Author Question: The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally ... (Read 128 times)

segrsyd · **on:** Jun 27, 2018

The nurse is caring for a premature baby in the NICU. The mother reports that the infant's normally happy and outgoing 5-year-old sister is acting sad and withdrawn.

The nurse understands that due to her developmental stage, the girl is at risk of which of the following? A) Viewing her baby sister's illness as her fault
B) Harming the baby
C) Experiencing clinical depression
D) Creating an imaginary friend to cope with the situation

Question 2

The nurse is using a postoperative pain management scale to determine if a newborn recovering from emergency surgery is experiencing pain. Which observations indicate that the child is experiencing level 3 pain this time? (Select all that apply.)

A) High-pitched cry
B) Baby is grimacing
C) Baby has not fallen asleep
D) Heart rate elevated to greater than 20 over the baseline
E) Baby falls asleep for short periods and then wakes up crying

vickybb89 · **Reply #1 on:** Jun 27, 2018

Answer to Question 1

A
Feedback:
Since the preschool child is facing the psychosocial task of initiative versus guilt, it is natural for the child to experience guilt when something goes wrong. The child may have a strong belief that if someone is ill or dying, he or she may be at fault and the illness or death is punishment. It is less likely that the girl would be at risk of harming the baby or experiencing clinical depression as a result of the baby's illness. The child may create an imaginary friend to cope with the illness, but would not withdraw or express sadness as a result of the imaginary friend.

Answer to Question 2

A, C, D
Feedback:
Observations that the infant is experiencing pain at a level 3 include a high-pitched cry, not sleeping, and a heart rate elevated to greater than 20 over the baby's baseline. Grimacing and falling asleep for short periods indicate pain at a level 2.