Prep-U: Ch. 1: Introduction to Child Health and Pediatric Nursing

Consent for urgent treatment is needed for a minor. The parents are unable to be at the hospital. What action by the nurse constitutes informed consent?

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

The 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?

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

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?

Continuity of care Explanation: 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 is receiving an extension of the care received in the hospital to the home.

The student nurse is preparing a presentation on Lillian Wald's contributions to nursing. After presenting information on the Henry Street Settlement House, which comments by the audience indicates understanding of the material presented? Select all that apply.

"A lot of financially poor families were helped by the Henry Street Settlement House." "Lillian Wald helped initiate public health nursing through the Henry Street Settlement House." "Many children were helped by the Henry Street Settlement House by educating mothers about proper health care of their children." Explanation: In the early 1900s, Lillian Wald established the Henry Street Settlement House in New York City; this was the start of public health nursing. This facility provided medical and other services to poor families. These services included home nurse visits to teach mothers about health care.

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?

"This certifies that I have specialized in the field of oncology/hematology care of children." Explanation: While all statements may be accurate, the statement that best defines the certification, "This certification represents specialized learning that I have in the field of oncology/hematology care of children," 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 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.v

"This group will review each case presented and formulate a decision for the facility." "Education concerning ethics is a role of the committee." "The role of the ethics committee has increased over the years." Explanation: 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, physicians, 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 school nurse is calculating the morbidity rate of an elementary school's absenteeism related to a highly communicable infection that has been present in the school over the last two weeks. Today the school has 127 of its 300 students absent. What is the morbidity rate that the nurse will report?

42.3 Explanation: The most important aspect of morbidity is the degree of disability it produces, which is identified in children as the number of days missed from school or confined to bed. There are 127 students absent, which when divided by 300 (total student population) is 42.33%, which rounds to 42.3%.

The nurse is caring for a child who underwent an appendectomy 12 hours ago. The child has reported incisional pain. When the nurse attempts to administer the prescribed analgesic the child's mother declines the medication. What initial action by the nurse is most appropriate?

Ask the child's mother to elaborate on her concerns about the medication. Explanation: Some people may not approve of the administration of narcotics or medications containing alcohol. The nurse must first determine the cause of the concern. Then action can be taken to best provide care to the child. Continuing observation of the child does not address the needs related to pain management. Although the client's physician or the nursing supervisor may be contacted, it is not the initial action in this scenario.

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?

Family-centered care Explanation: 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.

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 is the most important first step in developing the nursing care plan for these children?

Determining whether the children were traumatized by the accident Explanation: Determining whether the children were traumatized by the accident requires assessing the children and their responses. This is the first step in the nursing process and basic to establishing a nursing diagnosis. Arranging for counseling of children and friends of the injured may later become part of the plan if the need is demonstrated. Gaining permission from the parents for counseling would also be a later step.

The nurse is caring for a 2-year-old boy who needs a lumbar puncture. His mother is present. What would prevent informed consent from being obtained?

Learning the mother is not the custodial parent Explanation: 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 parent of an 11-year-old girl with an inoperable brain tumor confides to the nurse that her daughter's physician is "pushing them" to convince their daughter to participate in a controversial treatment that has a high risk for side effects. She further states that she told him twice that they were not interested. What would be the nurse's best response to this situation?

Meet with the physician and disclose the concerns of the family; refer the case to the institutional ethics committee if not resolved. Rationale: When a nurse believes the physician has unduly coerced parents in their treatment decision, the nurse would be obliged to intervene and disclose any concerns. Such intentional or unintentional action would violate ethical principles of conduct.

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?

Showing the mother how to teach hand washing to her child Explanation: Teaching hand washing 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 hand washing does. Knowing about developmental milestones and typical physical changes in toddlers does not directly promote preventive care.

A group of students are reviewing information about Medicaid. Which statement shows inadequate knowledge of the topic?

The federal government is responsible for administering it. Ratiionale: Medicaid is a form of health insurance for low-income and disabled individuals. It is financed by federal and state funds and administered by the states. Medicaid is not a direct provider of service, but rather provides compensation for health care services. Federal guidelines define the scope of basic services, the extent of coverage, and certain administrative requirements. The states administer the program and determine income eligibility criteria, specific services to be covered, and payment levels and methods.

The community health nurse is looking at measurements to capture information about general health status for a group of inner city children using recommendations of Healthy People 2020. Which factors are appropriate? Select all that apply.v

The number of days missed from school related to illness. How the individual child considers his health. History of chronic disease. Explanation: Healthy People has established "Four Foundation Health Measures". When reviewing general health status, there are a series of measures identified. These include life expectancy, health life expectancy, years of potential life lost, physically and mentally unhealthy days, self-assessed health status, limitation of activity, and chronic disease prevalence.

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?

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.

What was the primary goal for the establishment of the Children's Bureau?v

To improve the standards of health care Explanation: 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.

Which nursing activity requires the pediatric nurse to implement the ethical principle of nonmaleficence?

Weighing the potential harm caused by a child's chemotherapy with its potential benefits Explanation: 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.

Pediatric nurses are developing more home care and community-based services for children with chronic illnesses because:

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

A nurse is caring for a child. Which individual would the nurse identify as being primarily responsible for initiating and coordinating health care?

parents Rationale: Parents and guardians have the primary responsibility for initiating and coordinating services rendered by health professionals. A social worker or case manager may be involved but are not primarily responsible for the child's care. The community provides programs to promote and support children's health.