Question 1

During the first 4 days of hospitalization,Eric,age 18 months,cried inconsolably when his parents left him,and he refused the staff's attention.Now the nurse observes that Eric appears to be "settled in" and unconcerned about seeing his parents.The nurse should interpret this as which of the following?

Accepted Answer

Detachment is a behavioral manifestation of separation anxiety.Superficially it appears that the child has adjusted to the loss and transferred his trust to the nursing staff.Detachment is a sign of resignation,not contentment.Parents should be encouraged to be with their child.If parents restrict visits,they may begin a pattern of misunderstanding the child's cues and not meeting his needs.

Question 2

A nurse is preparing to complete an admission assessment on a 2-year-old child.The child is sitting on the parent's lap.Which technique should the nurse implement to complete the physical exam?

Accepted Answer

The nurse should complete the exam while the child is on the parent's lap.For young children,particularly infants and toddlers,preserving parent-child contact is the best means of decreasing the need for or stress of restraint.The entire physical examination can be done in a parent's lap with the parent hugging the child for procedures such as an otoscopic examination.Placing the child in the crib,taking the child to the exam room,or asking the child to stand by the parent would separate the child from the parent and cause anxiety.

Question 3

The nurse is doing a prehospitalization orientation for Kayla,age 7,who is scheduled for cardiac surgery.As part of the preparation,the nurse explains that Kayla will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed.This explanation is:

Accepted Answer

This is a necessary part of preoperative preparation that will help reduce the anxiety associated with surgery.If the child wakes and is not prepared for the inability to speak,she will be even more anxious.It is a joint responsibility of nursing,medical staff,and child life personnel.This is a necessary component of preparation that will help reduce the anxiety associated with surgery.

Question 4

What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years?

Accepted Answer

The major stress 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.

Question 5

What is the primary disadvantage associated with outpatient and day facility care?

Accepted Answer

Outpatient and day facility care do not provide extended care; therefore,a child requiring extended care must be transferred to the hospital,causing increased stress to the child and parents.Outpatient care decreases cost and reduces the risk of infection.Outpatient care also minimizes separation of the child from family.

Question 6

A child is playing in the playroom.The nurse needs to take a blood pressure on the child.Which is the appropriate procedure for obtaining the blood pressure?

Accepted Answer

The playroom is a safe haven for children,free from medical or nursing procedures.The child can be returned to his or her room for the blood pressure and then escorted back to the playroom.The exam room is reserved for painful procedures that should not be performed in the child's hospital bed.Documenting that the blood pressure was not obtained because the child was in the playroom is inappropriate.

Question 7

The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident.Which statement by the adolescent would be expected about separation anxiety?

Accepted Answer

Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status; friends visiting is an important aspect of hospitalization for an adolescent and would be very reassuring.Adolescents may welcome the opportunity to be away from their parents.The separation from siblings may produce reactions from difficulty coping to a welcome relief.

Question 8

A previously "potty-trained" 30-month-old child has reverted to wearing diapers while hospitalized.The nurse should reassure the parents that this is normal because:

Accepted Answer

Regression is expected and normal for all age-groups when hospitalized.Nurses should assure the parents this is temporary and the child will return to the previously mastered developmental milestone when back home.This does not indicate a developmental delay.The child should not be experiencing urinary urgency because of hospitalization and this would not be normal.Successful "potty-training" can be started at 2 years of age if the child is ready.

Question 9

A 14-year-old boy is being admitted to the hospital for an appendectomy.Which roommate should the nurse assign with this patient?

Accepted Answer

When a child is admitted,nurses follow several fairly universal admission procedures.The minimum considerations for room assignment are age,sex,and nature of the illness.Age-grouping is especially important for adolescents.The 14-year-old boy being admitted to the unit after appendectomy surgery should be placed with a noninfectious child of the same sex and age.The 15-year-old child with sickle cell is the best choice.The 4-year-old boy who is post-appendectomy is too young,and the child with pneumonia is too young and possibly has an infectious process.The 12-year-old boy with cellulitis is the right age,but he has an infection (cellulitis).

Question 10

A 10-year-old girl needs to have another intravenous (IV)line started.She keeps telling the nurse,"Wait a minute," and,"I'm not ready." The nurse should recognize that:

Accepted Answer

This school-age child is attempting to maintain control.The nurse should provide the girl with structured choices about when the IV will be inserted.This can be characteristic behavior when an individual needs to maintain some control over a situation.The child is trying to have some control in the hospital experience.

Question 11

Olivia,age 5 years,tells the nurse that she "needs a Band-Aid" where she had an injection.The best nursing action is to:

Accepted Answer

Children in this age-group still fear that their insides may leak out at the injection site,even if the bleeding has stopped.Provide the Band-Aid.No explanation should be required.

Question 12

Which situation poses the greatest challenge to the nurse working with a child and family?

Accepted Answer

Emergency hospitalization involves (1)limited time for preparation both for the child and family,(2)situations that cause fear for the family that the child may die or be permanently disabled,and (3)a high level of activity,which can foster further anxiety.Although preparation time may be limited with a 24-hour observation,this situation does not usually involve the acuteness of the situation and the high levels of anxiety associated with emergency admission.Outpatient admission generally involves preparation time for the family and child.Because of the lower level of acuteness in this setting,anxiety levels are not as high.Rehabilitation admission follows a serious illness or disease.This type of unit may resemble a home environment,which decreases the child's and family's anxiety.

Question 13

Emma,age 3 years,is being admitted for about 1 week of hospitalization.Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding that:

Accepted Answer

Parents should bring favorite items from home to be with the child.Young children associate inanimate objects with significant people; they gain comfort and reassurance from these items.New toys will not serve the purpose of familiar toys and objects from home.The parents may experience some guilt as a response to the hospitalization,but there is no evidence that it is maladaptive.

Question 14

An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to:

Accepted Answer

A toddler experiences separation anxiety secondary to being separated from the parents.To avoid this,the parents should be encouraged to room in as much as possible.Maintaining routines and ensuring privacy are helpful interventions,but they would not substitute for the parents.Contact with same-aged children would not substitute for having the parents present.

Question 15

A school-age child,admitted for intravenous antibiotic therapy for osteomyelitis,reports difficulty in going to sleep at night.Which intervention should the nurse implement to assist the child in going to sleep at bedtime?

Accepted Answer

Many children obtain significantly less sleep in the hospital than at home; the primary causes are a delay in sleep onset and early termination of sleep because of hospital routines.One technique that can minimize the disruption in the child's routine is establishing a daily schedule.This approach is most suitable for non-critically ill school-age and adolescent children who have mastered the concept of time.It involves scheduling the child's day to include all those activities that are important to the child and nurse,such as treatment procedures,schoolwork,exercise,television,playroom,and hobbies.The school-age child with osteomyelitis would benefit from a schedule similar to the one followed at home.Requesting a prescription for a sleeping pill would be inappropriate,and allowing the child to stay up late and sleep late would not be keeping the child in a routine followed at home.Passive activities in the morning and interactive activities at bedtime should be reversed; it would be better to keep the child active in the morning hours and plan quiet activities at bedtime.

Question 16

Because of their striving for independence and productivity,which age-group of children is particularly vulnerable to events that may lessen their feeling of control and power?

Accepted Answer

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 by loss of power,are not as significantly affected as are school-age children.

Question 17

Amy,age 6 years,needs to be hospitalized again because of a chronic illness.The clinic nurse overhears her school-age siblings tell her,"We are sick of Mom always sitting with you in the hospital and playing with you.It isn't fair that you get everything and we have to stay with the neighbors." The nurse's best assessment of this situation is that:

Accepted Answer

Siblings experience loneliness,fear,worry,anger,resentment,jealousy,and guilt.The siblings experience stress equal to that of the hospitalized child.These are not uncommon responses by normal siblings.There is no evidence that the family has maladaptive coping or that the siblings lack understanding.

Question 18

Latasha,age 8 years,is being admitted to the hospital from the emergency department with an injury from falling off her bicycle.What will help her most in her adjustment to the hospital?

Accepted Answer

School-age children need to have control of their environment.The nurse should offer explanations or prepare the child for experiences that are unavoidable.The nurse should refer to the child by the preferred name.Telling the child about all of the limitations of visiting does not help her adjust to the hospital.At the age of 8 years,the child and parents should be oriented to the environment.

Question 19

What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of intravenous (IV)antibiotics cries,screams,and resists having the IV restarted?

Accepted Answer

Giving the preschooler some choice and control,while maintaining boundaries of treatment,supports the child's coping skills.Leaving the child alone robs the child of support when a coping difficulty exists.Crying is a normal response to stress.The child needs time to adjust and support to cope with unfamiliar and painful procedures during hospitalization.Although administration of a topical analgesic is indicated before restarting the child's IV,a narcotic analgesic is not indicated.

Question 20

When a preschool child is hospitalized without adequate preparation,the nurse should recognize that the child may likely see hospitalization as:

Accepted Answer

If a toddler is not prepared for hospitalization,a typical preschooler fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds.Threat to child's self-image and loss of companionship with friends are reactions typical of school-age children.Regression is a response characteristic of toddlers when threatened with loss of control.

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