Chapter1 Flashcards
Which nursing role is not directly involved when providing a family-centered approach to the pediatric population?
- Advocacy
- Case management
- Patient education
- Researcher
Answer: 4
Explanation:
A researcher is not involved in the family-centered approach to patient care of children and their families. Advocacy, case management, and patient education are all roles directly involved in the care of children and their families.
A nurse is working with pediatric clients in a research facility. The nurse recognizes that federal guidelines are in place that delineate which pediatrics clients must give assent for participation in research trials. Based upon the client’s age, the nurse would seek assent from which children?
Select all that apply.
1. The precocious 4-year-old commencing as a cystic fibrosis research-study participant.
2. The 7-year-old leukemia client electing to receive a newly developed medication, now being researched.
3. The 10-year-old commencing in an investigative study for clients with precocious puberty.
4. The 13-year-old client commencing participation in a research program for Attention Deficit Hyperactivity Disorder (ADHD) treatments.
Answer: 2, 3, 4
Explanation:
Federal guidelines mandate that research participants 7 years old and older must receive developmentally appropriate information about healthcare procedures and treatments and give assent.
Page Ref: 11, 12
The nurse in a pediatric acute care unit is assigned the following tasks. Which task is not appropriate for the nurse to complete?
- Diagnose an 8-year-old with acute otitis media and prescribe an antibiotic.
- Listen to the concerns of an adolescent about being out of school for a lengthy surgical recovery.
- Provide information to a mother of a newly diagnosed 4-year-old diabetic about local support-group options.
- Diagnose a 6-year-old with a Diversional Activity Deficit related to placement in isolation
Answer: 1
Explanation:
The role of the pediatric nurse includes providing nursing assessment, directing nursing care interventions, and educating client and family at developmentally appropriate levels; client advocacy, case management, minimization of distress, and enhancement of coping. Advanced practice nurse practitioners perform assessment, diagnosis, and management of health conditions.
A 7-year-old child is admitted for acute appendicitis. The parents are questioning the nurse about expectations during the child’s recovery. Which information tool would be most useful in answering a parent’s questions about the timing of key events?
- Healthy People 2020
- Clinical pathways
- Child mortality statistics
- National clinical practice guidelines
Answer: 2
Explanation:
Clinical pathways are interdisciplinary documents provided by a hospital to suggest ideal sequencing and timing of events and interventions for specific diseases to improve efficiency of care and enhance recovery. This pathway serves as a model outlining the typical hospital stay for individuals with specified conditions. Healthy People 2020 contains objectives set by the U.S. government to improve the health and reduce the incidence of death in the twenty-first century. Child mortality statistics can be compared with those from other decades for the evaluation of achievement toward health-care goals. National clinical practice guidelines promote uniformity in care for specific disease conditions by suggesting expected outcomes from specific interventions.
The nurse recognizes that the pediatric client is from a cultural background different from that of the hospital staff. Which goal is most appropriate for this client when planning nursing care?
- Overlook or minimize the differences that exist.
- Facilitate the family’s ability to comply with the care needed.
- Avoid inadvertently offending the family by imposing the nurse’s perspective.
- Encourage complementary beneficial cultural practices as primary therapies.
Answer: 2
Explanation:
The incorporation of the family’s cultural perspective into the care plan is most likely to result in the family’s ability to accept medical care and comply with the regimen prescribed. Since culture develops from social learning, attempts to ignore or minimize cultural consideration will result in mistrust, suspicion, or offenses that can have negative effects upon the health of children by reducing the resources available to promote health and prevent illness. Complementary therapy may be used later if other primary therapies prove to be ineffective.
The telephone triage nurse at a pediatric clinic knows each call is important. Which call would require attentiveness from the nurse because of an increased risk of mortality?
- A 3-week-old infant born at 35 weeks gestation with gastroenteritis
- A term 2-week-old infant of American Indian descent with an upper respiratory infection
- A postterm 4-week-old infant non-Hispanic black descent with moderate emesis after feeding
- A 1-week-old infant born at 40 weeks’ gestation with symptoms of colic
Answer: 1
Explanation:
The leading causes of death in the neonatal period (birth to 28 days of age) are short gestation, low birth weight, and congenital malformations. The preterm infant experiencing gastroenteritis at 3 weeks of age is at the greatest risk for mortality; therefore, would require extra attentiveness from the registered nurse.
Despite the availability of Children’s Health Insurance Programs (CHIP), many eligible children are not enrolled. Which nursing intervention would be the most appropriate to help children become enrolled in CHIP?
- Assess details of the family’s income and expenditures
- Case management to limit costly, unnecessary duplication of services
- Advocate for the child by encouraging the family to investigate SCHIP eligibility
- Educate the family about the need for keeping regular well-child-visit appointments
Answer: 3
Explanation:
In the role of an advocate, a nurse will advance the interests of another; by suggesting the family investigate its CHIP eligibility, the nurse is directing their action toward the child’s best interest. Financial assessment is more commonly the function of a social worker. The case-management activity mentioned will not provide a source of funding nor will the educational effort described.
A supervisor is reviewing documentation of the nurses in the unit. Which client documentation is the most accurate and contains all the required part for a narrative entry?
- “2/2/05 1630 Catheterized using an 8 French catheter, 45 mL clear yellow urine obtained, specimen sent to lab, squirmed and cried softly during insertion of catheter. Quiet in mother’s arms following catheter removal. M. May RN”
- “1/9/05 2 pm nasogastric tube placement confirmed and irrigated with 30 ml sterile water. Suction set at low, intermittent. Oxygen via nasal canal at 2 L/min. Nares patent, pink, and nonirritated. K. Earnst RN”
- “4:00 tracheostomy dressing removed with dime-size stain of dry serous exudate. Site cleansed with normal saline. Dried with sterile gauze. New sterile tracheostomy sponge and trach ties applied. Respirations regular and even throughout the procedure. F. Luck RN”
- “Feb. ‘05 Port-A-Cath assessed with Huber needle. Blood return present. Flushed with NaCl solution, IV gamma globulins hung and infusing at 30 cc/hr. Child smiling and playful throughout the procedure. P. Potter, RN”
Answer: 1
Explanation:
The client record should include the date and time of entry, nursing care provided, assessments, an objective report of the client’s physiologic response, exact quotes, and the nurse’s signature and title.
A 12-year-old pediatric client is in need of surgery. Which member of the healthcare team is legally responsible for obtaining informed consent for an invasive procedure?
- Nurse
- Physician
- Unit secretary
- Social worker
Answer: 2
Explanation:
Informed consent is legal preauthorization for an invasive procedure. It is the physician’s legal responsibility to obtain this, because it consists of an explanation about the medical condition, a detailed description of treatment plans, the expected benefits and risks related to the proposed treatment plan, alternative treatment options, the client’s questions, and the guardian’s right to refuse treatment.
A child is being prepared for an invasive procedure. The mother of the child has legal custody but is not present. After details of the procedure are explained, who can provide legal consent on behalf of a minor child for treatment?
- The divorced parent without custody
- A cohabitating boyfriend of the child’s mother
- A grandparent who lives in the home with the child
- A babysitter with a written proxy
Answer: 4
Explanation:
A parent may grant proxy consent in writing to another adult so that children are not denied necessary healthcare. In the case of divorced parents, the parent with custody may be the only parent allowed by some states to give informed consent. Residence in the same household with a child does not authorize an adult to sign consent for treatment.
A 12-year-old child is admitted to the unit for a surgical procedure. The child is accompanied by two parents and a younger sibling. What is the level of involvement in treatment decision making for this child?
- Emancipated minor
- Mature minor
- Assent
- None
Answer: 3
Explanation:
Assent requires the ability to generally understand what procedure and treatments are planned, to understand what participation is required, and to make a statement of agreement or disagreement with the plan. Usually, in Piaget’s stage of formal operations, 11- to 13-year-olds should be able to problem solve using abstract concepts and are able to give valid assent when parents sign the informed consent. An emancipated minor is a self-supporting adolescent who is not subject to the control of a parent or guardian. A mature minor is a 14- or 15-year-old whom the state law designates as being able to understand medical risks and who is thus permitted to give informed consent for treatment.
Which nursing intervention is most appropriate when providing education to the pediatric client and family?
- Giving primary care for high-risk children who are in hospital settings
- Giving primary care for healthy children
- Working toward the goal of informed choices with the family
- Obtaining a physician consultation for any technical procedures at delivery
Answer: 3
Explanation:
The educator works with the family toward the goal of making informed choices through education and explanation.
What is the pediatric nurse’s best defense against an accusation of malpractice or negligence?
- Following the physician’s written orders
- Meeting the scope and standards of practice for pediatric nursing
- Being a nurse practitioner or clinical nurse specialist
- Acting on the advice of the nurse manager
Answer: 2
Explanation:
Meeting the scope and standards of practice for pediatric nursing would cover the pediatric nurse against an accusation of malpractice or negligence because the standards are rigorous and cover all bases of excellent nursing practice. Following the physician’s written orders or acting on the advice of the nurse manager are not enough to defend the nurse from accusations because the orders and/or advice may be wrong or unethical. Being a clinical nurse specialist or nurse practitioner does not defend the nurse against these accusations if he or she does not follow the Society of Pediatric Nurses standards of practice.
Which legal or ethical offense would be committed if a nurse tells family members the condition of a newborn baby without first consulting the parents?
- A breach of privacy
- Negligence
- Malpractice
- A breach of ethics
Answer: 1
Explanation:
A breach of privacy would have been committed in this situation, because it violates the right to privacy of this family. The right to privacy is the right of a person to keep his or her person and property free from public scrutiny, including other family members. Negligence and malpractice are punishable legal offenses and are more serious. A breach of ethics would not apply to this situation.
Pediatric nurses have foundational knowledge obtained in nursing school and add specific competencies related to the pediatric client. Which would be considered an additional specific expected competency of the pediatric nurse?
- Physical assessment
- Anatomical and developmental differences
- Nursing process
- Management of healthcare conditions
Answer: 2
Explanation: 1. Assessing anatomical and developmental differences would be a specific expected competency for the pediatric nurse that would not be learned in nursing school. Physical assessment, nursing process, and management of health conditions are all foundational knowledge learned in nursing school.
