Exam 1: Chapter 39
The nurse is providing care to a pediatric client who is experiencing separation anxiety. Which data would support the documentation of the "despair" phase? 1. Lies quietly in bed. 2. Does not cry if his parents return and leave again. 3. Appears to be happy and content with staff. 4. Screams and cries when his parents leave.
Answer: 1 Explanation: *1. Children in the "despair" stage appear sad, depressed, or withdrawn. A child who is lying in bed might be exhibiting any of these.* 2. The young child who appears to be happy and content with everyone is in the "denial" stage, as is the child who does not cry if his parents return and leave again. 3. The young child who appears to be happy and content with everyone is in the "denial" stage, as is the child who does not cry if his parents return and leave again. 4. Screaming and crying are components of the "protest" stage.
17) Prior to discharging the child from the hospital, what routine discharge instructions should the nurse discuss with the family? 1. Monitoring signs and symptoms specific to condition 2. Instruction on performing a medical examination on the child 3. No instructions are needed; the family is familiar with the child. 4. A list of all diagnostic tests obtained during the hospitalization and their results
Answer: 1 Explanation: *1. Families need support and education as they continue to be anxious or stressed over their child's hospitalization. Standard discharge plans for routine hospital discharge include monitoring signs and symptoms specific to the condition and care at home.* 2. The family does not need to know how to complete a medical examination on the child. 3. The family knows the child but needs teaching regarding the signs and symptoms to watch for in case of recurrence or complications arise. 4. This information was shared with the family as the tests were performed and results received.
13) Which is the rationale for why parents should be allowed to be present with their children during a medical procedure? 1. Parents want to support their child before, during, and immediately after the procedure. 2. Parents want to ensure that nothing goes wrong with the child. 3. Parents are interested because they are also in the medical field. 4. Parents want to ensure that the correct medication is being used.
Answer: 1 Explanation: *1. Many hospitals now allow parents to be present with their child during and after procedures. Parents often want to support their child, and their presence offers reassurance and comfort to the child.* 2. When parents ask to be present for a procedure, they are doing so to be available to comfort the child, not to control the procedural outcome. 3. Parents might be in the medical field, but their primary concern is to comfort their child during the procedure. 4. The parents' first concern is to comfort their child, not supervising the nursing staff.
11) The nursing action is most appropriate when performing a procedure on a toddler-age child? 1. Allowing the child to cry or scream 2. Performing the procedure in the child's hospital bed 3. Asking the child if it is okay to start the procedure 4. Asking the mother to restrain the child during the procedure
Answer: 1 Explanation: *1. The child should be allowed to cry or scream during the procedure.* 2. The treatment room should be utilized for the procedure so that the hospital bed remains a safe place. 3. The nurse should avoid giving the child a choice if there is no choice. 4. While the toddler will need to be restrained, the parent should not be the one to do this.
15) The mother of a child admitted after a motor vehicle accident expresses concern about caring for the child's wounds at home. The mother has demonstrated appropriate technique with medication administration and wound care. Which is the priority nursing diagnosis? 1. Parental Anxiety related to care of the child at home 2. Altered Family Processes related to hospitalization 3. Risk for Infection for related to presence of healing wounds 4. Knowledge Deficit related to home care
Answer: 1 Explanation: *1. While all of the diagnoses might have been appropriate at some point, the current focus is the mother's anxiety about caring for the child at home. The priority of the nurse is relieving this anxiety.* 2. The child is being discharged, so this is not the priority diagnosis. 3. The mother has shown appropriate care of the wounds, decreasing the likelihood of infection, so this diagnosis is not the priority. 4. The mother has exhibited correct technique, so this is not the priority diagnosis.
20) A 6-year-old child is hospitalized for a surgical procedure. The parents ask if the child's four siblings can visit. Which response by the nurse is the most appropriate? 1. "Let's plan their visit for a time when the child has received pain medication." 2. "Only those siblings over 16 will be allowed to visit." 3. "I don't think the other children should visit because it might scare them to see their sibling so sick." 4. "Very young children shouldn't visit as they may carry germs."
Answer: 1 Explanation: *1. Planning a time to visit when the child is most comfortable will be best for the client and the siblings.* 2. Unless hospital policy prevents visitation by younger children, they should be allowed to visit. 3. Children should be prepared for a visit, but visits should be allowed. Children who cannot visit often imagine the situation is worse than it is. 4. All children may carry germs. Children should be assessed for signs of infection, but if they are free of symptoms, they should be allowed to visit.
22) An adolescent tells the nurse that the new diagnosis of diabetes has him "stressed out." Which stress-reduction activities will the nurse recommend to this adolescent? Select all that apply. 1. Daily exercise, such as walking 2. Learning more about his illness 3. Practicing deep breathing and other relaxation techniques 4. Not thinking about his diagnosis 5. Allowing the parents control of his disease
Answer: 1, 2, 3 Explanation: *1. Exercise is an effective stress reducer.* *2. Fully understanding his condition will reduce his stress.* *3. Relaxation techniques can help reduce stress.* 4. Keeping feelings and emotions in will increase stress in the adolescent. 5. Adolescents like to be in control of themselves and are working on separation from the parents, so it would be inappropriate to encourage the child to give control to others.
26) The nurse is providing care to an infant who is hospitalized for bronchiolitis. Which infant stressors should the nurse plan for when providing care for this infant? Select all that apply. 1. Separation anxiety 2. Stanger anxiety 3. Disrupted sleep-wake cycle 4. Loss of self-control 5. Fear of the dark
Answer: 1, 2, 3 Explanation: *1. Separation anxiety is an infant stressor that the nurse should plan for when providing care to the hospitalized infant.* *2. Stranger anxiety is an infant stressor that the nurse should plan for when providing care to the hospitalized infant.* *3. A disrupted sleep-wake cycle is an infant stressor that the nurse should plan for when providing care to the hospitalized infant.* 4. Loss of the control is a stressor for the hospitalized toddler, not the infant. 5. Fear of the dark is a stressor for the hospitalized toddler, not the infant.
23) The healthcare provider has prescribed the toddler an oral medication. The toddler has fought medication administration in the past. Which strategies may be helpful when administering the medication to this toddler? Select all that apply. 1. Request the medication in liquid form and draw the medication in an oral syringe. 2. Put the medication in a favorite drink in the child's sippy cup. 3. Allow the mother to administer the medication to the child. 4. Notify the healthcare provider to change the route to intravenous. 5. Hold the child down and squirt the medication in the corner of his mouth.
Answer: 1, 3 Explanation: *1. These activities will make the administration easier.* 2. This would not be appropriate as it increases the volume that must be administered and may unfavorably change the taste of the drink. *3. The child is more willing to take the medication from the mother.* 4. This would not be appropriate. 5. This could cause the child to choke on the medication and is inappropriate.
27) The nurse is providing care to a hospitalized adolescent client. Which should the nurse include in the adolescent's plan of care related to stressors? Select all that apply. 1. Loss of privacy 2. Fear of the dark 3. Loss of identity 4. Fear of altered body image 5. Separation anxiety
Answer: 1, 3, 4 Explanation: *1. Loss of privacy is a stressor the nurse should plan for when providing care to a hospitalized adolescent client.* 2. Fear of the dark is a stressor for the hospitalized toddler and preschool-age client not the adolescent client. *3. Loss of identity is a stressor the nurse should plan for when providing care to a hospitalized adolescent client.* *4. A fear of altered body image is a stressor the nurse should plan for when providing care to a hospitalized adolescent client.* 5. Separation anxiety is a stressor for the hospitalized infant, toddler, and preschool-age child not the adolescent.
2) Which is a common fear, in addition to separation anxiety, for the hospitalized pediatric client between the ages of 6 and 18 months? 1. Disfigurement 2. Death 3. Stranger anxiety 4. Bodily injury
Answer: 3 Explanation: 1. Infants do not fear disfigurement. 2. Infants and toddlers do not fear death *3. In addition to separation anxiety, infants between 6 and 18 months of age might display stranger anxiety when confronted with strangers such as healthcare providers.* 4. Infants and toddlers do not fear bodily injury.
16) A child is being discharged from the hospital requiring complex, long-term care with medication administration through a central line and maintenance of oxygen administration by nasal cannula. A home health nurse will be visiting each day. What should the nurse teach the family members prior to hospital discharge? 1. How to insert an IV line 2. Nothing, the family is familiar with the care 3. Instruction on oxygen administration 4. How to remove a central line
Answer: 3 Explanation: 1. Starting an IV line is not within the family's responsibilities for home care. 2. The nurse can never assume the family members are familiar with the care required, even if they have been participating during the hospital stay. *3. Prior to discharge, the parents will need to learn about oxygen administration.* 4. Removing a central line is not within the realm of what family members need to do at home.
3) The parents of a child who is critically injured wish to stay in the room while the child is receiving emergency care. Which nursing action is most appropriate in this situation? 1. Asking the healthcare provider if the parents can stay with the child 2. Allowing the parents to stay with the child 3. Escorting the parents to the waiting room and assuring them that they can see their child soon 4. Telling the parents that they do not need to stay with the child
Answer: 2 Explanation: 1. The physician does not make the decision whether the parents stay with the child; the parents make the decision. *2. Parents should be allowed to stay with their child if they wish to do so. This position is supported by the Emergency Nurses Association and is a key aspect of family-centered care.* 3. Parents should be allowed to stay with their child if they wish instead of going to the waiting room where they lack privacy. 4. The parents need to make the decision about staying with their child without input from the nurse.
12) A child has a planned hospitalization in a few weeks, and the client and family appear very stressed. Which nursing action will minimize the stress for the client and family? 1. Telling the client and family that everything will be fine 2. Explaining to the client and family how the child will benefit from the surgery 3. Telling the client and family that the surgeon is very good 4. Giving a tour of the hospital unit or surgical area to the client and family
Answer: 4 Explanation: 1. The nurse cannot know for certain that everything will be fine. 2. The pros and cons of the surgery would have been explained to the family prior to the decision to have the surgery. Restating the benefits will not reduce the stress of the client and family. 3. Telling them the surgeon is very good is not going to minimize stress for long. They need to be more familiar with what to expect in a familiar environment. *4. A variety of approaches can be used to provide information and allay fears. Tours of the hospital unit or surgical area are helpful. This activity assists the child and family to become familiar with the environment they will encounter.*
29) Which nursing actions are appropriate for teaching the family of a pediatric client requiring skilled care prior to discharge? Select all that apply. 1. Teaching how to use home equipment 2. Educating on symptoms that indicate distress 3. Encouraging participation in a cardiopulmonary resuscitation course 4. Recommending that one parent take a leave of absence from work 5. Discouraging participation in case coordination activities
Answer: 1, 2, 3 Explanation: *1. The nurse will educate the family regarding equipment that will be used after discharge. It is essential that the family perform a successful return demonstration.* *2. The nurse will teach the family symptoms that indicate the client is experiencing distress and include information on who to contact if these symptoms should occur.* *3. The nurse will encourage the family to participate in a cardiopulmonary resuscitation course prior to discharge.* 4. While it is appropriate for the nurse to educate the family on the Family Medical Leave Act (FMLA), it is not appropriate for the nurse to recommend that one parent take a leave of absence from work. 5. The nurse should encourage the family to participate in care coordination for their child if they indicate they would like to learn about this portion of the child's healthcare management.
28) Which are barriers to successful discharge planning that the nurse may need to plan for when providing care to a pediatric client who is approaching discharge? Select all that apply. 1. Financial concerns 2. Parental unavailability for teaching 3. Lack of equipment 4. Poor teamwork 5. Insurance payment for services
Answer: 1, 2, 3, 4 Explanation: *1. Financial concerns related to the cost associated with care that is needed after discharge is one barrier to successful discharge planning when providing care to the pediatric client who is approaching discharge.* *2. Parents who are not available for discharge instruction is one barrier to successful discharge planning when providing care to the pediatric client who is approaching discharge.* *3. Not having the equipment the family will use after discharge is one barrier to successful discharge planning when providing care to the pediatric client who is approaching discharge.* *4. Poor teamwork is one barrier to successful discharge planning when providing care to the pediatric client who is approaching discharge.* 5. Insurance payment for services is not a known barrier to successful discharge planning when providing care to the pediatric client who is approaching discharge.
21) The 4-year-old child is undergoing cardiac surgery. Which nursing action will reduce the child's stress in the preoperative period? Select all that apply. 1. Explain the procedure to the child in simple terms of what the child will see, hear, and feel while awake. 2. Explain to the child that the surgery will fix her "broken" heart. 3. Allow the parents to accompany the child to the surgical holding room and wait with the child. 4. Allow the child to hold onto their special "teddy bear" while awake. 5. Wait until the child is in the holding room to insert the Foley catheter.
Answer: 1, 3, 4 Explanation: *1. The child does not need to understand the surgical activity while asleep.* 2. Care must be utilized in selecting terminology for the child. To the child, the heart is not just a muscle, but the center of the child's love. A "broken" heart may be discarded. *3. This is appropriate as parents are the child's main source of support.* *4. Children of this age often have security objects; the child should be allowed to hold the object for comfort. Care must be taken that the teddy bear be labeled and returned to the child after the surgical procedure.* 5. The child is awake in the holding room. It is better to wait until the child is under anesthesia to insert the catheter.
25) Which nursing actions are important when providing care to a pediatric client who is on contact precautions due to a communicable disease? Select all that apply. 1. Encouraging frequent family visits 2. Scheduling physical therapy (PT) for the child 3. Providing age-appropriate stimulation and activities 4. Allowing the parents to have physical contact with the child 5. Educating the family about personal protective equipment (PPE)
Answer: 1, 3, 4, 5 Explanation: *1. It is important for the nurse to encourage frequent family visits to decrease the sense of isolation that can occur for the pediatric client who is on contact precautions.* 2. This nursing action is more appropriate for a client who is receiving rehabilitative care versus a client who is on contact precautions. *3. It is important for the nurse to provide age-appropriate stimulation and activities due to limited contact with other children and family members while on contact precautions.* *4. It is important to allow parents to have physical contact with their child when the child is on contact precautions. PPE should be limited to only what is needed to protect the parent from being exposed to the communicable disease.* *5. It is important for the nurse to educate the family regarding which PPE to use and how to properly wear it when providing care to a child on contact precautions.*
18) Which age groups can best tolerate separation from parents during hospitalization? Select all that apply. 1. Infants birth to 5 months 2. Infants 5 months to 1 year 3. Toddlers and preschoolers 4. School-age children 5. Adolescents
Answer: 1, 4, 5 Explanation: *1. Infants in this age group do not recognize parents as separate from themselves so will not feel abandoned when parents do not stay.* 2. Infants in this age group recognize object permanence and will be aware of the absence of their parents. 3. Both groups suffer from separation anxiety and fear of abandonment. *4. School-age children are accustomed to dealing with adults other than parents and can better tolerate separation.* *5. Adolescents are able to understand separation and time and thus will not suffer from separation from parents.*
5) A preschool-age boy presents to the outpatient clinic for a sore throat. In the child's mind, which is the most likely causative agent of the sore throat? 1. Being exposed to a classmate with strep throat 2. Yelling at sibling for being annoying 3. Not eating the right foods 4. Not taking daily vitamins
Answer: 2 Explanation: 1. At this age, the child does not yet understand that he can become sick from exposure to someone else who is sick. *2. Preschoolers understand some aspects of being sick, but not the cause of illness. They are likely to think that they are sick as a result of something that they have done. They frequently will view illness as punishment.* 3. Not eating the right foods can be a factor in some illnesses, but this thinking is beyond the level of a 4-year-old boy. 4. While not taking his vitamins can be a factor in some illnesses, this thinking is beyond the capabilities of a 4-year-old boy.
8) A child is being prepared for surgery. The parents request to be present during anesthesia induction. Which response by the nurse is most appropriate? 1. Telling the parents the names of all the medications that will be administered 2. Explaining what the parents will see and hear during induction 3. Telling the parents they will be upset to see the child under anesthesia 4. Ignoring the request and focusing on the child
Answer: 2 Explanation: 1. Parents do not need to know the names of the medications the child will receive. *2. The nurse explains visual and auditory experiences, such as a surgical gown, cap, shoe covers, and the parents' role during induction. The nurse offers the parents an opportunity to ask questions and voice concerns.* 3. The nurse should tell the parents what to expect but not how they will feel while they watch their child. 4. The nurse should never ignore a request made by parents.
9) The mother of a child admitted to the intensive care unit (ICU) appears very angry and tells the nurse no one is providing information about the child. Which response by the nurse is most appropriate? 1. Asking the mother to leave if the behavior continues 2. Apologizing for the mother's perception and assure the mother that the staff will keep her informed. 3. Offering to ask the healthcare provider to come and talk with her 4. Telling the mother her behavior will upset the child
Answer: 2 Explanation: 1. Telling the mother she will be asked to leave will only worsen the situation. *2. Nursing techniques include informing the family of potential problems that could occur. If the child's condition changes, make every effort to inform the family immediately.* 3. The mother is already angry because of the lack of information sharing. The nurse should not "pass the buck" to the healthcare provider. 4. The mother is already angry, and informing her that her behavior will upset the child will only anger her more.
4) The pediatric group is providing care to a group of hospitalized clients. Which client is at the greatest risk for developing separation anxiety if the parents are unable to stay with the child at all times? 1. 6 month old 2. 18 month old 3. 4 year old 4. 6 year old
Answer: 2 Explanation: 1. The 6-month-old child does not experience separation anxiety, which usually begins at around 1 year of age. *2. The young toddler is at greatest risk. Toddlers are the group most at risk for a stressful experience when hospitalized. Separation from parents increases this risk greatly.* 3. The 4-year-old child is past the age when separation anxiety would be most prevalent. 4. The 6-year-old child is attending school and is used to short periods of separation from parents.
19) A hospitalized preschool-age child will be left alone for short periods of time for the mother to return home to care for the child's siblings. The mother asks the nurse what is the best way to leave. Which response by the nurse is appropriate? Select all that apply. 1. "Leave after your child falls asleep so he won't know you are going." 2. "Tell your child you are leaving and identify when you will return after dinner." 3. "Leave an article of clothing behind to comfort your child." 4. "Tell the nurse on duty when you are leaving so that the nurse can stay with your child while you are gone." 5. "Plan to leave when your child is having procedures performed as the child will be busy and less aware of the parents' absence."
Answer: 2, 3 Explanation: 1. The child will awaken and feel mom has disappeared. When mom returns, the child may be unwilling to fall asleep again for fear she will disappear again. *2. The child cannot tell time, so it is appropriate to associate time of return with an event that the child recognizes rather than give a specific time. It is appropriate for the mother to tell the child she is leaving and promise to return.* *3. The child recognizes that mother will return for her clothing, and this may provide comfort.* 4. The nurses need to know that the child is alone, but staffing demands will not allow a nurse to sit with the child during the parent's absence. 5. Whenever possible, the parents should be present when procedures are being performed.
10) The nurse is caring for a child in the pediatric intensive care unit (PICU). The parents have expressed anger over the nursing care their child is receiving. Which nursing action is most appropriate? 1. Explaining to the parents that their anger is affecting their child, and they will not be allowed to visit the child until they calm down 2. Asking the healthcare provider to talk with the family 3. Acknowledging the parents' concerns and collaborating with them regarding the care of their child 4. Calling the hospital chaplain to sit with the family
Answer: 3 Explanation: 1. Telling the parents that they cannot visit their child will only increase their anger. 2. Calling the healthcare provider might be appropriate at some point, but the nurse must assume the role of supporter in this situation to promote a sense of trust. *3. Hospitalization of the child in a PICU is a great stressor for parents. If the parents feel that they are not informed or involved in the care of their child, they might become angry and upset.* 4. Calling the chaplain could be appropriate at some point, but the nurse needs to collaborate with the parents about the care the child receives.
6) A school-age client is in the playroom when the respiratory therapist arrives to give a scheduled breathing treatment. Which is the most appropriate nursing action? 1. Escorting the child to his room and asking the child-life specialist to bring toys to the bedside 2. Rescheduling the treatment for a later time 3. Assisting the child back to his room for the treatment but reassuring him that he may return when the procedure is completed 4. Showing the respiratory therapist to the playroom so the treatment can be performed
Answer: 3 Explanation: 1. The child should be allowed to return to the playroom as soon as the procedure is completed; bringing toys to the bedside is unnecessary. 2. Scheduled respiratory treatments should be performed on time. *3. It is important for scheduled treatments to occur on time, so the child should go back to his room. He can return to the playroom as soon as the treatment is completed.* 4. Procedures should not be performed in the playroom.
14) The parents have requested to be present during their child's procedure. How should the nurse plan for this request? 1. Explain in detail, using medical terms, what will occur. 2. Explain to the family that it is not permitted for family members to be present. 3. Prepare family members for what they should anticipate and what is expected of them. 4. Prepare the family to speak with the healthcare provider.
Answer: 3 Explanation: 1. The nurse should not use medical terms to discuss the child's procedure. 2. In most circumstances, it is not only permitted but desired to have the parents present during a procedure. *3. Parents often want to support their child before and after procedures, and their presence offers reassurance and comfort to the child. Prepare family members for what to anticipate and what is expected of them.* 4. The nurse can speak to the family to prepare them and does not need to wait for the healthcare provider.
7) A preschool-age child is admitted to the pediatric unit for surgery. The parents request to stay with their child. Which is the best response by the nurse? 1. Tell the parents they can stay in the hospital but not on the unit. 2. Read the rules and regulations of rooming in with the child. 3. Let the parents know they are allowed to stay with the child. 4. Explain to the parents why they cannot stay with the child.
Answer: 3 Explanation: 1. The parents should be allowed to stay with their child on the unit. 2. The parents should be aware of the rules about rooming in, but they should know first that they can stay. *3. The practice of rooming-in involves a parent's staying in the child's hospital room during the course of the child's hospitalization. Some hospitals provide cots, while others have special built-in beds on pediatric units.* 4. The parents should be allowed to stay with their child.
24) Which changes can a nurse manager implement to reduce the stress experienced by hospitalized pediatric clients? 1. Having only female nurses on the unit 2. Assigning nurses one-on-one with clients 3. Allowing the nurses to wear colored scrubs in place of white uniforms 4. Having the nurses avoid entering the client's room unless a procedure is to be performed
Answer: 3 Explanation: 1. The sex of the nurse has not been shown to be a source of stress. 2. Staffing patterns will not allow a one-to-one nurse to client ratio on the regular pediatric unit. *3. This change has been shown to reduce stress in children.* 4. Nurses should visit when not performing procedures to allow the children to become familiar and comfortable with the nurses.