Family-Centered Care of the Child During Illness and Hospitaliza- tion

MULTIPLE CHOICE

1. Which of the following represents the major stressor of hospitalization for children from middle infancy throughout the preschool years?
a. Separation anxiety
b. Loss of control

c. Fear of bodily injury d. Fear of pain

ANS: A
The major stressor for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization.

DIF: Cognitive Level: Comprehension REF: Page 659
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

2. During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his parents left him, and he refused the staff’s attention. Now the nurse observes that Eric appears to be “settled in” and unconcerned about seeing his parents. The nurse should interpret this as which of the following?

a. He has successfully adjusted to the hospital environment.
b. He has transferred his trust to the nursing staff.
c. He may be experiencing detachment, which is the third stage of separation

anxiety.
d. Because he is “at home” in the hospital now, seeing his mother frequently will

only start the cycle again.

ANS: C
These are the behavior manifestations of the separation anxiety phase of detachment. Superficially it appears that the child has adjusted to the loss.

DIF: Cognitive Level: Analysis REF: Page 659
TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

Pub Review 21-2

3. When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as which of the following?
a. Punishment

b. Threat to child’s self-image
c. An opportunity for regression
d. Loss of companionship with friends

ANS: A
If a toddler is not prepared for hospitalization, a typical preschooler fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds.

DIF: Cognitive Level: Comprehension REF: Page 662
TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

4. Because of their striving for independence and productivity, which age-group of children is particularly vulnerable to events that may lessen their feeling of control and power?
a. Infants

b. Toddlers
c. Preschoolers
d. School-age children

ANS: D
When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurp 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.

DIF: Cognitive Level: Analysis REF: Page 662
TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

5. 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.” The nurse should recognize that:
a. this is normal behavior for a school-age child.

b. this behavior 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.

ANS: A
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.

Pub Review 21-3

DIF: Cognitive Level: Analysis REF: Page 662
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

6. The most common initial reaction of parents to illness or injury and hospitalization in their child is which of the following?
a. Anger
b. Fear

c. Depression d. Disbelief

ANS: D
Disbelief is the most common initial response of parents. This is especially true if the illness is sudden and serious.

DIF: Cognitive Level: Comprehension REF: Page 664
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PsychosocialIntegrity:CopingMechanisms

7. 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 neighbors.” Which of the following 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. Family has ineffective coping mechanisms to deal with chronic illness. d. The siblings need to better understand their sister’s illness and needs.

ANS: B
Siblings experience loneliness, fear, and worry, as well as anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child.

DIF: Cognitive Level: Analysis REF: Page 668
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PsychosocialIntegrity:CopingMechanisms

8. An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler would be which of the following?
a. Provide for privacy.
b. Encourage parents to room in.

c. Explain procedures and routines.
d. Encourage contact with children the same age.

Pub Review 21-4

ANS: B
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.

DIF: Cognitive Level: Analysis REF: Page 668
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

9. Four-year-old Brian appears to be upset by hospitalization. Which of the following is an appropriate intervention?
a. Let him know 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.

ANS: A
Crying is an appropriate behavior for the upset preschooler. The nurse provides support through physical presence.

DIF: Cognitive Level: Analysis REF: Page 669
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

10. Latasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. Which of the following will help her most in her adjustment to the hospital?
a. Explain hospital schedules to her, 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.

ANS: A
School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for those experiences that are unavailable.

DIF: Cognitive Level: Comprehension REF: Page 671
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

11. Samantha, age 5 years, tells the nurse that she “needs a Band-Aid” where she had an injection. Which of the following is the best nursing action?
a. Apply a Band-Aid.
b. Ask her why she wants a Band-Aid.

Pub Review 21-5

c. Explain why a Band-Aid is not needed.
d. Show her that the bleeding has already stopped.

ANS: A
Children at this age-group still fear that their insides may leak out at the injection site. Provide the Band-Aid.

DIF: Cognitive Level: Comprehension REF: Page 672
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

12. 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 an understanding of which of the following?

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.

ANS: C
Parents should bring favorite items from home to be with the child. Young children associate inanimate objects with people who are significant in their lives. The favorite items will comfort and reassure the child. Since the parents left the objects, the preschooler knows the parents will return.

DIF: Cognitive Level: Analysis REF: Page 670
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

13. 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.” Which of the following is appropriate in the care plan for this parent who is experiencing guilt?

a. Clarify misconception about the illness.
b. Explain to parent that the illness is not serious.
c. Encourage parent to maintain a sense of control.
d. Assess further why parent has excessive guilt feelings.

ANS: A
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.

Pub Review 21-6

DIF: Cognitive Level: Analysis REF: Page 664
TOP: Integrated Process: Nursing Process: Planning
MSC: AreaofClientNeeds:PsychosocialIntegrity:CopingMechanisms

14. 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 because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is:
a. unnecessary.
b. the surgeon’s responsibility.
c. too stressful for a young child.
d. an appropriate part of the child’s preparation.

ANS: D
This is a necessary part of preoperative preparation. If the child wakes and is not prepared for the inability to speak, she will be even more anxious.

DIF: Cognitive Level: Analysis REF: Page 665
TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

15. 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 of the following statements 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 for 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.”

ANS: C
Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status, so friends visiting are an important aspect of hospitalization for an adolescent.

DIF: Cognitive Level: Analysis REF: Page 662 | Page 663
TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance: Growth and Development

MULTIPLE RESPONSE

1. 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 of the following stressors to be evident? (Select all that apply.)

Pub Review 21-7

Unfamiliar environment
Usual day-night routine
Strange smells
Provision of privacy
Inadequate knowledge of condition and routine

ANS: A, C, E
Intensive care units, especially when the family is unprepared for the admission, are a strange and unfamiliar place with many pieces of unfamiliar equipment. The sights and sounds are much different from those of 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.

DIF: Cognitive Level: Analysis REF: Page 682
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PsychosocialIntegrity:CopingandAdaptation