Chapter 21: The Childs Experience of Hospitalization My Nursing Test Banks

Chapter 21: The Childs Experience of Hospitalization

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier Inc.

MULTIPLE CHOICE

1. Which child would have the most difficulty in coping with separation from parents because of hospitalization?

a.

The 3-month-old child

b.

The 16-month-old child

c.

The 4-year-old child

d.

The 7-year-old child

ANS: B

Separation anxiety occurs after age 6 months and is most pronounced in the toddler.

DIF: Cognitive Level: Comprehension REF: 466-467 OBJ: 2

TOP: Separation Anxiety KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

2. A 2-year-old child has been crying constantly for his mother since he was hospitalized 3 days ago. The nurse understands that this behavior suggests:

a.

The toddler feels abandoned by his mother.

b.

The child still has not adjusted to his hospitalization.

c.

The child is not separated from his mother often.

d.

A poor mother-child bond exists.

ANS: A

Unless toddlers are extremely ill, their grief and sense of abandonment during hospitalization are obvious.

DIF: Cognitive Level: Analysis REF: 465-466 OBJ: 2

TOP: Separation Anxiety KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

3. The statement that best corresponds to a preschoolers understanding of hospitalization is:

a.

A germ made me get sick.

b.

I got sick because I was mad at my brother.

c.

My tonsils are sick and they have to come out.

d.

I have a cast because I broke my leg.

ANS: B

The preschooler may feel guilty, particularly if an accident happens as a result of mischief on his or her part.

DIF: Cognitive Level: Application REF: 476 OBJ: 6

TOP: The Hospitalized Preschooler KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

4. The parents of a hospitalized toddler are upset because she seems more interested in her toys when they come to visit her. The toddler is most likely in which stage of separation anxiety?

a.

Protest

b.

Despair

c.

Denial

d.

Attachment

ANS: C

In the stage of denial or detachment, the child appears to deny the need for the parents and becomes uninterested in their visits.

DIF: Cognitive Level: Comprehension REF: 465-466 OBJ: 2

TOP: Separation Anxiety KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

5. The nurse must make a room assignment for a 16-year-old teenager with cystic fibrosis. An optimal roommate might be:

a.

A 4-year-old child who had an appendectomy

b.

A 10-year-old child with sickle cell disease in vaso-occlusive crisis

c.

A 15-year-old teenager with type 1 diabetes mellitus

d.

To assign the adolescent to a private room

ANS: C

Adolescents usually do better in rooms with one or more roommates than in single rooms. The adolescent would do best with a roommate who is closest to his or her age and also lives with a chronic illness.

DIF: Cognitive Level: Application REF: 477 OBJ: 8

TOP: The Hospitalized Adolescent KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

6. The parents of a hospitalized 9-month-old infant ask if their preschool child may visit his younger sibling. The nurse understands that:

a.

Most facilities do not allow visitors under age 12 years for infection control purposes.

b.

Seeing his younger sibling would probably frighten the preschooler and thus should be avoided.

c.

The sibling could view the infant from the doorway but not enter the room to prevent the spread of microorganisms.

d.

The preschooler needs to visit his infant sister to reassure himself that she is all right.

ANS: D

Siblings are affected by a childs hospitalization. Their ability to cope is influenced by their age, experience, and intactness of the family.

DIF: Cognitive Level: Analysis REF: 474 OBJ: 3

TOP: Siblings-Parents Reaction to Hospitalization

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

7. A hospitalized toddler was drinking from a cup at home, but now refuses to drink from anything except his favorite bottle. This is because the toddler is:

a.

Dealing with the anxiety of hospitalization by regressing

b.

Demonstrating attention-seeking behaviors because of an overabundance of attention in the hospital

c.

Attempting to refocus the attention of the adults around him to avoid further painful procedures

d.

Exhibiting normal behavior for his age, as children often stop new behaviors after they feel they have mastered them

ANS: A

Hospitalization is frustrating for toddlers. They show their displeasure when illness restricts satisfaction of their desires. It is not unusual for a toddler who was drinking from a cup to refuse it in the hospital.

DIF: Cognitive Level: Comprehension REF: 468 OBJ: 4

TOP: Regression KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

8. A nurse encourages a school-age child to draw a picture after a painful procedure. The best rationale for this intervention is that the nurse is:

a.

Attempting to reestablish rapport

b.

Providing a way for the child to express his feelings

c.

Encouraging quiet play

d.

Distracting the child from thinking about the pain

ANS: B

Following treatments, the nurse should encourage children to draw and talk about their drawings or to act out their feelings through puppet play.

DIF: Cognitive Level: Comprehension REF: 490 OBJ: 7

TOP: The Hospitalized School-Age Child

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

9. The nurse suggests that the best time for parents to begin to prepare a 5-year-old for surgery and hospitalization is:

a.

As soon as the surgery is scheduled

b.

About 2 weeks before surgery

c.

About 4 days before surgery

d.

On the night before admission to the hospital

ANS: C

Parents should prepare children for procedures and hospitalization a few days in advance.

DIF: Cognitive Level: Application REF: 471 OBJ: 4, 6

TOP: The Nurses Role in Hospital Admission-Preparing the Child

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

10. The mother of a 3-year-old tells the nurse that she will be in to visit tomorrow around 12:00 PM. The next morning, the child asks the nurse, When is my mommy coming? The best response for the nurse to make is:

a.

Your mommy will be here around noon.

b.

Your mommy will be here when you have lunch.

c.

Mommy will be here very soon.

d.

Your mommy is coming in 4 hours.

ANS: B

The toddler and preschooler do not understand time yet. They understand time relationships through activities in their experience, such as naptime and mealtimes.

DIF: Cognitive Level: Application REF: 476 OBJ: 6

TOP: The Hospitalized Toddler/Preschooler

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

11. A 13-year-old girl has been hospitalized for the past week. When discussing the girls feelings about her illness, the nurse would expect the girl to express the most concern about:

a.

Invasive procedures

b.

Loss of control

c.

Appearance

d.

Separation from her boyfriend

ANS: C

Illness during early adolescence (12 to 15 years) is seen mainly as a threat to body image.

DIF: Cognitive Level: Comprehension REF: 477 OBJ: 8

TOP: The Hospitalized Adolescent KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

12. The nurse notices that the mother of a child with cerebral palsy corrects and redoes many of the things the nurse does for her child. The most appropriate response to this mother would be:

a.

Would you like to do all of your childs care?

b.

Im doing the very best job that I can with your child.

c.

Why dont you go have a cup of coffee. You are going to be exhausted if you dont take a break.

d.

Id be happy if you would share with me some of the special things you do for your child.

ANS: D

The person who cares daily for the child with a chronic illness can provide information that will best guarantee continuity of care between the home and the hospital.

DIF: Cognitive Level: Application REF: 472 OBJ: 4

TOP: The Parents Reaction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

13. The mother of a hospitalized toddler states, He cries when I visit. Maybe I should just stay away. The nurses best response would be:

a.

Perhaps you are right. He only gets upset when you have to leave.

b.

It is important that you are here. This is a common reaction in children when they are separated from their parents.

c.

It might be easier for your child if you would stay with him, but this decision is up to you.

d.

We take good care of him and he seems fine when you are not here.

ANS: B

During the second stage of separation anxiety (despair), the child is quiet, is not crying, and is sad and depressed. The child will revert to protest when the parent arrives for a visit.

DIF: Cognitive Level: Application REF: 466 OBJ: 3

TOP: Separation Anxiety KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

14. The nurse, preparing to collect an admission history from parents who have recently immigrated from Russia, would keep in mind that:

a.

Eye-to-eye contact is considered disrespectful.

b.

Touching the childs head means the nurse is superior.

c.

Smiling is inappropriate in a serious situation.

d.

Staring is a sign of the nurses rudeness.

ANS: C

In Russia, a smile indicates happiness and is inappropriate in a serious or sad situation.

DIF: Cognitive Level: Analysis REF: 468 OBJ: 4

TOP: Fostering Intercultural Communication

KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

15. The nursing action that would facilitate rapport with a child and the childs parents during the admission process is:

a.

Direct the parents to undress the child.

b.

Answer questions in a calm and matter-of-fact way.

c.

Perform assessments and ask questions as quickly as possible.

d.

Express concern about the seriousness of the childs condition.

ANS: B

The nurse tries not to appear rushed. A matter-of-fact attitude must be maintained regardless of the childs condition.

DIF: Cognitive Level: Application REF: 474 OBJ: 4

TOP: Nurses Role in Hospital Admission

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

16. When a 2-year-old returns to her hospital room following a diagnostic procedure, her parents are not available and the child is crying loudly. The technique that is most appropriate to alleviate the childs distress is:

a.

Rock the child gently to sleep.

b.

Play with the child using pop-up toys.

c.

Role play with the child to act out her feelings.

d.

Ask the child to draw a picture about her feelings.

ANS: B

Distractions such as blowing bubbles, looking through a kaleidoscope, and playing with pop-up toys may help reduce anxiety and pain.

DIF: Cognitive Level: Analysis REF: 474 OBJ: 10

TOP: The Hospitalized Toddler KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

17. A 4-year-old begins to cry when his mother tells him it is time for his operation. The nurse understands this is an expected reaction because the preschooler is particularly fearful of:

a.

Loss of control

b.

Restricted mobility

c.

Unfamiliar routines

d.

Invasive procedures

ANS: D

The preschool-age child is afraid of bodily harm, particularly invasive procedures.

DIF: Cognitive Level: Knowledge REF: 476 OBJ: 6

TOP: The Hospitalized Preschooler KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

18. The nurse determines a parent understands a hospitalized toddlers need for transitional objects when the parent states:

a.

This stuffed animal makes him feel secure.

b.

He insisted on bringing this dirty old blanket with him.

c.

Im going to buy him a big stuffed animal from the gift shop.

d.

Id like to get him some toys from the playroom.

ANS: A

The use of a transitional object such as a blanket or a favorite toy promotes security.

DIF: Cognitive Level: Comprehension REF: 475 OBJ: 10

TOP: The Hospitalized Toddler KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

19. An 8-year-old child will be hospitalized for several weeks in skeletal traction to treat a fractured femur. In planning care for the child, the nurse realizes immobilization in this age group can generate feelings of:

a.

Loss of control

b.

Altered body image

c.

Shame and guilt

d.

Fear of bodily harm

ANS: A

Forced dependency in the hospital, such as immobilization, can result in a feeling of loss of control and loss of security.

DIF: Cognitive Level: Analysis REF: 477 OBJ: 10

TOP: The Hospitalized School-Age Child

KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

20. The nurse explains the use of fentanyl has the advantages of:

a.

Being specifically designed for children

b.

Rapid onset

c.

Nonaddicting

d.

Long duration

ANS: B

Fentanyl is a drug useful for all ages because of its rapid onset and brief duration.

DIF: Cognitive Level: Application REF: 467 OBJ: 5

TOP: Fentanyl KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

MULTIPLE RESPONSE

1. The nurse suggests to parents that they avail themselves of the outpatient surgical center for their childs upcoming surgery because the surgical center has the advantages of:

Select all that apply.

a.

Lower cost

b.

Less incidence of nosocomial infections

c.

Reduction of parent-child separation

d.

Recuperation at home

e.

Decreased emotional impact of illness

ANS: A, B, C, D, E

All options listed are advantages of outpatient services.

DIF: Cognitive Level: Application REF: 463 OBJ: 4

TOP: Use of Outpatient Facilities KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

2. The nurse understands that no matter the reason for the young child being hospitalized, the basic fears are:

Select all that apply.

a.

Separation

b.

Permanent scarring

c.

Pain

d.

Cost

e.

Body intrusion

ANS: A, C, E

Small children all share the same basic fears relative to hospitalization, which are separation from family, pain, and body intrusion or mutilation.

DIF: Cognitive Level: Comprehension REF: 465 OBJ: 2

TOP: Basic Fear KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

3. The nurse taking a developmental history will include information relative to:

Select all that apply.

a.

Previous experience with hospitalization

b.

Cultural needs

c.

History of illness

d.

Allergies

e.

Childs nickname

ANS: A, B, E

The developmental history has information about the child and the childs developmental and cultural needs and personal preferences. The information relative to history of illness or allergies would be covered in the medical history.

DIF: Cognitive Level: Application REF: 475 OBJ: 4

TOP: Developmental History KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

COMPLETION

1. When the preschooler who is hospitalized for surgery to correct a poorly healed fracture says, My doctor is going to unscrew my bent arm and screw on a new one, the nurse should ____________________ this misconception.

ANS: correct

DIF: Cognitive Level: Knowledge REF: 476 OBJ: 7

TOP: Misconceptions KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

NOT: Rationale: All misconceptions that a youngster has about procedures should be corrected.

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