An 8-year-old child will be hospitalized for several weeks in skeletal traction to treat a fractured femur. In planning care for the child, the nurse realizes immobilization in this age group can generate feeling of:
Fear of bodily harm.
Shame and guilt.
Altered body image
Loss of control.
The Correct Answer is D
School-aged children experience psychosocial development characterized by Erikson’s stage of industry versus inferiority, where mastery, competence, and autonomy are central. Hospitalization and prolonged immobilization disrupt perceived independence and self-directed activity, leading to psychological distress related to control and competence.
Rationale:
A. Fear of bodily harm is more prominent in younger children or during acute painful procedures. An 8-year-old in prolonged skeletal traction is more affected by loss of autonomy than immediate physical threat perception, making bodily fear less dominant in this developmental stage.
B. Shame and guilt are characteristic of preschool children in Erikson’s initiative versus guilt stage. At age 8, the child has already developed more advanced cognitive understanding, so emotional conflict is less about guilt formation and more about competence and independence.
C. Altered body image may occur in adolescents who are more focused on physical appearance and identity formation. An 8-year-old typically has less concern with body image distortion, making this less relevant compared with psychosocial autonomy disruption.
D. School-aged children placed in traction experience significant restriction of movement and participation in activities, leading to perceived loss of control. This directly impacts their developmental need for mastery and independence, making it the most prominent psychological response to immobilization.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Meningitis is an acute inflammation of the meninges typically caused by bacterial or viral infection, leading to increased intracranial pressure, cerebral irritation, and systemic toxicity. Classic pediatric signs include irritability, high-pitched cry, poor feeding, fever, and meningeal irritation due to central nervous system involvement.
Rationale:
A. Meningitis presents with meningeal inflammation causing irritability, poor feeding, and a high-pitched cry in young children due to increased intracranial pressure and cerebral irritation. These are early pediatric signs before classic neck stiffness becomes evident.
B. Lyme disease primarily causes erythema migrans, arthritis, and later neurologic complications. It does not typically present acutely with a high-pitched cry or severe irritability suggestive of intracranial infection in toddlers.
C. Reye syndrome is associated with hepatic dysfunction and cerebral edema following viral illness and aspirin use. It typically presents with vomiting and altered consciousness rather than a high-pitched cry and early irritability in this presentation.
D. Febrile seizures involve transient convulsions associated with fever but do not cause persistent irritability, poor feeding, or a shrill cry between episodes, making them inconsistent with the ongoing neurologic irritation described.
Correct Answer is C
Explanation
Osteomyelitis is a bone infection typically caused by hematogenous spread or direct inoculation of bacteria, most commonly Staphylococcus aureus. Risk increases with bone trauma, open fractures, foreign devices, and impaired local circulation, which facilitate bacterial seeding and reduce host immune clearance in affected bone tissue.
Rationale:
A. A tick bite may transmit Borrelia burgdorferi, causing Lyme disease, which can involve joints but is not a common direct cause of acute osteomyelitis. There is no indication of systemic bacterial dissemination to bone in this scenario.
B. Recent antibiotic treatment for streptococcal pharyngitis reduces bacterial load rather than increasing osteomyelitis risk. It does not directly predispose bone tissue to infection unless there is ongoing bacteremia or untreated systemic infection.
C. Skeletal traction involves bone manipulation and potential soft tissue disruption, creating a risk for localized infection. In the presence of trauma or invasive orthopedic devices, bacteria can directly seed bone, making this the strongest predisposing factor for osteomyelitis.
D. Short-term corticosteroid use may cause mild immune suppression, but a 2-week course is generally insufficient alone to significantly increase risk of deep bone infection compared to direct trauma or orthopedic intervention such as traction.
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