San Jacinto College - RNSG 2201

Chapter 19: Family-Centered Care of the Child During Illness and Hospitalization Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition

MULTIPLE CHOICE

1)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?

1. 1. Separation anxiety
   2. Loss of control
   3. Fear of bodily injury
   4. Fear of pain

2. 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 statement?

1. 1. He has successfully adjusted to the hospital environment.
   2. He has transferred his trust to the nursing staff.
   3. He may be experiencing detachment, which is the third stage of separation anxiety.
   4. Because he is “at home” in the hospital now, seeing his mother frequently will only start the cycle again.

3. When a preschool child is hospitalized without adequate preparation, how does the child often react to the hospitalization?
   1. Sees it as a punishment
   2. A threat to child’s self-image
   3. An opportunity for regression
   4. Loss of companionship with friends

4. Which age group should the pediatric nurse recognize as being vulnerable to events that lessen their feeling of control and power?
   1. Infants
   2. Toddlers
   3. Preschoolers
   4. School-age children

5. 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 this as which description?
   1. This is normal behavior for a school-age child.
   2. The behavior is not seen past the preschool years.
   3. The child thinks the nurse is punishing her.
   4. The child has successfully manipulated the nurse in the past.

6. What is a common initial reaction of parents to illness or injury and hospitalization in their child?
   1. Anger
   2. Fear
   3. Depression

1. 4. Helplessness

7. 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.” Which is the nurse’s best assessment of this situation?
   1. The siblings are immature and probably spoiled.
   2. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling.
   3. Family has ineffective coping mechanisms to deal with chronic illness.
   4. The siblings need to better understand their sister’s illness and needs.

8. What is an appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler?
   1. Provide for privacy
   2. Encourage parents to room in
   3. Explain procedures and routines
   4. Encourage contact with children the same age

9. Four-year-old Brian appears to be upset by hospitalization. Which is an appropriate intervention?
   1. Let him know it is all right to cry.
   2. Give him time to gain control of himself.
   3. Show him how other children are cooperating.
   4. Tell him what a big boy he is to be so quiet.

10. Latasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. Which will help her most in her adjustment to the hospital?
    1. Explain hospital schedules to her, such as mealtimes.
    2. Use terms such as “honey” and “dear” to show a caring attitude.
    3. Explain when parents can visit and why siblings cannot come to see her.
    4. Orient her parents, because she is young, to her room and hospital facility.

11. Samantha, age 5 years, tells the nurse that she “needs a Band-Aid” where she had an injection. Which is the best nursing action?
    1. Apply a Band-Aid.
    2. Ask her why she wants a Band-Aid.
    3. Explain why a Band-Aid is not needed.
    4. Show her that the bleeding has already stopped.

12. Kimberly, 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 of which concept?

1. 1. New toys make hospitalization easier.
   2. New toys are usually better than older ones for children of this age.
   3. At this age, children often need the comfort and reassurance of familiar toys from home.
   4. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

13. Matthew, age 18 months, has just been admitted with croup. His parent is tearful and tells the nurse, “This is all my fault. I should have taken him to the doctor sooner so he wouldn’t have to be here.” Which is appropriate in the care plan for this parent who is experiencing guilt?
    1. Clarify misconception about the illness.
    2. Explain to the parent that the illness is note serious.
    3. Encourage the parent to maintain a sense of control.
    4. Assess further why the parent has excessive guilt feelings.

14. A 14-year-old boy is being admitted to the hospital for an appendectomy. Which roommate should the nurse assign with this patient?
    1. A 4-year-old boy post-appendectomy surgery
    2. A 6-year-old boy with pneumonia
    3. A 15-year-old boy admitted with a vasoocclusive sickle cell crisis
    4. A 12-year-old boy with cellulitis

15. 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 should be expected about separation anxiety?
    1. “I wish my parents could spend the night with me while I am in the hospital.”
    2. “I think I would like for my siblings to visit me but not my friends.”
    3. “I hope my friends don’t forget about visiting me.”
    4. “I will be embarrassed if my friends come to the hospital to visit.”

16. 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?
    1. Ask the parent to place the child in the hospital crib.
    2. Take the child and parent to the exam room.
    3. Perform the exam while the child is on the parent’s lap.
    4. Ask the child to stand by the parent while completing the exam.

17. 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?
    1. Request a prescription for a sleeping pill.
    2. Allow the child to stay up late and sleep late in the morning.
    3. Create a schedule similar to the one the child follows at home.
    4. Plan passive activities in the morning and interactive activities right before bedtime.

18. 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 of which reason?
    1. Regression is seen during hospitalization.
    2. Developmental delays occur because of the hospitalization.
    3. The child is experiencing urinary urgency because of hospitalization.
    4. The child was too young to be “potty-trained.”

19. A child is playing in the playroom. The nurse needs to obtain a child’s blood pressure. Which is the appropriate procedure for obtaining the blood pressure?

1. 1. Take the blood pressure in the playroom.
   2. Ask the child to come to the exam room to obtain the blood pressure.
   3. Ask the child to return to his or her room for the blood pressure, then escort the child back to the playroom.
   4. Document that the blood pressure was not obtained because the child was in the playroom.

20. A nurse in the emergency department is assessing a 5-year-old child with symptoms of pneumonia and a fever of 102° F. Which intervention can the nurse implement to promote a sense of control for the child?
    1. None; this is an emergency and the child should not participate in care.
    2. Allow the child to hold the digital thermometer while taking the child’s blood pressure.
    3. Ask the child if it is OK to take a temperature in the ear.
    4. Have parents wait in the waiting room.

21. Which is an effective strategy to reduce the stress of burn dressing procedures?
    1. Give the child as many choices as possible.
    2. Reassure the child that dressing changes are not painful.
    3. Explain to the child why analgesics cannot be used.
    4. Encourage the child to master stress with controlled passivity.

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

23. 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?

a.

b.

c.

d.

MULTIPLE RESPONSE

1. 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.)
   1. Unfamiliar environment
   2. Usual day-night routine
   3. Strange smells
   4. Provision of privacy
   5. Inadequate knowledge of condition and routine

2. A nurse plans therapeutic play time for a hospitalized child. What are the benefits of play? (Select all that apply.)
   1. Serves as method to assist disturbed children
   2. Allows the child to express feelings
   3. The nurse can gain insight into the child’s feelings.
   4. The child can deal with concerns and feelings.
   5. Gives the child a structured play environment

3. 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.)
   1. Discuss dietary restrictions.
   2. Hold any analgesic medications until the child is home.
   3. Send a pain scale home with the family.
   4. Suggest the parents fill the prescriptions on the way home.
   5. Discuss complications that may occur.