chapter 1 pediatrics
To decrease childhood mortality, pediatric nurses need to consistently engage in what activity throughout all age groups? 1 Provide guidance regarding proper nutrition. 2 Help integrate exercise practices and programs into the lifestyles of individuals and communities. 3 Teach injury prevention and proper safety practices. 4 Advocate for more research into control of environmental toxins.
3 Teach injury prevention and proper safety practices. Rationale: The leading cause of death throughout childhood is unintentional injury.
The nurse knows that children can give assent (agree) to participate in research. At what intellectual age does the American Academy of Pediatrics suggest minors may first do this?
7 years The age of 7 years is considered competent to provide assent when a developmentally appropriate explanation has been given. A child older than 14 years is considered a mature minor in many states.
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? Collaboration Leadership Quality Education
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.
An older couple approaches the nurse's station seeking information about their hospitalized grandchild. What should be the nurse's response? 1 Ask to see identification from the two individuals. 2 Tell the couple to seek information directly from the child's parents. 3. Assume "busy-looking" behaviors and move away. 4 Answer the grandparents' questions in a less public place.
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.
parens patriae
This is referred to as parens patriae (the state has a right and a duty to protect children).
Nurses can help to decrease the United States' mortality rate by advocating for improved access to healthcare for which ethnic groups in particular? Select all that apply. 1. Native Americans and Native Alaskans 2. African Americans 3. Asian Americans 4. Mexican Americans 5. Puerto Ricans
1 and 2 Rationale: African Americans, American Indians and Native Alaskans have consistently had higher infant mortality rates than other groups.
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 Evaluation 2 Nursing diagnosis 3 Assessment 4 Implementation
3 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.
The nurse is caring for a 16-year-old girl who is terminally ill with bone cancer. Which of the following orders is least likely to be in her advance medical directive? 1 Do not place on ventilator 2 Stop all opioid analgesics 3 No tube feedings or intravenous fluids 4 Do not resuscitate (DNR)
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 focusing on health promotion for a 6-year-old child. Which intervention best supports Healthy People goals? 1 Eplaining proper diet in the child's terms 2 Recommending a helmet for biking 3 Discussing needed amount of sleep 4 Providing information about after-school child care
2 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.
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 Healthcare provider offices 2 Emergency departments 3 Hospital-based clinics 4 Free-standing clinics
1 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.
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 "Education concerning ethics is a role of the committee." 4 "The ethics committee is made up of healthcare providers and hospital administrators." 5 "This group will review each case presented and formulate a decision for the facility."
1, 3, 5 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.
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 psychological state 2 physical age 3 education level 4 maturity 5 developmental level
1, 4 and 5 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.
Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because: 1 increasing numbers of children live with chronic disabilities due to advances in health care that allow children with formerly fatal diseases to survive. 2 there are fewer positions for nurses in institutions providing acute care. 3 disability and chronic illness have increased with the appearance of more genetic abnormalities. 4 uninsured families can access these services.
1. Increasing numbers of children live with chronic disabilities due to advances in healthcare 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.
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 have a conference with the healthcare provider about the planned course of care and treatment. 3 The client will be discharged to home in the coming days. 4 The client will begin to have increasing amounts of time spent unsupervised.
2 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.
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 Refer all questions concerning permission and consents for treatment to the child's parent. 2 Recognize the child's care has been ordered by the state. 3 Refer inquiries about the client's plan of treatment to the facility's ethics committee for review. 4 Allow the client who is emancipated to sign for his own treatment.
2 Reconginze the child's care had 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).
Consent for urgent treatment is needed for a minor. The parents are at a distance. What action by the nurse constitutes informed consent? 1 Explaining the needed treatment to the minor and documenting this action 2 Telephone consent with two witnesses listening simultaneously 3 Treating the minor and obtaining written informed consent when the parent arrives 4 Contacting the institution's attorney to provide and document consent
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.xplaining proper diet in the child's terms Recommending a helmet for biking Discussing needed amount of sleep Providing information about after-school child care6-
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 Case manager 2 Pediatric nurse practitioner 3 Clinical nurse specialist 4 Clinical coordinator
3 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.
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 Advocacy care 2 Family-centered care 3 Continuity of care 4 Culturally competent care
3 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.
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 Following the orders of the primary care provider by administering the G-tube feedings 4 times a day 2 Explaining the steps of feeding to the child and parent during the procedure 3 Using litmus paper to determine the pH of the stomach contents when checking placement of the G-tube 4 Asking the child and parents how they are feeling about the G-tube being used for feeding purposes
3 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.
The 5-year-old in the emergency room is having glass removed from a wound. Which action constitutes ethical behavior by the nurse? 1 Asking the parent to leave the emergency room cubicle due to crowding 2 Discussing with the healthcare provider the merits of sutures versus staples for wound closure 3 Holding the child's hand in order to facilitate removal of the glass 4 Telling the child, Stop screaming! You are scaring the other kids here!
3 Holding/Restraining the child with the nurse's hands and body while the glass removal occurs 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).
The nurse is talking with the mother of a 2-year-old girl during a scheduled visit. Which of the following teaching subjects best supports the emphasis on preventive care? 1 Describing physical changes taking place in the child 2 Discussing with the parent anticipated developmental milestones 3 Showing the parent how to teach hand washing to the child 4 Reminding the parent that the child will imitate him or her
3 Showing the mother how to teach hand washing to her 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.
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 of the following is the most effective way of advocating for this child and family? 1 Helping parents access the area's multidisciplinary cystic fibrosis clinic 2 Assisting the parents in getting the child on a lung transplant list 3 Teaching the parents how to perform chest physiotherapy 4 Locating the best price on a high-frequency chest compression vest
3. 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 nurse is caring for a 16-year-old child with injuries from a car accident. Which activity describes the nurse's manager role? 1. Discussing driving safety with the teen 2. Changing dressings covering the skin abrasions 3. Teaching the parent cast care 4. Facilitating return to school by working with the school nurse
4 Facilitating return to school by working with 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.
The nurse is caring for a 2-year-old boy who needs a lumbar puncture. His mother is present. Which of the following would prevent informed consent from being obtained? 1 Establishing the parent was never married 2 Determining the parent cannot read the form 3 Finding out the parent is younger than 18 years of age 4 Learning the parent present is not the custodial parent
4. Learning the mother 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.
The school nurse is caring for several children who witnessed an accident in which an 8-year-old girl was struck by a car on the way to school. Which of the following is the most important first step in developing the nursing care plan for these children? 1 Arranging for friends of the injured child to receive counseling 2 Arranging for counseling for the children who saw the accident 3 Seeking permission from parents of children needing counseling for them to participate 4 Determining whether the children were traumatized by the accident
Determining whether the children were traumatized by the accident Rationale: 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 updating the records of a 10-year-old boy who had his appendix removed. Which of the following actions could jeopardize the privacy of the child's medical records? 1 Letting another nurse use the nurse's log-in session 2 Changing identification and passwords regularly and according to institutional policy 3 Encrypting any e-mail transmissions 4 Closing files before stepping away from the computer
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.
The nurse is assessing a 9-year-old boy with pneumonia. Which of the following findings 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
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.
Morbidity data indicate that support is needed from pediatric nursing groups to establish improved and additional services for children with what health issues? 1 Illnesses due to environmental toxins 2 Poor immunization status 3 Mental health and behavioral disorders 4 Digestive system problems
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.
The nurse is caring for a 5-year-old girl with meningitis. Which of the following may be considered ethical behavior? 1 tarting intravenous fluids even though the child protests 2 Referring to the child in the third person when the child is present 3 Scheduling a laboratory procedure at lunchtime 4 Telling the child an intramuscular injection won't hurt
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.
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 foreign-born adopted child 2 The toddler with a "poor appetite" 3 The teen needing a sports assessment 4 The infant at the 25th percentile on the growth chart
The foreign-born adopted child 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.
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 Nurses make clinical decisions---this action is acceptable. 2 The intervention on the nursing care plan came from the family, not the nurse---the nurse may omit it. 3 This nurse has not met the standard of care that constitutes adequate nursing practice identified in Pediatric Nursing: Scope of Standards and Practice. 4 Sexuality education is a function of the schools---the nurse need not assume the function.
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.
