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

MULTIPLE CHOICE

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

Twenty-four hour observation

Emergency hospitalization

Outpatient admission

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 child’s and family’s 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?

Increased cost

Increased risk of infection

Lack of physical connection to the hospital

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 5-month-old infant

A 15-month-old toddler

A 4-year-old child

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?

The child is protesting because of separation from caregivers.

The child has adjusted to the hospitalization.

The child is experiencing the despair stage of separation.

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 nurse’s best response to the parents about this behavior?

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

“Your child is not coping effectively with hospitalization. We’ll need to get a psychological consult fr

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

“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 child’s 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 child’s 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, that’s why I got sick.” Which is the best rationale for this child’s statement?

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

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

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

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

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?

Encouraging peers to call and visit when the adolescent’s condition allows

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

Discouraging questions and concerns about the effects of the illness on the adolescent’s appearance

Asking the parents how the adolescent usually copes in new situations

ANS: A

The peer group is important to the adolescent’s 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 adolescent’s 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 toddler’s developmental task?

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

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

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

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

ANS: D

The toddler’s 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?

Assign the same nurse to care for the child.

Put a cover over the child’s crib.

Require parents to stay with the child.

Follow the child’s 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 child’s 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 child’s 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?

“Longer hospital stays are more costly.”

“Children become ill quickly and recover quickly.”

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

“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 child’s 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 child’s 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?

Newborns and infants

Infants and toddlers

Toddlers and preschoolers

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?

Toddlers

Preschoolers

School-age children

Adolescents

ANS: B

Active imagination is a primary characteristic of preschoolers. A toddler’s 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?

Blowing bubbles

Throwing a Nerf ball

Using a spirometer

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?

Toddlers

Preschoolers

School-age children

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?

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

Tell the child big boys and girls “don’t cry.”

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

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 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. 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 sibling’s repeated hospitalizations?

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

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

Assume the child understands that the sibling will soon be discharged because the child asks no quest Help the mother give the child a simple explanation of the treatment and encourage the mother to hav

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

Parents are expressing concerned about their preschooler’s current sleep habits, which were disrupted by a recent hospitalization, stating that the child now awakens frequently at night.

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

The child is probably expressing anger.

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

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?

Assign the neonate to a room with other neonates.

Provide play activities in the hospital room.

Offer the neonate a pacifier between feedings.

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