Essentials of Pediatric Nursing CH 11 EXAM REVIEWS

Essentials of Pediatric Nursing CH 11 EXAM REVIEWS The nurse working in the emergency room monitors the admission of children. Statistically, for which disorder would children younger than 5 years most commonly be admitted? Mental health problems Injuries Respiratory disorders Gastrointestinal disorders - CORRECT ANSWER-Ans: C Feedback: According to Child Health USA 2010, diseases of the respiratory system, such as asthma and pneumonia, account for the majority of hospitalizations in children younger than 5 years of age, while diseases of the respiratory system, mental health problems, injuries, and gastrointestinal disorders lead to more hospitalizations in older children. Origin: Chapter 11, 2 The nurse is caring for a 7-year-old girl hospitalized in isolation. The nurse notices that she has begun sucking her thumb and changing her speech patterns to those of a toddler. What condition is the girl manifesting? A) Regression B) Suppression C) Repression D) Denial - CORRECT ANSWER-Ans: A Feedback: Sucking the thumb and changing of speech pattern (such as to baby talk) are signs of regression, a defense mechanism used by children to deal with unpleasant experiences by returning to a previous stage that may be more comfortable to the child. Suppression is a conscious inhibition of an idea or desire. Repression is an unconscious inhibition of an idea or desire. Denial would be exhibited by expressions of resignation instead of true contentment, not thumb sucking or baby talk. Origin: Chapter 11, 3 The nurse is caring for an 8-year-old boy hospitalized for a bone marrow transplant. His parents are in and out of his room throughout the day. Which behaviors of the child would alert the nurse that he is in the second stage of separation anxiety? A) He ignores his parents when they return to his room. B) He cries uncontrollably whenever they leave. C) He forms superficial relationships with his caregivers. D) He sits quietly and is uninterested in playing and eating. - CORRECT ANSWER-Ans: D Feedback: Separation anxiety consists of three stages—protest, despair, and detachment. In the protest stage, the child reacts aggressively to separation and exhibits great distress by crying, expressing agitation, and rejecting others who attempt to offer comfort. In the despair phase the child displays hopelessness by withdrawing from others, becoming quiet without crying, and exhibiting apathy, depression, lack of interest in play and food, and overall feelings of sadness. In the detachment stage the child shows interest in the environment, starts to play again, and forms superficial relationships with the nurses and other children. If the parents return, the child ignores them. A child in this phase of separation anxiety exhibits resignation, not contentment. Origin: Chapter 11, 4 The nurse is caring for a 4-year-old girl who has been hospitalized for over a week with severe burns. Which would be a priority intervention to help satisfy this preschool child's basic needs? A) Encourage friends to visit as often as possible. B) Suggest that a family member be present with her 24 hours a day. C) Explain necessary procedures in simple language that she will understand. D) Allow her to make choices about her meals and activities as much as permitted. - CORRECT ANSWER-Ans: C Feedback: Preschoolers fear mutilation and are afraid of intrusive procedures since they do not understand the body's integrity. They interpret words literally and have an active imagination; therefore, procedures should be demonstrated and/or explained in simple terms. Adolescents typically do not experience separation anxiety from being away from their parents; instead, their anxiety comes from being separated from friends, and therefore encouraging friends to visit is a priority intervention. Toddlers are especially susceptible to separation anxiety and would benefit from a family member being present as much as possible. School-age children are accustomed to controlling self-care and typically are highly social; they would benefit from being involved in choices about meals and activities. Origin: Chapter 11, 5 The nurse is caring for a hospitalized 13-year-old girl, who is questioning everything the medical staff is doing and is resistant to treatment. How should the nurse respond? A) "Let's work together to plan your day along with your treatments." B) "The sooner you cooperate, the sooner you are going to leave." C) "If you are more cooperative, perhaps we can arrange a visit from friends." D) "Please don't make me call your parents about this." - CORRECT ANSWER-Ans: A Feedback: Collaborating with the adolescent will provide the teen with increased control. The nurse should work with the teen to provide a mutually agreeable schedule that allows for the teen's preferences while incorporating the required nursing care. Threatening to call the parents will most likely promote further resistance. The nurse should try to immediately engage the girl, rather than making the nurse's cooperation conditional upon the girl's cooperation. Telling the girl that the sooner she cooperates, the sooner she will leave is inappropriate. The nurse is incorrectly implying that her behavior, rather than her medical needs, is going to determine when she will be discharged from the hospital. Origin: Chapter 11, 6 The nurse is caring for a 10-year-old boy who is in traction. The boy has a nursing diagnosis of deficient diversional activity related to confinement in bed that is evidenced by verbalization of boredom and lack of participation in play, reading, and schoolwork. What would be the best intervention? A) Offer the child reading materials. B) Enlist the aid of a child life specialist. C) Encourage the child to complete his homework. D) Ask for the parents' assistance. - CORRECT ANSWER-Ans: B Feedback: The nurse should enlist the aid of a child life specialist to provide suggestions for appropriate activities. Offering the child reading materials or encouraging him to complete his homework would most likely be met with resistance as he has already verbalized his boredom and disinterest in play, reading, and schoolwork. The parents could offer the child life specialist ideas about the boy's likes and dislikes; however, the child life specialist could offer expertise in assisting hospitalized children. Origin: Chapter 11, 7 The nurse is caring for a 13-year-old girl hospitalized for complications from type 1 diabetes. The girl has a nursing diagnosis of powerlessness related to lack of control of multiple demands associated with hospitalization, procedures, treatments, and changes in usual routine. How can the nurse help promote control? A) Ask the child to identify her areas of concern. B) Encourage participation of parents in care activities. C) Offer the girl as many choices as possible. D) Enlist the family's assistance in creating a time schedule. - CORRECT ANSWERAns: C Feedback: The nurse needs to offer the girl as many choices as possible, such as options for food and drink (as her diet allows), hygiene, activities, or clothing options to promote feelings of individuality and control. Two of the other options engage the parents in the process. A 13-year-old girl is capable of making her own choices regarding activities, schedules, and routine, but she may not be able to identify her areas of concern. Origin: Chapter 11, 8 The nurse is caring for an 8-year-old girl who requires numerous venipunctures and injections daily. The nurse understands that the child is exhibiting signs of sensory overload and enlists the assistance of the child life specialist. What should the therapeutic play involve to best deal with the child's stressors? A) Puppets and dolls B) Drawing paper and crayons C) Wooden hammer and pegs D) Sewing puppets with needles - CORRECT ANSWER-Ans: D Feedback: The nurse understands that the child may benefit from supervised needle play to assist the child undergoing frequent blood work, injections, or intravenous procedures. The child life specialist can determine what form of therapeutic play is best, but the nurse can recommend interventions based on his or her knowledge of the specific child. Origin: Chapter 11, 9 After teaching a group of students about therapeutic play, the instructor determines that additional teaching is needed when the students identify what as a characteristic of therapeutic play? A) Focus on coping B) Use of a highly structured format C) Dramatization of emotions D) Expression of feelings - CORRECT ANSWER-Ans: B Feedback: Therapeutic play is nondirected play, focused on helping the child cope with feelings and fears. Real-life stressors and emotions can be acted out or dramatized, allowing the child to express his or her feelings. Origin: Chapter 11, 10 The mother of a hospitalized child reports that her daughter, who is having some difficulty eating, just had a 4-ounce cup of ice chips. The nurse documents this on the child's intake flow sheet as how much? A) 2 ounces B) 4 ounces C) 6 ounces D) 8 ounces - CORRECT ANSWER-Ans: A Feedback: Ice chips are included as fluid intake, and the amount is approximately equivalent to half the same amount of water. Therefore, the nurse would document this fluid intake as 2 ounces. Origin: Chapter 11, 11 The nurse is preparing a nursing care plan for a child hospitalized for cardiac surgery. Which are examples of interventions that nurses perform in the 'building a trusting relationship' stage? Select all that apply. A) Gathering information about the child using the child's own toys B) Preparing the child for a procedure by playing games C) Explaining in simple terms what will happen during surgery D) Allowing the child to devise an exercise plan following surgery E) Praising the child for how well he is doing following instructions F) Giving the child a favorite toy to cuddle following a painful procedure - CORRECT ANSWER-Ans: B, C Feedback: The introduction phase involves the initial contact with children and their families and it establishes the foundation for a trusting relationship. A trusting relationship can be built