Pediatric Nursing An Introductory Text 11th edition by Debra L. Price-Test Bank

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Pediatric Nursing An Introductory Text 11th edition by Debra L. Price-Test Bank

Price: Pediatric Nursing, 11th Edition

 

Chapter 02: Care of the Child with Medical/Surgical Needs

 

Testbank

 

MULTIPLE CHOICE

 

  1. A nurse who may have a private practice in the office of a pediatrician or a family practice physician is:
a. A school nurse
b. A home health nurse
c. A pediatric nurse practitioner
d. Any licensed LVN or RN

 

 

ANS:   C

A pediatric nurse practitioner may conduct a private practice in the office of a pediatrician or family practice physician performing physical examinations and general well-child services such as school-based clinics or health clinics.

 

DIF:    Cognitive Level: Application             REF:    p. 8                  OBJ:    2

TOP:    The Pediatric Nurse Practitioner        KEY:   Nursing Process Step: N/A

MSC:   NCLEX: N/A

 

  1. A newly admitted 5-year-old asks if he can wear his cowboy shirt. The nurse’s response will be based on the understanding that wearing his own clothes will
a. Make child feel more comfortable
b. Present an infection control problem
c. Make caring for the child more difficult
d. Not be permitted

 

 

ANS:   A

Allowing the child to wear his own clothes helps to bridge the gap between home and hospital. Wearing clothes from home should not pose an infection control problem. The nurse can assess the clothing and determine if this is a risk.

 

DIF:    Cognitive Level: Application             REF:    p. 10                OBJ:    4

TOP:    The Hospital Setting                          KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. A 4-year-old is going to have a dressing change that may be painful and frightening, therefore the nurse will perform this procedure in:
a. The patient room, because the surroundings are familiar
b. The treatment room, so the child will not associate negative feelings with the patient room
c. The playroom, so the child will be distracted by other children
d. A screened-off area in the hall to reduce visual stimulation

 

 

ANS:   B

Painful and frightening procedures are accomplished in the treatment room. The child needs to feel safe and secure in the patient room. Performing the procedure in front of other children is inappropriate.

 

DIF:    Cognitive Level: Application             REF:    pp. 11-12         OBJ:    4

TOP:    The Hospital Setting                          KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The nurse clarifies that the purpose of the pediatric unit playroom is to provide:
a. A safe place for children to go when the nurses take a break
b. An incentive for patients to choose this hospital
c. An activity area to alleviate the stress of hospitalization
d. An environment to determine if the child is well enough for discharge

 

 

ANS:   C

Playrooms provide a place for children to play and interact with other children. Many units include a play therapist or a child life specialist in attendance.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 10                OBJ:    3

TOP:    Playrooms       KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The nurse assesses that a 2-year-old who cries continuously after his mother leaves, watches the door for her return, and then finally exhausts himself and goes to sleep is in the separation anxiety phase of:
a. Despair
b. Denial
c. Protest
d. Depression

 

 

ANS:   C

The child is in the protest stage. Depression is not a stage of separation.

 

DIF:    Cognitive Level: Application             REF:    p. 11                OBJ:    3

TOP:    The Child’s Reaction to Hospitalization

KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The parents of a 3-year-old who is scheduled to have surgery the following week ask the home health nurse if a tour of the pediatric unit prior to the procedure is wise. The nurse responds:
a. “Yes, because it allows the parents to meet the people that will be taking care of their child.”
b. “No, because it will overwhelm and frighten your child.”
c. “No, because it will be an infection control risk.”
d. “Yes, because parents will not be allowed to stay with the child in the hospital.”

 

 

ANS:   A

A prehospitalization tour or class will help to alleviate the anxiety of the parent and child. The child will be with his parents during the tour. It is not an infection control risk. The parents will be encouraged to stay with the child.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 15                OBJ:    5

TOP:    The Family’s Reaction to Hospitalization

KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity

 

  1. When greeting a newly admitted pediatric patient and family, the nurse should:
a. Stand erect in a confident manner
b. Show warmth and friendliness to the child and family
c. Be polite and formal to show respect
d. Hurry through the interview to lessen the stress on the child

 

 

ANS:   B

The nurse will greet the child at eye level. Towering over the child is frightening. The nurse should be warm and friendly. The nurse should be calm and unhurried when talking with the child and family.

 

DIF:    Cognitive Level: Application             REF:    p. 16                OBJ:    4

TOP:    Therapeutic Relationships                  KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The school nurse would consider a recommendation for referral to Shriner’s Hospital to the parents of a child with:
a. A developmental retardation
b. A cleft lip
c. An orthopedic deformity
d. A behavioral problem

 

 

ANS:   C

Shriner’s Hospitals is a network of pediatric specialty hospitals in which children younger than 18 years of age with orthopedic conditions or burns are treated without cost.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 9                  OBJ:    2

TOP:    Shriner’s Hospitals                             KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Safe, Effective Care Environment: Coordinated Care

 

  1. The nurse performing a review of systems on an 8-month-old infant who is awake and calm should make the initial assessment:
a. Examination of the ears with an otoscope
b. Auscultation of the heart, lungs, and bowel sounds
c. Obtaining a rectal temperature
d. Palpation of the abdomen

 

 

ANS:   B

Auscultation of the heart, lungs, and abdomen should be the initial assessment as it is the least stressful, especially if the child has had an opportunity to handle the stethoscope.

 

DIF:    Cognitive Level: Application             REF:    p. 17                OBJ:    7

TOP:    Systems Review                                 KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. When auscultating the heart of a 3-year-old girl, an irregular heartbeat is assessed. The nurse recognizes that:
a. This is normal for a child younger than 4 years of age
b. The arrhythmia should be documented and reported to the charge nurse
c. This may be caused by anxiety and should be rechecked in 1 hour
d. This is an emergency, and help should be called

 

 

ANS:   B

A child of 3 years of age should have a regular rhythm. An irregular heart rhythm should be documented and reported to the nurse in charge immediately. Arrhythmias do not pose an immediate threat.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 18                OBJ:    7

TOP:    Systems Review                                 KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. When referring a child and family to a hospice service, the nurse considers that to qualify for hospice, the child must:
a. Have adequate insurance coverage
b. Be in an active therapeutic protocol
c. Have a terminal diagnosis
d. Have less than 6 months to live

 

 

ANS:   D

To qualify for hospice, a patient must have less than 6 months to live. These services are supplied either in the hospital or at home.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 9                  OBJ:    2

TOP:    Vital Signs      KEY:   Nursing Process Step: Planning

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. The parents of a hospitalized 2-year-old are distressed that the child no longer is toilet trained and now requires a diaper. The nurse’s best response to this would be:
a. “Don’t worry. Your child will regain toilet training in a few days.”
b. “We can start a bladder training program that will restore toilet training.”
c. “Toddlers often regress when stressed. Using a diaper now is appropriate.”
d. “You need to strongly enforce toilet training practices now.”

 

 

ANS:   C

With the stress of hospitalization, toddlers may abandon recently acquired skills. When the stress is manageable, the skills will return.

 

DIF:    Cognitive Level: Application             REF:    p. 11                OBJ:    5

TOP:    Regression      KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The parents of a 3-year-old who is hospitalized with mumps and is in isolation ask if their child may be allowed out of bed. The nurse’s most helpful response would be:
a. “No. A child with an infectious disease needs to stay in bed.”
b. “Yes. Your child may go anywhere in the unit.”
c. “No. Your child will spread the mumps if allowed out of bed.”
d. “Yes. Your child can walk around here in the room, but not out in the hall.”

 

 

ANS:   D

A toddler who feels like getting out of bed and walking should do so; however, keep in mind that a child with an infectious disease should stay within the confines of the room.

 

DIF:    Cognitive Level: Application             REF:    p. 12                OBJ:    10

TOP:    Toddler Activity                                KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. When a 4-year-old asks the nurse if an injection will hurt, the most therapeutic response would be:
a. “No. It is over so quickly you will not feel a thing.”
b. “Yes. You can see how sharp the needle is, so it will hurt when it goes in.”
c. “No. A big 4-year-old like you won’t be bothered by a little needle stick.”
d. “Yes. There will be a little sting, but hugging this bear will help.”

 

 

ANS:   D

The nurse should be truthful about procedures. Honesty helps the child not to feel betrayed. Preparation for a painful procedure should be done immediately before the procedure so as not to draw out the anticipation.

 

DIF:    Cognitive Level: Application             REF:    p. 12                OBJ:    4

TOP:    Preparation for a Painful Procedure

KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. The pediatric nurse takes into consideration that the most stressful procedure for a preschooler would be:
a. Casting a broken arm
b. Circumcision
c. Suturing a laceration on the hand
d. Removing sutures from the face

 

 

ANS:   B

Preschoolers fear mutilation during hospitalization, particularly invasive procedures that involve the genital area.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 12                OBJ:    5

TOP:    Preschoolers’ Fear of Mutilation        KEY:   Nursing Process Step: Planning

MSC:   NCLEX: Health Promotion and Maintenance: Growth and Development

 

  1. After the nurse has lowered the crib rail on the bed of a 6-month-old, in order to prevent the child from rolling out of bed, the nurse should:
a. Restrain the child with a sheet
b. Stand touching the side of the bed
c. Place the child perpendicular to the side rail
d. Ask assistance from the parent or coworker to hold the child

 

 

ANS:   C

Placing the child perpendicular to the side rails prevents the child from rolling off the bed.

 

DIF:    Cognitive Level: Application             REF:    p. 22                OBJ:    9

TOP:    Safety             KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. A 6-year-old newly diagnosed with Type I diabetes is going home today. Her parents have been taught how to manage her disease, but the nurse is concerned that they may not remember everything that was taught. The nurse can best help the parents by:
a. Instructing the parents that they can bring their child back to the unit for additional help as needed
b. Beginning discharge planning as soon as the order for discharge has been written by the attending physician
c. Providing the family with written instructions regarding diet, medications, activity, and procedures needed by the child
d. Delaying informing the parents of the impending discharge to prevent stress and anxiety for the parents and child

 

 

ANS:   C

Providing written instructions about all aspects of care will reinforce teaching and provide an important resource for the parents. The parents need to be informed of discharge as soon as possible so that they can begin making arrangements and can prepare for departure.

 

DIF:    Cognitive Level: Synthesis                REF:    p. 22                OBJ:    8

TOP:    Discharge Planning                            KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. A child is admitted with an infectious disease and is placed in an isolation room. In order to assess this child, the nurse should:
a. Use his or her own stethoscope, and wipe it thoroughly with antiseptic after each use
b. Use a stethoscope reserved for this patient in the room
c. Use a sterile stethoscope each time the patient is assessed
d. Remove the used equipment each day for disinfection

 

 

ANS:   B

A patient in isolation will have equipment for daily care placed in the isolation room. A sterile stethoscope is not needed. Equipment is kept in the room until the patient is discharged. Removing the equipment daily will increase exposure risk to others.

 

DIF:    Cognitive Level: Application             REF:    p. 25                OBJ:    10

TOP:    Preventing the Transmission of Infection

KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Safe, Effective Care Environment: Safety and Infection Control

 

  1. Because the child in isolation is not permitted to go to the playroom, the nurse explains that toys that are:
a. Brought from the playroom will have to be thrown away
b. Washable can be brought from the playroom and later disinfected
c. From the playroom must be sealed in a plastic bag
d. For the child’s use must be brought from home

 

 

ANS:   B

The child can have toys when in isolation, but they must be washable. Children do not have to bring their own toys to play.

 

DIF:    Cognitive Level: Application             REF:    p. 25                OBJ:    10

TOP:    Preventing the Transmission of Infection

KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Safe, Effective Care Environment: Safety and Infection Control

 

  1. The best restraint for an 8-month-old with sutures after the repair of a cleft lip would be:
a. Elbow restraint
b. Mummy restraint
c. Jacket restraint
d. No restraint at all

 

 

ANS:   A

The elbow restraint is the best choice as it is useful in the prevention of the child touching the face. Mummy or jacket restraints are excessive and not particularly helpful with a facial injury.

 

DIF:    Cognitive Level: Application             REF:    p. 24                OBJ:    11

TOP:    Restraints        KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Safe, Effective Care Environment: Safety and Infection Control

 

  1. The nurse is caring for a 5-year-old who had surgery yesterday. In order to evaluate the degree of pain the child is experiencing, the nurse will:
a. Expect the child to complain if she is in pain
b. Observe for verbal and nonverbal cues that the child is in pain
c. Give pain medication if the child is crying
d. Ask the child to rate her pain on a scale of 1 to 10

 

 

ANS:   B

Children do not always complain if they are in pain. They are frightened by the events and their surroundings. The nurse should evaluate for both verbal and nonverbal cues of pain. Children may not always cry if they are in pain. Conversely, they may be crying for another reason. Children at this age cannot rate their pain in this way. The nurse would use a pictorial pain scale.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 28                OBJ:    12

TOP:    The Child in Pain                                KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. The nurse assesses an 8-month-old who had abdominal surgery yesterday as showing an occasional grimace, is kicking legs constantly, is squirming and tense, moans and whimpers occasionally, and is difficult to console. Using the FLACC scale, the nurse would document a score of:
a. 4
b. 5
c. 6
d. 7

 

 

ANS:   D

RAT: Occasional grimacing = 1, kicking = 2, squirming and tense = 1, occasional moaning = 1, difficult to console = 2. This is a total score of 7.

 

DIF:    Cognitive Level: Application             REF:    p. 29                OBJ:    11

TOP:    Pain Assessment (FLACC)                KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. The nurse who is admitting a child with severe asthma is alarmed when the parents confess that they have been giving the child Echinacea because this herbal remedy may cause:
a. Severe headache
b. Increased asthma
c. Increased blood pressure
d. Liver inflammation

 

 

ANS:   B

The herbal remedy Echinacea may cause increased asthma or anaphylaxis.

 

DIF:    Cognitive Level: Application             REF:    p. 17                OBJ:    6

TOP:    Alternative Remedies                         KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Pharmacological Therapies

 

COMPLETION

 

  1. The nurse recommends a method for children to act out situations that are part of their hospital experience through __________.

 

ANS:

Dramatic play

Dramatic play allows small children to work through emotions and stressors that they may not be able to verbalize.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 13                OBJ:    4

TOP:    The Child’s Reaction to Hospitalization

KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The nurse takes into consideration that a Mexican-American family may seek the advice of a __________ , a folk healer, for treatment or herbal remedies.

 

ANS:

Curandero

The curandero is used by the Hispanic community as a folk healer or spiritual healer.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 19                OBJ:    5

TOP:    Curandero       KEY:   Nursing Process Step: Planning

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

MULTIPLE RESPONSE

 

  1. The role of the school nurse has been expanded to include such services as: (Select all that apply.)
a. Provision of health counseling
b. Student advocate
c. Administration of selected immunizations
d. Health screenings
e. Complete physical examinations (system review)

 

 

ANS:   A, B, C, D

School nurses may provide health counseling and education and health screenings, and act as student advocate.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 9                  OBJ:    2

TOP:    Duties of the School Nurse                KEY:   Nursing Process Step: N/A

MSC:   NCLEX: N/A

 

  1. The school nurse recommends to a family that they consider the use of an outpatient clinic for the upcoming tonsillectomy of their child because the advantages of this service are: (Select all that apply.)
a. Reduction of risk of infection
b. Less stress to the child
c. Reduced cost
d. Requires no insurance coverage
e. No prolonged separation of the child from the family

 

 

ANS:   A, B, C, E

Outpatient surgery, although it may require insurance coverage, has the advantages of reduced risk of infection and reduced cost. The child is less stressed as there is no familial separation.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 9                  OBJ:    3

TOP:    Outpatient Surgery                             KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Safe, Effective Care Environment: Coordinated Care

 

  1. The nurse who is in the role of case manager has the responsibilities of: (Select all that apply.)
a. Making home care arrangements
b. Performing hands-on care of the patient in the home
c. Monitoring the continuum of care
d. Managing medical care
e. Assessing the needs of the patient and family

 

 

ANS:   A, C, D, E

The case manager arranges for home care by organizing medical care, assessing the needs of the patient and family, and organizing the availability of necessary equipment. The case manager does not do hands-on care.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 9                  OBJ:    2

TOP:    The Case Manager                              KEY:   Nursing Process Step: N/A

MSC:   NCLEX: Safe, Effective Care Environment: Coordinated Care

 

  1. The family of a hospitalized 12-year-old who has been burned confides to the nurse that the patient’s 6-year-old sister is distressed about where her brother has gone. They ask what might allay her fears. The nurse suggests: (Select all that apply.)
a. Allow the sister to visit in the hospital
b. Explain in detail about the painful surgery and necessary care
c. Encourage the sibling to send cards
d. Request that the patient call his sister on the telephone
e. Report the daily progress to the sibling

 

 

ANS:   A, C, D, E

Keeping siblings informed and in touch helps to allay concerns. Telephone calls and sending of cards is helpful. Explaining in detail about the treatment may increase anxiety in a sibling.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 15                OBJ:    5

TOP:    Sibling Concerns                                KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. A patient in an isolation room is experiencing projectile vomiting. In order to assist this patient, the personal protective equipment that the nurse should don would be: (Select all that apply.)
a. Gloves
b. Mask
c. Gown
d. Protective eyewear
e. Head cover

 

 

ANS:   A, C, D

Standard precautions call for the use of gloves and gowns; because there is a problem with projectile vomiting, protective eyewear should be included. Head cover is not necessary.

 

DIF:    Cognitive Level: Comprehension       REF:    pp. 25-26         OBJ:    12

TOP:    Preventing the Spread of Infection    KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Safe, Effective Care Environment: Safety and Infection Control

 

  1. The nurse reviews nursing implementations that can help relieve the stressors of hospitalization for a child to include: (Select all that apply.)
a. Providing a consistent caregiver
b. Keeping explanations to a minimum
c. Encouraging parents to stay with the child
d. Discouraging play in order to keep the child calm
e. Allowing the child to make as many choices as possible

 

 

ANS:   A, C, E

Consistent caregivers, presence of the parent(s), and allowing as many choices as possible will relieve the stress of hospitalization. Explanations should be frequent and age-appropriate, and play should be encouraged.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 15                OBJ:    4

TOP:    The Child’s Reaction to Hospitalization

KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Psychological Integrity: Coping and Adaptation

Price: Pediatric Nursing, 11th Edition

 

Chapter 12: Cardiac Disorders

 

Testbank

 

MULTIPLE CHOICE

 

  1. The nurse draws a picture of fetal circulation showing how blood flows from the right atrium to the left atrium through the:
a. Ductus arteriosus
b. Foramen ovale
c. Ductus venous
d. Pulmonary arteries

 

 

ANS:   B

In fetal circulation, the blood flows through a hole in the septum between the atria called the foramen ovale. The opening closes at birth.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 227              OBJ:    1

TOP:    Foramen Ovale                                   KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse caring for a 6-month-old child with tetralogy of Fallot, which allows a right to left shunting, would expect to assess in this child:
a. Cyanosis
b. Dyspnea
c. Bradycardia
d. Hypotension

 

 

ANS:   A

A defect that allows unoxygenated blood to be mixed with oxygenated blood in the circulating blood volume will result in cyanosis.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 229              OBJ:    3

TOP:    Tetralogy of Fallot                             KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse caring for a 6-month-old child who had cardiac catheterization the same morning, with the insertion site in the left groin, will include in the post-operative care:
a. Keep the left extremity straight for 4 to 6 hours
b. Remove the dressing over the insertion site to assess for bleeding
c. Keep both legs flexed
d. Discourage the parents from holding the baby

 

 

ANS:   A

The extremity on the side of the puncture should be kept straight for 4 to 6 hours. The dressing over the site should not be removed, but it should be assessed for bleeding through the dressing. Parents may hold the infant if they keep the leg straight.

 

DIF:    Cognitive Level: Application             REF:    p. 230              OBJ:    4

TOP:    Cardiac Catheterization                     KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. The school nurse recognizes an indicator of a possible congenital heart defect when a first grader assumes a squatting position during periods of physical activity. This procedure helps the child by:
a. Allowing blood to leave the heart more forcefully through the aorta
b. Occluding the femoral veins and reducing the work of the right side of the heart
c. Reducing the cramping sensation in the legs due to poor function of the left side of the heart
d. Easing respiratory effort by compressing the abdominal organs

 

 

ANS:   B

This position is assumed by instinct as it occludes the venous return, reducing the work of the right side of the heart and improving oxygenation.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 230              OBJ:    2

TOP:    Squatting Position                              KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse is aware that when the body experiences frequent hypoxemia, it compensates by:
a. Producing more white blood cells
b. Producing more red blood cells
c. Dilating the pulmonary artery
d. Increasing urinary output to reduce blood volume

 

 

ANS:   B

Chronic hypoxia causes the body to compensate with the production of more red blood cells, resulting in a condition called polycythemia.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 230              OBJ:    3

TOP:    Polycythemia                                      KEY:   Nursing Process Step: Planning

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse caring for a 9-month-old child with a mixed-type congenital heart defect who is also diagnosed as physiologic failure to thrive assesses that this size deficit is most likely due to:
a. Inadequate systemic circulation related to the heart defect
b. Inability to metabolize nutrients
c. Inadequate intake related to the child trying to nurse and breathe at the same time
d. Inappropriate types of formula offered to the infant

 

 

ANS:   C

These children fail to thrive because they have difficulty feeding as they try to nurse and breathe. Children become fatigued with the effort and stop nursing.

 

DIF:    Cognitive Level: Application             REF:    p. 230              OBJ:    3

TOP:    Failure to Thrive                                 KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse caring for an African-American baby with a mixed congenital heart defect will assess cyanosis by observing the baby’s:
a. Sclera
b. Mucous membranes of the mouth
c. Hollows beneath the eyes
d. Earlobes

 

 

ANS:   B

Cyanosis can be assessed in children with a dark complexion by assessing the oral mucous membranes, the palms of the hands, and the bottoms of the feet.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 230              OBJ:    3

TOP:    Cyanosis         KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. When assessing clubbed fingers in an 8-year-old child with a mixed congenital cardiac defect, the nurse is aware that this sign is due to:
a. Intermittent hypertension
b. Shunting of the blood from left to right
c. Chronic hypoxia
d. Vasoconstriction

 

 

ANS:   C

Chronic hypoxia in children with a mixed CHD causes pooling of the blood in the capillaries, which results in clubbing of the fingers.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 230              OBJ:    3

TOP:    Clubbing of the Fingers                     KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse is aware that the child with an atrial septal defect may be a candidate for a repair with an Amplatzer device if:
a. The defect is high in the atrial septum
b. The child has not experienced cyanotic spells
c. The child is at a normal weight for his or her age
d. The defect has a small diameter

 

 

ANS:   D

Rather than putting the child through open heart surgery, an occluding device called an Amplatzer can be placed in the defect if the defect is small enough. This device can be placed during cardiac catheterization.

 

DIF:    Cognitive Level: Application             REF:    p. 232              OBJ:    2

TOP:    Amplatzer Devices                             KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Reduction of Risk

 

  1. The nurse who is assessing a child with patent ductus arteriosus, which is a defect that increases pulmonary congestion, would anticipate finding:
a. A machine-like murmur
b. A weak, thready pulse on exertion
c. A history absent of infections
d. A child of normal weight and height

 

 

ANS:   A

The patent ductus creates a machine-like murmur. The child will have a full bounding pulse on exertion, a history of frequent respiratory infections, and possible failure to thrive.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 231              OBJ:    2

TOP:    Patent Ductus Arteriosus                   KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. One of the characteristics of children who have atrial septal defects is that these children:
a. Are always slightly cyanotic and short of breath
b. Are usually asymptomatic
c. Have unpredictable outcomes from surgical correction
d. Are not at risk for infective endocarditis

 

 

ANS:   B

These children usually have no symptoms.

 

DIF:    Cognitive Level: Application             REF:    p. 232              OBJ:    3

TOP:    Atrial Septal Defect                           KEY:   Nursing Process Step: N/A

MSC:   NCLEX: N/A

 

  1. The nurse assessing a 10-year-old child diagnosed with coarctation of the aorta anticipates that this child will have:
a. Bounding pulses in the upper extremities and weak pulses in the lower extremities
b. Chest pain on exertion
c. Edema in the lower extremities
d. A harsh diastolic murmur

 

 

ANS:   A

Coarctation of the aorta is a narrowing of the aorta that causes bounding pulses in the upper extremities, leaving weak pulses in the lower extremities. There is no pain or edema.

 

DIF:    Cognitive Level: Application             REF:    p. 233              OBJ:    N/A

TOP:    Coarctation of the Aorta                    KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The parents of a 9-month-old child who has been diagnosed with coarctation of the aorta are anxious to have the defect repaired quickly. The nurse’s best response will be based on the knowledge that:
a. The repair can be done when the child has tripled the birth weight
b. The repair will be done in stages over a period of several months
c. Repair at such an early age will almost assure recurrence
d. Surgical repair is the only option

 

 

ANS:   C

Repair of a coarctation is best done between 3 and 6 years of age. Repair done earlier than that presents a high rate of recurrence. Surgery can be delayed by using an aortic balloon to open the aorta.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 233              OBJ:    N/A

TOP:    Coarctation of the Aorta                    KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Reduction of Risk

 

  1. When the baby with tetralogy of Fallot becomes irritable and begins to cyanose, the nurse should:
a. Lift the baby to a sitting position
b. Position the baby on the right side with the head elevated
c. Administer oxygen per nasal cannula
d. Place the baby in a knee–chest position

 

 

ANS:   D

The baby should be placed in a knee–chest position. This decreases blood flow to the lower extremities and increases blood flow to the upper body and head. Oxygen is not helpful.

 

DIF:    Cognitive Level: Application             REF:    p. 233              OBJ:    3

TOP:    Tet Spells        KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse explains that the medication Prostaglandin E1 is being given to their child with transposition of the great vessels to:
a. Increase blood flow to the system
b. Keep the ductus arteriosus open
c. Stimulate the production of red blood cells
d. Decrease pulmonary congestion

 

 

ANS:   B

The administration of Prostaglandin E1 has been found beneficial in keeping the ductus arteriosus open after birth. This opening allows oxygenated blood to enter the systemic circulation. Without a patent ductus or a septal defect, the child would not have access to oxygenated blood.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 234              OBJ:    3

TOP:    Prostaglandin E1                                KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. The nurse caring for a 22-pound 1-year-old child who has had open heart surgery is aware that the minimum acceptable urine output for the child is:
a. 8 mL/hour
b. 10 mL/hour
c. 12 mL/hour
d. 42 mL/hour

 

 

ANS:   B

A 22-pound child weighs 10 kg (22 pounds/2.2 = 10 kg). Using the guideline 1 mL/kg/hour, the minimal acceptable urine output for this child would be 10 mL/hour.

 

DIF:    Cognitive Level: Application             REF:    p. 235              OBJ:    6

TOP:    Adequate Urine Output                     KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. When the physician removes the chest tube from an infant who has had open heart surgery, the nurse’s responsibility is to:
a. Cover the chest opening with a petrolatum-covered gauze dressing
b. Record the vital signs as a baseline for future assessments
c. Administer oxygen at 3 liters per minute until respirations are stabilized
d. Turn the child to the opposite side of the puncture wound

 

 

ANS:   A

The application of a petrolatum-covered gauze dressing makes the opening airtight to prevent air from entering the pleural space.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 235              OBJ:    3

TOP:    Chest Tube Removal                          KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Reduction of Risk

 

  1. In order to prevent damage to the grafts, the nurse caring for the infant who had open heart surgery the previous day will teach the parents:
a. Not to lift the child at all
b. To lift the child gently under his or her arms
c. To logroll the child using a draw sheet
d. To lift the child supporting his or her head and hips

 

 

ANS:   D

The child should be lifted by supporting his or her head and hips. The child should not be lifted by the arms as it might disrupt the grafts or suture lines.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 235              OBJ:    6

TOP:    Post-surgical Care                              KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Reduction of Risk

 

  1. To reduce the effort of nursing for an infant, following open heart surgery, the nurse will:
a. Allow the child to nurse while in a side-lying position
b. Provide a soft nipple with a large hole
c. Give large feedings twice a day
d. Refrain from burping the child

 

 

ANS:   B

Providing a soft nipple with a large hole eases the effort of nursing. The child should be fed in an upright position with frequent small feedings. The child should be burped often.

 

DIF:    Cognitive Level: Application             REF:    p. 235              OBJ:    6

TOP:    Feeding the Post-surgical Child         KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. The dose of Lanoxin (digoxin) should be withheld from a 7-month-old infant when the nurse assesses:
a. A pulse of 88
b. A rash in the groin and underarms
c. A pulse of 100
d. Periorbital edema

 

 

ANS:   A

A pulse below 90 in an infant is cause to withhold Lanoxin.

 

DIF:    Cognitive Level: Application             REF:    p. 235              OBJ:    5

TOP:    Lanoxin           KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. The nurse recognizes a need for further education when the parent of a child who is to receive Lanoxin (digoxin) at home says:
a. “I will use a syringe to measure the medication rather than a spoon.”
b. “I will add more bananas to the baby’s diet to prevent hypokalemia.”
c. “I will take my baby’s apical pulse for a full minute before giving the drug.”
d. “If my baby vomits the dose, I will repeat the dose.”

 

 

ANS:   D

If the child vomits, the dose should not be repeated.

 

DIF:    Cognitive Level: Application             REF:    p. 235              OBJ:    5

TOP:    Lanoxin Dose                                     KEY:   Nursing Process Step: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. An 8-year-old child who has had open heart surgery is tired of activity restrictions and asks when he may ride his bike and play outside. The nurse’s response is based on the knowledge that limitation on strenuous activity will last for approximately:
a. 4 weeks
b. 6 weeks
c. 8 weeks
d. 10 weeks

 

 

ANS:   B

Restriction on strenuous activity lasts for about 6 weeks.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 238              OBJ:    6

TOP:    Post-operative Activity                      KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Reduction of Risk

 

  1. Rheumatic fever follows an infection with the organism:
a. Group A b-hemolytic streptococcus
b. Staphylococcus aureus
c. Streptococcus pneumoniae
d. Haemophilus influenzae

 

 

ANS:   A

Group A b-hemolytic streptococcus infection (GABHS) precedes rheumatic fever.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 239              OBJ:    8

TOP:    Rheumatic Fever                                KEY:   Nursing Process Step: N/A

MSC:   NCLEX: N/A

 

  1. The nurse explains that the diagnosis of rheumatic fever is difficult and is based on the Jones Criteria, which outline that the diagnosis of rheumatic fever may be made if there are:
a. All five major criteria
b. One major criterion and one minor criterion
c. Two major criteria
d. Three minor criteria

 

 

ANS:   C

Rheumatic fever can be diagnosed if there are two major criteria or one major and two minor criteria present.

 

DIF:    Cognitive Level: Application             REF:    p. 239              OBJ:    8

TOP:    Jones Criteria                                      KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. The nurse reminds the parents of a child with rheumatic fever that extra antibiotic prophylaxis is needed before the child:
a. Leaves the country
b. Returns to school
c. Has dental surgery
d. Goes to camp

 

 

ANS:   C

To prevent endocarditis, extra antibiotic prophylaxis is required before the child has dental work or surgery.

 

DIF:    Cognitive Level: Application             REF:    p. 241              OBJ:    8

TOP:    Antibiotic Prophylaxis                       KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Reduction of Risk

 

COMPLETION

 

  1. The murmur that is heard as blood passes through the normal heart is labeled as ____________.

 

ANS:

Functional

A functional murmur is the sound of blood passing through a normal heart.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 228              OBJ:    1

TOP:    Functional Murmurs                           KEY:   Nursing Process Step: N/A

MSC:   NCLEX: N/A

 

  1. The nurse clarifies that the condition that results in the heart’s inability to maintain adequate cardiac output is called __________.

 

ANS:

Congestive heart failure

Congestive heart failure is a collection of symptoms caused by a defective heart, which results in the heart’s inability to maintain adequate cardiac output.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 231              OBJ:    5

TOP:    Congestive Heart Failure                   KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse explains that a “tet spell” is a period of:

 

ANS:

Hypoxia

The term tet spell refers to a period of hypoxia experienced by children who have tetralogy of Fallot, which is usually triggered by an increased oxygen demand.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 233              OBJ:    3

TOP:    Tet Spells        KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

MULTIPLE RESPONSE

 

  1. The nurse explains that environmental risk factors that may lead to a congenital heart defect (CHD) include: (Select all that apply.)
a. Maternal alcoholism
b. A family member with CHD
c. Maternal hepatitis B
d. Maternal syphilis
e. Exposure to the coxsackie virus

 

 

ANS:   A, B, E

Congenital heart defects can be caused by maternal alcoholism, a family history of CHD, exposure to the coxsackie virus, maternal use of Accutane or lithium, and maternal advanced age.

 

DIF:    Cognitive Level: Application             REF:    p. 229              OBJ:    N/A

TOP:    Causes of Congenital Heart Defects

KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse understands that congenital heart defects are classified relative to hemodynamics. These classifications are: (Select all that apply.)
a. Defects with increased pulmonary blood flow
b. Defects with decreased pulmonary blood flow
c. Obstructive defects
d. Defects with cyanosis
e. Mixed defects

 

 

ANS:   A, B, C, E

Classifications of CHD are based on hemodynamics and are: defects with increased pulmonary blood flow, defects with decreased pulmonary blood flow, obstructive defects, and mixed defects.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 229              OBJ:    2

TOP:    Classifications of Congenital Heart Defects

KEY:   Nursing Process Step: Planning

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse is alert for complications of polycythemia, which include: (Select all that apply.)
a. Indication of increased cardiac workload
b. Thromboembolism
c. Cyanosis
d. Hypotension
e. Cardiovascular accident

 

 

ANS:   A, B, E

The thickened blood causes an increased workload on the heart; the thickened blood also puts the patient at risk for thromboembolism and cardiovascular accident.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 230              OBJ:    3

TOP:    Polycythemia                                      KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. Assessing the signs associated with respiratory infection in a child with a mixed CHD is difficult as the dyspnea does not change. The nurse will be alert for other indicators such as: (Select all that apply.)
a. Flaring of the nostrils
b. Coughing
c. Mouth breathing
d. Excessive salivation
e. Sternal retractions

 

 

ANS:   A, C, E

Because dyspnea is frequently present due to the CHD, the nurse will have to assess increased respiratory distress by flaring of the nostrils, mouth breathing, and sternal retractions.

 

DIF:    Cognitive Level: Application             REF:    p. 230              OBJ:    3

TOP:    Assessing Dyspnea                             KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. The nurse recognizes the signs of air hunger in an infant with a mixed CHD, which include: (Select all that apply.)
a. Increasing irritability
b. Vomiting
c. Twitching
d. Restlessness
e. Weak, hoarse cry

 

 

ANS:   A, D, E

Signs of air hunger in the infant are increasing irritability and restlessness, a weak, hoarse cry, and respirations over 60 breaths per minute.

 

DIF:    Cognitive Level: Comprehension       REF:    pp. 230-231     OBJ:    3

TOP:    Signs of Air Hunger                           KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

 

  1. The nurse assessing a child with long-term congestive heart failure would anticipate signs that include: (Select all that apply.)
a. Periorbital edema
b. Enlarged liver
c. Polyuria
d. Tachypnea
e. Flushed face

 

 

ANS:   A, B, D

As CHF progresses and systemic perfusion is challenged, the child shows the characteristic signs of periorbital edema, hepatomegaly, tachypnea, reduced urine output, and pallor.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 231              OBJ:    5

TOP:    Congestive Heart Failure                   KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse uses a diagram to demonstrate the four cardiac defects present in tetralogy of Fallot, which are: (Select all that apply.)
a. Atrial septal defect
b. Hypertrophy of the right ventricle
c. Pulmonary stenosis
d. Overriding aorta
e. Ventricular septal defect

 

 

ANS:   B, C, D, E

Tetralogy of Fallot has four defects: pulmonary stenosis; hypertrophy of the right ventricle; ventricular septal defect; and aortic dextraposition, which causes it to override both ventricles.

 

DIF:    Cognitive Level: Application             REF:    p. 233              OBJ:    3

TOP:    Tetralogy of Fallot                             KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The signs that would lead a nurse to suspect Lanoxin (digoxin) toxicity in an infant would include: (Select all that apply.)
a. Pulse of 120
b. Vomiting
c. Refusal to nurse
d. Irregular pulse
e. Liquid stool

 

 

ANS:   B, C, D

Vomiting, anorexia, pulse irregularities, and pulse of less than 90 are all indicators of toxicity.

 

DIF:    Cognitive Level: Application             REF:    p. 235              OBJ:    5

TOP:    Lanoxin Toxicity                                KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Physiological Integrity: Pharmacological Therapies

 

  1. The nurse advises parents whose child is taking Lanoxin (digoxin) that the child should be provided with fruits high in potassium such as: (Select all that apply.)
a. Apples
b. Pears
c. Apricots
d. Grapes
e. Oranges

 

 

ANS:   E

Foods high in potassium are oranges, bananas, and prune juice.

 

DIF:    Cognitive Level: Application             REF:    p. 238              OBJ:    5

TOP:    Foods High in Potassium                   KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Pharmacological Therapies

Price: Pediatric Nursing, 11th Edition

 

Chapter 22: End-of-Life Care for Children and Their Families

 

Testbank

 

MULTIPLE CHOICE

 

  1. The nurse notes on the chart that a patient with Wilms tumor is to receive palliative care only. The nurse knows this means:
a. The child will continue to receive treatment to cure the tumor
b. The child will be kept sedated
c. The parents will be relieved of the care of their child
d. The child will achieve a comfortable and dignified death

 

 

ANS:   D

Palliative care provides a patient with a comfortable and dignified death. Palliative care focuses on relieving symptoms and comfort. All curative therapies are halted. A great deal of care is involved because the care also involves the family of the patient.

 

DIF:    Cognitive Level: Application             REF:    p. 416              OBJ:    3

TOP:    Palliative Care

KEY:   Nursing Process Step: Psychosocial Integrity

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. The nurse caring for a child on palliative care would include in the plan of care to:
a. Distract the child when the child begins to talk about the impending death
b. Encourage the child to discuss the illness
c. Reassure the child that death will not hurt
d. Deny that the child is dying

 

 

ANS:   C

The child should be reassured that death will not hurt because this is a major fear. The child should not be overly encouraged to discuss his illness. The child should not be pressured to discuss anything. The child should be told that it is okay to die, because children often feel guilty. The nurse should be honest and not deny that death is imminent.

 

DIF:    Cognitive Level: Application             REF:    p. 416              OBJ:    3

TOP:    Palliative Care             KEY:              Nursing Process Step: Intervention

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The nurse working with a 15-year-old patient who is dying understands that the adolescent’s concept of death is that:
a. Death is not permanent
b. Death may happen in the distant future
c. Death can be understood in a logical manner
d. Death is a form of punishment

 

 

ANS:   C

A teenager understands death in a logical manner.

 

DIF:    Cognitive Level: Application             REF:    p. 416              OBJ:    4

TOP:    Child’s Reaction to Death                 KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The dying 16-year-old patient threw her food tray on the floor and yelled, “I can’t eat this slop! I want some real food!” The nurse’s best response to this episode would be:
a. “Just calm down. We will get you another tray.”
b. “I know you’re tired of bland food, but this kind of behavior doesn’t help anyone.”
c. “I imagine you are pretty mad. Do you want to tell me what you might like?”
d. “It is slop, but now someone has to clean this up.”

 

 

ANS:   C

The nurse understands that the teen is displacing her anger about dying on this situation. The nurse will show acceptance in recognizing the anger. The other three options cast guilt on the patient.

 

DIF:    Cognitive Level: Application             REF:    p. 418              OBJ:    4

TOP:    Child’s Reaction to Death                 KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. A dying child’s parents have told the nurse that they do not want their child to know that she is dying. The nurse reminds the parents that this choice might cause the child to feel:
a. Isolated and suffering alone
b. Free to express her fears
c. Less anxiety
d. Protected and loved

 

 

ANS:   A

This choice will force the child to suffer alone, because she will not be able to share or understand her fears and feelings. Children need clear, age-appropriate information about their illness.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 418              OBJ:    5

TOP:    Child’s Awareness of Death              KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. A dying 8-year-old child tells the nurse that she is still in pain even though the nurse has administered the maximum dosage of pain medication only 1 hour ago. The nurse’s most effective initial intervention would be to:
a. Tell the child she will have to wait 3 hours
b. Assess the child to determine if the pain is real
c. Inquire if the medication dosage can be adjusted
d. Distract the child by reading a story

 

 

ANS:   D

When pain medication becomes ineffective in the course of a child’s illness, complementary methods such as distraction, relaxation, biofeedback, or guided imagery may be helpful. Inquiring about a dosage change is also appropriate but will not get immediate results, but the distraction might.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 418              OBJ:    7

TOP:    Pain Management                               KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. A 10-year-old child has lapsed into a coma. In order to let the child know he is not alone, the nurse would:
a. Encourage the parents to speak to the child
b. Keep the room as quiet as possible
c. Avoid touching the child unnecessarily
d. Leave the parents alone with the child

 

 

ANS:   A

The nurse would instruct the family to talk to the child because the child would be comforted by the familiar voices. The nurse would touch the child and encourage the family to do so because, like talking to the child, touching is also reassuring. An absolutely quiet room enhances the feeling of being alone. Parents need the nurse’s support and shouldn’t be left alone for long periods.

 

DIF:    Cognitive Level: Application             REF:    p. 419              OBJ:    6

TOP:    Fear of Being Alone                           KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. A grieving mother sobs “All this is just so useless…I am useless…nothing I am doing is going to make my baby well.” The nurse’s most therapeutic response would be:
a. “Your constant loving care does more for your baby than any medicine.”
b. “Don’t worry. The nursing staff can take over the care any time you want.”
c. “Oh, be brave! This is hard, but getting upset won’t help your baby.”
d. “I know exactly how you feel.”

 

 

ANS:   A

The parents should be praised for the care they are giving to their child. The family should be encouraged to discuss their feelings now and to encourage communication about the death with the child. There is no way the nurse can know exactly how this mother feels!

 

DIF:    Cognitive Level: Application             REF:    p. 419              OBJ:    8

TOP:    Family Roles and Needs                    KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The parents of a dying child are concerned about the jealousy expressed by the two siblings of the patient. They ask the nurse how to deal with the sibling’s feelings. The most realistic suggestion the nurse could make would be:
a. Give equal time to all of their children
b. Involve the siblings in the care of the dying child
c. Tell the siblings they should not be jealous of their dying sibling
d. Avoid enforcing any rules until after the death

 

 

ANS:   B

Giving equal time to all of the children may not be possible. The siblings should be encouraged to participate in the care of the dying child. They may feel jealous of the extra attention the dying child is receiving. The siblings should be allowed to express their feelings. Jealousy about the extra attention should be expected. The parents should continue to enforce all of the rules.

 

DIF:    Cognitive Level: Application             REF:    p. 419              OBJ:    8

TOP:    Family Roles and Needs                    KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The parents of a dying 2-year old child are showing signs of tension when the wife says, “Oh, go on to your office. You have a place to run away to. I am the one here with our dying child!” The nurse can help by:
a. Encouraging the parents to suppress their feelings
b. Focusing interventions on the mother
c. Understanding that the father may feel the need to conceal his emotions
d. Allowing the parents to deal with it on their own

 

 

ANS:   C

The parents should be encouraged to share their feelings. The father should not be ignored. He may not be seen as often because of work. The father may feel that he needs to conceal his emotions from the family as part of the male image, but the nurse should remember that he may have strong feelings and may feel abandoned.

 

DIF:    Cognitive Level: Intervention            REF:    p. 419              OBJ:    8

TOP:    Family Roles and Needs                    KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The pediatric nurse reminds the ancillary personnel that cultural needs and customs of the dying patient from an Asian culture are:
a. The same across all cultures
b. Secondary to providing care
c. Best discussed using an interpreter
d. Unique to a given culture

 

 

ANS:   D

The cultural needs of the dying patient are unique to a given culture. Attending to cultural needs regarding death is just as important as providing palliative care. Cultural care is affected by language barriers, because the patient may not be able to communicate needs and the staff may misinterpret the actions of the person of another culture. The use of an interpreter delays communication.

 

DIF:    Cognitive Level: Application             REF:    p. 419              OBJ:    9

TOP:    Cultural Issues                                    KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The parents and family of a Jewish child are at the bedside praying at the time of death. The culturally sensitive nurse will:
a. Ask the family to step into the hall while final care is being performed
b. Gently close the child’s eyes and mouth
c. Cover the child’s face with a sheet
d. Help turn the child so that the feet are facing east

 

 

ANS:   C

The face should be covered with a sheet as a sign of respect. The Jewish culture requires that the body not be left alone. A family member is responsible for closing the eyes and mouth. If possible, the feet should be facing the door.

 

DIF:    Cognitive Level: Application             REF:    p. 420              OBJ:    9

TOP:    Cultural Issues                                    KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. When a family member asks the nurse where his terminally ill loved one might receive hospice care, the nurse’s most helpful response would be based on the knowledge that hospice services are provided:
a. Only in special hospice care facilities
b. As part of a hospital stay
c. In the home or hospital
d. Only through Medicaid

 

 

ANS:   C

Hospice services are provided to those in their final phase of life in the home, hospital, or hospice care facility. Care is provided to both the patient and the family members. Palliative care is not curative.

 

DIF:    Cognitive Level: Application             REF:    p. 420              OBJ:    10

TOP:    Hospice Care                                      KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. When the 17-year-old leukemic child says, “I am going to the Mayo Clinic so we can get the correct diagnosis. I do not have leukemia!” the nurse recognizes that the patient is in the Kübler-Ross grief stage of:
a. Bargaining
b. Depression
c. Denial
d. Anger

 

 

ANS:   C

This statement represents the state of denial in that the patient is denying the diagnosis and seeks better information to support the denial.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 419              OBJ:    5

TOP:    Hospice Care                                      KEY:   Nursing Process Step: Assessment

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The nurse observes that a dying child is experiencing dyspnea. The nurse can perform which of the following interventions to help?
a. Having the child lie flat in bed
b. Administering oxygen
c. Holding the morphine
d. Avoiding changing position

 

 

ANS:   B

Dyspnea is a common occurrence when death is near. The nurse would position the child in a high Fowler’s position to facilitate respirations. Administering oxygen will help relieve some of the distress. Morphine diminishes the cough reflex and diminishes air hunger, so it should not be withheld. Changing positions will also help facilitate respirations.

 

DIF:    Cognitive Level: Application             REF:    pp. 420-421     OBJ:    11

TOP:    Preparing for Death                            KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. When the dying child who is experiencing anorexia asks for ice cream, the nurse can:
a. Offer the child a more nutritious food
b. Offer a cold beverage
c. Allow the child to eat anything desired
d. Place the child NPO

 

 

ANS:   C

The nurse should encourage the child to eat anything desired. The nurse would not place the child NPO or on a strict diet. The substitution of a nutritious food or a cold beverage does not respond to the child’s wishes. The nurse would also explain to the mother that this is a normal occurrence at the end of life.

 

DIF:    Cognitive Level: Application             REF:    p. 421              OBJ:    11

TOP:    Preparing for Death                            KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. As the dying child becomes weak and fatigued, the nurse should alter the plan of care to include:
a. Restricting the child to bed rest
b. Discouraging visitors
c. Using a wheelchair or wagon for transportation
d. Doing all of the child’s care quickly and at once

 

 

ANS:   C

The child would not be restricted to bed rest. Visitors are encouraged and are therapeutic. A wheelchair or wagon can be used to transport the child. The patient care can be done in stages throughout the day.

 

DIF:    Cognitive Level: Application             REF:    p. 421              OBJ:    11

TOP:    Preparing for Death                            KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. As the dying 6-year-old child becomes incontinent of bowel and bladder, the nurse focuses care on methods to:
a. Keep the child hydrated
b. Spare the child embarrassment
c. Reduce odor in the room
d. Protect skin integrity

 

 

ANS:   D

Incontinence of bowel and bladder is a common occurrence when death is near. Attention to skin care is paramount, such as keeping bed linens clean and dry and turning the patient frequently.

 

DIF:    Cognitive Level: Application             REF:    p. 421              OBJ:    11

TOP:    Preparing for Death                            KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Physiological Integrity

 

  1. The infant has had a peaceful death. The nurse’s next responsibility is to:
a. Call the hospital chaplain
b. Usher the parents into the hall
c. Pronounce the child dead
d. Gently baptize the child

 

 

ANS:   A

The nurse should notify the chaplain in the absence of a priest or pastor.

 

DIF:    Cognitive Level: Application             REF:    p. 422              OBJ:    12

TOP:    Care after Death                                 KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. The family has viewed the body. The body is moved when:
a. The family has had 1 hour with the child
b. The family is ready and has given permission
c. The mortician arrives
d. The child has been pronounced dead

 

 

ANS:   B

The body is removed when the family is ready and has given permission.

 

DIF:    Cognitive Level: Application             REF:    p. 422              OBJ:    12

TOP:    Care after Death                                 KEY:   Nursing Process Step: Intervention

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. A student nurse complains to the charge nurse about the mother of a Hispanic child who refuses to make the decision about hospice care until her husband comes to the hospital. The charge nurse explains that:
a. The mother probably did not understand due to a language barrier
b. The male head of the family makes health care decisions
c. The mother is in denial about the condition of the child
d. Hispanic culture requires that efforts at cure should continue until death

 

 

ANS:   B

In the Mexican-American community, the male head of the family makes all decisions, health care included.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 420              OBJ:    9

TOP:    Cultural Values                                  KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. The Haitian mother asks to bring a large picture of St. Jude into her child’s isolation room. The nurse’s best intervention would be to:
a. Wrap the picture in plastic and prop it against the wall
b. Gently explain that nothing should be brought into an isolation room
c. Prop the picture in the hall next to the door
d. Explain that no religious icons are permitted in the patient rooms

 

 

ANS:   A

Haitians use religious icons as a form of protection or the bringer of good luck. Wrapping the picture in plastic will allow the family to have the icon at the bedside. Placing the picture in the hall will cause a traffic hazard.

 

DIF:    Cognitive Level: Application             REF:    p. 420              OBJ:    9

TOP:    Cultural Considerations                     KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. The 14-year-old child who is dying of leukemia is trying to comb her thinning hair and is having a great deal of difficulty due to weakness. The nurse should:
a. Take the hairbrush from her hand and finish the job
b. Remind the child to stop in order to save her energy
c. Compliment the child on the appearance of her hair
d. Caution her that brushing will cause more hair to fall out

 

 

ANS:   C

The nurse should recognize the effort of self-care. Long illnesses threaten a child’s independence, a developmental drive in the adolescent. Overprotection will increase dependence.

 

DIF:    Cognitive Level: Application             REF:    p. 419              OBJ:    5

TOP:    Self-Care         KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity: Psychosocial Adaptation

 

  1. The complementary method of guided imagery for pain relief is used with a 5-year-old when the nurse:
a. Helps the child identify muscle groups to tense and relax
b. Asks the child to close her eyes and tell about Christmas
c. Encourages the child to blow a bubble big enough to take a ride in
d. Asks the child to recite a prayer

 

 

ANS:   B

Guided imagery uses pleasant mental images of events or times that will make the child less afraid and more comfortable.

 

DIF:    Cognitive Level: Application             REF:    p. 418              OBJ:    7

TOP:    Guided Imagery                                 KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. When the nurse is preparing to give the dyspneic 1-year-old child a dose of liquid morphine, the father requests that the morphine not be given as it may cause addiction. The nurse’s most informative response will be based on the knowledge that morphine:
a. Is not addictive to infants
b. In the liquid form does not create dependence
c. Will only sedate the child
d. Diminishes the feelings of air hunger

 

 

ANS:   D

Morphine in any form is addictive, but in small doses it is extremely effective in relieving the discomfort of dyspnea.

 

DIF:    Cognitive Level: Application             REF:    p. 421              OBJ:    11

TOP:    Morphine        KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

COMPLETION

 

  1. The nurse is aware that the organization supporting hospice care for children is __________.

 

ANS:

Children’s Hospice International (CHI)

Founded in 1983, Children’s Hospice International supports hospice care for children.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 420              OBJ:    10

TOP:    Children’s Hospice International       KEY:   Nursing Process Step: Planning

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The nurse clarifies to the family that a(n) __________ drug such as a bronchodilator will be administered to decrease dyspnea.

 

ANS:

Anxiolytic

An anxiolytic such as a bronchodilator will diminish dyspnea.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 421              OBJ:    1

TOP:    Anxiolytics     KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. The nurse is aware that many parents experience a sense of loss and grief called __________ grief before the death of their child occurs.

 

ANS:

Anticipatory

Parents experience a sense of loss and grief called anticipatory grief before the actual death of their child.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 422              OBJ:    1

TOP:    Anticipatory Grief                              KEY:   Nursing Process Step: Planning

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

MULTIPLE RESPONSE

 

  1. While discussing the option of hospice care, a mother says, “It just makes me feel like we are giving up. I don’t see how this can help.” The nurse’s response is based on the knowledge that hospice care is designed to: (Select all that apply.)
a. Encourage day-to-day communication
b. Provide durable medical equipment
c. Help with funeral planning
d. Focus entirely on the patient’s comfort
e. Support in the grieving process

 

 

ANS:   A, B, E

Hospice care can provide medical equipment and care, but is also a support to the family in the day-to-day communication and grief. Hospice does not help with funeral planning, and the focus of care is on the patient and the family.

 

DIF:    Cognitive Level: Application             REF:    p. 419              OBJ:    10

TOP:    Hospice Care                                      KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

  1. The nurse includes in the plan of care for a 2-year-old child adequate oral care such as: (Select all that apply.)
a. Using an astringent mouthwash
b. Brushing the teeth with soft-bristled brush
c. Cleansing the tongue with a washcloth
d. Applying cool alcohol to cracked lips
e. Allowing the child to suck on small ice cubes

 

 

ANS:   B

Using a soft-bristled brush to clean the teeth, tongue, and gums is refreshing and hydrating. Mouthwashes are not effective on such a small child. Ice cubes pose a choking threat, and alcohol is drying.

 

DIF:    Cognitive Level: Application             REF:    pp. 419-420     OBJ:    11

TOP:    Oral Care        KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Physiological Integrity: Basic Care and Comfort

 

  1. After the death of the child, the nurse prepares the body for viewing. This includes: (Select all that apply.)
a. Bathing the child
b. Dressing the child in a clean gown
c. Changing the linens
d. Removing medical equipment
e. Removing toys and flowers from the room

 

 

ANS:   A, B, C, D

Removing toys and flowers from the room is not necessary; in fact, rearrangement of the flowers and toys may be comforting to the family.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 421              OBJ:    12

TOP:    Aftercare         KEY:   Nursing Process Step: Implementation

MSC:   NCLEX: Psychosocial Integrity: Coping and Adaptation

 

OTHER

 

  1. Place the Kübler-Ross stages of dying in the appropriate order.
  2. Bargaining
  3. Acceptance
  4. Anger
  5. Denial
  6. Depression

 

ANS:

D, C, A, E, B

Kübler-Ross outlines the stages of acceptance of death as: denial, anger, bargaining, depression, and acceptance.

 

DIF:    Cognitive Level: Comprehension       REF:    p. 422              OBJ:    4

TOP:    Kübler-Ross    KEY:   Nursing Process Step: N/A                MSC:   NCLEX: N/A

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