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Nursing Care of Children 3rd Edition James Ashwill Test Bank

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Nursing Care of Children 3rd Edition James Ashwill Test Bank

ISBN: 9781416042228

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Nursing Care of Children 3rd Edition James Ashwill Test Bank

ISBN: 9781416042228

 

 

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Free Nursing Test Questions:

James: Nursing Care of Children: Principles and Practice, 3rd Edition

Test Bank

Chapter 11: The Ill Child in the Hospital and Other Care Settings

MULTIPLE CHOICE

 

  1. Which of the following situations poses the greatest challenge to the nurse working with a child and family?
a. Twenty-four hour observation
b. Emergency hospitalization
c. Outpatient admission
d. Rehabilitation admission

 

 

ANS:   B

 

  Feedback
A Although preparation time may be limited with a 24-hour observation, this situation does not usually involve the acuteness of the situation and the high levels of anxiety associated with emergency admission.
B Emergency hospitalization involves (1) limited time for preparation both for the child and family, (2) situations that cause fear for the family that the child may die or be permanently disabled, and (3) a high level of activity, which can foster further anxiety.
C Outpatient admission generally involves preparation time for family and child. Because of the lower level of acuteness in these settings, anxiety levels are not as high.
D Rehabilitation admission follows a serious illness or disease. This type of unit may resemble a home environment, which decreases the child and family’s anxiety.

 

 

DIF:    Cognitive Level: Comprehension      REF:    Text Reference: pg 285

OBJ:    Nursing Process Step: Planning

MSC:   NCLEX: Safe Effective Care Environment

 

  1. What is the primary disadvantage associated with outpatient and day facility care?
a. Increased cost
b. Increased risk of infection
c. Lack of physical connection to the hospital
d. Longer separation of the child from family

 

 

ANS:   C

 

  Feedback
A This type of care decreases cost.
B This type of care decreases risk of infection.
C Outpatient and day facility care do not provide extended care; therefore, a child requiring extended care would have to be transferred to the hospital, causing increased stress to the child and parents.
D This type of care minimizes separation of the child from family.

 

 

DIF:    Cognitive Level: Comprehension      REF:    Text Reference: pg 285

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Safe Effective Care Environment

 

  1. Which child would have the most difficulty with separation from family during hospitalization?
a. A 5-month-old infant
b. A 15-month-old toddler
c. A 4-year-old child
d. A 7-year-old child

 

 

ANS:   B

 

  Feedback
A Infants younger than 6 months of age will generally adapt to hospitalization if their basic needs for food, warmth, and comfort are met.
B Separation is the major stressor for children hospitalized between the ages of 6 and 30 months.
C Although separation anxiety occurs in hospitalized preschoolers, it is usually less obvious and less serious than that experienced by the toddler.
D The school-age child is accustomed to separation from parents. Although hospitalization is a stressor, the 7-year-old child will have less separation anxiety than a 15-month-old toddler.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 288

OBJ:    Nursing Process Step: Assessment    MSC:   NCLEX: Psychosocial Integrity

 

  1. What is the best explanation for a 2-year-old child who is quiet and withdrawn on the fourth day of a hospital admission?
a. The child is protesting her separation from her caregivers.
b. The child has adjusted to the hospitalization.
c. The child is experiencing the despair stage of separation.
d. The child has reached the stage of detachment.

 

 

ANS:   C

 

  Feedback
A In the protest stage, the child would be agitated, crying, resistant to caregivers, and inconsolable.
B Toddlers do not readily “adjust” to hospitalization and separation from caregivers.
C In the despair stage of separation, the child exhibits signs of hopelessness and becomes quiet, withdrawn, and apathetic.
D The detachment stage occurs after prolonged separation. During this phase, the child becomes interested in the environment and begins to play.

 

 

DIF:    Cognitive Level: Comprehension      REF:    Text Reference: pg 289

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. A 3-year-old child cries, kicks, and clings to the father when the parents try to leave the hospital room. What is the nurse’s best response to the parents about this behavior?
a. “Your child is showing a normal response to the stress of hospitalization.”
b. “Your child is not coping effectively with hospitalization. We’ll need to get a psychologic consult from the doctor.”
c. “It is helpful for parents to stay with children during hospitalization.”
d. “You can avoid this if you wait to leave after your child falls asleep.”

 

 

ANS:   A

 

  Feedback
A The child is exhibiting a healthy attachment to the father.
B The child’s behavior represents the protest stage of separation and does not represent maladaptive behavior.
C This response places undue stress and guilt on the parents.
D This response fosters the child’s mistrust.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 289

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. The hospitalized preschooler fears mutilation and misunderstands illness. Which of the following is the best rationale for this?
a. The child has a fear that mutilation will lead to death.
b. The toddler’s imagination is very active, and he may believe the illness is a result of something he did.
c. The child has a general understanding of body integrity at this age.
d. The child will not have fear related to an IV catheter initiation but will have fear of an impending surgery.

 

 

ANS:   B

 

  Feedback
A Preschoolers do not have the cognitive ability to connect mutilation to death.
B The child has imaginative thoughts at this stage of growth and development. The child may believe that an illness occurred as a result of some personal deed or thought or perhaps because he touched something or someone.
C Preschoolers do not have a sound understanding of body integrity.
D The preschooler fears all types of intrusive procedures whether undergoing a simple procedure such as an IV start or something more invasive such as surgery.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 290

OBJ:    Nursing Process Step: Evaluation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which is the most developmentally appropriate intervention when working with the hospitalized adolescent?
a. Encourage peers to call and visit when the adolescent’s condition allows.
b. Be sure the adolescent wears a hospital gown or pajamas throughout the hospitalization.
c. Discourage questions and concerns about the effects of the illness on the adolescent’s appearance.
d. Ask the parents how the adolescent usually copes in new situations.

 

 

ANS:   A

 

  Feedback
A The peer group is important to the adolescent’s sense of belonging and identity; therefore separation from friends is a major source of anxiety for the hospitalized adolescent.
B Adolescents should be encouraged to wear their own clothes to foster their sense of identity.
C Questions and concerns about the adolescent’s appearance and the effects of illness on appearance should be encouraged.
D How the adolescent copes should be asked directly of the adolescent.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 292

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. The nurse is discussing toddler development with the mother of a -year-old child. Which statements by the mother indicate she has an understanding of how to help the child succeed in a developmental task?
a. “I always help my daughter complete tasks to help her achieve a sense of accomplishment.”
b. “I provide many opportunities for my daughter to play with other children her age.”
c. “I consistently stress the difference between right and wrong to my daughter.”
d. “I encourage my daughter to do things for herself when she can.”

 

 

ANS:   D

 

  Feedback
A Toddlers should be encouraged to do what they can for themselves.
B Toddlers participate in parallel play. They play next to rather than with age mates.
C Excessive stress on the differences between right and wrong can stifle autonomy in the toddler and foster shame and doubt.
D The toddler’s developmental task is to achieve autonomy. Encouraging toddlers to do things for themselves assists with this developmental task.

 

 

DIF:    Cognitive Level: Comprehension      REF:    Text Reference: pg 290

OBJ:    Nursing Process Step: Evaluation

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. Which of the following interventions would help a hospitalized toddler feel a sense of control?
a. Assign the same nurses to care for the child.
b. Put a cover over the child’s crib.
c. Require parents to stay with the child.
d. Follow the child’s usual routines for feeding and bedtime.

 

 

ANS:   D

 

  Feedback
A Providing consistent caregivers is most applicable for the very young child, such as the neonate and infant.
B Placing a cover over the child’s crib may increase feelings of loss of control.
C Parents are encouraged, rather than expected, to stay with the child during hospitalization.
D Familiar rituals and routines are important to toddlers and give the child a sense of control. Following the child’s usual routines during hospitalization minimizes feelings of loss of control.

 

 

DIF:    Cognitive Level: Comprehension      REF:    Text Reference: pg 290

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. Why is observation for 24 hours in an acute-care setting often appropriate for children?
a. Longer hospital stays are more costly.
b. Children become ill quickly and recover quickly.
c. Children feel less separation anxiety when hospitalized for 24 hours.
d. Families experience less disruption during short hospital stays.

 

 

ANS:   B

 

  Feedback
A A child’s state of wellness, rather than cost, determines the length of stay.
B Children become ill quickly and recover quickly; therefore, they can require acute care for a shorter period of time.
C Separation anxiety is primarily a factor of the stage of development not the length of hospital stay.
D Family disruption is a secondary outcome of a child’s hospitalization; it does not determine length of stay.

 

 

DIF:    Cognitive Level: Comprehension      REF:    Text Reference: pg 285

OBJ:    Nursing Process Step: N/A                MSC:   NCLEX: Physiological Integrity

 

  1. The nurse is aware that separation is the major stressor for which age group?
a. Newborns and infants
b. Infants and toddlers
c. Toddlers and preschoolers
d. Preschoolers and school-age children

 

 

ANS:   B

 

  Feedback
A Newborns feel little separation anxiety as long as their comfort needs are met.
B Separation anxiety is at its peak during the infant and toddler ages.
C Preschoolers are most fearful of injury and pain.
D Loss of control is the primary stressor for school-age children.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 289

OBJ:    Nursing Process Step: Assessment    MSC:   NCLEX: Psychosocial Integrity

 

  1. In which age group does the child’s active imagination during unfamiliar experiences increase the stress of hospitalization?
a. Toddlers
b. Preschoolers
c. School-age children
d. Adolescents

 

 

ANS:   B

 

  Feedback
A A toddler’s primary response to hospitalization is separation anxiety.
B Active imagination is a primary characteristic of preschoolers.
C School-age children experience stress with loss of control.
D Adolescents experience stress from separation from their peers.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 290

OBJ:    Nursing Process Step: Planning

MSC:   NCLEX: Health Promotion and Maintenance

 

  1. What are the stages of separation experienced by young children when they are hospitalized?
a. Crying, hopelessness, and withdrawal
b. Protest, apathy, and re-entry
c. Protest, despair, and detachment
d. Fear, hopelessness, and detachment

 

 

ANS:   C

 

  Feedback
A Crying, hopelessness, and withdrawal are symptoms of separation.
B Apathy and re-entry are not stages of separation.
C The correct sequence for the stages of separation is protest, despair, and detachment.
D Fear and hopelessness can be felt by the hospitalized child, but they are not stages of separation.

 

 

DIF:    Cognitive Level: Knowledge             REF:    Text Reference: pg 289

OBJ:    Nursing Process Step: N/A                MSC:   NCLEX: Psychosocial Integrity

 

  1. Having explanations for all procedures and selecting their own meals from hospital menus is an important coping mechanism for which of the following age groups?
a. Toddlers
b. Preschoolers
c. School-age children
d. Adolescents

 

 

ANS:   C

 

  Feedback
A Toddlers need routine and parent involvement for coping.
B Preschoolers need simple explanations of procedures.
C School-age children are developmentally ready to accept detailed explanations. School-aged children can select their own menus and become actively involved in other areas of their care.
D Detailed explanations and support of peers help adolescents cope.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 291

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of IV antibiotics, cries, screams, and resists having his IV restarted?
a. Exit the room and leave the child alone until he stops crying.
b. Tell the child big boys and girls “don’t cry.”
c. Let the child decide which color arm board to use with his IV.
d. Proceed quickly with the IV antibiotics to decrease stress.

 

 

ANS:   C

 

  Feedback
A Leaving the child alone robs the child of support when a coping difficulty exists.
B Crying is a normal response to stress.
C Giving the preschooler some choice and control, while maintaining boundaries of treatment, supports the child’s coping skills.
D The child needs time to adjust and support to cope with unfamiliar and painful procedures during hospitalization.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 290

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. What is the best nursing response to the mother of a 4-year-old child who asks what she can do to help the child cope with a sibling’s repeated hospitalizations?
a. Recommend that the child be sent to visit the grandmother until the sibling returns home.
b. Inform the parent that the child is too young to visit the hospital.
c. Assume the child understands that the sibling will soon be discharged because the child asks no questions.
d. Help the mother give the child a simple explanation of the treatment and encourage the mother to have the child visit the hospitalized sibling.

 

 

ANS:   D

 

  Feedback
A Separation from family and home may intensify fear and anxiety.
B Parents are experts on their children and need to determine when their child can visit a hospital.
C Children may have difficulty expressing questions and fears and need the support of parents and other caregivers.
D Needs of a sibling will be better met with factual information and contact with the ill child.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 302

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. How would the nurse advise parents whose preschooler used to sleep through the night and now awakens at intervals after a short hospitalization?
a. Regressive behavior after a hospitalization is normal and usually short term.
b. The child is probably expressing anger.
c. Egocentric behavior often manifests itself when the child is left alone to sleep.
d. The child is probably feeling pain and needs further evaluation.

 

 

ANS:   A

 

  Feedback
A Regression is manifested in a variety of ways, is normal, and usually is short term.
B Nighttime waking is not associated with anger.
C Egocentric behavior is not an explanation for nighttime waking.
D More information is needed before assessment of pain can be made.

 

 

DIF:    Cognitive Level: Comprehension      REF:    Text Reference: pg 295

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity

 

  1. Which of the following is an appropriate nursing intervention for the hospitalized neonate?
a. Assign the neonate to a room with other neonates.
b. Provide play activities in the hospital room.
c. Offer the neonate a pacifier between feedings.
d. Request that parents bring security object from home.

 

 

ANS:   C

 

  Feedback
A The neonate is not aware of other children. The choice of roommate will not affect the neonate socially. It is important for older children to room with similar-age children.
B Formal play activities would not be relevant for the neonate.
C The neonate needs opportunities for nonnutritive sucking and oral stimulation with a pacifier.
D Having parents bring a security object from home is applicable to older children.

 

 

DIF:    Cognitive Level: Comprehension      REF:    Text Reference: pg 294

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity

 

  1. Which approach will best help a 7-year-old child cope with a lengthy course of intravenous antibiotic therapy?
a. Arrange for the child to go to the playroom daily.
b. Ask the child to draw you a picture about himself.
c. Allow the child to participate in injection play.
d. Give the child stickers for cooperative behavior.

 

 

ANS:   C

 

  Feedback
A The hospitalized child should have opportunities to go to the playroom each day if his condition warrants. This free play does not have any specific therapeutic purpose.
B Children can express their thoughts and beliefs through drawing. Asking the child to draw a picture of himself may not elicit the child’s feelings about his treatment.
C Injection play is an appropriate intervention for the child who has to undergo frequent blood work, injections, intravenous therapy, or any other therapy involving syringes and needles.
D Rewards such as stickers may enhance cooperative behavior. They will not address coping with painful treatments.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 295

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. A 6-year-old child tells the nurse that she does not like the food at the hospital. A review of intake reveals she has eaten very little for the past 2 days. Which of the following is an appropriate intervention for the nursing diagnosis: Imbalanced Nutrition: Less than body requirements?
a. Select nutritious foods on the menu for the child.
b. Permit the child to eat junk foods at snack times.
c. Arrange the child’s meal tray with generous portions of food.
d. Encourage family members to bring foods from home.

 

 

ANS:   D

 

  Feedback
A A 6-year-old child should be permitted to make her own menu selections with the assistance of an adult as needed. Allowing the child to select foods gives the child control and provides an opportunity to select foods that the child likes.
B Junk foods have little or no nutritional value. If the child is permitted to eat junk food, she may refuse to eat nutritious food at mealtimes.
C Meals served to children should have small portions. Children may feel overwhelmed by large portions and refuse to eat any of the food.
D Having the parents bring foods that the child likes and is familiar with will increase the likelihood that she will eat.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 298

OBJ:    Nursing Process Step: Planning         MSC:   NCLEX: Physiological Integrity

 

  1. A -year-old child who is toilet trained has had several “accidents” since hospital admission. What is the nurse’s best action in this situation?
a. Find out how long the child has been toilet trained at home.
b. Tell the parent it is necessary to begin toilet training again.
c. Explain how to use a bedpan and place it close to the child.
d. Follow home routines of elimination.

 

 

ANS:   D

 

  Feedback
A Some regression to previous behaviors is normal during hospitalization, even when the child has been practicing the skill for some time.
B Hospitalization is a stressful experience and is not an appropriate time to learn or relearn a skill.
C Developmentally, the -year-old child cannot use a bedpan independently.
D Cooperation will increase and anxiety will decrease if the child’s normal routine and rituals are maintained.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pgs 298-299

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. Which question would most likely elicit information about how a family is coping with a child’s hospitalization?
a. “Was this admission an emergency?”
b. “How has your child’s hospitalization affected your family?”
c. “Who is taking care of your other children while you are here?”
d. “Is this the child’s first hospitalization?”

 

 

ANS:   B

 

  Feedback
A This is a closed-ended question. The nurse would have to ask other questions to gather additional information.
B Open-ended questions encourage communication. Ensuring a positive outcome from the hospital experience can be optimized by the nurse addressing the health needs of family members as well as the needs of the child.
C This is a closed-ended question. The parent answers the question with a short response. The nurse must ask additional questions to learn more about the family.
D The parent would answer “yes” or “no” to this question and expect the conversation to be over. The nurse must ask additional questions to learn more about the family.

 

 

DIF:    Cognitive Level: Comprehension      REF:    Text Reference: pgs 301-302

OBJ:    Nursing Process Step: Assessment    MSC:   NCLEX: Psychosocial Integrity

 

  1. What would the nurse advise the mother of a 4-year-old child to bring with her child to the outpatient surgery center on the day of surgery?
a. Snacks
b. Fruit juice boxes
c. All of the child’s medications
d. One of the child’s favorite toys

 

 

ANS:   D

 

  Feedback
A The child will be NPO before surgery; therefore, including snacks for the child is contraindicated.
B The child will be NPO before surgery. Unnecessary stress will result when the child is denied the juice.
C It is not necessary to bring all medications on the day of surgery. The medication the child has been receiving should have been noted during the preoperative workup. The parent should be knowledgeable of which medications the child has been taking if further information is necessary.
D A familiar toy can be effective in decreasing a child’s stress in an unfamiliar environment.

 

 

DIF:    Cognitive Level: Application             REF:    Text Reference: pg 295

OBJ:    Nursing Process Step: Implementation

MSC:   NCLEX: Health Promotion and Maintenance

 

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