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Sherpath- Hospitalized Child Class 19
and 20
A child with a serious chronic illness will soon be discharged home. The case manager requests that the family provide total care for the child for a couple of days while the child is still hospitalized. In light of the principles of family-centered care, which statement addresses this principle? This is appropriate because families are usually eager to get involved. This is appropriate because it can be beneficial to the transition from hospital to home. This is inappropriate because of legal issues when parents care for their children on hospital property. This is inappropriate because the family will have to assume the care soon enough and this may increase their stress unnecessarily. - ✔✔This is appropriate because it can be beneficial to the transition from hospital to home. Rationale: Having the family care for the child is appropriate, because at least two family members should be comfortable caring for the child before discharge. Caring for the child with the nurse available to answer questions and provide support and guidance will make the transition home for the parents and child easier. The family needs to learn the skills necessary to care for the child at home. Their eagerness is important, but it is not the reason for them to provide total care for their child while still hospitalized. The family members will be able to learn to care for their child with the supervision of nursing staff. Legal issues related to caring for their child in the hospital setting are not relevant. Learning to care for their child before discharge is essential to properly prepare the family to assume the care and minimize their stress level as much as possible. What is the most common reaction of many parents to their child's hospitalization? Relief
Anger Fear Depression - ✔✔Fear Rationale: Fear, anxiety, and frustration are common responses of parents when a child becomes ill or is hospitalized. Relief, anger, and depression are not common reactions. Which is an example of dramatic play? Using puppets to decrease anxiety Decorating the hospital room to decrease anxiety Using crayons and paper to express anxiety Using paint and imagination to reduce anxiety - ✔✔Using puppets to decrease anxiety Rationale: Dramatic play is a technique for emotional release of the child during hospitalization. A puppet show includes dramatic play. Providing crayons and paper for the child are diversion activities. Asking the child to decorate the room will help divert the child through creative expression. Painting is also a type of creative expression. Separation anxiety is common in which age group of children? Toddlers Neonates Adolescents School-age - ✔✔Toddlers
ambulatory setting eliminates the need for overnight stay. The cost of treatment is reduced, as the amount of time spent in the hospital is less. When caring for children, which child does the nurse recognize as having an increased risk for poor coping strategies? A child who is visited frequently by the family A child undergoing multiple invasive procedures A sick school-age child who loves board games A teenager who is given information about physical status. - ✔✔A child undergoing multiple invasive procedures Rationale: Frequent hospitalizations and multiple invasive procedures increase the risk for poor coping strategies. Supportive behavior such as frequent visits from the family helps the child cope. The sick school-age child who overcomes boredom and physical restriction in the hospital by playing board games is able to cope well. Adolescents rely on nurses for anticipatory preparation to decrease fear and anxiety. A teenager who is provided information about health status copes better while in the hospital. A 4-year-old child is scheduled for cardiac surgery in a week. The child's parents call the hospital to ask how to prepare the child for the upcoming hospitalization and surgical procedure. The nurse's reply should be based on what knowledge? Preparation at this age will only increase the child's stress. Children who are prepared experience less fear and stress during hospitalization. Preparation needs to be at least 2 to 3 weeks before hospitalization to be effective. Children who are prepared experience overwhelming fear by the time hospitalization occurs. - ✔✔Children who are prepared experience less fear and stress during hospitalization.
Rationale: Preparing the child for the hospitalization will reduce the number of unknown elements. Taking tours, handling some of the equipment, or being told stories about what to expect will increase the familiar items. Timing of the preparation must also be considered. Four- to 7-year-old children may be prepared up to 1 week in advance of the hospitalization. Preparation of a 4-year-old child will reduce stress because the child can incorporate and assimilate the information more slowly. Children between the ages of 4 and 7 years should be prepared about 1 week before hospitalization. A reduction, not a worsening, of fear is usually observed when children are prepared appropriately for hospitalization. What intervention by the nurse can help ease negative feelings and fear in a 5-year-old child being admitted to the hospital? Preparing the child for the hospital experience No intervention because children this age cannot be prepared No intervention because preparation will increase the child's stress Preparing the child for the potential negative effects of hospitalization - ✔✔Preparing the child for the hospital experience. Rationale: The best intervention the nurse can use to help decrease negative feelings and fear in a 5-year-old child being admitted to the hospital is to prepare the child for the hospital experience. A 5-year-old child can be prepared for hospitalization. Preparation will decrease, rather than increase stress. Preparing the child for the potential negative effects of hospitalization is not helpful and may likely increase the child's stress. What is the most appropriate way for the nurse help a child feel empowered to cope during a painful procedure? Apologizing for hurting the child Coaching the child to hold her feelings inside Telling the child that the pain will be over soon
The parents of a young child tell the nurse that they cannot stay with their daughter during hospitalization. What can the nurse say to the parents that will help the child adjust to their absence? "A child just needs her parents. Can't you find a way to be here?" "It'll be fine. Just buy some new toys from the hospital gift store." "Young children like new toys much better than they do older ones." "At this age children often need the comfort and reassurance of familiar toys from home." - ✔✔"At this age children often need the comfort and reassurance of familiar toys from home." Rationale: Parents should bring favorite items from home for the child. Young children associate inanimate objects with significant people, and they gain comfort and reassurance from these items. Because the parents are leaving the objects at the hospital, the preschooler knows that the parents will return. Trying to guilt the parents into staying with the child after they have already said that they cannot stay will not help the child or parent adjust to hospitalization. New toys will not serve the purpose of familiar toys and objects from home. A nurse is caring for a 6-year-old child recovering from surgery in an outpatient setting. What is the priority nursing intervention for this family at discharge? Bagging all of their belongings before discharge Getting the child back to socializing with friends Placing a blanket and pillow in the car to keep the child comfortable on the drive home Providing guidelines on when to call their practitioner regarding a change in the child's condition - ✔✔Providing guidelines on when to call their practitioner regarding a change in the child's condition Rationale: The priority nursing intervention for this family is proper and complete discharge planning, including guidelines on when to call the practitioner regarding a change in the child's
condition. Bagging all their belongings before discharge, getting the child back to socializing with friends, and placing a blanket and pillow in the car to keep the child comfortable on the drive home are not nursing priorities for this family. The nurse is caring for a child whose parents are unable to stay with the child for long hours. What action by the nurse helps to ease the feelings of separation from home? Surround the child with familiar articles. Move the child's bed toward the window. Provide musical, visual, or tactile activities. Allow the child to continue school lessons. - ✔✔Surround the child with familiar articles. Rationales: If the parents cannot stay long, the nurse can allow familiar articles in the room to ease the feelings of separation from home. Favorite toys, photographs, and recordings of the family members provide comfort and reassurance. The nurse ensures sensory freedom for the child who has restricted physical movement by moving the bed toward the window or providing musical, visual, or tactile activities. The nurse helps the child to maintain a usual routine by allowing the child to continue school lessons. Which behavior would most likely manifest in a young child experiencing the protest phase of separation anxiety? Inactivity Clinging to the parent Depression and sadness Forming superficial relationships - ✔✔Clinging to the parent Rationale: In the protest phase of separation anxiety, the child aggressively responds to separation from a parent by clinging and holding onto the parent and screaming for the parent.
regarded as a major stressor. Pain is a concern, because it affects body image, but adolescents have more self-control than do younger children when it comes to dealing with pain. Restricted motor activity is an issue if it affects the adolescent's body image. Adolescents are able to tolerate separation from their material things better than they can tolerate the fear of altered body image. A school-age child is at risk for infection and is placed in an isolation room. What does the nurse tell the child to prevent stress? Says that it is a special place that makes all the germs go away Says that it is a magical room that will make the child well Says that the child needs to stay in the room for some time Says that the child is not well and needs special care - ✔✔Says that it is a special place that makes all the germs go away Rationale: An isolation room affects the child's orientation of time and place and increases stress, so the nurse explains the purpose of keeping the child in the isolation room. The nurse can explain that the child needs to be in the room to get better, because it is a special place that will make the germs go away. This will alleviate the child's anxiety. The nurse does not say that the room is magical, because this may lead the child to imagine something unusual. The child is likely to view the isolation room as a punishment if the nurse says that the child needs to stay there for some time. Saying that the child is not well may make the child more anxious. The parents of a child in isolation ask the nurse about the kinds of toys that would be appropriate for their child. What is the nurse's best response? Provide the child with new colorful toys. Give the child only one large toy to play. Bring a few of the child's stuffed toys from home.
Provide toys that can be disinfected after every use. - ✔✔Provide toys that can be disinfected after every use. Rationale: Toys for isolated children must be disposable or disinfected after every use to prevent the transmission of infection. Hospitalized children prefer to play with familiar toys that remind them of home rather than new ones. A few small, well-chosen toys are usually preferred to a single large toy. Most children prefer to play with stuffed toys from home; however, it is not easy to clean stuffed toys after every use. What is the primary nursing goal for a hospitalized toddler? Providing privacy Encouraging parents to room in Explaining procedures and routines Encouraging contact with children of the same age - ✔✔Encouraging parents to room in Rationale: A toddler experiences separation anxiety when separated from the parents. As a means of avoiding this, the parents should be encouraged to room in. Explaining routines and ensuring privacy are helpful goals, but the primary goal for a hospitalized toddler is to prevent separation. A child is sad, does not communicate, and has no interest in playing. In what stage of separation anxiety is the child? Denial Protest Despair Detachment - ✔✔Despair
or she will be rewarded with chocolate every time he or she cries. The child may get scared if he or she is left alone in the hospital surroundings. Rationale: A child who appears sad, is nontalkative, and lacks interest is in the despair stage of separation anxiety. During the protest stage, the child will refuse to be apart from his or her parents and will cry or scream while being separated from his or her loved ones. During the detachment (or denial) stage, children show increased interest in their surroundings. A preschool child admitted to the hospital does not seem to be happy when the parents visit. The parents express their concern to the nurse. What is the best response by the nurse? The child is an "ideal patient" and is adjusting well to the situation. The child is happy and content in the new surroundings. The absence of the parents is beneficial to the child's recovery. The child's behavior is a superficial adjustment to the separation. - ✔✔The child's behavior is a superficial adjustment to the separation. Rationale: The child's behavior is a superficial adjustment to the separation. The child detaches from the parents in an effort to overcome the emotional pain of desiring the parents' presence. The child copes with the absence of parents by appearing to be happy and interested in the new surroundings. This behavior leads the health team members to wrongly assume that the child is an "ideal patient." The parents may be wrongly considered as "intruders" and may shorten their visits. The result is a destructive cycle of misunderstanding. When caring for a school-age child, what interventions by the nurse help the child to become a cooperative and satisfied patient? Select all that apply. Helping the child with a bed bath Engaging the child in a hobby
Allowing the child to choose a menu Permitting age-appropriate board games Ensuring complete bed rest for the child. - ✔✔Engaging the child in a hobby Allowing the child to choose a menu Permitting age-appropriate board games Rationale: Engaging the child in a hobby helps to promote adjustment to physical restrictions in the hospital. The child cooperates with nursing care when allowed to exert a certain measure of control, such as choosing a menu. Age-appropriate board games help the child overcome boredom and depression. Routine nursing interventions, such as helping the child with a bed bath or ensuring complete bed rest, may be perceived as a threat to individual control, resulting in lack of cooperation or satisfaction. The nurse is providing care for a toddler in a hospital setting. The nurse observes that the parents are unable to visit the child often, and the child has become inactive, sad, and uncommunicative. What does the nurse conclude from the child's behavior? The child is in the protest stage of separation anxiety. The child is in the despair stage of separation anxiety. The child is in the detachment stage of separation anxiety. The child is trying to cope with the hospitalization stress. - ✔✔The child is in the despair stage of separation anxiety. Rationale: Signs of sadness, inactivity, and lack of communication indicate that the child is in the despair stage of separation anxiety. The protest stage is indicated by the child's crying and screaming for parents. The detachment stage is seen when the child detaches from the parents to cope with the anxiety of separation. The child is not trying to cope in the despair stage; instead there is inability to cope.
Rationale: Questions about allergy to medicine are directed toward evaluation of the child's preparation for hospitalization and the need for additional preparation for hospitalization. Allergy to medicines must be considered for treatment and diagnostic tests. Information about the family's mealtimes, the child's food preferences, and sleep patterns help the nurse to assess the child's usual health habits at home. This helps the nurse to promote a more normal environment for the child during hospitalization. The parents of a ventilator-dependent child tell the nurse that their insurance company wants the child discharged. The child's parents explain that they do not want the child home "under any circumstances." What should the nurse consider when working with this family? Parents should not be expected to care for a technology-dependent child. The parents' desire to have the child home is essential to effective home care. Having a technology-dependent child at home is better for both child and family. The parents' role in the decision-making process is limited compared with that of the insurance company because of the costs of hospitalization. - ✔✔The parents' desire to have the child home is essential to effective home care. Rationale: For high-quality home care to be provided to a child, parental desire and ability are essential. The community must have adequate resources for the child and parent, including capable professional support. Most parents can learn how to manage the care of the technology-dependent child, thereby enhancing their desire to have their child at home. The child's psychosocial care will be improved if the child is in a home where the parents are comfortable with the care and grow to see their life as a family as "normal." Parents need to be included in the decision-making process in to all aspects of their child's care, both in the health care setting and at home. Placement of the child at home will not be effective without parental participation. Insurance companies should never dictate or have complete authority over any decisions regarding children and their health care. Whether having a technology-dependent child at home is better for the child and family depends on the family. Parental comfort, community support, and available resources are critical to the care provided and to the family structure and relationships.
What does the nurse avoid when communicating with a child during emergency admission counseling? Asking the child about his or her pain Asking what grade the child is in this year Using the words "honey" or "dear" Inquiring about previous hospital experiences - ✔✔Using the words "honey" or "dear" Rationale: The nurse should focus on essential components of admission counseling, including use of the child's name, not terms such as "honey" or "dear." The nurse can gather information about the chief complaint by asking, "Where does it hurt the most?" Asking the child about his or her grade will help judge the developmental age to provide appropriate care. Asking about previous hospital experiences provides information about the child's general state of health. A 2-year-old child has just been admitted to the hospital with pneumonia. The child is crying and visibly upset. The nurse is beginning to perform the physical assessment when the mother asks, "Would it be better if I left the room?" What is the best response by the nurse? "Yes, please—that would preferable." "If you want to run to the coffee shop, that would be great!" "Whatever you want to do is fine. I just need to get this assessment done." "I can perform the assessment while you hug him on your lap. I think he'll feel safer that way." - ✔✔"I can perform the assessment while you hug him on your lap. I think he'll feel safer that way." Rationale: A 2-year-old child will feel safer sitting on the parent's lap while the nurse performs the assessment. Telling the parent to leave is not a developmentally appropriate response.
convincing, because the child understands simple and clear messages. Telling the child that an operation is not painful is not appropriate, because the child may find the concept of surgery traumatic. What is a common experience of a sibling during a sister's or brother's illness or hospitalization? Anger Support Detachment Positive adaptation - ✔✔Anger Rationale: Siblings tend to react to a sister's or brother's illness or hospitalization with anger and/or jealousy. Support, detachment, and positive adaptation are not as common as anger and jealousy. The nurse is caring for a school-age child with a leg cast. What types of play activities does the nurse include in the child's care plan? Provides Lego blocks and building materials for the child Takes the child to a play area in a wheelchair Tells parents to bring new and expensive toys for the child Provides varied and large number of toys for the child - ✔✔Provides Lego blocks and building materials for the child Rationale: The nurse provides Lego blocks and building materials for the child to keep the child active and prevent boredom. Taking the child to a play area is not appropriate, because the child cannot engage in normal activities. The nurse asks the parents to bring old familiar toys for the child to provide comfort. New toys will not help the child to link with home. The nurse
does not provide a large number of toys, because they may confuse and frustrate the child. Instead the nurse provides small, well-chosen toys as appropriate for the child. What strategies can the nurse suggest to help the family of a 5-year-old child prepare for transportation home from the ambulatory setting? Select all that apply. Have a blanket or pillow in the car. Take a basin or plastic bag along in case of vomiting. Wait to give the prescribed pain medication until the child returns home. Ensure that they take all personal items home with them from the ambulatory setting. Carry the written discharge information regarding potential side effects of pain medication with them. - ✔✔Have a blanket or pillow in the car. Take a basin or plastic bag along in case of vomiting. Ensure that they take all personal items home with them from the ambulatory setting. Carry the written discharge information regarding potential side effects of pain medication with them. Rationale: Strategies that the nurse can suggest to help the family of a 5-year-old child prepare for transportation home from the ambulatory setting include having a blanket or pillow in the car, taking a basin or plastic bag with them in case of vomiting, ensuring that they take all personal items home with them from the ambulatory setting, and carrying the written discharge information regarding potential side effects of pain medication with them. It is better to suggest giving the prescribed pain medications before the child leaves the ambulatory setting than it is to wait to give the prescribed pain medication when the child returns home. The nurse removes an intravenous needle from a toddler's hand and quickly covers the area with a bandage. Why is a bandage particularly important in this age group?
