Chapter 35 Caring for the Critically Ill Child

Chapter 35  Caring for the Critically Ill Child

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. A nurse is working with a student in the pediatric intensive care unit. The student reports that a 3-year-old patient looks very anxious, and the parents report that this behavior is not normal for her and she seems disoriented. Which action suggested by the registered nurse is the most appropriate?
A.
Assess the child for sensory overload.
B.
Encourage the child to take a short nap.
C.
Have the parents leave for a short break.
D.
Plan age-appropriate diversionary activities.

ANS: A
Sensory overload is a common finding in the pediatric intensive care unit. Manifestations of this finding include lethargy, behavioral changes, disorientation, panic, withdrawal, hallucinations, fear, and anxiety. The student (and nurse) should assess the child for sensory overload. Regular sleep-wake cycles can help diminish stress, but a short nap would not alleviate these symptoms. Having the parents leave is not consistent with family-centered care. Diversionary activities are always appropriate for hospitalized children, but, again, will not diminish the symptoms.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

2. The nursing manager of the pediatric intensive care unit wants to provide patients with improved sleep and rest. Which intervention would have the greatest impact on promoting rest in this environment?
A.
Clustering care so nursing interruptions are limited
B.
Decreasing the noise in the unit, especially at night
C.
Enforcing a 2-hour “quiet time” on each shift
D.
Turning off equipment alarms when children are sleeping

ANS: B
Research shows that over half of all awakenings and arousals in intensive care unit patients are due to noise. To have the greatest impact on sleep and rest, the manager should work with staff to reduce the noise level on the unit, especially at night, so that normal sleep-wake cycles can be maintained as much as possible. Clustering care is a good idea to allow for some periods of uninterrupted rest and to decrease sensory overload from all sources, but may not always be practical and, even when done, will not have the same impact as overall noise reduction. A 2-hour “quiet time” may not provide all children with adequate rest and may be impossible to enforce. Turning off alarms is a dangerous practice and should not be done.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Basic Care and Comfort
Integrated Process: Nursing Process: Application
Difficulty: Easy

PTS: 1

3. A nursing student asks how excessive noise and sensory overload could cause feelings of panic in hospitalized children. Which response by the registered nurse is the most appropriate?
A.
“Children are frightened by all the activity in the intensive care unit.”
B.
“Excessive noise irritates the inner ear, which leads to behavior changes.”
C.
“It’s just the body’s natural way of dealing with unfamiliar stimuli.”
D.
“Stimulation of the adrenal glands leads to secretion of stress hormones.”

ANS: D
Sensory overload and excessive noise stimulate the adrenal glands, which secrete the stress hormones epinephrine and norepinephrine, leading to activation of the fight-or-flight response. This response can lead to feelings of panic. Children may well be frightened by all the activity in the unit, but this is not the best explanation. Excessive noise may well irritate the child’s ears, but this does not lead to behavior problems. Stating that this is just the body’s natural way of dealing with stress does not provide any specific information.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

4. A pediatric intensive care nurse wants to practice in a way that helps reduce parents’ stress while their child is in the unit. Which action by the nurse would be most helpful?
A.
Explain procedures to the parents first, then to the child.
B.
Include the parents in all decisions and care activities.
C.
Provide comprehensive discharge teaching in advance.
D.
Round with physicians to ensure parents’ understanding.

ANS: B
Incorporating a family-centered approach to care is the best way to reduce stress and anxiety in the critically ill child’s family. Involving the family in all decisions and care activities (if appropriate) is one of the most powerful ways of providing family-centered care. Comprehensive discharge teaching is a good nursing intervention, but not as important as including the family. Discharge teaching also cannot be done too far in advance. Rounding with physicians to ensure understanding is a great intervention, but is not as important as inclusion. Explaining procedures to the parents first, then to the child, may or may not be appropriate.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Nursing Process: Implementation
Difficulty: Easy

PTS: 1

5. A nursing student asks a pediatric intensive care nurse why being bed-bound for several weeks would affect a young child’s growth and development. Which response by the nurse is the most appropriate?
A.
“A child on bedrest has depression, slowing development.”
B.
“Bedrest causes muscle weakness that limits activity.”
C.
“Growth and development are highly connected to activity.”
D.
“Isolation from peers has a negative effect on growth.”

ANS: C
In all children, but especially younger ones, growth and development are tightly bound to activity and movement. Children who have their movement restricted for medical purposes often regress in their developmental stage. The other options are all part of this reaction, but do not explain the phenomenon as comprehensively as the correct option.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Psychosocial Integrity
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1