Emergency Care of Children

MULTIPLE CHOICE

1. Which nursing action would facilitate care being provided to a child in an emergency situation?

a.
Encourage the family to remain in the waiting room.
b.
Assist parents in distracting the child during a procedure.
c.
Always reassure the child and family.
d.
Give explanations using professional terminology.

ANS: B

Include parents as partners in the child’s treatments. Parents may need direct guidance in concrete terms to help distract the child. Allowing the parents to remain with the child may help calm the child. Telling the truth is the most important thing. False reassurance does not facilitate a trusting relationship. Professional terminology may not be understood. Speak to the child and family in language that they will understand.

DIF: Cognitive Level: Comprehension REF: p. 203|p. 205

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

2. The father of a child in the emergency department is yelling at the physician and nurses. Which action would becontraindicated in this situation?

a.
Provide a nondefensive response.
b.
Encourage the father to talk about his feelings.
c.
Speak in simple, short sentences.
d.
Tell the father he must wait in the waiting room.

ANS: D

Because a parent who is upset may be aggravated by observers, he should be directed to a quiet area. When dealing with parents who are upset, it is important not to be defensive or attempt to justify anyone’s actions. Encouraging the father to talk about his feelings may assist him to acknowledge his emotions and may defuse his angry reaction. People who are upset need to be spoken to with simple words (no longer than five letters) and short sentences (no more than five words).

DIF: Cognitive Level: Application REF: p. 204

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

3. Which would be an appropriate nursing intervention for a 6-month-old infant in the emergency department?

a.
Distract the infant with noise or bright lights.
b.
Avoid warming the infant.
c.
Remove any pacifiers from the baby.
d.
Encourage the parent to hold the infant.

ANS: D

Parents should be encouraged to hold the infant as much as possible while in the emergency department. Having the parent hold the infant may help to calm the child. Distraction with noise or bright lights would be most appropriate for a preschool-age child. In an emergency healthcare facility, it is important to keep infants warm. Infants use pacifiers to comfort themselves; therefore, the pacifier should not be taken away.

DIF: Cognitive Level: Application REF: pp. 204-205

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

4. Which action should the nurse working in the emergency department initiate to decrease fear in a 2-year-old child?

a.
Keep the child physically restrained during nursing care.
b.
Allow the child to hold a favorite toy or blanket.
c.
Direct the parents to remain outside the treatment room.
d.
Let the child decide whether to sit up or lie down for procedures.

ANS: B

Allowing a child to hold a favorite toy or blanket is comforting. It may be necessary to restrain the toddler for some nursing care or procedures. Because toddlers need autonomy and do not respond well to restrictions, the nurse should remove any restriction or restraint as soon as safety permits. Parents should remain with the child as much as possible to calm and reassure the child. The toddler should not be given the overwhelming choice of deciding which position she prefers.

DIF: Cognitive Level: Application REF: p. 205

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

5. Which nursing action would be most appropriate to assist a preschool-age child in coping with the emergency department experience?

a.
Explain the procedures and give the child some time to prepare.
b.
Remind the child that she is a big girl.
c.
Avoid the use of bandages.
d.
Use positive terms and avoid terms such as “shot” and “cut.”

ANS: D

Using positive terms and avoiding words that have frightening connotations assist the child in coping. Preschool-age children should be told about procedures immediately before they are done. Time to prepare only allows time for fantasies and increased anxiety. Children should not be shamed into cooperation. Bandages are important to preschool-aged children. Children in this age group believe that their insides can leak out and that bandages stop this from happening.

DIF: Cognitive Level: Application REF: p. 205

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

6. Which action should the nurse incorporate into a care plan for a 14-year-old child in the emergency department?

a.
Limit the number of choices to be made by the adolescent.
b.
Insist that parents remain with the adolescent.
c.
Provide clear explanations and encourage questions.
d.
Give rewards for cooperation with procedures.

ANS: C

Adolescents are capable of abstract thinking and can understand explanations. They should be offered the opportunity to ask questions and make decisions. Adolescents should have the choice of whether parents remain with them. They are very modest, and this modesty should be respected. Giving rewards such as stickers for cooperation with treatments or procedures is more appropriate for the younger child.

DIF: Cognitive Level: Application REF: p. 205

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

7. The emergency department nurse notices that the mother of a young child is making a lot of phone calls and getting advice from her friends about what she should do. This behavior is an indication of which of the following?

a.
Stress
b.
Healthy coping skills
c.
Attention-getting behaviors
d.
Low self-esteem

ANS: A

Hyperactive behavior such as making a lot of phone calls and enlisting everyone’s opinions is a sign of stress. This is not a healthy coping skill and may be an attention-getting behavior or indicative of the mother having low self-esteem, but is more likely an indicator of stress.

DIF: Cognitive Level: Analysis REF: p. 206

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

8. A preschool child in the emergency department has a respiratory rate of 10 breaths per minute. How should the nurse interpret this finding?

a.
The child is relaxed.
b.
Respiratory failure is likely.
c.
This child is in respiratory distress.
d.
The child’s condition is improving.

ANS: B

Very slow breathing in an ill child is an ominous sign, indicating respiratory failure. Althoug