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Which one of the following is a major stressor when children from middle infancy through the preschool years are hospitalized?
a. Separation anxiety
b. Loss of control
c. Fear of bodily injury
d. Fear of pain

The major stress caused by hospitalization for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization as well. However, separation from the family is a primary stressor for this age group.


When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child will likely see hospitalization as which one of the following?
a. A punishment
b. A threat to child’s self-image
c. An opportunity for regression
d. Loss of companionship with friends

If a preschool child is not prepared for hospitalization, they typically believe the hospitalization is a punishment for real or imagined misdeeds. Viewing hospitalization as a threat to the child’s self-image and fearing the loss of companionship with friends are reactions typical of school-age children. Regression is a response characteristic of toddlers when threatened with loss of control.


Because they strive for independence and productivity, which age group of children is particularly vulnerable to events that may lessen their feelings of control and power?
a. Infants
b. Toddlers
c. Preschoolers
d. School-age children

When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurps individual power and identity. This is especially detrimental to school-age children who are striving for independence and productivity and are now experiencing events that lessen their control and power. Infants, toddlers, and preschoolers, although affected by loss of power, are not as significantly affected as school-age children.


A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, “Wait a minute,” and, “I’m not ready.” What should the nurse recognize about this behaviour?
a. This is normal behaviour for a school-age child.
b. This behaviour is usually not seen past the preschool years.
c. The child thinks the nurse is punishing her.
d. The child has successfully manipulated the nurse in the past.

This school-age child is attempting to maintain control. The nurse should provide the girl with structured choices about when the IV will be inserted. This is characteristic behaviour when an individual needs to maintain some control over a situation. The child is trying to have some control in the hospital experience.


Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, “We are sick of Mom always sitting with you in the hospital and playing with you. It isn’t fair that you get everything and we have to stay with the neighbours.” What is the nurse’s best assessment of this situation?
a. The siblings are immature and probably spoiled.
b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling.
c. The family has ineffective coping mechanisms to deal with chronic illness.
d. The siblings need to better understand their sister’s illness and needs.

Siblings experience loneliness, fear, worry, anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These are not uncommon responses by normal siblings. There is no evidence that the family has maladaptive coping.


What is an appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler in the Critical Care Unit?
a. Provide for privacy.
b. Encourage parents to room in.
c. Explain procedures and routines.
d. Encourage contact with children the same age.

A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible and visiting hours need to be liberal. Maintaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents. Contact with same-aged children would not substitute for having the parents present.


Four-year-old Brian appears to be upset by hospitalization. What is an appropriate intervention?
a. Let him know that it is all right to cry.
b. Give him time to gain control of himself.
c. Show him how other children are cooperating.
d. Tell him what a big boy he is to be so quiet.

Crying is an appropriate behaviour for the upset preschooler. The nurse provides support with his or her physical presence. Giving the child time to gain control is appropriate, but the child must know that crying is acceptable. The preschooler does not engage in competitive behaviours.


Natasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What will help her most in her adjustment to the hospital?
a. Explain hospital routines such as mealtimes.
b. Use terms such as “honey” and “dear” to show a caring attitude.
c. Explain when parents can visit and why siblings cannot come to see her.
d. Orient her parents, because she is young, to her room and hospital facility.

School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for experiences that are unavoidable, and should refer to the child by the preferred name. Telling the child about all of the limitations of visiting does not help her adjust to the hospital. At the age of 8 years, both the child and parent should be oriented to the environment.


Samantha, age 5 years, tells the nurse that she “needs a Band-Aid” where she had an injection. What is the best nursing action?
a. Apply a Band-Aid.
b. Ask her why she wants a Band-Aid.
c. Explain why a Band-Aid is not needed.
d. Show her that the bleeding has already stopped.

Children in this age group still fear that their insides may leak out at the injection site. Provide the Band-Aid. No explanation should be required.


Kimberly, age 3 years, is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her “a lot of new toys because she will be in the hospital.” The nurse’s reply should be based on knowing which of the following statements?
a. New toys make hospitalization easier.
b. New toys are usually better than older ones for children of this age.
c. At this age, children often need the comfort and reassurance of familiar toys from home.
d. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

Parents should bring favourite items from home to be with the child. Young children associate inanimate objects with significant people; they gain comfort and reassurance from these items. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive


Matthew, age 18 months, has just been admitted with croup. His parent is tearful and tells the nurse, “This is all my fault. I should have taken him to the doctor sooner so he wouldn’t have to be here.” What is the appropriate response for this parent who is experiencing guilt?
a. Clarify the misconception about the illness.
b. Explain to the parent that the illness is not serious.
c. Encourage the parent to maintain a sense of control.
d. Assess further why the parent has excessive guilt feelings.

Guilt is a common response of parents when a child is hospitalized. They may blame themselves for the child’s illness or for not recognizing it soon enough. The nurse should clarify the nature of the problem and reassure parents that the child is being cared for. Croup is potentially a very serious illness; it is unwise to lie about or trivialize the child’s condition. The nurse should also not minimize the parents’ feelings. Encouraging the parents to maintain a sense of control is not helpful, as it would be difficult while their child is seriously ill. No further assessment is indicated at this time—guilt is a common response for parents.


The nurse is doing a prehospitalization orientation for Diana, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that she will not be able to talk right after the surgery because of an endotracheal tube, but that she will be able to when it is removed. Which of the following statements best describes this explanation?
a. It is unnecessary.
b. It is the surgeon’s responsibility.
c. It is too stressful for a young child.
d. It is an appropriate part of the child’s preparation.

This is a necessary part of preoperative preparation that will help reduce the anxiety associated with surgery. If the child wakes and is not prepared for the inability to speak, she will be even more anxious. Preparing the child for what to expect is a joint responsibility of nursing, medical staff, and child life personnel.


The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which statement by the adolescent would be expected about separation anxiety?
a. “I wish my parents could spend the night with me while I am in the hospital.”
b. “I think I would like my siblings to visit me, but not my friends.”
c. “I hope my friends don’t forget about visiting me.”
d. “I will be embarrassed if my friends come to the hospital to visit.”

Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status; visits from friends are an important aspect of hospitalization for an adolescent and are very reassuring. Adolescents may welcome the opportunity to be away from their parents. The separation from siblings may produce reactions from difficulty coping to a welcome relief.


Ryan has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and Ryan’s condition is beginning to stabilize. When speaking with the parents, the nurses should expect which one of the following stressors to be evident?
a. Familiar environment
b. Usual day-night routine
c. Provision of privacy
d. Inadequate knowledge of condition and routine

Although there are several stressors caused by a child’s admittance to the ICU, inadequate knowledge of his condition and the routine are applicable in this scenario. The intensive care unit, especially when the family is unprepared for the admission, is a strange and unfamiliar place. There are many kinds of unfamiliar equipment, and the sights and sounds are very different from a general hospital unit. Also, with the child’s condition being more precarious, it may be difficult to keep the parents updated and knowledgeable about what is happening. Lights are usually on around the clock, seriously disrupting the diurnal rhythm. There is usually little privacy available for families in intensive care units.