ch 27

A father repeatedly heard that it was important for his son to get his immunizations before he entered school. What are the most probable reasons that his son has not yet received them? (Select all that apply.) a. No public transportation was available to take them to the clinic. b. The father was familiar with many of the staff members who worked at the clinic. c. The clinic was open only during the day. d. The clinic had a lengthy application in order to receive low cost or free care. e. The father did not have health insurance coverage for his son. f. There was no clinic located in their neighborhood.

, C, D, E, F It is often very difficult for poor families to obtain care, since the single parent may be employed. Clinic hours are limited, transportation can be unavailable, the fees may be high and unaffordable if they do not have health insurance, and the eligibility processes can be extremely challenging. Working with staff members from other cultures can also be a barrier; however, if the father knows many of the staff at the clinic, this would not be a barrier. After all the teaching received, the father probably understands the importance, but barriers prevent him from taking action.

A community/public health nurse decided to provide a free program to the newly employed staff at a local daycare facility. What would the nurse want to emphasize during this presentation? a. Consistent hand-washing for both children and staff b. Environmental safety throughout the center c. First aid measures to use in case of an accident d. Normal growth and development of preschool-age children

A A primary concern in daycare is the easy spread of pathogens, which is attributable, in part, to the young age of the children, the increased amount of bodily contact, and the decreased ability of children to control their bodily functions.

What is the major cause of death in children aged 1 to 18? a. Accidents b. Birth defects c. Homicide d. Infectious diseases

A Accidents are the major cause of death in children aged 1 to 18. Most accidents occur in or near the home and can be prevented.

An adolescent was at a clinic with her mother for a sports physical examination. After filling out the sports form and completing the examination, the nurse practitioner asked the mother to step out of the room. Why would the health care provider have asked the mother to leave momentarily? a. The adolescent should be allowed privacy with the health care provider to share information or ask questions perhaps related to sexuality. b. Having a private conversation with the health care provider demonstrates the adolescent's maturity and independence. c. The health care provider wanted the adolescent, not the mother, to answer the questions asked. d. The gynecologic examination is usually performed in private.

A Adolescents may share information with health care providers that they do not want to share with their parents. Adolescents may seek information about birth control, human immunodeficiency virus (HIV) infection, sexually transmitted diseases (STDs), or peer relationships. Privacy should be given for this opportunity. Having a conversation in private with a health care provider does not necessarily demonstrate the adolescent's maturity.

A nurse believed strongly that intervention for technology-dependent children was needed. What is the most useful intervention that could be implemented by the nurse? a. Advocating for quality child care, especially respite care b. Emphasizing with all the nurse's friends and neighbors the necessity of supporting parents with technology-dependent children c. Lobbying insurance companies to pay as much for home care as for hospital care d. Teaching young parents how to care for their technology-dependent children at home with minimal stress

A All parents need quality child care, especially respite care for chronically ill children. Although all of the options might be useful, the need for child care is of highest priority.

Which of the following would be an appropriate tertiary intervention for a young mother who had previously physically hurt her baby? a. A hotline or crisis phone number for when the mother believes she is losing control b. A support group with professionals for new mothers to answer questions c. Education regarding age-appropriate behaviors in a young child d. Reporting the suspected child abuse to children's protective services or the police

A Although all of the options would be helpful, only a crisis number for when the mother believes she may be getting too frustrated and angry represents tertiary intervention. Families in abusive situations need parenting role models and a support system during periods of stress. Hotline or crisis telephone numbers can be one way to provide help in stressful situations. A support group and education are primary prevention. The child abuse would have been reported to children's protective services the first time the child was hurt because such reporting is mandatory. It is hoped that a social welfare representative has been to the home and has concluded that the mother should keep the baby. Therefore, to maximize the health of the newborn, a hotline allows the mother to reach out for additional support.

A woman explained to a nurse that she knew her children needed to receive health care. However, she had no money to pay for their care and there was no way for her to obtain care for them. Should the nurse be surprised by the mother's statement? a. No; many parents of eligible children do not know how to access Medicaid. b. No; most parents are too proud to ask for assistance from Medicaid. c. Yes; it is common knowledge that poor persons are eligible to apply for Medicaid. d. Yes; many public health clinics see children without charge.

A Because of the inability to document meeting eligibility requirements or overcome administrative barriers, or because of the sheer lack of knowledge about how to obtain health care, many children do not have access to Medicaid or Children's Health Insurance Program (CHIP) funds. Although public health clinics are often the caregivers of last resort, they typically use a sliding scale for payment rather than providing care totally free of charge.

Which statistic is most often used by governments, whether state or national, to compare health outcomes? a. Infant mortality rates b. Length of life of citizens c. Newborn mortality rates d. Premature birth rates

A Infant mortality rates provide an excellent indicator of the health status of a community, state, or nation.

A community/public health nurse is working with an extremely poor child who does not have health insurance. What should the nurse recommend the family do in order for the child to receive preventive care? a. Apply for Medicaid, including the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. b. Contact the Children's Health Insurance Program (CHIP). c. Determine the child's eligibility for Title V. d. Request that preventive care be provided at a local free clinic.

A Many poverty-level children are eligible for care through the Medicaid program (Title XIX), including the EPSDT program. The CHIP program (Title V) allows states to provide health insurance to children whose families are above the financial eligibility for Medicaid. Because this child is extremely poor, use of Medicaid is the most appropriate choice. Although free clinics provide care for people without insurance, regular preventive care is best provided through a stable funding source such as Medicaid.

Why has there been an increasing emphasis on caring for chronically ill children in their homes rather than in the hospital? a. Hospitalized children are at risk for contracting a nosocomial infection and do not cope well with all the noise, light, and people. b. Insurance will not pay for children to stay in the hospital, but they will pay for home care. c. It is too dangerous to use unlicensed assistive personnel to staff pediatric units and too expensive to hire professional nurses. d. There are not enough expert pediatric nurses to staff additional pediatric units.

A The hospital setting interferes with normal growth and development and is a high-risk environment. A hospitalized child is at increased risk for contracting nosocomial infections because of invasive procedures, multiple caretakers, and increased contact with organisms from other children and staff. Altered environments with noise, light, and large numbers of people result in sensory overload, sleep deprivation, and decreased learning opportunities.

A nurse at a school-based neighborhood health clinic noticed there were many different nationalities of children at the school, including some who did not speak English. What is important for the nurse to do? a. Recognize that certain ethnic groups may have different expectations of appropriate behaviors by their child. b. Share with the families research findings regarding appropriate childhood and effective parenting behavior. c. Teach the mother how to make the major health care decisions for the family. d. Help the families adapt to the United States by using teaching materials that demonstrate American beliefs and values.

A To engage in culturally sensitive nursing care, the nurse should clarify what each parent considers appropriate childhood behavior and use teaching materials that are culturally sensitive.

Which of the following actions should the nurse take before performing a painful procedure on a 6-year-old child? (Select all that apply.) a. Providing the child an opportunity to express an opinion b. Obtaining consent from the parent c. Notifying the child's primary physician d. Consulting the ethics committee e. Obtaining consent from the parent and the child f. Offering suggestions for alternative treatments

A, B Parents decide on health care, with some exceptions such as refusal of lifesaving measures. In that case, the child has the right to petition the court. However, whenever possible, the nurse should give children opportunities to express opinions about decisions that affect them. Children should participate in the decision-making process as soon as they are able. Because children are minors, their parents or guardians make the legal decisions, such as consenting or not consenting to treatment. Although nurses can tell parents various options, the treatment is typically chosen by the parents in collaboration with the primary health care provider. It is not typically necessary to involve the ethics committee when procedures are performed. The committee is typically involved when the nurse is addressing an ethical dilemma. A physician has ordered the procedure, and so it should not be necessary to contact the primary physician before the procedure is performed.

Why would parents resist having their chronically ill child cared for in their home? (Select all that apply.) a. All the necessary high-technology equipment limits living space. b. Career demands and household functioning leave little time for child care. c. Finding supportive funding can involve incredible time and effort. d. Home care results in less time for bonding between child and parents. e. Normal growth and development of the child may be delayed. f. Other children in the family may resent being caregivers and receiving less parental attention.

A, B, C, F There are drawbacks to home care. Home environments become disrupted with high-technology equipment, which limits living space. Siblings feel displaced or frightened by all the equipment, procedures, and disrupted routines. Other siblings often have to serve as caregivers. Demands of caregiving, careers, household duties, and other children in the household limit leisure and cause stress. The most significant barrier is funding. Obtaining funding involves long waiting periods, negotiations, and evidence of discharge planning. Although insurance programs pay for inpatient care, they typically do not pay for home care.

A nurse is making a home visit to see a new teenage mother who is currently living with her own mother. With whom should the nurse discuss how to care for the new baby? a. All the family members who happen to be home when the nurse visits b. Both the infant's mother and the infant's grandmother c. The infant's grandmother, who will probably be providing most of his care d. The new young mother, who is the one responsible for the infant

B All caregivers should be included in well-baby care counseling. Teenage mothers frequently live with their mothers, who may help care for the baby.

Which of the following programs provides educational, nutrition, health services, and parent involvement opportunities to low-income children? a. Daycare centers b. The Head Start program c. Nursery school d. Private child care providers

B Head Start provides educational services, nutrition, health services, and parent involvement opportunities to low-income children. It was based on the model of nursery schools, which originally were designed to enhance children's ability to learn, promote social skills, and provide remedial learning time, if it was needed.

Which tendency common to adolescents is the primary reason why it is so difficult to keep them healthy and safe? a. Binge drinking at parties b. Engaging in high-risk behaviors c. Engaging in unprotected sex d. Using tobacco and other drugs

B High-risk behaviors include smoking, drinking, and unprotected sex. Adolescents have a tendency to dismiss the dangers associated with high-risk behaviors. Alcohol and drug use contributes to this tendency.

What is a problem with the federal government's Education for All Handicapped Children Act (PL 94-142) and its amendment (PL 99-457)? a. Each state decides how to educate its children who have handicaps. b. The federal government did not allocate any funds to implement the law. c. The law established rigid definitions for "at risk" or "handicapped" children. d. Most parents choose not to be involved in the program because of its restrictions.

B The federal government enacted the law but provided no funding. Funding is the responsibility of the individual states. Locating such funding is difficult for states in a time of fiscal restraint.

What right do all handicapped children with disabilities aged 6 through 21 have because of the Education for All Handicapped Children Act? a. At-home tutors to maximize their learning b. Education in the least restrictive environment c. Learning without excessive cost to the local school system d. Attending public schools at regular intervals for socialization

B The law guaranteed free and appropriate education for all children in the least restrictive environment. For most children, this means they have the privilege of attending public school at the schools' expense.

A new resident was touring the local elementary school where she planned to enroll her 5-year-old child. She was surprised by the number of children who had special needs that she saw in the classrooms. She asked, "Why are all of these children in the regular classroom setting? Don't you have a special place for them to go?" How might the nurse respond? a. "Most of these children will be transferring soon to a new school that will better meet their needs." b. "All children may receive education in the traditional classroom setting." c. "Our school receives additional federal funding to provide care for these children." d. "The rising cost of special education has forced us to combine classrooms."

B The number of children surviving the perinatal period with significant impairment has grown rapidly as a result of advances in medical technology. The 1975 Public Law 94-142, the Education for All Handicapped Children Act, guaranteed free and appropriate education for all children in the least restrictive environment. Thus, children with disabilities are in public schools and may receive education in the traditional classroom setting

Which of the following interventions is an example of primary prevention? a. Assessing the neighborhood children for lead paint poisoning b. Encouraging use of car seats and bicycle helmets c. Facilitating a support group for divorced parents with children d. Screening all the children for scoliosis at the local school

B The only one of the options that represents primary prevention is encouragement to engage in safe habits, such as wearing seat belts and helmets. The other options are examples of secondary or tertiary prevention

Why do health care providers support providing care for children with chronic conditions at home? (Select all that apply.) a. At home, there are more caregivers. b. At home, there is decreased chance of infection. c. Home care is less expensive for the family than hospital care. d. There is less sensory overload and sleep deprivation at home. e. Living at home with a family is the normal lifestyle. f. At home, there will be more room for all the special equipment needed for the child.

B, D, E Home care promotes the professional care goals of normalization and maximizing the family's self-care. However, care at home may also be disruptive for the family, may be expensive, and may require both family and home structure readjustments

Two young people were smiling as a nurse brought in their new baby in preparation for leaving the hospital and going home. What do the new parents need? a. A diaper bag filled with formula, baby product brochures, and coupons b. A list of community agencies who work with young families c. Anticipatory guidance on parenting and time management d. Educational material related to continuing marital satisfaction while raising a child

C Although any of the options might be helpful, the primary need is for anticipatory guidance and education regarding infant and child care, normal growth and development, new communication patterns, and the task of managing time and energy.

A mother who provides care for her ventilator-dependent child told the nurse, "My child is ill and has to go to the hospital. I think she is getting a serious infection." What other factor should the nurse assess in addition to possible infection? a. Potential child abuse by the mother b. Hydration and nutritional status of the child c. The mother's level of exhaustion and stress d. The cleanliness of the ventilator equipment

C Although any of these could be true, the most probable response, because a ventilator-dependent child requires more services than almost any other child, is that the overwhelmed mother feels inadequate and desperately needs a respite. The nurse must always be alert for signs of parent stress and burnout. Acknowledging the mother's heavy responsibility will help.

A 7-year-old boy happily introduced a nurse to a man he called "Dad" and a woman he called "Mom." What may the nurse safely assume? a. The mother and father are the child's biologic parents. b. The mother and the father are married to each other. c. The child lives with a man and a woman whom he considers his parents. d. The mother, father, and child live together as a nuclear family.

C Although most children younger than 18 typically live with both parents, it is not safe to assume that either parent is the biologic parent or that they are married or that they live together. Thus, they may or may not be a nuclear family. On the basis of the introduction, the child considers the woman his mother and the man his father. Either one may be a stepparent or an adoptive parent. The values of affection and responsibility, not biology, are what bond contemporary families.

A school nurse decided to offer a parenting class to all parents of children in kindergarten and first grade. Which of the following content would the nurse want to discuss? a. Correctly interpreting the child's communication cues b. Importance of immunization and screening schedules on the child's health c. Recognizing the influence of school peers on the child's behavior and health d. Understanding their own feelings about having a second child

C Immunizations are required before a child enters school, and most parents decide whether to have a second child when the first child is at the preschool age. Parents and children learn to recognize communication cues when the child is still an infant. Thus, the crucial information is recognizing the influence of the school on the child's behavior, as well as how children are exposed to contagious diseases in the school setting.

What must a child achieve to legally become an adult? a. Demonstrate adequate maturity and judgment. b. Join the military. c. Meet state law requirements based on chronologic age. d. Obtain a driver's license or otherwise demonstrate responsibility.

C State laws determine legal age, typically by chronologic age rather than maturational or mental age

What should a nurse know about American children? a. Any child younger than 21 years must have parental consent to receive health care. b. Children with significant disabilities are cared for primarily in institutions. c. Almost one per five children lives in poverty, especially if living with a single parent. d. Since the early 1900s, infection has been the primary cause of death among children.

C The proportion of U.S. children younger than 18 years who live in poverty increased from 18% in 2007 to 20% in 2009. Women earn less than men do, and single-parent families have only one adult wage earner. Although, in the past, infection was the primary threat to well-being and children with significant disabilities were institutionalized, more children now die from accidents than from infections.

A school health nurse made a home visit each month to a ventilator-dependent child. The mother verbalized wanting to stop taking care of her child at home. What benefits of receiving home care should the nurse reinforce to the mother? (Select all that apply.) a. Home care provides a quieter and less intrusive environment. b. The child will enjoy better sibling interaction at home. c. The child will have better motor and socialization skills. d. The child will have fewer infections and better nutrition. e. Home care improves marital relationships with her spouse. f. Home care is a much safer environment with less chance of mortality.

C, D The home environment provides better socialization opportunities and usually better motor skills. It also means fewer infections and better nutrition. However, because siblings may be asked to help care for the ventilator-dependent child, relationships between siblings may worsen. In addition, there is risk of accidental death related to the complex care provided in the home.

Children make up approximately what percentage of the total population in the United States? a. 10% b. 15% c. 20% d. 25%

D Children made up about 25% of the population in 2010.

What information would be helpful for a mother of a toddler who was just beginning to explore the mother's small apartment? a. Persuade the child to take his vitamins by saying, "Isn't this good candy?" b. Give the child lots of finger foods such as peanuts, popcorn, or banana slices. c. Provide a warm, caring environment for the child. d. Suggest environmental changes such as safety plugs in all electrical outlets.

D Safety measures include keeping pot handles away from the edge of the stove; using safety plugs in the outlets; not providing peanuts, popcorn, or other hard-to-chew foods; and reinforcing that pills are not candy. Providing a warm, caring environment does not assist with keeping the home safe.

Why do not all public health agencies provide nursing home visits for new mothers and babies? a. It is too difficult to get the names and addresses of new mothers from the hospitals. b. New mothers are too overwhelmed to have another visitor in their homes. c. Physicians prefer to do the education with new mothers in their offices. d. Private third-party payers will not reimburse such a primary health promotion effort.

D Third-party payers do not reimburse home visits for early intervention, even though such interventions decrease mortality and morbidity.

What conclusion can be drawn in a comparison of hospital costs with home care costs for ventilator-dependent children? a. Hospital costs are about the same as home care costs. b. Hospital care is less expensive than home care. c. Hospital care is more expensive than home care. d. Hospital care is less expensive if one of the parents is not in the labor market.

D Whether there are significant cost savings in home care of the ventilator-dependent child remains in question. When caregiver time value or forfeited wages are factored in, home care remains less costly in 70% of the situations. If the caregiver is not in the labor market or holds only a low-paying job, then it may be less expensive. The primary reason for home care is not to save money but the increased family interaction for the child.