Chapter 22: Family-Centered Care of the Child During Illness and Hospitalization My Nursing Test Banks

Chapter 22: Family-Centered Care of the Child During Illness and Hospitalization

MULTIPLE CHOICE

1. What behavior should most likely be manifested in an infant experiencing the protest phase of separation anxiety?

a.

Inactivity

b.

Depression and sadness

c.

Inconsolable and crying

d.

Regression to earlier behavior

ANS: C

For older infants, being inconsolable and crying is seen during the protest phase of separation anxiety. Inactivity is observed during the stage of despair. The child is much less active and withdraws from others. Depression, sadness, and regression to earlier behaviors are observed during the phase of despair.

DIF: Cognitive Level: Understanding REF: p. 864

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

2. 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?

a.

Infants

b.

Toddlers

c.

Preschoolers

d.

School-age children

ANS: D

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 decrease their control and power. Infants, toddlers, and preschoolers, although affected by loss of power, are not as significantly affected as school-age children.

DIF: Cognitive Level: Analyzing REF: p. 866

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

3. Cognitive development influences response to pain. What age group is most concerned with the fear of losing control during a painful experience?

a.

Toddlers

b.

Preschoolers

c.

School-age children

d.

Adolescents

ANS: D

Adolescents view illness as physiologic (an organ malfunction) and psychophysiologic (psychologic factors that affect health). Adolescents usually approach pain with self-control. They are concerned with remaining composed and feel embarrassed and ashamed of losing control. Toddlers and preschoolers react to pain primarily as a physical, concrete experience. Preschoolers may try to escape a procedure with verbal statements such as go away. Young school-age children may view pain as punishment for wrongdoing. This age group fears bodily harm.

DIF: Cognitive Level: Analyzing REF: p. 865

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. A child, age 4 years, tells the nurse that she needs a Band-Aid where she had an injection. What nursing action should the nurse implement?

a.

Apply a Band-Aid.

b.

Ask her why she wants a Band-Aid.

c.

Explain why a Band-Aid is not needed.

d.

Show her that the bleeding has already stopped.

ANS: A

Children in this age group still fear that their insides may leak out at the injection site. The nurse should be prepared to apply a small Band-Aid after the injection. No explanation should be required.

DIF: Cognitive Level: Understanding REF: p. 873

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

5. The psychosexual conflicts of preschool children make them extremely vulnerable to which threat?

a.

Loss of control

b.

Loss of identity

c.

Separation anxiety

d.

Bodily injury and pain

ANS: D

The psychosexual conflicts of children in this age group make them vulnerable to threats of bodily injury. Intrusive procedures, whether painful or painless, are threatening to preschoolers, whose concept of body integrity is still poorly developed. Loss of control, loss of identity, and separation anxiety are not related to psychosexual conflicts.

DIF: Cognitive Level: Understanding REF: p. 873

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

6. A spinal tap must be done on a 9-year-old boy. While he is waiting in the treatment room, the nurse observes that he seems composed. When the nurse asks him if he wants his mother to stay with him, he says, I am fine. How should the nurse interpret this situation?

a.

This child is unusually brave.

b.

He has learned that support does not help.

c.

Nine-year-old boys do not usually want a parent present during the procedure.

d.

Children in this age group often do not request support even though they need and want it.

ANS: D

The school-age childs visible composure, calmness, and acceptance often mask an inner longing for support. Children of this age have a more passive approach to pain and an indirect request for support. It is especially important to be aware of nonverbal cues such as facial expression, silence, and lack of activity. Usually when someone identifies the unspoken messages, the child will readily accept support.

DIF: Cognitive Level: Analyzing REF: p. 866

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

7. The mother of a 7-month-old infant newly diagnosed with cystic fibrosis is rooming in with her infant. She is breastfeeding and provides all the care except for the medication administration. What should the nurse include in the plan of care?

a.

Ensuring that the mother has time away from the infant

b.

Making sure the mother is providing all of the infants care

c.

Determining whether other family members can provide the necessary care so the mother can rest

d.

Contacting the social worker because of the mothers interference with the nursing care

ANS: A

The mother needs sufficient rest and nutrition so she can be effective as a caregiver. While the infant is hospitalized, the care is the responsibility of the nursing staff. The mother should be made comfortable with the care the staff provides in her absence. The mother has a right to provide care for the infant. The nursing staff and the mother should agree on the care division.

DIF: Cognitive Level: Applying REF: p. 868

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

8. A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, Wait a minute, and, Im not ready. How should the nurse interpret this behavior?

a.

IV insertions are viewed as punishment.

b.

This is expected behavior for a school-age child.

c.

Protesting like this is usually not seen past the preschool years.

d.

The child has successfully manipulated the nurse in the past.

ANS: B

This school-age child is attempting to maintain some control over the hospital experience. The nurse should provide the girl with structured choices about when the IV line will be inserted. Preschoolers can view procedures as punishment; this is not typical behavior of a preschool-age child.

DIF: Cognitive Level: Analyzing REF: p. 867

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

9. The parents of a 4-month-old infant cannot visit except on weekends. What action by the nurse indicates an understanding of the emotional needs of a young infant?

a.

Place her in a room away from other children.

b.

Assign her to the same nurse as much as possible.

c.

Tell the parents that frequent visiting is unnecessary.

d.

Assign her to different nurses so she will have varied contacts.

ANS: B

The infant is developing a sense of trust. This is accomplished by the consistent, loving care of a nurturing person. If the parents are unable to visit, then the same staff nurses should be used as much as possible. Placing her in a room away from other children would isolate the child. The parents should be encouraged to visit. The nurse should describe how the staff will care for the infant in their absence.

DIF: Cognitive Level: Applying REF: p. 866

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

10. An 8-year-old girl is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What intervention will help her most in her adjustment to the hospital?

a.

Explain hospital schedules to her, such as mealtimes.

b.

Use terms such as honey and dear to show a caring attitude.

c.

Explain when parents can visit and why siblings cannot come to see her.

d.

Orient her parents, because she is too young, to her room and hospital facility.

ANS: A

School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for what to expect. The nurse should refer to the child by the preferred name. Explaining when parents can visit and why siblings cannot come focuses on the limitations rather than helping her adjust to the hospital. At the age of 8 years, the child should be oriented to the environment along with the parents.

DIF: Cognitive Level: Applying REF: p. 866

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

11. A 13-year-old child with cystic fibrosis (CF) is a frequent patient on the pediatric unit. This admission, she is sleeping during the daytime and unable to sleep at night. What should be a beneficial strategy for this child?

a.

Administer prescribed sedative at night to aid in sleep.

b.

Negotiate a daily schedule that incorporates hospital routine, therapy, and free time.

c.

Have the practitioner speak with the child about the need for rest when receiving therapy for CF.

d.

Arrange a consult with the social worker to determine whether issues at home are interfering with her care.

ANS: B

Childrens response to the disruption of routine during hospitalization is demonstrated in eating, sleeping, and other activities of daily living. The lack of structure is allowing the child to sleep during the day, rather than at night. Most likely the lack of schedule is the problem. The nurse and child can plan a schedule that incorporates all necessary activities, including medications, mealtimes, homework, and patient care procedures. The schedule can then be posted so the child has a ready reference. Sedatives are not usually used with children. The child has a chronic illness and most likely knows the importance of rest. The parents and child can be questioned about changes at home since the last hospitalization.

DIF: Cognitive Level: Applying REF: p. 869

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

12. Two hospitalized adolescents are playing pool in the activity room. Neither of them seems enthusiastic about the game. How should the nurse interpret this situation?

a.

Playing pool requires too much concentration for this age group.

b.

Pool is an activity better suited for younger children.

c.

The adolescents may be enjoying themselves but have lower energy levels than healthy children.

d.

The adolescents lack of enthusiasm is one of the signs of depression.

ANS: C

Children who are ill and hospitalized typically have lower energy levels than healthy children. Therefore, children may not appear enthusiastic about an activity even when they are enjoying it. Pool is an appropriate activity for adolescents. They have the cognitive and psychomotor skills that are necessary. If the adolescents were significantly depressed, they would be unable to engage in the game.

DIF: Cognitive Level: Applying REF: p. 875

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

13. A 6-year-old child is admitted to the pediatric unit and requires bed rest. Having art supplies available meets which purpose?

a.

Allows the child to create gifts for parents

b.

Provides developmentally appropriate activities

c.

Is essential for play therapy so the child can work on past problems

d.

Lets the child express thoughts and feelings through pictures rather than words

ANS: D

The art supplies allow the child to draw images that come into the mind. This can help the child develop symbols and then verbalize reactions to illness and hospitalization. The child can make gifts and drawings for parents, but the goal is to allow expression of feelings. Although art is developmentally and situationally appropriate, the child benefits by being able to express feelings nonverbally. The art supplies are not therapeutic play but a mechanism for expressive play. The child will not work on past problems.

DIF: Cognitive Level: Applying REF: p. 874

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

14. The parents of a 3-year-old admitted for recurrent diarrhea are upset that the practitioner has not told them what is going on with their child. What is the priority intervention for this family?

a.

Answer all of the parents questions about the childs illness.

b.

Immediately page the practitioner to come to the unit to speak with the family.

c.

Help the family develop a written list of specific questions to ask the practitioner.

d.

Inform the family of the time that hospital rounds are made so that they can be present.

ANS: C

Often families ask general questions of health care providers and do not receive the information they need. The nurse should determine what information the family does want and then help develop a list of questions. When the questions are written, the family can remember which questions to ask or can hand the sheet to the practitioner for answers. The nurse may have the information the parents want, but they are asking for specific information from the practitioner. Unless it is an emergency, the nurse should not place a stat page for the practitioner. Being present is not necessarily the issue but rather the ability to get answers to specific questions.

DIF: Cognitive Level: Applying REF: p. 874

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

15. The nurse is admitting a 7-year-old child to the pediatric unit for abdominal pain. To determine what the child understands about the reason for hospitalization, what should the nurse do?

a.

Find out what the parents have told the child.

b.

Review the note from the admitting practitioner.

c.

Ask the child why he came to the hospital today.

d.

Question the parents about why they brought the child to the hospital.

ANS: C

School-age children are able to answer questions. The only way for the nurse to know about the childs understanding of the reason for hospitalization is to ask the child directly. Finding out what the parents told the child and why they brought the child to the hospital or reading the admitting practitioners description of the reason for admission will not provide information about what the child has heard and retained.

DIF: Cognitive Level: Applying REF: p. 870

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

16. The nurse is notified that a 9-year-old boy with nephrotic syndrome is being admitted. Only semiprivate rooms are available. What roommate should be best to select?

a.

A 10-year-old girl with pneumonia

b.

An 8-year-old boy with a fractured femur

c.

A 10-year-old boy with a ruptured appendix

d.

A 9-year-old girl with congenital heart disease

ANS: B

An 8-year-old boy with a fractured femur would be the best choice for a roommate. The boys are similar in age. The child with nephrotic syndrome most likely will be on immunosuppressive agents and susceptible to infection. The child with a fractured femur is not infectious. A girl should not be a good roommate for a school-age boy. In addition, the 10-year-old girl with pneumonia and the 10-year-old boy with a ruptured appendix have infections and could pose a risk for the child with nephrotic syndrome.

DIF: Cognitive Level: Applying REF: p. 869

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

17. The nurse is doing a prehospitalization orientation for a girl, age 7 years, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that after the surgery, the child will be in the intensive care unit. How might the explanation by the nurse be viewed?

a.

Unnecessary

b.

The surgeons responsibility

c.

Too stressful for a young child

d.

An appropriate part of the childs preparation

ANS: D

The explanation is a necessary part of preoperative preparation and will help reduce the anxiety associated with surgery. If the child wakes in the intensive care unit and is not prepared for the environment, she will be even more anxious. This is a joint responsibility of nursing, medical staff, and child life personnel.

DIF: Cognitive Level: Analyzing REF: p. 878

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

18. A 9-year-old boy has an unplanned admission to the intensive care unit (ICU) after abdominal surgery. The nursing staff has completed the admission process, and his condition is beginning to stabilize. When speaking with the parents, the nurse should expect what additional stressor to be evident?

a.

Usual daynight routine

b.

Calming influence of staff

c.

Adequate privacy and support

d.

Insufficient remembering of his condition and routine

ANS: D

ICUs, especially when the family is unprepared for the admission, are strange and unfamiliar. There are many pieces of unfamiliar equipment, and the sights and sounds are much different from those of a general hospital unit. Also, with the childs condition being more precarious, it may be difficult to keep the parents updated on what is happening. Lights are usually on around the clock, seriously disrupting the diurnal rhythm. In most ICUs, the staff works with a sense of urgency. It is difficult for parents to ask questions about their child when staff is with other patients. Usually little privacy is available for families in ICUs.

DIF: Cognitive Level: Analyzing REF: p. 878

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

19. A 6-year-old is being discharged home, which is 90 miles from the hospital, after an outpatient hernia repair. In addition to explicit discharge instructions, what should the nurse provide?

a.

An ambulance for transport home

b.

Verbal information about follow-up care

c.

Prescribed pain medication before discharge

d.

Driving instructions for a route with less traffic

ANS: C

The nurse should anticipate that the child will begin experiencing pain on the trip home. By providing a dose of oral analgesia, the nurse can ensure the child remains comfortable during the trip. Transport by ambulance is not indicated for a hernia repair. Discharge instructions should be written. The parents will be focusing on their child and returning home, which limits their ability to retain information. The parents should know the most expedient route home.

DIF: Cognitive Level: Applying REF: p. 877

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Physiological Integrity

20. The nurse is caring for a 10-year-old child during a long hospitalization. What intervention should the nurse include in the care plan to minimize loss of control and autonomy during the hospitalization?

a.

Allow the child to skip morning self-care activities to watch a favorite television program.

b.

Create a calendar with special events such as a visit from a friend to maintain a routine.

c.

Allow the child to sleep later in the morning and go to bed later at night to promote control.

d.

Create a restrictive environment so the child feels in control of sensory stimulation.

ANS: B

School-age children may feel an overwhelming loss of control and autonomy during a longer hospitalization. One intervention to minimize this loss of control is to create a calendar with planned special events such as a visit from a friend. Maintaining the childs daily routine is another intervention to minimize the sense of loss of control; allowing the child to skip morning self-care activities, sleep later, or stay up later would work against this goal. Environments should be as nonrestrictive as possible to allow the child freedom to move about, thus allowing a sense of autonomy.

DIF: Cognitive Level: Applying REF: p. 874

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

21. The nurse is caring for a 3-year-old child during a long hospitalization. The parent is concerned about how to support the childs siblings during the hospitalization. What statement is appropriate for the nurse to make?

a.

You should choose one parent to spend every night in the hospital while the other parent stays at home with the other children.

b.

You could leave your hospitalized child for periods at night to be at home with the other children.

c.

You should discourage the siblings from visiting because this could upset everyone in the family.

d.

You could encourage a nightly phone call between the siblings as part of the bedtime routine.

ANS: D

A supportive measure for siblings of a hospitalized child is to have a routine of a phone call at some point during the day or evening so the parent at the hospital can stay in touch and the children at home are involved and can hear that their sibling is doing well. Parents should alternate who stays at the hospital overnight to prevent burnout and to allow each parent time at home with the siblings. Encourage siblings to visit if appropriate to keep the family unit intact. Leaving the hospitalized child alone at night will not support the siblings at home and may cause problems with the hospitalized child.

DIF: Cognitive Level: Applying REF: p. 877

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Psychosocial Integrity

22. The nurse should expect a toddler to cope with the stress of a short period of separation from parents by displaying what?

a.

Regression

b.

Happiness

c.

Detachment

d.

Indifference

ANS: A

Children in the toddler stage demonstrate goal-directed behaviors when separated from parents for short periods. They may demonstrate displeasure on the parents return or departure by having temper tantrums; refusing to comply with the usual routines of mealtime, bedtime, or toileting; or regressing to more primitive levels of development. Detachment would be seen with a prolonged absence of parents, not a short one. Toddlers would not be indifferent or happy when experiencing short separations from parents.

DIF: Cognitive Level: Understanding REF: p. 866

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

23. The nurse is providing support to parents adapting to the hospitalization of their child to the pediatric intensive care unit. The nurse notices that the parents keep asking the same questions. What should the nurse do?

a.

Patiently continue to answer questions, trying different approaches.

b.

Kindly refer them to someone else for answering their questions.

c.

Recognize that some parents cannot understand explanations.

d.

Suggest that they ask their questions when they are not upset.

ANS: A

In addition to a general pediatric unit, children may be admitted to special facilities such as an ambulatory or outpatient setting, an isolation room, or intensive care. Wherever the location, the core principles of patient and family-centered care provide a foundation for all communication and interventions with the patient, family, and health care team. The nurse should do the therapeutic action and patiently continue to answer questions, trying different approaches.

DIF: Cognitive Level: Applying REF: p. 878

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Psychosocial Integrity

24. The nurse is instructing student nurses about the stress of hospitalization for children from middle infancy throughout the preschool years. What major stress should the nurse relate to the students?

a.

Pain

b.

Bodily injury

c.

Loss of control

d.

Separation anxiety

ANS: D

The major stress from middle infancy throughout the preschool years, especially for children ages 6 to 30 months, is separation anxiety.

DIF: Cognitive Level: Applying REF: p. 864

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

25. Parents of a hospitalized child often question the skill of staff. The nurse interprets this behavior by the parents as what?

a.

Normal

b.

Paranoid

c.

Indifferent

d.

Wanting attention

ANS: A

Recent research has identified common themes among parents whose children were hospitalized, including feeling an overall sense of helplessness, questioning the skills of staff, accepting the reality of hospitalization, needing to have information explained in simple language, dealing with fear, coping with uncertainty, and seeking reassurance from the health care team. The behavior does not indicate the parents are paranoid, indifferent, or wanting attention.

DIF: Cognitive Level: Analyzing REF: p. 868 TOP: Nursing Process: Evaluation

MSC: Client Needs: Psychosocial Integrity

26. When a preschool-age child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as what?

a.

Punishment

b.

Loss of parental love

c.

Threat to the childs self-image

d.

Loss of companionship with friends

ANS: A

The rationale for preparing children for the hospital experience and related procedures is based on the principle that a fear of the unknown (fantasy) exceeds fear of the known. Preschool-age children see hospitalization as a punishment. Loss of parental love would be a toddlers reaction. Threat to the childs self-image would be a school-age childs reaction. Loss of companionship with friends would be an adolescents reaction.

DIF: Cognitive Level: Analyzing REF: p. 878 TOP: Nursing Process: Evaluation

MSC: Client Needs: Psychosocial Integrity

27. A parent needs to leave a hospitalized toddler for a short period of time. What action should the nurse suggest to the parent to ease the separation for the toddler?

a.

Bring a new toy when returning.

b.

Leave when the child is distracted.

c.

Tell the child when they will return.

d.

Leave a favorite article from home with the child.

ANS: D

If the parents cannot stay with the child, they should leave favorite articles from home with the child, such as a blanket, toy, bottle, feeding utensil, or article of clothing. Because young children associate such inanimate objects with significant people, they gain comfort and reassurance from these possessions. They make the association that if the parents left this, the parents will surely return. Bringing a new toy would not help with the separation. The parent should not leave when the child is distracted, and toddlers would not understand when the parent should return because time is not a concept they understand.

DIF: Cognitive Level: Applying REF: p. 872

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

28. The nurse needs to assess a 15-month-old child who is sitting quietly on his fathers lap. What initial action by the nurse would be most appropriate?

a.

Ask the father to place the child on the exam table.

b.

Undress the child while he is still sitting on his fathers lap.

c.

Talk softly to the child while taking him from his father.

d.

Begin the assessment while the child is in his fathers lap.

ANS: D

For young children, particularly infants and toddlers, preserving parentchild contact is a good way of decreasing stress or the need for physical restraint during an assessment. For example, much of a patients physical examination can be done with the patient in a parents lap with the parent providing reassuring and comforting contact. The initial action would be to begin the assessment while the child is in his fathers lap.

DIF: Cognitive Level: Applying REF: p. 873

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

29. What parents should have the most difficult time coping with their childs hospitalization?

a.

Parents of a child hospitalized for juvenile arthritis

b.

Parents of a child hospitalized with a recent diagnosis of bronchiolitis

c.

Parents of a child hospitalized for sepsis resulting from an untreated injury

d.

Parents of a child hospitalized for surgical correction of undescended testicles

ANS: C

Factors that affect parents reactions to their childs illness include the seriousness of the threat to the child. The parents of a child hospitalized for sepsis resulting from an untreated injury would have more difficulty coping because of the seriousness of the illness and because the wound was not treated immediately.

DIF: Cognitive Level: Analyzing REF: p. 868

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

30. What choice of words or phrases would be inappropriate to use with a child?

a.

Rolling bed for stretcher

b.

Special medicine for dye

c.

Make sleepy for deaden

d.

Catheter for intravenous

ANS: D

Children can grasp information only if it is presented on or close to their level of cognitive development. This necessitates an awareness of the words used to describe events or processes, and exploring family traditions or approaches to information sharing and creating patient specific language or context. Therefore, to prevent or alleviate fears, nurses must be aware of the medical terminology and vocabulary that they use every day and be sensitive to the use of slang or confusing terminology. Catheter is a medical term and would be confusing.

DIF: Cognitive Level: Applying REF: p. 873

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Health Promotion and Maintenance

31. The nurse is assessing a childs functional self-care level for feeding, bathing and hygiene, dressing, and grooming and toileting. The child requires assistance or supervision from another person and equipment or device. What code does the nurse assign for this child?

a.

I

b.

II

c.

III

d.

IV

ANS: C

A code of III indicates the child requires assistance from another person and equipment or device. A code of I indicates use of equipment or device. A code of II indicates assistance or supervision from another person. A code of IV indicates the child is totally dependent.

DIF: Cognitive Level: Analyzing REF: p. 870

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. What are signs and symptoms of the stage of despair in relation to separation anxiety in young children? (Select all that apply.)

a.

Withdrawn from others

b.

Uncommunicative

c.

Clings to parents

d.

Physically attacks strangers

e.

Forms new but superficial relationships

f.

Regresses to early behaviors

ANS: A, B, F

Manifestations of the stage of despair seen in children during a hospitalization may include withdrawing from others, being uncommunicative, and regressing to earlier behaviors. Clinging to parents and physically attacking a stranger should be seen during the stage of protest, and forming new but superficial relationships is seen during the stage of detachment.

DIF: Cognitive Level: Applying REF: p. 865

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

2. What influences a childs reaction to the stressors of hospitalization? (Select all that apply.)

a.

Gender

b.

Separation

c.

Support systems

d.

Developmental age

e.

Previous experience with illness

ANS: B, C, D, E

Major stressors of hospitalization include separation, loss of control, bodily injury, and pain. Childrens reactions to these crises are influenced by their developmental age; previous experience with illness, separation, or hospitalization; innate and acquired coping skills; seriousness of the diagnosis; and support systems available. Gender does not have an effect on a childs reaction to stressors of hospitalization.

DIF: Cognitive Level: Understanding REF: p. 867

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

3. The parents tell a nurse our child is having some short-term negative outcomes since the hospitalization. The nurse recognizes that what can negatively affect short-term negative outcomes? (Select all that apply.)

a.

Parents anxiety

b.

Consistent nurses

c.

Number of visitors

d.

Length of hospitalization

e.

Multiple invasive procedures

ANS: A, D, E

The stressors of hospitalization may cause young children to experience short- and long-term negative outcomes. Adverse outcomes may be related to the length and number of admissions, multiple invasive procedures, and the parents anxiety. Consistent nurses would have a positive effect on short-term negative outcomes. The number of visitors does not have an effect on negative outcomes.

DIF: Cognitive Level: Understanding REF: p. 867

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. What are signs and symptoms of the stage of detachment in relation to separation anxiety in young children? (Select all that apply.)

a.

Appears happy

b.

Lacks interest in the environment

c.

Regresses to an earlier behavior

d.

Forms new but superficial relationships

e.

Interacts with strangers or familiar caregivers

ANS: A, D, E

Manifestations of the stage of detachment seen in children during a hospitalization may include appearing happy, forming new but superficial relationships, and interacting with strangers or familiar caregivers. Lacking interest in the environment and regressing to an earlier behavior are manifestations seen in the stage of despair.

DIF: Cognitive Level: Applying REF: p. 864

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

5. What factors influence the effects of a childs hospitalization on siblings? (Select all that apply.)

a.

Older siblings

b.

Experiencing minimal changes

c.

Receiving little information about their ill brother or sister

d.

Being cared for outside the home by care providers who are not relatives

e.

Perceiving that their parents treat them differently compared with before their siblings hospitalization

ANS: C, D, E

Various factors have been identified that influence the effects of a childs hospitalization on siblings. Factors that are related specifically to the hospital experience and increase the effects on the sibling are being cared for outside the home by care providers who are not relatives, receiving little information about their ill brother or sister, and perceiving that their parents treat them differently compared with before their siblings hospitalization. Being younger, not older, and experiencing many changes, not minimal changes, are factors that influence the effects of a childs hospitalization on siblings.

DIF: Cognitive Level: Analyzing REF: p. 868

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

6. What factors can negatively affect parents reactions to their childs illness? (Select all that apply.)

a.

Additional stresses

b.

Previous coping abilities

c.

Lack of support systems

d.

Seriousness of the threat to the child

e.

Previous experience with hospitalization

ANS: A, C, D

The factors that can negatively affect parents reactions to their childs illness are additional stresses, lack of support systems, and the seriousness of the threat to the child. Previous coping abilities and previous experience with hospitalization would have a positive effect on coping.

DIF: Cognitive Level: Understanding REF: p. 868

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

7. The nurse is assessing a familys use of complementary medicine practices. What practices are classified as mindbody control therapies? (Select all that apply.)

a.

Relaxation

b.

Acupuncture

c.

Prayer therapy

d.

Guided imagery

e.

Herbal medicine

ANS: A, C, D

Relaxation, prayer therapy, and guided imagery are classified as mindbody control therapies. Acupuncture and herbal medicine are classified as traditional and ethnomedicine therapies.

DIF: Cognitive Level: Analyzing REF: p. 872

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

8. The nurse is assessing a familys use of complementary medicine practices. What practices are classified as nutrition, diet, and lifestyle or behavioral health changes? (Select all that apply.)

a.

Reflexology

b.

Macrobiotics

c.

Megavitamins

d.

Health risk reduction

e.

Chiropractic medicine

ANS: B, C, D

Macrobiotics, megavitamins, and health risk reduction are classified as nutrition, diet, and lifestyle or behavioral health changes. Reflexology and chiropractic medicine are classified as structural manipulation and energetic therapies.

DIF: Cognitive Level: Analyzing REF: p. 872

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

9. Parents tell the nurse that siblings of their hospitalized child are feeling left out. What suggestions should the nurse make to the parents to assist the siblings to adjust to the hospitalization of their brother or sister? (Select all that apply.)

a.

Arrange for visits to the hospital.

b.

Limit information given to the siblings.

c.

Encourage phone calls to the hospitalized child.

d.

Make or buy inexpensive toys or trinkets for the siblings.

e.

Identify an extended family member to be their support system.

ANS: A, C, D, E

Strategies to support siblings during hospitalization include arranging for visits, encouraging phone calls, giving inexpensive gifts, and identifying a support person. Information should be shared with the siblings not limited.

DIF: Cognitive Level: Applying REF: p. 877

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity

10. What are core principles of patient- and family-centered care? (Select all that apply.)

a.

Collaboration

b.

Empowering families

c.

Providing formal and informal support

d.

Maintaining strict policy and procedure routines

e.

Withholding information that is likely to cause anxiety

ANS: B, C

Core principles of patent- and family-centered care include collaboration, empowerment, and providing formal and informal support. There should be flexibility in policy and procedures, and communication should be complete, honest, and unbiased, not withheld.

DIF: Cognitive Level: Understanding REF: p. 880

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

11. The nurse relates to parents that there are some beneficial effects of hospitalization for their child. What are beneficial effects of hospitalization? (Select all that apply.)

a.

Recovery from illness

b.

Improve coping abilities

c.

Opportunity to master stress

d.

Provide a break from school

e.

Provide new socialization experiences

ANS: A, B, C, E

The most obvious benefit is the recovery from illness, but hospitalization also can present an opportunity for children to master stress and feel competent in their coping abilities. The hospital environment can provide children with new socialization experiences that can broaden their interpersonal relationships. Having a break from school is not a benefit of hospitalization.

DIF: Cognitive Level: Applying REF: p. 867

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity

12. What nursing interventions should the nurse plan for a hospitalized toddler to minimize fear of bodily injury? (Select all that apply.)

a.

Perform procedures slowly.

b.

Maintain parentchild contact.

c.

Use progressively smaller dressings on surgical incisions.

d.

Tell the child bleeding will stop after the needle is removed.

e.

Remove a dressing as quickly as possible from surgical incisions.

ANS: B, C

Whenever procedures are performed on young children, the most supportive intervention to minimize the fear of bodily injury is to do the procedure as quickly as possible while maintaining parentchild contact. Because of toddlers and preschool childrens poorly defined body boundaries, the use of bandages may be particularly helpful. For example, telling children that the bleeding will stop after the needle is removed does little to relieve their fears, but applying a small Band-Aid usually reassures them. The size of bandages is also significant to children in this age group; the larger the bandage, the more importance is attached to the wound. Watching their surgical dressings become successively smaller is one way young children can measure healing and improvement. Prematurely removing a dressing may cause these children considerable concern for their well-being.

DIF: Cognitive Level: Applying REF: p. 873

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

Leave a Reply