Peds Terms: Chapter 29 Care of the Hospitalized Child: NCLEX-Style Chapter Review Questions
Caregivers of a hospitalized toddler are being given safety instructions upon admission to the pediatric floor. Which action by the caregiver would be most important to the toddler's safety? - If side rails are down, never be more than 3 feet away from the child. - Keep the crib at the highest setting so the nurse can assess the child easily. - Show the child how to push the nurse call button. - Keep the crib side rails up at all times.
ANS: Keep the crib side rails up at all times. Rationale: Many toddlers are climbers and are always curious. So side rails must be kept fully up at all times, except when direct care is being provided. If side rails are down, the nurse or caregiver must keep a hand firmly on the child. Providing a call button to a toddler is not a good idea since the child will be pushing it all the time. Beds and cribs are kept at the lowest setting to minimize the possibility of injury if the child does fall out.
A school-aged child is in isolation at the hospital and her family members ask what they can do to help the child feel less lonely. What would the nurse suggest to this family? Select all that apply. - Limit the time the nurse spends with the child when performing procedures. - Have a child wear a gown and mask so he or she will feel like everyone else. - Draw a smile on the nurse's mask before entering the room. - Have the child 's classmates send cards to the child. - Have parents bring the child's electronic game system.
ANS: - Draw a smile on the nurse's mask before entering the room - Have the child's classmates send cards to the child - Have parents bring the child 's electronic game system Rationale: Being in isolation causes a child to feel lonely and depressed. Parents are encouraged to visit and bring items from home that the child likes to play with, such as a gaming system. Having classmates send cards makes the child feel that he or she is not forgotten. Since wearing a gown and mask may frighten a young child, doing something as simple as drawing a smile on the nurse's mask helps the child relax and often brings laughter.
Which approach by the nurse best demonstrates the correct way to prepare a Hispanic child for a planned hospital admission? - Since the family is Hispanic, all preparation needs to be in Spanish. - Allow the child to put on surgical attire and "operate" on a doll to teach what will be happening. - Tell the child that the procedure will not hurt because we have "magic medicine. - Discourage questions so as to not frighten the child.
ANS: Allow the child to put on surgical attire and "operate" on a doll to teach what will be happening. Rationale: 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 caring for a 10-year-old child admitted for a surgical procedure to be done the next day. The nurse takes the child to a special area in the playroom and lets the child "start" an IV on a stuffed bear. This is an example of: - therapeutic play. - play therapy - age-related activity. - positive reinforcement.
ANS: therapeutic play. Rationale: Therapeutic play is a play technique used to help the child have a better understanding of what will be happening to him or her in a specific situation. It is nondirected and focuses on helping the child cope with feelings and fears. Positive reinforcement is offering praise for doing well so that the good behavior will happen again. Play therapy or emotional outlet play is used for the child to act out or dramatize life stressors. An age-related activity would be one where the play was directed to the ability of the child's age, such as a toddler stacking blocks. The 10-year-old child would have the capability to start the IV on the bear, but a toddler or preschooler would not.
The nurse approaches a client room and notes a sign stating the client is on droplet precautions. Which personal protective equipment (PPE) will the nurse use for this client? - mask with face shield - gloves and gown - N95 respirator - gloves only
ANS: mask with face shield Rationale: A client on droplet precautions has a disease that is spread by coughing and sneezing; anyone entering the room needs protection from the infected droplets. Droplet precautions require a mask and eye protection (face shield or goggles) for all people who enter the client's room. An N95 respiratory is used for airborne precaution.
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.
ANS: - Remain calm, explaining procedures to both the family and the client in a caring manner. - Ask the family members health history questions while the child is being initially treated. - Place an identification bracelet on the child, explaning that this will help the hospital staff know who he or she is at all times.
The nurse is caring for a preoperative pediatric client. What would it be best for the nurse to do with this client? - Explain how the therapeutic plan can be used in preparing the child for surgery. - Teach technical terminology to the caregivers so they will understand what is being said postoperatively. - Determine how much the child knows and is capable of understanding. - Keep the child away from any food or drinks to ensure the child is NPO.
ANS: Determine how much the child knows and is capable of understanding. Rationale: 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.
Health care providers follow transmission-based precautions when caring for children with documented pathogens or children suspected of having highly transmissible pathogens. Which of the following are included in transmission-based precautions? - contact precautions - droplet precautions - airbone precautions - protective precautions
ANS: contact precautions, droplet precautions, airbone precautions Rationale: For clients documented or suspected of having highly transmissible pathogens, health care providers must follow transmission-based precautions. These precautions are in addition to the standard precautions. Transmission-based precautions include three types: airborne precautions, droplet precautions, and contact precautions.
A school-aged child needs to have an IV started. Where would be the best place for the nurse to perform this procedure? - in the playroom where there are distractions - in a treatment room - off the floor in a procedural suite - in the child's room, ensuring privacypl
ANS: in a treatment room Rationale: 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 preschooler is admitted to the pediatric floor for dehydration and is frightened. Which nursing intervention would be least effective in alleviating the child's anxiety? - Explain all procedures using medical terminology. - Encourage a caregiver to stay with the child when possible. - Assign the child to the same nurse each day. - Allow the child to handle the blood pressure cuff before using it.
ANS: Explain all procedures using medical terminology. Rationale: Using medical terminology will ensure that the child will not understand what is happening and only increase his or her anxiety. Allowing touching of equipment, assigning the child to the same nurse, and encouraging caregivers to stay with the child all help alleviate anxiety and reduce the child's fears.
A mother is scheduled for rooming-in with her infant prior to discharge from the hospital. The nurse realizes that rooming-in is done for what purpose? - reduce the cost of the hospital stay since rates for rooming-in are less - to allow the infant to bond with the parent - allow the caregiver to practice treatments and procedures that will be necessary once the infant is home - take overall care of the infant in the hospital
ANS: allow the caregiver to practice treatments and procedures that will be necessary once the infant is home Rationale: Rooming-in allows parents and caregivers the opportunity, under nursing supervision and guidance, to provide care and perform treatments that will be necessary after discharge. There is no reduction of cost for rooming-in. The caregivers do not take over care of the child and the infant is already bonded to the parent.
When a child is hospitalized and must be away from the caregiver, the child goes through stages of response to the separation. The child who cries and refuses to let the nurse or anyone else provide comfort and is continually looking out the door to see if the caregiver is returning is in which stage of separation? - protest - denial - despair - anger
ANS: protest Rationale: Children often go through three characteristic stages of response to the separation: protest, despair, and detachment. During the first stage (protest), the young child cries, often refuses to be comforted by others, and constantly seeks the primary caregiver at every sight and sound. Despair is the second stage of separation. In this stage the child withdraws, is quiet without crying and becomes apathetic. Anger and denial are not included in stages of separation.
A child is scheduled for a diagnostic procedure later today. The mother has been at the hospital with the child for the past 2 days and needs to go home. Which nursing intervention would be most beneficial for this caregiver? - Get the mother's cell phone number and tell her you will call her when the child goes down for the procedure. - Suggest that the mother go home since the procedure will probably not be done until much later today. - Recommend that she stay until the child leaves so that the child will not know that she left. - Tell the mother that she doesn't need to stay since the procedure is quite safe.
ANS: Get the mother's cell phone number and tell her you will call her when the child goes down for the procedure. Rationale: Obtaining a caregiver's cell phone number can help the staff contact the mother and provide her with the comfort of knowing what is going on with her child. Recommending that she stay may not be a possibility, and suggesting it make the mother feel guilty for leaving. Minimizing the risks of any procedure is not therapeutic since there is no assurance of 100% success rate with any medical procedure. Telling her it will be much later may not be accurate.
The nurse is preparing a family to visit their child, who has been admitted to the pediatric intensive care unit (PICU) following a motor vehicle accident. What actions by the nurse would reduce the family's anxiety? Select all that apply. - Ask the parents to not bring in personal items such as stuffed animals or toys. - Tell the family that the child will be fine soon. - Prepare the family for what the child will look like when they first visit. -Ask the parents what the doctor has told them to ensure their understanding. -Provide written information about visiting hours.
ANS: Prepare the family for what the child will look like when they first visit. , Ask the parents what the doctor has told them to ensure their understanding. , Provide written information about visiting hours. Rationale: Parents need preparation for visiting their child in the PICU to help them and the child adjust to this serious medical situation. Providing information on visiting hours, following up on information provided to them by the physician, and preparing the family for the child's appearance (especially following a traumatic accident) will serve to reduce the family's anxieties. The nurse never tells family members that a child will be fine, nor would the nurse discourage toys or stuffed animals, which can provide emotional security.
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? - The school nurse set up posters and displays showing pictures of what the inside of a hospital looked like, and we made sure our daughter saw the display. - Our next door neighbor was sick and died in the hospital. We explained to our son that usually babies are born and people get well in hospitals. - We are going to take our child to an open house at the hospital so she can see the pediatric unit - My wife brought home several books about hospitalization and surgery, and she and I are reading them to our son
ANS: We are going to take our child to an open house at the hospital so she can see the pediatric unit Rationale: 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.
