33,34, ob2

The nurse is interviewing the caregiver of a 5-year-old child who has been admitted with bruises on the abdomen and thighs as well as additional bruises in various stages of healing. Which of the following statements made by the caregiver might alert the health care team to the possibility of child abuse?

"His brother plays too rough with him"

The nurse is working with a group of caregivers who have dying children. Which of the following statements made by one of the caregivers indicates that this caregiver is in the depression stage of anticipatory grief?

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

A group of pediatric nurses is discussing the diagnosis of Munchausen syndrome by proxy. Which of the following statements most accurately describes this disorder?

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

A 3-year-old who has been attending preschool has been diagnosed with leukemia. The caregivers of this child ask the nurse what they can do to help their child feel secure. Which of the following recommendations could the nurse make to these caregivers that would be helpful in making the child feel secure?

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

The nurse has recently started caring for a dying child. The nurse has not yet had a chance to discuss the family's beliefs with the child's caregivers. In the middle of the night, the child awakens and is frightened. She asks the nurse what the nurse's religious beliefs are about death. Which of the following would be an appropriate response?

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

The father of a 10-year-old who has recently been diagnosed with a terminal illness tells the nurse that his family had been working together for the previous year trying to get the 10-year-old and his 6-year-old sister to play better together and to share with each other. Which of the following statements would be most appropriate for the nurse to tell the father regarding children and the diagnosis of an illness?

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

In interacting for several days with a dying child, the nurse realizes that the child has not mentioned death. There are some dead flowers in a vase on the child's windowsill. The child looks at the flowers and says, "Did they die?" Which of the following statements would be the most appropriate for the nurse to make to give the child an opportunity to open up and talk about dying?

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

A child who is dying becomes restless and fidgety, then becomes calm and peaceful. The caregivers feel hopeful that the child seems "better." Which of the following statements would be the best one for the nurse to tell the caregivers about this pattern?

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

The nurse is admitting a pediatric client for a common pediatric surgical procedure. When completing the domestic violence screening, which statements require clarification? Select all that apply.

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

The health care provider is unsure of physical symptoms and diagnosis of a pediatric client. The health care provider is prescribing diagnostic testing to determine possible poisoning by the parent. When the parent asks why laboratory work is being drawn, which response is best?

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

12. A toddler's older sibling has died. Which nursing response best addresses a toddler's concern about, "Where has my brother gone?"

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

The parents of a terminally ill child ask the nurse how to have a conversation about illness. Which is the most appropriate concept for the nurse to base the response?

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

When evaluating a terminally ill client for pain relief following medication administration, which nursing assessments would be documented to support that the medication was effective? Select all that apply.

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

The nurse is attempting to include family in the care of a hospitalized, terminally ill adolescent. Which interventions can be appropriately delegated to family members? Select all that apply.

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

18. Which technique will best foster the initial communication between the nurse and a school-aged child recently told of a cancer diagnosis?

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

A single parent of a dying child has told the nurse she would like to take care of her daughter at home. What would be best for the nurse to do to help the mother reach a decision that will be good for both the mother and the child? The nurse should:

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

Which communication strategies are appropriate when discussing the topic of death and dying with a terminally ill school-aged child? Select all that apply.

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

The nurse is providing client-centered support to an adolescent diagnosed with a terminal illness. Keeping the client's developmental stage in mind, which nursing intervention will best meet the client's needs?

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

Which type of abuse is reported most quickly to the police?

A. sexual assault

A child is brought to the emergency department for evaluation. The caregiver states, "The child was running and tripped over the scooter on the sidewalk and landed on the left arm." The nurse assesses and records the findings (above). The nurse suspects child abuse (child mistreatment) and notifies the proper authorities. Which finding(s) will the nurse use to support this suspicion

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

Which physical symptoms confirm that a child has been sexually abused or assaulted? Select all that apply.

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

A young nurse has had no experiences of death in her own life. As a staff nurse, she finds herself dealing with young children who are terminally ill. She feels extremely uncomfortable facing these children and their caregivers. What is the best approach for the nurse to take in caring for these families?

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

The nurse is caring for a 4-year-old child with bruises on various areas of the body. Which parental statement does the nurse note as most suspicious?

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

A graduate nurse has provided care for a pediatric client who has died. Which statement to the family would require further discussion between the graduate nurse and the registered nurse (RN) mentor?

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

When mentoring a graduate practical nurse (PN), which behavior would the registered nurse (RN) address if demonstrated by the PN in the care of a dying child?

B. checking on the client and family once every shift

The emergency room nurse is caring for a family who lost an adolescent in a violent car accident. Which initial nursing action best helps the family's grieving process?

B. cleaning and making the deceased presentable to the family

Which is essential in working with caregivers who have been affected by abuse?

B. developing a therapeutic relationship

The nurse is caring for a young child whose parents have been charged with physical abuse. Which child reaction is noted as a result of the parental behavior?

B. fretful and shrinks away when approached

14. A toddler is brought to the emergency department with burns on the feet and buttocks. The toddler is screaming in pain. The caregiver states that she did not know the bath water was so hot. What is the initial action completed by the nurse?

B. notifying a health care provider

Which adolescent behavior is most common if the parents have substance use problems?

B. taking on adult responsibilities

Which statement made by a participant at a workshop on sexual abuse needs further clarification from the group leader?

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

The nurse is discussing the principles of hospice care to the family of a terminally ill pediatric client. Which parental statement would the nurse clarify as a misconception?

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

When caring for a child who is dying, which statement by the child leads the nurse to believe that the topic of death needs to be discussed further?

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

The nurse on a pediatric unit is caring for a client who has been physically and emotionally abused. Which adjustment in care is most appropriate?

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

Which factor associated with the caring of a dying pediatric client is most often cited by nurses as presenting the greatest degree of difficulty?

C. being constantly reminded of their personal mortality

18. Which is the primary physical sign of a child who the nurse suspects as being emotionally abused?

C. delays in physical development

When considering a school-aged child, the nurse should anticipate which factor as playing an influential role in the development of the concept of death?

C. family

The nurse has identified the outcome of improving parenting and coping skills in a caregiver who has shown past poor judgement in caring for the children. Which action promotes a positive image of his or her abilities?

C. providing a compliment when a caregiver does something well

Which action by the nurse providing end-of-life care to a preschool-aged client best promotes comfort?

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

24. A mother brings a 23-month-old child for a well-child check. She apologizes, stating, "It's my allergies, not a cold, that is causing me to sniffle so much." The mother reports that the toddler seems "slower at doing things than my older children did." The nurse notices that the child sits in the mother's lap without fear or hesitation and responds to the her questions, but fails to looks at the mother's face when being spoken to. These behaviors are supportive of what additional assessment?

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

The school nurse observes an elementary school child arriving in the winter inshorts and a short sleeved shirt with no coat. The nurse would consider this as which type of abuse?

D. neglect

The nurse is assessing an infant diagnosed with abusive head trauma (shaken baby syndrome). Clinical manifestations of shaken baby syndrome affect which body system the most?

D. nervous system

The caregivers of a dying 9-year-old boy are in his hospital room. Death is near and the child has drifted in and out of consciousness for several days. The caregivers are at two different stages of anticipatory grief and are arguing in whispers in the room. The best response in this situation would be for the nurse to

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

A caregiver who works in the hospital brings his 9-year-old son to the emergency room with a spiral fracture of the tibia. The careterm-1giver reports that the injury occurred when the boy's 5-year-old sister hit him with wooden bat. The injury is inconsistent with an impact and with the sister's strength. Which of the following would be appropriate for the nurse to do in this situation?

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

The nurse is caring for a small child who has been admitted with a diagnosis of shaken baby syndrome. Which of the following conditions or concerns often occur with shaken baby syndrome?

Loss of vision and intellectual disability

A group of nurses is discussing child abuse and one nurse suggests that inadequate parenting skills may lead to child abuse. The nurse recognizes that sometimes child abuse occurs because the parent:

May have unrealistic expectations of the child

In caring for a child who has been admitted after being sexually abused, which of the following interventions would be included in the child's plan of care?

Observe for signs of anxiety

Which of the following situations should the nurse explore for possible emotional abuse of the child by the caregiver?

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

The nurse is assisting with a physical exam on a child who has been admitted with a diagnosis of possible child abuse. Which of the following findings might alert the nurse to this possibility that the child may have been abused?

The child has a burn that has not been treated.

The nurse is caring for a child who has been a patient in the pediatric unit for several weeks. The child has a terminal illness and is dying. The caregivers and the nurse are in the room when the child takes the last breath and dies. Which of the following actions by the nurse would be considered appropriate at this time?

The nurse tells the family that he or she shares in their sadness and cries with them.