A child is to undergo a tympanostomy tube placement in a freestanding outpatient surgery center. What is the major disadvantage associated with this location?

Increased risk for infection

Increased health care costs

Need to be transferred if overnight stay is required

Increased disruption of family functioning

Answer and Explanation

The Correct Answer is C

A tympanostomy tube placement is a minor outpatient procedure typically done in children with recurrent otitis media. Freestanding outpatient surgery centers, also known as ambulatory surgical centers (ASCs), are independent medical facilities designed specifically for same-day surgical procedures that don’t require an overnight hospital stay.

Rationale for correct answer:

C. Freestanding centers do not have the capacity for inpatient admissions. This is the major disadvantage compared to hospital-based surgery centers, as unplanned transfers delay continuity of care and increase risks in case of complications.

Rationale for incorrect answers:

A. Outpatient centers actually have lower infection risks compared to hospitals due to shorter stays and reduced exposure to hospital-acquired infections.

B. Care at outpatient centers is usually less expensive, making this an advantage rather than a disadvantage.

D. Outpatient centers allow same-day discharge, which reduces family disruption, making this incorrect.

Take-Home Points

Main disadvantage of freestanding surgery centers: inability to provide overnight care, requiring transfer if complications arise.
Outpatient centers are generally safe, cost-effective, and less disruptive for families.
Nurses should educate parents about possible transfer needs and what to expect in the rare event of complications.
Preoperative and postoperative planning should always consider the setting’s limitations.

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Correct Answer is C

Explanation

When caring for children with life-threatening or terminal illnesses, nurses often face difficult questions about death. School-age children, around 12 years old, understand that death is final and irreversible, and they seek honest, empathetic answers.

Rationale for correct answer:

C. “Some children who have been diagnosed with your illness do die.” This response is honest, developmentally appropriate, and empathetic. At age 12, children in the concrete–formal operational stage (Piaget) understand that death is permanent and universal. They deserve truthful answers. The nurse’s role is to provide open, supportive communication, allowing the child to express fears, feelings, and questions while fostering trust.

Rationale for incorrect answers:

A. “Don’t talk like that. You are going to get better very soon.” This is false reassurance and invalidates the child’s feelings and undermines trust.

B. “It would be best if you were to ask your doctor about that.” This avoids the child’s question, shuts down communication, and conveys that the nurse is uncomfortable discussing important concerns.

D. “It’s hard for me to talk about death. It would be best if you were to ask your parents.” This focuses on the nurse’s feelings instead of the child’s. This avoidance leaves the child unsupported and isolated with their fears.

Take home points

Children around 10–12 years old understand the permanence of death and may ask direct questions.
The nurse should respond with honesty, empathy, and openness, validating the child’s feelings while providing comfort.
Avoid false reassurance or deflection, these erode trust and increase anxiety.
Facilitating discussions with parents, providers, and chaplains may also help, but the nurse should not avoid the child’s direct questions.

A. “I know that the procedure is supposed to make me better.” B. “The procedure is going to be done at 10 a.m. this morning.” C. “Dr. Jones wants to perform the procedure on me.” D. “My mother signed the form that the doctor brought in.”

Correct Answer is B

Explanation

Assent is the child’s affirmative agreement to the procedure. It means the child understands, in their developmental capacity, what will happen and why, and expresses willingness to proceed.

Rationale for correct answer:

B. “The procedure is going to be done at 10 a.m. this morning.” This statement shows the child understands what is happening and when it will occur. It reflects awareness and agreement, which is age-appropriate for an 8-year-old.

Rationale for incorrect answers:

A. “I know that the procedure is supposed to make me better.” While this reflects some understanding of why the procedure is being done, it does not confirm the child’s willingness or agreement to undergo it.

C. “Dr. Jones wants to perform the procedure on me.” This reflects awareness of who is performing the procedure, but it does not demonstrate the child’s assent.

D. “My mother signed the form that the doctor brought in.” This reflects parental consent, not the child’s assent. The parent has the legal authority to consent, but assent still requires the child’s understanding and willingness.

Take home points

Consent is the legal, by parent/guardian.
Assent involves:
1. Basic understanding of the procedure.
2. Awareness of its purpose/benefit.
3. Voluntary agreement (without coercion).
Nurses play a key role in ensuring that assent is sought when appropriate, even if legal consent is already given by parents.

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A child is to undergo a tympanostomy tube placement in a freestanding outpatient surgery center. What is the major disadvantage associated with this location?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse has been assigned to care for a 12-year-old child who will likely die from his illness. The child asks the nurse, “Do you think I am going to die?” Which of the following responses would be appropriate for the nurse to make?

Correct Answer is C

Explanation

The nurse is assessing whether or not an 8-year-old child has given assent for a scheduled painful procedure. Which of the following statements by the child would reflect that the child has given assent?

Correct Answer is B

Explanation

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