Unit 1- Family-Centered Care, Stress, Coping

Information in a consent form should be __________, _____________, and _____________.

Simple, Concise, and appropriate to the level of education and language of the decision maker.

Authoritarian

Style of parenting where parents expect obedience from the child and discourages the child from questioning the family rules. High Control. Strict Rules.

A child with a new prosthetic limb needs extensive care to learn how to use the prosthesis. Which unit or facility is best equipped to provide this care? 1. Pediatric intensive care unit 2. Isolation unit 3. Rehabilitation unit 4. Inpatient stay unit

3. Rehabilitation unit Rationale:The care in a rehabilitation unit involves an interdisciplinary approach that assists the child to reach his or her potential and achieve developmental skills. General inpatient unit stays for children are shorter and involve more acute conditions. The pediatric intensive care unit (PICU) specializes in caring for children in crisis. Isolation rooms are used for situations involving the risk for infection.

The nurse is providing home care for a 4-year-old client with a chronic respiratory illness. What would be a case management activity? 1. Teaching the grandparent how to do chest physiotherapy 2. Establishing eligibility for a Medicaid waiver 3. Scheduling intravenous and respiratory therapy services needed by the child 4. Assessing the cleanliness of the home

3. Scheduling intravenous and respiratory therapy services needed by the child Rationale:Coordinating healthcare services such as IV and respiratory therapy is one of the case manager's functions. Helping a family member learn to perform a procedure belongs to the teaching role. Checking cleanliness of the home is part of assessing resources during discharge planning. Establishing eligibility for a Medicaid waiver is advocacy and resource management.

What is the key nursing role when managing the health care of a child living with a foster family? 1. Determining if the child has mental health needs 2. Identifying any developmental delays 3. Advocating for the child and the services needed 4. Securing proper educational placement

3. Advocating for the child and the services needed Rationale: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 healthcare 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.

Veracity

Truthfulness

What are some concerns for toddlers when they are ill and hospitalized?

Disruption in their autonomy and experiencing separation/stranger anxiety.

Uninvolved, rejecting, neglecting parenting style

Indifferent without rules or standards

What is a child life specialist?

Individual specially trained in the developmental impact of illness, injury, and trauma who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful or distressing.

Authoritative

A type of parenting that is democratic and who shows respect for the child's opinion.

When obtaining consent from a patient, how must this decision be made?

Voluntarily, without coercion, force, or influence of duress.

What are school- aged children concerned with when ill and/or hospitalized?

Disability, death, fear injury and pain, and are uncomfortable with sexual exams

Acquiring knowledge and internalizing values

Enculturation

Type of discipline that focuses on reducing or eliminating the positive reinforcement for inappropriate behavior- ie. ignoring temper tantrums, with holding or removing privileges, time outs.

Extinction

Fidelity

Keeping promises and maintaining confidentiality and privacy

How can we provide atraumatic therapeutic care for our pediatric patients?

Minimize physical and psychological stress for the children and their parents.

What is Assent?

The child's willingness to participate in the decision-making process

An 8-year-old child seeks out the school nurse crying because the child recently learned the parents are getting a divorce. What is the most important idea the nurse will help the child grasp? The child will feel better after some adjustment time. The child's situation is not unusual. The divorce is not the child's fault. Feeling scared and sad is okay.

The divorce is not the child's fault. Rationale:Children often believe they have caused a divorce or could have prevented it. They need to be told repeatedly that this is not the case. Knowing one's situation is not unique (50% of marriages fail) and that time aids adjustment is true but not supportive at this time. Knowing feelings of fear and sadness are accepted allows the child to freely express them, which is important to the child's mental health. However, preventing feelings of guilt needs initial attention.

What are 6 risk factors for vulnerable child syndrome?

1. Preterm Birth 2. Congenital Anomaly 3. Newborn Jaundice 4. Handicapping condition 5. An accident or illness that the child was not expected to recover from 6. Crying or feeding problems in the last 5 years of life

The nurse is caring for a preschooler who requires postsurgical breathing exercises. Which approach will best elicit the child's cooperation? 1. "Let's see who can blow these cotton balls off the table first." 2. "You will need to cooperate. Otherwise, you might not feel better." 3. "Do you want to play a breathing exercise game with me?" 4. "You need to do the breathing or you could get pneumonia."

1. "Let's see who can blow these cotton balls off the table first." Rationale:Any intervention should be developmentally appropriate, and play can often serve as a vehicle for care. Turning breathing exercises into a game is likely to engage the preschooler. Telling the child he needs to do breathing exercises or he will develop another illness or not feel better is not likely to impress the young child. Connecting the two events in a meaningful way is beyond his cognitive ability. Asking if the child "wants" to play a breathing game is an open invitation for a "No" answer.

What are the responsibilities of a nurse regarding obtaining informed consent?

1. Determine that the parents/guardians understand what they are signing. 2. Obtain signatures. 3. Serve as witness 4. Ask questions to assess the parent's knowledge of the consent 5. Clarify and resolve knowledge deficit. 6. Must determine if they are of legal age, info provided must be understandable, be given voluntarily, must be witnessed

A parent in the outpatient setting is explaining how plans to prepare the 5-year-old child for hospital admission. What remark indicates the parent requires additional teaching? 1. "We watched a program for kids on public television about being in the hospital." 2. "We told our child to use manners and behave like a big, brave child." 3. "We have a date to visit pediatrics and tour their department." 4. "We found several books for our child at the library that talk about being in the hospital."

2. "We told our child to use manners and behave like a big, brave child." Rationale:Expecting manners and big, brave behavior is unrealistic. The child's coping skills are not yet well developed. Expressing true feelings should be allowed. The other preparations are helpful and promote understanding of the experience.

How much ahead of time should nurses recommend that a school-ager be prepared for elective surgery? 1. 1 hour 2. A few days 3. Immediately before 4. 1 week

2. A few days Rationale:Most school-agers will do well being prepared a few days ahead of the event. One week is suggested for adolescents. One hour ahead for preschoolers and immediately prior for toddlers is appropriate. Much preparation is done in the out-of-hospital setting and by parents taught about the experience and how to prepare their child based on the child's age.

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? 1. Culturally competent care 2. Continuity of care 3. Family-centered care 4. Advocacy care

2. Continuity of care Rationale: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 child is receiving an extension of the care received in the hospital to the home.

An adolescent remarks rather sarcastically about feeling like a "lab rat." What is the priority nursing action? 1. Arrange for additional bedside activities of the adolescent's choice. 2. Ensure information is shared with and decisions about care are made with and not for the adolescent. 3. Provide more physical privacy for this adolescent. 4. Enable the adolescent to stay in contact with peers electronically.

2. Ensure information is shared with and decisions about care are made with and not for the adolescent. Rationale:Sharing information openly and honestly plus including the adolescent in all decision making is the priority action. Parents or staff should not be seen as in complete charge. More privacy, connection with peers, and additional diversional activity all support the teen developmentally and need to be part of the care.

The nurse is talking with the parent of a 2-year-old child during a scheduled visit. Which teaching subject best supports the emphasis on preventive care? 1. Reminding the parent that the child will imitate him or her 2. Showing the parent how to teach hand washing to the child 3. Discussing with the parent anticipated developmental milestones 4. Describing physical changes taking place in the child

2. Showing the parent how to teach hand washing to the child Rationale:Teaching hand washing helps to prevent infection, emphasizes preventive care, and is basic to avoiding many common illnesses. Reminding the parent that the child will imitate her may promote safe parental role-modeling but does not reach the level of prevention that hand washing does. Knowing about developmental milestones and typical physical changes in toddlers does not directly promote preventive care.

Nurses can help to decrease the United States' mortality rate by advocating for improved access to health care for which ethnic groups in particular? (Select all that apply.) 1. Asian Americans 2. Puerto Ricans 3. Native Americans and Native Alaskans 4. African Americans 5. Mexican Americans

3. Native Americans and Native Alaskans 4. African Americans Rationale:African Americans, American Indians and Native Alaskans have consistently had higher infant mortality rates than other groups.

The public health nurse is aware suicide in teens is a significant health issue. Which child is most at risk? 1. The 15-year-old Black girl who did not make the cheerleading squad 2. The overweight 16-year-old White girl 3. The 17-year-old Native American/First Nations boy 4. The 11-year-old Asian American boy who is smaller than his peers

3. The 17-year-old Native American/First Nations boy Rationale:Native American/First Nations people have the highest rate of suicide while Hispanic American 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, 2017).

A parent rooming-in with the 10-month-old infant appears upset following the visit of a consulting healthcare provider. The parent has questions but states, "The healthcare provider is always so busy." The nurse will: 1. encourage the parent to remain at the infant's bedside so as not to miss any future consultant visits. 2. explain to the parent the limits on the consultant's time. 3. assist the parent in preparing a list of questions for the healthcare provider's next visit. 4. ask the parent for her questions so that the nurse can relay them to the medical team.

3. assist the parent in preparing a list of questions for the healthcare provider's next visit. Rationale:Empowering parents so that they can be active partners in their child's care is part of family-centered care. Helping the parent state and write the questions will provide information to which the nurse can respond plus help the parent interact more effectively with the consultant and other healthcare team members. Relaying the parent's questions may be helpful on limited occasions but places the nurse between the parent and healthcare provider relaying information in a "third party" manner. Keeping the parent at the bedside watching and waiting causes unnecessary watchfulness and stress. Supporting the "busyness" of the consultant burdens the parent further.

The nurse is caring for a technology-dependent school-age child in his home. Which action best builds a trusting relationship? 1. Encouraging the parents to join a support group 2. Changing the date and time of the child's physical therapy to fit the family schedule 3. Talking with the brother of the child who feels ignored 4 Discussing care and treatment with the parent and child together

4 Discussing care and treatment with the parent and child together Rationale:To build a trusting relationship with the family, the nurse must remember the child is both the client and a family member. He needs to be included in all discussions. Encouraging parents to join a support group and talking with the sibling of the ill child who feels ignored are important and supportive activities. Changing the date and time of a therapy session to fit the family schedule is a case management activity. These are important elements of family-centered home care, but are not meant specifically to build trust.

When this age group is ill or hospitalized they are concerned with body image and ambivalent about having parents near, worried about separation from friends, and concerned about their loss of control.

Adolescents

Permissive

Laissez-faire parents that have little control over the behavior of their children and rules or standards that may be inconsistent, unclear, or nonexistent.

When hospitalized, this age group may understand that they are sick but maybe not the cause. They also fear invasive procedures and don't understand body integrity.

Preschoolers

The nurse suspects poor literacy skills in a child's family member when which statement is made? 1. "I forgot my glasses, so I'll read this when I get home and let you know if I have questions." 2. "We communicate with the special education teachers and school daily with a notebook." 3. "The child gets a suppository every 3 days to prevent constipation." 4. "I need you to review once more the best way to be sure the child swallowed all the medicine."

1. "I forgot my glasses, so I'll read this when I get home and let you know if I have questions." Rationale:Identifying poor literacy or health literacy skills can be difficult. Many will work to hide this lack. "Forgetting" one's glasses could provide an excuse for not reading or questioning and should raise concerns about literacy. If other indicators such as a history of medication errors, English as a second language, an elderly caretaker (grandparent), or numerous missed appointments are present, the index of suspicion is higher. Needing a review, knowing how the suppository was used, and notebook communication with the school would ordinarily not raise a literacy or health literacy concern, although they do not rule it out.

The telephone triage nurse answers the call from a stay-at-home parent of an infant; the parent is unable to describe clearly the signs and symptoms the child displays but keeps saying, "My child doesn't act like oneself," and "Things with my child are just not right." The best response by the nurse is: 1. "Please bring the child to the clinic to be seen. You seem concerned." 2. "Is there another caretaker available that I can talk with?" 3. "Please call again in 2 hours and describe your child's symptoms then." 4. "Try very hard to answer my questions. I will repeat them."

1. "Please bring the child to the clinic to be seen. You seem concerned." Rationale:Telephone triage is useful in responding to many concerns and helping parents provide appropriate care. It is not meant to function as a gatekeeper discouraging parents from having a child seen. If a parent is very concerned, the nurse needs to listen and the child should be examined. The other responses do not accomplish this. With the vagueness of the parent, asking if someone else was present to describe the symptoms was reasonable, just not the best answer.

A newly hired nurse is receiving education about the role of the facility's ethics committee during the orientation period. Which statements indicate an understanding of the role of this group? (Select all that apply.) 1. "The role of the ethics committee has increased over the years." 2. "Decisions of the ethics committee are protected by law." 3. "This group will review each case presented and formulate a decision for the facility." 4. "The ethics committee is made up of healthcare providers and hospital administrators." 5. "Education concerning ethics is a role of the committee."

1. "The role of the ethics committee has increased over the years." 3. "This group will review each case presented and formulate a decision for the facility." 5. "Education concerning ethics is a role of the committee." Rationale:Ethics committees are formulated to assist a facility in making ethical decisions. These committees not only provide case-by-case review and resolution of ethical dilemmas but also review existing institutional policies and provide education to staff, healthcare providers, children, and families on ethical issues. As technology has advanced, ethical dilemmas have increased and made the role of the committees more important over time.

Resilient children are able to cope effectively with stressors. What external factors can nurses promote to foster this resiliency? (Select all that apply.) 1. A caring relationship with an adult 2. Ability to accept one's limits 3. Enjoying school and learning 4. Feeling part of a team 5. Good grooming behaviors

1. A caring relationship with an adult 3. Enjoying school and learning 4. Feeling part of a team Rationale:Caring relationships with parents and/or other important adults, feeling part of a group (having a purpose), and a positive school experience all are factors outside the child that promote resiliency. Though good grooming promotes social acceptance, this is not one of the resiliency-promoting factors. The ability to accept one's limits and abilities is an internal factor that promotes resiliency.

The nurse is caring for a 9-year-old child on an inpatient pediatric unit that is admitted for an extended stay. The child continually refuses meals. What can the nurse do to help increase the child's intake? (Select all that apply.) 1. Ask the dietitian to visit the child to help determine foods the child prefers. 2. Encourage the child to eat several small meals instead of fewer larger meals. 3. Tell the child that their play time will be shortened if they don't eat. 4. If approved by the healthcare provider, allow the parents to bring food from home for the child. 5. Assist the child to choose from the facility menu foods they like.

1. Ask the dietitian to visit the child to help determine foods the child prefers. 2. Encourage the child to eat several small meals instead of fewer larger meals. 4. If approved by the healthcare provider, allow the parents to bring food from home for the child. 5. Assist the child to choose from the facility menu foods they like. Rationale:Ensuring the child receives food preferences and rewarding the child with praise can help in increasing the intake when hospitalized. Children should never be forced or punished for not eating as this can cause an aversion for food that carries beyond the hospital stay into the home environment.

The nurse is providing care to a 6-year-old child following surgery. The nurse asks the child to rate the pain using the Faces of Pain scale. Which phase of the nursing process is the nurse demonstrating? 1. Assessment 2. Nursing diagnosis 3. Evaluation 4. Implementation

1. Assessment Rationale:By using the pain scale the nurse is assessing the child's level of pain. A nursing diagnosis is not demonstrated in this scenario. Implementation in this scenario would involve pain control interventions, and evaluation would be determining if pain control had been achieved.

6 Special Considerations Related to Informed consent

1. Child not living with parent 2. Mature or emancipated minors 3. Parental consent after divorce 4. Consent for organ donation 5. Consent for medical experimentation 6. Psychiatric and reproductive health services (may be a different age of consent than for other health care services)

A family is anxious for information about the status of their ill infant. The parents do not understand English, but the 14-year-old child is competent in spoken and written English. The healthcare provider is present, but an interpreter is unavailable. The nurse should: 1. Coordinate the healthcare provider and interpreter schedules and arrange an information-sharing session for later in the day. 2. Develop a written account of the infant's status with the healthcare provider that the child can read and explain to the parents. 3. Support the 14-year-old while the child interprets for the parents and the healthcare provider at the bedside. 4. Have the adolescent and healthcare provider discuss the information thoroughly and help the adolescent share this data with the parents.

1. Coordinate the healthcare provider and interpreter schedules and arrange an information-sharing session for later in the day. Rationale:An interpreter is essential. Explanations need to be given and questions relayed and answered. The interpreter needs understanding of the healthcare environment, not just the language. The parents are anxious for information and "not knowing" is difficult. However, children in the family should not be used as interpreters. This may upset family dynamics giving a great deal of power to a child.

During a well child care visit, the parent of a 4-year-old child reports the son is extremely active at home and cries easily if frustrated. This is consistent with which level of the Classic Temperament Theory? 1. Difficult temperament 2. Slow to warm up temperament 3. Complex temperament 4. Flexible temperament

1. Difficult temperament Rationale:The Classic Temperament Theory proposes nine parameters of temperament: activity level, rhythmicity, approach and withdrawal, adaptability, threshold of responsiveness, intensity of reaction, quality of mood, distractibility, and attention span and persistence. This theory seeks to identify behavioral characteristics that lead the child to respond to the world in specific ways. Using the nine parameters, children''s temperaments may be categorized into three major groups: easy, difficult, and slow to warm up. Difficult children are irritable, highly active, and intense; they react to new experiences by withdrawing and are frustrated easily. Flexible and complex are not categories of temperament. A slow to warm up child would display moodiness and less activity.

A homeless single mother and her 6-year-old child present to the emergency room with vomiting and diarrhea. Nurses provide illness care. Shelter is found. An additional priority goal is: 1. Enroll the child in school. 2. Assess for behavior problems in the child. 3. Determine if there are other family members. 4. Check for signs of drug abuse in the mother.

1. Enroll the child in school. Rationale:Education is part of the key to breaking the poverty/homeless cycle. School will also provide some stability for the child plus socialization with peers and meals. Behavior problems are common in homeless children related to their lack of security. Drug use could be part of the mother's lifestyle and a contributing factor to homelessness. Numbers of homeless families are increasing. The typical homeless family is a single mother with one or two children younger than 6 years.

The 5-year-old in the emergency room is having glass removed from a wound. Which action constitutes ethical behavior by the nurse? 1. Holding the child's hand in order to facilitate removal of the glass 2. Discussing with the healthcare provider the merits of sutures versus staples for wound closure 3. Telling the child, Stop screaming! You are scaring the other kids here! 4. Asking the parent to leave the emergency room cubicle due to crowding

1. Holding the child's hand in order to facilitate removal of the glass Rationale:Restraining the child only as much as is needed in order to provide needed care is practicing ethically while being sensitive to the sanctity and quality of human life. It is practicing nonmaleficence means avoiding causing harm, intentionally or unintentionally. Removing the parent is not just. The child needs the support. Discussing sutures and staples while the child listens harms through fear. Developmentally, the child will misinterpret and not understand. Telling the child not to scream and promoting guilt ("scare others") does not benefit the child. At 5 years of age, he does not have emotional control when hurt. Promoting guilt is inappropriate for the developmental stage (initiative vs. guilt).

During a parenting class the nurse gives examples of extinction as a form of discipline. What would be an example of this technique? 1. Ignoring a temper tantrum 2. Praising desired behavior 3. Using verbal reprimand 4. Spanking a toddler

1. Ignoring a temper tantrum Rationale:The goal of extinction is to reduce parental attention (reinforcement). Ignoring a temper tantrum does that. Loss of privileges and time-out also are extinction techniques. Praising is positive reinforcement. Spanking is corporal punishment, while verbal reprimand is verbal punishment.

The nurse is caring for a 2-year-old child who needs a lumbar puncture. His parent is present. What would prevent informed consent from being obtained? 1. Learning the parent present is not the custodial parent 2. Determining the parent cannot read the form 3. Finding out the parent is younger than 18 years of age 4. Establishing the parent was never married

1. Learning the parent present is not the custodial parent Rationale:It would not be legal for this parent to give consent. A parent younger than 18 years of age or never married may not be a problem in most states because she would be considered autonomous. The healthcare provider or nurse could read the consent form to a parent who cannot read plus carefully explain the medical information in terms she understood.

Over coffee, parents ask the 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.) 1. Maintain consistency in expectations at all ages. 2. Show parental anger when administering consequences of poor behavior. 3. Use parental attention as positive reinforcement for desired behaviors. 4. Role model appropriate behavior in word and deed. 5. Delay applying consequences to allow time to choose appropriate action.

1. Maintain consistency in expectations at all ages. 3. Use parental attention as positive reinforcement for desired behaviors. 4. Role model appropriate behavior in word and deed. Rationale: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.

The nurse is assessing a 9-year-old child with pneumonia. Which finding is a factor for this child's morbidity? 1. Medical records reveal a history of asthma 2. Child is active in a Boy Scout troop 3. Child's white blood cell (WBC) count is within normal limits 4. Child's height and weight plot at the 50th percentile on the growth chart

1. Medical records reveal a history of asthma Rationale:Asthma is a morbidity factor for additional childhood illness, particularly respiratory illness. The child's height and weight are appropriate and not associated with increased risk. The normal WBC count may help to determine if the pneumonia is bacterial or viral. Being in a Boy Scout troop may increase the risk of exposure, but would not be as closely associated with morbidity as is asthma.

The 10-year-old client hospitalized for bladder surgery will be most stressed when nurses provide what care? 1. Perineal and indwelling catheter care 2. Abdominal dressing change 3. Change of the hospital gown 4. Auscultation of breath and bowel sounds

1. Perineal and indwelling catheter care Rationale:School-agers are often quite uncomfortable with any type of sexually related examination or care. Modesty is well developed and privacy important. The nurse should handle perineal and catheter care in a sensitive manner. Teaching the parent to provide this care is helpful. The abdominal dressing change may cause the school-ager some concern but can be done discreetly, as can listening to breath and bowel sounds and changing the hospital gown.`

A 5-year-old child is obviously relieved yet angry following a procedure he resisted and needed to be restrained to complete. Which nursing action may be most helpful to this kindergartener? 1. Providing Play-Doh for him to manipulate 2. Discussing the reasons for the procedure with the child and parents 3. Finding an age-appropriate action DVD for the child to view 4. Getting paper and markers so that the child can draw and color

1. Providing Play-Doh for him to manipulate Rationale:All actions have some merit. The Play-Doh choice is the best means for the child to pound, smash, and otherwise vent feelings in a safe, age-appropriate way. Drawing also is a means to express feelings but is less active. The action DVD may provide venting opportunity through the behaviors of the hero (indirect expression). Discussion is the least helpful immediately, but can be useful later.

The nurse is teaching the parents of a newborn with a metabolic problem about the disorder and its treatment. What is the least effective teaching technique? 1. Providing a print handout for the parent to read and asking for questions 2. Explaining the disorder in common terms 3. Using the food pyramid diagram to teach necessary nutrition alterations 4. Discussing how to handle a possible emergency situation

1. Providing a print handout for the parent to read and asking for questions Rationale:The parents may not understand the print handout based on their reading level or ability, their understanding of terms, or their own overall literacy. They may not ask questions for all of the former reasons or to avoid appearing "dumb." The other techniques should provide support by using "lay" words, exchanging ideas (discussion) regarding managing an emergency, and using a common visual symbol (food pyramid) to teach about nutrition.

The nurse is reviewing documentation on a client's chart. The healthcare provider has referred to parens patriae. When considering this notation, what should be included in the client's plan of care? 1. Recognize the child's care has been ordered by the state. 2. Refer all questions concerning permission and consents for treatment to the child's parent. 3. Allow the client who is emancipated to sign for his own treatment. 4. Refer inquiries about the client's plan of treatment to the facility's ethics committee for review.

1. Recognize the child's care has been ordered by the state. Rationale:Generally the parents of a minor child have the right to make care decisions. In the event the parents have decided on a course of nontreatment, the state may intervene and overrule the parents. In this case an order for treatment to continue can be made by the courts. This is referred to as parens patriae (the state has a right and a duty to protect children).

Parents are concerned because their 18-month-old will eat only when they feed him. They report he was independent with feeding at home but is unwilling in the hospital. The nurse considers this behavior: 1. Regression 2. Ritualism 3. Negativism 4. Egocentrism

1. Regression Rationale:This is regression caused by the stress of hospitalization. The child feels threatened and moves back to a more secure stage of development. Egocentrism is a thought pattern of toddlers not expressed in this manner. Negativism is a control mechanism and uses the power of "no" to assert autonomy. Instead, this toddler is exhibiting increased dependency. Ritualism is reassuring to toddlers, creating sameness and predictability. Ritualism is not being expressed here.

Development should continue during hospitalization. What play activities will the nurse choose for toddlers to accomplish this? (Select all that apply.) 1. Stacking blocks 2. Pulling a toy train 3. Batting balloons 4. Putting together a large-piece puzzle 5. Watching a mobile

1. Stacking blocks 2. Pulling a toy train 4. Putting together a large-piece puzzle Rationale:Pulling a toy train encourages movement and the development of gross motor skills important to the toddler. Stacking blocks and putting together a puzzle uses fine motor skills and an understanding of shapes and space and are stimulating cognitively. Watching a mobile is appropriate for infants and may be unsafe if the toddler could reach it. Balloons are inappropriate in the hospital setting (latex sensitivity) and are an aspiration risk. Mylar balloons may be considered safe, although attached long strings or ribbons are not.

The nurse is assessing the learning needs for a 12-year-old child with a chronic health condition and the parents. Which aspect would be least pertinent to a learning needs assessment? 1. The family belongs to a mainline traditional faith community 2. Finding that the parent relies on American Sign Language 3. Concluding that the parents are emotionally distraught 4. Discovering that the parent is highly healthcare literate

1. The family belongs to a mainline traditional faith community Rationale:Membership in this traditional faith community impacts learning needs the least. There are no particular values or traditions that would require modification of the care plan for a child with this health problem. Parents experiencing a highly charged emotional state create a learning barrier for them. A very health care--literate person would require less repetition and simplification of the explanations given. A deaf parent may require an interpreter if the nurse does not know American Sign Language.

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? 1. This nurse has not met the standard of care that constitutes adequate nursing practice identified in Pediatric Nursing: Scope of Standards and Practice. 2. Nurses make clinical decisions---this action is acceptable. 3. Sexuality education is a function of the schools---the nurse need not assume the function. 4. The intervention on the nursing care plan came from the family, not the nurse---the nurse may omit it.

1. This nurse has not met the standard of care that constitutes adequate nursing practice identified in Pediatric Nursing: Scope of Standards and Practice. Rationale: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 a wise choice. Sexuality education falls to the school, family, and nurse.

The nurse is caring for a child who has a gastrostomy tube (G-tube) used for feeding. When planning interventions, the nurse best demonstrates the use of evidenced-based practice when performing which intervention? 1. Using litmus paper to determine the pH of the stomach contents when checking placement of the G-tube 2. Following the orders of the primary care provider by administering the G-tube feedings 4 times a day 3. Asking the child and parents how they are feeling about the G-tube being used for feeding purposes 4. Explaining the steps of feeding to the child and parent during the procedure

1. Using litmus paper to determine the pH of the stomach contents when checking placement of the G-tube Rationale:Evidenced-based practice guides care by using scientific evidence of proper care. While all of the interventions are correct in this scenario, the nurse checking the pH of the stomach contents best demonstrates evidenced-based practice.

When caring for hospitalized teens, nurses should choose their words and actions carefully since adolescents typically are concerned about: 1. appearing out of control of the situation and/or themselves. 2. mutilation of their body. 3. separation from peers and family. 4. mobility restrictions.

1. appearing out of control of the situation and/or themselves. Rationale:Adolescents are concerned about how others view them. They wish not to do or say "dumb" things or appear babyish. This concern may cause them to worry about postanesthesia behavior or about how they might react to a procedure. Independence is desired yet a concern. Mobility restrictions, mutilation, and separation are more common fears and anxieties in preschoolers and school-age children.

First-time parents are discussing temperament with the nurse. They describe their child as easily frustrated by his toys and withdrawing from anything new. Overall, he is quite physically active and can become irritated easily. The nurse believes this child could be categorized as: 1. difficult. 2. intolerant. 3. easy. 4. slow to warm up.

1. difficult. Rationale:The parents described the difficult child. The easy child is even-tempered, predictable, and positive. The slow-to-warm-up child can be moody and moderately active and may need time to adjust to something new while doing so with mild resistance. Intolerant is not a category of temperament.

The parent of a 15-month-old child mentions to the nurse how much can be accomplished at home while the child watches videos and TV programs. The nurse's response is based on knowledge that: 1. screen time prior to 18 months of age is not recommended. 2. programming without commercials should be chosen. 3. many good children's programs are available, especially on public broadcasting. 4. children's TV/video time should be limited to 2 hours or less daily.

1. screen time prior to 18 months of age is not recommended. Rationale:The American Academy of Pediatrics recommends no screen media prior to 18 months of age. Public broadcasting does offer age-appropriate and educational content that is commercial-free. Commercials easily influence children since their thinking skills are not mature. The 2-hour screen time limit is for older children.

A parent asks why spanking works so well to stop her toddler's behavior. The nurse explains it is the: 1. suddenness and shock value of the act. 2. attention the child receives. 3. anger of the parent. 4. anxiety created in the child.

1. suddenness and shock value of the act. Rationale: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.

A new staff member asks veteran nurses about the meaning of atraumatic care for children. These nurses explain that the concept is based on: 1. the underlying premise of "do no harm." 2. peers being helped to develop empathy for the child. 3. units staffed to provide one nurse for each child. 4. the child's need to experience no trauma.

1. the underlying premise of "do no harm." Rationale:Atraumatic care can also be called therapeutic care for children that minimizes the child's and family's physical and psychological distress when cared for within the healthcare system. It is based on the underlying premise of "do no harm." All trauma to children cannot be avoided, but it should be limited to the greatest degree possible. Assigning of one nurse to one child is not practically or economically feasible. Nurses should be assigned to the same child and family as consistently as possible, however. Helping the youngster's peers develop empathy for the child is supportive but not the basic idea that underlies atraumatic care.

The nurse is providing teaching for the parents of an 8-year-old client who has undergone surgery. The nurse emphasizes the importance of maintaining adequate hydration. Which response by the parent would indicate a need for further teaching? 1."I should offer my child small amounts of fluid frequently." 2. "I will remind my child that about needing an IV if my child does not drink." 3. "Ice chips count as fluid intake. One cup of ice equals a half-cup of water." 4. "Anything that melts at body temperature is counted as a fluid."

2. "I will remind my child that about needing an IV if my child does not drink." Rationale:The child is likely to view an IV both as frightening and as punishment. Intravenous fluids should be seen as therapy. Threats such as this should not be used to achieve compliance with eating or drinking. The other statements show understanding.

The nurse is explaining a diagnostic procedure to a 7-year-old child before the procedure begins. Which statement by the nurse best utilizes the principles of atraumatic care? 1. "I don't think you will be in the X-ray department very long." 2. "You will lie on a special bed that moves in the machine but you can still see out." 3. "The big machine will look inside you to see why you are sick so just hold still." 4. "The technician needs to take several tubes of blood from you."

2. "You will lie on a special bed that moves in the machine but you can still see out." Rationale:Introducing strange equipment to the child in words appropriate for this age that the child will understand is atraumatic care. Telling the child the technician is going to take several tubes of blood can be scary as the child may not understand the word technician and the child may worry that all of one's blood is being taken. Telling the child that a big machine will look inside the body may scare the child into thinking that the machine might cut the child open to look inside. Not giving the child an exact time when the procedure will end is not utilizing the principles of atraumatic care. The child should be told something like after lunchtime or until dinner time.

The nurse in a free clinic is caring for a 1-year-old child and single parent. Which nursing intervention would most likely be needed initially? 1. Discussing family beliefs 2. Assessing the child's nutritional status 3. Providing a list of low-cost child care centers 4. Obtaining food assistance for the family

2. Assessing the child's nutritional status Rationale:A single parent using a free clinic probably means that the child and parent are living on an income at or below poverty levels. The child could be malnourished; therefore, the nurse should complete a nutritional assessment as the priority intervention. This would affect all aspects of the child's growth and development. Obtaining food assistance may be a partial solution to a nutritional problem if this is confirmed following assessment. Family beliefs are important but not the first concern. Good child care promotes healthy growth and development. This can be addressed later.

The nurse is assessing a 9-year-old child during a back-to-school check-up. Which findings are factors for childhood injury? (Select all that apply.) 1. Having been adopted from a foreign country 2. Being a typical school-aged child 3. Lack of after-school supervision by an adult 4. Having a BMI in the 90th percentile 5. Low socioeconomic status of family

2. Being a typical school-aged child 3. Lack of after-school supervision by an adult 5. Low socioeconomic status of family Rationale:School-aged children are prone to injury due to their high activity level and immature ability to analyze risks. A common time for school-aged children to experience injury is during the unsupervised time between school and parents' arrival from work. Low economic status correlates directly with childhood injury (poor living conditions, family disorganization). Foreign adoption is not related to childhood injury but is related to health problems that could have been avoided through proper prenatal or child health care. Although a BMI in the 90th percentile is overweight, there is no known association to injury.

An adolescent would benefit from being out of his hospital room. What can the nurse do to promote this? (Select all that apply.) 1. Encourage the teen to investigate the playroom. 2. Challenge the adolescent to a video game in the recreation area. 3. Suggest the adolescent visit other areas within the hospital that are away from the pediatric unit. 4. Include the adolescent in a hospital tour for incoming clients. 5. Invite the adolescent to meet with other teens for lunch in a common space.

2. Challenge the adolescent to a video game in the recreation area. 4. Include the adolescent in a hospital tour for incoming clients. 5. Invite the adolescent to meet with other teens for lunch in a common space. Rationale:A video game in the "recreation area" is more appealing than investigating the "playroom." If only one activity space is available, avoid calling it the playroom to school-agers and teens. Arranging for teens to spend time together and socialize over lunch may stimulate appetites and new supportive friendships. Suggesting the adolescent leave the unit may not be safe based on his knowledge of the hospital or his condition. Doing so accompanied would be appropriate. If physically able, the adolescent will benefit from the social activity of being on the hospital tour; the staff member giving the tour will be able to keep an eye on participants.

A nurse is providing care to a child on an oncology unit. The nurse is both administering chemotherapy to the child and teaching the parents about the actions, side effects, and complications of the drug. These actions best describe which nursing role? 1. Pediatric nurse practitioner 2. Clinical nurse specialist 3. Clinical coordinator 4. Case manager

2. Clinical nurse specialist Rationale:The clinical nurse specialist has a master's degree and provides expertise as an educator, clinician, or researcher, meeting the needs of staff, children, and families as demonstrated in this scenario by both administering and providing information regarding the chemotherapy. The clinical coordinator typically holds a baccalaureate degree and fills a leadership role in a variety of settings. The case manager, also usually a baccalaureate-prepared nurse, is responsible for integrating care from before admission to after discharge. The pediatric nurse practitioner provides health maintenance care for children (such as well-child examinations and developmental screenings) and diagnoses and treats common childhood illnesses. He or she manages children's health in primary, acute, or intensive care settings or provides long-term management of the child with a chronic illness.

The nurse is caring for a 7-year-old child and family, who are immigrants. Which intervention will most significantly affect the success of the care provided? 1. Referring them to state and local aid programs 2. Communicating with sensitivity using understandable terms 3. Asking about transportation to the appointment 4. Inquiring about common health problems in their home country

2. Communicating with sensitivity using understandable terms Rationale: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 nurse is caring for a 5-year-old Hispanic child and family. Which actions demonstrate cultural competence? (Select all that apply.) 1. Directing questions about care to the father 2. Coordinating care through the mother 3. Promoting the use of medical intervention over prayer 4. Asking about folk remedies used 5. Checking the child's weight regularly

2. Coordinating care through the mother 4. Asking about folk remedies used 5. Checking the child's weight regularly Rationale:The mother in Hispanic families makes decisions about health. Therefore, care should be coordinated through her. Asking about folk remedies used is appropriate since these are common in the culture. Some may have no effect or even be helpful and can be incorporated in the overall treatment plan. Others may be harmful. All children should have their weight checked regularly; specific attention should be given to Hispanic children because obesity rates in the population are rising. Directing care questions to the father and minimizing the importance of prayer do not fit well with the cultural norms and values.

The nurse is teaching home care to the parents of a 4-year-old child with asthma. Which information would be least important to the family's immediate needs? 1. Demonstrating how to administer medication with a nebulizer 2. Determining if the child should enroll in a preschool 3. Having emergency instructions and phone numbers 4. Explaining what kinds of things can trigger an attack

2. Determining if the child should enroll in a preschool Rationale:Enrolling in preschool is presently of least priority. Should the child enroll, the nurse can assist in meeting the asthma education needs of the preschool staff through counseling the parent and providing access to sound asthma education materials. The important immediate information for the family is knowing how and when to properly use the nebulizer, knowing about and avoiding triggers, and being well prepared to deal with a possible emergency.

The school nurse is caring for several children who witnessed an accident in which an 8-year-old child was struck by a car on the way to school. Which is the first step in developing the nursing care plan for these children? 1. Arranging for counseling for the children who saw the accident 2. Determining whether the children were traumatized by the accident 3. Arranging for friends of the injured child to receive counseling 4. Seeking permission from parents of children needing counseling for them to participate

2. Determining whether the children were traumatized by the accident. When prioritizing care for children who witnessed a traumatic incident, the nurse must remember that assessment is the first step in the nursing process. Determining whether the children were traumatized by the accident requires assessing the children and their responses. This is the first step in the nursing process and basic to establishing a nursing diagnosis. Arranging for counseling of children and friends of the injured may later become part of the plan if the need is demonstrated. Gaining permission from the parents for counseling would also be a later step.

The nurse is caring for a 7-year-old child 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? 1. Locating the best price on a high-frequency chest compression vest 2. Helping parents access the area's multidisciplinary cystic fibrosis clinic 3. Teaching the parents how to perform chest physiotherapy 4. Assisting the parents in getting the child on a lung transplant list

2. Helping parents access the area's multidisciplinary cystic fibrosis clinic. Rationale: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. Chest physiotherapy will be a known skill since it is nearly certain the child has been diagnosed with this genetic disease for a number of years. Lung transplant may be a future treatment option but is probably not under present consideration. Helping save money on a treatment device is considerate but not the most effective advocacy method.

The school nurse is caring for an 8-year-old client with asthma. What is most likely to be part of the child's individualized health plan? 1. Making a monthly report of the child's asthma episodes to the healthcare provider 2. Helping the child modify physical activity requirements 3. Giving the child the prescribed asthma medications 4. Storing the child's asthma inhaler in the health office

2. Helping the child modify physical activity requirements Rationale:Assisting the child in modifying the physical activity required is most likely to be part of the individualized health plan. The nurse would record asthma episodes but probably not make a monthly report to the healthcare provider. The nurse would assist the 8-year-old with the medication regimen to promote self-care rather than administering the medications to child. The child should have ready access to the inhaler. It would not be stored in the health office.

A 10-year-old child is recovering from an appendectomy. Which nursing intervention is seen as most important to the child and parents? 1. Bringing immunizations up-to-date 2. Immediate and effective pain control 3. Receiving home care instructions 4. Scheduling the follow-up visit with the surgeon

2. Immediate and effective pain control Rationale:Pain is viewed as unpleasant and needing control as soon as possible. The family will comply with home care instructions and surgical follow-up, but both will receive less present attention by the parents.

The nurse is meeting an 8-year-old child with cancer and the family for the first time. What will best help to establish a relationship with the child and family? (Select all that apply.) 1. Avoiding the use of the parents' and child's descriptors 2. Keeping both a relaxed posture and word flow 3. Listening to the child and family while interjecting one's own knowledge of the events 4. Redirecting the conversation to maintain focus 5. Sitting at eye level with the child and parents

2. Keeping both a relaxed posture and word flow 4. Redirecting the conversation to maintain focus 5. Sitting at eye level with the child and parents Rationale:Sitting at eye level, keeping congruence between verbals and nonverbals, and redirecting the exchange to maintain focus are all good communication techniques and help build a positive working relationship. Listening to the child/family while continuing with the nurse's own agenda will uncover little information and signal a lack of true interest. Not using the family's or child's descriptors (substituting own) is a controlling maneuver on the part of the nurse and disallows reflection and the opportunity to truly understand and show empathy.

What action might the nurse take to stimulate trust and open communication with an adolescent? 1. While admitting the adolescent, use closed questions so only limited response is required of the reluctant adolescent. 2. Listen actively while maintaining a relaxed, open body posture. 3. Speak to the parents while the adolescent listens and observes. 4. Avoid using medical terminology altogether.

2. Listen actively while maintaining a relaxed, open body posture. Rationale:Adolescents desire to have their perspectives and desires heard. Listening actively is conveyed through paraphrasing comments and using some of the teens own words. Body language also conveys interest and careful listening through leaning forward, not crossing arms, sitting while talking, and making eye contact. These nurse behaviors indicate interest in better understanding the adolescent and the adolescent's wishes. Using some medical terminology (and explaining it) treats the adolescent as an individual able to understand more complex issues. Using closed questions offers the adolescent little opportunity to share views. Speaking to the parents while the adolescent listens and observes is an approach more in tune with the needs of a toddler.

The parent of a 12-year-old client is concerned about the dangers of the Internet. Which suggestion by the nurse best targets safety related to this? 1. Avoid putting a computer in a child's room. 2. Never share personal information online. 3. Use the phone for interacting with others. 4. Limit daily the time spent online.

2. Never share personal information online. Rationale: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 providing home care for an 8-year-old client who is dependent on a ventilator, What is a part of case management for the child and family? 1. Problem solving with the parents and child ways to get the child's homework when the child is unable to attend school 2. Scheduling respite care of the child with a child care provider 3. Doing the complex sterile dressing changes the child requires 4. Teaching the parents how to do passive range of motion and active range of motion with their child

2. Scheduling respite care of the child with a child care provider Rationale:Scheduling the respite care is case management since it involves coordinating healthcare services. Teaching PROM and AROM skills to the parents helps them meet their child's physical care needs with the nurse assuming a teaching role. Finding ways to get homework to the child by working with parents and the child promotes the development of a trusting relationship. The nurse is providing direct care (not case management) in doing the complex sterile dressing changes.

The nurse is caring for a 16-year-old child who is terminally ill with bone cancer. Which order is least likely to be in the child's advance medical directive? 1. Do not place on ventilator 2. Stop all opioid analgesics 3. Do not resuscitate (DNR) 4. No tube feedings or intravenous fluids

2. Stop all opioid analgesics Rationale:Opioid analgesics will most likely continue to be used to keep the teen comfortable. The intent of an advance medical directive is to allow the child to die peacefully, with little or no pain, providing only palliative care. Authorizing no cardiopulmonary resuscitation, withholding artificial nutrition and hydration, and withdrawing mechanical ventilation are typical specifications when life is not to be prolonged unnaturally.

The nurse is working with an interpreter to meet the health needs of a family with limited skills in the English language. Which action is not recommended? 1. Meeting with the interpreter before, including the family, to provide some background information 2. Talking one-on-one with the interpreter at numerous points throughout the session with the family 3. Pausing after approximately 30 seconds of speaking so the interpreter can translate 4. Having the interpreter review printed information with the family

2. Talking one-on-one with the interpreter at numerous points throughout the session with the family Rationale:Side conversations with the interpreter can create discomfort for the family and undermine trust. The other actions all enhance the communication.

To decrease childhood mortality, pediatric nurses need to consistently engage in what activity throughout all age groups? 1. Provide guidance regarding proper nutrition. 2. Teach injury prevention and proper safety practices. 3. Advocate for more research into control of environmental toxins. 4. Help integrate exercise practices and programs into the lifestyles of individuals and communities.

2. Teach injury prevention and proper safety practices. Rationale: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? 1.Contacting the institution's attorney to provide and document consent 2. Telephone consent with two witnesses listening simultaneously 3. Explaining the needed treatment to the minor and documenting this action 4. Treating the minor and obtaining written informed consent when the parent arrives

2. Telephone consent with two witnesses listening simultaneously Rationale:Telephone consent documented with two witness signatures is appropriate. None of the other options constitutes informed consent.

The community health nurse is preparing a program about racial and ethnic diversity. When determining the focus of the program, the nurse should keep which factors in mind? 1. The number of Black Americans will decline in the next decade. 2. The Hispanic American population will double in the coming decades. 3. The number of Asian Americans will face a moderate decline in the next decade. 4. The number of non-Hispanic white Americans will increase by almost 25%.

2. The Hispanic American population will double in the coming decades. Rationale:It is projected that over the next four decades the United States will experience a dramatic increase in racial and ethnic diversity. The Hispanic population is expected to nearly double, the Asian population is expected to double, and all other racial groups will see an increase with the exception of non-Hispanic whites, who are expected to decline.

The nurse is caring for a 6-year-old child who will be undergoing a surgical procedure that will result in a temporary ileostomy. Which approach would be most effective in helping prepare the child for surgery? 1. Draw a picture that explains the procedure. 2. Use a doll to role-play the events surrounding the surgical experience and the procedure. 3. Show the child photographs of another child with the ileostomy. 4. Show the child a teaching DVD about ileostomy care.

2. Use a doll to role-play the events surrounding the surgical experience and the procedure. Rationale:Using a doll to help the child understand surgery and the procedure will promote understanding in a developmentally appropriate way. Children this age enjoy role-play and regularly use it in everyday life to rehearse events. Drawing a picture may be helpful and age appropriate but less effective than the role-play. Showing the teaching DVD will include information the child is not yet ready for and, unless prepared for young school-agers (unlikely), would not be at the child's level of understanding. Showing the child photographs of another child with an ileostomy would be more helpful to an older school-ager. At that time peer modeling can be helpful in teaching as well as in capturing interest.

A 6-year-old needs to cough and deep breathe following surgery. To accomplish this, the nurse will: 1. teach the young school-ager to use an incentive spirometer. 2. blow a pinwheel and bubbles with the child. 3. arrange for respiratory therapy to do coughing and deep breathing exercises with the child. 4. instruct the parents to remind the child to cough and deep breathe every 2 hours.

2. blow a pinwheel and bubbles with the child. Rationale:All of the measures have potential to get the child to cough and deep breathe to some extent. The most playful and familiar methods of bubbles and a pinwheel will accomplish the most since they are likely to be accepted and even enjoyed.

The nurse who wishes to be as supportive as possible to the hospitalized preschooler makes great effort to avoid threatening the 4-year-old's: 1. food preferences. 2. body integrity. 3. creativity. 4. verbal skills.

2. body integrity. Rationale:Preschoolers are very concerned about physically intrusive procedures. They lack understanding of the way in which the body works and feel extremely threatened by all that could possibly cause bodily harm. Preschoolers are creative, have useful verbal skills, and often have very particular food preference. All of these characteristics and abilities should be recognized and supported by the nurse, but they do not produce the level of anxiety a preschooler feels when body integrity is threatened.

The nurse is providing support to a parent whose religion is Mormon (Church of Jesus Christ of Latter-Day Saints). The infant child is critically ill. The appropriate support measure for the nurse to use is to: 1. bring the parent a cup of coffee. 2. stay in the room with the infant so the mother feels free to take a break. 3. obtain some over-the-counter cough syrup for the parent's cough. 4. ask if the child has been baptized.

2. stay in the room with the infant so the mother feels free to take a break. Rationale:Staying with the child offers the parent a brief opportunity for renewal and possibly prayer. Coffee and alcohol (possible ingredient in cough syrup) are not used by Mormons. Mormons bless but do not baptize children.

The nurse is talking with the parents of a hospitalized child who has three siblings at home being cared for by the grandparents. The main idea the nurse wants the parents to understand is that siblings may experience: 1. jealousy toward their ill brother or sister. 2. stress equal to that of the affected child. 3. guilt, believing they caused their bother's or sister's illness. 4. resentment toward the parents.

2. stress equal to that of the affected child. Rationale:Research indicates sibling stress is often equal to that of the hospitalized child, and parents are often unaware that this is the case. The feelings of jealousy, resentment, guilt, insecurity, and more all add to the stress level of the siblings. The effect of each can be mitigated or compounded based on the child's particular developmental level.

An urgent care nurse is cleaning a forehead laceration on a 7-year-old. The parent is present. The child is crying and screaming. The nurse should: 1. ask the child to be less noisy because he is "scaring and bothering other children." 2. tell the child, "It's OK to cry, but I need you to hold still." 3. have the parent speak firmly to the child to correct the crying and screaming. 4. close the door tightly and reassure the child, "I am being gentle and am almost done."

2. tell the child, "It's OK to cry, but I need you to hold still." Rationale:Children should be able to express their feelings openly when they are hurt or frightened. Acknowledging the crying/screaming is developmentally sound. Stating the need to hold still is accurate and respects the child's ability to help. Closing the door is a good idea but "gentle" and "almost done" show little understanding of the child's experience. Expecting the parent to discipline the child or for the child to be able to consider others is unrealistic.

A nurse is caring for an 18-month-old client undergoing traction therapy in a rehabilitation unit. The nurse understands that the client is in the second phase of separation anxiety when the nurse observes what behavior? 1. The client acts extremely agitated. 2.. The client is quiet, looks sad, and is disinterested in playing. 3. The client cries inconsolably. 4. The client exhibits signs of anger.

2.. The client is quiet, looks sad, and is disinterested in playing. Rationale:Despair is the second phase of separation anxiety. During this phase the child appears hopeless, depressed, and apathetic. Exhibiting signs of anger and agitation or crying inconsolably all indicate the first phase of separation anxiety called protest. Denial or detachment is the third phase of separation anxiety. The child uses this to protect against further emotional pain. When parents return the child will ignore them and, instead, has formed superficial relationships with other caretakers. This third stage is seen infrequently when family-centered care is in place.

The nurse is working with the 5-day-old baby boy of a young Jewish couple. What comment is not culturally sensitive? 1. "What a beautiful little boy!" 2. "He seems hungry. Go ahead and nurse him." 3. "Oh, I see you have chosen not to have your baby circumcised." 4. "I'll make sure he gets a blue blanket."

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

Which statement is most appropriate when initiating a nursing action with a preschooler? 1. "Is it OK if I listen to your heart?" 2."It is time to take your temperature." 3. "These sticky snaps are for your chest." 4. "Can I put this little clip on your finger?" (oxygen saturation monitor)

3. "These sticky snaps are for your chest." Rationale:Many healthcare words can be confusing or scary for children. Avoiding those that are not understood or have double meanings reduces stress. "Sticky snaps" is nonthreatening and understood; "electrode patches" would not be. "Take" implies removing something, which can raise anxiety. "Can I?" and "Is it OK?" are an invitation for the preschooler to refuse.

The nurse notes that a 5-year-old child is approaching obesity. Which is the priority intervention? 1. Determining the activity level of the child 2. Screening the child for metabolic disorders 3. Assessing the diet of the child and family 4. Asking about culturally related eating habits

3. Assessing the diet of the child and family Rationale: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 social worker's notes in the child's chart report the child is "slow to warm up." With regard to the Classic Temperament Theory, what behaviors may be noted to support this documentation? (Select all that apply.) 1. Labile emotions 2. Frustration with change to the environment 3. Demonstrates the need for additional time to acclimate to environmental changes 4. Infrequent constipation 5. Moodiness

3. Demonstrates the need for additional time to acclimate to environmental changes 5. Moodiness Rationale:The Classic Temperament Theory proposes nine parameters of temperament: activity level, rhythmicity, approach and withdrawal, adaptability, threshold of responsiveness, intensity of reaction, quality of mood, distractibility, and attention span and persistence. Children in the slow-to-warm-up category are moody and less active and have more irregular reactions; they react to new experiences with mild but passive resistance and need extra time to adjust to new situations.

The nurse is preparing a 4-year-old child for a lumbar puncture. The child is extremely fearful and crying. The nurse needs to quickly gain the child's cooperation so the procedure can move forward as ordered. Which approach by the nurse would be best to be used? 1. Apply a mummy restraint. 2. Explain to the child that she must calm down. 3. Engage the parent in therapeutic hugging. 4. Tell the child everyone is trying to help.

3. Engage the parent in therapeutic hugging. Rationale:Often therapeutic hugging will calm a child and keep the youngster still for a procedure. Asking the child to calm down or telling the child everyone is trying to help will not assist the child adequately for the child to be able to cooperate. Alternate measures should be tried before using a restraint, and the least restrictive type of restraint should be used. A mummy restraint is quite restrictive.

The nurse is teaching a 15-year-old child with diabetes mellitus and the parents how to monitor glucose levels. Which communication technique is least effective? 1. Using reflection to clarify the parents' understanding 2. Paraphrasing the parents' comments before responding 3. Ignoring the adolescent's tirade about the therapy 4. Using the adolescent's words during the conversation

3. Ignoring the adolescent's tirade about the therapy Rationale:The least effective technique is ignoring the adolescent's tirade about therapy. The adolescent is expressing frustration over lack of control, and the adolescent's emotions should be acknowledged. Paraphrasing the parents' comments recognizes their feelings. Using the adolescent's words during the conversation indicates active listening and interest. Reflection clarifies the parents' understanding and point of view.

A 4-year-old child is residing permanently with grandparents. Which situation is unique to this type of family or living arrangement? 1. Difficulty obtaining accurate health history and records 2. Obstacles to obtaining informed consent for treatment 3. Physical and financial stress on the caregivers 4. Gaining consensus between the caregivers regarding treatment

3. Physical and financial stress on the caregivers Rationale: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 nurse is preparing a postsurgical care plan for an infant located on a general hospital unit that only occasionally admits children. To ensure the infant's safety, what should the nurse include in the plan? 1. Place the infant in a room with an ambulatory adolescent. 2. Put the infant in a carrier and bring her to the nurses' station. 3. Place the infant in a room close to the nurses' station. 4. Ask the family to stay with the infant at all times.

3. Place the infant in a room close to the nurses' station. The infant will need close monitoring, and having the child nearby will promote frequent checks and awareness of her status. Family cannot be required to stay at all times. That may be impossible for some. One client should never be responsible for another. The infant is the nurses' responsibility. Putting the infant in a carrier and bringing her to the nurses' station is not safe.

The nurse is taking a health history and examining a 3-year-old child. Which alteration is most important for the parents to make? 1. Eat fewer chips and sweets. 2. Argue less in the child's presence. 3. Protect the child from all tobacco smoke. 4. Reduce the number of hours the television set is turned on.

3. Protect the child from all tobacco smoke. Rationale: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 alterations 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 nurse is focusing on health promotion for a 6-year-old child. Which intervention best supports Healthy People goals? 1. Explaining proper diet in the child's terms 2. Discussing needed amount of sleep 3. Recommending a helmet for biking 4. Providing information about after-school child care

3. Recommending a helmet for biking Rationale:Recommending that the child wear a protective helmet best supports the goals of Healthy People because unintentional injury remains a leading cause of mortality and morbidity for children. Proper diet, adequate sleep, and after-school child care are important but do not affect child health status as much as injury prevention does.

The toddler needs elbow restraints to keep his hands away from a facial wound. What will the nurse do to best ensure their safe use? 1. Have the parent check for equal warmth bilaterally in his hands and fingers. 2. Choose restraints long enough to fit closely under the arm and extend over the wrist. 3. Remove one restraint at a time on a regular basis to check for skin irritation. 4. Apply lotion to the skin prior to putting on the restraints.

3. Remove one restraint at a time on a regular basis to check for skin irritation. Rationale:Removing one restraint at a time provides for control of both hands. A long-sleeve shirt under the elbow restraints also protects the skin, and is a better choice than lotion since lotion will soften the skin and not be protective. The restraints should not extend into the axilla. Movement would create pressure and irritation. The parent can help monitor the restraints, but the nurse is responsible for the safety of their use.`

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? 1. The teen needing a sports assessment 2. The toddler with a "poor appetite" 3. The foreign-born adopted child 4. The infant at the 25th percentile on the growth chart

3. The foreign-born adopted child Rationale:The adopted foreign-born child is at risk for health problems often due to poor health surveillance prior to adoption. The infant at the 25th percentile is within the range of normal. "Poor appetite" in a toddler is common due to slowed growth following infancy. Most teens are healthy. The sports assessment can occur later.

Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because: 1. there are fewer positions for nurses in institutions providing acute care. 2. disability and chronic illness have increased with the appearance of more genetic abnormalities. 3. increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive. 4. uninsured families can access these services.

3. increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive. Rationale: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.

The nurse knows that children can give assent (agree) to participate in research, but first each child's decision making ability must be assessed by the healthcare team. Based on the American Academy of Pedicatrics recommendations, which area(s) will the team assess? (Select all that apply.) 1. education level 2. physical age 3. psychological state 4. maturity 5. developmental level

3. psychological state 4. maturity 5. developmental level Rationale:The age of assent depends on the child's developmental level, maturity, and psychological state. The American Academy of Pediatrics recommends that children and adolescents be involved in the discussions about their health care and be kept informed in an age-appropriate manner. As a child gets older, assent or dissent should be given more serious consideration.

A parent wants to wait outside the room while a procedure is completed on the young child, saying, "I don't think I can stand to see you do this!" The nurse's best response is: 1. "Come, stand by your child's head. You won't see much up there." 2. "Stay. It will be less scary for your child." 3. "This will only take a few minutes. You should be with your child." 4. "Certainly. I will stay with your child during the procedure."

4. "Certainly. I will stay with your child during the procedure." Rationale:Excusing the parent from the procedure is the best response. The parent's needs and abilities need to be respected and supported. Children usually receive the most support from parents. However, others can provide effective support including nurses and child life personnel. Consider, also, that an anxious parent usually means an anxious child. Assist the parent to comfort the child after the procedure.

The nurse is providing hair care for an black 10-year-old client hospitalized with a painful disorder. What should the nurse do first? 1. Condition the hair before shampooing. 2. Dry the hair before combing. 3. Use commercial detangling solutions prior to brushing. 4. Ask the client and/or the family about any preferences in hair care or for usual procedures used.

4. Ask the client and/or the family about any preferences in hair care or for usual procedures used. Rationale:Due to the child's ethnicity, the hair is likely to require certain care measures. Often products are used to lubricate the hair and make it easier to handle. Wet hair is easier to comb and a wide-tooth comb is helpful. The family can bring any special preparations needed.

The nurse is caring for a Native American child. Which approach would be most consistent with the culture? 1. Warning about overuse of analgesics 2. Urging parents to arrange respite care through an agency 3. Reminding the child to speak respectfully to older adults 4. Discussing treatment as reestablishing harmony

4. Discussing treatment as reestablishing harmony Rationale:Harmony with nature means health and disharmony means illness in the Native American culture. Treatment explained as restoring harmony would be understood. Overuse of analgesics is not likely due to the belief that pain is meant to be tolerated. Respite care would be sought through the tribe and extended family, not an agency. Elders are highly respected in the culture; reminding about respectful speech should not be necessary.

The nurse is caring for a 16-year-old child with injuries from a car accident. Which activity describes the nurse's manager role? 1. Changing dressings covering the skin abrasions 2. Teaching the parent cast care 3. Discussing driving safety with the teen 4. Facilitating return to school by working with the school nurse

4. Facilitating return to school by working with the school nurse Rationale: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. Teaching the parent cast care addresses the parent'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.

A student nurse is interested in working at a practice caring for children. When considering work locations, where will the greatest opportunity to care for children be likely? 1. Hospital-based clinics 2. Emergency departments 3. Free-standing clinics 4. Healthcare provider offices

4. Healthcare provider offices Rationale:The professional pediatric registered nurse provides care for children in a variety of settings. Acute care focuses on the diagnosis and treatment of illness and occurs in such settings as general pediatric hospital units, pediatric intensive care units, emergency departments, ambulatory clinics, surgical centers, and psychiatric centers. In the community the focus is usually on health promotion and illness prevention. Various community settings include health clinics or offices, schools, homes, day care centers, and summer camps. Care involving restorative, rehabilitative, or quality-of-life care generally takes place in rehabilitation centers or hospice programs or through service with a home health agency.

What will the nurse view as best maintaining normalcy in the life of a 10-year-old child who is experiencing a lengthy hospitalization? 1. Playing board games with the child life specialist 2. Writing down the oral intake on the day and evening shifts 3. Choosing the time of one's bath or shower 4. Keeping up with schoolwork

4. Keeping up with schoolwork Rationale:A school-ager is exactly that---someone whose life is centered around school. Doing school and homework assignments is part of the usual day when not hospitalized. Choosing the time hygiene activities occur provides the child some control, while tracking oral intake is an opportunity to participate in one's care. Playing board games with the child life specialist is an age-appropriate activity that provides distraction. These three actions support the child developmentally but do not normalize the day as does keeping up with school assignments. It will be easier for the child to return to the classroom and feel more in step with peers by doing this.

The nurse is updating the records of a 10-year-old child who had his appendix removed. Which action could jeopardize the privacy of the child's medical records? 1. Encrypting any e-mail transmissions 2. Changing identification and passwords regularly and according to institutional policy 3. Closing files before stepping away from the computer 4. Letting another nurse use the nurse's log-in session

4. Letting another nurse use the nurse's log-in session Rationale:It is important to log off whenever leaving the computer. A person who shares the nurse's log-in session may get called away from the computer, leaving the nurse responsible for any breech in security. Keeping identifications and passwords confidential is basic computer security. Closing files before leaving the computer helps ensure privacy. Encrypting e-mail transmissions is considered safe.

Morbidity data indicate that support is needed from pediatric nursing groups to establish improved and additional services for children with what health issues? 1. Digestive system problems 2. Illnesses due to environmental toxins 3. Poor immunization status 4. Mental health and behavioral disorders

4. Mental health and behavioral disorders Rationale:Morbidity findings show mental health, emotional, social, and behavioral disorders trending upward. Immunization status in childhood has been improving. Digestive system problems remain fairly static. Illness due to environmental toxins has not shown a significant increase; this may change.

A pediatric clinical nurse specialist offers to provide a workshop for colleagues regarding recent advances in the care of children with head injuries. Which Standard of Professional Performance is the nurse demonstrating? 1.Leadership 2. Collaboration 3. Education 4. Quality

4. Quality Rationale:The pediatric nurse systematically improves the quality and effectiveness of pediatric nursing practice as evidenced in this scenario by offering to educate colleagues in a workshop setting. Education as a standard of professional performance refers to the nurse acquiring and maintaining current knowledge and competency in pediatric nursing practice. The collaboration standard is described as collaborating with the child, family, and other healthcare providers in providing client care, and the leadership standard means the pediatric nurse demonstrates leadership in the practice setting and the profession.

The nurse is teaching a 6-year-old child and the parent about home care for an eye infection. Which communication techniques would be least effective with this child? 1. Asking permission to touch the child before doing so 2. Listening attentively to the child while giving time to finish thoughts and ideas 3. Talking directly to the child even though the parent makes comments 4. Standing beside the child when doing the teaching

4. Standing beside the child when doing the teaching Rationale:Standing above a 6-year-old may create the feeling of being dominated. Sitting at the child's level promotes equality and a more comfortable teaching--learning setting. Listening with patience to the child when the child speaks or questions allows the child time to completely formulate and express a thought or question. It is respectful. Talking to the child as well as the parent during health teaching keeps the child a participant in care. Asking permission to touch the child reduces threat.

The nurse is caring for a 5-year-old child with meningitis. What action by the nurse may be considered ethical behavior? 1. Telling the child an intramuscular injection won't hurt 2. Referring to the child in the third person when the child is present 3. Scheduling a laboratory procedure at lunchtime 4. Starting intravenous fluids even though the child protests

4. Starting intravenous fluids even though the child protests Rationale:Ignoring the child's dissent regarding proposed therapy is ethically sound. The treatment will benefit the child, and at 5 years of age the decision maker is nearly always the parent or legal guardian. However, the nurse must use developmentally appropriate techniques to inform the child about the therapy and to carry it out. Telling the child an intramuscular injection won't hurt lacks veracity. Referring to the child in the third person when the child is present shows disrespect. Scheduling a laboratory procedure at lunchtime is unfair to the child and lacks justice.

An older couple approaches the nurse's station seeking information about their hospitalized grandchild. What should be the nurse's response? 1. Assume "busy-looking" behaviors and move away. 2. Ask to see identification from the two individuals. 3. Answer the grandparents' questions in a less public place. 4. Tell the couple to seek information directly from the child's parents.

4. Tell the couple to seek information directly from the child's parents. Rationale:To protect the child's privacy, information can be shared only with legal guardians, parents, or those identified in writing. "Looking busy" only temporarily avoids confronting the privacy rights.

The nurse is talking with an adopted child and the family. Which statement represents "positive" adoption language? 1. When were you given up for adoption? 2. Has your adopted child started kindergarten? 3. Are you in touch with your natural parent? 4. The birth mother was how old when your child was born?

4. The birth mother was how old when your child was born? Rationale:Birth mother, not natural or real mother, is a positive term for the biologic 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. Noting that the adoption plan was followed also provides a positive message.

During the weekly team meetings, the healthcare provider and case manager discuss the client's planned assent. What activity should the nurse most anticipate? 1. The client will be moving toward legal emancipation. 2. The client will be discharged to home in the coming days. 3. The client will begin to have increasing amounts of time spent unsupervised. 4. The client will have a conference with the healthcare provider about the planned course of care and treatment.

4. The client will have a conference with the healthcare provider about the planned course of care and treatment. Rationale: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 healthcare providers 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 5-month-old infant has had a head-to-toe assessment by the nurse, been examined by a teaching team of healthcare providers, and now experienced a blood draw. What behaviors might this infant manifest? 1. Turning toward new sounds and bright toys and making throaty verbalizations 2. Opening eyes widely, kicking, and looking intently at a black-and-white mobile 3.Assuming a tonic neck reflex posture while looking toward the opposite wall 4. Yawning, turning away, and making little eye contact

4. Yawning, turning away, and making little eye contact Rationale:This infant is likely overstimulated, and yawning, turning away, avoiding eye contact, and irritability are signs of this. The infant is attempting to disengage. The tonic neck reflex should have disappeared by 5 months of age. The other behaviors are those of an infant interested in the environment and ready for interaction.

A 15-year-old client asks numerous questions about recovery from anesthesia and typical behaviors of someone awakening from sedation. The nurse interprets the concern of this adolescent to be: 1. adequacy of postsurgical pain control. 2. anxiety related to the surgical procedure itself. 3. about a change in body image. 4. about the ability to control one's own behavior.

4. about the ability to control one's own behavior. Rationale:These questions point to anxiety about how the adolescent may act while having limited control of one's behaviors. It is likely the client does not want to appear "stupid, babyish, or uncool." All the other factors are typical adolescent concerns that may surface during the hospital stay.

Parents tell the nurse that they respect and elicit their three children's ideas. They enjoy their differing interests and personalities. The family has set rules the children are expected to follow; punishment is not emphasized. Their parenting style is: 1. authoritarian. 2. permissive. 3. laissez-faire. 4. authoritative.

4. authoritative. Rationale:The parents are using the authoritative or democratic style and will likely raise self-confident, responsible children. Permissive parents (laissez-faire) have few or inconsistent rules while maintaining little control of their children's behavior. Authoritarian parents expect obedience to strictly set rules. Nonadherence results in punishment, which can be severe. These parents often raise followers or aggressive children.

The nurse caring for a 6-month-old infant can best reduce the stress of hospitalization by: 1. keeping the infant warm and dry. 2. holding and rocking the infant. 3. providing opportunity for nonnutritive sucking. 4. supporting the parent in his or her presence and caregiving.

4. supporting the parent in his or her presence and caregiving. Rationale:All the actions by the nurse would be helpful in reducing stress. However, the 6-month-old infant, who prefers his parents to other caregivers, will be stressed the least by having that person available to provide basic care and give comfort.

What is an emancipated minor?

A minor who has proven to the court that they can legally sustain themselves without the help of their parents

The nurse suggests to the parent of a preschooler who had unexpected surgery that the child be given a healthcare provider/nurse kit to play with at home. The nurse bases this advice on which reasons that this would be an effective strategy? (Select all that apply.) 1. Role-play is an age-appropriate, common form of play for preschoolers through which experimentation and learning occur. 2. The child can use the kit with dolls or stuffed animals to work through feelings about the health care experience. 3. The parent can observe the child's play to identify any misperceptions about the unprepared-for experience and correct them. 4. The preschooler can pretend to be a health care provider or nurse practitioner who has the power to control events that the child lacked as a recipient of care.

All are appropriate developmental explanations for the nurse's suggestion. Using the kit to work through the child's emotional response to the experience as well as to deal with misperceptions are the reasons most directly applicable. Role-play is enjoyed by preschoolers, and using it to experience some after-the-fact control is also a valid reason to suggest the kit.

When this age group is ill or hospitalized they can experience separation/stranger anxiety and their routines & needs have disruptions that can throw off their demeanor.

Infants

The nurse in a school housing kindergarten through grade 12 has identified signs of stress in the students that may indicate exposure to intimate partner violence or child abuse. What has the nurse found? (Select all that apply.) 1. Truancy and absenteeism 2. Developmental regression and fearfulness 3. Reports of headaches, stomach aches, and enuresis 4. Bullying and poor social skills 5. Early-age smoking and drug use

Rationale:All are signs of stress that can indicate exposure to intimate partner violence or child abuse. The younger the child is and the longer the exposure, the more serious the problems seen. Short-term problems include headaches, stomach aches, enuresis, developmental regression, fears, poor social skills, and bullying. Long-term problems include truancy and absenteeism. A strong correlation exists between the number of exposures to adverse events and early smoking and illicit drug use.

Bill of Rights for Pediatric Patients

i. To be called by name ii. To receive compassionate healthcare in a careful, prompt and courteous manner iii. To know the names of all providers caring for a child iv. To have basic needs met and usual schedules or routines honored v. To make choices wherever possible vi. To be kept without food or drink when necessary for the shortest time possible vii. To be unrestrained if able viii. To have parents or other important persons with the child ix. To have an interpreter for the child and family when needed x. To object noisily if desired xi. To be educated honestly about the child's health care xii. To be respected as a person xiii. For all physicians to respect eh child's confidentiality