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Flashcards in Chapter 20 Deck (10):
1

The nurse working in an outpatient surgery center for children should understand that
a. children's anxiety is minimal in such a center.
b. waiting is not stressful for parents in such a center.
c. accurate and complete discharge teaching is the responsibility of the surgeon.
d. families need to be prepared for what to expect after discharge.

Ans: D
Discharge instructions should be provided in both written and oral form and in the primary language of the patient and family. Instructions need to include normal responses to the procedure and when to notify the practitioner if untoward reactions occur.
Although anxiety may be reduced because of the lack of an overnight stay, the child will still experience the stress associated with a medical procedure.
The waiting period while the child is having the procedure is a stressful time for families in both outpatient and inpatient settings.
Discharge instructions are a responsibility of both the surgeon and the nursing staff.

2

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress the
a. importance of reducing caloric intake to decrease cardiac demands.
b. importance of relaxing discipline and limit-setting to prevent crying.
c. need to be extremely concerned about cyanotic spells.
d. desirability of promoting normalcy within the limits of the child's condition.

Ans: D
The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child.
The child needs increased caloric intake after cardiac surgery.
The child needs discipline and appropriate limit setting, as would be done with any other child his or her age.
Because cyanotic spells will occur in children with some defects, the parents need to be taught how to assess for and manage them appropriately, thereby decreasing their anxiety and concern.

3

A case manager is assigned to coordinate the care of a child with a complex medical condition. The family is told that one of the goals is to control costs. This goal should be recognized as
a. unsafe.
b. realistic.
c. impossible.
d. inappropriate.

Ans: B
Management of costs is one part of case management. With a case manager providing coordination and continuity across care settings and facilitating access to needed medical services, cost control is a realistic outcome.
Cost management will only be unsafe if treatment and equipment necessary for the child's care are denied.
Cost management is a realistic goal for the case manager, not an impossible one.
Cost management is a realistic goal for the case manager, not an inappropriate one, unless treatment or equipment necessary for the child's care is denied.

4

A nurse has been assigned as the home health nurse for a technologically dependent child. The nurse recognizes that the background of this family differs widely from the nurse's own. The nurse views some of their lifestyle choices as less than ideal. What is the most appropriate nursing intervention?
a. Assign the nurse a different family to follow.
b. Respect the differences
c. Assess why the family is different
d. Determine whether the family is dysfunctional

Ans: B
The nurse must respect the family's culture and background. The family is the constant in the child's life, and cultural awareness and sensitivity are critical to a nurse's care of a child and family.
The nurse may have some influence on care necessary for the child, but it is inappropriate to assign the nurse to a different family. Nurses must be able to work with families from all cultural groups and respect the differences between the families' cultural norms and those of the nurse’s own culture.
The nurse will assess the differences, but respecting these differences is what is important.
Cultural differences do not make a family dysfunctional, unless the cultural practices are putting the child at risk.

5

Prior to accepting an assignment as a home health nurse, the nurse must realize that
a. the family is in charge.
b. all decisions are made by the healthcare provider.
c. the family will adapt their lifestyle to the needs of the nurse.
d. independent decisions regarding emergency care of the child are made by the nurse.

Ans: A
The nurse must realize that the family is in charge.
The family is in charge and the healthcare providers must realize this matter.
The nurse must be flexible and adaptable to the family’s lifestyle.
Informed consent must be provided by the family for emergency care – any care.

6

Prior to returning to school, an individualized home care plan (IHCP) needs to be developed for which child?
a. The child recently identified with a penicillin allergy.
b. The child being treated for pediculosis capitis (head lice).
c. The child out of school for two week due to mononucleosis.
d. The child recently diagnosed with insulin-dependent diabetes mellitus.

Ans: D
An IHCP is needed for the insulin-dependent child to ensure appropriate management of health care needs is in place.
The child allergic to penicillin will not receive this medication anymore and a medication alert ID is necessary. An IHCP is not needed.
The child treated for pediculosis capitis (head lice) can return to school and does not need an IHCP.
The child who missed two weeks of school will need arrangements made for make-up work and an IHCP is not needed.

7

A home health nurse is assigned to an adolescent with recently acquired quadriplegia. The adolescent’s mother tells the nurse, “I’m sick of providing all the care while my husband does whatever he wants and whenever he wants.” Based on the nurse’s knowledge of family-centered care, the most appropriate nursing intervention is to
a. listen and reflect the mother’s feelings.
b. refer the mother for psychological counseling.
c. suggest ways the mother can get the husband to help with care.
d. meet with the adolescent’s father in private and ask why he does not help.

Ans: A
It is appropriate for the nurse to reflect with the mother about her feelings and explore avenues for additional home health assistance and provide respite care for the mother.
A support group for caregivers is more appropriate at this time, not counseling.
It is inappropriate for the nurse to agree with the mother that the husband is not helping enough. The nurse is making a judgment that is beyond the role of the nurse in addition to undermining the family relationship.
It is inappropriate to meet with the father privately because the meeting is based on the mother’s assumption of the father’s minimal involvement with the adolescent’s care. The father may be working two jobs to support the family’s additional expenses.

8

A home health nurse is caring for a 2-week-old infant and notes on assessment that the infant has a string tied around the wrist. The nurse checks for adequate circulation. The most appropriate nursing intervention by the nurse is to
a. ask the parents to remove the string.
b. report the parents to Social Services for child endangerment.
c. remove the string and inform the parents that the string is dangerous.
d. ask the parents the meaning of the string and leave the string in place.

Ans: D
Families of various cultural backgrounds have specific beliefs about health care. These beliefs may differ from the nurse’s beliefs and the nurse needs to honor the practices and seek clarification of the cultural practice.
The nurse should honor the practices of the family. For the nurse to do otherwise would lead to loss of trust from the family. The nurse needs to provide education to the family that includes safety principles as the infant grows.
The nurse should honor the practices of the family. For the nurse to do otherwise would lead to loss of trust from the family. The nurse needs to provide education to the family that includes safety principles as the infant grows.
The nurse should honor the practices of the family. For the nurse to do otherwise would lead to loss of trust from the family. The nurse needs to provide education to the family that includes safety principles as the infant grows.

9

A ventilator-dependent child is being discharged home from the hospital. Prior to discharge, the home health care nurse discusses the development of an emergency plan with the family. The most essential component(s) of the plan is/are (Select all that apply.)
a. acquisition of a backup generator.
b. designation of an emergency shelter.
c. notifying the power company that the child is on life support.
d. provision for alternate heating and cooling source if power is lost.
e. notifying emergency medical services that child is on life support.

Ans: A

10

____________ ___________ ensures continuity of care, prevents duplication of services, helps control costs, reduces fragmentation of care, and decrease the burden of care for the family.

Ans: "Care coordination, Care coordination"
Care coordination (case management) goal is to link patient-family with special health needs to services and resources in a coordinated effort to provide optimum care.