Chapter 2: Factors Influencing Child Health

The pediatric home health nurse notices many of her clients exhibit great resiliency given their circumstances. Which client comments demonstrate resiliency as a result of internal protective factors? Select all that apply. "I know my mom wants me to try out for the tennis team this year, but I know my limits and will only try out if I think I am able. If not, I will work toward trying out next year." "Since getting ill a few months ago I have been so fortunate to have my friends at school help me get to my club meetings. It's helped me so much." "One of my goals before I got sick was to qualify to compete in the national academic bowl. Even though I have had a setback, I'm confident I can make it." "My family has been so supportive of me since my accident. I am where I am with my therapy because of them. I don't know what I would do without them." "I have fought hard through physical therapy since my knee injury. I am going to be back playing varsity football before the recruiters are watching our games."

"I know my mom wants me to try out for the tennis team this year, but I know my limits and will only try out if I think I am able. If not, I will work toward trying out next year." "One of my goals before I got sick was to qualify to compete in the national academic bowl. Even though I have had a setback, I'm confident I can make it." "I have fought hard through physical therapy since my knee injury. I am going to be back playing varsity football before the recruiters are watching our games." Explanation: Internal factors that promote resiliency (qualities that enable an individual to cope with significant adverse events or stresses in a positive way) include the person's ability to take control and be proactive, to be responsible for his or her own decisions, to understand and accept his or her own limits and abilities, and to be goal-directed, knowing when to continue or when to stop. Internal factors are demonstrated with the child referring to the tennis team next year, the child working toward qualifying for the academic bowl, and the football player. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Environmental Exposure, p. 30. Chapter 2: Factors Influencing Child Health - Page 30

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

Assessing the child's nutritional status. Explanation: A single mother using a free clinic probably means that the two are living in poverty. The child could be malnourished. This would affect all aspects of the child's growth and development. Obtaining food stamps may be a partial solution to a nutritional problem if this is confirmed following assessment. Family beliefs are important but not the first concern. Good child care promotes healthy growth and development. This can be addressed later. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Nutrition, p. 29. Chapter 2: Factors Influencing Child Health - Page 29

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

Assessing the diet of the child and family Explanation: The greatest influence on the child's behaviors is the family. Therefore, habits of the family are likely to be those of the child. Evaluating the family diet is most important. Determining the activity level of the child ranks next in importance. Sedentary behaviors lead to weight gain. Asking about culturally related eating habits can produce some helpful, but limited, nutrition information. Screening the child for metabolic disorders would not be done unless there was other evidence that points to this possibility. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Nutrition, p. 29. Chapter 2: Factors Influencing Child Health - Page 29

The nurse is caring for a 7-year-old child who is being treated for multiple fractures after being involved in an automobile accident. The nurse observes that the father frequently takes on the role of nurturer in the family. When planning care, which nursing intervention would most involve the father? Bathing the child Leaving the hospital to work Meeting with the discharge planner Assuring medications are received on time

Bathing the child Explanation: The nurse would focus on the father for decisions about the course of treatment. Assuring medications are received on time is the family health manager's role. Staying with the child in the hospital will be handled by the family nurturer. All clinical input will be provided to the family gatekeeper for dissemination. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Development and Disease Distribution, p. 29. Chapter 2: Factors Influencing Child Health - Page 29

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

Communicating with sensitivity using understandable terms Explanation: Being understood is essential to the provision of all nursing care. An interpreter may be needed. Speaking slowly and using simple terms is also useful. Inquiring about common health problems in their home country, asking about transportation, and helping them access aid programs are all secondary to and dependent upon effective communication. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Immigration, p. 41. Chapter 2: Factors Influencing Child Health - Page 41

A client who just learned she is pregnant says, "I can no longer eat strawberries, even though they are my favorite." What best explains this statement? It is related to finances. It is related to the time of year. It is related to culture. It is related to a food preference.

It is related to culture. Explanation: People from different cultures tend to eat different types of food. Some women may omit various foods during pregnancy because they believe a particular food will mark the baby (e.g., strawberries cause birthmarks, raisins cause brown spots). Food preferences, selections, and seasons do not explain her sudden omission of strawberries in her diet. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Environmental Exposure, p. 40. Chapter 2: Factors Influencing Child Health - Page 40

A woman has presented to the clinic with her sick school-aged child. The child's mother reports she rarely has enough money to meet the health care needs of her chronically ill child. What information should be provided to the woman? Medicaid is a federal program designed to meet the specific needs of children. Medicaid is a state assistance program that provides health care for all children under the age of 13. Medicaid may be available to low-income parents and their children. Medicare may be available to help with the health care needs of indigent children.

Medicaid may be available to low-income parents and their children. Explanation: Medicaid is a joint federal and state program that provides health insurance to low-income parents and their children. It is state-administered, and each state has its own set of guidelines. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Access to Health Care, p. 30. Chapter 2: Factors Influencing Child Health - Page 30

The mother of a school-aged child is discussing parenting behaviors with the nurse. She questions the nurse about the best way to provide feedback to her child. What suggestion by the nurse is most appropriate? Positive reinforcement is more valuable than negative feedback. Emphasizing negative behaviors is more important than focusing on positive behaviors. Timing of feedback is not of importance. Positive and negative feedback should be equally provided to children.

Positive reinforcement is more valuable than negative feedback. Explanation: It is most important that feedback is consistent and timely. It is important to focus most on positive feedback rather than the reinforcement of negative problematic behaviors. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Discipline, p. 38. Chapter 2: Factors Influencing Child Health - Page 38

The mother of a child who has been termed to have a "difficult" temperament voices frustration in managing his care. What would be the best initial course of action by the nurse for this parent? Explain how her child's temperament determines how he reacts in stressful situations. Refer the mother to a support group for children with behavioral difficulties. Encourage the parent to keep a journal of difficult encounters with the child. Review strategies that are beneficial in the care of a child with a difficult temperament.

Review strategies that are beneficial in the care of a child with a difficult temperament. Explanation: Difficult temperament children have challenges with regard to behavior. These children may be frustrating to their caregivers and parents. The best course of action would be to provide coping strategies and suggestions for how to best manage the care of the child. Labeling the child should be avoided. The remaining options may be beneficial but are not of the highest priority. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, GENETIC INFLUENCE ON CHILD HEALTH, p. 27. Chapter 2: Factors Influencing Child Health - Page 27

When a woman is admitted to the labor-and-delivery unit, her husband says he is going to work and asks you to call when the baby is born. Your best response to this husband would be to tell him that all fathers now stay with their wives during labor. insist he stay with his wife during labor because she will need his support. ask him if he knows that he can stay with his wife during labor. tell him he is missing out on the opportunity of a lifetime by leaving.

ask him if he knows that he can stay with his wife during labor. Explanation: Respect for cultural values is important for developing effective nurse-client relationships. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Access to Health Care, p. 30. Chapter 2: Factors Influencing Child Health - Page 30

While caring for a hospitalized child, the nurse notes the parent does not take into consideration the wishes or opinions of the child. During a period of discussion, the parent states "My child needs clear rules and knows I expect my child to do as I say." This is consistent with which style of parenting? permissive uninvolved authoritative authoritarian

authoritarian Explanation: Authoritarian parenting style consists of the parents making the rules for the child to follow. There is little to no flexibility or decision making by the child. Authoritative parenting is also referred to as democratic parenting. In this style of parenting, there are rules and expectations of behavior but the parents embrace the individuality of the child and do allow some input by the child. Permissive parents have little control over the behavior of their children. Rules are often inconsistent, unclear or nonexistent. Uninvolved parents are indifferent. They do not provide rules or standards. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, PARENTING STYLES, p. 37. Chapter 2: Factors Influencing Child Health - Page 37

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

binuclear Explanation: A child of a binuclear family is the member of two families due to joint custody; parenting is considered a joint venture and there should be discussed and agreed-upon common rules and parenting styles. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, TABLE 2.2 Types of Family Structures, p. 34. Chapter 2: Factors Influencing Child Health - Page 34

The nurse is caring for a child from a different culture. Which statement(s) by the nurse demonstrates an understanding of how culture impacts a client? Select all that apply. "A client's cultural beliefs can impact spirituality and/or religion." "Culture can impact the diet a client follows." "When a client moves to a different city, the client follows the cultural practices that are prevalent in the new city." "A client's cultural beliefs should be incorporated into the care a client receives. "Culture can impact who a client chooses to see for health care needs."

"A client's cultural beliefs can impact spirituality and/or religion." "Culture can impact the diet a client follows." "A client's cultural beliefs should be incorporated into the care a client receives. "Culture can impact who a client chooses to see for health care needs." Explanation: Culture is a set of traditions and beliefs held by groups of people. Beliefs, diet, language, values, religion and spirituality are included in culture. Some cultures utilize folk healers to provide health care. The nurse should incorporate a client's beliefs as much as possible into care. When a client moves to a different location, the client tends to bring cultural beliefs and does not necessarily follow all the cultural practices of the new location. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, CULTURE, p. 40. Chapter 2: Factors Influencing Child Health - Page 40

The student nurse is shadowing a registered nurse on the pediatric inpatient care unit. They are caring for a teen who has openly shared that she was adopted at birth. Which statement by the student nurse indicates the need for intervention by the nurse? "Are you in contact with your real mother?" "How long have you known about your adoption?" "How many siblings do you have?" "Do your parents have any biological children?"

"Are you in contact with your real mother?" "Are you in contact with your real mother?" Explanation: The needs of adoptive children may be unique. It is important to ensure the correct terminology is used. There should not be references to a "real mother." The term biological mother is preferred. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Genetically Linked Diseases, p. 28. Chapter 2: Factors Influencing Child Health - Page 28

During the admission assessment of a child for a well-child check-up, the father of the child tells the nurse, "It is so tough being a single parent. Sometimes I wonder if I am doing a good job?" Which is the best response by the nurse? "Being a single parent must be really difficult. Can I offer you some information about a support group, Parents Without Partners?" "If your child does well in school and doesn't get into any trouble you will know that you are doing a good job with being a single parent." "I have been a single mother for many years. My mother was a single mother too. I would think being a single dad would be a little easier." "I am sure you are. You always seem like such a good dad when you are here."

"Being a single parent must be really difficult. Can I offer you some information about a support group, Parents Without Partners?" Explanation: Acknowledging the father's comments with an empathetic response and offering support from an outside resource such as Parents Without Partners addresses the father's concerns. The other responses don't address the concerns and only give the nurse's personal thoughts and ideas. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, INTRODUCTION, p. 27. Chapter 2: Factors Influencing Child Health - Page 27

The nurse is discussing the impact of smoking with the mother of a toddler. Which statement by the mother indicates an adequate understanding of the impact of her smoking? "Even the clothing I wear when smoking can pose a danger to my son." "Exposure to cigarette smoke will be of the greatest danger to my son when he is school age." "Smoking outside will protect my child from harm." "Smoking will not harm my son as long as I am in another room."

"Even the clothing I wear when smoking can pose a danger to my son." Explanation: Secondhand smoke and other pollutants are a health hazard for children. A recent study found that residual tobacco smoke and carcinogens remain after a cigarette is extinguished (referred to as third-hand smoke). These toxins cling to the smoker's hair and clothes and can be present on any surface in the house, such as carpet and cushions. Children are particularly susceptible to third-hand smoke since they breathe near, crawl, touch and mouth contaminated surfaces. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Media, p. 49. Chapter 2: Factors Influencing Child Health - Page 49

The father of a child mentions to the nurse that he is very worried about his 14-year-old son because he is associating with a group of kids that get into trouble frequently. What responses by the nurse would be appropriate? Select all that apply. "Maybe you should not allow your son to associate with this group of children so that he doesn't get into trouble." "Have you thought about encouraging your son to become involved in a sport? This could occupy his time in a constructive way." "It is hard being a parent these days." "I'm sure if you have instilled good values in your son he will make the right choices and not be influenced by his friends." "Are there any activities that your son likes? There are often clubs offered at schools for a variety of interests."

"Have you thought about encouraging your son to become involved in a sport? This could occupy his time in a constructive way." "Are there any activities that your son likes? There are often clubs offered at schools for a variety of interests." Explanation: A child's friends can have a major influence, positive or negative, on his or her growth and development. Encouraging sports or clubs can help the father guide the son to friends that will likely have a more positive influence. Telling the father to prevent him from associating with a certain group often ends up pushing the child to that peer group. Instilling good values is not a guarantee to good choices at this age. Stating it's hard to be a parent offers no support or guidance. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Immigration, p. 42. Chapter 2: Factors Influencing Child Health - Page 42

The nurse is educating a group of caregivers of 3-year-old children on behavior. Which statement made by a caregiver concerns the nurse? "I have my child apologize when mean to another child." "I place my child in time-out for 10 minutes." "My child's behavior declines if her schedule is interrupted." "My child acts out when he does not get his way."

"I place my child in time-out for 10 minutes." Explanation: A useful method for dealing with a child who is not cooperating or who is out of control is to send the child to a "time-out" space. This should be a place where the child can be alone but may be observed without other distractions. The duration of the isolation should be limited—1 minute per year of age is usually adequate. Having a 3-year-old sit in time-out for 10 minutes is excessive and should be addressed. Having a child apologize when he/she is mean assists the child in learning appropriate actions. It is common for children to act out when they are told no or if their schedule is interrupted. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Genetically Linked Diseases, p. 28. Chapter 2: Factors Influencing Child Health - Page 28

The parents of a 16-year-old child are meeting with the pediatrician to discuss the behavior problems of their adolescent. Which statements by the parents about their parenting style are consistent with an authoritarian style? Select all that apply. "We are beginning to reduce restrictions as she gets older so she can begin to have more freedoms." "We encourage our daughter to share her thoughts about the household rules." "It is important that our daughter follow the rules of the household." "She will thank us one day for outlining clear expectations for her behavior." "We tell our teen the rules of the household and the importance of her complying."

"It is important that our daughter follow the rules of the household." "She will thank us one day for outlining clear expectations for her behavior." "We tell our teen the rules of the household and the importance of her complying." Explanation: The authoritarian parent expects obedience from the child and discourages the child from questioning the family's rules. The parent provides low support and high control over the child (Cherry, 2014). The rules and standards set forth by the parents are strictly enforced and firm. The parents expect the child to accept the family's beliefs and values and demand respect for these beliefs. The parents are the ultimate authority and allow little, if any, participation by the child in making decisions. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, PARENTING STYLES, p. 37. Chapter 2: Factors Influencing Child Health - Page 37

A nursing instructor is discussing ways to promote safe internet use in children with a group of nursing students. Which statement by a student would indicate a need for further education? "It is okay for a parent to place a computer in a child's room if it is used for homework." "Parents should teach their children to not open emails from people they don't know." "There should be a limit on how much time a child should spend online each day." "Parents should teach their children to not share their passwords with anyone, including their friends."

"It is okay for a parent to place a computer in a child's room if it is used for homework." Explanation: Computers in a child's room should be avoided. They should be placed where a parent can monitor use. Time limits, not opening emails from people they don't know, and not sharing passwords with anyone are all correct statements regarding safe internet use. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Media, p. 49. Chapter 2: Factors Influencing Child Health - Page 49

A nursing instructor is discussing ways to promote safe internet use in children with a group of nursing students. Which statement by a student would indicate a need for further education? "There should be a limit on how much time a child should spend online each day." "Parents should teach their children to not share their passwords with anyone, including their friends." "Parents should teach their children to not open emails from people they don't know." "It is okay for a parent to place a computer in a child's room if it is used for homework."

"It is okay for a parent to place a computer in a child's room if it is used for homework." Explanation: Computers in a child's room should be avoided. They should be placed where a parent can monitor use. Time limits, not opening emails from people they don't know, and not sharing passwords with anyone are all correct statements regarding safe internet use. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Media, p. 49. Chapter 2: Factors Influencing Child Health - Page 49

The nurse is doing an intake history on a 15-year-old client being admitted to a facility. Which statement(s) by the parents demonstrate effective means of discipline according to the American Academy of Pediatrics? Select all that apply. "Taking away phone privileges from our child seems to work better than any other form of discipline." "It seems like using positive reinforcement is such a lazy way of parenting." "We always try to sit down and talk to our child when in trouble instead of scolding the child." "We frequently use scolding to discipline our child. It is better than corporal punishment." "There is nothing wrong with corporal punishment. I know some people do not approve but it worked when I was a kid."

"Taking away phone privileges from our child seems to work better than any other form of discipline." "We always try to sit down and talk to our child when in trouble instead of scolding the child." Explanation: Discipline involves increasing desirable behavior and decreasing or eliminating undesirable behavior. Scolding and corporal punishment are forms of punishment rather than discipline. The American Academy of Pediatrics recommends forms of discipline such as using positive reinforcement for good behavior and removing or eliminating the positive reinforcement for inappropriate behavior as well as effective communication. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Divorced Family, p. 32. Chapter 2: Factors Influencing Child Health - Page 32

The nurse is providing education concerning discipline to the parents of a 2-year-old girl. Which of the nurse's comments follows the strategies for good discipline? "Tell her what will result in her being sent to her room." "Always have the father do the disciplining." "You can modify the discipline when she is sick." "Tell her adults can do as they please, children can't."

"Tell her what will result in her being sent to her room." Explanation: It is important to make the consequence known before the bad behavior. This way the child has the opportunity to avoid misbehaving. Effective discipline is performed in close proximity to the misbehavior. It is important to set a good example and avoid hypocritical behavior. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Discipline, p. 38. Chapter 2: Factors Influencing Child Health - Page 38

The nurse is caring for a teen who has been hospitalized after a motor vehicle accident. The accident is believed to have been caused by alcohol and drug use. The teen states, "I fit in when I use marijuana and, besides, it is legal in some states." Which response by the nurse is most therapeutic? "Marijuana may be legal in some states for adults but not children." "Those people you are trying to fit in with are not your real friends." "Marijuana will lead you to other harder drugs." "Tell me how you feel when you use marijuana."

"Tell me how you feel when you use marijuana." Explanation: Substance use is problematic in the adolescent population. The education and open communication is important. It is correct that marijuana is legal in some states. It is also true that the laws where it is legal pertain to adults and not children—but this statement does not establish open, therapeutic communication. Marijuana use may lead to other "harder" drugs over time but that statement does little to establish open, therapeutic communication. Voicing criticism to the teen's friends will do little to establish open communication. The statement asking how drugs make him feel is the most open statement and may provide an introduction to a discussion. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Development and Disease Distribution, p. 29. Chapter 2: Factors Influencing Child Health - Page 29

The father of a 6-year-old boy reports that his son is having difficulty adapting to the changes in the family structure since the father remarried a few months ago. The father asks the nurse for suggestions on what to do. What information can be provided by the nurse? "The only thing that will take care of these problems is likely the passage of time." "The most important thing is for your son to learn to accept the authority of your wife." "The display of a united front between you, your wife, and your son's mother is important." "Your son's mother must retain control of being the primary maternal influence for your son."

"The display of a united front between you, your wife, and your son's mother is important." Explanation: Unified decision-making by the father, his new wife, and the mother of the 6-year-old boy will best help the school-age child of divorce to adapt to the changes in the family structure that have occurred since the father remarried. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Family Structure, p. 32. Chapter 2: Factors Influencing Child Health - Page 32

The public health nurse is assessing the risk potential for suicide among a group of adolescents. Which adolescent would the nurse determine is at highest risk of dying from suicide? 14-year-old Asian-American male adolescent who is smaller than his peers 17-year-old Native American/First Nations male adolescent who has poor school attendance 16-year-old White female adolescent who lives in a low socioeconomic household 15-year-old Black female adolescent who did not make the cheerleading squad

17-year-old Native American/First Nations male adolescent who has poor school attendance Explanation: Native American/First Nations and non-Hispanic White adolescents have the highest rate of suicide. Increased exposure to adverse events, such as intimate partner violence, childhood abuse or neglect, and coming from a low socioeconomic household lead to an increased risk of negative behaviors such as suicide attempts. Males are more likely than females to die from suicide; therefore, of these adolescents, the 17-year-old Native American/First Nations male adolescent is at the highest risk of death from suicide. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Community, Society, pp. 45-51. Chapter 2: Factors Influencing Child Health - Page 45-51

A parent is disciplining the 5-year-old daughter by putting her in time-out. How long should the child be in time-out? 10 minutes 3 minutes It depends what the child did. 5 minutes

5 minutes Explanation: The amount of time that a child spends in time-out is typically 1 minute per year of age; for example, a 3-year-old would spend 3 minutes in time-out. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Blended Families, p. 35. Chapter 2: Factors Influencing Child Health - Page 35

The nurse is providing an educational program for the staff working at a homeless shelter. The program is focused on the impact of homelessness on children. What information should be included in the presentation? Select all that apply. Having space in a shelter will neutralize the health risks to the homeless child. Acute health conditions are increased in homeless children. Homeless children are at an increased risk for sexual abuse. A short period of uncertain housing is not detrimental as long as the family are able to remain available. Homeless children are at risk for developing chronic health problems.

Acute health conditions are increased in homeless children. Homeless children are at an increased risk for sexual abuse. Homeless children are at risk for developing chronic health problems. Explanation: Homelessness is a psychological and physiological stressor on the family unit. Children who are homeless are at an increase risk for both acute and chronic health concerns. Even when homeless families have beds in shelter settings these children and their parents are still at an elevated risk for health problems. Incidence of sexual abuse is increased in homeless children. Although the family unit may remain together, this does not minimize the overall risk of homelessness. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Violence in the Home, p. 46. Chapter 2: Factors Influencing Child Health - Page 46

Personal space and distance is a cultural perspective that can impact nurse-client interactions. What is the best way for the nurse to interact with a client who has a different cultural perspective on space and distance? Allow the client to adopt a position that is comfortable for him or her. Remember not to intrude into the personal space of the elderly. Realize that sitting close to the client is an indication of warmth and caring. Adopt a cultural preference similar to that of the client.

Allow the client to adopt a position that is comfortable for him or her. Explanation: If the client appears to position himself or herself too close or too far away, the nurse should consider cultural preferences for space and distance. Ideally, the client should be permitted to assume a position that is comfortable to him or her in terms of personal space and distance. "Realizing" and "remembering" are not interactions. It is also incorrect to attempt to adopt someone else's cultural preference as this can be very uncomfortable for the nurse, which adds a barrier to nurse-client interactions. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Sex and Gender, p. 27. Chapter 2: Factors Influencing Child Health - Page 27

A 12-year-old child has low resiliency. The parent has asked for tips in working with the child to promote the improvement of this trait. What would be the most effective advice the nurse can provide to the parent? Encourage the parent to add exercise to the child's routine. Encourage the child's parent to assist the child to set short-term goals for identified projects. Instruct the parent to encourage the child to develop relationships with others. Discuss with the parent how to add dietary supplementation to the child's diet.

Encourage the child's parent to assist the child to set short-term goals for identified projects. Explanation: The term resilience refers to the qualities that enable a person to cope with significant adverse events or stresses and still function competently and have positive outcomes. Various internal and external protective factors promote resiliency. Internal factors include the person's ability to take control and be proactive, to be responsible for his or her own decisions, to understand and accept his or her own limits and abilities, and to be goal-directed, knowing when to continue or when to stop. External factors include caring relationships with a family member, a positive, safe learning environment at school (including clubs and social organizations), and positive influences in the community. Dietary supplementation and exercise can promote overall health, but working on goal setting will provide a direct impact on the process. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Environmental Exposure, p. 30.

An 8-year-old seeks out the school nurse crying because she was recently told her parents would divorce. What is the most important idea the nurse will help the child grasp? Her situation is not unusual. The divorce is not her fault. Feeling scared and sad is okay. She will feel better after some adjustment time.

The divorce is not her fault. "I have fought hard through physical therapy since my knee injury. I am going to be back playing varsity football before the recruiters are watching our games."

The community health nurse is preparing a program about racial and ethnic diversity. When determining the focus of the program, the nurse should keep which factors in mind? The number of Asians will face a moderate decline in the next decade. The number of non-Hispanic Whites will increase only by 25%. The number of Hispanics will double in the coming decades. The number of Blacks will decline in the next decade.

The number of Hispanics will double in the coming decades. Explanation: It is projected that over the next four decades the United States will experience a dramatic increase in racial and ethnic diversity. The Hispanic population is expected to double, the Asian population is expected to more than double, and all other racial groups will see an increase with the exception of non-Hispanic Whites, who are expected to decline. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Barriers to Health Care, p. 31. Chapter 2: Factors Influencing Child Health - Page 31

The student nurse views a boy from a large extended family as poor because his father is unemployed. Considering his family structure, in what way might he view the student nurse as "poor"? You stated you value honesty. You are unmarried and live alone. You are planning to be a nurse. You own only one student nurse's uniform.

You are unmarried and live alone. Explanation: An extended family is "rich" in that it can provide support to family members in times of family stress. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Poverty, p. 48. Chapter 2: Factors Influencing Child Health - Page 48

A 10-year-old girl is living with her grandparents. Which nursing intervention is most important with this family structure? helping to access the need for financial aid determining the decision-maker teaching the couple basic child care skills assessing the child for emotional problems

assessing the child for emotional problems Explanation: Children living with their grandparents may experience emotional stress if the biological parents are in and out of the child's life. Teaching basic child care skills is appropriate for the adolescent family. Determining the decision-maker is important with an extended family, and financial aid is important for single parents. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Family Structure, p. 31. Chapter 2: Factors Influencing Child Health - Page 31

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

difficult Explanation: The parents described the difficult child. The easy child is even-tempered, predictable, and positive. The slow-to-warm-up child can be moody and moderately active and may need time to adjust to something new while doing so with mild resistance. Intolerant is not a category of temperament. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, GENETIC INFLUENCE ON CHILD HEALTH, p. 27. Chapter 2: Factors Influencing Child Health - Page 27

During a well-child care visit, the mother of a 4-year-old child reports her son is extremely active at home and cries easily if frustrated. This is consistent with which level of the classic temperament theory? complex temperament difficult temperament slow-to-warm-up temperament flexible temperament

difficult temperament Explanation: The classic temperament theory proposes nine parameters of temperament: activity level, rhythmicity, approach and withdrawal, adaptability, threshold of responsiveness, intensity of reaction, quality of mood, distractibility, and attention span and persistence. This theory seeks to identify behavioral characteristics that lead the child to respond to the world in specific ways. Using the nine parameters, children's temperaments may be categorized into three major groups: easy, difficult, and slow to warm up. Difficult children are irritable, highly active, and intense; they react to new experiences by withdrawing and are frustrated easily. Flexible and complex are not categories of temperament. A slow-to-warm-up child would display moodiness and less activity. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, GENETIC INFLUENCE ON CHILD HEALTH, p. 27. Chapter 2: Factors Influencing Child Health - Page 27

The nurse is caring for a Native American child. Which approach would be most consistent with the culture? warning about overuse of analgesics discussing treatment as reestablishing harmony reminding the child to speak respectfully to older adults urging parents to arrange respite care through an agency

discussing treatment as reestablishing harmony Explanation: Harmony with nature means health and disharmony means illness in the Native American culture. Treatment explained as restoring harmony would be understood. Overuse of analgesics is not likely due to the belief that pain is meant to be tolerated. Respite care would be sought through the tribe and extended family, not an agency. Elders are highly respected in the culture; reminding about respectful speech should not be necessary. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Development and Disease Distribution, p. 29. Chapter 2: Factors Influencing Child Health - Page 29

When caring for a woman in her sixth month of pregnancy, the client reports her plans to nurse her baby for at least 2 to 3 years like the rest of the women in her family. Based upon the nurse's knowledge, the nurse should: document her report but do nothing as this is a cultural belief that should be respected. advise her to be careful who she discusses this with as many will consider that a type of reportable child mistreatment. encourage her to start the baby on formula after the first year as recommended by many health care providers. discuss how painful this will be once the baby has teeth.

document her report but do nothing as this is a cultural belief that should be respected. Explanation: Culturally specific decisions should be respected and incorporated into the plan of care. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, TABLE 2.2 Types of Family Structures, p. 34. Chapter 2: Factors Influencing Child Health - Page 34

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

ethnocentrism. Explanation: Ethnocentrism is a belief that one's own culture or customs are superior to those of others. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, CULTURE, p. 40. Chapter 2: Factors Influencing Child Health - Page 40

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

infants Explanation: The physiologic immaturity of an infant's body systems increases the risk for infection. Ingestion of toxic substances and risk of poisoning are major health concerns for toddlers as they become more mobile and inquisitive. Because preschool- and school-age children are, generally, very active, they are more prone to injury and accidents. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Temperament, p. 28. Chapter 2: Factors Influencing Child Health - Page 28

A 4-year-old boy is residing permanently with his grandparents. Which situation is unique to this type of family or living arrangement? obstacles to obtaining informed consent for treatment physical and financial stress on the caregivers gaining consensus between the caregivers regarding treatment difficulty obtaining accurate health history and records

physical and financial stress on the caregivers Explanation: Grandparents, due to age and income levels, are uniquely prone to this type of stress. Difficulty obtaining an accurate health history or records is common in foster families. Obstacles to obtaining informed consent for treatment and gaining consensus between caregivers regarding treatment occur most often in the binuclear family. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Barriers to Health Care, p. 31. Chapter 2: Factors Influencing Child Health - Page 31

The nurse is collecting information from the mother of 3-year-old twins. The records show the mother is single. When planning care, what topic is of the highest priority for the nurse to investigate? support network home size financial resources availability of health insurance

support network Explanation: Single-parent families have several concerns that can affect the health of the children. Life in a single-parent household can be stressful for both the adult and for the children. The single parent may feel overwhelmed with no one to share the day-to-day responsibilities. Financial resources, insurance, and living conditions are of concern but are not the highest priority. Reference: Kyle, T., & Carman, S., Essentials of Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 2: Factors Influencing Child Health, Genetically Linked Diseases, p. 28. Chapter 2: Factors Influencing Child Health - Page 28