Chapter 19 Wong

A nurse is caring for four patients; three are toddlers and one is a preschooler. Which represents the major stressor of hospitalization for these four patients? ***a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain

ANS: A The major stressor for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age group. DIF: Cognitive Level: Analyze REF: p. 554 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance

A nurse is admitting a toddler to the hospital. The parent needs to leave for a brief period. Which figure depicts the reaction the nurse expects from the child?

ANS: A (separation anxiety) The major stress from middle infancy throughout the preschool years, especially for children ages 6 to 30 months, is separation anxiety, also called anaclitic depression. During the stage of protest, children react aggressively to the separation from the parent. They cry and scream for their parents, refuse the attention of anyone else, and are inconsolable in their grief. When the parent leaves even for a short time this is the expected reaction and the figure that depicts the child not wanting the parent to leave is what the nurse should expect as a reaction from the child. The child sitting alone sadly depicts a child in the despair stage. In this stage depression is evident. The child is much less active, is uninterested in play or food, and withdraws from others. The child sitting on the parent's lap is withdrawn and sad, even in the presence of the parent. The child depicted playing a game is adjusting to the hospitalization with play. DIF: Cognitive Level: Analyze REF: p. 554 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Psychosocial Integrity

A child has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and the child's condition is beginning to stabilize. When speaking with the parents, the nurses should expect which stressors to be evident? (Select all that apply.) ***a. Unfamiliar environment b. Usual day-night routine ***c. Strange smells d. Provision of privacy ***e. Inadequate knowledge of condition and routine

ANS: A, C, E Intensive care units, especially when the family is unprepared for the admission, are a strange and unfamiliar place with many pieces of unfamiliar equipment. The sights and sounds are much different from those of a general hospital unit. Also, with the child's condition being more precarious, it may be difficult to keep the parents updated and knowledgeable about what is happening. Lights are usually on around the clock, seriously disrupting the diurnal rhythm. There is usually little privacy available for families in intensive care units. DIF: Cognitive Level: Understand REF: p. 554 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Psychosocial Integrity

A child is being discharged from an ambulatory care center after an inguinal hernia repair. Which discharge interventions should the nurse implement? (Select all that apply.) ***a. Discuss dietary restrictions. b. Hold any analgesic medications until the child is home. ***c. Send a pain scale home with the family. d. Suggest the parents fill the prescriptions on the way home. ***e. Discuss complications that may occur.

ANS: A, C, E The discharge interventions a nurse should implement when a child is being discharged from an ambulatory care center should include dietary restrictions, being very specific and giving examples of "clear fluids" or what is meant by a "full liquid diet." The nurse should give specific information on pain control and send a pain scale home with the family. All complications that may occur after an inguinal hernia repair should be discussed with the parents. The pain medication, as prescribed, should be given before the child leaves the building and prescriptions should be filled and given to the family before discharge. DIF: Cognitive Level: Apply REF: p. 570 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance

Which is an important consideration for the nurse when changing dressings and applying topical medication to a child's abdomen and leg burns? a. Apply topical medication with clean hands. ***b. Wash hands and forearms before and after dressing change. c. If dressings adhere to the wound, soak in hot water before removal. d. Apply dressing so that movement is limited during the healing process.

ANS: B Frequent hand and forearm washing is the single most important element of the infection-control program. Topical medications should be applied with a tongue blade or gloved hand. Dressings that have adhered to the wound can be removed with tepid water or normal saline. Dressings are applied with sufficient tension to remain in place but not so tightly as to impair circulation or limit motion. DIF: Cognitive Level: Apply REF: p. 562 TOP: Integrated Process: Nursing Process: Implementation MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

A nurse plans therapeutic play time for a hospitalized child. What are the benefits of play? (Select all that apply.) a. Serves as method to assist disturbed children ***b. Allows the child to express feelings ***c. The nurse can gain insight into the child's feelings. ***d. The child can deal with concerns and feelings. e. Gives the child a structured play environment

ANS: B, C, D Play is an effective, nondirective modality for helping children deal with their concerns and fears, and at the same time, it often helps the nurse gain insights into children's needs and feelings. Play and other expressive activities provide one of the best opportunities for encouraging emotional expression, including the safe release of anger and hostility. Nondirective play that allows children freedom for expression can be tremendously therapeutic. Play therapy is a structured therapy that helps disturbed children. It should not be confused with therapeutic play. DIF: Cognitive Level: Understand REF: p. 565 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Psychosocial Integrity

A nurse is interviewing the parents of a toddler about use of complementary or alternative medical practices. The parents share several practices they use in their household. Which should the nurse document as complementary or alternative medical practices? (Select all that apply.) a. Use of acetaminophen (Tylenol) for fever ***b. Administration of chamomile tea at bedtime ***c. Hypnotherapy for relief of pain ***d. Acupressure to relieve headaches e. Cool mist vaporizer at the bedside for "stuffiness"

ANS: B, C, D When conducting an assessment, the nurse should inquire about the use of complementary or alternative medical practices. Administration of chamomile tea at bedtime, hypnotherapy for relief of pain, and acupressure to relieve headaches are complementary or alternative medical practices. Using Tylenol for fever relief and a cool mist vaporizer at the bedside to reduce "stuffiness" are not considered complementary or alternative medical practices. DIF: Cognitive Level: Understand REF: p. 560 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance

What is a common initial reaction of parents to illness or injury and hospitalization in their child? a. Anger b. Fear c. Depression ***d. Helplessness

ANS: D Recent research has identified common themes among parents whose children were hospitalized, including feeling an overall sense of helplessness, questioning the skills of staff, accepting the reality of hospitalization, needing to have information explained in simple language, dealing with fear, coping with uncertainty, and seeking reassurance from caregivers. Anger or guilt is usually the second reaction stage. Fear, anxiety, and frustrations also are common feelings. Parents may finally react with some form of depression related to the physical and emotional exhaustion associated with a hospitalized child. DIF: Cognitive Level: Understand REF: p. 557 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Psychosocial Integrity

Which age group should the pediatric nurse recognize as being vulnerable to events that lessen their feeling of control and power? a. Infants b. Toddlers c. Preschoolers ***d. School-age children

ANS: D When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurp individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that lessen their control and power. Infants, toddlers, and preschoolers, although affected to different extents by loss of power, are not as significantly affected as are school-age children. DIF: Cognitive Level: Understand REF: p. 556 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance