C 21

Chapter 21: Family-Centered Care of the Child During Illness and Hospitalization
MULTIPLE CHOICE
1. A nurse is caring for four patients; three are toddlers and one is a preschooler. Which
represents the major stressor of hospitalization for these four patients?

Separation anxiety
Loss of control
Fear of bodily injury
Fear of pain
a.
b.
c.
d.
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. Loss of control,
fear of bodily injury, and fear of pain are all stressors associated with hospitalization.
However, separation from family is a primary stressor in this age group.
PTS: 1
DIF: Cognitive Level: Analyze
REF: 613
TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Health Promotion and Maintenance
2. During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his
parents left him, and he refused the staffs 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 statement?
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
Detachment is a behavior manifestation of separation anxiety. Superficially it appears that the

child has adjusted to the loss. Detachment is a sign of resignation, not contentment. Parents
should be encouraged to be with their child. If parents restrict visits, they may begin a pattern
of misunderstanding the childs cues and not meeting his needs.
PTS: 1
REF: 613
TOP: Integrated Process: Nursing Process: Diagnosis
3. When a preschool child is hospitalized without adequate preparation, the nurse should
recognize that the child may likely see hospitalization as:

punishment.
threat to childs self-image.
an opportunity for regression.
loss of companionship with friends.
a.
b.
c.
d.
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. Attributing the hospitalization to
punishment for real or imagined misdeeds is a reaction typical of toddler and school-age
children when threatened with loss of control.
PTS: 1
DIF: Cognitive Level: Understand
REF: 615
4. Which age group should the pediatric nurse recognize as being vulnerable to events that 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. Infants, toddlers, and preschoolers, although affected to different extents by loss of
power, are not as significantly affected as are school-age children.
PTS: 1
REF: 615
5. A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the
nurse, Wait a minute and Im not ready. The nurse should recognize this as which
description?
a. This is normal behavior for a school-age child.
b. The behavior is 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
The 10-year-old girl is attempting to maintain control. The nurse should provide the girl with
structured choices about when the IV will be inserted. Telling the nurse Wait a minute and
Im not ready can be characteristic behavior when an individual needs to maintain some
control over a situation.
PTS: 1
REF: 616
TOP: Integrated Process: Nursing Process: Implementation
6. The most common initial reaction of parents to illness or injury and hospitalization in their
child is:
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. Anger or guilt is usually the second reaction stage. Fear, anxiety, and
frustrations also are common feelings. Parents may finally react with some form of depression
related to the physical and emotional exhaustion associated with a hospitalized child.
PTS: 1
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Psychosocial Integrity
REF: 617
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 isnt fair that you get everything and we have to stay with the
neighbors. Which is the nurses 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 sisters 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. There is no
evidence that the family has maladaptive coping mechanisms.
PTS: 1
REF: 617
8. An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler
would be to:
a. provide for privacy.
b. encourage parents to room in.
c. explain procedures and routines.
d. encourage contact with children the same age.
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. Maintaining
routines and ensuring privacy are helpful interventions, but they would not substitute for the
parents. Encouraging contact with children the same age would not substitute for having the
parents present.
PTS: 1
DIF: Cognitive Level: Apply
REF: 628
9. Four-year-old Brian appears to be upset by hospitalization. Which 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. 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
behaviors.
PTS: 1
REF: 621
10. Latasha, age 8 years, is being admitted to the hospital from the emergency department with an
injury from falling off her bicycle. Which will help her most in her adjustment to the hospital?
Explain hospital schedules to her, such as mealtimes.
Use terms such as honey and dear to show a caring attitude.
Explain when parents can visit and why siblings cannot come to see her.
Orient her parents, because she is young, to her room and hospital facility.
a.
b.
c.
d.
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. The nurse should
refer to the child by the preferred name. Explaining when parents can visit and why siblings
cannot come to see her is telling the child all of the limitations, not helping her adjust to the
hospital. At the age of 8 years, the child should be oriented to the environment along with the
parents.
PTS: 1
REF: 614
11. Samantha, age 5 years, tells the nurse that she needs a Band-Aid where she had an injection.
Which 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.
ANS: A
Children at this age group still fear that their insides may leak out at the injection site. Provide
the Band-Aid. No explanation should be required. The nurse should be prepared to apply a
small Band-Aid after the injection.
PTS: 1
REF: 623
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 nurses reply should be based on an understanding of which concept?
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. Because the parents left the objects, the preschooler knows the
parents will return. 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.
PTS: 1
REF: 621
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 wouldnt have
to be here. Which 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 childs 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
a potentially serious illness. The nurse should not minimize the parents feelings. It would be
difficult for the parent to maintain a sense of control while the child is seriously ill. No further
assessment is indicated at this time; guilt is a common response for parents.
PTS: 1
TOP: Integrated Process: Nursing Process: Planning
REF: 627
14. A 14-year-old boy is being admitted to the hospital for an appendectomy. Which roommate
should the nurse assign with this patient?

A 4-year-old boy with first day post-appendectomy surgery
A 6-year-old boy with pneumonia
A 15-year-old boy admitted with a vasoocclusive sickle cell crisis
A 12-year-old boy with cellulitis
a.
b.
c.
d.
ANS: C
When a child is admitted, nurses follow several fairly universal admission procedures. The
minimum considerations for room assignment are age, sex, and nature of the illness. Age
grouping is especially important for adolescents. The 14-year-old boy being admitted to the
unit after appendectomy surgery should be placed with a noninfectious child of the same sex
and age. The 15-year-old child with sickle cell is the best choice. The 4-year-old postappendectomy is too young, and the child with pneumonia is too young and possibly has an
infectious process. The 12-year-old boy with cellulitis is the right age, but he has an infection
(cellulitis).
PTS: 1
REF: 618 | 621
MSC: Area of Client Needs: Safe and Effective Care Environment: Management of Care
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 statement by the adolescent should 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 dont 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. Most adolescents do not need a parent to spend the night during hospitalization
and sometimes view the hospitalization as a welcome event. Adolescents would be more
concerned about friends visiting than siblings. Adolescents want visitors to keep control and
maintain social status among their group of peers.
PTS: 1
REF: 615
16. A nurse is preparing to complete an admission assessment on a 2-year-old child. The child is
sitting on the parents lap. Which technique should the nurse implement to complete the
physical exam?
a. Ask the parent to place the child in the hospital crib.
b. Take the child and parent to the exam room.
c. Perform the exam while the child is on the parents lap.
d. Ask the child to stand by the parent while completing the exam.
ANS: C
The nurse should complete the exam while the child is on the parents lap. For young children,
particularly infants and toddlers, preserving parentchild contact is the best means of
decreasing the need for or stress of restraint. The entire physical examination can be done in a
parents lap with the parent hugging the child for procedures such as an otoscopic
examination. Placing the child in the crib, taking the child to the exam room, or asking the
child to stand by the parent would separate the child from the parent and cause anxiety.
PTS: 1
REF: 622

17. A school-age child, admitted for intravenous antibiotic therapy for osteomyelitis, reports
difficulty in going to sleep at night. Which intervention should the nurse implement to assist
the child in going to sleep at bedtime?
a. Request a prescription for a sleeping pill.
b. Allow the child to stay up late and sleep late in the morning.
c. Create a schedule similar to the one the child follows at home.
d. Plan passive activities in the morning and interactive activities right before
bedtime.
ANS: C
Many children obtain significantly less sleep in the hospital than at home; the primary causes
are a delay in sleep onset and early termination of sleep because of hospital routines. One
technique that can minimize the disruption in the childs routine is establishing a daily
schedule. This approach is most suitable for noncritically ill school-age and adolescent
children who have mastered the concept of time. It involves scheduling the childs day to
include all those activities that are important to the child and nurse, such as treatment
procedures, schoolwork, exercise, television, playroom, and hobbies. The school-age child
with osteomyelitis would benefit from a schedule similar to the one followed at home.
Requesting a prescription for a sleeping pill would be inappropriate and allowing the child to
stay up late and sleep late would not be keeping the child in a routine followed at home.
Passive activities in the morning and interactive activities at bedtime should be reversed; it
would be better to keep the child active in the morning hours and plan quiet activities at
bedtime.
PTS: 1
REF: 622
18. A previously potty-trained 30-month-old child has reverted to wearing diapers while
hospitalized. The nurse should reassure the parents that this is normal because of which
reason?
a. Regression is seen during hospitalization.
b. Developmental delays occur because of the hospitalization.
c. The child is experiencing urinary urgency because of hospitalization.
d. The child was too young to be potty-trained.
ANS: A
Regression is expected and normal for all age groups when hospitalized. Nurses should assure
the parents this is temporary and the child will return to the previously mastered
developmental milestone when back home. This does not indicate a developmental delay. The
child should not be experiencing urinary urgency because of hospitalization and this would
not be normal. Successful potty-training can be started at 2 years of age if the child is ready.
PTS: 1
REF: 624
TOP: Integrated Process: Teaching/Learning
19. A child is playing in the playroom. The nurse needs to do a blood pressure on the child. Which
is the appropriate procedure for obtaining the blood pressure?

a. Take the blood pressure in the playroom.
b. Ask the child to come to the exam room to obtain the blood pressure.
c. Ask the child to return to his or her room for the blood pressure, then escort the
child back to the playroom.

d. Document that the blood pressure was not obtained because the child was in the
playroom.
ANS: C
The play room is a safe haven for children, free from medical or nursing procedures. The child
can be returned to his or her room for the blood pressure and then escorted back to the
playroom. The exam room is reserved for painful procedures that should not be performed in
the childs hospital bed. Documenting that the blood pressure was not obtained because the
child was in the playroom is inappropriate.
PTS: 1
REF: 624
20. A nurse in the emergency department is assessing a 5-year-old child with symptoms of
pneumonia and a fever of 102 F. Which intervention can the nurse implement to promote a
sense of control for the child?
a. None, this is an emergency and the child should not participate in care.
b. Allow the child to hold the digital thermometer while taking the childs blood
pressure.
c. Ask the child if it is OK to take a temperature in the ear.
d. Have parents wait in the waiting room.
ANS: B
The nurse should allow the child to hold the digital thermometer while taking the childs
blood pressure. Unless an emergency is life threatening, children need to participate in their
care to maintain a sense of control. Because emergency departments are frequently hectic,
there is a tendency to rush through procedures to save time. However, the extra few minutes
needed to allow children to participate may save many more minutes of useless resistance and
uncooperativeness during subsequent procedures. The child may not give permission, if asked,
for a procedure that is necessary to be performed. It is better to give choices such as, Which
ear do you want me to do your temperature in? instead of, Can I take your temperature?
Parents should remain with their child to help with decreasing the childs anxiety.
PTS: 1
REF: 631
21. A nurse is admitting a toddler to the hospital. The parent needs to leave for a brief period.
Which figure depicts the reaction the nurse expects from the child?
a.
c.
b.
d.
ANS: A
The major stress from middle infancy throughout the preschool years, especially for children
ages 6 to 30 months, is separation anxiety, also called anaclitic depression. During the stage
of protest, children react aggressively to the separation from the parent. They cry and scream
for their parents, refuse the attention of anyone else, and are inconsolable in their grief. When
the parent leaves even for a short time this is the expected reaction and the figure that depicts
the child not wanting the parent to leave is what the nurse should expect as a reaction from the
child. The child sitting alone sadly depicts a child in the despair stage. In this stage depression
is evident. The child is much less active, is uninterested in play or food, and withdraws from
others. The child sitting on the parents lap is withdrawn and sad, even in the presence of the
parent. The child depicted playing a game is adjusting to the hospitalization with play.
PTS: 1
REF: 613
MULTIPLE RESPONSE
1. A child has just been unexpectedly admitted to the intensive care unit after abdominal surgery.
The nursing staff has completed the admission process, and the childs condition is beginning
to stabilize. When speaking with the parents, the nurses should expect which stressors to be
evident? (Select all that apply.)
a. Unfamiliar environment
b. Usual day-night routine
c. Strange smells
d. Provision of privacy
e. 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 childs 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.
PTS: 1
REF: 632
2. A nurse plans therapeutic play time for a hospitalized child. Which are the benefits of
therapeutic play? (Select all that apply.)

a. Serves as method to assist disturbed children
b. Allows the child to express feelings
c. The nurse can gain insight into the childs feelings.
d. The child can deal with concerns and feelings.
e. Gives the child a structured play environment
ANS: B, C, D
Therapeutic play is an effective, nondirective modality for helping children deal with their
concerns and fears, and at the same time, it often helps the nurse gain insights into childrens
needs and feelings. Play and other expressive activities provide one of the best opportunities
for encouraging emotional expression, including the safe release of anger and hostility.
Nondirective play that allows children freedom for expression can be tremendously
therapeutic. Play therapy is a structured therapy that helps disturbed children. It should not be
confused with therapeutic play.
PTS: 1
REF: 625
3. A child is being discharged from an ambulatory care center after an inguinal hernia repair.
Which discharge interventions should the nurse implement? (Select all that apply.)
Discuss dietary restrictions.
Hold any analgesic medications until the child is home.
Send a pain scale home with the family.
Suggest the parents fill the prescriptions on the way home.
Discuss complications that may occur.
a.
b.
c.
d.
e.
ANS: A, C, E
The discharge interventions a nurse should implement when a child is being discharged from
an ambulatory care center should include dietary restrictions, being very specific and giving
examples of clear fluids or what is meant by a full liquid diet. The nurse should give
specific information on pain control and send a pain scale home with the family. All
complications that may occur after an inguinal hernia repair should be discussed with the
parents. The pain medication, as prescribed, should be given before the child leaves the
building and prescriptions should be filled and given to the family before discharge.
PTS: 1
REF: 630
TOP: Integrated Process: Teaching/Learning

4. A child is being admitted to the intensive care unit (ICU) and the parents are with the child.
Which creates stressors for children and parents in ICUs? (Select all that apply.)
Equipment noise
Privacy
Caring behavior by the nurse
Unfamiliar smells
Sleep deprivation
a.
b.
c.
d.
e.
ANS: A, D, E
The ICU can create physical and environmental stressors for children and their families.
Equipment noise (monitors, suction equipment, telephones, computers), unfamiliar smells
(alcohol, adhesive remover, body odors), and sleep deprivation all are stressors found in the
ICU. Privacy as opposed to no privacy and a caring nurse as opposed to unkind or thoughtless
comments from staff help reduce the stressors of the ICU.
PTS: 1
REF: 633
5. A nurse is interviewing the parents of a toddler about use of complementary or alternative
medical practices. The parents share several practices they use in their household. Which
should the nurse document as complementary or alternative medical practices? (Select all that
apply.)
a. Use of acetaminophen (Tylenol) for fever
b. Administration of chamomile tea at bedtime
c. Hypnotherapy for relief of pain
d. Acupressure to relieve headaches
e. Cool mist vaporizer at the bedside for stuffiness
ANS: B, C, D
When conducting an assessment, the nurse should inquire about the use of complementary or
alternative medical practices. Administration of chamomile tea at bedtime, hypnotherapy for
relief of pain, and acupressure to relieve headaches are complementary or alternative medical
practices. Using Tylenol for fever relief and a cool mist vaporizer at the bedside to reduce
stuffiness are not considered complementary or alternative medical practices.
PTS: 1
REF: 620

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C 21

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Chapter 21: Family-Centered Care of the Child During Illness and Hospitalization

represents the major stressor of hospitalization for these four patients?

Detachment is a behavior manifestation of separation anxiety. Superficially it appears that the

recognize that the child may likely see hospitalization as:

their feeling of control and power?

8. An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler

b. Give him time to gain control of himself.

Which is the best nursing action?

a. New toys make hospitalization easier.

should the nurse assign with this patient?

MSC: Area of Client Needs: Psychosocial Integrity

is the appropriate procedure for obtaining the blood pressure?

child back to the playroom.

therapeutic play? (Select all that apply.)

DIF: Cognitive Level: Apply

TOP: Integrated Process: Teaching/Learning

5. A nurse is interviewing the parents of a toddler about use of complementary or alternative

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