Class 8 – Flashcard

b. Clings to parent These are characteristics of despair. In the protest phase, the child aggressively responds to separation from parents. These are characteristics of despair. These are characteristics of despair.

d. facial expression of discomfort. These responses vary, depending on infant and pain. These responses vary, depending on infant and pain. These responses vary, depending on infant and pain. This is the most consistent behavioral manifestation of pain in infants.

c. bodily injury and pain. Separation anxiety is a characteristic of infancy. Loss of control is a characteristic fear of school-age children. Intrusive procedures, whether or not they are perceived as painful, are threatening to the preschool child because of the poorly developed concept of body integrity. Loss of identity is a concern of adolescents because illnesses are conceptualized as the effect on the individual.

b. start the IV line because unlimited procrastination results in heightened anxiety. The nurse should start the IV line, recognizing that the child is attempting to gain control. Intravenous antibiotics are a priority action for the nurse. A short delay may be possible to allow the child some choice, but a prolonged delay only serves to increase the anxiety. If the timing of the IV line start was not essential for the start of IV antibiotics, this might be acceptable. The child may never be ready. The anxiety is likely to increase with prolonged delay.

c. children who are prepared experience less fear and stress during hospitalization. Preparation will reduce stress by having the child incorporate the threat more slowly. For this age group 1 week of preparation is recommended. Preparing the child for the hospitalization will reduce the number of unknown elements. Tours, handling some of the equipment, or being told stories about what to expect will increase the familiarity with items. A reduction in fear is usually observed.

a. "Mommy will be here after lunch." Since toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon by linking the arrival time to a familiar activity that takes place at that time. Such statements do not give the child any information about when his mother will visit. Twelve noon is a meaningless concept for a toddler. Such statements do not give the child any information about when his mother will visit.

d. families need to be prepared for what to expect after discharge. Although anxiety may be reduced because of the lack of an overnight stay, the child will still experience the stress associated with a medical procedure. The waiting period while the child is having the procedure is a very stressful time for families. Discharge teaching is a responsibility of both the surgeon and the nursing staff. Discharge instructions should be provided in both written and oral form. They need to include normal responses to the procedure and when to notify the practitioner if untoward reactions are occurring.

a. Previous experience with illness or hospitalization b. Available support systems c. Medical procedures involved with treatment d. Previous coping abilities e. Cultural and religious beliefs The following are all factors affecting parents' responses to their child's illness or hospitalization: • Seriousness of the threat to the child • Previous experience with illness or hospitalization • Medical procedures involved in diagnosis and treatment • Available support systems • Personal ego strengths • Previous coping abilities • Additional stresses on the family system • Cultural and religious beliefs • Communicationpatterns among family members

b. Lack of fit between parent and child c. Below-average intelligence d. Age e. Gender Risk factors for increased stress level of a child to illness or hospitalization: • "Difficult" temperament • Lack of fit between child and parent • Age (especially between 6 months and 5 years old) • Male gender • Below-average intelligence • Multiple and continuing stresses (e.g., frequent hospitalizations)

a. Tendency to cling to parents c. Demands for parents' attention e. New fears such as nightmares Young children's posthospital behaviors include: • They show initial aloofness toward parents; this may last from a few minutes (most common) to a few days. This is frequently followed by dependency behaviors: • Tendency to cling to parents • Demands for parents' attention • Vigorous opposition to any separation (e.g., staying at preschool or with a babysitter) Other negative behaviors include: • New fears (e.g., nightmares) • Resistance to going to bed, night waking • Withdrawal and shyness • Hyperactivity • Temper tantrums • Food peculiarities • Attachment to blanket or toy • Regression in newly learned skills (e.g., self-toileting) Posthospital behaviors for older children include: Negative behaviors: • Emotional coldness followed by intense, demanding dependence on parents • Anger toward parents • Jealousy toward others (e.g., siblings

d. Permitting him to handle equipment and see the dial move before putting the cuff in place. The parent's presence will be helpful, but it will not alleviate fear of the unknown. This is not a true statement, and the child will not be able to understand the relationship between blood pressure and feeling better. Such an explanation is too complex for this age group. This is the best approach for a preschooler. It allows the child to play out the experience ahead of time.

a. "It's time for your medication now. Would you like water or apple juice afterward?" This statement provides the child with a structured choice with two acceptable options. Posed as a question, this approach allows the child the option to say "no." This statement can elicit negative behavior from the child; the nurse is abdicating responsibility to the doctor. Encouraging competition is not appropriate for this age group.

d. preanesthetic medication should be "atraumatic," using oral, existing intravenous, or rectal routes. reanesthetic medicines can be given in a variety of routes other than intramuscular. The IV route is preferable. The muscle may be sore following the injection. The necessity of premedication is being investigated. If necessary, numerous drug regimens and routes exist.

a. Establishing a contract with her, including rewards For school-age children, behavior contracting associated with desirable rewards is an effective method for achieving compliance. Time-outs should be used only if the behavioral contracting is not successful. Although nagging is not an effective strategy, the nurse needs to assist the mother in problem solving rather than criticize the actions. Monitoring the medicine supply may be tried if the contracting is not successful.

a. relief of discomfort. This is the primary reason for treating a fever with pharmacologic or environmental interventions. Treatment does not provide reassurance that illness is temporary. Fever-reducing medications (acetaminophen and ibuprofen) do not have antibacterial actions and may inhibit the fever-enhancing effects on the immune system. Fever-reducing medications (acetaminophen and ibuprofen) do not have antibacterial actions and may inhibit the fever-enhancing effects on the immune system.

c. gloves are worn to change diapers when there are loose or explosive stools. Gloves are not indicated unless there is potential for contact with body substances. Needles should not be recapped. They should be immediately disposed of in a rigid, puncture-proof container. This situation has the greatest risk for exposure to body substances. Masks are a component of transmission-based precautions and not Standard Precautions.

d. a plastic syringe (without needle) calibrated in milliliters. Household measuring spoons can be used if other more precise devices are not available. A dinner table utensil is not acceptable because household teaspoons vary greatly in size. A paper cup does not contain calibration for the additional 2.5 ml that is needed. This offers the most accurate measurement. The nurse should teach the mother to give the child 7.5 ml of the medication.

c. does not need to limit regular physical activity, including swimming. The port has to be accessed with a special needle. Because the port is totally under the skin, a needle must be used to access the port. Because this device is totally under the skin, there are no activity limitations for the child. The port site is under the skin, so there is nothing for the child to play with.

a. Immediately stop the infusion. This describes an extravasation/infiltration. The IV must be stopped to prevent further damage to the child. A blood return suggests that the IV catheter is still within the vein, but the description here is a definition of an infiltrated IV. The site can be checked after the IV is stopped. The IV drip should not be increased. It will add additional fluid to the child's tissue.

a. is noninvasive. Pulse oximetry is a noninvasive method to determine oxygen saturation. Capnography measures carbon dioxide exhalation. It does not reflect oxygen perfusion. It is less invasive and easier to test than arterial blood gases. It provides continuous or intermittent measurements of oxygen saturation.

b. Before meals and at bedtime It is more effective after other respiratory therapy, such as bronchodilators or nebulizer treatments. The most effective time for bronchial drainage is before meals and at bedtime. The procedure should be done 3 to 4 times each day. When drainage is done after meals, it may cause the child to vomit.

d. Trying to insert smaller-size tube Notify the surgeon after the emergent situation is handled. Oral intubation is done if a tube cannot be inserted. A larger tube would cause trauma to the trachea. A smaller size tube should be available. This will keep the stoma open until further action can be taken.

c. leave the gastrostomy tube open and suspended after feedings. The child should be positioned on the right side with head elevated at approximately 30 degrees. The child should be positioned on the right side with head elevated at approximately 30 degrees. The formula is backing up into the tube because of the delayed emptying. By keeping the tube open to air, the buildup of pressure on the operative site will be prevented. Leaving the tube clamped will create pressure on the operative site.

c. a person is over the age of majority and competent. d. information is provided to make an intelligent decision. e. the choice exercised is free of force, fraud, duress, or coercion. The age of majority is usually 18 years. The term competent is defined as possessing the mental capacity to make choices and understand their consequences. Enough information is provided so that the person can make an intelligent decision. The person giving consent does so voluntarily; that is, freely without coercion, any form of constraint, force, fraud, duress, or deceit. Universal consent is not sufficient. Informed consent must be obtained for each surgical or diagnostic procedure. Informed consents must be obtained for major and minor surgery, diagnostic tests, medical treatments, release of medical information, postmortem examination, removal of a child from the health care provider against medical advice, and photographs for medical, educational, or public use.

a. use an infusion pump with a microdropper to ensure the prescribed infusion rate. b. check IV fluids and infusion rate with another licensed professional. d. observe the insertion site frequently for signs of infiltration. An infusion pump with a microdropper is recommended for IV infusions in pediatrics to ensure the correct amount is infused and checked at least every 1 to 2 hours to ensure that the desired rate is infused. IV fluids and infusion rates should be checked with another licensed professional to ensure right fluids and correct infusion rate based on the pediatric age and weight. The nurse is responsible for close observation at least every 1 to 2 hours to ensure the system remains intact and the infusion site remains free of redness, edema, infiltration, or irritation. Soft restraints may be required at times in pediatrics to ensure the IV site is protected. IV infusion sites do not need to be changed every 24 hours unless a problem is found with the site. Frequent changes expose the pediatric patient to significant trauma.

d. Balance on one foot for a few seconds 3-year-olds are able to accomplish the gross motor skill of balancing on one foot. Jumping rope, riding a two-wheel bike, and skipping on alternative feet are gross motor skills of 5-year-old children.

d. Copy (draw) a circle. 3-year-olds are able to accomplish the fine motor skill of drawing a circle. Tying shoelaces, using scissors or a pencil very well, and drawing a person with multiple parts are fine motor skills of 5-year-old children.

a. Use magical thinking. Magical thinking is believing that thoughts can cause events. Abstract thought does not develop until school-age years. The concept of conservation is the cognitive task of school-age children ages 5 to 7 years. Five-year-olds cannot understand another's perspective.

b. Associates time with events In a preschooler's understanding time has a relation with events such as, "We'll go outside after lunch." Preschoolers develop an abstract sense of time at age 3 years. Children can tell time on a clock at age 7 years. Children do not fully understand use of time-oriented words until age 6 years.

b. "They will come after dinner." A 4-year-old understands time in relation to events such as meals. Children perceive "soon" as a very short time. The nurse may lose the child's trust if his parents do not return in the time he perceives as "soon." Children cannot read or use a clock for practical purposes until age 7 years. This answer assumes that the child understands the concept of hours and minutes, which is not developed until age 5 or 6 years.

b. Common at this age. Preschoolers cannot understand the cause and effect of illness. Their egocentrism makes them think that they are directly responsible for events, making them feel guilt for things outside of their control. Children of this age show stress by regressing developmentally or acting out. Maladaptation is unlikely. This comment does not imply excessive discipline at home.

b. Follow simple commands. Children ages 3 to 4 years can give and follow simple commands. Children cannot think abstractly at age 4 years. Conservation of matter is a developmental task of the school-age child. A 4-year-old child cannot comprehend another's perspective.

c. Associative Associative play is group play in similar or identical activities but without rigid organization or rules. Solitary play is that of infants. Parallel play is that of toddlers. School-age children play in teams.

c. Become friends in times of loneliness. One purpose of an imaginary friend is to be a friend in time of loneliness. Imaginary friends do not take the place of social interaction but may encourage conversation. Imaginary friends do not take the place of pets or toys. They accomplish what the child is still attempting, not what has already been accomplished.

d. Talks incessantly, regardless of whether anyone is listening Because of the dramatic vocabulary increase at this age, 3-year-olds are known to talk incessantly, regardless of whether anyone is listening. A 4- to 5-year-old asks lots of questions and can follow simple directional commands. A 6-year-old can describe an object according to its composition.

d. 4 years At 4 years, children can understand directional phrases. 18 to 24 months and 3 years is too young.

a. Tie shoelaces. Tying shoelaces is a fine motor task typical of 5-year-olds. Using a knife to cut meat is a fine motor task of a 7-year-old. Hammering a nail and making change from a quarter are fine motor tasks of an 8- to 9-year-old.

d. Teachers knowledgeable about development. A teacher knowledgeable about development will structure activities for learning. A structured learning environment is not necessary at this age. Socioeconomic status is not the most important factor in selecting a preschool. Preschool is about expanding experiences with others; cultural similarities are not necessary.

b. Suggest involving the child to find a practical solution such as a night light. A night light shows a child that imaginary creatures do not lurk in the darkness. Letting the child sleep with parents will not get rid of the fears. A 4-year-old is in the preconceptual age and cannot understand logical thought.

a. Actively involving them in finding practical methods to deal with the frightening experience. Actively involving the child in finding practical methods to deal with the frightening experience is the best way to deal with fears. Forcing a child to confront fears may make the child more afraid. Preconceptual thought prevents logical understanding. Ridiculing fears does not make them go away.

b. Stammering. Stammering and stuttering are normal dysfluency in preschool-age children. Lisps are not a normal characteristic of language development. Echolalia and repetition are traits of toddlers' language.

c. Education for safety and potential hazards. Education for safety and potential hazards is appropriate for preschoolers because they can begin to understand dangers. Constant vigilance and protection is not practical at this age since preschoolers are becoming more independent. Punishment may make children scared of trying new things. Limitation of physical activities is not appropriate.

b. Decrease the number of lesions. Acyclovir decreases the number of lesions; shortens duration of fever; and decreases itching, lethargy, and anorexia; however, it does not prevent scarring. Preventing aplastic anemia is not a function of acyclovir. Only quarantine of the infected child can prevent the spread of disease.

d. Varicella zoster immune globulin (VZIG) VZIG is given to high risk children to help prevent the development of chickenpox. Immune globulin intravenous may also be recommended. Acyclovir is given to immunocompromised children to reduce the severity of symptoms. Vitamin A reduces morbidity and mortality associated with the measles. The antihistamine diphenhydramine is administered to reduce the itching associated with chickenpox.

c. Measles (rubeola). Evidence shows that vitamin A decreases morbidity and mortality associated with measles. Vitamin A will not lessen the effects of mumps, rubella or fifth disease.

b. When lesions are crusted When the lesions are crusted, the chickenpox is no longer contagious. This may be a week after onset of disease. The child is still contagious once the fever has subsided, after the lesions erupt, and may or may not be contagious any time after 6 days as long as all lesions are crusted over.

b. Measles (rubeola) Koplik spots are small, irregular red spots with a minute, bluish white center found on the buccal mucosa 2 days before systemic rash. Koplik spots are not present with rubella, varicella, or roseola.

a. Unintentionally contributes to the abusing situation A child's temperament, position in the family, additional physical needs, activity level, or degree of sensitivity to parental needs unintentionally contributes to the abusing situation. Socioeconomic status is an environmental characteristic. This child is less likely to be abused than one who is premature, disabled, or very young. The abused child does not in turn abuse his or her siblings.

a. Pressure the victim into secrecy. Sex offenders may pressure the victim into secrecy, regarding the activity as a "secret between us" that other people may take away if they find out. Abusers are often employed upstanding members of the community. Most sexual abuse is committed by men and persons who are well known to the child. Abuse is often repeated with the same child over time. The relationship may start insidiously without the child realizing that sexual activity is part of the offer.

b. Shaken-baby syndrome. Shaken-baby syndrome causes internal bleeding but may have no external signs. Violent shaking of the brain results in shearing forces that tears blood vessels and neurons. The baby will then present with subdural hematoma and retinal hemorrhage. This is not the characteristic injury pattern of a baby who has received an unintentional injury. With SIDS the baby usually presents to the emergency department with no signs of life. These findings are inconsistent with a congenital neurologic problem.