PEDS Practice: Chapter 2 Factors Influencing Child Health

The mother of two school-age children is getting divorced. Which would be the best advice for the nurse to give?

"Discuss how things will work after the divorce." Both parents together should discuss with the children how things will work after the divorce. The children should not be expected to act like adults because they are not. Tell them about the divorce ahead of time, and tell them the reasons in nonjudgmental terms that they can understand.

A 14-year-old child shares with the nurse that she is adopted. She reports she was born in another country and now wishes she had more information about her ethnic and cultural background. She states her parents are not comfortable with this. What response by the nurse is most appropriate?

"Finding out about your culture may be enlightening for you." The child of adoption will understandably have questions about their background. It is helpful for them to know about their culture and ethnicity. Open communication about this is helpful to them. Sympathizing with the parents is not indicated or helpful.

The father of a child mentions to the nurse that he is very worried about his 14-year-old son because he is associating with a group of kids that get into trouble frequently. What responses by the nurse would be appropriate? (Select all that apply.)

"Have you thought about encouraging your son to become involved in a sport? This could occupy his time in a constructive way." "Are there any activities that your son likes? There are often clubs offered at schools for a variety of interests." A child's friends can have a major influence, positive or negative, on his or her growth and development. Encouraging sports or clubs can help the father guide the son to friends that will likely have a more positive influence. Telling the father to prevent him from associating with a certain group often ends up pushing the child to that peer group. Instilling good values is not a guarantee to good choices at this age. Stating it's hard to be a parent offers no support or guidance.

The nurse is assessing for violence in the home. Which statement by a parent would warrant further investigation?

"I don't think my children have seen my husband hit me." The statement "I don't think my children have seen my husband hit me" indicates that there is violence in the house. This would warrant further investigation. Arguing, having a gun in the house, and police at the neighbor's house do not indicate violence in the house.

A nursing instructor is discussing ways to promote safe Internet use in children with a group of nursing students. Which statement by a student would indicate a need for further education?

"It is okay for a parent to place a computer in a child's room if it is used for homework." Computers in a child's room should be avoided. They should be placed where a parent can monitor use. Time limits, not opening emails from people they don't know, and not sharing passwords with anyone are all correct statements regarding safe Internet use.

The mother of a child tells the school nurse that her son has been acting out at home ever since she got remarried. "My new husband is a wonderful man and is great to my son. I don't understand why he is acting this way." What is the best response by the nurse?

"It's not unusual for children in a new step role to act out. He's feeling lots of different emotions. Be sure to keep communication open with him." Offering support to the mother and offering suggestions for open communication are effective techniques in dealing with this situation. Children may feel jealous of the stepparent or feel disloyal toward the previous biological parent. There may be competition or rivalry among the stepchildren. The child may fear that the stepparent is interfering with the child's relationship with the parent or taking away his or her source of love, affection, and attention. The other responses do not offer support or suggestions on how to deal with the son's behavior.

The nurse is providing a class to a group of parents about child rearing. One of the participants reports that she regularly uses spanking as a form of discipline for her 5-year-old son. What is the best response by the nurse?

"Many studies show that spanking can lead to aggression in children." Spanking is a controversial issue. Some argue that it provides children with a model of aggressive behavior as a solution for conflict, that it has been associated with increased aggression in children, and that it can lead to an altered parent-child relationship. Various studies have linked spanking in childhood with physical aggression and violence in childhood and persistent anger in adulthood. Spanking is not largely considered to be a useful form of discipline. Spanking is not considered beneficial in children older than age 5. Telling the mother that spanking is wrong is argumentative and does little to provide the needed education.

The nurse is working with the 5-day-old baby boy of a young Jewish couple. What comment is not culturally sensitive?

"Oh, I see you have chosen not to have your baby circumcised." Ritual circumcision for Jewish babies takes place on the eighth day of life. All the other comments are acceptable.

The nurse is caring for a child of Asian descent. The nurse is trying to ensure that the family's cultural practices are supported. Which statement by the nurse indicates a lack of understanding regarding cultural competence?

"Since your child is only 8, I doubt that your child has any cultural practices we need to be aware of." Typically, a child begins to understand his or her culture at approximately 5 years of age, so stating that the child does not have any cultural practices at the age of 8 is inaccurate. Diet, cultural practices, and religious practices related to culture are important for the nurse to know so that the nursing staff can support as many of these practices as possible.

The mother of a 15-year-old child reports that her husband is very strict with her son. She voices concerns about the future impact of this style of parenting on him later in life. What response by the nurse is most appropriate?

"The children who have parents who are authoritarians often are resentful later in life." Parenting style has an impact on the future of children. The authoritative parenting style is associated with negative effects on self-esteem, happiness, and social skills and increased aggression and defiance.

The father of a 6-year-old boy reports that his son is having difficulty adapting to the changes in the family structure since the father remarried a few months ago. The father asks the nurse for suggestions on what to do. What information can be provided by the nurse?

"The display of a united front between you, your wife, and your son's mother is important."

The nurse in a community clinic is speaking with the parents of a child. The parents are planning to get a divorce and discuss with the nurse how they plan on handling talking with their child. Which statements by the parents demonstrate an effective approach to speaking with their child? Select all that apply.

"We plan on reminding our child that the divorce is not their fault in any way." "We both plan on communicating with our child every day, no matter whose house our child is staying at the time." "We plan on seeking the advice of a counselor during this difficult transition." There are several ways a divorce can be made less stressful for a child. The child should be informed well in advance of anyone moving out of the house (except when abuse is present or there are concerns for immediate safety), so waiting until the child is at school is not advisable. Reasons for the divorce and that the divorce is occurring should be done with both parents present.

The parents of a 16-year-old child are meeting with the pediatrician to discuss behavior problems of their teen. Which statements by the parents about their parenting style are consistent with an authoritarian style? Select all that apply.

"We tell our teen the rules of the household and the importance of her complying." "It is important that our daughter follow the rules of the household." "She will thank us one day for outlining clear expectations for her behavior." The authoritarian parent expects obedience from the child and discourages the child from questioning the family's rules. The parent provides low support and high control over the child (Cherry, 2014). The rules and standards set forth by the parents are strictly enforced and firm. The parents expect the child to accept the family's beliefs and values and demand respect for these beliefs. The parents are the ultimate authority and allow little, if any, participation by the child in making decisions.

A parent is disciplining the 5-year-old daughter by putting her in time-out. How long should the child be in time-out?

5 minutes The amount of time that a child spends in time-out is typically 1 minute per year of age; for example, a 3-year-old would spend 3 minutes in time-out.

What is the key nursing role when managing the health care of a child living with a foster family?

Advocating for the child and the services needed Advocating for the child is the overarching nursing role. Unmet health needs are likely. Advocacy gives the child a "voice" so that the wide range of health care needs often prevalent in foster children can be met. Determining presence of mental health issues and developmental status as well as securing educational placement are specific issues among many that advocacy would address.

Personal space and distance is a cultural perspective that can impact nurse-client interactions. What is the best way for the nurse to interact with a client who has a different cultural perspective on space and distance?

Allow the client to adopt a position that is comfortable for him or her. If the client appears to position himself or herself too close or too far away, the nurse should consider cultural preferences for space and distance. Ideally, the client should be permitted to assume a position that is comfortable to him or her in terms of personal space and distance. "Realizing" and "remembering" are not interactions. It is also incorrect to attempt to adopt someone else's cultural preference as this can be very uncomfortable for the nurse, which adds a barrier to nurse-client interactions.

Traditionally, hot and cold are viewed as potential causes of disease by which group?

Arab Americans Arab American beliefs often hold that hot and cold are potential causes for illness

A 10-year-old girl is living with her grandparents. Which nursing intervention is most important with this family structure?

Assessing the child for emotional problems Children living with their grandparents may experience emotional stress if the biological parents are in and out of the child's life. Teaching basic child care skills is appropriate for the adolescent family. Determining the decision maker is important with an extended family, and financial aid is important for single parents.

The nurse notes that a 5-year-old boy is approaching obesity. Which is the priority intervention?

Assessing the diet of the child and family The greatest influence on the child's behaviors is the family. Therefore, habits of the family are likely to be those of the child. Evaluating the family diet is most important. Determining the activity level of the child ranks next in importance. Sedentary behaviors lead to weight gain. Asking about culturally related eating habits can produce some helpful but limited nutrition information. Screening the child for metabolic disorders would not be done unless there was other evidence that points to this possibility.

The nurse is assessing a woman who is pregnant. Her health history reveals she has three young adult children. Which nursing intervention would be most appropriate according to Duvall's developmental theory?

Assessing the parent's coping abilities It would be most appropriate to assess the parent's coping abilities because they are in the wrong stage of the family life cycle to be having another child. Providing anticipatory guidance, describing the nutritional value of breastfeeding, and promoting the importance of vaccinations are interventions for younger parents.

The nurse is caring for a 7-year-old child who is being treated for multiple fractures after being involved in an automobile accident. The nurse observes that the father frequently takes on the role of nurturer in the family. When planning care, which nursing intervention would most involve the father?

Bathing the child. The nurse would focus on the father for decisions about the course of treatment. Assuring medications are received on time is the family health manager's role. Staying with the child in the hospital will be handled by the family nurturer. All clinical input will be provided to the family gatekeeper for dissemination

The nurse is caring for a 7-year-old boy and his family, who are immigrants. Which intervention will most significantly affect the success of the care provided?

Communicating with sensitivity using understandable terms Being understood is essential to the provision of all nursing care. An interpreter may be needed. Speaking slowly and using simple terms is also useful. Inquiring about common health problems in their home country, asking about transportation, and helping them access aid programs are all secondary to and dependent upon effective communication.

The father of a 12-year-old child who has low resiliency has asked for tips in working with his son to promote the improvement of this trait. What would be the most effective advice the nurse can provide to the parent?

Encourage the child's father to assist his son to set short-term goals for identified projects. The term resilience refers to the qualities that enable an individual to cope with significant adverse events or stresses and still function competently and have positive outcomes. Various internal and external protective factors promote resiliency. Internal factors include the person's ability to take control and be proactive, to be responsible for his or her own decisions, to understand and accept his or her own limits and abilities, and to be goal directed, knowing when to continue or when to stop. External factors include caring relationships with a family member; a positive, safe learning environment at school (including clubs and social organizations); and positive influences in the community. Dietary supplementation and exercise can promote overall health but working on goal setting will provide a direct impact on the process.

The nurse is teaching techniques for effective discipline to the parents of a 9-year-old girl. The girl is misbehaving, and the parents wish to use the extinction method. Which action is an example of extinction?

Going home early from shopping Going home early from shopping if the child misbehaves is an example of extinction discipline. Positive reinforcement is eliminated for inappropriate behavior. Going out for ice cream, praising her for polite behavior, and letting her go to a friend's house are all types of positive reinforcement.

To assess the sociocultural aspects of the family of an adolescent in an ambulatory clinic, what would you try to find out more about?

His family structure Family structure is a characteristic strongly influenced by culture and ethnicity

A client who just learned she is pregnant says, "I can no longer eat strawberries, even though they are my favorite." What best explains this statement?

It is related to culture. People from different cultures tend to eat different types of food. Some women may omit various foods during pregnancy because they believe a particular food will mark the baby (e.g., strawberries cause birthmarks, raisins cause brown spots). Food preferences, selections, and seasons do not explain her sudden omission of strawberries in her diet.

A woman has presented to the clinic with her sick school-aged child. The child's mother reports she rarely has enough money to meet the health care needs of her chronically ill child. What information should be provided to the woman?

Medicaid may be available to low-income parents and their children. Medicaid is a joint federal and state program that provides health insurance to low-income parents and their children. It is state-administered, and each state has its own set of guidelines.

The mother of a 12-year-old boy is concerned about the dangers of the Internet. Which suggestion by the nurse best targets safety related to this?

Never share personal information online. Protecting personal information is key to computer safety. Having the computer in a common family area allows adults to monitor the child's activities and promotes some level of safety. Limiting time spent online is a wise overall strategy to encourage physical activity but not safety. Using the phone also limits computer time but does not address safety.

The nurse is caring for a 12-year-old African American girl. The child is in pain as a result of a back injury. The nurse correctly recognizes which belief regarding pain to be most consistent with the child's culture?

Pain may be relieved through prayer and folk healing. African American traditional beliefs include the use of prayer, folk healing and home remedies to promote a return to health and reduction of discomfort.

A 4-year-old boy is residing permanently with his grandparents. Which situation is unique to this type of family or living arrangement?

Physical and financial stress on the caregivers Grandparents, due to age and income levels, are uniquely prone to this type of stress. Difficulty obtaining an accurate health history or records is common in foster families. Obstacles to obtaining informed consent for treatment and gaining consensus between caregivers regarding treatment occur most often in the binuclear family.

The mother of a school-aged child is discussing parenting behaviors with the nurse. She questions the nurse about the best way to provide feedback to her child. What suggestion by the nurse is most appropriate?

Positive reinforcement is more valuable than negative feedback It is most important that feedback is consistent and timely. It is important to focus most on positive feedback rather than the reinforcement of negative problematic behaviors.

The nurse is taking a health history and examining a 3-year-old boy. Which action is most important for the parents to take?

Protect the child from all tobacco smoke First-, second-, and third-hand tobacco smoke has been shown to have many detrimental effects on children. This is the first lifestyle change the parents should make. All other actions are important, and if not changed, can have negative effects on the preschooler's growth and development. However, they are not known to be as harmful as tobacco smoke.

The mother of a child who has been termed to have a "difficult" temperament voices frustration in managing his care. What would be the best initial course of action by the nurse for this parent?

Review strategies that are beneficial in the care of a child with a difficult temperament. Difficult temperament children have challenges with regard to behavior. These children may be frustrating to their caregivers and parents. The best course of action would be to provide coping strategies and suggestions for how to best manage the care of the child. Labeling the child should be avoided. The remaining options may be beneficial but are not of the highest priority

The public health nurse is aware suicide in teens is a significant health issue. Which child is most at risk?

The 17-year-old American Indian boy American Indian/Alaskan Natives have the highest rate of suicide while Hispanic youth are more likely to report attempting suicide. Male rates exceed those of females. Suicide is the third-leading cause of death in people ages 10 to 24 years (CDC, 2012a).

The nurse is talking with an adopted child and the family. Which statement represents "positive" adoption language?

The birth mother was how old when your child was born? Birth mother, not natural or real mother, is a positive term for the biological parent, as is simply parent for the adoptive mother or father. The adopted child is just a child and not someone given up or given away. Saying an adoption plan was followed makes a positive statement.

The nurse is assessing a child brought to the emergency department with a badly abscessed ingrown toenail that could have been avoided with early treatment. When assessing for potential barriers to health care, the nurse should address which possible factors? Select all that apply.

The family's current health care insurance status The family's cultural beliefs about health and illness The family's spirituality and religion The child's previous experiences in the health care system There are numerous potential barriers to health care in varied domains, including spirituality, finances, culture, and previous experience. Genetics have a major effect on health and illness but are not considered to be an independent barrier to health care.

The nurse is assessing for violence in the home. Which response by the mother represents the greatest risk to the child?

The mother's partner calls the child names. If the mother's partner is being verbally abusive of the child, there is risk of physical violence. There could be a number of reasons other than violence to dread going home. Strictness is not necessarily a sign of abuse. The boyfriend's absence may only be a sign or irresponsibility and not of a violent nature.

Over coffee following a worship service, parents ask the parish nurse for guidance in disciplining their children ages 4 years, 9 years, and 14 years. What concepts will guide the nurse's response? Select all that apply.

Use parental attention as positive reinforcement for desired behaviors. Maintain consistency in expectations at all ages. Role model appropriate behavior in word and deed. Attention, consistency, and role modeling are all appropriate disciplinary concepts. Showing anger can cause the child to believe the parent is angry at him or her as a person. A calm demeanor helps indicate displeasure with the behavior. Delaying punishment interferes with connecting the behavior to the consequence.

While caring for a hospitalized child, the nurse notes the father does not take into consideration the wishes or opinions of the child. During a period of discussion the father explains to the nurse that he feels his child is best served having clearly outlined rules and expectations. This is most consistent with which style of parenting?

authoritarian Authoritarian parenting style consists of the parents making the rules for the child to follow. There is little to no flexibility or decision making by the child. Authoritative parenting is also referred to as democratic parenting. In this style of parenting the there are rules and expectations of behavior but the parents embrace the individuality of the child and do allow some input by the child. There is no "strict" parenting style.

The nurse is assessing an adolescent. When discussing his parents, the adolescent states that his parents have very strict rules and he is expected to follow them. If he breaks a rule, he is punished. The nurse is aware that this is which parenting style?

authoritarian The authoritarian parent expects obedience from the child and punishes when rules are broken. The authoritative or democratic parent shows some respect for the child's opinions. Permissive or laissez-faire parents have little control over the behavior of their children. Uninvolved parents are indifferent. They do not provide rules or standards.

A child in an elementary school visits the school nurse frequently reports being tired. Upon questioning, the child says that when at the mother's house there is no set time for bed, but at the father's house there is a set bedtime. Before discussing this issue with the parents, the nurse determines that the child is living in which type of family structure?

binuclear

When caring for a woman in her sixth month of pregnancy, the client reports her plans to nurse her baby for at least 2 to 3 years like the rest of the women in her family. Based upon the nurse's knowledge, the nurse should:

document her report but do nothing as this is a cultural belief that should be respected. Culturally specific decisions should be respected and incorporated into the plan of care.

A boy tells you that his family celebrates the Fourth of July by eating out at a local restaurant. He tells you this is a better way to celebrate the holiday than having a picnic like his neighbors. This statement is an example of:

ethnocentrism. Ethnocentrism is a belief that one's own culture or customs are superior to those of others.

The nurse is assessing the risk potential for infection for children on a pediatric unit, based on their developmental level. Which group does the nurse determine is at the highest risk for respiratory infections?

infants The physiologic immaturity of an infant's body systems increases the risk for infection. Ingestion of toxic substances and risk of poisoning are major health concerns for toddlers as they become more mobile and inquisitive. Because preschool- and school-age children are, generally, very active, they are more prone to injury and accidents.

A parent asks why spanking works so well to stop her toddler's behavior. The nurse explains it is the:

suddenness and shock value of the act. The surprise and shock interrupt the behavior quickly. With repeated use these effects diminish; then the intensity must increase. The American Academy of Pediatrics recommends against spanking due to its many negative effects and lack of effectiveness over other methods. When punishing, the parent should remain calm. Anger may result in injury. Anxiety is one of the negative effects of spanking. The attention is negative; however, a child without appropriate attention may settle for the negative.