Essentials Of Pediatric NUR-Chap 1 Prep U

A nurse is faced with an ethical conflict involving the care of a child. The child's parents disagree with the physician about the use of a feeding tube. The nurse sees the benefits and limitations of both parties' views. Which of the following would be most appropriate?

Take the issue to the Institutional Ethics Committee for advice.

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?

"We had to sign the form right away so the surgery could get scheduled."

The nurse knows that children can give assent (agree) to participate in research. At what intellectual age does the American Academy of Pediatrics suggest minors may first do this?

7 years

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?

Ask the baby's mother to sign the surgical consent Explanation 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.

A single18-year-old woman in her second trimester presents at the clinic with vaginal bleeding. She confides to the nurse in confidence that she has been using cocaine to "calm her nerves" and hopes it didn't harm her baby. What would be the nurse's best response to this situation?

Consult with the healthcare facility's institutional ethics committee for an appropriate response

The parents of a 12-year-old child preparing to undergo surgery explain to the nurse that their religious beliefs do not allow for blood transfusions. What initial action by the nurse is most appropriate?

Document the parents' requests.

A 16-year-old child is admitted to the hospital for treatment after a motor vehicle crash. Review of the child's record reveals that she has the legal right to consent to and make decisions for treatment. What is the term for this client's status?

Emancipated minor

The nurse is talking with the mother of a 2-year-old girl during a scheduled visit. Which of the following teaching subjects least supports the emphasis on preventive care?

Explaining how to teach self hand washing Explanation: Teaching hand washing helps to prevent infection, emphasizes preventive care, and is basic to avoiding many common illnesses.

The nurse is caring for a 16-year-old boy with injuries from a car accident. Which activity describes the nurse's manager role?

Facilitating return to school by working with the school nurse Explanation Much of an adolescent's life revolves around school and peers. In helping the teen return to school and friends, the nurse and the school nurse are achieving continuity of care and a supportive environment for healing.

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?

Family-centered care Explanation 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.

Which of the following would be a current trend that is influencing child care?

Greater use of alternative treatment modalities

Which of the following isa current trend in child health care today?

Health restoration is stressed over health promotion Explanation It is recognized that keeping individuals well is more cost effective for a system than helping ill individuals return to wellness.

The nurse is caring for a 7-year-old boy with cystic fibrosis whose parents are intensely interested in all aspects of his condition and care. Which is the most effective way of advocating for this child and family?

Helping parents access the area's multidisciplinary cystic fibrosis clinic Explanation Accessing the cystic fibrosis clinic where specialists collaborate with the child and family to provide information, direct care, and services empowers the family with tools to meet their needs.

The 5-year-old in the emergency room is having glass removed from a wound. Which action constitutes ethical behavior by the nurse?

Holding the child's hand in order to facilitate removal of the glass

When describing the State Children's Health Insurance Program (SCHIP) to a group of families, which of the following would the nurse include?

It provides health insurance to children whose families are not eligible for Medicaid but cannot afford to purchase health insurance Explanation 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 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?

Learning the mother is not the custodial parent Explanation It would not be legal for this mother to give consent.

The nurse is updating the records of a 10-year-old boy who had his appendix removed. Which action could jeopardize the privacy of the child's medical records?

Letting another nurse use the nurse's log-in session

In 2007 the World Factbook published statistics that showed the United States still lagged behind other industrialized nations in the incidence of infant mortality. What is one reason that the United States has a higher infant mortality rate than other countries?

Low birth weight Explanation Many factors may be associated with high infant mortality rates and poor health. Low birth weight and late or nonexistent prenatal care are the main factors in the poor rankings in infant mortality.

The school nurse is caring for several children who witnessed an 8-year-old girl get hit by car on the way to school. Which intervention is least important to the nursing plan of care for these children?

Making phone calls to the parents of the children counseled

What is the number one cause for mortality among children?

Motor vehicle accidents

A nurse is caring for a child. Which individual would the nurse identify as being primarily responsible for initiating and coordinating healthcare?

Parents Explanation Parents and guardians have the primary responsibility for initiating and coordinating services rendered by health professionals.

More nurses are stepping into the role of the advanced practice nurse. Which of the following would be the nurse to provide care for children under the age of 18?

Pediatric nurse practitioner

A nurse is reviewing the medical record of a terminally ill child who has a DNAR order. The nurse interprets this as refraining from which of the following?

Performing cardiopulmonary resuscitation

The pediatric nurse knows that the state of children's health in the United States is evaluated by specific determinants and measures of health status. These determinants include:

Race and ethnicity

A nurse is looking for information about advocacy activities related to promoting literacy. Which of the following would be most appropriate for the nurse to contact?

Society of Pediatric Nurses (SPN) Explanation 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 nurse is caring for a 5-year-old girl with meningitis. What action by the nurse may be considered ethical behavior?

Starting intravenous fluids even though the child protests

To decrease childhood mortality, pediatric nurses need to consistently engage in what activity throughout all age groups?

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

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?

Telephone consent with two witnesses listening simultaneously Explanation Telephone consent documented with two witness signatures is appropriate

An older couple approaches the nurse's station seeking information about their hospitalized grandchild. What should be the nurse's response?

Tell the couple to seek information directly from the child's parents.

During the weekly team meetings, the physician and case manager discuss the client's planned assent. What activity should the nurse most anticipate?

The client will have a conference with the physician about the planned course of care and treatment. Explanation 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 group of students are reviewing information about Medicaid. The students demonstrate a need for additional study when they identify which of the following?

The federal government is responsible for administering it.

The line at the well-child walk-in clinic is long, with closing time near. Which child does the nurse assess based on knowledge of morbidity data?

The foreign-born adopted child

You are going to provide an education program to early grade-school children. Which of the following topics would address the number one cause of death for this age group?

The importance of crossing streets safely Explanation Motor-vehicle accidents are a leading cause of death in this age group.

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 which of the following?

The prevalence of chronic disease is increasing.

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?

This nurse has not met the standard of care that constitutes adequate nursing practice identified in Pediatric Nursing: Scope of Standards and Practice. Explanation The nurse is not meeting professional role expectations. Implementing the interventions identified in the plan of care is expected

When caring for an adolescent, in which case must the nurse share information with the parents no matter which state the care is provided in?

Tuberculosis

A nurse is considering employment in a practice that promotes family-centered care. When considering this position, the nurse recognizes that this philosophy will:

promote the involvement of the child and parents as members of the health care team.

A nurse caring for children and their families must respect the rights of the parents and guardians and their charges relevant to child health issues. Which statement best describes these rights? Select all that apply.

• Parents are able to raise the child according to their religion. • Parents and guardians can give permission for treatment. • The mother of the child assumes parental responsibility when the couple is not married

A group of students are reviewing information about the Education for All Handicapped Children Act and its amendments. The students demonstrate understanding of this information when they identify which of the following as a service that may be provided? Select all that apply.

• Speech therapy • Infant stimulation • Psychological services • Special education

A 15-year-old with leukemia tells the nurse that she wants to file for emancipation in order to control her own treatment plan. The nurse explains the process by stating: Select all that apply.

• The process is governed by individual state laws. • The minor must demonstrate the ability to manage financial affairs. • The minor must be at least 14 years of age.

An instructor is describing the issues of research involving children. Which of the following would the instructor include?

Children are considered vulnerable subjects at high risk for injury.

Morbidity rates among children are most highly associated with which cause?

Environmental factors Explanation 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

An important role of the nurse caring for children and their families is that of child advocate. Which one of the following interventions best reflects this role?

Working to change agency policy to better serve families

The parents of a 9-year-old agree to allow their child to participate in a research project involving drug trials for a new drug for attention deficit hyperactivity disorder. Which of the following rights of the child are related to beneficence? Select all that apply.

• The parents and child are told the physical and nonphysical risks associated with the research. • The parents and child are informed of the possible adverse effects of the research. • The parents and child are told of the direct and indirect benefits of participation.

The nurse is assessing the vital signs of a child who is being evaluated in an urgent care center. The child is to be seen by the pediatric nurse practitioner (PNP). The mother asks, "Why is my child seeing the PNP and not the doctor?" What is the best response by the nurse?

"The PNP is an experienced RN with advanced education in the diagnosis and treatment of children."

A nurse is talking with the parents of a child who is participating in a research study evaluating drug therapy. Which statement by the parents indicates that the principle of beneficence is being addressed?

"There is some risk that the medication could cause him to have seizures."

A terminally ill 15-year-old tells the nurse that she wants to stop all treatments and go home despite her parents' directives to provide extraordinary means to keep their child alive. What is the best resource available to this nurse to help solve this dilemma?

An institutional ethics committee Explanation Every institution has an Institutional Ethics Committee (IEC), which is required by The Joint Commission. The IEC should always be consulted in difficult or unusual cases when conflict and lack of agreement exists between parents and physicians or among the professional staff as to the course of action that is in the best interests of the child.

The school nurse is planning a screening program. What items should be included to address issues related to the "new morbidity"?

Academic difficulties, violence, and other mental health issues

The nurse is caring for a 14-year-old boy with a debilitating illness who wants to attend school. Which of the following interventions addresses the child's physical health but not his quality of life?

Assessing the child's daily oxygen supplement needs

The school nurse is caring for several children who witnessed an accident in which an 8-year-old girl was struck by a car on the way to school. Which is the most important first step in developing the nursing care plan for these children?

Determining whether the children were traumatized by the accident

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:

Family

Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because:

Increasing numbers of children live with chronic disabilities due to advances in healthcare that allow children with formerly fatal diseases to survive. Explanation Advances in health care have led to more children living with chronic illness or disability.

The nurse is assessing a 9-year-old boy with pneumonia. Which finding is a factor for this child's morbidity?

Medical records reveal a history of asthma Explanation Asthma is a morbidity factor for additional childhood illness, particularly respiratory illness.

The parent of an 11-year-old female patient 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?

Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved. Explanation 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.

Morbidity data indicate that support is needed from pediatric nursing groups to establish improved and additional services for children with what health issues?

Mental health and behavioral disorders

The nurse is assessing a 9-year-old boy during a back-to-school check up. Which finding is a factor for childhood injury?

Mother reports she has abused alcohol and drugs. Explanation One of the factors associated with childhood injuries is parental drug or alcohol abuse. This is the leading cause for child mortality

The nurse is focusing on health promotion for a 6-year-old girl. Which intervention best supports Healthy People goals?

Recommending a helmet for biking

A family that makes too much money to qualify for Medicaid, but who cannot afford to purchase health insurance, should be referred to the Children's Health Insurance Program (CHIP).

True

A nurse is reviewing morbidity data related to a recent outbreak of severe influenza in the community. This epidemiological information will allow the nurse to determine:

what proportion of children in the community have recently been diagnosed with influenza. Explanation Morbidity is the measure of prevalence of a specific illness in a population at a particular time. It is presented in rates per 1,000 population

Nurses can help to decrease the United States' mortality rate by advocating for improved access to healthcare for which ethnic groups in particular? Select all that apply.

• African-Americans • American Indians and Native Alaskans • Puerto Rican-Americans