Chapter 11: The Ill Child in the Hospital and Other Care Settings My Nursing Test Banks

Chapter 11: The Ill Child in the Hospital and Other Care Settings

Test Bank

MULTIPLE CHOICE

1. In which situation should the nurse address anxiety as a priority problem in planning care for the child and family?

a.

Twenty-four hour observation

b.

Emergency hospitalization

c.

Outpatient admission

d.

Rehabilitation admission

ANS: B

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 these settings, 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 childs and familys anxiety.

DIF: Cognitive Level: Application REF: p. 232

OBJ: Nursing Process Step: Planning MSC: Safe and Effective Care Environment

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

a.

Increased cost

b.

Increased risk of infection

c.

Lack of physical connection to the hospital

d.

Longer separation of the child from the family

ANS: C

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

DIF: Cognitive Level: Comprehension REF: p. 232

OBJ: Nursing Process Step: Implementation

MSC: Safe and Effective Care Environment

3. In planning care, the nurse recognizes that which child should have the most difficulty with separation from family during hospitalization?

a.

A 5-month-old infant

b.

A 15-month-old toddler

c.

A 4-year-old child

d.

A 7-year-old child

ANS: B

Separation is the major stressor for children hospitalized between the ages of 6 and 30 months. Infants younger than 6 months of age will generally adapt to hospitalization if their basic needs for food, warmth, and comfort are met. Although separation anxiety occurs in hospitalized preschoolers, it is usually less obvious and less serious than that experienced by the toddler. The school-age child is accustomed to separation from parents. Although hospitalization is a stressor, the 7-year-old child will have less separation anxiety than a 15-month-old toddler.

DIF: Cognitive Level: Application REF: p. 235

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

4. A 2-year-old child has been hospitalized for 4 days. The nurse notes the child is quiet and withdrawn. Which is the best explanation for this behavior?

a.

The child is protesting because of separation from caregivers.

b.

The child has adjusted to the hospitalization.

c.

The child is experiencing the despair stage of separation.

d.

The child has reached the stage of detachment.

ANS: C

In the despair stage of separation, the child exhibits signs of hopelessness and becomes quiet, withdrawn, and apathetic. The detachment stage occurs after prolonged separation. During this phase, the child becomes interested in the environment and begins to play. In the protest stage, the child would be agitated, crying, resistant to caregivers, and inconsolable. Toddlers do not readily adjust to hospitalization and separation from caregivers.

DIF: Cognitive Level: Analysis REF: p. 235

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

5. A 3-year-old child cries, kicks, and clings to the father when the parents try to leave the hospital room. What is the nurses best response to the parents about this behavior?

a.

Your child is showing a normal response to the stress of hospitalization.

b.

Your child is not coping effectively with hospitalization. Well need to get a psychological consult from the doctor.

c.

It is helpful for parents to stay with children during hospitalization.

d.

You can avoid this if you wait to leave after your child falls asleep.

ANS: A

The child is exhibiting a healthy attachment to the father. The childs behavior represents the protest stage of separation and does not represent maladaptive behavior. Suggesting that the parents stay during hospitalization places undue stress and guilt on the parents. It fosters the childs mistrust when the parent waits to leave after the child falls asleep.

DIF: Cognitive Level: Application REF: p. 236

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

6. A preschool aged child tells the nurse I was bad, thats why I got sick. Which is the best rationale for this childs statement?

a.

The child has a fear that mutilation will lead to death.

b.

The childs imagination is very active, and he may believe the illness is a result of something he did.

c.

The child has a general understanding of body integrity at this age.

d.

The child will not have fear related to an IV catheter initiation but will have fear of an impending surgery.

ANS: B

The child has imaginative thoughts at this stage of growth and development. The child may believe that an illness occurred as a result of some personal deed or thought or perhaps because he touched something or someone. Preschoolers do not have the cognitive ability to connect mutilation to death and do not have a sound understanding of body integrity. The preschooler fears all types of intrusive procedures whether undergoing a simple procedure such as an IV start or something more invasive such as surgery.

DIF: Cognitive Level: Analysis REF: p. 236

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

7. A nurse caring for a hospitalized adolescent should implement which most developmentally appropriate intervention?

a.

Encouraging peers to call and visit when the adolescents condition allows

b.

Being sure the adolescent wears a hospital gown or pajamas throughout the hospitalization

c.

Discouraging questions and concerns about the effects of the illness on the adolescents appearance

d.

Asking the parents how the adolescent usually copes in new situations

ANS: A

The peer group is important to the adolescents sense of belonging and identity; therefore, separation from friends is a major source of anxiety for the hospitalized adolescent. Adolescents should be encouraged to wear their own clothes to foster their sense of identity. Questions and concerns about the adolescents appearance and the effects of illness on appearance should be encouraged. How the adolescent copes should be asked directly of the adolescent.

DIF: Cognitive Level: Application REF: p. 238

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

8. The nurse is discussing toddler development with the mother of a 2 1/2-year-old child. Which statement by the mother indicates she has an understanding of the toddlers developmental task?

a.

I always help my daughter complete tasks to help her achieve a sense of accomplishment.

b.

I provide many opportunities for my daughter to play with other children her age.

c.

I consistently stress the difference between right and wrong to my daughter.

d.

I encourage my daughter to do things for herself when she can.

ANS: D

The toddlers developmental task is to achieve autonomy. Encouraging toddlers to do things for themselves assists with this developmental task. Toddlers participate in parallel play. They play next to rather than with age mates. Excessive stress on the differences between right and wrong can stifle autonomy in the toddler and foster shame and doubt.

DIF: Cognitive Level: Analysis REF: p. 236

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

9. Which interventions would best help a hospitalized toddler feel a sense of control?

a.

Assign the same nurse to care for the child.

b.

Put a cover over the childs crib.

c.

Require parents to stay with the child.

d.

Follow the childs usual routines for feeding and bedtime.

ANS: D

Familiar rituals and routines are important to toddlers and give the child a sense of control. Following the childs usual routines during hospitalization minimizes feelings of loss of control. Providing consistent caregivers is most applicable for the very young child, such as the neonate and infant. Placing a cover over the childs crib may increase feelings of loss of control. Parents are encouraged, rather than expected, to stay with the child during hospitalization.

DIF: Cognitive Level: Application REF: p. 236

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

10. Parents ask the nurse why observation for 24 hours in an acute-care setting is often appropriate for children. Which is the best response by the nurse?

a.

Longer hospital stays are more costly.

b.

Children become ill quickly and recover quickly.

c.

Children feel less separation anxiety when hospitalized for just 24 hours.

d.

Families experience less disruption during short hospital stays.

ANS: B

Children become ill quickly and recover quickly; therefore, they can require acute care for a shorter period of time. A childs state of wellness, rather than cost, determines the length of stay. Separation anxiety is primarily a factor of the stage of development not the length of the hospital stay. Family disruption is a secondary outcome of a childs hospitalization; it does not determine length of stay.

DIF: Cognitive Level: Application REF: p. 232

OBJ: Nursing Process Step: Teaching and Learning MSC: Physiological Integrity

11. The nurse is aware that separation is the major stressor for which age group?

a.

Newborns and infants

b.

Infants and toddlers

c.

Toddlers and preschoolers

d.

Preschoolers and school-age children

ANS: B

Separation anxiety is at its peak during the infant and toddler ages. Newborns feel little separation anxiety as long as their comfort needs are met. Preschoolers are most fearful of injury and pain. Loss of control is the primary stressor for school-age children.

DIF: Cognitive Level: Comprehension REF: p. 235

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

12. The nurse recognizes that the stress of hospitalization is increased by an active imagination during unfamiliar experiences for which age group?

a.

Toddlers

b.

Preschoolers

c.

School-age children

d.

Adolescents

ANS: B

Active imagination is a primary characteristic of preschoolers. A toddlers primary response to hospitalization is separation anxiety. School-age children experience stress with loss of control. Adolescents experience stress from separation from their peers.

DIF: Cognitive Level: Comprehension REF: pp. 236-237

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

13. Which play activity should the nurse implement to enhance deep breathing exercises for a toddler?

a.

Blowing bubbles

b.

Throwing a Nerf ball

c.

Using a spirometer

d.

Keeping a chart of deep breathing

ANS: A

Age-appropriate play for a toddler to enhance deep breathing would be blowing bubbles. Throwing a Nerf ball would not enhance deep breathing. Using a spirometer and keeping a chart of deep breathing are more appropriate for a school-age child.

DIF: Cognitive Level: Application REF: p. 242

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

14. The nurse should plan to explain procedures and encourage selection of their own meals from hospital menus for which age group of patients?

a.

Toddlers

b.

Preschoolers

c.

School-age children

d.

Adolescents

ANS: C

School-age children are developmentally ready to accept detailed explanations. They can select their own menus and become actively involved in other areas of their care. Toddlers need routine and parent involvement for coping. Preschoolers need simple explanations of procedures. Detailed explanations and support of peers help adolescents cope.

DIF: Cognitive Level: Application REF: p. 238|p. 240

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

15. What is the best action for the nurse to take when a 5-year-old child cries, screams, and resists having his IV restarted because an IV antibiotic is due?

a.

Exit the room and leave the child alone until he stops crying.

b.

Tell the child big boys and girls dont cry.

c.

Let the child decide which color arm board to use with his IV.

d.

Proceed quickly with the IV insertion to decrease stress.

ANS: C

Giving the preschooler some choice and control, while maintaining boundaries of treatment, supports the childs 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.

DIF: Cognitive Level: Application REF: p. 237|p. 240

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

16. What is the best nursing response to the mother of a 4-year-old child who asks what she can do to help the child cope with a siblings repeated hospitalizations?

a.

Recommend that the child be sent to visit the grandmother until the sibling returns home.

b.

Inform the parent that the child is too young to visit the hospital.

c.

Assume the child understands that the sibling will soon be discharged because the child asks no questions.

d.

Help the mother give the child a simple explanation of the treatment and encourage the mother to have the child visit the hospitalized sibling.

ANS: D

Needs of a sibling will be better met with factual information and contact with the ill child. Separation from family and home may intensify fear and anxiety. Parents are experts on their children and need to determine when their child can visit a hospital. Children may have difficulty expressing questions and fears and need the support of parents and other caregivers.

DIF: Cognitive Level: Application REF: p. 247

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

17. Parents are expressing concerned about their preschoolers current sleep habits, which were disrupted by a recent hospitalization, stating that the child now awakens frequently at night. Which response by the nurse best addresses this problem?

a.

Regressive behavior after a hospitalization is normal and is usually short term.

b.

The child is probably expressing anger.

c.

Egocentric behavior often manifests itself when the child is left alone to sleep.

d.

The child is probably feeling pain and needs further evaluation.

ANS: A

Regression is manifested in a variety of ways, is normal, and usually is short term. Nighttime waking is not associated with anger. Egocentric behavior is not an explanation for nighttime waking. More information is needed before an assessment of pain can be made.

DIF: Cognitive Level: Application REF: p. 237

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

18. Which nursing intervention is appropriate for the hospitalized neonate?

a.

Assign the neonate to a room with other neonates.

b.

Provide play activities in the hospital room.

c.

Offer the neonate a pacifier between feedings.

d.

Request that parents bring a security object from home.

ANS: C

The neonate needs opportunities for nonnutritive sucking and oral stimulation with a pacifier. The neonate is not aware of other children. The choice of roommate will not affect the neonate socially. It is important for older children to room with similar-age children. Formal play activities would not be relevant for the neonate. Having parents bring a security object from home is applicable to older children.

DIF: Cognitive Level: Comprehension REF: p. 240

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

19. Which approach will best help a 7-year-old child cope with a lengthy course of intravenous antibiotic therapy?

a.

Arrange for the child to go to the playroom daily.

b.

Ask the child to draw you a picture about himself.

c.

Allow the child to participate in injection play.

d.

Give the child stickers for cooperative behavior.

ANS: C

Injection play is an appropriate intervention for the child who has to undergo frequent blood work, injections, intravenous therapy, or any other therapy involving syringes and needles. The hospitalized child should have opportunities to go to the playroom each day if his condition warrants. This free play does not have any specific therapeutic purpose. Children can express their thoughts and beliefs through drawing. Asking the child to draw a picture of himself may not elicit the childs feelings about his treatment. Rewards such as stickers may enhance cooperative behavior. They will not address coping with painful treatments.

DIF: Cognitive Level: Application REF: p. 242

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

20. A 6-year-old child tells the nurse that she does not like the food at the hospital. A review of intake reveals she has eaten very little for the past 2 days. Which intervention is appropriate for the nursing diagnosis: Imbalanced Nutrition: Less than body requirements?

a.

Select nutritious foods on the menu for the child.

b.

Permit the child to eat junk foods at snack times.

c.

Arrange the childs meal tray with generous portions of food.

d.

Encourage family members to bring foods from home.

ANS: D

Having the parents bring foods that the child likes and is familiar with will increase the likelihood that she will eat. A 6-year-old child should be permitted to make her own menu selections with the assistance of an adult as needed. Allowing the child to select foods gives the child control and provides an opportunity to select foods that the child likes. Junk foods have little or no nutritional value. If the child is permitted to eat junk food, she may refuse to eat nutritious food at mealtimes. Meals served to children should contain small portions. Children may feel overwhelmed by large portions and refuse to eat any of the food.

DIF: Cognitive Level: Application REF: p. 244

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

21. A 3 1/2-year-old child who is toilet trained has had several accidents since hospital admission. What is the nurses best action in this situation?

a.

Find out how long the child has been toilet trained at home.

b.

Tell the parent it is necessary to begin toilet training again.

c.

Explain how to use a bedpan and place it close to the child.

d.

Follow home routines of elimination.

ANS: D

Cooperation will increase and anxiety will decrease if the childs normal routine and rituals are maintained. Some regression to previous behaviors is normal during hospitalization, even when the child has been practicing the skill for some time. Hospitalization is a stressful experience and is not an appropriate time to learn or relearn a skill. Developmentally, the 3 1/2-year-old child cannot use a bedpan independently.

DIF: Cognitive Level: Application REF: p. 240

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

22. Which question would most likely elicit information about how a family is coping with a childs hospitalization?

a.

Was this admission an emergency?

b.

How has your childs hospitalization affected your family?

c.

Who is taking care of your other children while you are here?

d.

Is this the childs first hospitalization?

ANS: B

Open-ended questions encourage communication. Ensuring a positive outcome from the hospital experience can be optimized by the nurse addressing the health needs of family members as well as the needs of the child. Was this admission an emergency?, Who is taking care of your other children while you are here?, and Is this the childs first hospitalization? are closed-ended questions. The nurse would have to ask other questions to gather additional information.

DIF: Cognitive Level: Comprehension REF: p. 246

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

23. What would the nurse advise the mother of a 4-year-old child to bring for the child on the day of outpatient surgery?

a.

Snacks

b.

Fruit juice boxes

c.

All of the childs medications

d.

One of the childs favorite toys

ANS: D

A familiar toy can be effective in decreasing a childs stress in an unfamiliar environment. The child will be NPO before surgery; therefore, including snacks for the child is contraindicated, however unnecessary stress will result when the child is denied the juice. It is not necessary to bring all medications on the day of surgery. The medication the child has been receiving should have been noted during the preoperative workup. The parent should be knowledgeable concerning which medications the child has been taking if further information is necessary.

DIF: Cognitive Level: Application REF: p. 245

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Which developmental approaches should the nurse implement for the hospitalized adolescent? Select all that apply.

a.

Expect regression.

b.

Provide privacy.

c.

Encourage peers to call.

d.

Answer questions with simple concrete explanations.

e.

Encourage questions about appearance.

ANS: B, C, E

The developmental appropriate approaches for an adolescent include providing privacy for care and visiting, encouraging questions about appearance and the effects of illness, and encouraging peers to call and visit if the adolescents condition can tolerate this action. The adolescent requires the use of scientific terminology and detailed explanations; answering questions with simple concrete explanations is appropriate for the preschool age. Regression occurs for the school age and younger child, but is not common in the adolescent.

DIF: Cognitive Level: Application REF: p. 240

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

2. Parents of a school-age child ask the nurse about services provided by school-based clinics. Which statement made by the nurse is accurate with regard to school-based clinic services? Select all that apply.

a.

Vision, hearing, and growth screening are provided.

b.

Education about health-related topics is provided to children and parents.

c.

Minor outpatient surgical procedures can be performed.

d.

Emergency first aid treatment is provided.

e.

Casts can be applied to broken bones.

ANS: A, B, D

School-based clinics provide screening, emergency care, healthcare education, and immunization services. They are primary care clinics and cannot perform outpatient surgical procedures or apply casts to broken bones.

DIF: Cognitive Level: Application REF: p. 233

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

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