Pediatrics Chapter 1 PrepU

A student nurse shares an interest in pediatric nursing. When discussing her thoughts about pediatric nursing, which statements are consistent with the philosophies of pediatric nursing care? Select all that apply. a. "I believe the family should be included in all aspects of the plan of care and treatment." b. "I think the parents must be the director of the client's care until adulthood." c. "Since health care can be scary for a child, it's important to make them feel secure." d. "The child should be included as much as possible in the plan of care." e. "Until they are teens, kids should have a limited amount of decision making in their care."

a. "I believe the family should be included in all aspects of the plan of care and treatment." c. "Since health care can be scary for a child, it's important to make them feel secure." d. "The child should be included as much as possible in the plan of care." The three general concepts that form the philosophy of pediatric nursing care are family-centered care, atraumatic care, and evidence-based care. Pediatric nurses use these three concepts to provide quality, cost-effective care that is continuous, comprehensive, and compassionate.

Which child represents an increasingly common pediatric medical scenario currently present in the United States? a. 9-year-old girl diagnosed with type 2 diabetes b. 13-year-old boy admitted with a fall-induced fractured femur c. 4-year-old girl diagnosed with non-Hodgkin lymphoma d. 5-hour-old neonate diagnosed with Tetralogy of Fallot

a. 9-year-old girl diagnosed with type 2 diabetes The incidence of diabetes is rising in the United States. This is not noted to be the case with congenital anomalies, trauma or lymphoma.

The nurse is caring for a pediatric client who has been admitted after a serious automobile accident. Which actions would best promote veracity in the nurse's actions? a. Clearly explain the planned care to the child. b. Ask the child to participate in the care planned as he is able. c. Encourage participation of the family in the care delivery. d. Offer to sit with the child if he feels frightened.

a. Clearly explain the planned care to the child. Veracity refers to telling the truth. Clear explanations of the planned care will promote this concept. The remaining options are appropriate for inclusion in the plan of care but are not directly tied to veracity.

The nurse is caring for a minor child who has voiced an interest in becoming emancipated. What information can the nurse provide to the client? Select all that apply. a. Emancipation requires a minor to live apart from his or her parents. b. An emancipated minor needs to be self-supporting. c. The process to become emancipated will be very expensive. d. The courts will have to approve the request for emancipation. e. Parents must provide the initial request on behalf of the child to become emancipated.

a. Emancipation requires a minor to live apart from his or her parents. b. An emancipated minor needs to be self-supporting. d. The courts will have to approve the request for emancipation. Emancipated minors are considered adults in the eyes of the law and may make their own health care decisions. Laws about this topic will vary from state to state. The emancipated minor generally lives apart from the parents and is financially independent. Courts grant emancipation.

The student nurse is completing the care plan for a child newly diagnosed with diabetes. Which actions should the student nurse prioritize to successfully complete the planning and expected outcomes phase of the nursing process? Select all that apply. a. Ensure the child can properly injected insulin by time of discharge b. Teaches the child how to do a finger stick to check the blood glucose c. Provides written materials about proper meal planning d. Reviews the child's records of daily blood glucose levels for accuracy e. Collects necessary data from the child and parents

a. Ensure the child can properly injected insulin by time of discharge b. Teaches the child how to do a finger stick to check the blood glucose c. Provides written materials about proper meal planning During the planning and outcomes phase of the nursing process, goals or expected outcomes that improve the child's dysfunctional health patterns, promote appropriate health patterns, or provide for optimal developmental outcomes are developed and identified. The goal regarding correct injection procedure, providing proper nutritional plans, and teaching how to conduct a blood glucose screening demonstrates this phase of the nursing process. Collecting data is accomplished in the assessment phase. Reviewing the child's blood glucose level records will be accomplished in the implementation phase.

The nurse is caring for a 7-year-old boy with cystic fibrosis whose parents are intensely interested in all aspects of his condition and care. Which is the most effective way of advocating for this child and family? a. Helping parents access the area's multidisciplinary cystic fibrosis clinic b. Teaching the parents how to perform chest physiotherapy c. Assisting the parents in getting the child on a lung transplant list d. Locating the best price on a high-frequency chest compression vest

a. Helping parents access the area's multidisciplinary cystic fibrosis clinic 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.

When describing the State Children's Health Insurance Program (SCHIP) to a group of families, what information would the nurse include? a. It provides health insurance to children whose families are not eligible for Medicaid but cannot afford to purchase health insurance. b. Medicaid enrollment is necessary to receive a basic set of comprehensive services for children for health promotion and early treatment. c. The program provides monthly payments to income-eligible individuals, including children who are blind or disabled. d. States use federal funds for preventive, primary, and specialty care programs for pregnant women, mothers, infants, children, and adolescents.

a. It provides health insurance to children whose families are not eligible for Medicaid but cannot afford to purchase health insurance. The State Children's Health Insurance Program (SCHIP) is designed to expand health insurance to children whose families make too much money to qualify for Medicaid, but who cannot afford to purchase health insurance. The Early and Periodic Screening, Diagnostic and Treatment Program (EPSDT) is a program whose goal is to ensure that children enrolled in Medicaid receive a basic set of comprehensive services to promote health and identify and treat health problems at early stages. Supplemental Security Income (SSI) provides monthly payments to income-eligible individuals who are older than age 65, blind or disable. The Maternal and Child Health Services Block Grant provides federal funds to the states for preventive, primary, and specialty care for pregnant women, mothers, infants, children, and adolescents.

In 2007 the World Factbook published statistics that showed the United States still lagged behind other industrialized nations in the incidence of infant mortality. What is one reason that the United States has a higher infant mortality rate than other countries? a. Low birth weight b. Early prenatal care c. Low adolescent delivery rates d. Home deliveries

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

The nurse is talking with the mother of a 2-year-old girl during a scheduled visit. Which teaching subject best supports the emphasis on preventive care? a. Showing the mother how to teach handwashing to her child. b. Reminding the mother that the child will imitate her. c. Discussing with the mother anticipated developmental milestones. d. Describing physical changes taking place in her child.

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

The nurse is caring for a 5-year-old girl with meningitis. What action by the nurse may be considered ethical behavior? a. Starting intravenous fluids even though the child protests b. Telling her an intramuscular injection won't hurt c. Scheduling a laboratory procedure at lunchtime d. Referring to the child as "her" when she is present

a. Starting intravenous fluids even though the child protests 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 her an intramuscular injection won't hurt lacks veracity. Referring to the girl as "her" when she is present shows disrespect. Scheduling a laboratory procedure at lunchtime is unfair to the child and lacks justice.

A nurse is faced with an ethical conflict involving the care of a child. The child's parents disagree with the physician about the use of a feeding tube. The nurse sees the benefits and limitations of both parties' views. What action would be most appropriate? a. Take the issue to the Institutional Ethics Committee for advice. b. Contact the Institutional Review Board for guidelines as to how best to proceed. c. Support the parents' decision-making for their child regardless of the outcome. d. Provide care to the child without getting involved either way.

a. Take the issue to the Institutional Ethics Committee for advice. The values of the client and family must be ascertained and considered, and nursing input is important and often sought. Every institution has an Institutional Ethics Committee (IEC), which is required by The Joint Commission. The IEC should always be consulted in difficult or unusual cases when conflict and lack of agreement exist between parents and physicians or among the professional staff as to the course of action that is in the best interest of the child. The Institutional Review Board is involved in issues related to research. Although the nurse should support the parents and parents are the decision-makers for their child, a conflict is present that needs to be resolved to make sure that the child's best interests are addressed. The nurse must advocate for the child; therefore not getting involved would be impossible.

The nurse is running an education program for early grade-school children. Which topic would address the number one cause of death for this age group? a. The importance of crossing streets safely b. The importance of immunizations c. Prevention of infection and communicable disease d. Exercise and good nutrition

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

According to the pediatric client's Bill of Rights, the nurse manager should privately counsel a staff nurse to change her behavior in which situation(s)? Select all that apply. a. The nurse manager hears the staff nurse call the client "kiddo." b. The nurse manager hears the parents ask the name of the surgeon that has been consulted and the staff nurse responding, "I am not sure, it is best if you ask your doctor." c. The nurse manager witnesses the staff nurse holding the hand of a child and talking with the child while another nurse changes the surgical dressing. d. The nurse manager notices the nurse asking the parents if they would like to stay in the room during administration of medications via a gastrostomy tube. e. The nurse manager sees the staff nurse ask for an interpreter when caring for a child whose parents do not speak the dominant language.

a. The nurse manager hears the staff nurse call the client "kiddo." b. The nurse manager hears the parents ask the name of the surgeon that has been consulted and the staff nurse responding, "I am not sure, it is best if you ask your doctor." A client's Bill of Rights helps to ensure that the client's needs are being met in an ethical and legal manner. The staff nurse calling the child "kiddo" and not informing the parents of a child the name of the care provider consulted violates the bill of rights, requiring counseling by the nurse manager.

When providing care to the pediatric client recently diagnosed with diabetes, the role of nurse educator is best demonstrated with which scenarios? Select all that apply. a. The nurse provides diabetic teaching to the child and family. b. The nurse encourages the child and family to attend nutrition classes for those newly diagnosed with diabetes. c. The nurse contacts the primary care physician to provide information on the client's ability to perform blood sugar monitoring. d. The nurse asks the child to list signs and symptoms of hypoglycemic reaction after the family has attended diabetic teaching classes. e. The nurse reports the blood sugar levels for the day to the night duty nurse.

a. The nurse provides diabetic teaching to the child and family. b. The nurse encourages the child and family to attend nutrition classes for those newly diagnosed with diabetes. d. The nurse asks the child to list signs and symptoms of hypoglycemic reaction after the family has attended diabetic teaching classes. The roles of the pediatric nurse include that of providing direct nursing care to children and their families, being an advocate, educator, and manager. Being an educator means the nurse either provides the education to the child and/or family, evaluates learning, or arranges learning opportunities for the family. Contacting the primary care provider demonstrates the role of advocate, and reporting to other staff demonstrates coordination of care.

The parents of a 9-year-old agree to allow their child to participate in a research project involving drug trials for a new drug for attention deficit hyperactivity disorder. Which rights of the child are related to beneficence? Select all that apply. a. The parents and child are told of the physical and nonphysical risks associated with the research. b. The parents and child are informed of the possible adverse effects of the research. c. The parents and child are told of the direct and indirect benefits of participation. d. The parents and child are made aware of strategies to protect their identities. e. The parents and child are aware they can withdraw from the study at any time without prejudice. f. The parents and child are told whom to contact in the agency if they have any questions or concerns.

a. The parents and child are told of the physical and nonphysical risks associated with the research. b. The parents and child are informed of the possible adverse effects of the research. c. The parents and child are told of the direct and indirect benefits of participation. For issues related to beneficence, the parents and child should know the risks, adverse effects, and expected benefits of the research. Being fully informed of strategies to safeguard identity is an issue of confidentiality. Knowing they can withdraw at any time is a right of refusal, and knowing whom to contact for information is a basic right.

The nurse is caring for a 16-year-old boy with injuries from a car accident. Which activity describes the nurse's manager role? a. facilitating return to school by working with the school nurse b. teaching the mother cast care c. discussing driving safety with the teen d. changing dressings covering the skin abrasions

a. facilitating return to school by working with the school nurse Much of an adolescent's life revolves around school and peers. In helping the teen return to school, the nurse and the school nurse are achieving continuity of care and a supportive environment for healing. Teaching the mother cast care addresses the mother's learning needs and the teaching role of the nurse. Discussing driving safety with the teen is important and a factor in many adolescent injuries and deaths but is not a management activity. Changing dressings is a direct care activity of the nurse.

Following the discharge of a child who has a chronic health condition from the hospital, the nurse case manager follows up with a visit to the home and meets with the family and child. This visit best represents which philosophy of pediatric nursing? a. family-centered care b. atraumatic therapeutic care c. evidence-based nursing care d. risk-reduction potential care

a. family-centered care The home visit by the case manager to some degree meets principles of each type of care, but is most representative of family-centered care because family-centered care is described as a mutually beneficial partnership between the child, the family, and health care professionals.

Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because: a. increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive. b. uninsured families can access these services. c. there are fewer positions for nurses in institutions providing acute care. d. disability and chronic illness have increased with the appearance of more genetic abnormalities. e. more disabilities are occurring in children because many women are delaying pregnancy and giving birth to babies later in life.

a. increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive. Advances in health care have led to more children living with chronic illness or disability. The statements about genetic disease and older women may contain some truth but have only added a few people to the chronic illness total. Acute care pediatric nursing positions are decreasing in community hospitals but are more available in medical centers. Uninsured families may or may not be able to access nonhospital care.

The nurse is caring for a 2-year-old boy who needs a lumbar puncture. His mother is present. What would prevent informed consent from being obtained? a. learning the mother is not the custodial parent b. finding out the mother is younger than 18 years of age c. determining the mother cannot read the form d. establishing the mother was never married

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

The 6-year-old child is being prepared for a venipuncture. The child is tearful and reports feeling afraid. Which response by the nurse is most therapeutic? a. "You are a big girl and big girls do not get scared of needles." b. "It is ok to cry if it hurts or you are afraid." c. "Let's scream very loudly now and then you can sit quietly until we are finished." d. "If you cannot sit still we will need to hold you so that it is safe for you." e. "When we are done you can pick a treat from the toy box."

b. "It is ok to cry if it hurts or you are afraid." A venipuncture can be a frightening and potentially uncomfortable procedure for a child. Allowing the child to express fears or discomforts is the most therapeutic course of action. The child should not be afraid to be open and honest about the feelings encountered. Telling the child that he or she is "big" or other descriptors can be counterproductive if indeed pain or fears result; this can cause the child to feel inferior. Screaming loudly prior to the procedure will not manage the discomfort or fear of the procedure that will follow. Advising the child that failing to sit still will result in being held is somewhat confrontational.

The nurse is providing education to the caregivers of multiple pediatric clients. Which statement most concerns the nurse? a. "We will take our daughter to see a women's health nurse practitioner when she turns 13." b. "We plan to take our newborn to see a doula for the first year of life." c. "I do not agree with nurses being able to prescribe medications to children." d. "I only want my son to be seen by our local pediatric nurse practitioner."

b. "We plan to take our newborn to see a doula for the first year of life." The nurse would be most concerned with the caregivers stating they planned to take their newborn to see a doula for the first year of life as this is a safety concern. A doula is a nonmedical companion who supports a woman during the birthing process. It would be appropriate to take a teenage female to a women's health nurse practitioner. There are no immediate safety concerns in the statements regarding nurses prescribing medications or a child only being able to see a certain health care provider.

A hospitalized 6-year-old child has been diagnosed with a serious cardiac condition. The parents are refusing the treatment recommended by the physician. What is the first action that should be taken? a. Notification of the hospital's ethics committee. b. A conference including the parents and members of the health care team. c. Referral to the hospital's social worker. d. Modification to the plan of care to accept all of the parent's wishes.

b. A conference including the parents and members of the health care team. Parents may refuse treatment if they perceive that their child's quality of life may be significantly impaired by the medical care that is offered. The health care team must appropriately educate the family and communicate with them on a level that they can understand. The child and family should be informed of what to expect with certain tests or treatments. The health care team should make a clinical assessment of the child's and family's understanding of the situation and their reasons for refusing treatment. Active listening may allow the physician to address the concerns, fears, or reservations the family may have regarding their child's care. Referrals to social services or calling in the hospital's ethics committee are premature and may not be warranted after the care conference.

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

b. Client outcomes are improved with evidence-based practice. d. Evidence-based practice is a clinical decision-making approach to providing nursing care. e. The quest for practice improvement is the responsibility for all nurses. Evidence-based practice involves the use of research findings in establishing a plan of care and implementing that care. It is a clinical decision-making approach involving the integration of the best scientific evidence, client values and preferences, clinical circumstances, and clinical expertise to promote best outcomes. It involves the use of research findings in establishing a plan of care and implementing that care. Evidence-based practice may lead to a decrease in variations in care while at the same time increasing quality and improving health care. All nurses must be invested in asking questions and working to improve practice and client outcomes.

What is a current trend in child health care? a. Children are hospitalized for observation more than previously. b. Health promotion rather than health restoration is stressed. c. Child health care is moving out of regional centers. d. Nursing roles are decreasing because of the increasing role of families.

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

During an emergency department visit for an asthma attack, a child receives care from two nurses. Which intervention(s) represents care that provides atraumatic therapeutic care? Select all that apply. a. The nurse utilizes closed-ended questions when obtaining the child's medical history from the parent. b. One nurse uses distraction techniques while the other nurse inserts an intravenous catheter. c. The nurse requests the parent stay in the room with the child during the nebulizer treatment. d. The nurse includes the parent in discharge teaching because the parent is the primary caregiver. e. One nurse talks with the parent while the other nurse assists the radiology technician in obtaining a chest x-ray.

b. One nurse uses distraction techniques while the other nurse inserts an intravenous catheter. c. The nurse requests the parent stay in the room with the child during the nebulizer treatment. d. The nurse includes the parent in discharge teaching because the parent is the primary caregiver. e. One nurse talks with the parent while the other nurse assists the radiology technician in obtaining a chest x-ray. The overall philosophy of pediatric nursing is to provide care while focusing on the family, providing atraumatic therapeutic care, and using evidence-based practice. Using distraction during IV insertion and talking with the family while another nurse assists the child provides care to the family and child that promotes the least amount of stress and trauma. The nurse would minimize the child's separation from the parent by allowing the parent to be in the room during treatment. The nurse would use open-ended questions when obtaining the child's medical history, not closed-ended questions.

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

b. The client will have a conference with the physician about the planned course of care and treatment. Assent means agreeing to something. In pediatric health care, the term assent refers to the child's participation in the decision-making process about health care. As a child gets older assent or dissent should be given more serious consideration. The pediatric client needs to be empowered by physicians to the extent of his or her capabilities, and as the child matures and develops over time the client should become the primary decision maker regarding his or her health care.

Which nursing activity requires the pediatric nurse to implement the ethical principle of nonmaleficence? a. Encouraging an adolescent client to take ownership of her health status independent of her parents. b. Weighing the potential harm caused by a child's chemotherapy with its potential benefits. c. Mediating between a father, who wants his infant circumcised, and the mother who is opposed. d. Providing empathic, holistic care to a family who has just learned that their child's prognosis is poor.

b. Weighing the potential harm caused by a child's chemotherapy with its potential benefits. Questions of risks versus benefits often require the care team to examine options in the light of nonmaleficence; that is, the responsibility to avoid undue harm. Encouraging an adolescent to take ownership of her health will likely involve the principle of autonomy. Mediating in a family dispute or providing empathic care is less likely to involve the principle of nonmaleficence.

When providing care to a child and family, a nurse provides them with information about their rights and options, assists them in making informed decisions, identifies their needs, and makes sure that they have the necessary resources. The nurse is fulfilling which role? a. educator b. advocate c. collaborator d. consultant

b. advocate In the role of an advocate, the nurse safeguards and advances the interests of children and their families by knowing their needs and resources, informing them of their rights and options, and assisting them to make informed decisions. In the role of educator, the nurse instructs and counsels children and their families about all aspects of health and illness. In the role of collaborator, the nurse collaborates with the interdisciplinary health care team and helps to integrate the child's and family's needs into a coordinated plan of care. In the role of consultant, the pediatric nurse ensures that the child's and family's needs are met through such activities as support group facilitation or working with the school nurse to plan the child's care.

The nurse is working with the parents of an infant and a toddler in the clinical setting. What statement by the parent would alert the nurse to assess the children further? a. "We enjoy taking walks in the park and playing outside as much as possible." b. "We have baby gates installed at the top and bottom of our stairs in our home." c. "We live in an old house, and we are planning to renovate it when the kids are older." d. "We have to hire babysitters sometimes because our parents are not able to help babysit."

c. "We live in an old house, and we are planning to renovate it when the kids are older." Older homes are at risk for having lead-based paint (usually those built before the mid to late 1970s) and lead pipes used in plumbing. The nurse would further assess for the children's exposure to lead pipes, paint, paint chips, lead dust, and soil containing lead dust and paint chips. Additionally, during a renovation, the children will be exposed to areas with lead paint and/or dust. The other options are appropriate and demonstrate information only and not a need to further assess.

A child has been hospitalized after experiencing abuse at the hands of his parents, who have been charged with the related crimes. How will decisions be made for his continued care? a. The hospital's attorney will make the needed decisions about the child's care. b. The child's parents will be allowed to make decisions for the child's care since they have not been found guilty at this time. c. A guardian ad litem may be appointed. d. The child's "next of kin" will become the power of attorney for health care decisions.

c. A guardian ad litem may be appointed. In certain cases (such as child abuse or neglect, or during foster care), a guardian ad litem may be appointed by the courts. This person generally serves to protect the child's best interests. The hospital's attorney does not have the authority to make health care decisions for the client. The parents are not likely to be considered as the "decision-makers" for the child at this time. A change from the parental decision-making authority would require legal intervention. There is no guarantee that this would be granted to the next of kin.

The nurse is caring for several families with children aged from infant to adolescent. When obtaining the health history of each child, which data would be collected and studied to determine the general health of the community? a. A child born at 39 weeks' gestation to a single mother aged 23 years. b. An adolescent who is not up to date with current immunization recommendations. c. An infant born at 39 weeks' gestation and died unexpectedly at 4 months of age. d. A toddler who has been diagnosed with behavioral delays and is seeking intervention.

c. An infant born at 39 weeks' gestation and died unexpectedly at 4 months of age. The infant mortality rate is used as an index of the general health of a country. Generally, this statistic is one of the most significant measures of children's health. A child dying unexpectedly at age 4 months would be data used to collect infant mortality rates for the community. Being born at 39 weeks' gestation to a single mother is not a concern and would only impact the health of the child if resources were limited to the family. A child being diagnosed with behavioral delays and an adolescent not being current on immunizations would be situations needing further intervention, but are not indicative of the health of the community in terms of child mortality measurements.

Morbidity rates among children are most highly associated with which cause? a. Firearms at home b. School violence c. Environmental factors d. Suicide and homicide

c. Environmental factors The factors most commonly associated with child morbidity are environmental and socioeconomic problems. The more difficult the societal issues and the more marked the environmental poverty, the higher the illness rates and childhood morbidity. Firearms, violence in schools, homicide, and suicide are all factors in morbidity, but they are not strictly related to children.

The nurse is applying the nursing process to the care of a 5-year-old child who has been diagnosed with asthma. Which action should the nurse perform first? a. Identify the nursing diagnoses that are most commonly associated with childhood asthma. b. Teach the child and the caregivers basic strategies for preventing and managing asthma symptoms. c. Interview the child and the caregivers to determine the most common causes of the child's symptoms. d. Collaborate with the child and the caregivers to determine their specific, desired outcomes for care.

c. Interview the child and the caregivers to determine the most common causes of the child's symptoms. The nursing process always begins with assessment, an activity that would include an interview focusing on precipitating factors. Each of the other listed activities would be performed subsequent to an assessment.

The public health nurse is conducting a clinic to help identify those children who are most at risk of becoming obese due to poor nutrition. Which children does the nurse correctly identify as being at a high risk? Select all that apply. a. the child whose mother and father are married and live in an upper middle-class neighborhood b. the child whose mother is single and is a lawyer at a local law firm c. the child whose guardians are elderly grandparents living in senior government housing d. the child whose father and mother earn minimum wage at their jobs and have 3 younger siblings e. the child with 2 younger siblings whose father is single and has been out of work for 6 months

c. the child whose guardians are elderly grandparents living in senior government housing d. the child whose father and mother earn minimum wage at their jobs and have 3 younger siblings e. the child with 2 younger siblings whose father is single and has been out of work for 6 months Certain health concerns, such as poor nutrition, obesity, infections, lead poisoning, and asthma, affect poor children at higher rates and with greater severity than affluent and middle-class children. The child with elderly grandparents living in government housing, parents working for minimum wage, and a father unemployed for 6 months pose a high risk of obesity due to the likelihood of poor nutrition from the financial situation.

The parents of a child receiving chemotherapy for leukemia notice "certified pediatric hematology/oncology nurse" on the nurse's name badge. The parents ask the nurse about this. What is the best response by the nurse? a. "Many of us that work the oncology unit have this certification." b. "The hospital requires that we have this certification if we will be administering chemotherapy." c. "We receive a pay increase if we earn this certification." d. "This certifies that I have specialized in the field of oncology/hematology care of children."

d. "This certifies that I have specialized in the field of oncology/hematology care of children." While all the statements may be accurate, the statement that best defines the certification is: "This certification represents specialized learning that I have in the field of oncology/hematology care of children." This explanation also ensures the parents that the nurse is not just obtaining this certification for job requirements or a pay increase, but that the nurse is best prepared to care for their child.

A nurse is determining whether or not informed consent has been obtained from the family of a child who is going to have abdominal surgery. Which statement by the family would lead the nurse to suspect that informed consent is lacking? a. "Although there are risks involved, our son needs the surgery to cure the problem." b. "He might miss some school afterwards, but he'll be feeling much better." c. "We are amazed that he'll be up and walking around the day after surgery." d. "We had to sign the form right away so the surgery could get scheduled."

d. "We had to sign the form right away so the surgery could get scheduled." The statement about signing the form right away suggests that the family was coerced into agreeing to the surgery without being fully informed about the risks and benefits. The key ethical issues related to informed consent for treatment have similarities to those required for research participation: Consent must be voluntary and based upon shared information about the risks and benefits of the treatment. Furthermore, the parent must understand the information and be cognitively and mentally competent to make the decision. The statements about risks, activity limitations, and postoperative care indicate that information was shared with them and that they understood it.

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

d. Recognize that the child's care has been ordered by the state. 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).

The nurse reviews the medical record of a child with a Wilms tumor and notes the child has a do not attempt resuscitation (DNAR) prescription from the primary health care provider. During assessment, the nurse notes the child is not breathing, pulse is 20 beats/minute, and is unresponsive. Which action by the nurse is appropriate? a. Perform sternal rub. b. Measure the child's urine output. c. Perform cardiopulmonary resuscitation. d. Support the child and family members.

d. Support the child and family members. A DNAR prescription reflects a decision to not attempt cardiopulmonary resuscitation. The presence of a DNAR prescription does not mean that other interventions are to be withdrawn or withheld. The nurse would now support the child and family members while providing end-of-life care for the child. It is not appropriate to inflict pain on the child by performing sternal rub. Measuring output is not indicated at this time. This would be warranted earlier in the prognosis.

The nurse is advised in the change of shift report that a child on the unit is considered a "mature minor." What criteria must this child meet to be considered in this role? a. The child must be at least 16 years of age. b. The child's parents must approve of the child being considered a "mature minor." c. Signing any forms of consent by a mature minor must be witnessed by a court-appointed advocate of the child. d. The child must have the maturity to understand the information provided related to his condition and the planned course of treatment.

d. The child must have the maturity to understand the information provided related to his condition and the planned course of treatment. In some states, a mature minor may give consent to certain medical treatment. The physician must determine that the adolescent (usually older than 14 years of age) is sufficiently mature and intelligent to make the decision for treatment. The provider also considers the complexity of the treatment, its risks and benefits, and whether the treatment is necessary or elective before obtaining consent from a mature minor.

The nurse provides soy milk and fresh vegetables to a pregnant woman who is single, and the mother of a toddler. Which federal program is the nurse implementing? a. Maternity & Infancy (Sheppard-Towner) Act b. Expansion of Lunch & Nutrition Act c. No Child Left Behind Act d. WIC Food Package Revised

d. WIC Food Package Revised WIC Food Package Revised was designed to improve nutritional intake of the original WIC program (1966/1974) by supporting and promoting long-term breastfeeding and adding fruits and vegetables, whole grains, soy-based foods and a variety of culturally appropriate foods to recipients. In 1921 the Maternity & Infancy (Sheppard-Towner) Act provided grants to states to establish maternal and child health divisions in state health departments. Expansion of Lunch & Nutrition Act provides food for low-income school-age children year-round along with low-income children in day care and Head Start programs. The No Child Left Behind Act of 2002 was enacted to ensure that all children have a research-based curriculum, well-prepared teachers, and a safe learning environment.

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? a. clinical coordinator b. case manager c. pediatric nurse practitioner d. clinical nurse specialist

d. clinical nurse specialist 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 school nurse is caring for several children who witnessed an 8-year-old girl get hit by car on the way to school. Which intervention is least important to the nursing plan of care for these children? a. determining that the children were traumatized by what they saw b. arranging for counseling for the children who saw the accident c. including friends of the injured child to receive counseling too d. making phone calls to the parents of the children counseled

d. making phone calls to the parents of the children counseled Making phone calls to the parents of the children who were determined to need counseling is least important to the nursing plan of care. It is, no doubt, mandatory for the nurse to inform and support the parents. However, this intervention is the least important based on the nursing diagnosis of the children's need for counseling, the intervention to arrange for a counselor, and the adaptation of the intervention by providing counseling for the friends of the injured child.

After teaching a group of nursing students about major threats to children's health, the instructor determines that the teaching was successful when the students state that: a. infectious diseases continue to be prevalent. b. birth rates for teen moms have dramatically increased. c. infant mortality rates have dropped. d. the prevalence of chronic disease is increasing.

d. the prevalence of chronic disease is increasing. Many childhood infectious diseases, such as mumps and measles, have all but disappeared in North America because of the emphasis placed on immunization against certain preventable diseases. However, the prevalence of chronic diseases is increasing. The incidence of overweight and obesity in young children and teens is increasing rapidly. The birth rate for teen moms has seen a significant downward trend. Infant mortality rates have increased due to the numbers of infants born weighing less than 750 grams (1 lb, 10 oz).

What was the primary goal for the establishment of the Children's Bureau? a. to reduce prematurity b. to promote prenatal care c. the improvement of parenting behaviors d. to improve the standards of health care

d. to improve the standards of health care The establishment of the Children's Bureau in 1912 began a period of studying economic and social factors related to infant mortality, infant care in rural areas, and other factors related to children's health. The goal of these legislative efforts was to improve the standards of health care.

A nurse is reviewing morbidity data related to a recent outbreak of severe influenza in the community. This epidemiological information will allow the nurse to determine: a. the severity of each child's illness after being diagnosed with influenza. b. the main health factors associated with the development of childhood influenza in the community. c. the role that influenza has played in the deaths of any children in the community. d. what proportion of children in the community have recently been diagnosed with influenza.

d. what proportion of children in the community have recently been diagnosed with influenza. Morbidity is the measure of prevalence of a specific illness in a population at a particular time. It is presented in rates per 1,000 population. It does not address the severity of illness, deaths, or etiologic factors.