority can occur if independence is compromised by chronic illness in the school-age child.

What action is correct when administering ear drops to a 2-year-old child? a. Administer the ear drops straight from the refrigerator. b. Pull the pinna of the ear back and down. c. Massage the pinna after administering the medication. d. Pull the pinna of the ear back and up.

ANS: B For children younger than 3 years, the pinna, or lower lobe, of the ear should be pulled back and down to straighten the ear canal. Medication should be at room temperature because cold solutions in the ear will cause pain. The tragus, not the pinna, of the ear should be massaged to ensure that the drops reach the tympanic membrane. For children younger than 3 years, the pinna of the ear should be pulled back and down to straighten the ear canal.

The nurse is planning how to prepare a 4-year-old child for some diagnostic procedures. Guidelines for preparing this preschooler should include a. planning for a short teaching session of about 30 minutes. b. telling the child that procedures are never a form of punishment. c. keeping equipment out of the child's view. d. using correct scientific and medical terminology in explanations.

ANS: B Illness and hospitalization may be viewed as punishment in preschoolers. Always state directly that procedures are never a form of punishment. Teaching sessions for this age-group should be much shorter in length. Demonstrate the use of equipment, and allow the child to play with miniature or actual equipment. Explain the procedure in simple terms and how it affects the child.

Which factor should the nurse remember when administering topical medication to an infant as compared with an adolescent? a. Infants require a larger dosage because of a greater body surface area. b. Infants have a thinner stratum corneum that absorbs more medication. c. Infants have a smaller percentage of muscle mass. d. The skin of infants is less sensitive to allergic reactions.

ANS: B Infants and young children have a thinner outer skin layer (stratum corneum), which increases the absorption of topical medication. A similar dose of a topical medication administered to an infant compared with an adult is approximately three times greater in the infant because of the greater body surface area. The smaller muscle mass in infants affects site selection for injected medications but should not affect administration of topical medications. The young child's skin is more prone to irritation, making contact dermatitis and other allergic reactions more common.

In preparing to give enemas to a 4-year-old child, what action by the nurse is best? a. Use tap water. b. Only use normal saline. c. Insert the tip of the tube at least 3 inches. d. Instill 120 to 240 mL of solution.

ANS: B Isotonic solutions should be used in children. Saline is the solution of choice. Plain water is not used. This is a hypotonic solution and can cause fluid and electrolyte disturbances. The tip of the tubing should be inserted 3 inches (7.5 cm) maximum. 240 to 360 mL is appropriate for this age group.

A parent wants to know why acetaminophen should only be given for 2 days for a fever without checking with the provider. What response by the nurse is best? a. Acetaminophen is a dangerous drug with bad side effects. b. Long-term acetaminophen use can cause liver damage. c. There may be better fever relievers you could use. d. What if there were something seriously wrong with your child?

ANS: B Long-term use of acetaminophen can lead to liver damage. It is not a particularly dangerous drug and, like all drugs, has side effects. The provider needs to see the child to determine if something is more seriously wrong, but this statement sounds like a threat. There may be other medications the parent could try, but the main concern is liver damage.

Which question most likely elicits information about how a family is coping with a child's hospitalization? a. "Was this admission an emergency?" b. "How has your child's hospitalization affected your family?" c. "Who is taking care of your other children while you are here?" d. "Is this the child's first hospitalization?"

ANS: B Open-ended questions encourage communication. Ensuring a positive outcome from the hospital experience can be optimized by the nurse addressing the health needs of family members, as well as the needs of the child. Asking closed-ended questions inhibits communication.

The nurse comes into the room of a child who was just diagnosed with a chronic disability. The child's parents begin to yell at the nurse about a variety of concerns. The nurse's best response is a. "What is really wrong?" b. "Being angry is only natural." c. "Yelling at me will not change things." d. "I will come back when you settle down."

ANS: B Parental anger after the diagnosis of a child with a chronic disability is a common response. One of the most common targets for parental anger is members of the staff. The nurse should recognize the common response of anger to the diagnosis and allow the family to ventilate. The other responses do not validate the parents' feelings and concerns and may hamper a therapeutic nurse-family relationship.

20. The feeling of guilt that the child "caused" the disability or illness is especially critical in which child? a. Toddler b. Preschooler c. School-age child d. Adolescent

ANS: B Preschoolers are most likely to be affected by feelings of guilt that they caused the illness/disability or are being punished for wrongdoings.

A child with a serious, chronic illness is hospitalized frequently. The parents are worried about the child's growth and development. What action by the nurse is best? a. Tell parents developmental delays are likely in this case. b. Make a referral to the play therapist for therapeutic play. c. Encourage the child to perform age-appropriate activities. d. Ask the parents if they want a child psychology referral.

ANS: B Since developmental delay is a high risk in this situation, the nurse consults with the play therapist for therapeutic play interventions. Encouraging age-appropriate activities is always important but does not address this concern. The child may need a psychology referral, but that is not the first step. Telling parents that delays are likely in this case is discouraging and does not offer any positive solutions.

A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. What should the nurse explain to the parents? a. This will help the child cope effectively by denial. b. This attitude is helpful to give parents time to cope. c. Terminally ill children know when they are seriously ill. d. Terminally ill children usually choose not to discuss their illness.

ANS: C The child needs honest and accurate information about the illnesses, treatments, and prognosis. Children, even at a young age, realize that something is seriously wrong and that it involves them. The nurse should help parents understand the importance of honesty. The child will know that something is wrong because of the increased attention of health professionals. The focus should be on the child's needs, not the parents'. Children will usually tell others how much information they want about their condition.

What should the nurse consider when having consent forms signed for surgery and procedures on children? a. Only a parent or legal guardian can give consent. b. The person giving consent must be at least 18 years old. c. The risks and benefits of a procedure are part of the consent process. d. A mental age of 7 years or older is required for a consent to be considered "informed."

ANS: C The informed consent must include the nature of the procedure, benefits and risks, and alternatives to the procedure. In special circumstances, such as emancipated minors, the consent can be given by someone younger than 18 years without the parent or legal guardian. A mental age of 7 years is too young for consent to be informed.

Which is an appropriate nursing intervention for the hospitalized neonate? a. Assign the neonate to a room with other neonates. b. Provide play activities in the hospital room. c. Offer the neonate a pacifier between feedings. d. Request that parents bring a security object from home.

ANS: C The neonate needs opportunities for nonnutritive sucking and oral stimulation with a pacifier. The neonate is not aware of other children. The choice of roommate will not affect the neonate socially. It is important for older children to room with similar-age children. Formal play activities are not relevant for the neonate. Having parents bring a security object from home is applicable to older children.

A student nurse in the emergency department is preparing to obtain a throat culture on a child with suspected epiglottis secondary to a strep infection. What action by the registered nurse is best? a. Remind the student to wear personal protective equipment. b. Tell the student to get the child to say "ahhh." c. Consult with the provider prior to obtaining the culture. d. Inform the parents and child that a throat culture is needed.

ANS: C The nurse never obtains a throat culture on a child in whom epiglottitis is suspected because it may precipitate sudden airway obstruction. The nurse consults with the provider about this issue. Wearing personal protective equipment, having the child say "ahhh," and informing the child and parents of the needed culture would all be appropriate when obtaining it.

Which nursing action is most appropriate when treating a child who has a fever of 102.5° F (39.1° C)? a. Restrict fluid intake. b. Administer an aspirin. c. Administer acetaminophen. d. Bathe the child in tepid water.

ANS: C Treatment of a fever can include administration of an antipyretic such as acetaminophen. Dehydration can occur from insensible water loss. Offer the child fluids frequently and evaluate the need for IV therapy. Aspirin is avoided because of the potential association with Reye syndrome. A sponge or tub bath with tepid water to reduce fever can cause shivering and ultimately increase the child's temperature.

Which action is appropriate to promote a toddler's nutrition during hospitalization? a. Allow the child to walk around during meals. b. Require the child to empty his or her plate. c. Ask the child's parents to bring a cup and utensils from home. d. Select new foods for the child from the menu.

ANS: C Using familiar items during mealtimes increases the toddler's sense of security and control and may encourage eating. For safety reasons, "roaming" while eating should not be permitted. The child should be seated during meals. Toddlers often use food as a source of control. Forcing a toddler to eat only increases the child's sense of powerlessness. Toddlers also experience food jags, a normal phenomenon when they will only eat certain foods. Hospitalization is a stressful experience for the toddler. It is not the time to introduce the child to new foods.

What should the nurse advise the mother of a 4-year-old child to bring with her child to the outpatient surgery center on the day of surgery? a. Snacks b. Fruit juice boxes c. All of the child's medications d. One of the child's favorite toys

ANS: D A familiar toy can be effective in decreasing a child's stress in an unfamiliar environment. The child will be NPO before surgery; therefore including snacks for the child is contraindicated. The child will be NPO before surgery. Unnecessary stress will result when the child is denied the juice. It is not necessary to bring all medications on the day of surgery. The medication the child has been receiving should have been noted during the preoperative workup. The parent should be knowledgeable of which medications the child has been taking if further information is necessary.

At what developmental period do children have the most difficulty coping with death, particularly if it is their own? a. Toddlerhood b. Preschool c. School-age d. Adolescence

ANS: D Adolescents, because of their mature understanding of death, remnants of guilt and shame, and issues with deviations from normal, have the most difficulty coping with death. Toddlers and preschoolers will fear separation from parents. School-age children will fear the unknown, such as the consequences of the illness and the threat to their sense of security.

A 3 1/2-year-old child who is toilet trained has had several "accidents" since hospital admission. What is the nurse's best action in this situation? a. Find out how long the child has been toilet trained at home. b. Encourage the parents to scold the child. c. Explain how to use a bedpan and place it close to the child. d. Follow home routines of elimination.

ANS: D Cooperation will increase and anxiety will decrease if the child's normal routine and rituals are maintained. Some regression to previous behaviors is normal during hospitalization, even when the child has been practicing the skill for some time. Hospitalization is a stressful experience. If the incontinence is caused by anxiety, scolding is not indicated and may increase the anxiety. Developmentally, the 3 1/2-year-old child cannot use a bedpan independently.

Which intervention helps a hospitalized toddler feel a sense of control? a. Assign the same nurses to care for the child. b. Put a cover over the child's crib. c. Require parents to stay with the child. d. Follow the child's usual routines for feeding and bedtime.

ANS: D Familiar rituals and routines are important to toddlers and give the child a sense of control. Following the child's usual routines during hospitalization minimizes feelings of loss of control. Providing consistent caregivers is most applicable for the very young child, such as the neonate and infant. Placing a cover over the child's crib may increase feelings of loss of control. Parents are encouraged, rather than expected, to stay with the child during hospitalization.

What is the most appropriate response to a school-age child who asks if she can talk to her dying sister? a. "You need to talk loudly so she can hear you." b. "Holding her hand would be better because at this point she can't hear you." c. "Although she can't hear you, she can feel your presence so sit close to her." d. "Even though she will probably not answer you, she can still hear what you say to her."

ANS: D Hearing is the last sense to cease before death. Talking to the dying child is important both for the child and the family. The sense of hearing is intact before death and there is no need to speak loudly. The sibling should be encouraged to speak to the child, as well as hold the child's hand. The sibling should be encouraged to sit close and speak to the dying child.

The home health nurse outlines short- and long-term goals for a 10-year-old child with many complex health problems. Who should agree on these goals? a. Family and nurse b. Child, family, and nurse c. All professionals involved d. Child, family, and all professionals involved

ANS: D In the home, the family is a partner in each step of the nursing process. The family priorities should guide the planning process. Both short-term and long-term goals should be outlined and agreed on by the child, family, and professionals involved. Involvement of the individuals who are essential to the child's care is necessary during this very important stage. The elimination of any one of these groups can potentially create a plan of care that does not meet the needs of the child and family.

What is the best nursing response to the mother of a 4-year-old child who asks what she can do to help the child cope with a sibling's repeated hospitalizations? a. Recommend that the child be sent to visit the grandmother until the sibling returns home. b. Inform the parent that the child is too young to visit the hospital. c. Assume the child understands that the sibling will soon be discharged because the child asks no questions. d. Help the mother give the child a simple explanation of the treatment, and encourage the mother to have the child visit the hospitalized sibling.

ANS: D Needs of a sibling will be better met with factual information and contact with the ill child. Separation from family and home may intensify fear and anxiety. Parents are experts on their children and need to determine when their child can visit a hospital. Children may have difficulty expressing questions and fears and need the support of parents and other caregivers.

Identify the most appropriate nursing response to a parent who tells the nurse, "I don't want my child to know she is dying." a. "I shall respect your decision. I won't say anything to your child." b. "Don't you think she has a right to know about her condition?" c. "Would you like me to arrange for the provider to speak with your child?" d. "I'll answer any questions she asks me as honestly as I can."

ANS: D Nurses can inform parents that they will not initiate any discussion with the child but that they intend to respond openly and honestly if and when the child initiates such a discussion. As the caregiver and advocate, the nurse should first meet the child's needs. Asking the parent if the child has the right to know is judgmental and could affect the nurse's relationship with the child's parents. Having the provider speak with the child does not address the parent's concerns or the nurse's responsibility.

Which physiologic difference affects the absorption of oral medications administered to a 3-month-old infant? a. More rapid peristaltic activity b. More acidic gastric secretions c. Usually more rapid gastric emptying d. Variable pancreatic enzyme activity

ANS: D Pancreatic enzyme activity is variable in infants for the first 3 months of life as the gastrointestinal system matures. Medications that require specific enzymes for dissolution and absorption might not be digested to a form suitable for intestinal action. Infants up to 8 months of age tend to have prolonged motility. The longer the intestinal transit time, the more medication is absorbed. The gastric secretions of infants are less acidic than in older children or adults. Gastric emptying is usually slower in infants.

An important nursing consideration when performing a bladder catheterization on a young child is to a. use clean technique, not Standard Precautions. b. insert 2% lidocaine lubricant into the urethra. c. lubricate catheter with water-soluble lubricant such as K-Y Jelly. d. delay catheterization for 20 minutes while anesthetic lubricant is absorbed.

ANS: B The anxiety, fear, and discomfort experienced during catheterization can be significantly decreased by preparation of the child and parents, by selection of the correct catheter, and by appropriate technique of insertion. Generous lubrication of the urethra before catheterization and use of lubricant containing 2% lidocaine may reduce or eliminate the burning and discomfort associated with this procedure. Catheterization is a sterile procedure. Water-soluble lubricants do not provide appropriate local anesthesia. Catheterization should be delayed only 2 to 3 minutes. This provides sufficient local anesthesia for the procedure.

A preschool-aged child tells the nurse "I was bad, that's why I got sick." What is the best rationale for this child's statement? a. The child has a fear that mutilation will lead to death. b. The child's imagination is very active, and he may believe the illness is a result of something he did. c. The child has a general understanding of body integrity at this age. d. The child will not have fear related to an IV catheter initiation but will have fear of an impending surgery.

ANS: B The child may believe that an illness occurred as a result of some personal deed or thought or perhaps because he touched something or someone. The child has imaginative thoughts at this stage of growth and development. Preschoolers do not have the cognitive ability to connect mutilation to death and do not have a sound understanding of body integrity. The preschooler fears all types of intrusive procedures, whether undergoing a simple procedure such as an IV start or something more invasive such as surgery.

The nurse wore gloves during a dressing change. When the gloves are removed, the nurse should a. wash hands thoroughly. b. check the gloves for leaks. c. use an alcohol-based hand rub. d. apply new gloves before touching the next patient.

ANS: C Evidence-based research has demonstrated that alcohol-based rubs are more effective for eliminating organisms. If the nurse's hands are clean, alcohol-based hand rubs are most appropriate. If hands are soiled, then soap and water are used. Gloves should be disposed of after use. Hands should be thoroughly cleaned before new gloves are applied.

. What is an important focus of nursing care for the dying child and his or her family? a. Nursing care should be organized to minimize contact with the child. b. Adequate oral intake is crucial to the dying child. c. Families should be taught that hearing is the last sense to stop functioning before death. d. It is best for the family if nursing care takes place during periods when the child is alert.

ANS: C Families should be encouraged to talk to the child because verbal communication and physical touch are important both for the family and child. Nursing care should minimize disruptions but not contact. When a child is dying, fluids should be based on the child's requests, with a focus on comfort and preventing a dry mouth. The times when the child is alert should be devoted to family contacts.

What is the predominant trait of the resilient family associated with chronic illness? a. Social separation b. Family flexibility c. Family cohesiveness d. Clear family boundaries

ANS: C Family cohesiveness is the predominant trait of the resilient family. Social integration, not separation is another trait. Family flexibility and clear family boundaries are other traits of the resilient family but not the predominant one.

What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of IV antibiotics cries, screams, and resists having the IV restarted? a. Exit the room and leave the child alone until he or she 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 an opioid analgesic for pain to quiet the child.

ANS: C Giving the preschooler some choice and control, while maintaining boundaries of treatment, supports the child's coping skills. Leaving the child alone robs the child of support when a coping difficulty exists. Crying is a normal response to stress. The child needs time to adjust and support to cope with unfamiliar and painful procedures during hospitalization. Although administration of a topical analgesic is indicated before restarting the child's IV, an opioid analgesic is not indicated.

The nurse is counseling the family of a 12-month-old child who has lost his mother in a car accident. How should you explain to the father what the child's understanding of death is, related to theories of growth and development? a. Temporary b. Permanent c. Loss of caretaker d. Punishment

ANS: C Infants and toddlers view death as loss of a caretaker. The preschool-age child views death as temporary. The school-age child and adolescent understand the permanence of death. The preschool-age child facing impending death may view his or her condition as punishment for behaviors or thoughts.

Which therapeutic approach will best help a 7-year-old child cope with a lengthy course of intravenous antibiotic therapy? a. Arrange for the child to go to the playroom daily. b. Ask the child to draw you a picture of himself or herself. c. Allow the child to participate in injection play. d. Give the child stickers for cooperative behavior.

ANS: C Injection play is an appropriate intervention for the child who has to undergo frequent blood work, injections, intravenous therapy, or any other therapy involving syringes and needles. The hospitalized child should have opportunities to go to the playroom each day if the child's condition warrants. This free play does not have any specific therapeutic purpose. Children can express their thoughts and beliefs through drawing. Asking the child to draw a picture of himself or herself may not elicit the child's feelings about the treatment. Rewards such as stickers may enhance cooperative behavior. They will not address coping with painful treatments.

A child is being discharged from the hospital on insulin. The mother is apprehensive about giving the medication. What action by the nurse is most important? a. Review the side effects of insulin with the mother. b. Have the mother verbalize that she knows the importance of follow-up care. c. Observe the mother while she administers an insulin injection. d. Help the mother devise a rotation schedule for injections.

ANS: C It is important that the nurse evaluate the mother's ability to give the insulin injection before discharge. Watching her give the injection to the child will give the nurse an opportunity to offer assistance and correct any errors. The other items are important too, but the priority would be ensuring the mother can administer the medication safely.

Home care is being considered for a young child who is ventilator dependent. Which factor is most important in deciding whether home care is appropriate? a. Level of parents' education b. Presence of two parents in the home c. Preparation and training of family d. Family's ability to assume all health care costs

ANS: C One of the essential elements is the training and preparation of the family. The family must be able to demonstrate all aspects of care for the child. In many areas, it cannot be guaranteed that nursing care will be available on a continual basis, and the family will have to care for the child. The amount of formal education reached by the parents is not the important issue. The determinant is the family's ability to care adequately for the child in the home. At least two family members should learn and demonstrate all aspects of the child's care in the hospital, but it does not have to be two parents.

A nurse must do a venipuncture on a 6-year-old child. An important consideration in providing atraumatic care is to a. use an 18-gauge needle if possible. b. wait 10 minutes after applying EMLA cream. c. restrain child only as needed to perform venipuncture safely. d. have the parents choose the child's favorite bandage afterward.

ANS: C Restrain child only as needed to perform the procedure safely. Smaller needles are used. After applying EMLA cream, the nurse must wait a minimum of 60 minutes. Allow the child to choose a favorite bandage.

Having explanations for all procedures and selecting their own meals from hospital menus is an important coping mechanism for which age-group? a. Toddlers b. Preschoolers c. School-age children d. Adolescents

ANS: C School-age children are developmentally ready to accept detailed explanations. School-age children can select their own menus and become actively involved in other areas of their care. Toddlers need routine and parental involvement for coping. Preschoolers need simple explanations of procedures. Detailed explanations and support of peers help adolescents cope.

What nursing action is appropriate for specimen collection? a. Follow sterile technique for specimen collection. b. Sterile gloves are worn if the nurse plans to touch the specimen. c. Use Standard Precautions when handling body fluids. d. Avoid wearing gloves in front of the child and family.

ANS: C Standard Precautions should always be used when handling body fluids. Sterile gloves may be needed for some specimens, but Standard Precautions are important for all. The child and family should be educated in the purpose of glove use, including the fact that gloves are used with every patient, so that they will not be offended or frightened.

What intervention will best help the siblings of a child with special needs? a. Explaining to the siblings that embarrassment is unhealthy b. Encouraging the parents not to expect siblings to help them care for the child with special needs c. Providing information to the siblings about the child's condition only as they request it d. Suggesting to the parents ways of maintaining the siblings' usual routine and participation in activities

ANS: D Parents should strive for integrating all family members' needs into daily activities. The nurse can help the parents problem solve and come up with ways to maintain as normal a daily routine for the siblings as possible while still meeting the needs of the child with special needs. Siblings may or may not be embarrassed by the special needs of the family member, but this statement belittles their feelings. Parents can ask the siblings if they want to help provide care and offer information but should not force the child into anything.

7. The nurse is discussing toddler development with the mother of a 2 1/2-year-old child. Which statement by the mother indicates she has an understanding of how to help her daughter succeed in a developmental task while hospitalized? a. "I always help my daughter complete tasks to help her achieve a sense of accomplishment." b. "I provide many opportunities for my daughter to play with other children her age." c. "I consistently stress the difference between right and wrong to my daughter." d. "I encourage my daughter to do things for herself when she can."

ANS: D The toddler's developmental task is to achieve autonomy. Encouraging toddlers to do things for themselves assists with this developmental task (i.e., feeding self, putting on own socks). Toddlers should be encouraged to do what they can for themselves. Toddlers participate in parallel play. They play next to rather than with age mates. Excessive stress on the differences between right and wrong can stifle autonomy in the toddler and foster shame and doubt.

Which muscle should the nurse select to give a 6-month-old infant an intramuscular injection? a. Deltoid b. Ventrogluteal c. Dorsogluteal d. Vastus lateralis

ANS: D The vastus lateralis is not located near any vital nerves or blood vessels. It is the best choice for intramuscular injections for children younger than 3 years of age. The deltoid muscle is not used for intramuscular injections in young children. The ventrogluteal muscle is safe for intramuscular injections for children older than 13 months. The dorsogluteal muscle does not develop until a child has been walking for at least 1 year.

What is the priority goal for the child with a chronic illness? a. To maintain the intactness of the family b. To eliminate all stressors c. To achieve complete wellness d. To obtain the highest level of wellness

ANS: D To obtain the highest level of health and function possible is the priority goal of nursing children with a chronic illness. Maintaining intactness of the family is a great goal, but it is for the family, not the child. Eliminating all stressors and achieving complete wellness are not realistic

The nurse is preparing for the admission of an infant who will have several procedures performed. In which situations is informed consent required? (Select all that apply.) a. Catheterized urine collection b. IV line insertion c. Oxygen administration d. Lumbar puncture e. Bone marrow aspiration

ANS: D, E Informed consent is required for invasive procedures that involve a risk to a child such as lumbar puncture and bone marrow aspiration. Informed consent is not required for procedures that are covered under the general consent to treat that is signed at admission by a parent or a guardian. These include catheterized urine collection, IV insertion, and oxygen administration.

What is the best explanation for a 2-year-old child who is quiet and withdrawn on the fourth day of a hospital admission? a. The child is protesting her separation from her caregivers. b. The child has adjusted to the hospitalization. c. The child is experiencing the despair stage of separation. d. The child has reached the stage of detachment.

c. The child is experiencing the despair stage of separation. In the despair stage of separation, the child exhibits signs of hopelessness and becomes quiet, withdrawn, and apathetic. In the protest stage, the child would be agitated, crying, resistant to caregivers, and inconsolable. Toddlers do not readily "adjust" to hospitalization and separation from caregivers. The detachment stage occurs after prolonged separation. During this phase, the child becomes interested in the environment and begins to play.

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

emergency hospitalization Emergency hospitalization involves (1) limited time for preparation both for the child and family, (2) situations that cause fear for the family that the child may die or be permanently disabled, and (3) a high level of activity, which can foster further anxiety. Although preparation time may be limited with a 24-hour observation, this situation does not usually involve the acuteness of the situation and the high levels of anxiety associated with emergency admission. Outpatient admission generally involves preparation time for the family and child. Because of the lower level of acuteness in these settings, anxiety levels are not as high. Rehabilitation admission follows a serious illness or disease. This type of unit may resemble a home environment, which decreases the child's and family's anxiety.

Which indicators of imminent death in a child should the nurse expect to assess? (Select all that apply.) a. Heart rate increases. b. Blood pressure increases. c. Respirations become rapid and shallow. d. The extremities become warm. e. Peripheral pulses become stronger.

ANS: A, C Indicators of imminent death include heart rate increasing, with a concomitant decrease in the strength and quality of peripheral pulses; respiratory effort decline, as evidenced by rapid, shallow respirations; and cool and cyanotic extremities. Increased BP, warm extremities, and strong peripheral pulses are not indicators of imminent death.

The student nurse learns the stages of grief according to Kübler-Ross. What stages does this include? (Select all that apply.) a. Shock b. Denial c. Anger d. Bargaining e. Acceptance

ANS: B, C, D, E The stages of grief outlined by Kübler-Ross include denial, anger, bargaining, sadness or depression, and acceptance. Shock occurs during the denial stage.

What should the nurse identify as major fears in the preschool child who is hospitalized with a chronic illness? (Select all that apply.) a. Altered body image b. Separation from peer group c. Bodily injury d. Mutilation e. Being left alone

ANS: C, D, E Body injury, mutilation, and being left alone are major fears of the preschooler. Altered body image and separation from peer group are fears of the adolescent.

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 Outpatient and day facility care do not provide extended care; therefore a child requiring extended care should be transferred to the hospital, causing increased stress to the child and parents. This type of care decreases cost and infection and minimizes separation between the child and family.

The nurse is providing support to a family who is experiencing anticipatory grief related to their child's imminent death. An appropriate nursing intervention is to a. be available to family. b. attempt to "lighten the mood." c. not allow visitors at this time. d. discourage crying because the child can hear it.

ANS: A The most valuable nursing intervention at this time is to be available to the family. Attempting to lighten the mood or to cheer people up is inappropriate. The family's wishes determine who can visit. The nurse should never discourage the expression of emotions.

At what age do most children have an adult concept of death as being inevitable, universal, and irreversible? a. 4 to 5 years b. 6 to 8 years c. 9 to 11 years d. 12 to 16 years

ANS: C By age 9 or 10 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible. Preschoolers and young school-age children are too little to have an adult concept of death. Adolescents have a mature understanding of death.

Which nursing diagnosis is appropriate for the 5-year-old child in isolation because of immunosuppression? a. Spiritual distress b. Social isolation c. Deficient diversional activity d. Sleep deprivation

ANS: C Children in isolation need extra attention to avoid boredom. A 5-year-old child is not developmentally advanced enough to feel spiritual distress. The main social system for a 5-year-old child is the family, who should be allowed liberal visitation. Sleep deprivation may occur during hospitalization but is not specific to isolation.

How can chronic illness and frequent hospitalizations affect the psychosocial development of an adolescent? a. They can lead to feelings of inadequacy. b. They can interfere with parental attachment. c. They can block the development of identity. d. They can prevent the development of imagination.

ANS: C Development of identity is the task of the adolescent. Inadequacy and inferiority refer to the school-age period. Parental attachment is a task of the infant. Development of imagination occurs in the preschool period.

How should the nurse advise parents whose preschooler used to sleep through the night and now awakens at intervals after a short hospitalization? a. Regressive behavior after a hospitalization is normal and usually short term. b. The child is probably expressing anger. c. Egocentric behavior often manifests itself when the child is left alone to sleep. d. The child is probably feeling pain and needs further evaluation.

ANS: A Regression is manifested in a variety of ways, is normal, and usually is short term. Nighttime waking is not associated with anger. Egocentric behavior is not an explanation for nighttime waking. More information is needed before assessment of pain can be made.

A toddler's temperature is 101.5° F (38.6° C) axillary. The physician has ordered acetaminophen 10 mg/kg every 4 to 6 hours. The child weighs 22 lb. The bottle of acetaminophen available is a suspension (160 mg/5 mL).______ How much should the nurse administer? Round to the nearest milliliter.

ANS: 3 mL The first thing the nurse should do is convert the 22 lb into kilograms (10 kg). Next multiply the number of kilograms the child weighs by the dose ordered by the physician (10 mg 10 kg = 100). Next, use the medication that is available (160 mg/5 mL) and calculate the amount for 100 mg. The answer is 3.125. The last step is to round to the nearest milliliter = 3 mL.

What parameter should guide the nurse when administering a subcutaneous injection to a school-age child with cellulitis? a. Do not to give injections in edematous areas. b. Attach a clean 1-inch needle to the syringe. c. The maximum volume injected into one site is 2 mL. d. Do not pinch up tissue before inserting the needle.

ANS: A Subcutaneous injections should never be given in areas of edema or infection because absorption is unreliable. A short (no more than 1/2- to 5/8-inch) needle should be used to deposit medication into subcutaneous tissue. Volumes for subcutaneous injections are small, usually averaging 0.5 mL. The skin is pinched up for a subcutaneous injection to raise the fatty tissue away from the muscle.

What is the main purpose for using a volume-control device or an infusion pump to administer intravenous fluids to children? a. To avoid fluid overload b. To aid in measuring intake c. To administer antibiotics d. To ensure adequate intravenous fluid intake

ANS: A A volume-control device or an infusion pump allows the nurse to set a specific volume of fluid to be given in a specific period of time and decreases the risk of inadvertently administering a large amount of fluid. A pump can display IV intake, making calculation of I&O easier, but that is not its main function. Medications can be given via IV pump, but that is not its main function. The nurse is responsible for knowing a child's fluid requirements.

Which play activity should the nurse implement to enhance deep breathing exercises for a toddler? a. Blowing bubbles b. Throwing a Nerf ball c. Using a spirometer d. Keeping a chart of deep breathing

ANS: A Age-appropriate play for a toddler to enhance deep breathing is blowing bubbles. Throwing a Nerf ball does not enhance deep breathing. Using a spirometer and keeping a chart of deep breathing are more appropriate for a school-age child.

A parent of a child with a chronic illness is complaining about "all these care planning meetings." What response by the home health care nurse is best? a. "Our plan will change with your child's growth and development." b. "We have legal regulations and company policies to follow." c. "Do you want to change the frequency of our meetings?" d. "If you don't want to come to the meetings you don't have to."

ANS: A As the child goes through the different phases of growth and development, goals and interventions will change to meet the changing needs of the child. This may require frequent care planning meetings and plan updates. The nurse may be also following regulations, but that response does not give the parent useful information. The plan should be based on the child's needs. Asking if the parent wants to change the frequency of meetings is a yes/no question and does not explain the rationale. Of course the parent can opt out of meetings, but the plan will be substandard, and again this does not give the parent useful information.

A parent asked, "When should I start dental care for my child?" What response by the nurse is best? a. "The recommendation is for children to have a dental examination no later than 2.5 years." b. "Children should see a dentist at least one time before kindergarten." c. "The recommendation is for children to have a dental examination before first grade." d. "A dental examination by 1 year of age is the current recommendation."

ANS: A Children should see a dentist by 1 year of age.

The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse's response should be based on knowledge that discipline is a. essential for the child. b. too difficult to implement with special-needs child. c. not needed unless the child becomes problematic. d. best achieved with punishment for misbehavior.

ANS: A Discipline is essential for the child. It provides boundaries on which to test out their behavior and teaches them socially acceptable behaviors. All children in the family should be held to the same standards of behavior to prevent resentment. The nurse should teach the parents ways to manage the child's behavior before it becomes problematic. Punishment is not effective in managing behavior.

What should the nurse use to prepare liquid medication in volumes less than 5 mL? a. Calibrated syringe b. Paper measuring cup c. Plastic measuring cup d. Household teaspoon

ANS: A For volumes of 5 mL or less, an oral syringe designed for oral medication administration only should be used. Measuring cups would be too large. A household teaspoon may or may not be accurate and the AAP recommends metric-only measuring devices.

The nurse administering an IV piggyback medication to a preschool child should a. use a "Smart" pump if available. b. flush the IV tubing before and after the infusion with normal saline solution. c. inject the medication into the IV catheter using the port closest to the child. d. inject the medication into the IV tubing in the direction away from the child.

ANS: A Programmable infusion pumps are frequently used to facilitate safe intermittent infusion of IV medications for children via the piggyback method. Some pumps have preprogrammed drug libraries to assist in the prevention of medication errors. Administering medications via this route does not require flushing unless the medication is incompatible with the maintenance fluid. The nurse is using the IV push method when injecting medication into the IV tubing using the port closest to the child. The medication is not injected away from the child.

Which activity should the nurse implement for the toddler hospitalized with a chronic illness to promote autonomy? a. Provide opportunities for play b. Making play dates with other toddlers in the unit c. Give the toddler art supplies d. Turn the television on to cartoons

ANS: A Providing play gives the toddler some time to work on growth and development skills and normalizes hospitalization at least for that time. Toddlers typically don't play together in groups. Art supplies may or may not be too advanced for the toddler, but in any case, this would be a form of play. Watching cartoons on television is passive and will not promote autonomy.

Which action by the nurse is appropriate when preparing a child for a procedure? a. Discourage the child from crying during the procedure. b. Use professional terms so the child will understand what is happening. c. Give the child choices whenever possible. d. Discourage the parents from staying in the room during the procedure.

ANS: C Allowing children to make choices gives them a sense of control. Children (and adults) should be given permission to cry. Age-appropriate language should always be used. Parents should be encouraged to stay in the room and give support to the child.

The nurse knows that measuring temperature is an integral part of assessment. Which concept is important for the nurse to know when taking a child's temperature? a. The method used should be consistent. b. Rectal temperatures should always be taken on infants. c. Oral temperatures can be taken on all children older than 5 years of age. d. Axillary temperatures should be taken at night.

ANS: A The method that is determined most appropriate for the child should be used consistently—the same site and device to maintain consistency and allow reliable comparison and tracking of temperatures over time. Because of the risk of rectal perforation and the intrusive nature of the procedure, rectal temperatures are measured only when no other route can be used or when it is necessary to obtain a core body temperature. Oral temperatures can be used on most children older than 6 years of age but may be inaccurate because of oral intake, oral surgery, oxygen therapy, nebulizer treatments, or crying. There is no time specification for when specific types of temperatures are taken.

The nurse is caring for a child who has just died. The parents ask to be left alone so that they can rock their child one more time. What response by the nurse is best? a. Grant their request. b. Assess why they feel this is necessary. c. Discourage this because it will only prolong their grief. d. Kindly explain that they need to say good-bye to their child now and leave.

ANS: A The parents should be allowed to remain with their child after the death for as long as they need to. No other response is needed.

The nurse is preparing a 12-year-old girl for a bone marrow aspiration. She tells the nurse she wants her mother with her "like before." Which response by the nurse is most appropriate? a. Grant her request. b. Explain why this is not possible. c. Identify an appropriate substitute for her mother. d. Offer to provide support to her during the procedure.

ANS: A The parents' preferences for assisting, observing, or waiting outside the room should be assessed as well as the child's preference for parental presence. The child's choice should be respected. If the mother and child are agreeable, then the mother is welcome to stay. An appropriate substitute for the mother is necessary only if the mother does not wish to stay. Support is offered to the child regardless of parental presence.

A nurse is caring for a dying child. What action by the nurse best meets the the primary concern of the parents? a. Giving the child pain medication on a schedule b. Placing the child on fall and safety precautions c. Providing the child with favorite foods when requested d. Ensuring the child gets the minimum fluid requirement

ANS: A The primary concern of all parents of dying children is the possibility of their child feeling pain. The nurse works vigilantly to assess and treat the child's pain. The other options are also important considerations but usually not the priority concern.

A nurse is working with a child who has a sudden, serious illness. To best support the parents, what action by the nurse is best? a. Assess the parents' usual coping methods. b. Give them information about the unit protocols. c. Tell them to stay with the child as much as desired. d. Reassure them about how common this illness is.

ANS: A The way these parents will cope with this sudden illness is the same as how they cope with other stressors. The nurse helps the parents identify coping methods and support systems. Giving information about the unit and telling them they can stay are positive interventions but too narrow in scope to be the best answer. Reassuring them that their child's illness is common belittles their concerns.

What is a priority nursing diagnosis for the preschool child with chronic illness? a. Risk for delayed growth and development related to chronic illness or disability b. Chronic pain related to frequent injections and invasive procedures c. Anticipatory grieving related to impending death d. Anxiety related to frequent hospitalizations

ANS: A This is the priority nursing diagnosis that is appropriate for the majority of chronic illnesses. The child may or may not have frequent injections and invasive procedures. A chronic illness is one that does not have a cure. It does not mean the child will die prematurely. Frequent hospitalizations are not required for all chronic illnesses.

What is appropriate to include in the teaching plan for a family of a child with a tracheostomy? a. Suction the tracheostomy as needed. b. Apply powder around the stoma to decrease irritation. c. Limit suctioning time to 30 seconds. d. Provide showers and discourage baths.

ANS: A To maintain a patent airway in a child with a tracheostomy, assessing respiratory status and suctioning as needed using Standard Precautions is an important intervention to teach families. Talc powder should be avoided because of the risk of inhalation injury from breathing the powder particles. Catheter insertion for suctioning should be less than 5 seconds to prevent hypoxia. The family should be taught to avoid getting water in the tracheostomy during bath time. Showers should be discouraged.

What is critical for the nurse to know when using restraints on a child? a. Use the least restrictive type of restraint. b. Tie knots securely so they cannot be untied easily. c. Secure the ties to the mattress or side rails. d. Remove restraints every 4 hours to assess skin integrity.

ANS: A When restraints are necessary, the nurse should institute the least restrictive type of restraint possible to meet goals. Knots must be tied so that they can be easily undone for quick access to the child. The ties are never tied to the mattress or side rails. They should be secured to a stable device, such as the bed frame. Restraints are removed every 2 hours to allow for range of motion, position changes, and assessment of skin integrity.

The nurse is working with a child in the intensive care unit. The family is from out of town. There are two siblings, both of whom are acting out at home. What suggestions does the nurse provide the family? (Select all that apply.) a. Let the siblings call the ill child at scheduled times. b. Take photographs of the sick child to show the siblings. c. Suggest the parents take the siblings to counseling. d. Reassure the siblings that they will not get ill themselves. e. Stay at home with the siblings until their behavior improves.

ANS: A, B, D Having siblings call or visit the sick child helps them cope with the situation and can ease anxiety. If the sibling fears a similar illness, parents can reassure them this will not happen if reasonable. Going to counseling may be needed if the siblings cannot be reassured but is not the first step as this is normal behavior. The parents may become overly stressed if told to stay at home.

A parent calls the pediatrician's office because her 1-year-old child has a 100° F temperature. What is the most appropriate initial nursing response to make to the parent? a. "Did you feel your child's forehead?" b. "Does your child appear to be uncomfortable?" c. "Has anyone in your home been sick lately?" d. "Don't worry if the temperature is less than 101° F."

ANS: B The child's comfort is the primary concern in treating a fever in a normally healthy child. The nurse asks about the child's comfort level before giving further information. Feeling a child's forehead can give clues related to whether the child's temperature should be measured; if it has already been measured, this is unnecessary because it does not give accurate information about the child's body temperature. Asking about other ill family members is important, but not as the initial response, which should be to get more data about the child. Although the height of the temperature is not an indication of the seriousness of the child's illness, it is incorrect to tell a parent to be unconcerned about temperatures less than 101° F.

At the time of a child's death, the nurse tells his mother, "We will miss him so much." The best interpretation of this is that the nurse is a. pretending to be experiencing grief. b. expressing personal feelings of loss. c. denying the mother's sense of loss. d. talking when listening would be better.

ANS: B The death of a patient is one of the most stressful experiences for a nurse. Nurses experience reactions similar to those of family members because of their involvement with the child and family during the illness. Nurses often have feelings of personal loss when a patient dies. The nurse is not pretending, denying the mother's sense of loss, or talking when listening would be better.

In order to minimize the negative effects of illness and hospitalization on an infant, the nurse focuses care on which of the following? a. Bodily injury and pain b. Separation from caregivers and fear of strangers c. Loss of control and altered body image d. The unknown and being left alone

ANS: B The major fear of infants during illness and hospitalization are separation from caregivers and fear of strangers. Bodily injury and pain are fears of preschool and school-age children. Loss of control is a fear of children from the preschool period through adolescence. Altered body image applies to adolescents. Fear of the unknown and being left alone are applicable to preschoolers.

What is the maximum safe volume that a neonate can receive in an intramuscular injection? a. 0.5 mL b. 1.0 mL c. 1.5 mL d. 2 mL

ANS: B The maximum volume of medication for an intramuscular injection to a neonate is 1.0 mL.

What is the most appropriate statement for the nurse to make to a 5-year-old child who is undergoing a venipuncture? a. "You must hold still or I'll have someone hold you down. This is not going to hurt." b. "This will hurt like a pinch. I'll get someone to help hold your arm still so it will be over fast and hurt less." c. "Be a big boy and hold still. This will be over in just a second." d. "I'm sending your mother out so she won't be scared. You are big, so hold still and this will be over soon."

ANS: B The nurse can help minimize the pain and stress of the venipuncture by having someone help the child maintain control during the procedure. Threatening the child with having someone hold him or her down is likely to produce less cooperation and frighten the child. Telling a child to be a "big boy" does not acknowledge the child's developmental stage. Parents should be allowed to stay during procedures when possible.

A nurse is teaching parents how to care for a child's gastrostomy tube at home. What information should the nurse include? a. Bring the child to the clinic for cleaning b. Clean around the insertion site daily with soap and water. c. Expect some leakage around the button. d. Remove the tube for cleaning once a week.

ANS: B The skin around the tube insertion site should be cleaned with soap and water once or twice daily. Parents must be able to clean the site; the child is not taken to the clinic for this. Leakage around the tube should be reported to the physician. A gastrostomy tube is placed surgically. It is not removed for cleaning.

Many parents who have children diagnosed with a chronic illness experience recurrent feelings of grief, loss, and fear related to the child's condition and loss of the ideal healthy child. The nurse recognizes this process as a. anticipatory grieving. b. chronic sorrow. c. bereavement. d. illness trajectory.

ANS: B The stated recurrent feelings define chronic sorrow, which is considered a normal process involving grief that may never be resolved. Anticipatory grieving is the process of mourning, coping, interacting, planning, and psychosocial reorganization that is begun as a response to the impending loss of a loved one. Bereavement is defined as the objective condition or state of loss. Illness trajectory is defined as the impact of the disease or condition on all family members, physiologic unfolding of the disease, and work organization done by the family to cope.

Which food is appropriate to mix with medication? a. Formula or milk b. Applesauce c. Baby food d. Orange juice

ANS: B To prevent the child from developing a negative association with an essential food, a nonessential food such as applesauce is best for mixing with medications. Formula, milk, baby food, and orange juice are essential foods in a child's diet. Medications may alter their flavor and cause the child to avoid them in the future.

The nurse case manager is planning a care conference about a young child who has complex health care needs and will soon be discharged home. Who should the nurse invite to the conference? a. Family and nursing staff b. Social worker, nursing staff, and primary care physician c. Family and key health professionals involved in the child's care d. Primary care physician and key health professionals involved in the child's care

ANS: C A multidisciplinary conference is necessary for coordination of care for children with complex health needs. The family is involved as well as key health professionals who are involved in the child's care. The nursing staff can address the nursing care needs of the child with the family, but other involved disciplines must be included. The family must be included in the discharge conferences, which allow them to determine what education they will require and the resources needed at home. A member of the nursing staff must be included to review the nursing needs of the child.

The parents of a school-age child are told that their child is diagnosed with leukemia. As the nurse caring for this child, what is the expected first response of the parents to the diagnosis of chronic illness in their child? a. Anger and resentment b. Sorrow and depression c. Shock and disbelief d. Acceptance and adjustment

ANS: C According to Kübler-Ross, denial is the initial stage of the grieving process when an individual reacts with shock and disbelief to the diagnosis of chronic illness. The other responses are also part of the grieving process although not usually the initial response.