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Flashcards in Chapter 21 Deck (12):

When the nurse uses a standard nursing care plan as a guide in planning care for a hospitalized child, which should be eliminated?
a. Expected outcome or goal
b. Dependent nursing functions
c. Problems not pertinent to the child and family
d. Potential health problems of the child and family

Ans: C
To create an individualized care plan, the nurse eliminates the irrelevant material and specific information not pertinent to the child and family in question.
Consideration of an expected outcome or goal is an essential component of an individualized nursing care plan.
Consideration of dependent nursing functions, or those interventions requiring an order, is an essential component of an individualized nursing care plan.
Consideration of potential health problems of the child and family is an essential component of an individualized nursing care plan.


Guidelines for a nurse using an interpreter in developing a care plan for an 8-year-old admitted to rule out epilepsy include
a. explaining to the interpreter what information is necessary to obtain from the patient and family.
b. encouraging the interpreter to ask several questions at a time to make the best use of time.
c. not giving the interpreter too much information so that the interview evolves.
d. discouraging the interpreter and client from discussing topics that are deemed irrelevant to the original intent of the interview.

Ans: A
The interpreter should be given guidance as to what information is necessary to obtain during the interview.
One question should be asked at a time, leaving sufficient time for the family to ANS.
The interpreter should not have to guess what to ask and what information to obtain during the interview.
The interpreter should gain as much information from the family as they are willing to share based on the questions posed. Limits should not be placed on the interview.


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?
a. The parents' desire to have the child home is essential to effective home care.
b. Parents should not be expected to care for a technology-dependent child.
c. Parents' role in the decision-making process is limited when compared with that of the insurance company because of the costs of hospitalization.
d. Having a technology-dependent child at home is better for both the child and the family.

Ans: A
To provide high-quality home care for children, 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, thus 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 becoming "normal."
Parents need to be included in the decision-making process related 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 relative to 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.


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. Based on the principles of family-centered care, which statement addresses this principle?
a. Appropriate because families are usually eager to get involved
b. Appropriate because it can be beneficial to the transition from hospital to home
c. Inappropriate because of legal issues when parents care for their children on hospital property
d. Inappropriate because the family will have to assume the care soon enough and this may increase their stress unnecessarily

Ans: B
This is appropriate. 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 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.


A 21/2-year-old ventilator-dependent child will be discharged home soon. The family expresses concern that their child might change the ventilator settings by exploring the control knobs and buttons. Based on the nurse’s knowledge of child development, the most appropriate intervention by the nurse is to
a. teach the child not to touch controls
b. explain that the child cannot be left alone because of the risk of the child changing the settings
c. recommend ways to cover the controls to reduce the risk of the child changing the settings
d. reassure the family that developmentally the child is unable to change the ventilator settings

Ans: C
If the equipment does not have "lock-out" capabilities, then clear plastic covers and tape should be applied, similar to how a parent might secure the knobs in a tub.
The toddler is too young to understand the concept associated with harm.
The child will need to be supervised while awake, and alarms must be on when the child is asleep.
Toddlers can manipulate dials; therefore, protective mechanisms must be in place at all times.


The nurse needs to start an intravenous (IV) line for an 8-year-old child to begin administering IV antibiotics. The child starts to cry and tells the nurse, "Do it later, OK?" The most appropriate action by the nurse is to
a. start the IV because allowing the child to manipulate the nurse is not professional behavior
b. start the IV because unlimited procrastination results in heightened anxiety
c. postpone starting the IV until the child is ready so that the child experiences a sense of control
d. postpone starting the IV until the child is ready so that the child's anxiety is reduced

Ans: B
Beginning IV antibiotics is a priority action for the nurse. A short delay may be possible to allow the child some choice, but a prolonged delay only serves to increase the child's anxiety.
The nurse should start the IV, recognizing that the child is attempting to gain control. Whether the child is trying to manipulate the nurse should have no bearing on the implementation of the nursing action.
If the timing of the IV start was not essential, delaying the starting of the IV might be acceptable.
The child may never be ready to have the IV started. The child's anxiety is likely to increase with a prolonged delay.


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 the knowledge that
a. preparation at this age will only increase the child's stress
b. preparation needs to be at least 2 to 3 weeks before hospitalization to be effective
c. children who are prepared experience less fear and stress during hospitalization
d. children who are prepared experience overwhelming fear by the time hospitalization occurs

Ans: C
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-olds can be prepared up to 1 week in advance of the hospitalization.
Preparation of a 4-year-old will reduce stress by having the child 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 in fear is usually observed when children are prepared appropriately for hospitalization.


A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for Mommy. What is the nurse's best reply?
a. "Mommy will be here after lunch."
b. "Mommy always comes back to see you."
c. "Your Mommy told me yesterday that she would be here today about noon."
d. "Mommy had to go home for a while, but she will be here today."

Ans: A
Because toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon to a familiar activity that takes place at that time.
Telling the child that his mother always comes back to see him does not give the child any meaningful information about when his mother will visit.
Twelve noon is a meaningless concept for a toddler.
Stating that his mother had to go home but will be back today does not provide the child with any meaningful information related to when she will actually visit.


An appropriate nursing intervention for a child with nephrotic syndrome on bed rest is to
a. restrain the child as necessary
b. discourage the parents from holding the child
c. do passive range-of-motion exercises once a day
d. adjust activities to the child's tolerance level

Ans: D
The child will have a variable level of tolerance for activity. The activity tolerance will also be affected by the labile moods associated with steroid administration. The nurse should assist the family in adjusting activities for the child that are age appropriate.
Restraints should not be used to confine a child to bed unless the child is a potential threat to self or others.
Parents should be encouraged to hold the child.
The child should be encouraged to move all extremities while in bed to prevent the potential complications of immobility.


Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety?
a. Inactivity
b. Clinging to the parent
c. Depression and sadness
d. Forming superficial relationships

Ans: B
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.
Inactivity is a sign of despair in a young child, not protest.
A depressed, sad child indicates despair, not the protest phase.
The formation of superficial relationships indicates that a young child is in the phase of detachment, not protest.


The psychosexual conflicts of preschool children make them extremely vulnerable to
a. separation anxiety.
b. loss of control.
c. bodily injury and pain.
d. loss of identity.

Ans: C
Intrusive procedures, whether or not they are perceived as painful, are threatening to the preschooler because of the poorly developed concept of body integrity.
Separation anxiety is more of a characteristic of infancy.
Loss of control is a characteristic fear of school-age children.
Loss of identity is a concern of adolescents because illnesses are conceptualized as the effect on the individual.


An adolescent is admitted to the hospital for a fractured femur. The most appropriate nursing intervention(s) in caring for this adolescent is/are to (Select all that apply.)
a. provide written material about the hospital.
b. provide an opportunity for the adolescent to try on surgical attire.
c. explain the upcoming surgery to the adolescent using anatomically correct models.
d. provide an opportunity for the adolescent to talk with peers who have had a similar experience.
e. provide education for the parents of what to teach so they can share with their adolescent.

Ans: A, C, D