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1

The role of the pediatric nurse is influenced by trends in health care. Which is an influential trend in pediatric health care?
a. Primary focus on treatment of disease or disability
b. Shift of focus to maintenance of health and illness prevention
c. National health care planning on a distributive or episodic basis
d. Accountability to professional codes and international standards

Ans: B
Maintenance of health and illness prevention is the current focus of health care in which nursing plays a major role.
Traditionally, the primary focus on treatment of disease or disability is the role of the physician.
National health care planning on a distributive or episodic basis is not a major trend.
Accountability to professional codes and international standards is an established responsibility, not a trend.

2

The etiology component of the nursing diagnosis describes the
a. projected changes in an individual's health status, clinical conditions, or behavior.
b. individual's responses to health pattern deficits in the child, family, or community.
c. cluster of cues and/or defining characteristics that are derived from patient assessment and indicate actual health problems.
d. physiologic, situational, and maturational factors that cause the problem or influence its development.

Ans: D
The etiology component of the nursing diagnosis, the second component of the nursing diagnosis, describes the physiologic, situational, and maturational factors that cause the problem or influence its development.
Projected changes in an individual's health status, clinical conditions, or behavior are the outcomes or goals that are established.
An individual's responses to health pattern deficits in the child, family, or community is the definition of the problem statement, the first component of the nursing diagnosis.
The cluster of cues and/or defining characteristics that are derived from patient assessment and indicate actual health problems is the third part of the nursing diagnosis, the signs and symptoms.

3

Nurses play an important role in current issues and trends in health care. Which is a current trend in pediatric nursing and health care today?
a. The patient is the unit of care for the health care provider.
b. Discharge planning begins when the physician writes the order.
c. Health promotion resources enable children to achieve their full potential.
d. The focus of pediatric health care is trending toward acute hospital care

Ans: C
Health promotion provides opportunities to reduce differences in current health status among members of different groups and provides a better chance to achieve the fullest health potential.
The patient and family is the unit of care for the health care provider.
Discharge planning begins when the patient is admitted.
The focus of pediatric health care is trending away from acute hospital settings.

4

The nurse is providing education to a group of parents at a health fair in a local kindergarten school. The nurse describes the most common cause of death for children age 5 to 9 years is
a. inappropriate use of bike helmets and seat belts.
b. childhood immunizations.
c. lack of hand washing in the prevention of communicable diseases.
d. the obesity epidemic.

Ans: A
The most common cause of death in children age 5 to 9 years is accidents. Education on safety is important to help prevent accidental deaths.
Accidents are the most common cause of death for children age 5 to 9 years, not childhood immunizations.
Accidents are the most common cause of death for children age 5 to 9 years. Hand washing helps to prevent communicable diseases.
Accidents are the most common cause of death for children 5 to 9 years, not obesity.

5

The nurse demonstrates understanding of family-centered care by
a. encouraging family visitation.
b. assuming total care for the child.
c. limiting visitation to three time periods per day.
d. expecting the child to perform self-care in activities of daily living.

Ans: A
Family-centered care recognizes the family as the constant in a child’s life and visitation supports this philosophy in addition to developing trusting relationships with families.
Family-centered care does not assume total care for the child.
Limiting visitation is the exact opposite of family-centered care.
Family-centered care involves more than expectations for the child.

6

A child is admitted to the hospital with a diagnosis of possible meningitis. Which information is the most important to ask at the time of admission?
a. “Are there any pets in the household?”
b. “Is anyone else in the household ill?”
c. “Are the immunizations up to date?
d. “Has the child had a recent injury?”

Ans: C
Immunizations are one of two public health interventions that have had the greatest impact on world health, with clean public drinking water being the other. Nurses should review individual immunization records at every clinical visit and/or hospitalization. In addition, nurses are responsible for keeping current in changes in immunization schedules, recommendations, and research related to childhood vaccines.

7

Which nursing intervention would be most effective in decreasing mortality from unintentional injury?
a. Teaching children the dangers of contact sports
b. Encouraging potential parents to obtain genetic counseling
c. Educating parents-caretakers about the benefits of immunizations
d. Teaching parents-caretakers about proper use of vehicle restraint seats

Ans: D
The most common cause of death for the age group 1-19 years is unintentional injuries such as motor vehicle accidents, drowning, and firearms.
Teaching the dangers of contact sports will not decrease mortality from unintentional injuries such as motor vehicle accidents.
Genetic counseling does not decrease mortality from unintentional injuries.
The most common cause of mortality in children is unintentional injuries. Immunization education is not most effective.

8

A nurse is preparing an educational workshop on atraumatic care in pediatric patient care. The most appropriate nursing intervention to include in the workshop is to
a. prepare the child that their parents will not be able stay during hospitalization by watching a video.
b. help the child to accept the pain associated with any treatments, procedures, or surgery.
c. tell the child that the loss of control and privacy in the hospital is temporary.
d. provide the child play activities for expression of fear and aggression.

Ans: D
Allowing the child play activities for the expression of fear and aggression are principles of atraumatic care.
Atraumatic care is to prevent or minimize the child’s separation from the family.
Minimizing or preventing bodily injury and pain are principles of atraumatic care.
Promoting a sense of control and privacy are components of atraumatic care.

9

____________ provides a rational approach to decision making that facilitates best practice.

Evidence-based practice (EBP) complements the nursing process by the use of critical thinking skills to make decisions based on existing knowledge.

10

The nursing process is a method of problem identification and problem-solving that describes what the nurse actually does. The five-step nursing process model includes (Select all that apply)
a. Planning
b. Diagnosis
c. Evaluation
d. Assessment
e. Identification
f. Implementation

Ans: A, B, C, D, F

11


1. A nurse is planning a teaching session for parents of preschool children. Which statement explains why the nurse should include information about morbidity and mortality?
a. Life-span statistics are included in the data.
b. It explains effectiveness of treatment.
c. Cost-effective treatment is detailed for the general population.
d. High-risk age groups for certain disorders or hazards are identified.

ANS: D
Analysis of morbidity and mortality data provides the parents with information about which groups of individuals are at risk for which health problems. Life-span statistics is a part of the mortality data. Treatment modalities and cost are not included in morbidity and mortality data.

12

2. A clinic nurse is planning a teaching session about childhood obesity prevention for parents of school-age children. The nurse should include which associated risk of obesity in the teaching plan?
a. Type I diabetes
b. Respiratory disease
c. Celiac disease
d. Type II diabetes

ANS: D
Childhood obesity has been associated with the rise of type II diabetes in children. Type I diabetes is not associated with obesity and has a genetic component. Respiratory disease is not associated with obesity, and celiac disease is the inability to metabolize gluten in foods and is not associated with obesity.

13

3. Which is the leading cause of death in infants younger than 1 year?
a. Congenital anomalies
b. Sudden infant death syndrome
c. Respiratory distress syndrome
d. Bacterial sepsis of the newborn

ANS: A
Congenital anomalies account for 20.1% of deaths in infants younger than 1 year. Sudden infant death syndrome accounts for 8.2% of deaths in this age group. Respiratory distress syndrome accounts for 3.4% of deaths in this age group. Infections specific to the perinatal period account for 2.7% of deaths in this age group.

14

4. Which leading cause of death topic should the nurse emphasize to a group of African-American boys ranging in ages 15 to 19 years?
a. Suicide
b. Cancer
c. Firearm homicide
d. Occupational injuries


ANS: C
Firearm homicide is the second overall cause of death in this age group and the leading cause of death in African-American males. Suicide is the third-leading cause of death in this population. Cancer, although a major health problem, is the fourth-leading cause of death in this age group. Occupational injuries do not contribute to a significant death rate for this age group.

15

5. Which is the major cause of death for children older than 1 year?
a. Cancer
b. Heart disease
c. Unintentional injuries
d. Congenital anomalies

ANS: C
Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence. Congenital anomalies are the leading cause of death in those younger than 1 year. Cancer ranks either second or fourth, depending on the age group, and heart disease ranks fifth in the majority of the age groups.

16

6. Which is the leading cause of death from unintentional injuries for females ranging in age from 1 to 14?
a. Mechanical suffocation
b. Drowning
c. Motor–vehicle-related fatalities
d. Fire- and burn-related fatalities


ANS: C
Motor–vehicle-related fatalities are the leading cause of death for females ranging in age from 1 to 14, either as passengers or as pedestrians. Mechanical suffocation is fourth or fifth, depending on the age. Drowning is the second- or third-leading cause of death, depending on the age. Fire- and burn-related fatalities are the second-leading cause of death.

17

7. Which factor most impacts the type of injury a child is susceptible to, according to the child’s age?
a. Physical health of the child
b. Developmental level of the child
c. Educational level of the child
d. Number of responsible adults in the home

ANS: B
The child’s developmental stage determines the type of injury that is likely to occur. The child’s physical health may facilitate the child’s recovery from an injury but does not impact the type of injury. Educational level is related to developmental level, but it is not as important as the child’s developmental level in determining the type of injury. The number of responsible adults in the home may affect the number of unintentional injuries, but the type of injury is related to the child’s developmental stage.

18

8. Which is now referred to as the “new morbidity”?
a. Limitations in the major activities of daily living
b. Unintentional injuries that cause chronic health problems
c. Discoveries of new therapies to treat health problems
d. Behavioral, social, and educational problems that alter health

ANS: D
The new morbidity reflects the behavioral, social, and educational problems that interfere with the child’s social and academic development. It is currently estimated that the incidence of these issues is from 5% to 30%. Limitations in major activities of daily living and unintentional injuries that result in chronic health problems are included in morbidity data. Discovery of new therapies would be reflected in changes in morbidity data over time.

19

9. A nurse on a pediatric unit is practicing family-centered care. Which is most descriptive of the care the nurse is delivering?
a. Taking over total care of the child to reduce stress on the family
b. Encouraging family dependence on health care systems
c. Recognizing that the family is the constant in a child’s life
d. Excluding families from the decision-making process

ANS: C
The three key components of family-centered care are respect, collaboration, and support. Family-centered care recognizes the family as the constant in the child’s life. Taking over total care does not include the family in the process and may increase stress instead of reducing stress. The family should be enabled and empowered to work with the health care system. The family is expected to be part of the decision-making process.

20

10. The nurse is preparing an in-service education to staff about atraumatic care for pediatric patients. Which intervention should the nurse include?
a. Prepare the child for separation from parents during hospitalization by reviewing a video.
b. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal.
c. Help the child accept the loss of control associated with hospitalization.
d. Help the child accept pain that is connected with a treatment or procedure.

ANS: B
Preparing the child for any unfamiliar treatments, controlling pain, allowing privacy, providing play activities for expression of fear and aggression, providing choices, and respecting cultural differences are components of atraumatic care. In the provision of atraumatic care, the separation of child from parents during hospitalization is minimized. The nurse should promote a sense of control for the child. Preventing and minimizing bodily injury and pain are major components of atraumatic care.

21

11. Which is most suggestive that a nurse has a nontherapeutic relationship with a patient and family?
a. Staff is concerned about the nurse’s actions with the patient and family.
b. Staff assignments allow the nurse to care for same patient and family over an extended time.
c. Nurse is able to withdraw emotionally when emotional overload occurs but still remains committed.
d. Nurse uses teaching skills to instruct patient and family rather than doing everything for them.

ANS: A
An important clue to a nontherapeutic staff-patient relationship is concern of other staff members. Allowing the nurse to care for the same patient over time would be therapeutic for the patient and family. Nurses who are able to somewhat withdraw emotionally can protect themselves while providing therapeutic care. Nurses using teaching skills to instruct patient and family will assist in transitioning the child and family to self-care.

22

12. Which is most descriptive of clinical reasoning?
a. A simple developmental process
b. Purposeful and goal-directed
c. Based on deliberate and irrational thought
d. Assists individuals in guessing what is most appropriate

ANS: B
Clinical reasoning is a complex, developmental process based on rational and deliberate thought. Clinical reasoning is not a developmental process. Clinical reasoning is based on rational and deliberate thought. Clinical reasoning is not a guessing process.

23

13. A nurse makes the decision to apply a topical anesthetic to a child’s skin before drawing blood. Which ethical principle is the nurse demonstrating?
a. Autonomy
b. Beneficence
c. Justice
d. Truthfulness

ANS: B
Beneficence is the obligation to promote the patient’s well-being. Applying a topical anesthetic before drawing blood promotes reducing the discomfort of the venipuncture. Autonomy is the patient’s right to be self-governing. Justice is the concept of fairness. Truthfulness is the concept of honesty.

24

14. Which action by the nurse demonstrates use of evidence-based practice (EBP)?
a. Gathering equipment for a procedure
b. Documenting changes in a patient’s status
c. Questioning the use of daily central line dressing changes
d. Clarifying a physician’s prescription for morphine

ANS: C
The nurse who questions the daily central line dressing change is ascertaining whether clinical interventions result in positive outcomes for patients. This demonstrates evidence-based practice (EBP), which implies questioning why something is effective and whether a better approach exists. Gathering equipment for a procedure and documenting changes in a patient’s status are practices that follow established guidelines. Clarifying a physician’s prescription for morphine constitutes safe nursing care.

25

15. A nurse is admitting a toddler to the hospital. The toddler is with both parents and is currently sitting comfortably on a parent’s lap. The parents state they will need to leave for a brief period. Which type of nursing diagnosis should the nurse formulate for this child?
a. Risk for anxiety
b. Anxiety
c. Readiness for enhanced coping
d. Ineffective coping

ANS: A
A potential problem is categorized as a risk. The toddler has a risk to become anxious when the parents leave. Nursing interventions will be geared toward reducing the risk. The child is not showing current anxiety or ineffective coping. The child is not at a point for readiness for enhanced coping, especially because the parents will be leaving.

26

16. A child has a postoperative appendectomy incision covered by a dressing. The nurse has just completed a prescribed dressing change for this child. Which description is an accurate documentation of this procedure?
a. Dressing change to appendectomy incision completed, child tolerated procedure well, parent present
b. No complications noted during dressing change to appendectomy incision
c. Appendectomy incision non-reddened, sutures intact, no drainage noted on old dressing, new dressing applied, procedure tolerated well by child
d. No changes to appendectomy incisional area, dressing changed, child complained of pain during procedure, new dressing clean, dry and intact

ANS: C
The nurse should document assessments and reassessments. Appearance of the incision described in objective terms should be included during a dressing change. The nurse should document patient’s response and the outcomes of the care provided. In this example, these include drainage on the old dressing, the application of the new dressing, and the child’s response. The other statements partially fulfill the requirements of documenting assessments and reassessments, patient’s response, and outcome, but do not include all three.

27

17. A nurse is planning a class on accident prevention for parents of toddlers. Which safety topic is the priority for this class?
a. Appropriate use of car seat restraints
b. Safety crossing the street
c. Helmet use when riding a bicycle
d. Poison control numbers

ANS: A
Motor vehicle accidents (MVAs) continue to be the most common cause of death in children older than 1 year, therefore the priority topic is appropriate use of car seat restraints. Safety crossing the street and bicycle helmet use are topics that should be included for preschool parents but are not priorities for parents of toddlers. Information about poison control is important for parents of toddlers and would be a safety topic to include but is not the priority over appropriate use of car seat restraints.

28

1. Which behaviors by the nurse indicate a therapeutic relationship with children and families? (Select all that apply.)
a. Spending off-duty time with children and families
b. Asking questions if families are not participating in the care
c. Clarifying information for families
d. Buying toys for a hospitalized child
e. Learning about the family’s religious preferences

ANS: B, C, E
Asking questions if families are not participating in the care, clarifying information for families, and learning about the family’s religious preferences are positive actions and foster therapeutic relationships with children and families. Spending off-duty time with children and families and buying toys for a hospitalized child are negative actions and indicate overinvolvement with children and families, which is nontherapeutic.

29

1. A nurse is formulating a clinical question for evidence-based practice. Place in order
the steps the nurse should use to clarify the scope of the problem and clinical topic of interest. Begin with the first step of the process and proceed ordering the steps ending with the final step of the process. Provide answer as lowercase letters separated by commas (e.g., a, b, c, d, e).
a. Intervention
b. Outcome
c. Population
d. Time
e. Control

ANS:
c, a, e, b, d
When formulating a clinical question for evidence-based practice, the nurse should follow a concise, organized way that allows for clear answers. Good clinical questions should be asked in the PICOT (population, intervention, control, outcome, time) format to assist with clarity and literature searching. PICOT questions assist with clarifying the scope of the problem and clinical topic of interest.