Peds: Chapters 4 & 5
A female nurse from the emergency department (ED) accompanies the healthcare provider to the waiting room to tell a man of a different culture than the nurse that his son was killed in an accident. The nurse reaches out and puts her hands on the man's hands and states, "I am so sorry, I know this is devastating news." The man pulls his hands away from the nurse. What should a nurse supervisor say to the ED nurse regarding this interaction? "Due to the patient's culture that touch could be considered inappropriate and might not be interpreted as you intended." "That was very touching how you reached out to that father in his time of sadness." "It is never appropriate to touch a patient." "You should have had another nurse with you when you delivered that type of news."
"Due to the patient's culture that touch could be considered inappropriate and might not be interpreted as you intended."
The nurse is discussing end-of-life care with the family of a terminally ill toddler. The family is of the Hindu faith, have many religious objects, and are saying prayers at the bedside. Which statement by the nurse would show spiritually and culturally appropriate communication? "If you are going to use oils and incense, you will need to do that outside of the hospital." "How may I best accommodate your needs?" "Please let me approve anything before you put it on your child's body." "May I call a pastor for you?"
"How may I best accommodate your needs?"
A nurse is providing education to the family of a child who needs end-of-life care and is considering hospice. Which statement by the family indicates an understanding of the goal of hospice care? "My child will be given the best treatments to fight this disease until the end." "I know my child will be in the hospital and will have all options available if needed." "My child will be kept comfortable and will experience a peaceful death." "This is going to mean the end, but we will keep fighting this disease as long as we can."
"My child will be kept comfortable and will experience a peaceful death."
The organ donation approach team nurse is providing education to the family of a child on hospice about organ donation. The nurse will consider the teaching effective when the parent makes which statement? "My child will pass away in the operating room, so we will need to say goodbye here." "I can't wait to keep in touch with the people who get my child's organs." "My child's organs can only go to other kids." "I'm glad I will get to have a say in who will get my child's organs."
"My child will pass away in the operating room, so we will need to say goodbye here."
The nurse is providing education about pediatric meals while in the hospital to a school age child and her family. When discussing the dietary information what statement by the parents would indicate a need for further instruction? "Children will more likely eat foods they have often." "Home eating times should be maintained as much as possible during the hospital stay." "Parents should allow children to eat alone in their rooms so they can focus on getting better." "Food storage practices may require two separate refrigerators."
"Parents should allow children to eat alone in their rooms so they can focus on getting better."
The nurse is providing education about end-of-life care to members of a large family who recently found out their school-age child was diagnosed with a terminal illness. Which initial statement by the nurse demonstrates understanding of appropriate communication? "I need to talk to the parents alone about this situation." "Tell me about what you already know concerning your child's condition." "Let me give you this information in writing so that you will have it to reflect on later." "I am going to give you detailed medical information about how this diagnosis will affect your child."
"Tell me about what you already know concerning your child's condition."
The nurse is performing a cultural assessment on an 8-year-old child with juvenile Tay-Sachs disease. What questions would be important for the nurse to ask? Select all that apply. "What culture do you consider yourself a part of?" "Are your cultural beliefs important to you?" "What do you believe is the biggest stereotype about your culture?" "How is your culture misrepresented?" "Do you have a social support system within your cultural community?"
"What culture do you consider yourself a part of?" "Are your cultural beliefs important to you?" "Do you have a social support system within your cultural community?"
The nurse is talking with the five-year-old sibling of a child who has end-stage brain cancer. The sibling is crying and states, "It's all my fault. I was mad at him for always taking my game and wished he would die. I made this happen." What is the nurse's best response? "Don't talk like that; it is not true." "You did nothing wrong. Your brother is very sick, but you did not cause it." "You should not feel that way. He has been sick for a long time." "Your brother is going to get better; don't worry about it."
"You did nothing wrong. Your brother is very sick, but you did not cause it."
Which of the following describes the "Denial" stage of grief as theorized by Kübler-Ross? The loss of interest in life and normal activities, along with feelings of guilt or low self-worth A refusal to believe that an infant or child is dead or dying An attempt to create a change in the situation through an agreement for services exchanged To receive or agree with what is offered; when family come to terms with the event and the associated loss
A refusal to believe that an infant or child is dead or dying
A nurse is doing a needs assessment of a school-age child with cystic fibrosis (CF). The nurse notes that the child comes from a low socioeconomic family in a rural setting. What are the biggest obstacles the nurse could identify for this patient? Select all that apply. Access to nutritious foods and/or the ability to pay for nutritious food Access to a full grocer that supplies fresh fruit and vegetables and healthy food options Access to a primary care provider (PCP) or health care clinic Access to education on the disease process and the necessary care access to a level 1 trauma care
Access to nutritious foods and/or the ability to pay for nutritious food Access to a full grocer that supplies fresh fruit and vegetables and healthy food options access to a level 1 trauma care
The mother of an infant became visibly upset and stopped the nurse as she attempted to remove a red string that was placed on the child's wrist prior to an intravenous infusion insertion. What are the most appropriate nursing actions? Select all that apply. Allow the mother to choose another site or put the string on the other hand. Find out about the significance of the string placement. Find out what is the matter with the mother. Apologize for your action. Tell her the child needs the procedure more than the string
Allow the mother to choose another site or put the string on the other hand. Find out about the significance of the string placement. Find out what is the matter with the mother. Apologize for your action.
A nurse is present at the time of death for a for a pre-school age child of Jewish faith. What is the most appropriate action the nurse should take initially? Ask the family to please step out so that the body can be prepared. Ask the family what needs they have and how they can best be met. Begin to clean and prepare the body. Quietly exit the room and leave the family alone.
Ask the family what needs they have and how they can best be met.
The nurse is caring for toddler whose family is of the Jewish faith. The nurse and many family and friends are at the bedside when the child passes away. What are the most therapeutic interventions the nurse can carry out at this time? Select all that apply. Ask the family to step out for a short time so the body can be prepared. Assist the family to carry out any special cultural or religious practices that are appropriate. Discourage any questions and keep this a solemn time. Offer the family time alone with their child. Assist the family in collecting or making any special mementos or keepsakes they request.
Assist the family to carry out any special cultural or religious practices that are appropriate.
The nurse is caring for a pre-school age client with a neuroblastoma, who is in the end stages. Which interventions would facilitate effective communication between a dying client and family? Select all that apply. Assisting the client and family to carry out spiritually meaningful practices Maintaining a calm attitude and one of acceptance when the family or client expresses anger Making decisions for the client and family to relieve them of unnecessary demands Encouraging the client and family to identify and discuss feelings openly Limiting visiting time daily to allow the client to get more rest
Assisting the client and family to carry out spiritually meaningful practices Maintaining a calm attitude and one of acceptance when the family or client expresses anger Encouraging the client and family to identify and discuss feelings openly
Which of the following measures should be used to prevent sudden infant death syndrome (SIDS)? Select all that apply. Baby on back to sleep Firm mattress Fitted sheet No more than \(2\;\frac38\) inches between crib slats No blanket, using a fitted onesie
Baby on back to sleep Firm mattress Fitted sheet No more than \(2\;\frac38\) inches between crib slats No blanket, using a fitted onesie
The nurse is assessing a school-age patient who is dying from a brain tumor. The patient states, "I just want to live long enough to go on our trip to Disney World. If I can do that with my family, I'll be ready to go." Which stage of grief is this patient experiencing? Denial Bargaining Anger Depression
Bargaining
Which attributes are imperatives for maintaining a positive nurse-patient therapeutic relationship in the care of children and families? Select all that apply. Identifying one's cultural biases Being culturally competent Addressing one's cultural biases Integrating evidence-based practice Good listening skills
Being culturally competent Addressing one's cultural biases Integrating evidence-based practice Good listening skills
The nurse is evaluating a new patient using the transcultural assessment model. Which aspects should the nurse use to evaluate the patient? Select all that apply. Communication and how thoughts and feelings are expressed. Personal space between the individuals who are communicating. Time, both the perception of time and when daily events should occur in general. Political beliefs and affiliations. Biological variations, such as appropriate weight and development.
Biological variations, such as appropriate weight and development. Communication and how thoughts and feelings are expressed. Personal space between the individuals who are communicating. Time, both the perception of time and when daily events should occur in general.
A nurse is caring for a school age child from a very quiet and soft spoken family. When asking the child questions about how he is feeling after his surgery, the child will never say anything negative and goes out of his way to be polite. How should the nurse interpret this behavior? The child is feeling well. This is a well behaved child who is conscious of his manners and it indicates there is no issue with his health. The child is trying to hide something by being overly polite and not causing any problems. Children often respond in the way that their caregivers would respond, or in an "acceptable" way rather than one that communicates their feelings
Children often respond in the way that their caregivers would respond, or in an "acceptable" way rather than one that communicates their feelings
A nurse is providing education to the family of a child who has end-stage heart failure. Identify what is important to include in the teaching to the family. Select all that apply. A lesson on the anatomy of the heart Current medical treatments available, including all available options Explanation of what will happen to the body at the time of death and after death Potential outcomes, with discussion of time frame when possible What to expect during the dying process
Current medical treatments available, including all available options Explanation of what will happen to the body at the time of death and after death Potential outcomes, with discussion of time frame when possible What to expect during the dying process
A nurse is caring for a Native-American school-age patient who is dying from complications of diabetes. Friends and family members surround the patient's bedside. Which therapeutic techniques should the nurse use when communicating in this situation? Select all that apply. Discuss what is happening in an open and honest manner. Be culturally appropriate, considering the culture of the patient and family in all communications. Avoid details regarding the diagnosis and the death and dying process. Treat the patient and family with kindness and compassion. Be developmentally appropriate.
Discuss what is happening in an open and honest manner. Be culturally appropriate, considering the culture of the patient and family in all communications. Treat the patient and family with kindness and compassion. Be developmentally appropriate.
After administering the Denver Development Screening Test (DDST), the nurse noted that the child had more than two cautions. What questions should be asked to complete the health assessment and guide nursing care. Select all that apply. Have you been exposed to lead based paint? Do you have access to safe parks? Do you have a history of allergies? Do you have access to drinking water? Were you exposed to viral illnesses during pregnancy?
Do you have access to drinking water? Were you exposed to viral illnesses during pregnancy? Have you been exposed to lead based paint? Do you have access to safe parks?
A nurse is providing education to a school-age child who has end-stage leukemia. Identify what is important for the nurse to include in the teaching to the client. Select all that apply. Explanation of cause for terminal diagnosis and how the disease will cause death Explanation of when time of death will occur Explanation of current medical interventions needed and what the client should expect Explanation of the dying process, with appropriate explanation of what to expect Explanation of what will happen to the body at the time of death and after death
Explanation of current medical interventions needed and what the client should expect Explanation of the dying process, with appropriate explanation of what to expect Explanation of cause for terminal diagnosis and how the disease will cause death
The mother of a toddler placed a small figurine on the child while in the cot. Recognizing that this might have cultural importance, but may also have health implications, what strategies should the nurse implement? Select all that apply. Give an affirming smile to the mother. Remove the figurine due to safety concerns. Explore the importance of this action for the family. Educate the mother about the potential safety risks. Spend more time with the family to understand the implication for care.
Explore the importance of this action for the family. Educate the mother about the potential safety risks. Spend more time with the family to understand the implication for care. Give an affirming smile to the mother.
The nurse is assessing a 2-year-old child brought in to the emergency department (ED) after a fall. Which pain scale would be most appropriate to use for a 2-year-old child? FLACC VAS FACES NIPS
FLACC
The nurse must obtain a signature on the consent for surgery form for a preschool child. The lady at the bedside states she is the child's aunt and that the child lives with her at this time. How should the nurse proceed? Have the aunt sign the consent form. Wait for the parent to come in and fill out the consent from. Find out who the legal guardian is for the child and have that person sign the consent form. Have two physicians sign the form since the parents are not present.
Find out who the legal guardian is for the child and have that person sign the consent form.
A nurse is caring for a school-age child with asthma who comes in regularly. The nurse notices unusual bruising on the child's upper arm as well as an abrasion to the left cheek. The child states, "Please don't tell anyone, you know my dad. He didn't mean to. I just made him mad is all. He won't do it anymore, he promised." What action should the nurse take? I can't keep secrets like that. I have to report it as part of my job. I understand but you need to contact 911. You should have told someone right away. Call me next time and I will help.
I can't keep secrets like that. I have to report it as part of my job.
The most important strategy to support cultural competence and equity in healthcare environments would require the nurse to do which of the following action? Encourage unrestricted visitation. Encourage good hand hygiene practices for all visitors. Investigate policies concerning these practices prior to applying for a job at the facility. Ensure active patient and family involvement in care delivery.
Investigate policies concerning these practices prior to applying for a job at the facility.
The nurse is providing care to a family after the loss of their child. The mother states, "I am just so angry! This isn't fair. My baby shouldn't be gone." How should the nurse respond to the mother? No its not fair. This sucks. You shouldn't feel that way. He's in a better place. It is normal to feel that way. Everyone grieves at different stages. It will be okay. It will be better in time.
It is normal to feel that way. Everyone grieves at different stages.
The nurse is performing a cultural assessment on a new patient. Which areas should the nurse include in the assessment? Select all that apply. Religious beliefs Political affiliation Patient and family perception of current health status Food preferences Typical daily schedule
Patient and family perception of current health status Food preferences Typical daily schedule Religious beliefs
A nurse is providing education on using a patient-controlled analgesia (PCA) pump for pain control to a school age child who is recovering from surgery. The patient's parent states, "We don't believe in using narcotic medications for pain, it is fundamentally against our beliefs. My child will be fine without it." How should the nurse respond? Respect the patient and the family's beliefs and work with them to find nonpharmacological measures for pain relief. Tell the family you cannot accommodate their preference that the surgery was too painful and this treatment is in the best interest of the patient. Report the family to social services. Tell the family they are being unreasonable and causing their child unnecessary harm.
Respect the patient and the family's beliefs and work with them to find nonpharmacological measures for pain relief.
The nurse is providing health-promotion education to a group of new parents on how to avoid sudden infant death syndrome (SIDS). The teaching would be considered successful if the participants were able to identify which facts about SIDS? Select all that apply. respiratory problems are the leading cause of death in infants SIDS is one of the leading causes of death for infants 1 month-1 year the peal time for SIDS death is 2-4 months of age babies should be put "back to sleep" the infant sleeping area should include a soft mattress
SIDS is one of the leading causes of death for infants 1 month-1 year the peal time for SIDS death is 2-4 months of age babies should be put "back to sleep"
A hospice nurse is caring for a child with end-stage cancer who has a "Do Not Resuscitate" order (DNR) on file. The patient stops breathing and is found to have no pulse while the grandmother is at the bedside. The grandmother, who is not the legal guardian, states, "The child lives with me and I want everything possible done to save his life!" What initial statement should the nurse make? Yes we will start CPR right now. You have to leave. The child's legal guardian has a DNR in place and we will follow that. You cannot make that decision.
The child's legal guardian has a DNR in place and we will follow that.
An infant is placed under hospice care for a congenital heart defect. The nurse notes a high-pitched cry, heart rate of 165, respirations of 60, and knees drawn up to the chest. What action should the nurse take first? contact PCP assess for other signs of pain burp infant put in oxygen
assess for other signs of pain
The nurse completed a cultural assessment on an adolescent patient who is being treated for recurrent episodes of gallbladder problems. Which finding should the nurse associate as being most useful when providing care for this patient's condition? The patient's family prefers all natural foods and cooks with many hot spices. The patient has a large extended family that lives in the home. The patient's grandfather is considered the head of the household. The patient will have a party when she turns 15 next month.
The patient's family prefers all natural foods and cooks with many hot spices.
The nurse is taking health history information from the family of a child who has an upper respiratory problem. There are several family members present and the nurse notices that all of the family members sit quietly, nodding, looking to the grandfather who is answering the questions. How should the nurse interpret this situation? The grandfather has everyone in the family scared to speak. The family does understand what is being asked. The family may be trying to hide something by not allowing all members to speak and contribute. Through the family's verbal and nonverbal communication they indicate that the grandfather is the family spokesperson.
Through the family's verbal and nonverbal communication they indicate that the grandfather is the family spokesperson.
A family is gathered around the bed of child with terminal Hodgkin's lymphoma. Together, the primary care provider (PCP) and the parents make the decision to withdraw care. Which interventions should the nurse make? Select all that apply. Turn off any monitors. Give a dose of pain medication to make the patient comfortable. Disconnect all invasive lines. Apply oxygen to provide comfort. Create a comfortable, undisturbed, peaceful, and private environment for the family.
Turn off any monitors. Disconnect all invasive lines. Create a comfortable, undisturbed, peaceful, and private environment for the family.
A hospice nurse is conducting a transcultural assessment on a school-age child. During the assessment, the nurse identifies that the family wishes to have prayer five times daily by kneeling to the east and that they would like the child to continue this practice for as long as possible. How should the nurse respond? Discourage the practice as not necessary and one that interferes with medical management. Allow the child and family to fulfill their spiritual practice, but monitor closely for complications. Tell them such practices are not allowed in the hospital setting. Tell them they can do anything they wish with their child.
allow child
A nurse is caring for a school-age child with an end-stage cancer. The patient comes from a large family. In what way could the nurse accommodate the cultural needs of the family? allow the extended family to visit from home as is comfortable for the patient encourage incense to be burned cover the head when caring for the pt. do not eat any pork or shellfish in the home
allow the extended family to visit from home as is comfortable for the patient
During the admission of a toddler to the ward, the nurse observed that all questions were answered by only the male family member without consultation from other members. This is characteristic of which family structure? Open Closed Insularity Protective
closed
The nurse is caring for a school-age patient during the end stages of lymphoma. The patient has a younger sibling who is 4 years of age. What could the nurse do to best help the sibling during this period of time? educate the siblings on the pt.'s diagnosis discuss the details of what will happen during the pt.'s death keep the sibling away from the pt. come up with some age appropriate activities to create normalcy
come up with some age appropriate activities to create normalcy
A student nurse is assisting in the NICU after the death of an infant. The charge nurse explains the cause of the death was physiologic. The student demonstrates understanding of this concept by identifying which option as a possible causative factor? Congenital defect Child abuse Car accident Fall from a changing table
congenital defect
A hospice nurse is caring for an adolescent child with acquired immune deficiency syndrome (AIDS). The parents are divorced and the father has sole custody. The mother has come to visit for the first time and is asking many personal healthcare related questions. How should the nurse best handle this situation? tell the mother what she wants to know tell the mother they cannot disclose that information tell the mother she must talk to the father of the child consult the chart prior to giving out any information
consult the chart prior to giving out any information
The nurse is making a home visit on a school-age child with newly diagnosed diabetes mellitus Type 1. The nurse notes the home is dirty, cluttered, and several kids are running around. The mother states, "I don't know if I can handle one more thing around here. This place is like a zoo as it is." What is an appropriate action for the nurse? contact social services to get assistance and make a referral to a diabetes educator report the family abuse or neglect to a hotline tell the mother not to worry or it will work out explain how the child needs need to come first
contact social services to get assistance and make a referral to a diabetes educator
The nurse in the hospital is caring for an adolescent patient with end-stage renal disease (ESRD) who is on hospice care. The nurse notes a heart rate of 40, shallow agonal breaths at 10, and lower limbs that are bluish in color. Which action should the nurse take initially? contact the PCP contact the patient's hospice nurse contact the pharmacist contact the social worker
contact the patient's hospice nurse
The nurse is doing an admission interview for a school-age child who is being admitted for respiratory problems. The child has several family members present. What should the nurse do initially? determine how long this has been a problem determine who can speak as the head of the household determine if the child has been immunized determine the s/sx the child has exhibited at home
determine who can speak as the head of the household
With the projected demographic change in the American society by 2020, nursing management is taking what steps to ensure cultural competence among staff? Select all that apply. displaying signs with multiple languages employing diverse groups that are multilingual having nursing education in cultural diversity have an organizational cultural competence audit integrating diverse values and beliefs into care
employing diverse groups that are multilingual having nursing education in cultural diversity have an organizational cultural competence audit integrating diverse values and beliefs into care
During communication with migrant families, the nurse should be culturally aware by ensuring adherence to the following strategies. Select all that apply. Ask the caregivers for input into care and beliefs The nurse should have self-awareness Be respectful in order to enhance the therapeutic environment Be reflective of past cultural experiences that may affect interpersonal communication and care delivery. Disclose conflicting values might affect care delivery to families.
everything but disclose
A school-age child who was recently on hospice, is undergoing a full code in a family-centered respite house. The patient stopped breathing with the family at the bedside and would need extensive resuscitation. What intervention by the nurse would be best for the family? explain to the parents what will go on and what they prefer allow the parents to stay, but only in the back of the room ask everyone to step outside the room allow everyone to stay and let the parents stay at bedside
explain to the parents what will go on and what they prefer
The nurse is taking the health history of a school-age child. The parents are at the bedside to answer questions. What question would be most important for the nurse to determine in regards to the patient's management of care? if the pt. is being raised by extended family if the pt. is an immigrant if the pt. has used alternative therapies if the pt. may avoid eye contact
if the pt. has used alternative therapies
The nurse is caring for a school-age child in need of a blood transfusion to improve his rare condition. The family are Jehovah's Witnesses and will not allow it due to their religious beliefs. What action should the nurse take? provide non judgmental care and examine personal beliefs refuse to care for patient tell the parents family they are killing their child say nothing and ignore the internal conflict
provide non judgmental care and examine personal beliefs
The nurse is developing a therapeutic relationship with the patient and family. To do this the nurse should take into account what practices? Select all that apply. recognizing appropriate boundaries keeping info confidential building mutual respect and trust be friends with patient keeping all of the patient's secrets
recognizing appropriate boundaries keeping info confidential building mutual respect and trust
Cultural diversity in health care institutions is necessary due to mass migration. Which ethical principle is the most important for cultural competent care? Fidelity Respect Justice Beneficence
respect
Health disparities are a leading contributor of ill health in some ethic groups and affect children negatively. The nurse is aware that the most important strategy for addressing these disparities and promote health equity nationally would be what? Agency policies Family-centered care Social justice policies Lobbying
social justice policies
The mother of a toddler placed a beaded necklace on the child while in the cot. Recognizing that this might have cultural importance, but may also have health implications, what strategies should the nurse implement? Select all that apply. giving an affirming smile to the mother explore the importance of this action to the family educate the mother on safety risks remove necklace spend more time with family to understand reason
spend more time with family to understand reason giving an affirming smile to the mother explore the importance of this action to the family educate the mother on safety risks
The pediatric nurse works as part of a collaborative team to provide health care to patients. What should the nurse identify as integral parts of a multidisciplinary relationship? Select all that apply. respect any differences of opinion senior member should get final say ethics consultations should be avoided when there are differences the patient's best interest should be the goal healthcare providers work as a team
the patient's best interest should be the goal healthcare providers work as a team respect any differences of opinion
A nurse is giving preoperative instruction for a pre-school age patient with Japanese-speaking parents who cannot understand the English language. To effectively communicate with someone who speaks a different language, which intervention should the nurse implement? use an interpreter to translate speak more slowly and use sign language make eye contact and speak where the parents can see you speak in a louder tone
use an interpreter to translate
A nurse is caring for a toddler whose parents only speak Spanish. The nurse needs to obtain consent to perform an emergency appendectomy. What options are recommended if an interpreter is not readily available? Select all that apply. use pictures to communicate use family members an interpreters use the internet for interpretation use charades and hand gestures use someone other than the parents to gain consent
use pictures to communicate use family members an interpreters use the internet for interpretation
A nurse is caring for a pre-school child who has recently undergone chemotherapy. The patient's appetite has been poor and the family asks, "May we bring in some chicken noodle soup? It is what he is asking for and all he will eat when he is sick. How should the nurse respond? no outside food send it to dietary to be approved no he is on a very strict diet and has to be monitored yes anything that is special to him that he will eat and is not restricted is allowed
yes anything that is special to him that he will eat and is not restricted is allowed