Carman Essentials of Pediatric Nursing 3rd Ed - Ch. 11 Caring for Children in Diverse Settings

The nurse is caring for a child hospitalized with complications from asthma. Which statement by the parents indicates a need for careful observation of the child's anxiety level? a. "My mother passed away here after surgery." b. "Our twins were born here 18 months ago." c. "My father undergoes kidney dialysis at this hospital." d. "We attended a 'living with asthma' class here."

Answer: a Previous experience with hospitalization can either add to the positive aspects of preparation or distract if the experiences were perceived as negative. If the child associates the hospital with the death of a relative, the experience is likely viewed as negative. The other statements would most likely indicate that the child's previous experiences were viewed as positive.

A nurse is developing a preoperative plan of care for a 2-year old. The nurse should pay particular attention to which of the child's age-related fears? a. Separation from friends b. Separation from parents c. Loss of control d. Loss of independence

Answer: b A toddler is most likely to develop anxiety and fears due to separation from the parents. Separation from friends, loss of control, and loss of independence are fears typically experienced by an adolescent.

The nurse is documenting the child's intake. The child ate four cups of ice during this shift. How many cups of fluid did the child ingest? a. Four cups of fluid b. One cup of fluid c. Half a cup of fluid d. Two cups of fluid

Answer: d Ice is approximately equivalent to half the same amount of water which in this instance would be 2 cups of fluid.

The nurse is providing care for a hospitalized child. Rank the following phases in the order of occurrence based on the nurse's statements. a. "Hi, my name is Cindy and I'm going to be your nurse for today." b. "Let's sit over here and play a game of "Go Fish"." c. "Would you like your medicine before or after your mom helps take a bath?" d. "You handled that procedure so well! Would you like me to get Mr. Snuggles for you?"

Correct Order: a, b, c, d Nursing care for a hospitalized child typically occurs in four phases: introduction, building a trusting relationship, decision-making phase, and providing comfort and reassurance.

The nurse is caring for an 18-month-old boy hospitalized with a gastrointestinal disorder. The nurse knows that the child is at risk for separation anxiety. The nurse watches for behaviors that indicate the first phase of separation anxiety. For which behavior should the nurse watch? a. Crying and acting out b. Embracing others who attempt to comfort him c. Losing interest in play and food d. Exhibiting apathy and withdrawing from others

Answer: a Children in the first phase, protest, react aggressively to this separation, and reject others who attempt to comfort the child. The other behaviors are indicators of the second phase, despair.

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? a. "I should not tell her how long she will be here." b. "She will watch our reactions carefully." c. "We must prepare her in advance." d. "She will be sensitive to our concerns."

Answer: a 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.

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? a. "We should talk about going to the hospital and what it will be like coming home" b. "We should visit the hospital and go through the preadmission tour in advance" c. "It is best to wait and let him bring up the surgery or any questions he has" d. "It is a good idea to read stories about experiences with hospitals or surgery"

Answer: c 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 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. a. Capillary refill is less than 2 seconds in upper extremities bilaterally b. Fingers are pink and warm bilaterally c. Lungs are clear throughout d. Radial pulses are easily palpable bilaterally e. Bowel sounds present in all four quadrants

Answer: a, b, d 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.

The student nurse is assisting the more experienced pediatric nurse. Which statements by the student indicate further education is required? Select all that apply. a. "Could you give the nauseated child some medicine before it is time for him to start thinking about ordering lunch?" b. "I'm going to redress the child's IV site while she is in the playroom." c. "I took our new teenaged child down to show him the playroom." d. "It would be easy to perform a straight catheterization while the baby is in his crib." e. "I told the child's mom to go ahead and bring in his blanket and stuffed animal."

Answer: b, c, d Even minor nursing interventions should not be performed in the playroom. The playroom should be referred to as the "activity room" or "social room" instead of "playroom" when speaking with adolescent children. It is inappropriate to perform procedures in the child's crib. It is better to perform procedures in the treatment room. It is important to give antiemetics prior to mealtimes. Parents can be encouraged to bring in security items to help reduce the child's level of stress.

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? a. "Your medicine is the only way you will get better." b. "Let me explain why you need to sit still." c. "Would you like to read or play video games?" d. "Do I need to call your parents?"

Answer: c 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.

The nurse is caring for a 7-year-old boy in a body cast. He is shy and seems fearful of the numerous personnel in and out of his room. How can the nurse help reduce his fear? a. Remind the boy he will be out of the hospital and going home soon. b. Encourage the boy's parents to stay with him at all times to reduce his fears. c. Write the name of his nurse on a board and identify all staff on each shift, every day. d. Tell him not to worry; explain that everyone is here to care for him.

Answer: c 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.

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? a. "The doctor is going to insert tympanostomy tubes in your ears." b. "Don't worry, you will be asleep the whole time." c. "Let me show you how tiny these tubes are." d. "Let me show you the operating room."

Answer: c 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 preschooler who is hospitalized with a suspected blood disorder and receives an order to draw a blood sample. Which approach is best? a. "I need to take some blood." b. "We need to put a little hole in your arm." c. "I need to remove a little blood." d. "Why don't you sit on your mom's lap?"

Answer: d 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.

A nurse is preparing to admit a child for a tonsillectomy. How should the nurse establish rapport? a. "Let's take a look at your tonsils." b. "Do you understand why you are here?" c. "Are you scared about having your tonsils out?" d. "Tell me about your cute stuffed dog you have."

Answer: d The nurse should start the initial contact with children and their families as a foundation for developing a trusting relationship. Asking about a favorite toy would be a good starting point. The nurse should allow the child to participate in the conversation without the pressure of having to comply with a request or undergo any procedures.