Quiz: Chapter 38, Family-Centered Care of the Child During Illness and Hospitalization

A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for Mommy. What is the nurse's best reply?

"Mommy will be here after lunch."

An 8-year-old child has been recently diagnosed with leukemia. What are the key assessments that a nurse should perform to determine the child's reaction to this crisis? Select all that apply.

Developmental age Acquired coping skills Past experience of illness Rational The child's reaction to the crisis is influenced by many factors. The developmental age of the child will influence the child's understanding of the disease condition and the reaction to it. The child's reaction to a crisis is also influenced by coping skills acquired through observation of family members and cultural practices. The child's previous experience of illness will also influence the child's reaction to illness. If the previous experience was positive, the reaction is likely to be positive. Separation and loss of self-control are types of crisis situation and not key assessments.

The pediatric clinic nurse is preparing a plan of care for a child who will experience a lengthy hospitalization and a prolonged recovery when discharged home. Which collaborative team member will the nurse contact who will be of most benefit to the family and child?

Child life specialist Rational Prior to hospitalization, the child life specialist will be most beneficial to the family. A child life specialist's primary objectives are to reduce the stress and anxiety related to the hospitalization and to promote normal growth and development in the health care setting and at home. A social worker, caseworker, and child therapist each have different roles and are important collaborative team members to consult as needed, but they are not the most beneficial team members for this particular patient.

The nursing student is caring for a child admitted to the hospital. The nursing student asks the nurse instructor, "How can we keep the child's routine habits while he is in the hospital?" What would be the best response by the nurse instructor? Select all that apply.

"Ask the parents what foods the child prefers to eat." "Ask the parents when the child goes to sleep at night." "Ask the parents which toy the child plays with at home." Rational The nurse should assess the child's usual health habits at home to promote a more normal environment in the hospital. This includes the child's sleep-rest, nutritional-metabolic, and activity-exercise patterns. The nurse would assess the sleep-rest pattern by asking when the child goes to sleep at night. Assessing the nutritional-metabolic pattern would include asking about food preferences. The nurse should also ask what toys the child plays with at home as part of the activity-exercise pattern. These will help the nurse plan individualized care for the child. History about herbal and complementary therapy helps in preventing drug-drug interaction and severe adverse effects.

The nurse is caring for a child with cancer. What should the nurse ask the child's parents about in order to obtain information about the child's coping-stress tolerance pattern?

"How does your child usually handle disappointment?" Rational The nurse should ask the child's parents about how the child usually handles disappointment. This can help the nurse understand the coping-stress tolerance pattern of the child. It is also helpful for identifying stressors in the child. It is important to know how discipline problems are managed in the child in order to understand the child and parent role-relationship pattern. When the nurse asks about the child's friends, it is to assess the child's role and relationship patterns outside the home. The nurse can also understand the role and relationship pattern between the parents and child after knowing who will stay in the hospital with the child.

Showing increased interest in the surroundings and forming new relationships with others are observed in the ___________________ stage. This happens because the child has given up on seeing the parents again and is now forming new bonds. In the______________________ stage, the child interacts happily with familiar caregivers.

detachment

The __________________________________ pattern reports the medication and the health history of the child.

health perception-health management

Separation anxiety is a characteristic of ____________________

infancy

.The _______________________ pattern is used in the assessment of nutrition in the patient, food allergies, and food intake habits.

nutrition-metabolic

The nurse is preparing to administer a vaccine to a child. The child is refusing to take the vaccination because of fear of bleeding. What should the nurse do in this situation?

Tell the child he or she can pick the bandage color.

Loss of control is a characteristic fear of ____________________ children.

school-age

The nurse is teaching a group of students the importance of play in sick children. What information does the nurse include in the teaching?

"Play activities should be kept simple for a sick child." Rational The nurse should select simple playing activities for a sick child. The child does not have the energy to cope with more challenging activities. Play does not increase the feeling of homesickness in the child. Instead, playing may distract the child from his or her illness. Play does not make the child nervous in a strange environment. It helps the child adjust in the hospital environment. Playing with complicated activities improves the child's skills, but it should not be given engaged in with the sick child. It is difficult for the child to perform these activities because of the child's illness, and it may physically harm the child.

The nurse is teaching the nursing students about functions of play in the hospital. Which statement made by the nursing student indicates the need for further teaching?

"Play makes the child nervous in a strange environment."

A child who has undergone orofacial surgery is getting discharged. The nurse teaches the parents about how to safely transport the child on the way home. Which statement made by the parents indicates a need for additional teaching?

"We should use a cup with a lid and a straw for giving fluids to our child." Rational Children who undergo orofacial surgery should not use a straw for drinking fluids because it can damage the surgical site. Therefore the parents should not use a cup with a lid and a straw for giving fluids to the child. The parents should bring a blanket and pillow for the child in the car so that the child can sit or sleep properly. Parents should bring a plastic bag, which will be helpful if the child becomes nauseated or vomits. The parents should give prescribed pain medication to the child before leaving the facility for relieving pain.

The nurse is obtaining the admission history of a recently admitted adolescent. The nurse notes the patient requires help inserting contact lenses. Under which functional health pattern should the nurse record this observation?

Activity-exercise pattern Rational The nurse records the admission history of the patient in terms of different functional health patterns. This helps in documenting all the required information about the patient. The patient requires help inserting his or her contact lenses. This implies that the patient needs support to perform an activity. The nurse should record this information under the activity-exercise pattern.The nutrition-metabolic pattern is used in the assessment of nutrition in the patient, food allergies, and food intake habits. The health perception-health management pattern reports the medication and the health history of the child.

The nurse is assessing a child for a general checkup. Which behavior of the child indicates that the child is in the protest stage of anxiety?

Attempts to leave to find the parents

The nurse is assessing a child for a general checkup. Which behavior of the child indicates that the child is in the protest stage of anxiety?

Attempts to leave to find the parents Rational A child who attempts to leave to find the parents indicates that the child is in the protest stage of separation anxiety. This is the first stage. In this stage, the child reacts aggressively after being separated from the parents.

After assessment, the nurse notices that a child is in the detachment stage of separation anxiety. Which behavioral changes would the nurse observe in the child? Select all that apply.

Begins to form new relationships with others Interacts with strangers or familiar caregivers Shows an increased interest in the surroundings Rational Detachment is the third stage of separation anxiety. It is also referred to as the denial stage. In this stage the child begins to take an interest in the surroundings. The child also forms new but superficial relationships with others and becomes more interested in interacting with strangers or familiar caregivers. The child's behavior indicates that the child has finally adjusted to the loss of the parents. This is a serious stage because reversal of the potential adverse effects is less likely to occur after detachment. Refusing to eat, drink, and get out of bed are characteristics of the despair stage of separation anxiety. Attempting to leave the hospital to find the parents is observed in protest stage of separation anxiety.

The psychosexual conflicts of preschool children make them extremely vulnerable to what?

Bodily injury and pain Rational Intrusive procedures, whether or not they are perceived as painful, are threatening to the preschool child because of the poorly developed concept of body integrity. Loss of control is a characteristic fear of school-age children. Loss of identity is a concern of adolescents because illnesses are conceptualized as the effect on the individual.

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety?

Clings to parent Rational In the protest phase, the child aggressively responds to separation from parents (such as clinging to a parent). Inactivity is characteristic of despair. Depression and sadness are characteristics of despair. Regression to earlier behavior is characteristic of despair.

The nurse is providing postoperative care for a child. The child continually asks for help in all aspects of self-care. The nurse observes that the child is able to get dressed without any help. What would be the nurse's best intervention?

Encouraging the child to perform self-care

Which risk factor increases a child's vulnerability to the stress of hospitalization?

Gender Rational Gender is a risk factor for a child's vulnerability to the stresses of hospitalization. Boys have a greater risk for vulnerability to the stress of hospitalization. Culture, religion, and a strong will are not risk factors that increase vulnerability.

The nurse is assessing a child who has been hospitalized for a long time. The nurse observes that the child is building a superficial relationship with others. The most relevant step that the nurse should take with respect to the child is to encourage the child to do what?

Get pictures of the family. Rational A child who remains hospitalized for a long time can develop detachment from parents because of the prolonged separation. At this stage, the child tends to develop superficial relationships to replace the pangs of separation from his or her family. The nurse should encourage the child to remember the family and have the parents bring in pictures from home to keep in the child's hospital room. The nurse should not suggest a diversional activity such as reading a book. The nurse should make family bonding a priority. Even though it is important to develop peer relationships, at this point the child needs the security and love from his or her family. The child's improvement of sleep patterns would not alleviate the behavior of building superficial relationships. The child should be encouraged to remember his or her family.

When admitting a child to the inpatient pediatric unit, the nurse should assess for which risk factors that can increase the child s stress level associated with hospitalization? (Select all that apply.)

Lack of fit between parent and child Below-average intelligence Age Gender

When admitting a child to the inpatient pediatric unit, the nurse should assess for which risk factors that can increase the child s stress level associated with hospitalization? (Select all that apply.)

Lack of fit between parent and child Below-average intelligence age gender

When completing a health history on a hospitalized child, the nurse should assess for which factors that can commonly affect the parents reaction to the child's illness? (Select all that apply.)

Previous experience with illness or hospitalization Available support systems Medical procedures involved with treatment Previous coping abilities Cultural and religious beliefs

The nurse is explaining play therapy to the parents of a child who has been admitted to the hospital. What information given by the nurse regarding play therapy is appropriate? Select all that apply.

Provides diversion from the disease condition Increases the feeling of security in a strange environment Encourages interaction and positive attitude towards others

The nurse is explaining the health care bill of rights for children to parents and children in a pediatric ward. What key information does the nurse discuss with the group? Select all that apply.

Quality health care Respect and personal dignity Making choices and decisions Rational The bill of rights emphasizes the quality of health care to the children and explains that children and teens should be treated with respect and dignity. The bill also states that children have the right to make choices and decisions in their health care. Children have the right to get emotional support from the health care professionals. Children cannot always expect economic assistance from the hospital. The nurse need not explain complicated information such as pathologic process of the disease to the child since the child will not be able to understand. Such information should be provided to the caregivers of the child.

The nurse is caring for a preschooler with malarial infection. The nurse observes that the preschooler is anxious because the parents are unable to stay in the hospital. Which behavioral changes does the nurse observe in the preschooler? Select all that apply.

Quietly cries for the parents Experiences difficulty sleeping Refuses to take food or medicine Rational The preschooler is less able to cope with separation because of the stress of illness. The preschooler shows behavioral changes as a result of separation anxiety. Therefore the preschooler cries quietly for the parents, experiences difficulty sleeping, and refuses to take food and medicine. In the detachment stage of separation anxiety, the preschooler shows interest in the surroundings and interacts happily with strangers.

The nurse observes that a child's parents have placed a toy on the child's bed in the hospital. Under which functional health pattern would this activity fall?

Role-relationship pattern Rational The nurse records the admission history of the child in terms of various functional health patterns. This helps in recording all the required information about the child. When the child holds on to objects such as a toy, the object is called a security object. This information is noted under the role-relationship pattern of the nursing history. The value-belief pattern includes the religious beliefs and practices of the child's family. The cognitive-perceptual pattern recognizes the cognitive development in the child and includes defects in hearing, vision, or grading in the school. The coping-stress tolerance pattern helps in understanding the child's anxiety or stress levels.

The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, "Do it later, OK?" What should the nurse do?

Start the IV line because unlimited procrastination results in heightened anxiety. Rational Intravenous antibiotics are a priority action for the nurse. A short delay may be possible to allow the child some choice, but a prolonged delay only serves to increase the anxiety. The nurse should start the IV line, recognizing that the child is attempting to gain control. If the timing of the IV line start was not essential for the start of IV antibiotics, postponing might be acceptable. The child may never be ready. The anxiety is likely to increase with prolonged delay.

The nurse is caring for a toddler with a severe illness. The toddler is frightened by the insertion of a rectal thermometer. What would be the best nursing intervention to alleviate the toddler's fears?

Substitute a different method for temperature measurement. Rational The toddler is afraid to have the rectal thermometer inserted for fear it may cause harm. The nurse should use another method to measure the child's temperature. The nurse can obtain an axillary temperature or use an electronic or tympanic membrane device. Making a family member sit beside the toddler is not helpful because it does not decrease the toddler's fear. Moving the toddler to face the window or giving a favorite toy to the toddler is unlikely to relieve the toddler's fear.

The nurse is discharging a young child from the hospital. The nurse should instruct the parents to look for which posthospital child behaviors? (Select all that apply.)

Tendency to cling to parents Demands for parents attention New fears such as nightmares

The nurse is discharging a young child from the hospital. The nurse should instruct the parents to look for which posthospital child behaviors? Select all that apply.

Tendency to cling to parents Demands for parents' attention New fears such as nightmares Rational Young children's posthospital behaviors may include initial aloofness toward parents; this may last from a few minutes (most common) to a few days. This is frequently followed by dependency behaviors: tendency to cling to parents, demands for parents' attention, and vigorous opposition to any separation (e.g., staying at preschool or with a babysitter). Other negative behaviors include: new fears (e.g., nightmares), resistance to going to bed and night waking, withdrawal and shyness, hyperactivity, temper tantrums, food peculiarities, attachment to blanket or toy, and regression in newly learned skills (e.g., self-toileting). Posthospital behaviors for older children include emotional coldness followed by intense, demanding dependence on parents; anger toward parents; and jealousy toward others (e.g., siblings).

The nurse has been assigned to the pediatric respiratory unit. What is the preliminary requirement for the nurse to evaluate improvement in the respiratory function of the child with treatment?

The baseline data Rational It is impossible to evaluate the improvement in the respiratory function of the child without having any baseline data. The child's feedback provides only subjective assessment. Evaluation of respiratory system function requires formal knowledge of the respiratory system assessment. Therefore, parent opinion is not reliable for improvement in the child's respiratory function. Evaluation of the improvement in the respiratory function requires objective assessment. Obtaining the primary health care provider's opinion is a type of subjective assessment.

The nurse gets out finger painting materials made from wallpaper paste for a child. After reviewing the child's medical record, the nurse decides to get out crayons and a coloring book instead. What information did the nurse find in the nursing history?

The child has an allergy to wheat. Rational The painting materials made from wallpaper paste may contain wheat. If the paint comes in contact with the child's skin, it can cause an allergic reaction. Therefore the nurse changes the activity. The child who is on a salt-restricted diet need not worry about salt being in the paint. A patient is placed on salt restriction to prevent water retention, not because of an allergy. The child who is lactose intolerant cannot ingest dairy products, but wallpaper paste does not contain dairy products. Beetroot is used as natural dyes in paintings; however, the wallpaper paste does not contain beetroot extract.

The parent of a hospitalized child tells the staff, "My child cries every time I try and visit." Based on the nurse's knowledge of separation anxiety in young children, what is the nurse's evaluation of the child's behavior?

The child is in the protest stage of separation anxiety. rational Based on the nurse's knowledge of separation anxiety in young children, a child who does not appear outwardly happy to see his or her parents is in the protest stage of separation anxiety. During this stage, the child may even cry louder than usual upon seeing the parent. The child is not necessarily communicating fear of the parent. Fear of the parent may be communicated in other ways such as silence. A detached child appears happy, shows an increased interest in his or her surroundings, and interacts with strangers and familiar caregivers. The child who displays despair is withdrawn, lacks interest in the environment, and is inactive.

A child is being treated in the emergency department because of a fracture in the lower extremity. After the cast is applied, the nurse asks the child, "How do you think you will look once the cast is removed? Could you please draw a picture for me?" What is the rationale for the nurse asking the child to draw the picture?

To assess the child's fear about bodily injury

The nurse asks the parents of a child who is scheduled for surgery if the child is taking any herbal medicine. What is the rationale for the nurse asking for this information?

To prevent any surgical complications

Why does the nurse ask the parents of a hospitalized child to bring the child's blanket from home?

To provide comfort for the child Rational If the parents cannot stay with the child in the hospital, the nurse may ask the parents to leave an article such as a blanket or toy from home. This is because young children associate such inanimate objects with significant people, and they gain comfort and reassurance from these possessions. When a child is frightened, the nurse should provide physical contact to ease the child. If the child is allergic to the linens at the hospital, it would be the hospital's responsibility to find alternative bedding. There are plenty of blankets available in the hospital, so the parents would not bring the blanket to keep the child warm.

Loss of identity is a concern of ______________________ because illnesses are conceptualized as the effect on the individual.

adolescents

A 4-year-old child will be having cardiac surgery next week. The child's parents call the hospital, asking about how to prepare her for this. The nurse's BEST response is to inform the parents that:

children who are prepared experience less fear and stress during hospitalization.

The _________________________ pattern recognizes the cognitive development in the child and includes information such as defects in vision, hearing, or grading in the school.

cognitive-perceptual

The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, "Do it later, O.K.?" The nurse should:

provide an explanation of the procedure prior to initiating therapy.