A 3-year-old child is hospitalized with nephrotic syndrome. The child has oliguria and generalized edema. What factor does the nurse identify that will have the greatest effect on the child's adjustment to hospitalization? Show 1 Hospitalization is traumatic to the preschooler because of separation from significant family members. When parents are unable to visit, the nurse should make arrangements with the parents for daily contact. Preschoolers are not interested in food; children with nephrotic syndrome often have decreased appetites. Preschoolers are not concerned about attitudes of peers; it is too early in their social development to have this concern. Massive edema results in easy fatigability and a lack of interest in play. A nurse is caring for a preschooler who is being prepared for surgery. What does the nurse expect to have the most influence on the child's response to hospitalization? 2 Fear of mutilation is typical of preschoolers because they have vague views of body boundaries. Toddlers are more likely to fear separation from parents. Preschoolers do not view death as final. Although preschoolers do indulge in magical thinking, they have not yet developed the concept of supernatural beliefs. The parents of a 3½ -year-old tell the nurse that their child has become a "picky eater" and has not gained much weight. How should the nurse respond? 3 A period of slow growth is an expected occurrence. Growth slows after the first year of life, and preschoolers and toddlers eat less. Telling the parents the child may be sick may be alarming to the parents; decreased appetite does not necessarily indicate illness. Offering rewards for meals encourages manipulative behavior by the child. A nurse is trying to involve a hospitalized preschooler in therapeutic play. Why is this so important? 1 Because their ability to express feelings verbally is limited, preschool children act out their feelings in play. Acceptance of hospitalization will not occur until the child has coped with fears. The child needs to cope with feelings rather than forget them. Therapeutic play does not necessarily involve other children. A nurse is teaching the parents of a 3-year-old child with a diagnosis of cystic fibrosis about their child's special needs. What statement indicates that the parents need further teaching about the issues related to cystic fibrosis? 2 Hot climates are contraindicated for children with cystic fibrosis because sweating precipitates excessive loss of sodium chloride. Air conditioning is advisable because it will keep the child from sweating. Pancreatic enzymes are essential to aid digestion of nutrients so they can be absorbed by the intestinal mucosa. After passage of the feces associated with this disorder, the perianal area may become inflamed if it is not adequately cleaned. When a nurse brings a dinner tray to a 4-year-old child hospitalized with pneumonia, the child says, "I'm too sick to feed myself." What is the best response by the nurse? 3 A few minutes will be enough time for the child to begin self-feeding. The nurse should provide both physical and emotional support because the child's request for help indicates regression and the need for dependence during a period of stress. Telling the child to eat as much as he or she can does not provide the child with the help that may be needed. It may be a while until the child feels better; in the meantime, adequate nourishment to foster healing is needed. Telling the child that he or she is not that sick and can feed himself could cause stress, feelings of guilt, and embarrassment. A preschooler is to have a peripheral intravenous catheter inserted. How can the nurse make the experience minimally traumatic for the
child? 1 Topical analgesics are used to make catheter insertion less uncomfortable. Telling the child that the procedure will not cause pain is not truthful; even with the application of a topical analgesic there may be some discomfort. The presence of the parents may provide a sense of security and help the child cope with the procedure. Although a brief explanation is necessary to prepare the child for the procedure, it should be given just before the procedure is performed; several hours is too long for the child to wait. A 3-year-old child is to receive a
liquid iron preparation. What should the nurse teach the mother regarding this medication? 4 A liquid iron preparation may stain tooth enamel; therefore it should be diluted and administered through a straw. Constipation, rather than loose stools, often results from the administration of iron. As a means of helping prevent gastric irritation, iron should be given with food. To improve absorption, iron may be given with orange juice. A preschool-age boy has been restricted to bedrest since being admitted to the hospital. As he begins to recover, he becomes interested in playing. In
light of his developmental level and activity restriction, what should the nurse provide for him? 3 Little cars and a shoebox garage allow an active preschooler to move within restrictions and encourages use of the imagination. Unless carefully selected, many television shows are inappropriate and uninteresting for a 4-year-old. Although a 4-year-old may still cling to a security toy, it will not stimulate the child's imagination. Simple three- or four-piece wooden puzzles may provide the child with rest, but this activity is too simple for a child of this age and will not promote development. A nurse is caring for a 4-year-old child with just-diagnosed cystic fibrosis. The child has been passing
loose, bulky, foul-smelling stools and is in the third percentile for weight. What is the best explanation of the growth failure? 1 Obstruction of the pancreatic duct and the absence of enzymes (e.g., trypsin, amylase, and lipase) to aid fat digestion and absorption lead to wasting of tissues and failure to thrive. Currently it is recommended that children with cystic fibrosis consume 150% to 200% of the calories recommended for their body weight. Despite dyspnea and shortness of breath, when feeling well these children have voracious appetites; the difficulty involves poor digestion and malabsorption of fats and fat-soluble vitamins. Increased bowel motility and diarrhea are not associated with cystic fibrosis. The pulmonary disease process leads to localized respiratory dysfunction, not to retarded physical growth. A nurse accompanies a 3-year-old child to the pediatric unit's playroom. The toddler seems reluctant to select a toy
or activity. Which toy is most appropriate for the nurse to offer as a means of fostering creativity? 2 Three-year-olds are entering the developmental stage of creative and imaginative play; using clay to make shapes enhances their creativity and improves their fine motor coordination. A plastic animal will probably be a boring toy for a 3-year-old child; a plastic animal is more appropriate for a 6- to 12-month-old child. A 3-year-old is too young to manipulate a pen or a pencil and may cause a self-injury or an injury to others. Pens and pencils should not be left in a playroom. A 3-year-old does not have the cognitive ability or the fine motor coordination to play even simple video games. Which type of play behavior does a preschooler exhibit? 4 Preschoolers engage in associative play, where they play with each other. Toddlers engage in parallel play, where they play beside each other without interacting. Infants engage in solitary play, where they play by themselves. School-age children engage in organized play. Which response would the nurse have when a 4When a nurse brings a dinner tray to a 4-year-old child hospitalized with pneumonia, the child says, "I'm too sick to feed myself." What is the best response by the nurse? "Try to eat as much as you can."
Which response would the nurse have to parents who are concerned that their 4Parents express concerns to the nurse that their 4-year-old child is spending a large amount of time playing with an imaginary friend. What is the best response by the nurse? "Perhaps your child needs more interaction with friends." "You have good reason to be concerned.
Which self care skill would the nurse expect a 4What self-care skill does the nurse expect 4-year-olds to be capable of performing? Four-year-old children can put on a shirt and can fasten it if the buttons are large.
Which source of stress would the nurse anticipate in a 4Attention, insecurity, and activity level are sources of stress in four-year-old children.
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Which response would the nurse have when a 4 year old child hospitalized with pneumonia says Im too sick to feed myself?
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