Review Practice Exercise 1

The child who is hospitalized > Child Health

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Practice Exercise 1

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Total Questions : 4

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Question 1:

A nurse is caring for a 4-year-old child who is admitted to the hospital. The child states, "I am sick because I was bad." The nurse knows this statement is a characteristic of which developmental stage's coping mechanism?

A. Toddler B. Preschooler C. School-age D. Adolescent

Answer and Explanation

Choice A:

Toddlers (1–3 years) have limited understanding of illness and are more focused on immediate needs and sensory experiences, rather than linking behavior to illness.

Choice B:

Magical thinking is characteristic of the preschool stage, where children may link unrelated events to their own actions or behavior. This belief can lead to feelings of guilt or fear about being “bad” and causing illness. Nurses should provide reassurance and simple explanations to correct misconceptions and reduce anxiety.

Choice C:

School-age children (6–12 years) think more logically and concretely; they understand cause and effect more realistically and are less likely to believe illness is punishment for behavior.

Choice D:

Adolescents are capable of abstract thinking and understand health and illness in logical, scientific terms; magical thinking is uncommon.

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Question 2:

Separation anxiety is something that affects children when they are hospitalized. Each developmental stage has a somewhat different reaction as they deal with this difficulty. Which stage corresponds to the adolescent stage?

A. May demonstrate separation anxiety by refusing to eat, experiencing difficulty in sleeping, crying quietly for their parents, continually asking when the parents will visit, or withdrawing from others. B. Separation anxiety comes in stages: protest, despair, and detachment. C. Loss of peer group contact may pose a severe emotional threat because of loss of group status, inability to exert group control or leadership, and loss of group acceptance. D. May need and desire parental guidance or support from other adult figures but may be unable or unwilling to ask for it.

Answer and Explanation

Choice A:

Refusing to eat, crying quietly, continually asking for parents is more typical of preschool children, who express separation anxiety with clinginess, sadness, and visible distress.

Choice B:

Protest, despair, and detachment stages describe the toddler stage response to separation, where children first cry loudly (protest), then become withdrawn (despair), and finally show detachment if prolonged.

Choice C:

Loss of peer group contact best reflects the adolescent stage. Hospitalization interrupts school, friendships, and social roles, causing anxiety, withdrawal, or rebellion. Peer acceptance is critical for adolescents’ self-coRationale for incorrect answers:

Choice D:

May need/desire parental guidance but unwilling to ask aligns more with school-age children, who seek security in adults but may avoid openly asking for support due to growing independence.

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Question 3:

The parents of a hospitalized 2½-year-old child tell the nurse and the child that they must leave the hospital to care for their children who are at home. Which of the following responses would the nurse expect the child to exhibit?

A. Kicking and crying B. Waving goodbye C. Sucking a thumb D. Hugging a doll

Answer and Explanation

Choice A:

Kicking and crying reflects the protest stage of separation anxiety, which is typical for toddlers when separated from parents. The child may be angry, loud, and inconsolable, showing distress over the parents’ departure.

Choice B:

Waving goodbye is more characteristic of an older preschooler who has developed better coping mechanisms. A 2½-year-old is unlikely to calmly wave goodbye when faced with parental separation.

Choice C:

Sucking a thumb is a self-comforting behavior but is more commonly seen in the despair stage, when the child becomes quieter after prolonged separation, not immediately when parents leave.

Choice D:

Hugging a doll indicates detachment or self-comfort, seen in later stages of separation anxiety (despair or detachment), not in the immediate protest stage.T

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Question 4:

A 10-year-old child on a regular diet refuses to eat the food on her meal tray. She requests chicken nuggets, French fries, and ice cream. What is the best nursing action?

A. Ask that the child’s desired foods be sent up from the kitchen. B. Negotiate with the child to eat at least part of the food on the tray. C. Remove a privilege. D. Offer the child cereal and milk from stock on the nursing unit.

Answer and Explanation

Choice A:

Asking that the child’s desired foods be sent up from the kitchen reinforces picky eating and gives in to demands, which undermines nutritional goals and sets an unhelpful precedent.

Choice B:

Negotiating with the child to eat at least part of the food on the tray is the best approach because it balances the child’s need for autonomy with the nurse’s responsibility to maintain nutritional intake. Negotiation encourages cooperation, allows the child to feel some control, and ensures they still receive adequate nutrition from the hospital-approved meal.

Choice C:

Using punishment is not therapeutic and may increase resistance, making mealtimes more stressful.

Choice D:

Offering the child cereal and milk from stock on the nursing unit bypasses negotiation and encourages food refusal by offering an easy alternative rather than teaching cooperation.

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Total Questions : 4

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Practice Exercise 1

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