NSG 334: Chapter 33: Caring for Children in Diverse Settings

A preschool teacher calls the hospital and wants to introduce the concept of a hospital to her preschool class in case they ever get sick and need to be admitted. What resources could the child life specialist provide for this group to aid in their learning? Select all that apply.

-Provide a room for the class with hospital gowns, masks and equipment used on children. -Tour the hospital, including the playrooms on the pediatric floors. -Let the children lie in the beds, use the call lights and practice being a patient. Preschoolers are curious and love to manipulate the equipment used at the hospital. By making admission to the hospital less frightening for them, they will adjust better if they have to be admitted. Mentioning people not leaving the hospital indicates they died; this is scary to the children and inappropriate for this session. Children are never allowed to play with needles or syringes - it is too dangerous.

A few days after discharge, the parent of an 8-year-old calls the pediatric clinic, expressing concern about the child's behavior now that she is home. The child has been treating her siblings badly and using inappropriate language. Which suggestion should the nurse prioritize to this caregiver as an appropriate way to handle this situation?

"Respond to her behavior in a firm, loving, consistent way." The return home may be a difficult period of adjustment for the entire family. The older child may demonstrate anger or jealousy of siblings. The family may be advised to encourage positive behavior and to avoid making the child the center of attention because of the illness. Discipline should be firm, loving, and consistent. The child may express feelings verbally or in play activities. The family may be reassured that this is not unusual.

The nurse is caring for an 11-year-old girl preparing to undergo a magnetic resonance imaging (MRI) scan. Which statement would best help prepare the girl for the test and decrease anxiety?

"The machine makes a very loud rattle; however, headphones will help." The nurse should acknowledge that an MRI is loud and briefly describe the noises the machine makes. Then, the nurse should immediately offer a solution: headphones. Telling the girl she won't hear a sound is untrue. Telling her that there are loud sounds isn't enough and could increase anxiety. Comparing the MRI scanner to the sound of a machine gun is not appropriate imagery for a child.

The nurse is caring for a preschooler who is hospitalized with a suspected blood disorder and receives an order to draw a blood sample. Which approach is best?

"Why don't you sit on your mom's lap?" It is best to include the families whenever possible so they can assist the child in coping with their fears. Preschoolers fear mutilation and are afraid of intrusive procedures. Their magical thinking limits their ability to understand everything, requiring communication and intervention to be on their level. Telling the child that we need to put a little hole in their arm might scare the child.

Which intervention is most important in assuring a child's cooperation and reducing his or her fear during an emergency room visit?

having the parent stay with the child The most effective way to enlist a child's cooperation and reduce his or her stress in an emergency room visit is to have the parent remain with the child and comfort him or her.

The mother of a 4-year-old returns to the hospital after being away for 3 days. She is anxious and excited to be back; however, the toddler turns his back to her and scoots away as she attempts to pick him up. Which response should the nurse prioritize in this situation?

"His distrust is normal and may have lingering effects, but you should touch and soothe him as much as possible." Three characteristic, consecutive stages of response to separation have been identified: protest, despair, and denial. In the denial stage, the child begins taking interest in his or her surroundings and appears to accept the situation. However, the damage is revealed when the caregivers do visit: the child may turn away from them, showing distrust and rejection. It may take a long time before the child accepts them again; even then remnants of the damage may linger. The child may always have a memory of being abandoned at the hospital.

The nurse is caring for a technology-dependent school-aged child in his home. Which action best builds a trusting relationship?

Discussing care and treatment with the parent and child together. To build a trusting relationship with the family, the nurse must remember the child is both the client and a family member. He needs to be included in all discussions. Encouraging parents to join a support group and talking with the sibling of the ill child who feels ignored are important and supportive activities. Changing the date and time of a therapy session to fit the family schedule is a case management activity. These are important elements of family-centered home care, but are not meant specifically to build trust.

The hospital nurse is providing discharge instructions to the caregivers of a 10-year-old child with a new prosthetic limb. Which finding will cause the nurse to contact the primary health care provider?

The child is being discharged home with the caregiver. The nurse would question the child with a new prosthetic limb being sent home immediately from the hospital. Sending the child to a rehabilitation unit is best to facilitate usage of the prosthetic limb. The care in a rehabilitation unit involves an interdisciplinary approach that assists the child to reach his or her potential and achieve developmental skills. A diagnosis of hypothyroidism in infancy would not be concerning to the use of a prosthetic. The WBC and blood pressure are both within normal range for a client of this age. The normal WBC is 5,000 to 10,000 mm3 (5 to 10 x 109/L) and blood pressure range is 95-120/55-76 mm Hg.

The nurse is caring for a 9-year-old child on an inpatient pediatric unit who is admitted for an extended stay. The child continually refuses meals. What can the nurse do to help increase the child's intake? Select all that apply.

-Assist the child to choose foods he or she likes from the facility menu. -Encourage the child to eat several small meals instead of fewer larger meals. -Ask the dietitian to visit the child to help determine foods the child prefers. -If approved by the physician, allow the parents to bring food from home for the child. Ensuring the child receives food preferences and rewarding the child with praise can help in increasing the intake when hospitalized. Children should never be forced or punished for not eating as this can cause an aversion for food that carries beyond the hospital stay into the home environment.

A nurse is admitting a 7-year-old child to the pediatric unit of the hospital. While the nurse is showing the child and parents the room and explaining where things are, the child becomes upset and frightened. What is the best action by the nurse?

Go slowly with the acquaintance process. The child who reacts with fear to well-meaning advances and who clings to the caregiver is telling the nurse to go slowly with the acquaintance process. The child who knows that the caregiver may stay is more quickly put at ease. To provide security for the child and to provide family-centered care, it is the responsibility of the nurse to form good partnerships with families. Asking the family to leave the room in this situation would only frighten the child more. The nurse should never provide false reassurance. Telling the child there is nothing to be afraid of or nothing will hurt him or her are promises the nurse cannot make to the child.

A nurse who has worked in a variety of settings over the past several years is trying to determine what setting she would most like to work in now. The nurse is very organized, works well in an autonomous environment, and prefers one-on-one care. Which setting would best fit this nurse's needs?

home health Home health would provide the most autonomy (which requires being organized), and takes place in the client's home, giving one-on-one care. All areas of nursing require organization in order to provide efficient care. A physician's office would likely provide the least amount of autonomy since the physician is always present, as well as other office staff. The health department nurse and the school nurse would favor an autonomous person, but there is still more direct supervision than with home health nursing.

The hospital charge nurse is evaluating the care given by one of the staff nurses to determine if the nurse is providing developmentally appropriate care to infants on the unit. Which actions by the staff nurse demonstrate knowledge of developmentally appropriate care for infants? Select all that apply.

-The staff nurse uses the en face position when holding newborns. -The charge nurse notices the staff nurse providing comfort during and after procedures by holding and talking to infants. -The staff nurse uses gentle stroking and holding of the infants. -The charge nurse witnesses the staff nurse assisting the parents with care of their infant. The nurse should encourage the family to maintain home routines while in the hospital, planning nursing care around the usual feeding and sleep times. Using the en face approach, providing comfort measures, and being supportive of the parents while giving care are developmentally appropriate interventions that promote infant growth and development.

The charge nurse is planning staffing on a pediatric unit. Which client will the charge nurse assign to the registered nurse?

the 1-year-old client with a respiratory disorder prescribed oxygen therapy The charge nurse would assign the RN to the most unstable client, which is the client with a respiratory disorder who is only 1 year of age. According to Child Health USA 2010, diseases of the respiratory system account for the majority of hospitalizations in children younger than 5 years of age, indicating this is a common occurrence. All other clients are stable and could be cared for by licensed practical nurses at this time.

A nurse is caring for a 6-year-old boy hospitalized due to an infection requiring intravenous antibiotic therapy. The child's motor activity is restricted and he is acting out, yelling, kicking, and screaming. How should the nurse respond to help promote positive coping?

"Would you like to read or play video games?" Distraction with books or games would be the best remedy to provide an outlet to distract the child from his restricted activity. The other responses would be unlikely to affect a change in the behavior of a 6-year-old.

A nurse is educating the parents on how to help their 10-year-old daughter deal with an extended hospital stay due to surgery, followed by traction. Which response indicates a need for further teaching?

"I should not tell her how long she will be here." Parents who do not tell their child the truth or do not answer the child's questions confuse, frighten, and may weaken the child's trust in them. The other statements are effective forms of communication.

A nurse with no pediatric experience has been transferred to a pediatric unit to work for the day. Which comment by the nurse indicate knowledge of developmental considerations when providing hygiene needs to a 3-month-old infant?

"I plan on using a sponge bath to bathe the infant." A 3-month-old would require a sponge bath or tub bath to bathe because he or she cannot sit unaided. Talcum powder is not suggested for infants. A bathtub can be used for toddlers or older. No child should ever be left alone during bathing for any length of time.

While the nurse is admitting a 5-year-old client, the caregiver asks, "What can I do to make my child feel secure? This is our first hospitalization." Which nursing response is best?

"You staying with your child will provide the most security." The nurse would recommend the caregiver stay with the child. Rooming-in minimizes the hospitalized child's separation anxiety and fears. One of the biggest advantages of rooming-in is the measure of security the child feels. Telling the caregiver to bring the child's favorite toy is okay; however, this does not address the concern of security. Stating "not to worry" and not addressing the caregiver's concerns at this time are not appropriate forms of therapeutic communication from the nurse. There is no indication the child is unstable, so the nurse could stop long enough to speak to the caregiver.

What can a nurse do during an emergency admission to alleviate some of the child's and family's fears/anxieties over the situation? Select all that apply.

-Ask the family members health history questions while the child is being initially treated. -Place an identification bracelet on the child, explaining that this will help the hospital staff know who he or she is at all times. -Remain calm, explaining procedures to both the family and the client in a caring manner. Children who undergo an emergency admission to the hospital are often frightened and anxious, so the nurse needs to provide education about everything done to the child. Explaining the reason for the identification bracelet, involving the family in providing client information (if they cannot remain with the child), and describing what is being done to the child all help alleviate anxiety and fear in both parents and the child.

The nurse is caring for a 6-year-old client who is prescribed to cough and deep breathe following surgery. Which nursing action is best for this client?

Blow a pinwheel and bubbles with the child. The nurse will have the child blow bubbles and a pinwheel to accomplish the prescription as these actions are most like play. These actions will encourage and engage the child and are likely to be accepted and even enjoyed. All of the measures have potential to get the child to cough and deep breathe to some extent, but blowing bubbles and a pinwheel is best for the client's age.

The nurse is caring for a preoperative pediatric client. What would it be best for the nurse to do with this client?

Determine how much the child knows and is capable of understanding. The nurse must determine how much the child knows and is capable of learning in order to best prepare the child for surgery. Keeping terminology at the child's and caregivers' level of understanding is important when doing teaching. Teaching the therapeutic plan is important, but it has to be done on the level of the child's and caregivers' knowledge and build on what they already know. The child going to surgery will be NPO, but the nurse needs to know on what level to teach the child the reason for this.

The student nurse is caring for an infant with the nursing instructor at her side. What action by the student would cause the instructor to need to intervene immediately?

Leaving an infant on the crib with a crib rail down. Keeping one hand on the infant when crib sides are down is essential in ensuring safety of the infant. Keeping crib rails all the way up, using the en face position when holding newborns and talking to the infant during interactions are all ways to ensure safety and promote healthy growth and development.

A 10-year-old boy who had an appendectomy had expressed worry that following the procedure he would have lots of pain. Two days after the procedure the child is claiming he is having no pain. Which nursing intervention should the nurse prioritize when assessing this child?

Observe him for physical signs which might indicate pain. Nursing judgment is in order. Some children may try to hide pain because they fear an injection or because they are afraid that admitting to pain will increase the time they have to stay in the hospital. To use the color scale, a child younger than 7 is given crayons ranging from yellow to red or black. Yellow represents no pain; the darkest color (or red) represents the most pain. The child selects the color that represents the amount of pain he or she feels. The most appropriate pain scale to use with this child would be the 1 to 10 (with 10 being the worst pain) or the faces scale.

The nurse is preparing a postsurgical care plan for an infant girl located on a general hospital unit that only occasionally admits children. To ensure the infant's safety, what should the nurse include in the plan?

Place the infant in a room close to the nurses' station. The infant will need close monitoring, and having the child nearby will promote frequent checks and awareness of her status. Family cannot be required to stay at all times. That may be impossible for some. One client should never be responsible for another. The infant is the nurses' responsibility. Putting the infant in a carrier and bringing her to the nurses' station is not safe.

The nurse is reviewing a job description of a school nurse. Which activity would the nurse question?

Provide immunizations to students. School nurses typically don't administer vaccines to children. They act as a liaison between the child and various health care provider and other community agencies. Training staff and students on topics such as first aid, CPR, and health promotion activities, and providing emergency first aid are examples of activities of the school nurse.

The nurse is preparing to discharge a 5-year-old child from the hospital who will require dressing changes to a wound at home. The parents have been taught the appropriate wound care measures during the stay in the hospital. Which action by the parents assures the nurse that learning occurred?

The parents have performed the wound care and dressing change with the nurse's supervision the last 2 days prior to discharge. Demonstration of wound care is the best way to evaluate if the parents are knowledgeable of the procedure. Voicing understanding and listing the steps does not assure the nurse that learning has occurred. Helping the nurse with wound care is beneficial when initially learning the procedure, but does not ensure the ability to perform the procedure independently.

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. What initial action would be best for the nurse to take in this situation?

While attending to the child, reassure the sister and suggest interventions she can help with. In an emergency, physical needs assume priority over emotional needs. The emergency itself is frightening to the child and the family and the need for treatment is urgent. Even though a caregiver tries to act calm and composed, the child often may sense the anxiety. If the hospital is still a great unknown, it will only add to the child's fear and panic. It is best if the caregiver can be present to reassure the child.

A 15-year-old boy asks numerous questions about recovery from anesthesia and typical behaviors of someone awakening from sedation. The nurse interprets the concern of this teen to be:

about his ability to control his own behavior. These questions point to anxiety about how the teen may act while he has limited control of his behaviors. It is likely he does not want to appear "stupid, babyish, or uncool." All the other factors are typical adolescent concerns that may surface during the hospital stay.

The pediatric nurse would use standard precautions in caring for which client on her floor?

an adolescent who has a broken arm Standard precautions involve avoidance of handling blood or body fluids from a client and involve use of personal protective equipment (PPE). In this case, with a fracture, there is minimal risk of exposure to body fluids so the nurse would wear gloves only. The other three clients would be in transmission-based precautions: airborne precautions for the toddler with chickenpox; contact precaution for the infant with diarrhea, or droplet precautions for the child with pertussis.

A school-aged child needs to have an IV started. Where would be the best place for the nurse to perform this procedure?

in a treatment room All treatments are performed in a treatment room so the child's room remains a "safe zone" for the child. By maintaining the client's room as a safe place, the child is reassured that nothing bad will happen when he or she is in the room. Procedures are never performed in public places such as a playroom to maintain the child's privacy. Distractions are provided in the treatment room.

A nurse is using a doll to explain what will be done when starting an intravenous (IV) line on a 4-year-old child. What type of play is this?

therapeutic play Play is a very important part of nursing care. Therapeutic play is nondirected and focuses on helping the child cope with feelings and fears. It helps the child deal with the challenges of illness and hospitalization. Therapeutic play is a technique to help children better understand what will be happening to them in a specific situation. For instance, the child who will have an IV line started before surgery might be given the materials and encouraged to "start" an IV on a stuffed animal or doll. Emotional play or play therapy is play that allows the child to act out stressors or dramatize real-life stressors. For example, to relieve anger a child may be given something to pound. Interactive play is where children play together cooperatively. Parallel play is where toddlers play side by side but not together.

The nurse has applied a restraint to the child's right wrist to prevent the child from pulling out an intravenous line. Which assessment findings ensure that there is proper circulation to the child's right arm? Select all that apply.

-Capillary refill is less than 2 seconds in upper extremities bilaterally. -Fingers are pink and warm bilaterally. -Radial pulses are easily palpable bilaterally. It is important to assess the child's peripheral vascular circulation especially when the child has a restraint placed on an extremity. Capillary refill, color, temperature, and pulses are appropriate to assess to ensure that the child's peripheral vascular circulation has not been compromised.

A 5-year-old child is scheduled for hospitalization in 2 weeks. Which is the best intervention to help ease the potential stress of hospitalization in this child?

Encourage the family and client to participate in a program to prepare for the hospitalization. Many hospitals have a child-life program to make hospitalization less threatening for children and parents. The best way to ease the stress of hospitalization is to ensure that the child has been well prepared, and this can be done with such a program. The other options will help relieve some stress, but the child-life program is the best all-inclusive intervention. Having the parent explain the situation may not be best because the parents may be anxious also and they will not be able to perceive the situation from a child's perspective.

The nurse is caring for a preschooler who requires postsurgical breathing exercises. Which approach will best elicit the child's cooperation?

"Let's see who can blow these cotton balls off the table first." Any intervention should be developmentally appropriate, and play can often serve as a vehicle for care. Turning breathing exercises into a game is likely to engage the preschooler. Telling the child he needs to do breathing exercises or he will develop another illness or not feel better is not likely to impress the young child. Connecting the two events in a meaningful way is beyond his cognitive ability. Asking if the child "wants" to play a breathing game is an open invitation for a "No" answer.

The nurse is providing care for a hospitalized child who is scheduled to receive morning medications. Place the statements in order that the nurse will state them, beginning with what the nurse will say first during the medication administration. Use all options.

Hello, I am going to be your nurse for today." "It is time for you to take your morning medications." "Would you like your medicine before or after your mom helps you take a bath?" "You are doing great today. Would you like to play a game now?" Nursing care for a hospitalized child typically occurs in four phases: introduction, building a trusting relationship, decision-making phase, and providing comfort and reassurance. After introductions, the nurse should let the child know it is time to take his or her medication, and then can offer the child a choice to take medications before or after the bath (or other appropriate choice). Lastly, the nurse should provide comfort and reassurance by offering to play a game with the child.

A school-aged child is hospitalized and is in contact isolation and must remain in his room. Which activity could the nurse use to entertain the client to reduce his sense of loneliness?

Play "I Spy" with items in his room. A school-aged child would enjoy playing "I Spy" with the nurse. Putting a large-piece puzzle together and playing with a lunch-bag puppet are for younger children. Making words out of the letters of his name is a bit advanced for him. That is appropriate for an adolescent client.

A nurse is caring for an 18-month-old girl undergoing traction therapy in a rehabilitation unit. The nurse understands that the girl is in the second phase of separation anxiety when she observes what behavior?

The toddler is quiet, looks sad, and is disinterested in playing. Despair is the second phase of separation anxiety. During this phase the child appears hopeless, depressed, and apathetic. Exhibiting signs of anger and agitation or crying inconsolably all indicate the first phase of separation anxiety called protest. Denial or detachment is the third phase of separation anxiety. The child uses this to protect against further emotional pain. When parents return the child will ignore them and, instead, has formed superficial relationships with other caretakers. This third stage is seen infrequently when family-centered care is in place.

The nurse is educating the parents of a 7-year-old boy scheduled for surgery to help prepare the child for hospitalization. Which statement by the parents indicates a need for further teaching?

"It is best to wait and let him bring up the surgery or any questions he has." It is important to be honest and encourage the child to ask questions rather than wait for the child to speak up. The other statements are correct.

The nurse is caring for a hospitalized toddler who is prescribed bedrest. Which item(s) would the nurse recognize as appropriate for the toddler? Select all that apply.

-boxes to put toys in and/or take out toys -stacking blocks or small boxes -nursery rhymes or sing-along songs on tape Hospitalized toddlers on bedrest benefit from toys that can be interacted with and that are age-appropriate. Examples would be stacking boxes, blocks, and sing-along-songs or nursery rhymes. Small piece puzzles, coins, tokens, and marbles are a choking risk for the toddler. Fine-print books and magazines are not age-appropriate and would not be of interest to a toddler.

The nurse is caring for a school-age child on the rehabilitation pediatric unit. The nurse hears the mother tell the child not to worry about doing schoolwork and just focus on getting better. What action should the nurse take?

Speak with the mother privately to let her know that keeping the normal routine, including schoolwork, is good for normal growth and development of her child. Allowing the child to keep a normal routine, including working on schoolwork, helps him or her to progress from a growth and development standpoint. Talking with the child's mother in private gives the nurse and mother to discuss this suggestion. There is no need to notify the doctor, and notifying the child's teacher is breaching confidentiality. The nurse should not undermine the mother by telling the child to go against her wishes.

The nurse is caring for a 7-year-old boy in a body cast. He is shy and seems fearful of the numerous personnel moving in and out of his room. How can the nurse help reduce his fear?

Write the name of his nurse on a board and identify all staff on each shift, every day. The best approach would be to write the name of his nurse on a small board and then identify all staff members working with the child (each shift and each day). Reminding the boy he will be going home soon or telling him not to worry does not address his concerns or provide solutions. Encouraging the boy's parents to stay with him at all times may be unrealistic and may place undue stress on the family.

What will the nurse view as best maintaining normalcy in the life of a 10-year-old boy who is experiencing a lengthy hospitalization?

keeping up with his schoolwork A school-ager is exactly that—someone whose life is centered around school. Doing school and homework assignments is part of his usual day when not hospitalized. Watching daytime TV is not. Choosing the time hygiene activities occur provides him some control, while tracking his oral intake is an opportunity to participate in his care. Playing board games with the child life specialist is an age-appropriate activity that provides distraction. These support him developmentally but do not normalize his day, as does keeping up with school assignments. It will be easier for him to return to the classroom and feel more in step with his peers by doing this.

A mother in the outpatient setting is explaining how she plans to prepare her 5-year-old for hospital admission. What remark indicates the parent requires additional teaching?

"We told him to use his manners and behave like a big, brave boy." Expecting manners and brave "big-boy" behavior is unrealistic. The child's coping skills are not yet well developed. Expressing true feelings should be allowed. The other preparations are helpful and promote understanding of the experience.

On the first postoperative day, a 4-year-old child who was hospitalized for an emergency appendectomy has begun to cry relentlessly, will not let the nurse touch him or her, and keeps asking for the parent. The pediatric nurse is aware that this client is in which stage of separation?

protest Separation anxiety is very real for the hospitalized child who is separated from parents or caretakers. Separation anxiety has three stages. This child is displaying symptoms of the first stage of separation, which is protest. The child reacts aggressively, cries, and exhibits great distress. The child rejects others who would attempt to provide care or comfort. The second stage is despair. During this stage the child displays hopelessness, is quiet without crying, and lacks any interest in play or food. The third stage is denial. During this phase, the child is detached and has formed coping mechanisms to avoid any further emotional pain. Grief is not a stage of separation anxiety.

The nurse is working with a child-life specialist to assist a young preadolescent who is preparing for treatment for cancer. Which technique will the nurse and specialist prioritize to assist this child in better understanding what will be happening in the treatment of the cancer?

therapeutic play Therapeutic play is a play technique used to help the child better understand what will be happening to him or her in a specific situation. For instance, the child who will be having an IV started before surgery might be given the materials and encouraged to "start" an IV on a stuffed animal or doll. By observing the child, you can often note concerns, fears, and anxieties the child might express. Therapeutic play helps the child express feelings, fears, and concerns. The other types of play will not accomplish this goal.

What are some reasons the nurse would implement therapeutic play for a hospitalized pediatric client? Select all that apply.

-to have a child act out previous experiences using dolls or puppets -to assist a child newly diagnosed with leukemia decrease stress -to help a child having an appendectomy better understand the procedure -to allow a child to express feelings of anxiety about an upcoming procedure Therapeutic play is used by nurses, child life specialists, and others to allow a child an opportunity to express any fears or anxieties related to the hospitalization, a diagnosis, or other life event. It is also used to teach a child about upcoming procedures. Uncovering thoughts and feelings is a part of play therapy and a psychoanalysis technique. The use of dolls to act out experiences is also part of therapeutic play. Therapeutic play is not a distraction technique.

Which approach by the nurse best demonstrates the correct way to prepare a Hispanic child for a planned hospital admission?

Allow the child to put on surgical attire and "operate" on a doll to teach what will be happening. Allowing the child to put on surgical attire lets him or her see that hospital equipment is "not scary" and prepares the child for what will be seen on the day of surgery. Both the child and parents should be encouraged to ask questions. Honesty is the most important part of the program, so the nurse would never tell the child that the procedure will be painless because even the best care by the nurse may not eliminate all pain. Assuming that the family only speaks Spanish is inappropriate and could be considered profiling and rude. The nurse needs to determine the family's preference of language.

The nurse is preparing to admit a 4-year-old who will be having tympanostomy tubes placed in both ears. Which strategy is most likely to reduce the child's fears of the procedure?

"Let me show you how tiny these tubes are." The nurse needs to describe the procedure and equipment in terms the child can understand. For a 4-year-old, a simple explanation along with the chance to touch and feel the tiny tubes would be best. Using the term tympanostomy tubes is not age-appropriate and does not teach. Telling the child that he or she will be asleep the whole time might increase fear. Showing the child the operating room might increase fear with all of the strange and imposing equipment.

The nurse is caring for a 13-year-old who is hospitalized for management of his recently diagnosed diabetes. The child has been withdrawn, and when asked she reports she is "just tired of being sick". What action by the nurse will be of the greatest benefit to helping the child with this concern?

Encourage the child to participate in planning her daily care. When teens face illness they are also faced with a loss of control and independence. Activities that foster her involvement and encourage her to participate in care will work to reduce these feelings related to loss of control. Interacting with friends by phone will be helpful but will not establish feelings of control. Parents are encouraged to spend the night but this will not promote a sense of control. Providing books and magazines will offer diversion but will not promote feelings of control.

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 action would be the best way to help the child feel comfortable with the nurse?

Let the child see the nurse's face before the mask is put on. If masks or gloves are part of the necessary precautions, the child may experience even greater feelings of isolation. Before putting on the mask, the nurse should allow the child to see his or her face; this process will help the child easily identify the nurse. Being introduced by the parents may be effective but is not likely to be possible. Reading to the child, or explaining that the caregiver will visit soon, are appropriate actions but are not the best ways to help the child feel less isolated and more comfortable with the nurse in the isolation setting.

The nurse is preparing to start an intravenous (IV) line on a stable pediatric client in the hospital. Which location is most appropriate for the nurse to use for this procedure?

the pediatric treatment room The nurse would perform procedures on stable pediatric clients in the pediatric treatment room. Using a separate room to perform procedures promotes the concept that the child's room is a "safe" place. The other "safe" place for a child in the hospital is the playroom and should not be used for any procedures or medication administrations. The client would not be allowed to select a location as the client may select one's room or the playroom.

A nurse is caring for a young child who has been hospitalized in a facility that is located several hours from the child's home. The child has not seen his parents in three weeks. When they arrive to visit, the child ignores them. The nurse is aware that this is common in which stage of separation anxiety?

third stage During the third stage of separation anxiety, the child shows interest in the environment, starts to play again, and forms superficial relationships with the nurses and other children. If the parents return, the child ignores them. In the first phase, the child reacts aggressively to this separation and exhibits great distress by crying, expressing agitation, and rejecting others who attempt to offer comfort. In the second phase of separation anxiety, the child displays hopelessness by withdrawing from others; becoming quiet without crying; and exhibiting apathy, depression, lack of interest in play and food, and overall feelings of sadness. There is no fourth phase of separation anxiety.

The nurse is preparing discharge teaching for a child and the caregivers after a week of hospitalization. Which activity should the nurse prioritize in this plan?

Plan to review information and procedures with the family caregivers before discharge. Shortly before the child is discharged from the hospital, it is important to review information and procedures with the family caregivers. The nurse should not wait until the client is almost out the door before starting discharge training. Depending on the training, it can begin shortly after admission. Not all families will need home health care to assist with transitioning from the hospital to the home setting. Written instructions may not always be appropriate if the family cannot read the literature or if it is not in their native language. The best option is to spend time with the family, demonstrating what needs to be done and observing them performing the various treatments.

A 6-year-old child will be hospitalized for a surgical procedure. How can the nurse best ease the stress of hospitalization for this child?

Prepare the child for hospitalization by explaining what to expect and showing him or her around the hospital. The best way to ease the stress of hospitalization is to ensure that the child has been well prepared for the hospital experience. Not only is the child's fear reduced but also the child has a better ability to cope. Preparation allows the child a better understanding of what's happening to him or her. Good preparation allows the child to see a hospital room, handle medical equipment and gain an understanding of procedures and hospital sounds. Another child would only give explanations from his or her point of view and that child may describe a negative experience. The child's favorite toy or blanket should come with the child to the hospital as a comfort to the child, but that does not prepare the child for hospitalization.

The nurse is working with a group of caregivers of children in a community setting. The topic of hospitalization and the effects of hospitalization on the child are being discussed. Which statement made by the caregivers supports the most effective way for children to be educated about hospitals?

"We are going to take our child to an open house at the hospital so she can see the pediatric unit." One factor in how children deal with hospitalization is the amount of preparation and the type of preparation they have been given prior to being hospitalized. A child's lack of understanding and experience with illness, hospitals, and hospital procedures increases his or her anxiety. Anything parents can do to prepare the child will decrease this anxiety. Families are encouraged to help children develop a positive attitude about hospitals from an early age. The family should avoid negative attitudes about hospitals and should help the child understand that not all experiences will be good. Some hospitals have regular open house programs for healthy children. Children may attend with parents or caregivers or in an organized community or school group. Anytime the child can visually see the hospital and physically touch furniture, equipment, etc. a positive experience can occur. Showing pictures in a book, seeing posters, and talking about the experience are also effective if a tour of the hospital is not available, but these do not replace the actual experience.