Chapter 19: Family-Centered Care COMBO (may contain duplicates)

A mother tells the nurse that she will visit her 2-year-old son tomorrow about noon. During the child's bath, he asks for Mommy. What is the nurse's best reply? "Mommy will be here after lunch." "Mommy always comes back to see you." "Your Mommy told me yesterday that she would be here today about noon." "Mommy had to go home for a while, but she will be here today."

"Mommy will be here after lunch." Because toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon to a familiar activity that takes place at that time. Telling the child that his mother always comes back to see him does not give the child any meaningful information about when his mother will visit. Twelve noon is a meaningless concept for a toddler. Stating that his mother had to go home but will be back today does not provide the child with any meaningful information related to when she will actually visit.

A nurse is preparing to complete an admission assessment on a 2-year-old child. The child is sitting on the parent's lap. Which technique should the nurse implement to complete the physical exam? a. Ask the parent to place the child in the hospital crib. b. Take the child and parent to the exam room. c. Perform the exam while the child is on the parent's lap. d. Ask the child to stand by the parent while completing the exam.

C

A previously "potty-trained" 30-month-old child has reverted to wearing diapers while hospitalized. The nurse should reassure the parents that this is normal because: a. Regression is seen during hospitalization. b. Developmental delays occur because of the hospitalization. c. The child is experiencing urinary urgency because of hospitalization. d. The child was too young to be "potty-trained."

A

What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Separation anxiety c. Fear of bodily injury b. Loss of control d. Fear of pain

A The major stress for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age-group.

Ryan has just been unexpectedly admitted to the intensive care unit after abdominal surgery. The nursing staff has completed the admission process, and Ryan's condition is beginning to stabilize. When speaking with the parents, the nurses should expect which stressors to be evident (select all that apply)? a. Unfamiliar environment b. Usual day-night routine c. Strange smells d. Provision of privacy e. Inadequate knowledge of condition and routine

A, C, E

What is an age-appropriate nursing intervention to facilitate psychologic adjustment for an adolescent expected to have a prolonged hospitalization (select all that apply)? a. Encourage parents to bring in homework and schedule study times. b. Allow the adolescent to wear street clothes. c. Involve the parents in care. d. Follow home routines. e. Encourage parents to bring in favorite foods.

A,B,E

A child is being discharged from an ambulatory care center after an inguinal hernia repair. Which discharge interventions should the nurse implement (select all that apply)? a. Discuss dietary restrictions. b. Hold any analgesic medications until the child is home. c. Send a pain scale home with the family. d. Suggest the parents fill the prescriptions on the way home. e. Discuss complications that may occur.

A,C,E

Olivia, age 5 years, tells the nurse that she "needs a Band-Aid" where she had an injection. The best nursing action is to: a. Apply a Band-Aid. b. Ask her why she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show her that the bleeding has already stopped.

ANS: A Children in this age-group still fear that their insides may leak out at the injection site, even if the bleeding has stopped. Provide the Band-Aid. No explanation should be required.

When a preschool child is hospitalized without adequate preparation, the nurse should recognize that the child may likely see hospitalization as: a. Punishment. c. An opportunity for regression. b. Threat to child's self-image. d. Loss of companionship with friends.

ANS: A If a toddler is not prepared for hospitalization, a typical preschooler fantasy is to attribute the hospitalization to punishment for real or imagined misdeeds. Threat to child's self-image and loss of companionship with friends are reactions typical of school-age children. Regression is a response characteristic of toddlers when threatened with loss of control.

Latasha, age 8 years, is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. What will help her most in her adjustment to the hospital? a. Explain hospital schedules such as mealtimes. b. Use terms such as "honey" and "dear" to show a caring attitude. c. Explain when parents can visit and why siblings cannot come to see her. d. Orient her parents, because she is young, to her room and hospital facility.

ANS: A School-age children need to have control of their environment. The nurse should offer explanations or prepare the child for experiences that are unavoidable. The nurse should refer to the child by the preferred name. Telling the child about all of the limitations of visiting does not help her adjust to the hospital. At the age of 8 years, the child and parents should be oriented to the environment.

A 10-year-old girl needs to have another intravenous (IV) line started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." The nurse should recognize that: a. This is normal behavior for a school-age child. b. This behavior is usually not seen past the preschool years. c. The child thinks the nurse is punishing her. d. The child has successfully manipulated the nurse in the past.

ANS: A This school-age child is attempting to maintain control. The nurse should provide the girl with structured choices about when the IV will be inserted. This can be characteristic behavior when an individual needs to maintain some control over a situation. The child is trying to have some control in the hospital experience.

An appropriate nursing intervention to minimize separation anxiety in a hospitalized toddler is to: a. Provide for privacy. b. Encourage parents to room in. c. Explain procedures and routines. d. Encourage contact with children the same age.

ANS: B A toddler experiences separation anxiety secondary to being separated from the parents. To avoid this, the parents should be encouraged to room in as much as possible. Maintaining routines and ensuring privacy are helpful interventions, but they would not substitute for the parents. Contact with same-aged children would not substitute for having the parents present.

Amy, age 6 years, needs to be hospitalized again because of a chronic illness. The clinic nurse overhears her school-age siblings tell her, "We are sick of Mom always sitting with you in the hospital and playing with you. It isn't fair that you get everything and we have to stay with the neighbors." The nurse's best assessment of this situation is that: a. The siblings are immature and probably spoiled. b. Jealousy and resentment are common reactions to the illness or hospitalization of a sibling. c. The family has ineffective coping mechanisms to deal with chronic illness. d. The siblings need to better understand their sister's illness and needs.

ANS: B Siblings experience loneliness, fear, worry, anger, resentment, jealousy, and guilt. The siblings experience stress equal to that of the hospitalized child. These are not uncommon responses by normal siblings. There is no evidence that the family has maladaptive coping or that the siblings lack understanding.

The nurse is caring for an adolescent who had an external fixator placed after suffering a fracture of the wrist during a bicycle accident. Which statement by the adolescent would be expected about separation anxiety? a. "I wish my parents could spend the night with me while I am in the hospital." b. "I think I would like for my siblings to visit me but not my friends." c. "I hope my friends don't forget about visiting me." d. "I will be embarrassed if my friends come to the hospital to visit."

ANS: C Loss of peer-group contact may pose a severe emotional threat to an adolescent because of loss of group status; friends visiting is an important aspect of hospitalization for an adolescent and would be very reassuring. Adolescents may welcome the opportunity to be away from their parents. The separation from siblings may produce reactions from difficulty coping to a welcome relief.

A school-age child, admitted for intravenous antibiotic therapy for osteomyelitis, reports difficulty in going to sleep at night. Which intervention should the nurse implement to assist the child in going to sleep at bedtime? a. Request a prescription for a sleeping pill. b. Allow the child to stay up late and sleep late in the morning. c. Create a schedule similar to the one the child follows at home. d. Plan passive activities in the morning and interactive activities right before bedtime.

C

Emma, age 3 years, is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are going to buy her "a lot of new toys because she will be in the hospital." The nurse's reply should be based on an understanding that: a. New toys make hospitalization easier. b. New toys are usually better than older ones for children of this age. c. At this age children often need the comfort and reassurance of familiar toys from home. d. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.

ANS: C Parents should bring favorite items from home to be with the child. Young children associate inanimate objects with significant people; they gain comfort and reassurance from these items. New toys will not serve the purpose of familiar toys and objects from home. The parents may experience some guilt as a response to the hospitalization, but there is no evidence that it is maladaptive.

Because of their striving for independence and productivity, which age-group of children is particularly vulnerable to events that may lessen their feeling of control and power? a. Infants c. Preschoolers b. Toddlers d. School-age children

ANS: D When a child is hospitalized, the altered family role, physical disability, loss of peer acceptance, lack of productivity, and inability to cope with stress usurp individual power and identity. This is especially detrimental to school-age children, who are striving for independence and productivity and are now experiencing events that lessen their control and power. Infants, toddlers, and preschoolers, although affected by loss of power, are not as significantly affected as are school-age children.

A toddler is hospitalized for an upcoming surgical procedure. Which method might provide the best way to inform the child about the surgery? By using anatomical drawings as illustrations and allowing the child to color them with markers. Allowing the child to dress up using surgical gown and mask. Having the child sign his name with an "X" on an actual surgical consent form. Taking the child to the operating theater to view a surgery.

Allowing the child to dress up using surgical gown and mask. The concept of dramatic play is used to provide information to children who are having complex health issues or who have to undergo surgical procedures or therapies. It allows for children to be able to respond and interact with the possibility of puzzling or frightening experiences related to the unknown. The use of anatomical drawings may be too realistic for the toddler even though markers would be allowed for coloring. Having the child sign an "X" on an actual surgical consent would not be understood this developmental level. Taking the child to view a surgery at this age may cause more anxiety.

A child with a serious chronic illness will soon be discharged home. The case manager requests that the family provide total care for the child for a couple of days while the child is still hospitalized. Based on the principles of family-centered care, which statement addresses this principle? Appropriate because families are usually eager to get involved. Appropriate because it can be beneficial to the transition from hospital to home. Inappropriate because of legal issues when parents care for their children on hospital property. Inappropriate because the family will have to assume the care soon enough and this may increase their stress unnecessarily.

Appropriate because it can be beneficial to the transition from hospital to home. This is appropriate. At least two family members should be comfortable caring for the child before discharge. Caring for the child with the nurse available to answer questions and provide support and guidance will make the transition home for the parents and child easier. The family needs to learn the skills necessary to care for the child at home. Their eagerness is important, but it is not the reason to provide total care for their child while still hospitalized. The family members will be able to learn to care for their child with the supervision of nursing staff. Legal issues related to caring for their child in the hospital setting are not relevant. Learning to care for their child before discharge is essential to properly prepare the family to assume the care and minimize their stress level as much as possible.

Working with parents in preparation for discharge of a hospitalized child who will need to have wet to dry dressing changes performed at home will require that the nurse include which element in the plan of care? Arrange for home health nurse to change dressings as the parents may not understand the complexity of the task. Arrange for a step by step training sequence for wet to dry dressing changes with the parents of the child with return demonstration to evaluate understanding. Provide the parents with a detailed instruction sheet regarding the dressing change procedure as the method of instruction. Arrange for follow up with the child's pediatrician prior to the next scheduled dressing change so that the parents can receive further instruction.

Arrange for a step by step training sequence for wet to dry dressing changes with the parents of the child with return demonstration to evaluate understanding. Arranging for step-by-step sequenced instructions along with return demonstration should be included in the plan of care for the discharge of this child who requires wet to dry dressing changes. Arranging for home health to provide this service may not be possible in terms of insurance coverage. Providing the parents with a detailed instruction sheet should be given but it not the sole method of instruction as it is important to assess and implement tasks so as to make sure that the parents have a thorough understanding of the process. And while follow up with the pediatrician is part of the discharge process, it is the hospital's responsibility to provide thorough discharge instructions and training.

A nurse in the emergency department is assessing a 5-year-old child with symptoms of pneumonia and a fever of 102° F. Which intervention can the nurse implement to promote a sense of control for the child? a. None, this is an emergency and the child should not participate in care. b. Allow the child to hold the digital thermometer while taking the child's blood pressure. c. Ask the child if it is OK to take a temperature in the ear. d. Have parents wait in the waiting room.

B

Which situation poses the greatest challenge to the nurse working with a child and family? a. Twenty-four-hour observation c. Outpatient admission b. Emergency hospitalization d. Rehabilitation admission

B

A nurse is interviewing the parents of a toddler about use of complementary or alternative medical practices. The parents share several practices they use in their household. Which should the nurse document as complementary or alternative medical practices (select all that apply)? a. Use of acetaminophen (Tylenol) for fever b. Administration of chamomile tea at bedtime c. Hypnotherapy for relief of pain d. Acupressure to relieve headaches e. Cool mist vaporizer at the bedside for "stuffiness"

B,C,D

A nurse plans therapeutic play time for a hospitalized child. Which are the benefits of therapeutic play (select all that apply)? a. Serves as method to assist disturbed children b. Allows the child to express feelings c. The nurse can gain insight into the child's feelings d. The child can deal with concerns and feelings e. Gives the child a structured play environment

B,C,D

A 14-year-old boy is being admitted to the hospital for an appendectomy. Which roommate should the nurse assign with this patient? a. A 4-year-old boy who is first day post-appendectomy surgery b. A 6-year-old boy with pneumonia c. A 15-year-old boy admitted with a vaso-occlusive sickle cell crisis d. A 12-year-old boy with cellulitis

C

During the first 4 days of hospitalization, Eric, age 18 months, cried inconsolably when his parents left him, and he refused the staff's attention. Now the nurse observes that Eric appears to be "settled in" and unconcerned about seeing his parents. The nurse should interpret this as which of the following? a. He has successfully adjusted to the hospital environment. b. He has transferred his trust to the nursing staff. c. He may be experiencing detachment, which is the third stage of separation anxiety. d. Because he is "at home" in the hospital now, seeing his mother frequently will only start the cycle again.

C

What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of intravenous (IV) antibiotics cries, screams, and resists having the IV restarted? a. Exit the room and leave the child alone until he stops crying. b. Tell the child big boys and girls "don't cry." c. Let the child decide which color arm board to use with the IV. d. Administer a narcotic analgesic for pain to quiet the child.

C

What is the primary disadvantage associated with outpatient and day facility care? a. Increased cost b. Increased risk of infection c. Lack of physical connection to the hospital d. Longer separation of the child from family

C

A child is playing in the playroom. The nurse needs to take a blood pressure on the child. Which is the appropriate procedure for obtaining the blood pressure? a. Take the blood pressure in the playroom. b. Ask the child to come to the exam room to obtain the blood pressure. c. Ask the child to return to his or her room for the blood pressure, then escort the child back to the playroom. d. Document that the blood pressure was not obtained because the child was in the playroom.

C The playroom is a safe haven for children, free from medical or nursing procedures. The child can be returned to his or her room for the blood pressure and then escorted back to the playroom. The exam room is reserved for painful procedures that should not be performed in the child's hospital bed. Documenting that the blood pressure was not obtained because the child was in the playroom is inappropriate.

With regard to separation anxiety displayed in a child who is hospitalized, which behavior would indicates the stage of despair? Child clings to parents for comfort. Child tells nurses and staff to "go away." Child is constantly crying and sobbing. Child demonstrates regressive behavior.

Child demonstrates regressive behavior. Demonstrating regressive behavior is a characteristic of the stage of despair. All of the other options indicate a stage of protest.

Which behavior would most likely be manifested in a young child experiencing the protest phase of separation anxiety? Inactivity Clinging to the parent Depression and sadness Forming superficial relationships

Clinging to the parent In the protest phase of separation anxiety, the child aggressively responds to separation from a parent by clinging and holding onto the parent and screaming for the parent. Inactivity is a sign of despair in a young child, not protest. A depressed, sad child indicates despair, not the protest phase. The formation of superficial relationships indicates that a young child is in the phase of detachment, not protest.

The nurse is doing a prehospitalization orientation for Kayla, age 7, who is scheduled for cardiac surgery. As part of the preparation, the nurse explains that Kayla will not be able to talk because of an endotracheal tube but that she will be able to talk when it is removed. This explanation is: a. Unnecessary. b. The surgeon's responsibility. c. Too stressful for a young child. d. An appropriate part of the child's preparation.

D

A 12-year-old child is admitted for an emergency appendectomy and rushed into surgery. The parents tell the nurse that they also have a 4-year-old son at home and wonder if they should tell him about his older brother being in the hospital. The best response by the nurse to this query would be to? Tell the parents to refrain from telling the 4-year-old as he will not be able to understand the concepts of hospitalization and surgery. Have the parents go home and bring their 4-year-old back to the hospital so he can be present throughout this family stress experience. It is important to tell their 4-year-old son about his older brother using words and terms that he can understand at his age. Have the parents bring their son in during visiting hours and arrange for a tour of the hospital unit.

It is important to tell their 4-year-old son about his older brother using words and terms that he can understand at his age. It is important to share a hospitalization experience with siblings, however being mindful of their developmental and cognitive level. And while the 4-year-old can be taken into the hospital setting and even receive a tour of the hospital unit, the experience should not be tied into a "show and tell" event. The 4-year-old child does not have to present throughout the entire hospitalization experience as that may produce unnecessary stress in altering his environment and daily routine.

A child has a long standing history of abuse which has triggered many emotional problems. Which type of therapy would be indicated to possibly help the child explore these emotional problems? Dramatic play Therapeutic play Play therapy Creative expression

Play therapy Play therapy is used for patients who have psychological problems facilitated by trained professionals to encourage expression of feelings. Dramatic play is used as a method of communication and interaction whereby children play with puppets and/or objects to gain understanding. Therapeutic play helps the child to learn to deal with fears and apprehension but is nondirective in nature. Creative expression is a method whereby children can use other media such as drawing and painting to express their feelings.

When the nurse uses a standard nursing care plan as a guide in planning care for a hospitalized child, which should be eliminated? Expected outcome or goal Dependent nursing functions Problems not pertinent to the child and family Potential health problems of the child and family

Problems not pertinent to the child and family To create an individualized care plan, the nurse eliminates the irrelevant material and specific information not pertinent to the child and family in question. Consideration of an expected outcome or goal is an essential component of an individualized nursing care plan. Consideration of dependent nursing functions, or those interventions requiring an order, is an essential component of an individualized nursing care plan. Consideration of potential health problems of the child and family is an essential component of an individualized nursing care plan.

A nurse has been assigned as the home health nurse for a technologically dependent child. The nurse recognizes that the background of this family differs widely from the nurse's own. The nurse views some of their lifestyle choices as less than ideal. What is the most appropriate nursing intervention? Assign the nurse a different family to follow. Respect the differences Assess why the family is different Determine whether the family is dysfunctional

Respect the differences The nurse must respect the family's culture and background. The family is the constant in the child's life, and cultural awareness and sensitivity are critical to a nurse's care of a child and family. The nurse may have some influence on care necessary for the child, but it is inappropriate to assign the nurse to a different family. Nurses must be able to work with families from all cultural groups and respect the differences between the families' cultural norms and those of the nurse's own culture. The nurse will assess the differences, but respecting these differences is what is important. Cultural differences do not make a family dysfunctional, unless the cultural practices are putting the child at risk.

Prior to returning to school, an individualized home care plan (IHCP) needs to be developed for which child? The child recently identified with a penicillin allergy. The child being treated for pediculosis capitis (head lice). The child out of school for two week due to mononucleosis. The child recently diagnosed with insulin-dependent diabetes mellitus.

The child recently diagnosed with insulin-dependent diabetes mellitus. An IHCP is needed for the insulin-dependent child to ensure appropriate management of health care needs is in place. The child allergic to penicillin will not receive this medication anymore and a medication alert ID is necessary. An IHCP is not needed. The child treated for pediculosis capitis (head lice) can return to school and does not need an IHCP. The child who missed two weeks of school will need arrangements made for make-up work and an IHCP is not needed.

A ventilator-dependent child is being discharged home from the hospital. Prior to discharge, the home health care nurse discusses the development of an emergency plan with the family. The most essential component of the plan is acquisition of a backup generator. designation of an emergency shelter. notifying the power company that the child is on life support. provision for alternate heating and cooling source if power is lost. notifying emergency medical services that child is on life support.

acquisition of a backup generator. It is essential that the family have a backup generator in place prior to discharge so that the child's life support is not interrupted should power be lost. Designation of an emergency shelter, notifying the power company that the child is on life support, provision for alternate hearing and cooling source if power is lost and notifying the emergency medical services that the child is on life support are important concerns but are not considered to be the most essential component of the discharge plan.

A home health nurse is caring for a 2-week-old infant and notes on assessment that the infant has a string tied around the wrist. The nurse checks for adequate circulation. The most appropriate nursing intervention by the nurse is to ask the parents to remove the string. report the parents to Social Services for child endangerment. remove the string and inform the parents that the string is dangerous. ask the parents the meaning of the string and leave the string in place.

ask the parents the meaning of the string and leave the string in place. Families of various cultural backgrounds have specific beliefs about health care. These beliefs may differ from the nurse's beliefs and the nurse needs to honor the practices and seek clarification of the cultural practice. The nurse should honor the practices of the family. For the nurse to do otherwise would lead to loss of trust from the family. The nurse needs to provide education to the family that includes safety principles as the infant grows.

The psychosexual conflicts of preschool children make them extremely vulnerable to separation anxiety. loss of control. bodily injury and pain. loss of identity.

bodily injury and pain. Intrusive procedures, whether or not they are perceived as painful, are threatening to the preschooler because of the poorly developed concept of body integrity. Separation anxiety is more of a characteristic of infancy. Loss of control is a characteristic fear of school-age children. Loss of identity is a concern of adolescents because illnesses are conceptualized as the effect on the individual.

A 4-year-old child is scheduled for cardiac surgery in a week. The child's parents call the hospital to ask how to prepare the child for the upcoming hospitalization and surgical procedure. The nurse's reply should be based on the knowledge that preparation at this age will only increase the child's stress. preparation needs to be at least 2 to 3 weeks before hospitalization to be effective. children who are prepared experience less fear and stress during hospitalization. children who are prepared experience overwhelming fear by the time hospitalization occurs.

children who are prepared experience less fear and stress during hospitalization. Preparing the child for the hospitalization will reduce the number of unknown elements. Taking tours, handling some of the equipment, or being told stories about what to expect will increase the familiar items. Timing of the preparation must also be considered. Four- to 7-year-olds can be prepared up to 1 week in advance of the hospitalization. Preparation of a 4-year-old will reduce stress by having the child incorporate and assimilate the information more slowly. Children between the ages of 4 and 7 years should be prepared about 1 week before hospitalization. A reduction in fear is usually observed when children are prepared appropriately for hospitalization.

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress the importance of reducing caloric intake to decrease cardiac demands. importance of relaxing discipline and limit-setting to prevent crying. need to be extremely concerned about cyanotic spells. desirability of promoting normalcy within the limits of the child's condition.

desirability of promoting normalcy within the limits of the child's condition. The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child. The child needs increased caloric intake after cardiac surgery. The child needs discipline and appropriate limit setting, as would be done with any other child his or her age. Because cyanotic spells will occur in children with some defects, the parents need to be taught how to assess for and manage them appropriately, thereby decreasing their anxiety and concern.

In helping a child to adapt to a hospitalization experience, the best approach would be to allow the child to bring in all of his favorite toys to the hospital so as to represent a more familiar environment. let the parents bring in food from home that the child is used to eating for all meals. establish a daily routine and schedule with the child and parent to help maintain consistency. allow the child to select his room on the unit.

establish a daily routine and schedule with the child and parent to help maintain consistency. By providing a daily routine and schedule, the nurse helps to support consistency. It is not realistic for the child to bring in all of his favorite toys or allow the child to make a room selection on the unit. Bringing food in from home for all meals is not realistic and may not be advised based on therapeutic treatment.

The nurse working in an outpatient surgery center for children should understand that children's anxiety is minimal in such a center. waiting is not stressful for parents in such a center. accurate and complete discharge teaching is the responsibility of the surgeon. families need to be prepared for what to expect after discharge.

families need to be prepared for what to expect after discharge. Discharge instructions should be provided in both written and oral form and in the primary language of the patient and family. Instructions need to include normal responses to the procedure and when to notify the practitioner if untoward reactions occur. Although anxiety may be reduced because of the lack of an overnight stay, the child will still experience the stress associated with a medical procedure. The waiting period while the child is having the procedure is a stressful time for families in both outpatient and inpatient settings. Discharge instructions are a responsibility of both the surgeon and the nursing staff.

A home health nurse is assigned to an adolescent with recently acquired tetraplegia. The adolescent's mother tells the nurse, "I'm sick of providing all the care while my husband does whatever he wants and whenever he wants." Based on the nurse's knowledge of family-centered care, the most appropriate nursing intervention is to listen and reflect the mother's feelings. refer the mother for psychological counseling. suggest ways the mother can get the husband to help with care. meet with the adolescent's father in private and ask why he does not help.

listen and reflect the mother's feelings. It is appropriate for the nurse to reflect with the mother about her feelings and explore avenues for additional home health assistance and provide respite care for the mother. A support group for caregivers is more appropriate at this time, not counseling. It is inappropriate for the nurse to agree with the mother that the husband is not helping enough. The nurse is making a judgment that is beyond the role of the nurse in addition to undermining the family relationship. It is inappropriate to meet with the father privately because the meeting is based on the mother's assumption of the father's minimal involvement with the adolescent's care. The father may be working two jobs to support the family's additional expenses.

An adolescent is admitted to the hospital for a fractured femur. The most appropriate nursing intervention(s) in caring for this adolescent is/are to Select all that apply. provide written material about the hospital. provide an opportunity for the adolescent to try on surgical attire. explain the upcoming surgery to the adolescent using anatomically correct models. provide an opportunity for the adolescent to talk with peers who have had a similar experience. provide education for the parents of what to teach so they can share with their adolescent.

provide written material about the hospital. explain the upcoming surgery to the adolescent using anatomically correct models. provide an opportunity for the adolescent to talk with peers who have had a similar experience. Adolescents benefit from written material about hospitalization. This material offers information and services provided in the hospital that the adolescent can access that gives a sense of control. The use of anatomically correct models to explain surgical procedures offers the adolescent opportunities to ask questions and decrease fear and anxiety. The opportunity for the adolescent to talk with peers who have had a similar experience to facilitate communication on their level. Dressing up in surgical attire is appropriate for the younger child, not the adolescent. The adolescent should be taught firsthand about the hospitalization and what to expect.

A case manager is assigned to coordinate the care of a child with a complex medical condition. The family is told that one of the goals is to control costs. This goal should be recognized as unsafe. realistic. impossible. inappropriate.

realistic. Management of costs is one part of case management. With a case manager providing coordination and continuity across care settings and facilitating access to needed medical services, cost control is a realistic outcome. Cost management will only be unsafe if treatment and equipment necessary for the child's care are denied. Cost management is a realistic goal for the case manager, not an impossible one. Cost management is not an inappropriate one, unless treatment or equipment necessary for the child's care is denied.

Prior to accepting an assignment as a home health nurse, the nurse must realize that the family is in charge. all decisions are made by the health care provider. the family will adapt their lifestyle to the needs of the nurse. independent decisions regarding emergency care of the child are made by the nurse.

the family is in charge. The nurse must realize that the family is in charge. The family is in charge and the health care providers must realize this matter. The nurse must be flexible and adaptable to the family's lifestyle. Informed consent must be provided by the family for emergency care-any care.