Wongs chapter 19: C & A exam 1

A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for Mommy. What is the nurse's best reply? a. "Mommy will be here after lunch." b. "Mommy always comes back to see you." c. "Your Mommy told me yesterday that she would be here today about noon." d. "Mommy had to go home for a while, but she will be here today."

a. "Mommy will be here after lunch."

Olivia, age 5 years, tells the nurse that she "needs a Band-Aid" where she had an injection. The best nursing action is to: a. Apply a Band-Aid. b. Ask her why she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show her that the bleeding has already stopped.

a. Apply a Band-Aid.

A child is being discharged from an ambulatory care center after an inguinal hernia repair. Which discharge interventions should the nurse implement (select all that apply)? a. Discuss dietary restrictions. b. Hold any analgesic medications until the child is home. c. Send a pain scale home with the family. d. Suggest the parents fill the prescriptions on the way home. e. Discuss complications that may occur.

a. Discuss dietary restrictions. c. Send a pain scale home with the family. e. Discuss complications that may occur.

What is an age-appropriate nursing intervention to facilitate psychologic adjustment for an adolescent expected to have a prolonged hospitalization (select all that apply)? a. Encourage parents to bring in homework and schedule study times. b. Allow the adolescent to wear street clothes. c. Involve the parents in care. d. Follow home routines. e. Encourage parents to bring in favorite foods.

a. Encourage parents to bring in homework and schedule study times. b. Allow the adolescent to wear street clothes. e. Encourage parents to bring in favorite foods.

Latasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What will help her most in her adjustment to the hospital? a. Explain hospital schedules such as mealtimes. b. Use terms such as "honey" and "dear" to show a caring attitude. c. Explain when parents can visit and why siblings cannot come to see her. d. Orient her parents, because she is young, to her room and hospital facility.

a. Explain hospital schedules such as mealtimes.

When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as: a. Punishment. b. Threat to child's self-image. c. An opportunity for regression. d. Loss of companionship with friends.

a. Punishment.

A previously "potty-trained" 30-month-old child has reverted to wearing diapers while hospitalized. The nurse should reassure the parents that this is normal because: a. Regression is seen during hospitalization. b. Developmental delays occur because of the hospitalization. c. The child is experiencing urinary urgency because of hospitalization. d. The child was too young to be "potty-trained."

a. Regression is seen during hospitalization.

What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain

a. Separation anxiety

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." The nurse should recognize that: a. This is normal behavior for a school-age child. b. This behavior is usually not seen past the preschool years. c. The child thinks the nurse is punishing her. d. The child has successfully manipulated the nurse in the past.

a. This is normal behavior for a school-age child.

Ryan has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and Ryan's condition is beginning to stabilize. When speaking with the parents, the nurses should expect which stressors to be evident (select all that apply)? a. Unfamiliar environment b. Usual day-night routine c. Strange smells d. Provision of privacy e. Inadequate knowledge of condition and routine

a. Unfamiliar environment c. Strange smells e. Inadequate knowledge of condition and routine

A ventilator-dependent child is being discharged home from the hospital. Prior to discharge, the home health care nurse discusses the development of an emergency plan with the family. The most essential component of the plan is a. acquisition of a backup generator. b. designation of an emergency shelter. c. notifying the power company that the child is on life support. d. provision for alternate heating and cooling source if power is lost. e. notifying emergency medical services that child is on life support.

a. acquisition of a backup generator.

A home health nurse is assigned to an adolescent with recently acquired tetraplegia. The adolescent's mother tells the nurse, "I'm sick of providing all the care while my husband does whatever he wants and whenever he wants." Based on the nurse's knowledge of family-centered care, the most appropriate nursing intervention is to a. listen and reflect the mother's feelings. b. refer the mother for psychological counseling. c. suggest ways the mother can get the husband to help with care. d. meet with the adolescent's father in private and ask why he does not help.

a. listen and reflect the mother's feelings.

An adolescent is admitted to the hospital for a fractured femur. The most appropriate nursing intervention(s) in caring for this adolescent is/are toSelect all that apply. a. provide written material about the hospital. b. provide an opportunity for the adolescent to try on surgical attire. c. explain the upcoming surgery to the adolescent using anatomically correct models. d. provide an opportunity for the adolescent to talk with peers who have had a similar experience. e. provide education for the parents of what to teach so they can share with their adolescent.

a. provide written material about the hospital. c. explain the upcoming surgery to the adolescent using anatomically correct models. e. provide education for the parents of what to teach so they can share with their adolescent.

Prior to accepting an assignment as a home health nurse, the nurse must realize that a. the family is in charge. b. all decisions are made by the health care provider. c. the family will adapt their lifestyle to the needs of the nurse. d. independent decisions regarding emergency care of the child are made by the nurse.

a. the family is in charge.

A nurse is interviewing the parents of a toddler about use of complementary or alternative medical practices. The parents share several practices they use in their household. Which should the nurse document as complementary or alternative medical practices (select all that apply)? a. Use of acetaminophen (Tylenol) for fever b. Administration of chamomile tea at bedtime c. Hypnotherapy for relief of pain d. Acupressure to relieve headaches e. Cool mist vaporizer at the bedside for "stuffiness"

b. Administration of chamomile tea at bedtime c. Hypnotherapy for relief of pain d. Acupressure to relieve headaches

A nurse in the emergency department is assessing a 5-year-old child with symptoms of pneumonia and a fever of 102° F. Which intervention can the nurse implement to promote a sense of control for the child? a. None, this is an emergency and the child should not participate in care. b. Allow the child to hold the digital thermometer while taking the child's blood pressure. c. Ask the child if it is OK to take a temperature in the ear. d. Have parents wait in the waiting room.

b. Allow the child to hold the digital thermometer while taking the child's blood pressure.

A toddler is hospitalized for an upcoming surgical procedure. Which method might provide the best way to inform the child about the surgery? a. By using anatomical drawings as illustrations and allowing the child to color them with markers. b. Allowing the child to dress up using surgical gown and mask. c. Having the child sign his name with an "X" on an actual surgical consent form. d. Taking the child to the operating theater to view a surgery.

b. Allowing the child to dress up using surgical gown and mask.

A nurse plans therapeutic play time for a hospitalized child. Which are the benefits of therapeutic play (select all that apply)? a. Serves as method to assist disturbed children b. Allows the child to express feelings c. The nurse can gain insight into the child's feelings d. The child can deal with concerns and feelings e. Gives the child a structured play environment

b. Allows the child to express feelings c. The nurse can gain insight into the child's feelings d. The child can deal with concerns and feelings

A child with a serious chronic illness will soon be discharged home. The case manager requests that the family provide total care for the child for a couple of days while the child is still hospitalized. Based on the principles of family-centered care, which statement addresses this principle? a. Appropriate because families are usually eager to get involved. b. Appropriate because it can be beneficial to the transition from hospital to home. c. Inappropriate because of legal issues when parents care for their children on hospital property. d. Inappropriate because the family will have to assume the care soon enough and this may increase their stress unnecessarily.

b. Appropriate because it can be beneficial to the transition from hospital to home.

Working with parents in preparation for discharge of a hospitalized child who will need to have wet to dry dressing changes performed at home will require that the nurse include which element in the plan of care? a. Arrange for home health nurse to change dressings as the parents may not understand the complexity of the task. b. Arrange for a step by step training sequence for wet to dry dressing changes with the parents of the child with return demonstration to evaluate understanding. c. Provide the parents with a detailed instruction sheet regarding the dressing change procedure as the method of instruction. d. Arrange for follow up with the child's pediatrician prior to the next scheduled dressing change so that the parents can receive further instruction.

b. Arrange for a step by step training sequence for wet to dry dressing changes with the parents of the child with return demonstration to evaluate understanding.

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? a. Inactivity b. Clinging to the parent c. Depression and sadness d. Forming superficial relationships

b. Clinging to the parent

Which situation poses the greatest challenge to the nurse working with a child and family? a. Twenty-four-hour observation b. Emergency hospitalization c. Outpatient admission d. Rehabilitation admission

b. Emergency hospitalization

An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to: a. Provide for privacy. b. Encourage parents to room in. c. Explain procedures and routines. d. Encourage contact with children the same age.

b. Encourage parents to room in.

Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, "We are sick of Mom always sitting with you in the hospital and playing with you. It isn't fair that you get everything and we have to stay with the neighbors." The nurse's best assessment of this situation is that: a. The siblings are immature and probably spoiled. b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. c. The family has ineffective coping mechanisms to deal with chronic illness. d. The siblings need to better understand their sister's illness and needs.

b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling.

A nurse has been assigned as the home health nurse for a technologically dependent child. The nurse recognizes that the background of this family differs widely from the nurse's own. The nurse views some of their lifestyle choices as less than ideal. What is the most appropriate nursing intervention? a. Assign the nurse a different family to follow. b. Respect the differences c. Assess why the family is different d. Determine whether the family is dysfunctional

b. Respect the differences

A case manager is assigned to coordinate the care of a child with a complex medical condition. The family is told that one of the goals is to control costs. This goal should be recognized as a. unsafe. b. realistic. c. impossible. d. inappropriate.

b. realistic.

The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which statement by the adolescent would be expected about separation anxiety? a. "I wish my parents could spend the night with me while I am in the hospital." b. "I think I would like for my siblings to visit me but not my friends." c. "I hope my friends don't forget about visiting me." d. "I will be embarrassed if my friends come to the hospital to visit."

c. "I hope my friends don't forget about visiting me."

A 14-year-old boy is being admitted to the hospital for an appendectomy. Which roommate should the nurse assign with this patient? a. A 4-year-old boy who is first day post-appendectomy surgery b. A 6-year-old boy with pneumonia c. A 15-year-old boy admitted with a vaso-occlusive sickle cell crisis d. A 12-year-old boy with cellulitis

c. A 15-year-old boy admitted with a vaso-occlusive sickle cell crisis

A child is playing in the playroom. The nurse needs to take a blood pressure on the child. Which is the appropriate procedure for obtaining the blood pressure? a. Take the blood pressure in the playroom. b. Ask the child to come to the exam room to obtain the blood pressure. c. Ask the child to return to his or her room for the blood pressure, then escort the child back to the playroom. d. Document that the blood pressure was not obtained because the child was in the playroom.

c. Ask the child to return to his or her room for the blood pressure, then escort the child back to the playroom.

Emma, age 3 years, is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding that: a. New toys make hospitalization easier. b. New toys are usually better than older ones for children of this age. c. At this age children often need the comfort and reassurance of familiar toys from home. d. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

c. At this age children often need the comfort and reassurance of familiar toys from home.

A school-age child, admitted for intravenous antibiotic therapy for osteomyelitis, reports difficulty in going to sleep at night. Which intervention should the nurse implement to assist the child in going to sleep at bedtime? a. Request a prescription for a sleeping pill. b. Allow the child to stay up late and sleep late in the morning. c. Create a schedule similar to the one the child follows at home. d. Plan passive activities in the morning and interactive activities right before bedtime.

c. Create a schedule similar to the one the child follows at home.

During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his parents left him, and he refused the staff's attention. Now the nurse observes that Eric appears to be "settled in" and unconcerned about seeing his parents. The nurse should interpret this as which of the following? a. He has successfully adjusted to the hospital environment. b. He has transferred his trust to the nursing staff. c. He may be experiencing detachment, which is the third stage of separation anxiety. d. Because he is "at home" in the hospital now, seeing his mother frequently will only start the cycle again.

c. He may be experiencing detachment, which is the third stage of separation anxiety.

A 12-year-old child is admitted for an emergency appendectomy and rushed into surgery. The parents tell the nurse that they also have a 4-year-old son at home and wonder if they should tell him about his older brother being in the hospital. The best response by the nurse to this query would be to? a. Tell the parents to refrain from telling the 4-year-old as he will not be able to understand the concepts of hospitalization and surgery. b. Have the parents go home and bring their 4-year-old back to the hospital so he can be present throughout this family stress experience. c. It is important to tell their 4-year-old son about his older brother using words and terms that he can understand at his age. d. Have the parents bring their son in during visiting hours and arrange for a tour of the hospital unit.

c. It is important to tell their 4-year-old son about his older brother using words and terms that he can understand at his age.

What is the primary disadvantage associated with outpatient and day facility care? a. Increased cost b. Increased risk of infection c. Lack of physical connection to the hospital d. Longer separation of the child from family

c. Lack of physical connection to the hospital

What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of intravenous (IV) antibiotics cries, screams, and resists having the IV restarted? a. Exit the room and leave the child alone until he stops crying. b. Tell the child big boys and girls "don't cry." c. Let the child decide which color arm board to use with the IV. d. Administer a narcotic analgesic for pain to quiet the child.

c. Let the child decide which color arm board to use with the IV.

A nurse is preparing to complete an admission assessment on a 2-year-old child. The child is sitting on the parent's lap. Which technique should the nurse implement to complete the physical exam? a. Ask the parent to place the child in the hospital crib. b. Take the child and parent to the exam room. c. Perform the exam while the child is on the parent's lap. d. Ask the child to stand by the parent while completing the exam.

c. Perform the exam while the child is on the parent's lap.

A child has a long standing history of abuse which has triggered many emotional problems. Which type of therapy would be indicated to possibly help the child explore these emotional problems? a. Dramatic play b. Therapeutic play c. Play therapy d. Creative expression

c. Play therapy

When the nurse uses a standard nursing care plan as a guide in planning care for a hospitalized child, which should be eliminated? a. Expected outcome or goal b. Dependent nursing functions c. Problems not pertinent to the child and family d. Potential health problems of the child and family

c. Problems not pertinent to the child and family

The psychosexual conflicts of preschool children make them extremely vulnerable to a. separation anxiety. b. loss of control. c. bodily injury and pain. d. loss of identity.

c. bodily injury and pain.

A 4-year-old child is scheduled for cardiac surgery in a week. The child's parents call the hospital to ask how to prepare the child for the upcoming hospitalization and surgical procedure. The nurse's reply should be based on the knowledge that a. preparation at this age will only increase the child's stress. b. preparation needs to be at least 2 to 3 weeks before hospitalization to be effective. c. children who are prepared experience less fear and stress during hospitalization. d. children who are prepared experience overwhelming fear by the time hospitalization occurs.

c. children who are prepared experience less fear and stress during hospitalization.

In helping a child to adapt to a hospitalization experience, the best approach would be to a. allow the child to bring in all of his favorite toys to the hospital so as to represent a more familiar environment. b. let the parents bring in food from home that the child is used to eating for all meals. c. establish a daily routine and schedule with the child and parent to help maintain consistency. d. allow the child to select his room on the unit.

c. establish a daily routine and schedule with the child and parent to help maintain consistency.

The nurse is doing a prehospitalization orientation for Kayla, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that Kayla will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is: a. Unnecessary. b. The surgeon's responsibility. c. Too stressful for a young child. d. An appropriate part of the child's preparation.

d. An appropriate part of the child's preparation.

With regard to separation anxiety displayed in a child who is hospitalized, which behavior would indicates the stage of despair? a. Child clings to parents for comfort. b. Child tells nurses and staff to "go away." c. Child is constantly crying and sobbing. d. Child demonstrates regressive behavior.

d. Child demonstrates regressive behavior.

Because of their striving for independence and productivity, which age-group of children is particularly vulnerable to events that may lessen their feeling of control and power? a. Infants b. Toddlers c. Preschoolers d. School-age children

d. School-age children

Prior to returning to school, an individualized home care plan (IHCP) needs to be developed for which child? a. The child recently identified with a penicillin allergy. b. The child being treated for pediculosis capitis (head lice). c. The child out of school for two week due to mononucleosis. d. The child recently diagnosed with insulin-dependent diabetes mellitus.

d. The child recently diagnosed with insulin-dependent diabetes mellitus.

A home health nurse is caring for a 2-week-old infant and notes on assessment that the infant has a string tied around the wrist. The nurse checks for adequate circulation. The most appropriate nursing intervention by the nurse is to a. ask the parents to remove the string. b. report the parents to Social Services for child endangerment. c. remove the string and inform the parents that the string is dangerous. d. ask the parents the meaning of the string and leave the string in place.

d. ask the parents the meaning of the string and leave the string in place.

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress the a. importance of reducing caloric intake to decrease cardiac demands. b. importance of relaxing discipline and limit-setting to prevent crying. c. need to be extremely concerned about cyanotic spells. d. desirability of promoting normalcy within the limits of the child's condition.

d. desirability of promoting normalcy within the limits of the child's condition.

The nurse working in an outpatient surgery center for children should understand that a. children's anxiety is minimal in such a center. b. waiting is not stressful for parents in such a center. c. accurate and complete discharge teaching is the responsibility of the surgeon. d. families need to be prepared for what to expect after discharge.

d. families need to be prepared for what to expect after discharge.