29:Care of the Hospitalized Child PrepU's

Jamie, who is 3 years old, has been in the hospital for a week. Her mother has been rooming in, but other family responsibilities require that she go back to the family home for a few days. Jamie has been inconsolable for the past 24 hours, but now you notice that she is lying quietly in bed sucking her thumb. Which of the following would be the most helpful thing you could say to her?

"Are you feeling sad? Your mom didn't want to leave, but she will be back after two more breakfasts."

When 4-year-old Vernon's mother returns to room-in at the hospital with him after a 3-day trip back home, she is anxious and excited to hug him. When she leans over his bed to pick him up, he turns his back and scoots away. Which of the following statements made by the nurse would be an explanation for the child's reaction?

"His distrust is normal and may have lingering effects, but you should touch and soothe him as much as possible."

In a preadmission visit, 9-year-old Bridget says she is afraid to come for her tonsillectomy the following week because it will hurt too much. Which of the following statements would be best for the nurse to make to help the child feel more comfortable and less afraid?

"I understand that you're worried. It will hurt but only for a few days; we'll give you something to help stop the pain when you need it."

Following surgery the use of a patient-controlled analgesia device would be most appropriate for a child in which of the following situations.

A 7-year-old who has told the nurse about using the control button.

The nurse is working with the caregivers of a child who is being discharged from a healthcare setting. Which of the following statements is most accurate regarding discharge planning?

A conference to review information and procedures with the family caregivers is important to do as part of discharge planning.

The nurse has been assigned to care for a child who is on transmission-based precautions. This nurse has not cared for this child before. Which of the following actions would be the best way to help the child feel comfortable with the nurse?

Let the child see his or her face before the mask is put on.

The nurse is caring for a postoperative pediatric patient. Of the following nursing interventions done for this patient, which intervention would be highest priority?

Monitor for any change in vital signs.

The nurse is caring for a 10-year-old boy who had an appendectomy 2 days ago. Prior to surgery he had expressed that he was worried that after the procedure he would hurt and have lots of pain. The nurse asks the child what his pain level is on a scale of 0 to 10, with 10 being the worst pain. He tells the nurse he has no pain. The most appropriate action by the nurse would be to

Observe him for physical signs which might indicate pain.

The pediatric unit in the hospital is designed to be comfortable for the child and to make the child feel secure. Which of the following aspects of the pediatric unit would be most likely to support the child who is hospitalized?

Procedures and treatments are done in a room other than the child's hospital room.

A 5-year-old boy is brought to the emergency room with a possible broken arm. His 18-year-old sister, who is also his primary caregiver, has come with him. The boy is relatively calm, but his sister is so upset she is nearly hysterical. The nurse notes that as her behaviors show more anxiety, the boy is getting more upset and his anxiety is also increasing. Which of the following would be best for the nurse to do in this situation?

Reassure the child. Tell him you need to ask his sister some questions, and then gently remove his sister from the room.

The nurse is working in the pediatric unit of the hospital and is making observations about the safety issues related to the pediatric unit. Which of the following is the biggest concern related to safety of the hospitalized child?

Taking a child in and out of bed, doing frequent checks and procedures, and caregivers sitting at the side of the bed leaves opportunity for the siderails to be left down.

Which of the following activities would be most beneficial in educating children regarding hospitals and hospitalization?

The caregivers take all of the children in the family to an open house at the hospital.

In caring for children the nurse follows certain precautions in order to protect the child and the nurse. Which of the following is most accurate related to transmission-based precautions?

Transmission-based precautions are followed if a patient has a disease that can be easily spread.

The nurse caring for children recognizes that the ill child is vulnerable to pathogenic (disease-carrying) microorganisms. If microorganisms are insects, the manner they are spread is known as which of the following?

Vector

The nurse caring for children recognizes that the ill child is vulnerable to pathogenic (disease-carrying) microorganisms. If microorganisms are spread by food, water, or blood the manner they are spread is known as which of the following?

Vehicle

The nurse would notify the care provider if the child had anuria following a surgical procedure at which of the following time frames?

Within the first six hours following the surgical procedure.

When a nurse is caring for a child who is admitted for an emergency, which of the following factors most affects the child's sense of security?

The physical needs have a priority over the emotional needs of the child.

A few days after discharge, the parent of an 8-year-old calls the pediatric clinic, concerned about the child's behavior now that she is home. The parent expresses that the child is treating her siblings badly and using language she knows she is not allowed to use. The parent asks the nurse for suggestions regarding how to handle this behavior. Which of the following statements would be most appropriate for the nurse to make to this parent?

"Respond to her behavior in a firm, loving, consistent way."

A 5-year-old child asks the nurse what happens at the hospital in which the nurse works. Which of the following statements would be the most appropriate response for the nurse to give this child?

"Some people come here to have babies, or when they're sick or hurt, so we can try to help them get better."

The nurse is working with the caregivers and families of children who are hospitalized. Members of the group make the following statements. Which statement gives an indication of an issue that would likely be a major factor influencing the family's response to the child's illness?

"Sometimes I wonder if the reason she is sick is because I have so many responsibilities at work and at home."

The nurse administering the preoperative medications to the child going to surgery would anticipate which of the following related to giving preop medications?

A sedative to be given one-and-a-half to two hours before surgery and an analgesic-atropine mixture given just before the child leaves for the operating room.

The nurse working on the pediatric unit is talking with the child-life specialist. The nurse asks the specialist what the technique is called in which activities are used to help the child have a better understanding of what will be happening to him or her in a specific situation. Which of the following best describes what the nurse is discussing?

Therapeutic play

The nurse is caring for a 14-year-old child who is scheduled to have surgery the next day. Which of the following would be most appropriate for the nurse to do to help prepare this child for surgery?

Give the child a book to read which describes the people who are involved in the preoperative, surgical, and postoperative areas.

The grandmother of a 1-year-old cancer patient comes to visit the child in the PICU. She sits in a chair near the child's bed but doesn't touch him. Which of the following actions by the nurse would be most appropriate?

Encourage the grandmother to rock the child in a rocking chair.

The nurse is doing the preop preparation for a 6-year-old who is having surgery. Which of the following is most important for the nurse to document in the child's preop chart?

The number of loose teeth the child has and which teeth are missing.