Answer to Question 1
ANS: B
Incorporating a family-centered approach to care is the best way to reduce stress and anxiety in the critically ill child's family. Involving the family in all decisions and care activities (if appropriate) is one of the most powerful ways of providing family-centered care. Comprehensive discharge teaching is a good nursing intervention, but not as important as including the family. Discharge teaching also cannot be done too far in advance. Rounding with physicians to ensure understanding is a great intervention, but is not as important as inclusion. Explaining procedures to the parents first, then to the child, may or may not be appropriate.
Answer to Question 2
ANS: B
Research shows that over half of all awakenings and arousals in intensive care unit patients are due to noise. To have the greatest impact on sleep and rest, the manager should work with staff to reduce the noise level on the unit, especially at night, so that normal sleep-wake cycles can be maintained as much as possible. Clustering care is a good idea to allow for some periods of uninterrupted rest and to decrease sensory overload from all sources, but may not always be practical and, even when done, will not have the same impact as overall noise reduction. A 2-hour quiet time may not provide all children with adequate rest and may be impossible to enforce. Turning off alarms is a dangerous practice and should not be done.
Application of an ostomy bag or pouch: B, An ostomy nurse applying an ostomy bag to a stoma;
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