Ch. 1- Introduction to Child Health and Pediatric Nursing PrepU
The nurse is caring for a 16-year-old boy with injuries from a car accident. Which activity describes the nurse's manager role? A. facilitating return to school by working with the school nurse B. teaching the mother cast care C. discussing driving safety with the teen D. changing dressings covering the skin abrasions
A. facilitating return to school by working with the school nurse Much of an adolescent's life revolves around school and peers. In helping the teen return to school, the nurse and the school nurse are achieving continuity of care and a supportive environment for healing. Teaching the mother cast care addresses the mother's learning needs and the teaching role of the nurse. Discussing driving safety with the teen is important and a factor in many adolescent injuries and deaths but is not a management activity. Changing dressings is a direct care activity of the nurse.
In order to advocate for children and families, the nurse must first acknowledge that the basic system in which health behavior and care are organized, secured, and performed is the: A. health care facility. B. family. C. government. D. community.
B. family. The family is the basic system in which health behavior and care are organized, secured, and performed. In most families, the parents or guardians, as advocates for their child, provide health promotion and health prevention care, as well as primary management of care when the child is sick. Parents and guardians have the prime responsibility for initiating and coordinating services rendered by health professionals.
Following the discharge of a child who has a chronic health condition from the hospital, the nurse case manager follows up with a visit to the home and meets with the family and child. This visit best represents which philosophy of pediatric nursing? A. risk-reduction potential care B. evidence-based nursing care C. family-centered care D. atraumatic therapeutic care
C. family-centered care The home visit by the case manager to some degree meets principles of each type of care, but is most representative of family-centered care because family-centered care is described as a mutually beneficial partnership between the child, the family, and health care professionals.
The nursery nurse is preparing a consent form for the circumcision of a newborn. The mother of the child is 16 years of age. The baby's father is not participating in the care. When planning to complete the surgical consent, which action by the nurse is most appropriate? A. Determine if the baby's father is older than 18 years, and if so ask for him to sign. B. Ask the grandmother of the newborn to sign the surgical consent. C. Recommend that the court appoint a guardian for the baby. D. Ask the baby's mother to sign the surgical consent.
D. Ask the baby's mother to sign the surgical consent. The consent of a parent or guardian is required for completion of a surgical procedure such as a circumcision. The parent in this case is underage. She may, however, consent for health care treatment of her child.
To decrease childhood mortality, pediatric nurses need to consistently engage in what activity throughout all age groups? A. Provide guidance regarding proper nutrition. B. Teach injury prevention and proper safety practices. C. Advocate for more research into control of environmental toxins. D. Help integrate exercise practices and programs into the lifestyles of individuals and communities.
B. Teach injury prevention and proper safety practices. The leading cause of death throughout childhood is unintentional injury.
The nurse is providing care to a 6-year-old child following surgery. The nurse asks the child to rate the pain using the Faces of Pain scale. Which phase of the nursing process is the nurse demonstrating? A. Implementation B. Nursing diagnosis C. Evaluation D. Assessment
D. Assessment By using the pain scale the nurse is assessing the child's level of pain. A nursing diagnosis is not demonstrated in this scenario. Implementation in this scenario would involve pain control interventions, and evaluation would be determining if pain control had been achieved.
During the weekly team meetings, the physician and case manager discuss the client's planned assent. What activity should the nurse most anticipate? A. The client will be discharged to home in the coming days. B. The client will be moving toward legal emancipation. C. The client will begin to have increasing amounts of time spent unsupervised. D. The client will have a conference with the physician about the planned course of care and treatment.
D. The client will have a conference with the physician about the planned course of care and treatment. Assent means agreeing to something. In pediatric health care, the term assent refers to the child's participation in the decision-making process about health care. As a child gets older assent or dissent should be given more serious consideration. The pediatric client needs to be empowered by physicians to the extent of his or her capabilities, and as the child matures and develops over time the client should become the primary decision maker regarding his or her health care.
A child with a serious health condition has been hospitalized to undergo treatments. After a week of treatment the physicians have determined that the child has only weeks to live. What is the most likely initial course of action the nurse can anticipate? A. "Do not resuscitate" orders should be obtained from the physician. B. The physician will confer with the parents to outline the severity of the child's condition. C. A referral to the hospital's ethics committee will be initiated. D. The parents will be asked to sign the do not resuscitate paperwork.
B. The physician will confer with the parents to outline the severity of the child's condition. When a child is not expected to recover, steps will be taken to review the care being provided. The parents will be told of the expected outlook for the child followed by likely recommendations to discontinue treatment and focus on comfort measures. Although orders may be received to withhold resuscitation, a conference with the parents is indicated first. There is no need at this time to notify the facility's ethics committee.
The nurse is talking with the mother of a 2-year-old girl during a scheduled visit. Which teaching subject best supports the emphasis on preventive care? A. Discussing with the mother anticipated developmental milestones. B. Describing physical changes taking place in her child. C. Showing the mother how to teach handwashing to her child. D. Reminding the mother that the child will imitate her.
C. Showing the mother how to teach handwashing to her child. Teaching handwashing helps to prevent infection, emphasizes preventive care, and is basic to avoiding many common illnesses. Reminding the mother that the child will imitate her may promote safe parental role-modeling but does not reach the level of prevention that handwashing does. Knowing about developmental milestones and typical physical changes in toddlers does not directly promote preventive care.
Consent for urgent treatment is needed for a minor. The parents are unable to be at the hospital. What action by the nurse constitutes informed consent? A. Treating the minor and obtaining written informed consent when the parent arrives. B. Explaining the needed treatment to the minor and documenting this action. C. Telephone consent with two witnesses listening simultaneously. D. Contacting the institution's attorney to provide and document consent.
C. Telephone consent with two witnesses listening simultaneously. Telephone consent documented with two witness signatures is appropriate. None of the other options constitutes informed consent.
A nurse is reviewing the medical record of a 3-year-old child who is brought to the clinic for an evaluation. The nurse notes that the child is participating in a community Early Head Start program. The nurse understands that this program focuses on which aspect? A. health insurance B. coverage by Medicaid C. services for handicapped children D. child development
D. child development - Early Head Start programs are federally funded community-based programs for low-income families that focus on child development. - The Children's Health Insurance Program (CHIP) offers federal assistance to state-based health insurance for low-income families that are not eligible for Medicaid but cannot afford private insurance. - The Omnibus Budget Reconciliation Act extended Medicaid coverage to all children with a family income below 133% of the poverty level. - The Education of Handicapped Act Amendments established federal funding for states to create statewide comprehensive, coordinated, and multidisciplinary early-intervention services for handicapped infants and toddlers.
A nurse is determining whether or not informed consent has been obtained from the family of a child who is going to have abdominal surgery. Which statement by the family would lead the nurse to suspect that informed consent is lacking? A. "We had to sign the form right away so the surgery could get scheduled." B. "Although there are risks involved, our son needs the surgery to cure the problem." C. "We are amazed that he'll be up and walking around the day after surgery." D. "He might miss some school afterwards, but he'll be feeling much better."
A. "We had to sign the form right away so the surgery could get scheduled." The statement about signing the form right away suggests that the family was coerced into agreeing to the surgery without being fully informed about the risks and benefits. The key ethical issues related to informed consent for treatment have similarities to those required for research participation: Consent must be voluntary and based upon shared information about the risks and benefits of the treatment. Furthermore, the parent must understand the information and be cognitively and mentally competent to make the decision. The statements about risks, activity limitations, and postoperative care indicate that information was shared with them and that they understood it.
A 17-year-old adolescent is brought to the emergency department after being injured in a motorcycle accident. The injuries do not appear to be life-threatening. Which action should the nurse take first? A. Collect data from the client, including insurance information needed for billing. B. Assess the client to determine what interventions are needed at this time. C. Inform the client he or she will be treated as soon as the parent or guardian has consented. D. Contact the client's parent or guardian to obtain consent for needed treatment.
B. Assess the client to determine what interventions are needed at this time. Certain federal laws, such as the Emergency Medical Treatment and Labor Act (EMTALA), require that every child who presents at an emergency department is given a medical examination regardless of informed consent or reimbursement ability. The parent or guardian will be contacted to consent to treatment and to obtain billing information, but the child will be assessed first.
The nurse is applying the nursing process to the care of a 5-year-old child who has been diagnosed with asthma. Which action should the nurse perform first? A. Collaborate with the child and the caregivers to determine their specific, desired outcomes for care. B. Interview the child and the caregivers to determine the most common causes of the child's symptoms. C. Teach the child and the caregivers basic strategies for preventing and managing asthma symptoms. D. Identify the nursing diagnoses that are most commonly associated with childhood asthma.
B. Interview the child and the caregivers to determine the most common causes of the child's symptoms. The nursing process always begins with assessment, an activity that would include an interview focusing on precipitating factors. Each of the other listed activities would be performed subsequent to an assessment.
Morbidity data indicates that support is needed from pediatric nursing groups to establish improved and additional services for children with what health issues? A. digestive system problems B. mental health and behavioral disorders C. poor immunization status D. illnesses due to environmental toxins
B. mental health and behavioral disorders Morbidity findings show mental health, emotional, social, and behavioral disorders trending upward. Immunization status in childhood has been improving. Digestive system problems remain fairly static. Illness due to environmental toxins has not shown a significant increase; this may change.
What was the primary goal for the establishment of the Children's Bureau? A. the improvement of parenting behaviors B. to improve the standards of health care C. to reduce prematurity D. to promote prenatal care
B. to improve the standards of health care The establishment of the Children's Bureau in 1912 began a period of studying economic and social factors related to infant mortality, infant care in rural areas, and other factors related to children's health. The goal of these legislative efforts was to improve the standards of health care.
The nurse is working with the parents of an infant and a toddler in the clinical setting. What statement by the parent would alert the nurse to assess the children further? A. "We have to hire babysitters sometimes because our parents are not able to help babysit." B. "We enjoy taking walks in the park and playing outside as much as possible." C. "We live in an old house, and we are planning to renovate it when the kids are older." D. "We have baby gates installed at the top and bottom of our stairs in our home."
C. "We live in an old house, and we are planning to renovate it when the kids are older." Older homes are at risk for having lead-based paint (usually those built before the mid to late 1970s) and lead pipes used in plumbing. The nurse would further assess for the children's exposure to lead pipes, paint, paint chips, lead dust, and soil containing lead dust and paint chips. Additionally, during a renovation, the children will be exposed to areas with lead paint and/or dust. The other options are appropriate and demonstrate information only and not a need to further assess.
Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because: A. more disabilities are occurring in children because many women are delaying pregnancy and giving birth to babies later in life. B. there are fewer positions for nurses in institutions providing acute care. C. increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive. D. uninsured families can access these services. E. disability and chronic illness have increased with the appearance of more genetic abnormalities.
C. increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive. Advances in health care have led to more children living with chronic illness or disability. The statements about genetic disease and older women may contain some truth but have only added a few people to the chronic illness total. Acute care pediatric nursing positions are decreasing in community hospitals but are more available in medical centers. Uninsured families may or may not be able to access nonhospital care.
Morbidity rates among children are most highly associated with which cause? A. Suicide and homicide B. Firearms at home C. School violence D. Environmental factors
D. Environmental factors The factors most commonly associated with child morbidity are environmental and socioeconomic problems. The more difficult the societal issues and the more marked the environmental poverty, the higher the illness rates and childhood morbidity. Firearms, violence in schools, homicide, and suicide are all factors in morbidity, but they are not strictly related to children.
The parent of an 11-year-old girl with an inoperable brain tumor confides to the nurse that her daughter's physician is "pushing them" to convince their daughter to participate in a controversial treatment that has a high risk for side effects. She further states that she told him twice that they were not interested. What would be the nurse's best response to this situation? A. Tell the doctor that the procedure is not in the best interests of this girl and ask him to respect the rights of the family. B. Reassure the family that the doctor is acting in their best interests and they should reconsider the treatment. C. Tell the parents to state in writing that they will not participate in the treatment and give the letter to their physician. D. Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved.
D. Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved. When a nurse believes the physician has unduly coerced parents in their treatment decision, the nurse would be obliged to intervene and disclose any concerns. Such intentional or unintentional action would violate ethical principles of conduct.
The home health nurse is visiting a child with chronic medical needs, including home oxygen and nebulizers. During the visit, the parents indicate the primary income earner recently was laid off from work and the family has lost their insurance benefits. What action would the nurse take next? A. Ask the health care provider to prescribe the most affordable or generic form of the medications. B. Encourage the family to seek the advice of their spiritual or religious advisor. C. Offer the name and contact number of a support group for parents of ill children. D. Refer the family to a case manager or social worker to assist in getting them resources.
D. Refer the family to a case manager or social worker to assist in getting them resources. The nurse would be diligent in doing all of these actions, but the most important one to take is a referral to a case manager or social worker. By doing so, the case manager or social worker can work on a comprehensive plan to maintain the family's benefits, community resources and assistance. Spiritual connection is one branch of holistic care and is important but can be completed after the referral. Helping with prescription costs is also important, but is not comprehensive of the family's medical needs. Emotional support is also an important aspect of holistic care but would be considered after the comprehensive approach.
The nurse reviews the medical record of a child with a Wilms tumor and notes the child has a do not attempt resuscitation (DNAR) prescription from the primary health care provider. During assessment, the nurse notes the child is not breathing, pulse is 20 beats/minute, and is unresponsive. Which action by the nurse is appropriate? A. Perform sternal rub. B. Perform cardiopulmonary resuscitation. C. Measure the child's urine output. D. Support the child and family members.
D. Support the child and family members. A DNAR prescription reflects a decision to not attempt cardiopulmonary resuscitation. The presence of a DNAR prescription does not mean that other interventions are to be withdrawn or withheld. The nurse would now support the child and family members while providing end-of-life care for the child. It is not appropriate to inflict pain on the child by performing sternal rub. Measuring output is not indicated at this time. This would be warranted earlier in the prognosis.
A student nurse shares an interest in pediatric nursing. When discussing her thoughts about pediatric nursing, which statements are consistent with the philosophies of pediatric nursing care? Select all that apply. A. "Since health care can be scary for a child, it's important to make them feel secure." B. "The child should be included as much as possible in the plan of care." C. "Until they are teens, kids should have a limited amount of decision making in their care." D. "I believe the family should be included in all aspects of the plan of care and treatment." E. "I think the parents must be the director of the client's care until adulthood."
A. "Since health care can be scary for a child, it's important to make them feel secure." B. "The child should be included as much as possible in the plan of care." D. "I believe the family should be included in all aspects of the plan of care and treatment." The three general concepts that form the philosophy of pediatric nursing care are family-centered care, atraumatic care, and evidence-based care. Pediatric nurses use these three concepts to provide quality, cost-effective care that is continuous, comprehensive, and compassionate.
A nurse is working as part of a research team evaluating children for participation in a research study. The nurse demonstrates respect when the nurse obtains assent from children over which age? A. 7 B. 18 C. 12 D. 16
A. 7 Respect for persons requires that the subject is able to independently and autonomously volunteer to participate in a study. Because infants and children do not have this ability, parents must consent on behalf of their children. Cognitively intact children over the age of 7 years should always be asked to give their assent.
Which child represents an increasingly common pediatric medical scenario currently present in the United States? A. 9-year-old girl diagnosed with type 2 diabetes B. 5-hour-old neonate diagnosed with Tetralogy of Fallot C. 13-year-old boy admitted with a fall-induced fractured femur D. 4-year-old girl diagnosed with non-Hodgkin lymphoma
A. 9-year-old girl diagnosed with type 2 diabetes The incidence of diabetes is rising in the United States. This is not noted to be the case with congenital anomalies, trauma or lymphoma.
The client is a 1-year-old girl from a low-income family presenting with a vitamin D deficiency and anemia. What assistance program would you recommend to the child's young mother? A. WIC B. ECI C. CHIP D. SCHIP
A. WIC - The special supplemental nutrition program for women, infants, and children (WIC) provides services to supply nutritional food to low-income women and their children. - SCHIP or CHIP provides health insurance to newborns and children in low-income families who do not otherwise qualify for Medicaid and are uninsured. - The Early Childhood Intervention (ECI) program, sponsored by Easter Seals, is available for the child with disabilities or developmental delays.
The nurse is running an education program for early grade-school children. Which topic would address the number one cause of death for this age group? A. Exercise and good nutrition B. The importance of crossing streets safely C. Prevention of infection and communicable disease D. The importance of immunizations
B. The importance of crossing streets safely Motor-vehicle accidents are a leading cause of death in this age group.
The nurse is assessing a 9-year-old boy during a back-to-school checkup. Which finding is a factor for childhood injury? A. Mother reports she has used alcohol and drugs. B. Records show child weighed 2,450 g at birth. C. Mother reports the child is hostile to other children. D, The parents adopted the boy from Guatemala.
A. Mother reports she has used alcohol and drugs. One of the factors associated with childhood injuries is parental drug or alcohol use. This is the leading cause for child mortality. Low-birth-weight babies are at higher risk for infant mortality. Foreign-born adoption is a factor for childhood morbidity. The child's hostility toward other children may be an environmental or psychosocial factor for childhood morbidity.
A new nurse asks what he can do to promote evidence-based practice. What information should be included in the response? Select all that apply. A. Participate in professional development activities. B. Maintain an open line of communication with the unit's management team. C. Ask pertinent clinical questions. D. Be attuned to client concerns. E. Participate in unit committees.
A. Participate in professional development activities. B. Maintain an open line of communication with the unit's management team. C. Ask pertinent clinical questions. D. Be attuned to client concerns. E. Participate in unit committees. Evidence-based practice involves the use of research findings in establishing a plan of care and implementing that care. It is a clinical decision-making approach involving the integration of the best scientific evidence, client values and preferences, clinical circumstances, and clinical expertise to promote best outcomes. It is important that nurses develop the skills and knowledge necessary to ask pertinent clinical questions, search for current best evidence, analyze the evidence, integrate the evidence into practice when appropriate, and evaluate outcomes.
The student nurse is completing the care plan for a child newly diagnosed with diabetes. Which actions should the student nurse prioritize to successfully complete the planning and expected outcomes phase of the nursing process? Select all that apply. A. Provides written materials about proper meal planning B. Collects necessary data from the child and parents C. Ensure the child can properly injected insulin by time of discharge D. Teaches the child how to do a finger stick to check the blood glucose E. Reviews the child's records of daily blood glucose levels for accuracy
A. Provides written materials about proper meal planning C. Ensure the child can properly injected insulin by time of discharge D. Teaches the child how to do a finger stick to check the blood glucose During the planning and outcomes phase of the nursing process, goals or expected outcomes that improve the child's dysfunctional health patterns, promote appropriate health patterns, or provide for optimal developmental outcomes are developed and identified. The goal regarding correct injection procedure, providing proper nutritional plans, and teaching how to conduct a blood glucose screening demonstrates this phase of the nursing process. Collecting data is accomplished in the assessment phase. Reviewing the child's blood glucose level records will be accomplished in the implementation phase.
A nurse is looking for information about advocacy activities related to promoting literacy. What group would be most appropriate for the nurse to contact? A. Society of Pediatric Nurses (SPN) B. National Association of Pediatric Nurse Practitioners (NAPNAP) C. Annie E. Casey Foundation D. National Association of School Nurses (NASN)
A. Society of Pediatric Nurses (SPN) - The Society of Pediatric Nurses (SPN) has several position statements regarding advocacy issues such as promoting literacy, preventing violence against children, and pediatric injury prevention. - The National Association of School Nurses (NASN) promotes programs to improve the health and education success of children. - The Annie E. Casey Foundation is a watchdog group for promoting child health. - The National Association of Pediatric Nurse Practitioners (NAPNAP) is involved in several programs. Examples include the Keep Your Child/Yourself Safe and Sound (KySS) program and the Healthy Eating and Activity Together (HEAT) initiative. These two initiatives focus on the nurse's role in the prevention and early identification of psychosocial morbidities and overweight, respectively.
The nurse is caring for a 5-year-old girl with meningitis. What action by the nurse may be considered ethical behavior? A. Starting intravenous fluids even though the child protests B. Referring to the child as "her" when she is present C. Telling her an intramuscular injection won't hurt D. Scheduling a laboratory procedure at lunchtime
A. Starting intravenous fluids even though the child protests Ignoring the child's dissent regarding proposed therapy is ethically sound. The treatment will benefit the child, and at 5 years of age the decision maker is nearly always the parent or legal guardian. However, the nurse must use developmentally appropriate techniques to inform the child about the therapy and to carry it out. Telling her an intramuscular injection won't hurt lacks veracity. Referring to the girl as "her" when she is present shows disrespect. Scheduling a laboratory procedure at lunchtime is unfair to the child and lacks justice.
The nurse is caring for a minor child who has voiced an interest in becoming emancipated. What information can the nurse provide to the client? Select all that apply. A. The courts will have to approve the request for emancipation. B. An emancipated minor needs to be self-supporting. C. Parents must provide the initial request on behalf of the child to become emancipated. D. Emancipation requires a minor to live apart from his or her parents. E. The process to become emancipated will be very expensive.
A. The courts will have to approve the request for emancipation. B. An emancipated minor needs to be self-supporting. D. Emancipation requires a minor to live apart from his or her parents. Emancipated minors are considered adults in the eyes of the law and may make their own health care decisions. Laws about this topic will vary from state to state. The emancipated minor generally lives apart from the parents and is financially independent. Courts grant emancipation.
A nurse is caring for a child. Which individual would the nurse identify as being primarily responsible for initiating and coordinating health care? A. parents B. social worker C. community D. case manager
A. parents Parents and guardians have the primary responsibility for initiating and coordinating services rendered by health professionals. A social worker or case manager may be involved but are not primarily responsible for the child's care. The community provides programs to promote and support children's health.
When providing care to the pediatric client recently diagnosed with diabetes, the role of nurse educator is best demonstrated with which scenarios? Select all that apply. A. The nurse provides diabetic teaching to the child and family. B. The nurse contacts the primary care physician to provide information on the client's ability to perform blood sugar monitoring. C. The nurse asks the child to list signs and symptoms of hypoglycemic reaction after the family has attended diabetic teaching classes. D. The nurse encourages the child and family to attend nutrition classes for those newly diagnosed with diabetes. E. The nurse reports the blood sugar levels for the day to the night duty nurse.
A. The nurse provides diabetic teaching to the child and family. C. The nurse asks the child to list signs and symptoms of hypoglycemic reaction after the family has attended diabetic teaching classes. D. The nurse encourages the child and family to attend nutrition classes for those newly diagnosed with diabetes. The roles of the pediatric nurse include that of providing direct nursing care to children and their families, being an advocate, educator, and manager. Being an educator means the nurse either provides the education to the child and/or family, evaluates learning, or arranges learning opportunities for the family. Contacting the primary care provider demonstrates the role of advocate, and reporting to other staff demonstrates coordination of care.
The nurse providing care to the fifth-grade child and his family reviews the nursing care plan, noting that teaching about pubertal changes is one of the individualized interventions. The nurse chooses not to address this. How should the nurse's action be evaluated? A. This nurse has not met the standard of care that constitutes adequate nursing practice identified in Pediatric Nursing: Scope of Standards and Practice. B. Sexuality education is a function of the schools—the nurse need not assume the function. C. Nurses make clinical decisions—this action is acceptable. D. The intervention on the nursing care plan came from the family, not the nurse—the nurse may omit it.
A. This nurse has not met the standard of care that constitutes adequate nursing practice identified in Pediatric Nursing: Scope of Standards and Practice. The nurse is not meeting professional role expectations. Implementing the interventions identified in the plan of care is expected. Nurses include families in developing the care plan. This is part of family-centered care. Nurses make clinical decisions but would omit teaching only if data indicated it is a wise choice. Sexuality education falls to the school, family, and nurse.
A child has been injured and his parents are not available. Which individuals may provide consent for the care in the event the parents have provided documentation allowing for this? Select all that apply. A. a babysitter B. a family friend C. a teacher D. a minor sibling D. a clergy member
A. a babysitter B. a family friend C. a teacher D. a clergy member There are special situations related to informed consent. If the parent is not available, then the person in charge (relative, babysitter, or teacher) may give consent for emergency treatment if that person has a signed form from the parent or legal guardian allowing him or her to do so.
When providing care to a child and family, a nurse provides them with information about their rights and options, assists them in making informed decisions, identifies their needs, and makes sure that they have the necessary resources. The nurse is fulfilling which role? A. advocate B. collaborator C. consultant D. educator
A. advocate - In the role of an advocate, the nurse safeguards and advances the interests of children and their families by knowing their needs and resources, informing them of their rights and options, and assisting them to make informed decisions. - In the role of educator, the nurse instructs and counsels children and their families about all aspects of health and illness. - In the role of collaborator, the nurse collaborates with the interdisciplinary health care team and helps to integrate the child's and family's needs into a coordinated plan of care. - In the role of consultant, the pediatric nurse ensures that the child's and family's needs are met through such activities as support group facilitation or working with the school nurse to plan the child's care.
A nurse is providing care to a child on an oncology unit. The nurse is both administering chemotherapy to the child and teaching the parents about the actions, side effects, and complications of the drug. These actions best describe which nursing role? A. clinical nurse specialist B. pediatric nurse practitioner C. case manager D. clinical coordinator
A. clinical nurse specialist - The clinical nurse specialist has a master's degree and provides expertise as an educator, clinician, or researcher, meeting the needs of staff, children, and families, as demonstrated in this scenario by both administering and providing information regarding the chemotherapy. - The clinical coordinator typically holds a baccalaureate degree and fills a leadership role in a variety of settings. - The case manager, also usually a baccalaureate-prepared nurse, is responsible for integrating care from before admission to after discharge. - The pediatric nurse practitioner provides health maintenance care for children (such as well-child examinations and developmental screenings) and diagnoses and treats common childhood illnesses. He or she manages children's health in primary, acute, or intensive care settings or provides long-term management of the child with a chronic illness.
A pediatric clinical nurse specialist offers to provide a workshop for colleagues regarding recent advances in the care of children with head injuries. Which standard of professional performance is the nurse demonstrating? A. collegiality B. collaboration C. education D. leadership
A. collegiality - Collegiality means that the pediatric nurse contributes to the professional development of peers, colleagues, and others, as evidenced in this scenario by offering to educate colleagues in a workshop setting. - Education as a standard of professional performance refers to the nurse acquiring and maintaining current knowledge and competency in pediatric nursing practice. - The collaboration standard is described as collaborating with the child, family, and other health care providers in providing client care. - The leadership standard means the pediatric nurse demonstrates leadership in the practice setting and the profession.
A child with a chronic illness is being discharged home. The nurse manager arranges for home care for the child. The nurse manager follows up with a phone call to check on the child's progress 1 week after discharge. Which concept best defines these actions? A. continuity of care B. advocacy care C. culturally competent care D. family-centered care
A. continuity of care Continuity of care extends from acute care settings such as hospitals to outpatient settings such as ambulatory care clinics, primary care offices, rehabilitative units, community care settings, long-term facilities, homes, and schools. The nurse manager's actions are ensuring that the client is receiving an extension of the care received in the hospital to the home.
The public health nurse is conducting a clinic to help identify those children who are most at risk of becoming obese due to poor nutrition. Which children does the nurse correctly identify as being at a high risk? Select all that apply. A. the child whose guardians are elderly grandparents living in senior government housing B. the child whose father and mother earn minimum wage at their jobs and have 3 younger siblings C. the child with 2 younger siblings whose father is single and has been out of work for 6 months D. the child whose mother and father are married and live in an upper middle-class neighborhood E. the child whose mother is single and is a lawyer at a local law firm
A. the child whose guardians are elderly grandparents living in senior government housing B. the child whose father and mother earn minimum wage at their jobs and have 3 younger siblings C. the child with 2 younger siblings whose father is single and has been out of work for 6 months Certain health concerns, such as poor nutrition, obesity, infections, lead poisoning, and asthma, affect poor children at higher rates and with greater severity than affluent and middle-class children. The child with elderly grandparents living in government housing, parents working for minimum wage, and a father unemployed for 6 months pose a high risk of obesity due to the likelihood of poor nutrition from the financial situation.
After teaching a group of nursing students about major threats to children's health, the instructor determines that the teaching was successful when the students state that: A. the prevalence of chronic disease is increasing. B. infant mortality rates have dropped. C. infectious diseases continue to be prevalent. D. birth rates for teen moms have dramatically increased.
A. the prevalence of chronic disease is increasing. Many childhood infectious diseases, such as mumps and measles, have all but disappeared in North America because of the emphasis placed on immunization against certain preventable diseases. However, the prevalence of chronic diseases is increasing. The incidence of overweight and obesity in young children and teens is increasing rapidly. The birth rate for teen moms has seen a significant downward trend. Infant mortality rates have increased due to the numbers of infants born weighing less than 750 grams (1 lb, 10 oz).
When describing the State Children's Health Insurance Program (SCHIP) to a group of families, what information would the nurse include? A. Medicaid enrollment is necessary to receive a basic set of comprehensive services for children for health promotion and early treatment. B. It provides health insurance to children whose families are not eligible for Medicaid but cannot afford to purchase health insurance. C. States use federal funds for preventive, primary, and specialty care programs for pregnant women, mothers, infants, children, and adolescents. D. The program provides monthly payments to income-eligible individuals, including children who are blind or disabled.
B. It provides health insurance to children whose families are not eligible for Medicaid but cannot afford to purchase health insurance. The State Children's Health Insurance Program (SCHIP) is designed to expand health insurance to children whose families make too much money to qualify for Medicaid, but who cannot afford to purchase health insurance. The Early and Periodic Screening, Diagnostic and Treatment Program (EPSDT) is a program whose goal is to ensure that children enrolled in Medicaid receive a basic set of comprehensive services to promote health and identify and treat health problems at early stages. Supplemental Security Income (SSI) provides monthly payments to income-eligible individuals who are older than age 65, blind or disable. The Maternal and Child Health Services Block Grant provides federal funds to the states for preventive, primary, and specialty care for pregnant women, mothers, infants, children, and adolescents.
Based on 2010 childhood mortality rate statistics, how can the nurse best help parents of children between the ages of 1 and 4 years prevent childhood death? Select all that apply. A. Reminding parents to teach the child to not open prescription medications. B. Providing resources such as poison control center numbers to the parents during a well-child visit. C. Teaching proper seat belt restraint using car seats or booster seats during parenting classes. D. Ensuring parents are using proper child dosing devices, such as properly marked syringes, when administering medications at home. E. Assessing the environment for childproof devices such as locks on cabinets during a home visit.
B. Providing resources such as poison control center numbers to the parents during a well-child visit. C. Teaching proper seat belt restraint using car seats or booster seats during parenting classes. D. Ensuring parents are using proper child dosing devices, such as properly marked syringes, when administering medications at home. E. Assessing the environment for childproof devices such as locks on cabinets during a home visit. In 2010, the mortality rate for children between ages 1 and 4 years was 26.5 per 100,000, with the leading cause of death being unintentional (accidental) injuries followed by congenital malformations. All of these interventions would help prevent unintentional injuries in children between the ages of 1 and 4 years. This child is too young to instruct on not opening medications. Childproof caps should be used and medications should be kept out of reach of children.
According to the pediatric client's Bill of Rights, the nurse manager should privately counsel a staff nurse to change her behavior in which situation(s)? Select all that apply. A. The nurse manager sees the staff nurse ask for an interpreter when caring for a child whose parents do not speak the dominant language. B. The nurse manager hears the staff nurse call the client "kiddo." C. The nurse manager hears the parents ask the name of the surgeon that has been consulted and the staff nurse responding, "I am not sure, it is best if you ask your doctor." D. The nurse manager witnesses the staff nurse holding the hand of a child and talking with the child while another nurse changes the surgical dressing. E. The nurse manager notices the nurse asking the parents if they would like to stay in the room during administration of medications via a gastrostomy tube.
B. The nurse manager hears the staff nurse call the client "kiddo." C. The nurse manager hears the parents ask the name of the surgeon that has been consulted and the staff nurse responding, "I am not sure, it is best if you ask your doctor." A client's Bill of Rights helps to ensure that the client's needs are being met in an ethical and legal manner. The staff nurse calling the child "kiddo" and not informing the parents of a child the name of the care provider consulted violates the bill of rights, requiring counseling by the nurse manager.
The nurse is caring for a pediatric client who has been admitted after a serious automobile accident. Which actions would best promote veracity in the nurse's actions? A. Encourage participation of the family in the care delivery. B. Offer to sit with the child if he feels frightened. C. Clearly explain the planned care to the child. D. Ask the child to participate in the care planned as he is able.
C. Clearly explain the planned care to the child. Veracity refers to telling the truth. Clear explanations of the planned care will promote this concept. The remaining options are appropriate for inclusion in the plan of care but are not directly tied to veracity.
The nurse is reviewing documentation on a client's chart. The physician has referred to parens patriae. When considering this notation, what should be included in the client's plan of care? A. Refer all questions concerning permission and consents for treatment to the child's father. B. Refer inquiries about the client's plan of treatment to the facility's ethics committee for review. C. Recognize that the child's care has been ordered by the state. D. Allow the client who is emancipated to sign for his own treatment.
C. Recognize that the child's care has been ordered by the state. Generally the parents of a minor child have the right to make care decisions. In the event the parents have decided on a course of nontreatment, the state may intervene and overrule the parents. In this case an order for treatment to continue can be made by the courts. This is referred to as parens patriae (the state has a right and a duty to protect children).
The nurse is providing education to the parents of a school-aged child. Which information would the nurse include in the teaching plan? A. teaching about the signs and symptoms of sexually transmitted infections B. information about and encouragement to avoid the dangers of distracted driving C. discussion of the importance of proper use and fit of a helmet for bike riding D. verbal directions regarding gates at the top and bottom of the stairs
C. discussion of the importance of proper use and fit of a helmet for bike riding The school-aged child is involved in many outside activities, including bike riding. Safety discussions should include the need for wearing a helmet when bike riding as well as the proper fit. Distracted driving and sexually transmitted infections would be appropriate for the adolescent client. Gates on the stairs would be appropriate for the infant and toddler age groups.
The nurse is caring for a 2-year-old boy who needs a lumbar puncture. His mother is present. What would prevent informed consent from being obtained? A. finding out the mother is younger than 18 years of age B. determining the mother cannot read the form C. learning the mother is not the custodial parent D. establishing the mother was never married
C. learning the mother is not the custodial parent It would not be legal for this mother to give consent. A mother younger than 18 years of age or never married may not be a problem in most states because she would be considered autonomous. The physician or nurse could read the consent form to a mother who cannot read plus carefully explain the medical information in terms she understood.
A hospitalized 6-year-old child has been diagnosed with a serious cardiac condition. The parents are refusing the treatment recommended by the physician. What is the first action that should be taken? A. Referral to the hospital's social worker. B. Notification of the hospital's ethics committee. C. Modification to the plan of care to accept all of the parent's wishes. D. A conference including the parents and members of the health care team.
D. A conference including the parents and members of the health care team. Parents may refuse treatment if they perceive that their child's quality of life may be significantly impaired by the medical care that is offered. The health care team must appropriately educate the family and communicate with them on a level that they can understand. The child and family should be informed of what to expect with certain tests or treatments. The health care team should make a clinical assessment of the child's and family's understanding of the situation and their reasons for refusing treatment. Active listening may allow the physician to address the concerns, fears, or reservations the family may have regarding their child's care. Referrals to social services or calling in the hospital's ethics committee are premature and may not be warranted after the care conference.
Which nursing activity requires the pediatric nurse to implement the ethical principle of nonmaleficence? A. Mediating between a father, who wants his infant circumcised, and the mother who is opposed. B. Encouraging an adolescent client to take ownership of her health status independent of her parents. C. Providing empathic, holistic care to a family who has just learned that their child's prognosis is poor. D. Weighing the potential harm caused by a child's chemotherapy with its potential benefits.
D. Weighing the potential harm caused by a child's chemotherapy with its potential benefits. Questions of risks versus benefits often require the care team to examine options in the light of nonmaleficence; that is, the responsibility to avoid undue harm. Encouraging an adolescent to take ownership of her health will likely involve the principle of autonomy. Mediating in a family dispute or providing empathic care is less likely to involve the principle of nonmaleficence.