Chapter 35 The Ill Child in the Hospital and Other Care Settings

Chapter 35  The Ill Child in the Hospital and Other Care Settings

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. Which situation 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
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. 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. Outpatient admission generally involves preparation time for the
family and child. Because of the lower level of acuteness in these settings, anxiety levels are
not as high. Rehabilitation admission follows a serious illness or disease. This type of unit
may resemble a home environment, which decreases the child’s and family’s anxiety.

PTS: 1 DIF: Cognitive Level: Comprehension/Remembering
REF: p. 783 OBJ: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity

2. 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
Outpatient and day facility care do not provide extended care; therefore a child requiring
extended care should be transferred to the hospital, causing increased stress to the child and
parents. This type of care decreases cost and infection and minimizes separation between the
child and family.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 783 OBJ: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment

3. Based on concepts related to the normal growth and development of children, 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

Separation is the major stressor for children hospitalized between ages 6 and 30 months.
Infants younger than 6 months of age will generally adapt to hospitalization if their basic
needs for food, warmth, and comfort are met. Although separation anxiety occurs in
hospitalized preschoolers, it is usually less obvious and less serious than that experienced by
the toddler. 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.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 786 OBJ: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity

4. 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
In the despair stage of separation, the child exhibits signs of hopelessness and becomes quiet,
withdrawn, and apathetic. In the protest stage, the child would be agitated, crying, resistant to
caregivers, and inconsolable. Toddlers do not readily “adjust” to hospitalization and
separation from caregivers. The detachment stage occurs after prolonged separation. During
this phase, the child becomes interested in the environment and begins to play.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 786 | Box 35.1 OBJ: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity

5. 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.”
c. “Parents should stay with children during hospitalization.”
d. “You can avoid this if you leave after your child falls asleep.”

ANS: A
The child is exhibiting a healthy attachment to the father. The child’s behavior represents the
protest stage of separation and does not represent maladaptive behavior. This response places
undue stress and guilt on the parents. Leaving when the child is asleep will foster mistrust.

PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 786 | Box 35.1 OBJ: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity