Chapter 19: Family-Centered Care of the Child During Illness and Hospitalization Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition

1. A nurse is caring for four patients; three are toddlers and one is a preschooler. Which represents the major stressor of hospitalization for these four patients? a. Separation anxiety b. Loss of control c. Fear of bodily injury d. Fear of pain ANS: A The major stressor for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age group. DIF: Cognitive Level: Analyze REF: p. 554 TOP: Integrated Process: Nursing Process: Evaluation MSC: Area of Client Needs: Health Promotion and Maintenance 2. During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his parents left him, and he refused the staff’s attention. Now the nurse observes that Eric appears to be “settled in” and unconcerned about seeing his parents. The nurse should interpret this as which statement? a. He has successfully adjusted to the hospital environment. b. He has transferred his trust to the nursing staff. c. He may be experiencing detachment, which is the third stage of separation anxiety. d. Because he is “at home” in the hospital now, seeing his mother frequently will only start the cycle again. ANS: C Detachment is a behavior manifestation of separation anxiety. Superficially it appears that the child has adjusted to the loss. Detachment is a sign of resignation, not contentment. Parents should be encouraged to be with their child. If parents restrict visits, they may begin a pattern of misunderstanding the child’s cues and not meeting his needs. DIF: Cognitive Level: Analyze REF: p. 554 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance 3. When a preschool child is hospitalized without adequate preparation, how does the child often react to the hospitalization? a. Sees it as a punishment b. A threat to child’s self-image c. An opportunity for regression d. Loss of companionship with friends ANS: A NURSINGTB.COM WONGS ESSENTIALS OF PEDIATRIC NURSING 10TH EDITION HOCKENBERRY TEST BANK NURSINGTB.COM If a toddler is not prepared for hospitalization, a typical preschooler fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds. Attributing the hospitalization to punishment for real or imagined misdeeds is a reaction typical of toddler and school-age children when threatened with loss of control. DIF: Cognitive Level: Understand REF: p. 554 TOP: Integrated Process: Nursing Process: Diagnosis MSC: Area of Client Needs: Health Promotion and Maintenance 4. Which age group should the pediatric nurse recognize as being vulnerable to events that lessen their feeling of control and power? a. Infants b. Toddlers c. Preschoolers d. School-age children ANS: D When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurp individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity