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What action should the practical nurse (PN) implement when caring for a dying child and the family?
a) Provide adequate oral intake on a regular schedule
b) Organize care to minimize contact that interrupts rests
c) Allow family to give basic care when the child is alert
d) Tell family to continue talking to the child until time of death –
Correct Answer :Answer: D
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Rationale:
Families should be encouraged to talk to the child because the sense of hearing is acute until death
(D), and verbal communication and physical touch provide comfort for both the family and child.
When a child is dying, comfort is based on measures that respond to the child's requests beyond a
regular schedule for fluids (A). Nursing care should minimize disruptions but not contact (B). family
involvement in the basic care of the child should continue throughout the child's dying process, not
only when the child is alert (C).
A 2 year old child who is hospitalized has become withdrawn and quiet on the fourth day after
admission. The parent expresses concern about this change in behavior. Which explanation should the
practical nurse (PN) provide? The child is
a) Experiencing the despair stage of separation
b) Detaching emotionally from the family
c) Protesting the separation from the parents
d) Adjusting to hospitalization –
Correct Answer :Answer: A
Rationale:
In the despair stage of separation (A), the child exhibits signs of hopelessness and becomes quiet,
withdrawn, and apathetic. Toddlers do not readily "adjust" to hospitalization (D) and separation from
caregivers. During the detachment stage (B) which occurs after prolonged separation, the child
becomes interested in the environment and begins to play. In the protest stage (C), the child is likely
to cry and resist care by others, and is inconsolable.
A 3 year old boy cries, kicks, and clings to his father when the parents try to leave the hospital room.
The parents express their concern to the practical nurse (PN). What response should the PN provide?
a) "It is not helpful for parents to stay with children during hospitalization."
b) "Your child's behavior indicates a need for a psychological consultation."
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c) "You can avoid this if you wait to leave after your child falls asleep."
d) "Your child is showing a normal response to the stress of hospitalization." –
Correct Answer :Answer: D
Rationale:
The child is exhibiting a healthy attachment to the father (D). Leaving while your child is asleep creates
mistrust in the child (C). To minimize the child's stress hospital policy often require someone to stay
with their child during hospitalization, not (A). The child's behavior represents the protest stage of
separation and does not represent maladaptive behavior (B).
Which action is best for the practical nurse (PN) to implement to help a 7 year old child cope with a
lengthy course of IV antibiotics therapy?
a) give the child stickers for cooperative behavior
b) arrange for the child to go to the playroom daily
c) ask the child to draw a picture about himself
d) allow the child to participate in injection play –
Correct Answer :Answer: D
Supervised injection play (D) is an effective coping strategy for a school aged child who is receiving
extended IV therapy, or any other therapy involving syringes and needles. Rewards, such as stickers
(A) may enhance cooperative behavior but do not address coping with painful treatments. The
hospitalized child should have opportunities for play each day, if his condition warrants, but free play
(B) does not have any specific therapeutic purpose in preparing for painful experiences. (C) may not
elicit the child's feeling about IV treatment.
A 3 year old male child who has been toilet trained has had several urinary "accidents" since hospital
admission. What action should the practical nuse (PN) implement?
a) provide the child with frequent opportunities to urinate
b) inform the parent that the child will need to be retrained
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c) determine how the long the child has been toilet trained
d) place a bedpan on the bedside table for the child to use –
Correct Answer :Answer: A
Rationale:
Offering choices and allowing the child to make a decision increases the child's sense of control.
Asking the child frequently if he has to go to the bathroom (A) helps reduce the incidents of accidental
urinations. Regression to previous behaviors is common during hospitalization, even when the child
has been practicing the skill successfully (B). A 3 year old child is not developmentally able to use a
bedpan independently (D). Relearning a skill such as toilet training, contributes to the child's stress
and should not be attempted during hospitalization.
The practical nurse (PN) is caring for a school aged male child who is having problems adjusting to a
new school. Which action should the PN recommend to the parents that may foster their child's
developmental task of industry.
a) identify failures immediately for feedback from the child and his peers
b) structure the tasks in the home environment and recreational settings
c) decrease their expectations of home tasks and school success
d) ask the child what the child wants to achieve in his new school –
Correct Answer :Answer: B
Rationale:
Structuring the environment (B) provides opportunities to solve increasingly more complex problems,
which enhances self-confidence and promotes a sense of mastery. (C) is not as important as
structuring the environment so that the child is successful. (D) Does not promote a sense of
achievement or mastery. Sharing failures with the child's peers (A) for feedback reinforces the child's
feelings of failure.
During a well child visit, the mother of an infant states, "I will probably not have my baby immunized
because I am concerned about the risk of a severe reaction." Which response should the PN provide?
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