Chapter 37: Principles and Procedures for Nursing Care of Children
Test Bank
MULTIPLE CHOICE
1. What is the most appropriate statement for the nurse to make to a 5-year-old child who is
undergoing a venipuncture?
a. “You must hold still or I’ll have someone hold you down. This is not going to
hurt.”
b. “This will hurt like a pinch. I’ll get someone to help hold your arm still so it will
be over fast and hurt less.”
c. “Be a big boy and hold still. This will be over in just a second.”
d. “I’m sending your mother out so she won’t be scared. You are big, so hold still and
this will be over soon.”
ANS: B
Feedback
A Honesty is always best and a venipuncture may hurt.
B Honesty is the best approach. Children should be told what sensation they will
feel during a procedure. A 5-year-old child should not be expected to hold still,
and assistance ensures safety to everyone.
C This statement is not supportive or honest.
D Parents should be encouraged to remain with the child unless they are extremely
uncomfortable doing so.
2. Which nursing diagnosis is appropriate for the 5-year-old child in isolation because of
immunosuppression?
a. Spiritual distress
b. Social isolation
c. Deficient diversional activity
d. Sleep deprivation
ANS: C
Feedback
A A 5-year-old child is not developmentally advanced enough to feel spiritual
distress.
B The main social system for a 5-year-old child is the family, who should be
allowed liberal visitation.
C Children in isolation need extra attention to avoid boredom.
D Sleep deprivation may occur during hospitalization but is not specific to
isolation.
PTS: 1 DIF: Cognitive Level: Application REF: p. 920
, OBJ: Nursing Process: Diagnosis
MSC: Client Needs: Safe and Effective Care Environment
3. What should the nurse consider when having consent forms signed for surgery and procedures
on children?
a. Only a parent or legal guardian can give consent.
b. The person giving consent must be at least 18 years old.
c. The risks and benefits of a procedure are part of the consent process.
d. A mental age of 7 years or older is required for a consent to be considered
“informed.”
ANS: C
Feedback
A In special circumstances, such as emancipated minors, the consent can be given
by someone younger than 18 years without the parent or legal guardian.
B In special circumstances, such as emancipated minors, the consent can be given
by someone younger than 18 years without the parent or legal guardian.
C The informed consent must include the nature of the procedure, benefits and
risks, and alternatives to the procedure.
D A mental age of 7 years is too young for consent to be informed.
PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 918
OBJ: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
4. The nurse is planning how to prepare a 4-year-old child for some diagnostic procedures.
Guidelines for preparing this preschooler should include
a. Planning for a short teaching session of about 30 minutes
b. Telling the child that procedures are never a form of punishment
c. Keeping equipment out of the child’s view
d. Using correct scientific and medical terminology in explanations
ANS: B
Feedback
A Teaching sessions for this age-group should be 10 to 15 minutes in length.
B Illness and hospitalization may be viewed as punishment in preschoolers.
Always state directly that procedures are never a form of punishment.
C Demonstrate the use of equipment, and allow the child to play with miniature or
actual equipment.
D Explain the procedure in simple terms and how it affects the child.
PTS: 1 DIF: Cognitive Level: Application REF: p. 918
OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
5. Which nursing action is most appropriate when treating a child who has a fever of 102.5° F?
a. Restrict fluid intake.
b. Administer an aspirin.
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