Grief and Loss/Death
The nurse is speaking with the parent of a toddler. The parent asks the nurse what reaction is expected from their child regarding impending death of a grandparent. The nurse should state that children in this age group:
A. Unaccepting of their own death
B. Are very interested in funerals and burials
C. Imagine the deceased person to still be alive
D. Believe their thoughts caused the death
C is correct because toddlers and infants may have a reaction with the death of someone else, they may continue to act as if the person is still alive. This age group also reacts to parental anxiety and sadness (pg. 1015, Table 36.4)
D would be more of the preschool age.
B would be indicative of school-age children.
And A would be adolescents or older.
The nurse is teaching staff members about caring for a child who has hemophilia. Which clinical manifestations from the box below identified by a staff member indicate a correct understanding of the teaching?
1. Excessive bleeding
2. Growth retardation
3. Hyperkalemia
4. Hemarthrosis
5. Spontaneous hematuria
6. Decreased bruising
A. 1, 3, 4, 6
B. 1, 4 ,5
C. 1, 2, 3, 4, 5
D. 1, 2, 3, 5
B. Excessive bleeding, hemarthrosis, and spontaneous hematuria. (pg. 1287, box 43.5)
Growth retardation is a sign of chronic anemia. (Unit 9, slide 5)
Hyperkalemia, caused by electrolyte loss in diuresis is a complication in sickle cell crisis. (1283)
Decreased bruising is not a sign of any mentioned blood disorders.
The nurse is caring for a 4-year-old who is 36 hours post-op following removal of a Wilm's tumor. Which requires IMMEDIATE follow up?
A. Temperature of 100.4 that occurs once in a 24 H period
B. Incision site is pink around the edges
C. Bowel sounds present in all 4 quadrants
D. WBC count of 15.0 mm^3.
D. WBC count of 15.0 mm^3.
The normal limits for a pediatric WBC is 4.5 to 13.5. (pg. 1272). So 15 is outside the normal limits, and could indicate infection, especially since it is 36 hours post op.
According to the Galen lab values chart, normal values are for < or = to 2 years old, 6.2-17 and > or = 2 years is 5-10.
The major nursing responsibilities post-op include those following any abdominal surgery, so bowel sounds, intestinal obstruction, abdominal distention and GI activity. Other considerations are frequent evaluation of BP and observation for signs of infection.
The nurse is caring for a child who has Reye's syndrome. Which of the following should the nurse include in the child's plan of care?
A. Assess for diplopia in both of the child's eyes
B. Change the positioning of the child every 2 hours
C. Administer salycilate for temp Q4H prn
D. Provide the child with a quiet atmosphere and dim lighting.
D. Provide the child with a quiet atmosphere and dim lighting. (pg. 1361, bottom right)
The care for a child with Reye's syndrome should be similar to those with signs of increased ICP. (s/s of increased ICP are on page 1356, box 46.1)
This includes the reduction of stimuli and maintenance of strict I and O's.
(Pg. 1377)
You would refrain from B and C because they can increase ICP and bleeding, and diplopia is a manifestation of increased ICP.
The nurse is caring for an infant who is having an atonic seizure. Which of the following actions should the nurse perform when caring for the infant having a seizure?
A. Placing the infant in the prone position inside the crib
B. Something the infant to keep them warm and safe
c. Suction any secretions out of the infants out of the mouth
D. Remove any items out of the crib that can harm the infant
D is correct because you would want to free the infant from harm. (pg. 1386)
The child should be in a lateral or side-lying position, not prone. Clothing and blankets should be removed, not added. You should not put anything into the child’s mouth.
The nurse is caring for a child who has just died due to a chronic illness. Which of the following is the most appropriate response to the grieving family?
A. I am very sorry; I will miss your child very much
B. You should feel relief for your child
C. Your child isn’t feeling pain anymore
D. I know how you feel: completely lost
A is correct because it is a straight-forward and honest statement, and nurses are encouraged to express personal feelings of loss or frustration. (pg. 1020)
Supporting grieving families includes:
Avoiding judgemental statements
Avoiding rationalizations such as “your child isn’t suffering anymore” (making C incorrect)
Avoiding artificial consolation, “I know how you feel” (making D incorrect.
B is incorrect because you should not tell the parents how they should feel.
The nurse is assessing a child who has severe iron deficiency anemia. Which of the following assessment findings should the nurse expect to observe?
A. Pallor
B. Visual disturbances
C. Painful swelling of the hands
D. An enlarged abdomen
A. Pallor
Decreased RBC Production caused by nutritional deficiency: Pallor, tachycardia, headache, fatigue, SOA, muscle weakness, systolic heart murmur, pica. (pg. 1273)
Pallor, fatigue, tachycardia, murmurs, delayed or stunted growth. (Slide 5, unit 9)
B, C, and D can all be signs of sickle cell anemia.
The nurse preceptor is discussing Wilm’s tumor with a newly hired nurse. The newly hired nurse asks, “why should we avoid palpating the child’s abdomen?” Which of the following responses from the nurse preceptor is appropriate?
A. It can cause dehydration from forced pressure that causes vomiting.
B. Pain will increase and force the use of opioids
C. It can increase the risk of infection
D. This can increase the risk of spreading the cancer cells throughout other areas of the body
D. This can increase the risk of spreading the cancer cells throughout other areas of the body.
It is vital that you do not palpate the tumor unless absolutely necessary because manipulation of the mass may cause dissemination of cancer cells to adjacent and distant sites. (pg. 1321, bottom right)
*Nursing Alert*
To reinforce the need for caution, it may be necessary to post a sign on the bed that reads, "Do not palpate the abdomen." Careful bathing and handling are also important in preventing trauma to the site of the tumor.
The nurse is caring for a child who has increased ICP and is in unstable condition. Which of the following interventions should the nurse implement to decrease the ICP to the staff?
A. Administer hypotonic IVF
B. Keep the child positioned on the left side
C. Administer opioids for pain relief
D. Limit the number of visitors inside the Childs room
Limit visitors to relieve discomfort (1361)
C is incorrect bc risk of respiratory depression and constipation, but pain can increase icp. IVF are contraindicated bc it can increase ICP. Child positioned on the side contraindicated bc it can increase icp and risk for jugular compression (1362/1363)
The nurse is caring for a child who is suspected to have bacterial meningitis. The results of the lumbar puncture are still pending. Which of the following actions for the nurse are PRIORITY?
A. Decrease noxious olfactory stimuli
B. Maintain a lighted environment
C. Administer morphine sulfate
D. Assessing the neurological status every 2 to 4 hours
Initial therapeutic management:
A is priority because it is a measure to reduce the chance of increasing ICP. (pg. 1374)
B is incorrect because you want to decrease stimuli (dimly lit room). Assessing neurological status every 2 to 4 hours is done, but after the initial assessment, prevention of an increase in ICP is vital.
The nurse is talking with the parents of an adolescent. The nurse explains to the parents that adolescents have trouble dealing with death because adolescents:
A. Consider funerals to be money making events
B. Have trouble understanding what happens to their bodies after death
C. Have a need to participate with rituals during the dying process
D. Are the most likely to accept death as a cessation of life
A is correct because adolescents have a mature understanding of death, and they have the most difficulty coping with death. They are least likely to accept death as the cessation of life, and because of their idealistic view of the world, they may criticize funeral rites as barbaric, money making and unnecessary. (pg. 1016)
The newly hired nurse is talking with the nurse preceptor about the prevention of iron-deficiency anemia in infants. Which of the following statement by the newly hired nurse is CORRECT regarding the prevention of this condition?
A. Whole cow's milk should not be given until 1 year of age with limited daily intake
B. Iron-fortified commercial formula should be given for the first 6 months of life
C. Ferrous sulfate drops are contraindicated in infants less than 6 months of age
D. Iron-fortified infant cereal should be introduced to infants at ten months
A. Whole cow's milk should not be given until 1 year of age with limited daily intake
Infants younger than 12 months of age should not be given fresh cow's milk because it may increase the risk of GI blood loss. (pg. 1274, under therapeutic management). Milk is a poor source of iron and increased fecal loss of blood occurs in 50% of iron-deficient infants fed cows milk.
B is incorrect as some mothers may choose to breastfeed.
C is incorrect bc ferrous sulfate drops are recommended when infants are exclusively breastfed.
D is incorrect because (pg. 1275 under diet) cereals are one of the first semisolid foods introduced into the infant's diet around SIX months of age, not TEN.
The nurse is preparing discharge instructions to the parents of a child who has a surgical resection of a neuroblastoma 4 days ago. Which statement from the parents indicates a proper understanding of the teaching?
A. I will need to begin slowly introducing my child back into social interaction
B. A protective helmet will need to be worn until the incision heals
C. An increase in temperature is expected after surgery
D. We will provide pain relief using pain medication and rest.
D. We will provide pain relief using pain medication and rest.
“Provide analgesics as needed to relieve discomfort” (pg. 1302, table 44.1)
B is wrong because a neuroblastoma is located within the abdomen.
C is wrong because increased temperature is not normal after surgery and can indicate complications
A slowly introducing the child back into social interaction has nothing to do with surgical removal of a neuroblastoma.
The nurse is caring for a child who is hospitalized for 24 hour observation following a head injury. Which of the following actions by the nurse is PRIORITY?
A. Lower the television sound
B. Restrict visitation to 1 person at a time
C. Assess for neck stiffness
D. Checking pupil reaction every 4 hours
D is correct because change in pupillary reaction or symmetry is a neurological emergency.
Going off of the order of the emergency trauma chart (pg. 1368)
After status is identified, the nurse should:
#6 check pupil reaction every 4 hours for 48 hours
#8 seek medical attention if they experience neck pain or stiffness (some neck stiffness is normal)
Visitation and tv sound are not PRIORITY.
The newly hired nurse is caring for a newborn who has a myelomeningocele sac. Which of the following interventions performed by the newly hired nurse requires IMMEDIATE intervention?
A. Changing the dressing every four hours to keep the sac from drying out
B. Refraining from placing a diaper on the newborn
C. Keeping the newborn in supine position unless feeding
D. Using latex free medical products
C requires immediate attention because before surgery, the infant is kept in prone position to minimize the risk for trauma and minimize tension on the sac. (pg. 1465)
The dressing is changed every 2 to 4 hours to prevent drying (it is moistened, usually with sterile saline). (Pg.1466) Diapering is often contraindicated until the defect has been repaired and the healing is well advanced. Latex allergies were identified as being a serious health hazard when it was found to be liked to children with SB (pg. 1467)
The nurse is caring for a child at the end of life. The parents ask the nurse if there are any signs approaching death. Which physical signs from the box below indicate that the child is approaching death?
1. Bradycardia
2. Increased blood pressure
3. Body feels warm
4. Decreased appetite
5. Slurred speech
6. Increased thirst
A. 1, 4, 5
B. 4, 5, 6
C. 3, 4, 5
D. 1, 4, 6
A is correct because bradycardia, decreased appetite, and slurred speech are all impending signs of death. (pg. 1018)
Blood pressure is decreased, the body feels cold even though the patient has a sensation of heat, and thirst is decreased.
The nurse is admitting a child who has vaso-occlusive sickle cell crisis. Which of the following interventions should the nurse anticipate being prescribed for the child?
A. Oxygenation and IV fluids
B. Electrolyte replacement and administration of heparin
C. Globulins and factor VIII replacement
D. Correction of alkalosis and reduction of energy expenditure
A is correct because a VOC is characterized by lack of perfusion to the capillaries and is often caused by dehydration, therefore oxygen and IVF are indicated for treatment. (pg. 1277)
C is incorrect because this would be a treatment for hemophilia.
The nurse is caring for a child who has retinoblastoma and is returning from an enucleation procedure. The parents are concerned about their child’s appearance after the procedure. Which of the following statements is correct for the nurse to inform the parents?
A. Moderate drainage will come from the affected eye socket initially.
B. The implanted sphere will need to be removed and cleaned daily.
C. The eye pad dressing is left open to air in the evenings.
D. A sphere is surgically implanted to maintain the shape of the eyeball.
D is correct: “The lids are usually closed and the area does not appear sunken because a surgically implanted sphere maintains the shape of the eyeball.” (pg. 1324, top left)
The implant is covered with the conjunctiva and when the lids are open, the exposed area resembles the mucosal lining of the mouth.
A is wrong because the wound itself is clean and has little or no drainage.
B is incorrect because the implanted sphere is not removed and cleaned daily, it remains intact until the prosthetic is placed.
C is incorrect it can be removed as soon as the socket has healed, and is to be changed daily.
The nurse is caring for a child who had a ventricular shunt placement 24 hours ago. The child is sitting up in bed crying and has leaked a small amount on the bed linens. Which of the following actions should the nurse take FIRST?
A. Obtain an complete metabolic panel (CMP) specimen
B. Comfort the child while the bed linens are changed
C. Perform a neurological assessment
D. Inspect the incision for infection
C is correct because performing a neurological assessment is vital when CSF leakage is suspected. (pg. 1390) This would be done first. The others are not priority
The nurse is screening infants for early signs of cerebral palsy. Which findings below should the nurse identify as early signs of cerebral palsy?
1. Poor head control after one month
2. Feeding difficulties
3. Failure to smile by 2 months
4. Persistent Moro reflex
5. Rigid arms or legs
A. 2, 4, 5
B. 3, 4, 5
C. 1, 2, 3, 5
D. 1, 2, 5
A is correct. Early signs include feeding difficulties, a persistent Moro reflex, and rigid arms or legs. (pg. 1457, box 49.3)
Poor head control is a sign, and so is failure to smile, but the time frame for those milestones are both THREE months of age.
The nurse has attended a continuing education conference on preschool-age children’s reactions to death. It indicates a correct understanding of the conference if the nurse states that preschool children:
A. Are very interested in funerals and burials
B. Understand that death is permanent
C. Imagine the deceased person is sleeping
D. Show more grief to a significant family member’s death
C is correct because preschoolers believe their thoughts and actions can cause death, death is seen as a departure/sleep, they don’t desperate death from living abilities and it is seen as temporary and gradual, with no understanding of inevitability of death. (pg. 1014)
Because they have fewer defense mechanisms to deal with loss, they may react to a less significant loss with more outward grief and the loss of a very significant person. They must deny it to survive the overwhelming impact.
A is incorrect because school-age children are very interested in post-death rituals.
B is incorrect because they don’t have a real understanding of the finality of death, that begins towards the end of school age and into adolescence.
D is incorrect because they usually have to suppress deep loss in order to cope.
The nurse is caring for a child who has leukemia with a white blood cell count <5000? Which of the following should be included in the nurse’s plan of care?
A. Use aseptic techniques for any procedures
B. Administer influenza vaccination
C. Allow the child to play with other children who do not have a fever
D. Require the child to wear a mask when outside of their room
D is correct because this is a measure to prevent infection.
A is incorrect bc it does not specifiy which procedures, some may be sterile. B is contraindicated while the child is sick and c also increases the risk of infection. (pg. 1300)
The nurse is providing a teaching session to the healthcare staff regarding osteosarcoma, which of the following statements by an attendee indicates a need for additional teaching?
A. In the early stage, the symptoms of this disease are usually attributed to intense pains
B. A common clinical manifestation is limping if a weight-bearing limb is affected
C. Children typically experience pain at the primary tumor site.
D. The sternum is the most common site of this sarcoma.
D is incorrect, the tumors are often manifested in the diaphyseal and metaphyseal region (wider part of the shaft, adjacent to the epiphyseal growth plate) of long bones, especially in the lower extremities. More than one half occur in the femur, the rest resolving in the humerus, tibia, pelvis, jaw and phalanges. (pg. 1319)
32.
The nurse is admitting a toddler who is being hospitalized following a near-drowning accident/submersion injury. The toddler is spontaneously breathing but is unconscious. Which of the following actions should the nurse perform FIRST?
A. Obtain arterial blood gases (ABG’s)
B. Implement seizure precautions
C. Administer oxygen via face mask
D. Notify spiritual advisor of parent’s choice
C is correct because the first priority (pg. 1371) is to restore oxygen delivery to cells and prevent further hypoxic damage. A spontaneously breathing child does well in an oxygen-enriched atmosphere; a more severely affected child will require intubation.
Blood gases and pH are monitored frequently as a guide to oxygen, fluid and electrolyte status/therapy. Seizures may occur due to hypoxia and cerebral edema, but these are not what will be performed FIRST.
The nurse is preparing information about ADHD at a school parent association meeting. Which of the following clinical manifestations should the nurse include in the presentation?
A. Difficulty waiting their turn
B. Prefers detailed tasks
C. Refrains from volunteering
D. Completes projects quickly
A is a sign of inattention and impulsiveness and could be included as a clinical manifestation. (pg. 954)
D is incorrect because kids with ADHD usually require MORE time to complete tasks. C is incorrect because selective attention is often seen and children don’t volunteer for non-preferred tasks. B is incorrect because inattention and distractibility is one of the most common manifestations and that makes detailed tasks more difficult to complete.