Chapter 1: Introduction to Child Health & Pediatric Nursing

The nurse is working in a pediatric facility whose mission statement strongly emphasizes providing family-centered care. What nursing intervention best exemplifies this facility's belief? A) The nurse plans a meeting with the parents, child, and case worker to discuss care alternatives for the child. B) The nurse assesses the interaction between a child and his parents when the parents visit. C) The nurse asks the child to describe his relationship with his parents. D) The nurse questions the competency of care provided by a single father to his child.

A) The nurse plans a meeting with the parents, child, and case worker to discuss care alternatives for the child. Providing care with an emphasis on a family-centered approach leads to better client outcomes as well as satisfaction with the facility and staff in care provided. Family-centered care involves a mutually beneficial partnership between the child, the family, and health care professionals.

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) The intervention on the nursing care plan came from the family, not the nurse—the nurse may omit it. D) Nurses make clinical decisions—this action is acceptable.

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 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) culturally competent care C) advocacy 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.

Morbidity rates among children are most highly associated with which cause? A) Suicide and homicide B) Environmental factors C) Firearms at home D) School violence

B) 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.

To decrease childhood mortality, pediatric nurses need to consistently engage in what activity throughout all age groups? A) Help integrate exercise practices and programs into the lifestyles of individuals and communities. B) Teach injury prevention and proper safety practices. C) Advocate for more research into control of environmental toxins. D) Provide guidance regarding proper nutrition.

B) Teach injury prevention and proper safety practices. The leading cause of death throughout childhood is unintentional injury.

What was the primary goal for the establishment of the Children's Bureau? A) to promote prenatal care B) to improve the standards of health care C) to reduce prematurity D) the improvement of parenting behaviors

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.

A student nurse raises questions about the value of evidence-based practice. What information should be contained in the response provided? (Select all that apply) A) Instructors of nursing and researchers are the most responsible parties for ensuring evidence-based practice. B) Client outcomes are improved with evidence-based practice. C) Evidence-based practice seeks to promote increased variation in the care delivered to clients. D) Evidence-based practice is a clinical decision-making approach to providing nursing care. E) The quest for practice improvement is the responsibility for all nurses.

B,D,E B) Client outcomes are improved with evidence-based practice. D) Evidence-based practice is a clinical decision-making approach to providing nursing care. E) The quest for practice improvement is the responsibility for all nurses. 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 involves the use of research findings in establishing a plan of care and implementing that care. Evidence-based practice may lead to a decrease in variations in care while at the same time increasing quality and improving health care. All nurses must be invested in asking questions and working to improve practice and client outcomes.

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 baby gates installed at the top and bottom of our stairs in our home." 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 to hire babysitters sometimes because our parents are not able to help babysit."

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.

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) Describing physical changes taking place in her child. B) Reminding the mother that the child will imitate her. C) Showing the mother how to teach hand-washing to her child. D) Discussing with the mother anticipated developmental milestones.

C) Showing the mother how to teach hand-washing 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) Contacting the institution's attorney to provide and document consent. C) Telephone consent with two witnesses listening simultaneously. D) Explaining the needed treatment to the minor and documenting this action.

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.

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) atraumatic therapeutic care C) family-centered care D) evidence-based nursing 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.

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.

A nurse is caring for a child. Which individual would the nurse identify as being primarily responsible for initiating and coordinating health care? A) community B) case manager C) parents D) social worker

C) 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.

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) Measure the child's urine output. B) Support the child and family members. C) Perform cardiopulmonary resuscitation. D) Perform sternal rub.

B) 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 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) A referral to the hospital's ethics committee will be initiated. B) The physician will confer with the parents to outline the severity of the child's condition. C) "Do not resuscitate" orders should be obtained from the physician. 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.

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) Weighing the potential harm caused by a child's chemotherapy with its potential benefits. C) Providing empathic, holistic care to a family who has just learned that their child's prognosis is poor. D) Encouraging an adolescent client to take ownership of her health status independent of her parents.

B) 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.

A nurse is considering employment in a practice that promotes family-centered care. When considering this position, the nurse recognizes that this philosophy will: A) promote the involvement of the child and parents as members of the health care team. B) consider the wishes of the child as the leading force in planning care. C) focus primarily on the use of herbal remedies to manage health concerns. D) embrace teaching the parents to manage the health care needs of their child.

A) promote the involvement of the child and parents as members of the health care team. Family-centered care involves a mutually beneficial partnership between the child, the family, and health care professionals. It applies to the planning, delivery, and evaluation of health care for children of all ages in any setting.

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) "The child should be included as much as possible in the plan of care." B) "I believe the family should be included in all aspects of the plan of care and treatment." C) "I think the parents must be the director of the client's care until adulthood." D) "Since health care can be scary for a child, it's important to make them feel secure." E) "Until they are teens, kids should have a limited amount of decision making in their care."

A,B,D A) "The child should be included as much as possible in the plan of care." B) "I believe the family should be included in all aspects of the plan of care and treatment." D) "Since health care can be scary for a child, it's important to make them feel secure." 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.

An important role of the nurse caring for children and their families is that of child advocate. Which intervention best reflects this role? A) Teaching parents the proper way to administer insulin to their child. B) Working to change agency policy to better serve families. C) Accurately documenting and reporting client conditions. D) Administering medications to clients on a timely basis.

B) Working to change agency policy to better serve families. An advocate acts to safeguard and to advance the interests of the child and family, as a means to help meet their health care needs. Advocacy ranges from calling an agency on behalf of a child, to writing letters to legislators to improve their understanding of an issue, to working to change agency policy to better meet the needs of the families it serves.

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) changing dressings covering the skin abrasions B) facilitating return to school by working with the school nurse C) teaching the mother cast care D) discussing driving safety with the teen

B) 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.