family nursing to promote quality maternal and

CHAPTER 31 child health nursing care.

NURSING CARE OF A FAMILY
KEY TERMS
WITH A PRESCHOOL CHILD 1. Broken fluency
CHAPTER OVERVIEW 2. Bruxism
Preschool-age children demonstrate the desire 3. Conservation
to care for themselves through daily activities, 4. Ectomorphic body build
insisting on self-dressing to the point of resisting 5. Electra complex
parental assistance. The nurse should asses the 6. Endomorphic body build
need for parent education related to this 7. Genu valgus
behavior when planning nursing care. This 8. Intuitional thought
chapter discusses developmental task and 9. Oedipus complex
anticipatory guidance for children in this age 10. Secondary stuttering
group. The case study provides an opportunity MASTERING THE INFORMATION
for educating about growth and development ACTIVITY A FILL IN THE BLANKS
during the preschool year. Supply the missing term or the information
requested
LEARNING OBJECTIVES The developmental task for the preschool-age
After mastering the content of this chapter child is to achieve a sense of __________.
you should be able to: _______ _________ refers to the strong emotional
Describe normal growth and development as attachment of a preschool to his mother.
well as common parental concern of the The repetition and/ or prolongation of sounds,
preschool period. symbols, and words is termed_____ _______.
Identify 2020 national health goals related to the ACTIVITY B MATCHING
preschool period that nurses can help the Match the term in column I with a definition,
national achieve. example, or related statement from column II.
Asses a pre-schooler for normal growth and Place the letter corresponding to the answer
development milestones. in the space provided.
Formulate nurses diagnoses related to preschool
growth and development or common parental COLUMN I COLUMN II
concerns. ___ 1) initiative 1. Reverting to
Identify expected outcomes for nursing care of a ___ 2) play behaviors
pre-schooler as well as help parents manage ___ 3) regression
seamless transition across differing health care practiced in
___4) broken fluency
settings. ___5) intuitional earlier years.
Using the nurses process, plan nursing care that thoughts 2. Repetition and
includes the six competencies of quality and prolongation
safety education for nurses (QSEN): patient- of sounds.
centered care, teamwork and collaboration, 3. Activity in w/c
evidence-based practice (EBP), quality important
preschooler
(QI), safety and informatics.
Implement nursing care related to normal need few toys
growth and development of the pre-schooler, due to using
such as preparing a pre-schooler where an their keen
invasive procedure. imagination.
Evaluate expected outcomes for achievements 4. Lacking insight
and effectiveness of care.
to view
Integrates knowledge of preschool growth and
development with the interplay of nursing themselves as
process, the six of competencies of QSEN, and other see
 them; thinking visit, Mrs. Bell ask if she could speak with you for
of themselves a few moments about Bryan. She explains that
as always she is very concerned about Bryan’s fixation on
his genitals, stating that he masturbates at times
right.
and seems to have forgotten what the family has
5. Achievement taught him about his “private parts”.
leading to 1. What guidelines would you use to advice
knowledge Mrs. Bell regarding Bryan’s masturbating?
that learning _______________________________________
new thing is _______________________________________
fun. _______________________________________
2. Outline a teaching plan to help the mother
explain pregnancy and the arrival of a
new baby.
ACTIVITY C SHORT ANSWER
_______________________________________
Supply the missing or the term information
_______________________________________
requested.
_______________________________________
1). Define the following term.
ACTIVITY E CRITICAL INQUIRY EXERCISE
1. endomorphic
Contrast the developmental milestones across
________________________________________________________
the life span of the 3-, 4-, and 5-year –old.
________________________________________________________
Prepare a teaching plan for the parent and
2. ectomorphic
preschooler regarding the implementation of
________________________________________________________
safety measures in the home.
________________________________________________________
ACTIVITY F CRITICAL EXPLORATION
3. genu valgus
Visit a kindergarten and talk with a preschool
________________________________________________________
child near the end of the day. Ask the child to tell
________________________________________________________
you what happened during the day. Asses the
2). Describe the Oedipus and Electra complexes.
child’s language development, understand how
________________________________________________________
the term “egocentrism” applies to the pre-
________________________________________________________
schooler, and identify if the child is
3). Explain how the pre-schooler’s inability to
accomplishing the developmental task of that age
understand the property of conservation may
group.
affect your ability to care for him or her.
Visit a preschool child who is hospitalized for an
________________________________________________________
elective surgery. Talk to the child before the
________________________________________________________
surgery. Obtained three or four pictures
4). what are some therapeutic methods that can
depicting a pediatric hospital area, including the
be practiced by the nurse and family to alleviate
patient’s room and the operating room. Do not
the pre-schooler’s fear of the dark?
include any pictures suggestive of invasive
________________________________________________________
procedures or treatment. Show these pictures to
________________________________________________________
the pre-schooler and ask him or her to make up a
5). Identify your basic rules recommended to
story about the pictures. Record the story as the
resolve secondary stuttering.
preschooler talks to you, identify the statements
________________________________________________________
indicating fear and stress. Notice in the story
________________________________________________________
how the child’s ability to fantasize allows him or
her to stretch the imagination to include the
APPLYING YOUR KNOWLEDGE
procedure, although the pictures do not suggest
ACTIVITY D CASE STUDY aggressive or invasive subjects.
Mrs. Bell and her two children, Amy (age 8 years)
and Bryan (age 4 years), are visiting the health
center today for a well-child appointment. Mrs.
Bell is 6 months pregnant. After the physician’s
 1. Which of the ff. are appropriate nursing
interventions for a pre-schooler?
a. Encourage the pre-schooler to speak
during the health examination.
PRACTICING FOR NLE b. Assess weight and height or standard
ACTIVITY G MULTIPLE-CHOICE QUESTIONS growth chart at each health visit.
Circle the letter that corresponds to the best c. Include head circumference on each
answer for each question. physical examination.
1. Which of the ff. types of play is primarily d. Encourage constructive play
demonstrated by pre-schoolers? e. Provide a helmet for bicycle riding.
1. parallel f. Avoid parental use of medication while
2. imaginary child is watching
3. solitary 2. Which of the ff. would you identify as a
4. cooperative common fear of the preschool period?
2. When preparing a pre-schooler for a. Fear of the dark
hospitalization, you would plan interventions to b. Fear of attending school
address which fear? c. Fear of mutilation
1. Fear of the dark e. Fear of separation
2. Fear of abandonment f. Fear of abandonment
3. Fear of losing control 3. Which of the ff. would you expect a 4-year-old
4. Fear of mutilation child to be able to accomplish?
3. Which action would be most appropriate to a. Draw a six-part man
help lessen the feelings of rivalry among b. Lace has or her shoes
siblings? c. Undress him- or herself
1. Punish for unacceptable behaviour. d. Do simple buttons
2. Separate siblings and give individual e. Throw a ball over hand
attention separately. f. Enjoy playing game with numbers
3. Interact with younger and older siblings
together.
4. Allows the older sibling to practice adult
roles to comfort him or her.
4. A pre-schooler appropriately explores his or
her body by
1. Dressing up in parents’ clothing.
2. Masturbating.
3. Inflecting harm.
4. Comparing his or her body parts with
play mates.
5. Which of the following is an appropriate
activity for the pre-schooler?
1. Cutting paper dolls
2. Playing house
3. Stacking blocks
4. Dart board games

ACTIVITY H ALTERNATE FORMAT

QUESTIONS
Multiple-answer multiple choice questions
Circle the letter (s) corresponding to the
appropriate answer (s). Select all that apply.
 quality and safety education for nurses
(QSEN): Patient-Centered care, teamwork
and collaboration, evidence-based
practice (EBP), Quality improvements
(QI), safety, and informatics.
7. Implement nursing care to help achieve
normal growth and development of a
CHAPTER 32 school-age child, such as counselling
NURSING CARE OF AFAMILY parents about helping their child adjust to
a new school.
WITH A SCHOOL-AGE CHILD 8. Evaluate expected outcomes for
CHAPTER OVERVIEW achievement and effectiveness of care.
The school-age years (ages 6 to 12 years) 9. Integrate knowledge of growth and
represent a time of slow physical growth w/ development and school-age children
rapid cognitive and developmental growth. with the interplay of nursing process, the
When caring for this age group, it is important to six competencies of QSEN, and family
stress the accomplishment of emotional, nursing to promote quality maternal and
cognitive, and moral developmental tasks. The child health nursing care.
school-age period is when the child becomes
increasingly independent, beginning to tolerate KEY TERMS
long periods of separation from the family. The 1. Accommodation
nurse should know the development related to 2. Carries
this age group to promote developmental needs 3. Class inclusion
and safety. This chapter contains exercises to 4. Conservation
help assimilate developmental tasks to assist the 5. Decentring
family of a school-age child by providing 6. inclusion
anticipatory guidance. The case study 7. malocclusion
emphasizes the principle of school-age growth 8. nocturnal emissions
and development.
MASTERING THE INFORMATION
LEARNING OBJECTIVES Activity A FILL IN THE BLANKS
After mastering the contents of this chapter, Supply the missing term or the information
you should be able to: requested.
1. Describe the normal growth and 1. Talent for music or art becomes evident,
development pattern and common and children respond well by age
parental concerns of the school-age __________.
period. 2. For the first 1 to 2 years after menarche,
2. Identify 2020 national health goals most girls experience menstrual
related to school-age children that nurses irregularity primarily because the cycle is
can help the nation achieve. ___________.
3. Asses a school-age child for normal Cycles become more regular with the
growth and development milestones. onset of __________.
4. Formulate nursing diagnoses related to 3. As seminal fluid is produced, boys begin
both school-age children and their to notice ejaculation during sleep, called
families. _________.
5. Establish expected outcomes for nursing
care of a school-age child to help children Activity B MATCHING
and parents manage seamless transition Match the terms in column I with a definition,
across different health care settings. example, or related statement from column II.
6. Using the nursing process, plan nursing Place the letter corresponding to the answer
care that includes the six competencies of in the space provided
 COLUMN I: COLUMN II: Physical 3. What advice would you give parents to
chronologic School- or physiological improve or increase their child’s interest
age. development in reading?
________________________________________________
___1. Age 6 years 1. Best friends ________________________________________________
___2. Age 7 years are important;
___3. Age 8 years whispering 4. Define school phobia. Discuss why this
___4. Age 9 years and giggling occurs and give ways to help the family
___5. Age 10 years 2. Teacher as the cope with and resolve this fears.
___6. Age 11 years authority ________________________________________________
___7. Age 12 years figure ________________________________________________
3. Social and 5. Describe measures that can be taken to
cooperative avoid the following accidents with the
4. Conservation school-age child;
learned 1. Drowning
5. Ready for ____________________________________________
competitive ____________________________________________
games 2. Motor vehicle
6. Clubs are ___________________________________________
formed, all ___________________________________________
boys or all girls
7. Insecure with 3. Sports inquiries
members of ___________________________________________
opposite sex ___________________________________________
4. Firearms
___________________________________________
Activity C SHORT ANSWER ___________________________________________
Supply the missing term or the information
1. Compare and contrast the APPLYING YOUR KNOWLEDGE
accomplishment or failure of the Activity D CASE STUDY
developmental task industry versus Mrs. Elway brings her daughter, Clois, age 11
inferiority. years, to the well child care center for an annual
________________________________________________ check-up. The nurse obtains the history and
________________________________________________ begins the assessment. Clois’ vital sign is within
2. Describe the characteristics of the normal limits: temperature, 98.6°F; pulse, 75
following forms of cognitive development; beats/ min; respiration, 26breath/min; and
1. Decentering blood pressure, 110/5mmHg. Mrs. Elway tell the
________________________________________ nurse she is concerned about Clois’ sudden
________________________________________ outbreaks of perspiration; although the episodes
________________________________________ are not frequent, they do not seem to correlate
2. Accommodation with environmental temperatures.
________________________________________ 1. What anticipatory guidance should the
________________________________________ nurse give to Mrs. Elway regarding breast
3. Conservation development and vaginal section?
________________________________________ 2. Clois wants to play soccer at school; mars
________________________________________ Elway ask the nurse if she think this
4. Class inclusion would be a good idea. What principles
________________________________________ regarding structured activities should the
________________________________________ nurse call upon to formulate a response?

Activity E CRITICAL INQUIRY EXERSICE

1. Develop a teaching plan for parents to 1. Lower cuspids
explain the physical growth related to 2. Upper central incisor
sexuality occurring during the school-age 3. First bicuspid
years. 4. Second molar
2. Create a set of key points to discuss when 4. Which of the following is correct
providing anticipatory guidance for regarding physical maturation before
parents on detecting recreational drug puberty?
use. 1. Boys are usually taller than girls
2. Girls are usually taller than boys.
3. Boys and girls are usually the same height
4. There is no pattern in height based on
Activity F CRITICAL EXPLORATION gender.
1. Observe students in an elementary school Activity H ALTERNATE FORMAT QUESTIONS
classroom. Record the behaviours of the Multiple-answer Multiple-Choice Questions
teacher that may be considered positive Circle the letter(s) corresponding to the
and valuable to the children’s transition appropriate answer(s). Select all that apply.
to the school environment. 1. Gross motor development will allow a 6-
2. Observe several students for gross and year-old child to do which of the
fine motor development. Compare the following?
findings to the expected motor 1. Jump
development for that chronologic age 2. Tumble
group. 3. Skip rope easily
3. Visit a school during recess and observe 4. Play hopscotch
the behaviours of children that are active 5. Ride a bicycle
with the following types of play; (a) 2. Which of the following would be most
group, (b) cooperative, (c) grouping, (d) helpful in promoting a sense of industry
same gender, and (e) consisting of rules. in a school age child?
1. Having the child read a book with many
PRACTICING FOR NLE short chapters.
Activity G MULTIPLE CHOICE QUESTIONS 2. Assembling a complicated model car kit
Circle the letter that corresponds to the best 3. Receiving a reward for completing a task
answer for each questions. 4. Reassuring the child that he or she is
1. Puberty is occurring earlier today than doing something correctly
ever before. When should sex education 5. Allowing the child to learn through
be introduced to increase its efficacy? frustration
1. High school
2. Junior high school
3. Middle school
4. Grade/ elementary school
2. Peer relationships are important to the
school-age child. Which of the following is
a characteristic of the 9-year-old child?
1. Boys and girls love to play together
2. Activities are very competitive.
3. Boys and girls begin to have social
interactions.
4. Loyalty and affiliation are directed to the
same- sex peer groups.
3. Which of the following permanent teeth
would the nurse expect to present when
assessing a 7-year-old child?
 7. Implement nursing care related to growth
and development or special needs of an
adolescent, such as organizing a
discussion group on ways to prevent
substance abuse.
8. Evaluate expected outcomes for
achievement and effectiveness of care.
9. Integrate knowledge adolescent growth
and development with the interplay of
CHAPTER 33 nursing process, the six competencies of
NURSING OF A FAMILY WITH QSEN, and family nursing to promote
quality maternal and child health nursing
AN ADOLESCENT care.
CHAPTER OVERVIEW
Chapter 33 provides an overview of an KEY TERMS
adolescent growth and development, nursing 1. Adolescence
care related to health promotion, and the 2. Comedones
management of illness in the adolescent. The 3. Formal operational thought
physiologic and psychological needs of the 4. Glycogen loading
adolescent and common health concerns 5. Identity
encountered during adolescence are reviewed. 6. Puberty
The use of the nursing process to plan and 7. Role confusion
provide appropriate health care for the 8. Stalking
adolescent and his or her family is explored. 9. Substance abuse
MASTERING THE INFORMATION
LEARNING OBJECTIVES Activity A FILL IN THE BLANKS
After mastering the contents of his chapter, you Supply the missing term or the information
should be able to: requested.
1. Describe the normal growth and 1. Females generally stop growing within
development and common paternal ________ years from menarche.
concerns of the adolescent period. 2. Adolescents will experience a slight
2. Identify 2020 National Health Growth ___________ in pulse rate as they move
related to adolescents that nurses could toward adulthood.
help the nation achieve. 3. Adolescents will experience slight ________
3. Asses an adolescent for normal growth in blood pressure as they move toward
and development milestones. adulthood
4. Formulate nursing diagnoses related to 4. One major dilemma encountered by
adolescent growth and development or adolescents that lead to many growth and
common parental concerns. development concerns is that they are
5. Identify the expected outcomes for _________ in some respects but still _______
nursing care of an adolescent as well as in others.
help parents manage seamless transition 5. Early adolescence generally occurs the
across differing health care settings. ages of ______ and _______ years, middle
6. Using the nursing process, plan nursing adolescence occurs between ________ and
care that includes the six competencies of _______ years, and late adolescent occurs
Quality and Safety Education for Nurses between _____ and ____ years.
(QSEN): Patient-Centered Care, 6. Cognitive development over the
Teamwork and Collaboration, Evidence adolescent years involve in the stage of
Based Practice (EBP), Quality ________ _________ ________, which begin at the
Improvement (QI), Safety, and age __________or _______.
informatics.
7. The goal of therapy for acne treatment is of long-term,
to decrease the formation of __________, meaningful
prevent ______, and control ______ relationship
proliferation. with others (of
8. As many as 90% of high school seniors both sexes)
report having used ________. 7. The stage of
which the
individual first
becomes
capable of
Activity B MATCHING sexual
Match the terms in column I with a definition, reproduction
example, or related statement from column II. 8. A 10- to 17-
Place the letter corresponding to the answer years-old
in the space provided. absent from
Column I Column II home at least
____1. Adolescence 1. The overnight
____2. Formal physiologic without
operational thought period permission of
____3. Empathy between the parent or
____4. Intimacy beginning of guardian
____5. Substance abuse puberty and 9. Condition
____6. Puberty the cessation often treated
____7. Pustular and of bodily with systemic
cystic acne growth antibiotics
____8. Runaway 2. Use of 10. Ability to think
____9. Suicide chemicals to in abstract
____10. Secondary sex improve a terms and use
characteristics mental state or the scientific
induce method
euphoria.
3. Deliberate self-
injury with the Activity C SHORT ANSWERS
planned intent Supply the missing term or the information
to ends one’s requested.
life 1. Discuss the two reasons the nurses
4. Body hair should obtain an adolescent’s health
configuration history in private, separately from his or
and breast her parents.
growth 2. List three common factors (primary
distinguishing assessment areas) that explain why
males from adolescents may suffer fatigue.
females 3. What major task must the adolescent
5. Feeling for achieve in each of the following
another by developmental areas: sense of intimacy,
projecting emancipation from parents, and value
one’s self into system?
the other 4. State two ways nurses can be
person’s instrumental in helping to achieve 2020
situation national health goals related to adolescent
6. Development health.
5. Describe the common social behaviours 2. Information regarding the need for
manifested by adolescents at ages increased fat soluble vitamins
13,14,15,16, and 17 years. 3. Instructions regarding medications for
6. Identify 7 of the 14 danger signs for inadequate sweat production
adolescent suicide. 4. Exercise that will minimize the
production of sweat
APPLYING YOUR KNOWLEDGE 2. When planning a teaching strategy for an
Activity D CASE STUDY adolescent, you should do which of the
Angelique Rodriguez, age 14 years, was referred following?
to you, the school nurse, by her guidance 1. Give information about how the teen can
counsellor. Angelique’s grades have dropped manage the specific problems he or she
from as to low Cs over the past two semesters, identifies.
and she has become aggressive and refuses to 2. Maintain an air of authority by providing
talk to the teachers or counsellors. The counselor explanations for care procedures to
suspects drugs, pregnancy, or depression but parents only.
does not know how to help Angelique. 3. Provide information related to long term
1. What would three of your first actions be health needs because adolescents
when approaching Angelique? responds best to long-range planning.
2. If Angelique admitted depression and 4. Teach the parents first because they will
drug abuse, what initial steps would you be better able to teach the teen.
take to get help for her? 3. At his physical, Bob, 14 years old, tells you
he is “a short, clumsy klutz”. You should
Activity E CRITICAL INQUIRY EXPERIENCE respond in which of the following ways?
1. Prepare a teaching plan for an adolescent 1. Discuss with Bob the fact that his
group that addresses methods for clumsiness is probably a sign of an easily
maintaining adequate nutrition, rest, and curable disease.
exercise. 2. Instruct Bob in methods of relieving
2. How could the usual social behaviour clumsiness through muscle exercises and
noted in adolescent ages 13 through 17 improving nutrition.
years contribute to problems or concerns 3. Explain to Bob that adolescent boys are
that may be experienced by the usually taller than adolescent girls, so he
adolescent and his or her family? should be examined.
4. Inform Bob that what he is experiencing
Activity F CRITICAL EXPLORATION will lessen; he will become coordinated as
Attend a group at an adolescent drug he grows taller over the next 4 to 6 years.
rehabilitation center (either in person or via 4. The mother of Sheila, 13 years, report
two-way mirror). Note common themes related that Sheila “talks for hours and spends
to why adolescents use drugs. most of her waking hours with her
girlfriends and doesn’t even seem
PRACTICING FOR NLE interested in the boys in her class”. You
Activity G MULTIPLE CHOICE QUESTIONS could reassure Sheila’s mother by explain
Circle the letter that corresponds to the best which of the following?
answer for each question. 1. If Sheila spends less time on the phone
1. Because of changes occurring in the during the next two years, she will mature
sebaceous glands and sweet glands of normally.
adolescents, you would include which of 2. Sheila is probably talking to boys when
the following in health care teaching? her parents are not around.
1. Increase hygiene requirements to reduce 3. Talking on the phone and spending time
body odour and acne. with girlfriend is normal for a girl of
Sheila’s age.
4. Her concern is well-founded since 1. The adolescent with diabetes will eat no
romantic interest in boys begins in girls sweet, sugary foods.
around 11 years of age, typically. 2. The adolescent with hypertension will not
5. Maria is 15 years old. Maria’s mother tells eat potato chips.
you that she fears that her daughter will 3. The adolescent with fatigue choose
get into serious trouble soon because she preferred foods high in vitamins and
is always “going to a walk or sitting minerals.
outside somewhere” you should respond 4. The adolescent with acne will discuss the
in which of the following ways tis need for foods high in lipids to replace the
information? deficient body supply.
1. Encourage Maria’s mother to follow to 10. Anna, age 17 years, has been identified as
determine why Maria is being so distant. a suicide risk. You should watch her
2. Inform the mother that Maria is probably carefully and during discharge teaching
all right and is seeking the privacy she discuss the need for the family to watch
needs. her particularly closely.
3. Schedule Maria for a blood and urine drug 1. Before the beginning of the school year
screening immediately. 2. Between noon and 3 pm.
4. Tell Maria’s mother to call a psychologist 3. During her menstrual period.
to help her deal with the stress of 4. During the evening hours.
adolescence.
6. Which of the following would be a Activity H ALTERNATEFORMAT QUESTIONS
positive sign of identity information in a Multiple-Answer Multiple-Choice Questions
client in late adolescence? Circle the letter(s) corresponding to the
1. Obtaining a job to save money appropriate answer(s). Select all that apply.
2. Continuous dieting 1. Which of the following would be
3. Getting pregnant and having a baby appropriate nursing inventions for an
4. Living with parents adolescent who is abusing the specific
7. Daryl, age 17 years, states he should not drug?
have sex and gets girls pregnant “mostly 1. Alcohol: investigate the presence of
because my parents would be really mad.” alcohol abuse by parents or other close
Daryl’s response may indicate a lack of family members.
development in which of the following 2. Amphetamines: monitor for symptoms
areas? such as aggressive and demanding
1. Cognitive development behaviour and paranoia.
2. Moral development 3. Anabolic steroids: instructs athletes that
3. Physiological development these drugs cause fatigue and depression,
4. Religious development which will lead to weight gain.
8. Which of the following would be a 4. Barbiturates: allow the suicide-prone
realistic outcome related to an adolescent adolescent the control of managing oral
with a history of experimentation with administration alone because these are
marijuana? The adolescent will generally harmless drugs.
1. Stop using drugs immediately without 5. Cigarette: have a nurse who smoke
assistance discuss with the teen the evils and
2. Discuss ways to enjoy life without drugs. problems caused by smoking as one who
3. Use only marijuana, without additional knows the problems personally.
drugs 6. Cocaine/ crack: educate adolescents on
4. Smoke marijuana in moderation. the potential for immediate death even
9. Which of the following would be a with the first use.
realistic outcome related to an adolescent 2. When developing a plan of care for an
with a medical condition requiring a adolescent runaway who will be
special diet?
 returning home to the family, which of the 2. Identify 2020 National Health Goals
following would be appropriate? related to health assessment of children
1. Enlisting the aid of a mediator that nurses can help the nation achieve.
2. Establishing a contract for behaviour 3. Asses a child and family by health
3. Setting up ground rules for interview, physical examination, and
communication developmental screening.
4. Allowing the adolescent to come and go as 4. Formulate nursing diagnoses based on
desired health assessment findings.
5. Ensuring the adolescent has limited 5. Identify expected outcomes based on
privacy health assessment findings as well as help
3. Which of the following medications would parents manage seamless transition
be appropriate for threating acne in an across differing health care settings.
adolescent? 6. Using the nursing process, plan nursing
1. Benzoyl peroxide care that includes the six competencies of
2. Isotretinoin Quality and Safety Education for Nurses
3. Cefoxitin (QSEN): Patient-Centered Care,
4. Penicillin Teamwork and Collaboration, Evidence-
5. Tetracycline Base Practice (EBP), Quality
Improvement (QI), Safety and
Informatics.
7. Implement nursing care, such as
conducting an age-appropriate health
interview or physical examination by
modifying technique based on the child’s
age.
8. Integrate knowledge of health assessment
with the interplay of nursing process, the
CHAPTER 34 six competencies of QSEN, and child
CHILD HEALTH ASSESMENT health nursing care.
CHAPTER OVERVIEW KEY TERMS
Chapter 34 offers an in-debt discussion of the 1. Antitoxins
nursing techniques used in child health 2. Audiogram
assessment. Interviewing skills and procedures 3. Auscultation
for performing physical and developmental 4. Bruit
assessment are described. Nursing inventions 5. Chief concern
aimed at reducing the child’s anxiety during 6. Conjunctivitis
assessment procedures are given. Normal 7. Deep tendon reflexes
growth and development parameters and health 8. Diaphragmatic excursion
deviations are explained for each component of 9. Epispadias
health assessment. A case study is presented to 10. Esotropia
help the student apply the principles used in 11. Exotropia
conducting an abdominal assessment. 12. gamma globulin
13. geographic tongue
LEARNING OBJECTIVES 14. hordeolum
After mastering the contents of this chapter, you 15. hydrocele
should be able to: 16. hypospadias
1. Describe the purposes and techniques of 17. inspection
health assessment in children of all ages. 18. intelligence
19. intercostal spaces
20. kwashiorkor
21. palpation
22. percussion present during
23. physiologic splitting examination
24. point of maximum impulse 4. Begin to
25. ptosis measure blood
26. retractions pressure each
27. review of systems examination
28. sinus arrhythmia
29. strabismus
30. temperament Activity C ADDITIONAL MATCHING
31. toxoid QUESTIONS
32. turgor Match the term in column I with a definition,
33. varicocele example, or related statement from column II.
Place the letter corresponding to the answer
MASTERING THE INFORMATION in the space provided.
Activity A FILL IN THE BLANKS Column I: child Column II: signs and
Supply the missing term or information health problems symptoms that may
requested. be noted on the
1. The mobility of the eardrum (tympanic extremities
membrane) can be tested by injecting 1. iron deficiency 1. Simian hand
_______ into the ear canal. anaemia line
2. _________ _________ rough-appearing tongue 2. decreased 2. Concave nails
surface that often accompanies general respiratory 3. Clubbed
symptoms of illness such as fever; it may function fingers
also normally occur. 3. endocarditis 4. Linear
3. Sinus arrhythmias are considered a 4. Chromosomal haemorrhages
normal phenomenon in children of _______ abnormalities under the nails
age. They are characterized by a marked
heart rate increase on ________ and a
marked heart rate decrease on _________. Activity D SHORT ANSWER
Activity B MATCHING Supply the missing term or the information
Match the term in column I with a definition, requested.
example, or related statement from column II. 1. List and explain the nine categories for
Place the letter corresponding to the answer data gathering in performing the initial
in the space provided. health assessment for the child and
Column I Column II: age of family.
Age/developmental client 2. What are the height and weight
physical deviations that indicate failure to thrive in
examination the child?
techniques 3. Name two tests used to detect strabismus.
1. Keep covered 1. Early school 4. Describe the assessment technique used
to maintain age to detect choanal atresia.
body 2. Adolescent 5. Name three prominent feature of chronic
temperature 3. Infant serous otitis media.
2. Use calm voice 4. new born
and distracting APPLYING YOUR KNOWLEDGE
toys during Activity E CASE STUDY
assessment Jennifer, age 14 years, is visiting the primary care
3. Offer choice for center for a routine “return to school” physical
whether check-up. She will be examined by the physician
parent is
to determine her diagnosis and immediate care 4. “What types of stools does your child
necessary. normally have?”
1. What is an important consideration 2. Which of the following is a priority when
related to the examination and privacy performing a physical assessment on a
that the nurse should be aware of new born?
regarding Jennifer? 1. Preventing the new born from squirming
2. On examination, how would the nurse 2. Maintaining body temperature
divide the abdomen for inspection? 3. Examining ears and throat before the eyes
3. What would be the appearance of the and nose
abdomen if the contour and structure are 4. Assessing the newborn’s brachial pulse
normal? 3. When performing an assessment of the
4. Describe the sounds to be heard when throat, depressing the tongue of a child
auscultating breath sounds. who has acute epiglottitis is
contraindicated because this
Activity F CRITICAL INQIRY EXERCISE 1. May precipitate upper airway
1. Pair off with another nursing student and obstruction.
practice performing an initial assessment 2. Overstimulates the cough and gag reflex.
using the nine categories for data 3. May be a source of bacterial infections.
gathering. 4. May rupture the epiglottis.
2. There is a significant change in the 4. The most effective way to assess a
growth and development of the child toddler’s gait is to
moving from a toddler to a pre-schooler 1. Observe play activity.
stage of development. Contrast the 2. Perform a specific motor test.
physical differences that you may find 3. Ask the child to walk toward the parent.
between the two groups of children. 4. Ask the child to hop on one foot.
5. To assess hearing in a 1-month-old infant,
Activity G CRITICAL EXPLORATION you should
1. Visit a well-child clinic or paediatrician’s 1. Play a musical toy 4 ft. from the infant’s
office and observe the performance of ear and observe for eye movement.
health assessment on child in various age 2. Repeat the infant’s name in a soft tone
groups. Focus on communication styles and observes a facial expression.
and techniques used by the parent, child, 3. Perform the Rhinne test and observe for
and health care provider. head turning.
2. Select a parent group and explain to them 4. Make a loud noise and observe for the
why the Denver II Development Screening startle reflex.
Test is used and how it is scored and 6. When assessing a child’s abdomen, which
interpreted. technique would you perform first?
1. Percussion
PRACTICING FOR NLE 2. Palpation
Activity H MULTIPLE CHOICE QUESTIONS 3. Inspection
Circle the letter that corresponds to the best 4. Auscultation
answer for each question. 7. Which of the following would you
1. When obtaining information regarding interpret as possibly indicating a bowel
the day history of a child, you should ask obstruction in a toddler?
1. “How much food does your child normally 1. Increased peristalsis with absence of
eat?” stools for two or more days
2. “Does your child socialize with the 2. Abdominal distention with absence of
others?” peristalsis
3. “Describe your child’s normal sleep 3. Severe abdominal pain with a loud bruit
patterns.” on auscultation
4. Presence of an abdominal hernia with dry, Circle the letter(s) corresponding to the
foul-smelling stools appropriate answer(s). Select all that apply.
8. Which assessments would be a priority 1. Assessment revealing which of the
for a child who complains of a sore throat following would lead you to suspect that a
and dizziness? child is at increased risk for hearing
1. Otoscopic and throat exam impairment?
2. Nasal and ophthalmic exam 1. Perinatal infections
3. Mental status evaluation and complete 2. High birth weight
neurologic exam 3. Hyperbilirubinemia
4. Respiratory and cardiovascular system 4. Bacterial meningitis
assessments 5. Anatomical malformation
9. When performing an assessment for the 2. Which of the following statement(s) is
presence of an inguinal hernia, which of correct regarding the assessment findings
the following should be considered a of the female genetalia?
positive test result? 1. Hair growth in the pubic area typhically
1. Palpable femoral lymph nodes appears triangular in shape.
2. Extreme pain and discomfort in rectal and 2. A vaginal discharge in a young child may
perineal area be a sign of sexual abuse.
3. Bulging of the intestine while coughing 3. An enlarge clitoris in an adolescent girl is
4. Pelvic pain on palpation a sign of sexual activity.
10. To assess the elder school-aged child for 4. Vaginal warts are common findings in
scoliosis, you should most children under the age of 13 years.
1. Ask the child to stand straight with feet 5. Pelvic examination is usually performed
together. when the girl reaches 16 years of age.
2. Measure the leg lengths and pelvic girth. 3. You are performing an abdominal
3. Have the child bend over, inspecting for a assessment of a school-aged child. Plain
dimpling. the actions below in the proper sequence
4. Ask the child to walk to observe posture. reflecting how you would proceed.
11. Tina is a preschooler who is brought to 1. Percuss the liver
the clinic by her mother for a check-up. 2. Inspect abdominal contour
Which of the following statements made 3. Auscultate for bowel sounds
by Tina’s mother would most likely 4. Palpate for tenderness
indicate that Tina has a vision problem? 5. Palpate for rebound tenderness
1. “Tina is always rubbing her eyes, blinking,
and squinting”.
2. “Tina sits so close to the television when
she’s watching it.”
3. “Tina still doesn’t know her colors.”
4. “Tina doesn’t seem to like to pay attention
to what’s in front of her.”
12. To conduct the Denver Articulation
Screening Examination (DASE), you
would ask the child to
1. Repeat some familiar words or phrases.
2. Read a favourite short story.
3. Recite a poem with age-appropriate
words.
4. Read a phrase and interpret it.

Activity I ALTERNATE FORMAT QUESTIONS

Multiple-Answer Multiple Choice Questions
 After mastering the contents of this chapter,
you should be able to:
1. Describe principles of effective
communication as well as teaching and
learning as they relate to health teaching
with children.
2. Identify 2020 National Health Goals
related to communication and teaching
with children that nurses could help the
nation achieve.
3. Assess children for their ability to
communicate and their readiness to learn.
4. Formulate nursing diagnoses related to
communication and health teaching with
children.
5. Identify expected outcomes for a specific
child based on the child’s age,
developmental maturity, emotional needs,
and communication or learning style to
better enable parents to manage seamless
transitions across differing health care
settings.
6. Using the nursing process, plan nursing
care that includes the six competencies of
Quality and Safety Education for Nurses
(QSEN): Patient-Centered Care,
Teamwork and Collaboration, Evidence-
Base Practice (EBP), Quality
Improvement (QI), Safety and
Informatics.
7. Implement health teaching, such as
CHAPTER 35 creating a puppet show using principles
COMMUNICATION AND of effective communication and teaching
and learning.
TEACHIG WITH CHILDREN 8. Evaluate expected outcomes for
AND FAMILIES achievement and effectiveness of care.
CHAPTER OVERVIEW 9. Integrate knowledge of communication
CHAPTER 35 discusses communication and and teaching with the interplay of nursing
health-teaching techniques as related to children, process, the six competencies of QSEN,
beginning with an interview of nursing process and family nursing to promote quality
specific to communication with children. Types maternal and child health nursing care.
of learning, the influence of age on learning, and
techniques for developing and implementing a KEY TERMS
teaching plan are included. A case study is 1. Effective learning
presented to help the student apply health 2. Behavioural therapy
teaching to a child requiring special 3. Clarifying
communication skills. 4. Cognitive learning
5. Communication
LEARNING OBJECTIVES 6. Demonstration
7. Empathy
8. Feedback
9. Focusing 11. Learning occurs best with ___________
10. Health literacy reinforcement.
11. Nontherapeutic communication
12. Paraphrasing Activity B MATCHING
13. Perception checking Match the terms in column I with a definition,
14. Positive reinforcement example, or related statement from column II.
15. Psychomotor learning Place the letter corresponding to the answer
16. Re-demonstration in the space provided.
17. Reflecting Column I Column II
18. Therapeutic communication 1. Nontherapeuti 1. Helping
c someone
MASTERING THE INFORMATION communicatio center on a
Activity A FILL IN THE BLANKS n subject that
Supply the missing term or the information 2. Therapeutic you suspect is
requested. communicatio causing anxiety
1. _______ _______ is a method that examines n because he or
statements, thoughts, and responses to 3. Feedback she comments
determine effectiveness with therapeutic 4. Reflecting about it
communications. 5. Clarifying indirectly or
2. Teaching in the home gives the nurses an 6. Perception completely
opportunity to assess the child’s _______ , checking avoids it
inter-actions with _______ ________ , and 7. Focusing 2. Interaction
over all _______ _________. 8. Paraphrasing that is planned,
3. Provide the term for the type of learning has structure,
described. and is helpful
1. ________ depends on the muscle and and
neurologic coordination. constructive
2. _________ requires adequate development, 3. Repeating
intelligence, and attention span. statements
3. _________ is gained best through role- someone has
modelling, role playing, or shared made so that
experience discussion. you both can
4. ________ is exact imitation of a be certain you
demonstrated procedure. understood.
5. Outcomes for learning should reflect the 4. Restating the
_________ of learning desired and should last word or
establish ________ and _______ guidelines. phrase
6. When teaching a psychomotor skill, someone has
always asses the child’s ________ ________ to said when
perform the procedure. there is a pause
7. Teaching strategies are most effective in the
when they are _________. communication
8. The use of flash cards or board games .
may assist a child in _________ certain 5. Documenting a
information. feeling or
9. Because children often absorb one piece emotion that
of information at a time, preparation for someone has
surgery should be thought in _______. expressed to
10. Children learn best those things that hold you
a particular _______ for them. 6. Restating what
someone has
 said not only to or knowledge
indicate that 4. Individuals
you have heard specialising in
correctly but teaching
also to explain particular
what the information or
person is skills
trying to say 5. A system
using different aimed at
words erasing some
7. Interaction form of
that lacks behaviour that
structure, interferes with
planning, and healthy
deliberate functioning
purpose 6. Presentation of
8. A response information so
acknowledging as to increase
a message has someone’s
been received knowledge or
and insight
understood 7. A helpful
method for
teaching
Activity C ADDITIONAL MATCHING preschool
Match the terms in column I with a definition, children about
example, or related statement from column II. the hospital
Place the letter corresponding to the answer and health care
in the space provided. staff
Column I Column II 8. Process
1. Behaviour 1. A two-step occurring
modification process when a nurse
2. Cognitive involving the spontaneously
learning acquisition of answers a
3. Informal knowledge child’s or
teaching resulting in a parent’s
4. Learning measurable question about
5. Psychomotor change in a care measure
learning behaviour 9. Demonstration
6. Puppetry 2. Process that of a certain
7. Resource involves a attitude that
people change in an you want a
8. Role modelling individual’s child to learn
9. Teaching ability to 10. Process that
10. Affective perform skill involves a
learning 3. Process that change in a
involves a person’s
change in the attitude
individual’s
level of
understanding
 teaching and note the differences in
approach and content needed for each
group.
Activity D SHORT ANSWER 2. Prepare a teaching plan for a toddler
Supply the missing term or the information related to nutrition. Use a creative
requested. approach and evaluate its effectiveness in
1. Discuss three benefits of group teaching. helping the child learn the content
2. Describe the first step in developing a presented.
teaching plan.
3. Discuss the benefit of using visual aids Activity G CRITICAL EXPLORATION
when teaching children. Examine the discharge-teaching forms or
4. Explain the concept of learning ability documentation at a local health care facility.
plateaus. Evaluate the clarity of instructions for children of
5. Discuss nursing measures that will help various age groups.
achieve 2020 National Health Goals
related to communication and health PRACTICING FOR NLE
teaching as an important mechanism of Activity H MULTIPLE-CHOICE QUESTIONS
preventive health care. Circle the letter that corresponds to the best
answers for each question.
APPLYING YOUR KNOWLEDGE 1. Which of the following indicates
Activity E CASE STUDY appropriate use of teaching and learning
Six-year-old Raoul Mendelez has been newly principles?
diagnosed with diabetes. He understands both 1. Explaining to a school-aged child that the
English and Spanish, although his parents kidney transplant is being done because it
communicate with him and each other almost will be good for him.
exclusively in Spanish. 2. Providing a booklet that encourages a
1. As the nurse caring for Raoul, what preschool child to eat extra meat because
communication and teaching techniques it will help to repair his incision
will you use to maximize his and his 3. Having a mother of an infant use a game
parents’ comprehension of the disease to teach the infant a desired activity
and the lifestyle changes it will 4. Using a firm tone to tell a toddler not to
necessitate? touch her bondage
2. During the first teaching session, you 2. A child may have the greatest difficulty
notice the parents are constantly learning which of the following?
interrupting and questioning Raoul, and 1. Dietary adjustments
they appear anxious. You realize you must 2. Insulin administration
modify your teaching plan to improve 3. Colostomy irrigation
effectiveness. What adjustments would 4. Range of motion exercises
you make? 3. Which of the following is true about
3. How might your teaching plan change if children relative to learning?
Raoul were 16 years old? 1. One child’s learning style may differ from
4. What effects might Raoul’s Hispanic another’s.
culture have on your communication and 2. Admitting your discomfort with teaching
teaching plan? a subject will negatively affect learning.
3. Chronologic age is more indicative of
Activity F CRITICAL INUIRY EXERCISE learning capability than mental age.
1. Prepare and execute a teaching plan for 4. The older the child, the shorter the
an adolescent and a school-aged child on attention span.
some aspect of health maintenance or
health promotion. Evaluate the
effectiveness of your communication and
4. You have to teach a group of preschoolers 5. Peak communication
to dial 911. The most effective strategy for 3. Which of the following would be most
this teaching would be appropriate to facilitate affective
1. Pamphlets learning?
2. Lecture 1. Role-playing
3. Discussion 2. Demonstration
4. Demonstration 3. Lecture
5. Which of the following should be included 4. Shared-experience discussion
in the teaching and learning process with 5. Pamphlet reading
a young child?
1. Focusing information solely to the child
because parents cannot change the child’s
behavior
2. Evaluating if the child is performing
desired behavior when indicated
3. Letting the child decide the depth of
information to be taught
4. Teaching the child special ways to
prepare the food on a restricted diet.

Activity I ALTERNATE FORMAT QUESTIONS

Multiple-Answer Multiple-Choice Questions
Circle the letter(s) corresponding to the
appropriate answer(s). Select all that apply.
1. Which of the following interventions
would be the most appropriate when
teaching a child and family?
1. Provide a long, clear explanation about
procedures to preschool clients to
facilitate understanding.
2. Have parents present each time health
teaching is performed with adolescents.
3. Offer an immediate, concrete reward to
school-aged children to encouraged
learning.
4. Assess the child’s family patterns before
planning the timing for exercise or
medication activities after discharge.
5. Avoid using puppets for teaching
preschool children.
6. Correct a wrong action by acknowledging
a positive aspect of what the child did or
how the child performed the action.
2. You are describing the five levels of
communication. Place the levels listed
below in their proper sequence from
lowest to highest debth.
1. Fact reporting
2. Shared feelings
3. Cliché conversation
4. Shared personal ideas and judgements
 2. Identify 2020 National Health Goals
related to the care of ill children that
nurses can help the nation achieve.
3. Assess the impact of an illness, especially
one requiring a hospital stay, on a child.
4. Formulate nursing diagnoses related to
the stress of illness in children.
5. Establish expected outcomes for an ill
child to help manage a childhood illness
as well as manage seamless transitions
across differing health care settings.
6. Plan nursing care to reduce the stress of
illness, such as helping parents plan for an
ambulatory care or therapeutic play.
7. Using the nursing process, plan nursing
care that includes six competencies of
Quality and Safety Education for Nurses
(QSEN): Patient-centered Care,
Teamwork and Collaboration, Evidence-
Based Practiced (EBP), Quality
Improvement (QI), Safety, and
informatics.
8. Evaluate expected outcomes for
achievement and effectiveness of care.
9. Integrate knowledge about a child’s
response to illness with the interplay of
nursing process, the six competencies of
QSEN, and family nursing to promote
quality maternal and child health nursing
CHAPTER 36 care.
NURSING CAREOF A FAMILY
KEY TERMS
WITH AN III CHILD 1. Calorie counting
CHAPTER OVERVIEW 2. Cage management nursing
Chapter 36 provides an overview of the 3. Non-rapid eye movement (NREM) sleep
experience of hospitalization and it’s effective on 4. Play therapy
children from infancy through adolescence and 5. Primary nursing
their families. The meaning of the hospital 6. Rapid eye movement (REM) sleep
experience to the children is discussed. The role 7. Sensory deprivation
of play therapy in the preparation and care of the 8. Sensory overload
hospitalized child is reviewed. The use of the 9. Therapeutic play
nursing process to plan and provide care for the
hospitalized child and the family is outlined. MASTERING THE INFORMATION

LEARNING OBJECTIVES Activity A FILL IN THE BLANKS

After mastering the contents of this chapter, Supply the missing term or the information
you should be able to: requested.
1. Describe illness and illness experiences as 1. The way children deal with
they must appear to children. hospitalization is based on the following
factors: _______ of the event, ______ ______
 available, and effectiveness of past ______ children
_______. develop
2. The response of the children to illness increasing
depends on their _______ ________, past cognitive,
______, and level of ______. psycho-motor,
3. Nurses can help the nation meet health and social
care goals related to mental health of capabilities.
children by helping with assessment of 4. Acting out an
children’s ________ level and reducing the anxiety
_______ of the hospitalization. situation; most
4. Parents of infants who will be effective with
hospitalized should bring the child’s preschoolers
________, _______, or _________ with the child 5. Type of play in
to the hospital. which children
5. The three chief fears of the hospitalized watch play
toddler or preschool are fear of the _______, intently but
_______, and _________. are not actively
6. The school-aged child and adolescent engaged in it
should have ________ explanations of what 6. Two children
will happen in the hospital. playing side by
side but
Activity B MATCHING seldom
attempting to
Match the terms in Column I with a definition,
interact with
example, or related statement from Column each other
II. Place the letter corresponding to the 7. Children
answer in the space provided. playing with
an organized
Column I Column B
structure or
____ 1. Observation 1. A
competing for
play psychoanalytic
a desired goal
____ 2. Cooperative technique that
or outcome
play is divided used
8. The child’s
____ 3. Creative play by
drawing a
____ 4. Dramatic play psychiatrists to
picture or
____ 5. Parallel play help children
making a list to
____ 6. Play understand
express
____ 7. Play therapy their feelings,
emotions or
____ 8. Therapeutic thoughts, and
knowledge
play motives
level
2. A play
technique that
is divided into Activity C TRUE OF FALSE
three parts:
energy release, Indicate if the following statements are true or
dramatic play, false by placing a “T” or “F” in the space
and creative provided.
play
3. The “work” of ____ 1. Children are not just small adults.
children; a ____ 2. Children should be told that the doctor will
mean by which be “taking their tonsils out.”
____ 3. New foods should be introduced to the APPLYING YOUR KNOWLEDGE
hospitalized infant to promote growth and
development. Activity A CASE STUDY

____ 4. School-age children cannot describe Devon, a 3-year-old who had emergency surgery
symptoms with accuracy. while on vacation, has been separated from her
single mother, who had to return home because
____ 5. Children can be reliable for monitoring of her job and to care for her 14-year-old
their own care and speaking up about incorrect daughter, Devon has been without her family for
procedures and medications. 4 days.
____6. Children need more nutrients than adults, 1. What behavior would you expect Devon to
and thus may require hospitalization for display to nursing staff over the next days?
vomiting or diarrhea when adults would not.
2. What effect might Devon’s hospitalization and
____ 7. Young children tend to respond to disease absence have on her mother and older sister?
locally rather that systematically.
3. What interventions might you plan for Devon
____ 8. Assess patient needs relative to cultural and her Family?
differences by using textbook descriptions of the
needs of persons of that culture. Activity F CRITICAL INQUIRY EXERCISE

____ 9. Separation is most damaging to a child 1. What measures would you implement to
between ages 2 and 3 months. prepare a 4-month-old infant and family
members for open heart surgery? How would
____ 10. Children older than age 7 years should be this separation differ if the surgery were minor?
told of a pending hospitalization as soon as the
parents are aware of it. 2. Design a teaching plan for parents whose 2-
year-old child will be admitted to the hospital for
Activity D SHORT ANSWER surgery.
1. List five potential problems common to all Activity G CRITICAL EXPLORATION
hospitalization regardless of the reason or length
of stay. 1. While on a pediatric clinical unit, assess
children in varying age groups. Determine if
2. Describe why explanations of procedures to separation anxiety is present, and notice the age
young children are not always successful in levels of children experiencing the highest level
relieving stress of illness and hospitalization. of anxiety.
3. Determine the appropriate age group for the 2. Interview the parent of a hospitalized child.
following childhood play activities. Indicate the Determine the type of preparation the parent
answer in the space provided. used before bringing the child to the hospital.
a. _______ need toy in their cribs, such as mobiles. PRACTICING FOR NLE
b. _______ would enjoy watching a soap opera and Activity H MULTIPLE-CHOICE QUESTIONS
then discussing the people and their problems.
Circle the letter that corresponds to the best
c. _______ need put-in and take out toys, such as answer for each question.
blocks that can be stacked.
1. A 6-year-old child is to be admitted to the
d. _______ need quit toys such as crayons, markers, hospital for an elective surgery. You should
or books. advice the parent to tell the child about the
surgery how many days before the admission to a. Instruct the child to place the thermometer
prevent unnecessary worry? into his or her arm and hold it there.
a. 1 b. Prepare the child for surgery by providing the
child with a doll and a small scalpel.
b. 2
c. Provide a child and syringe, alcohol wipes, and
c. 4
a tourniquet to prepare the child for a blood-
d. 6 drawing procedure.

2. You might initiate which of the following d. to help a child cope with a dressing change,
interventions when carrying for a hospitalized allow the child to hand the sterile gauze to the
child with a disability or chronic illness? nurse during the procedure.

a. Avoid using information from previous 5. Which of the following would be an

hospitalizations when planning to prepare a appropriate method for influencing a child to
child for the current hospitalization. assist with a care measure?
b. Help the child avoid contact with peers while a. encourages the fluid intake by explaining to
hospitalized to decreased self-consciousness and the child that fluid will keep him or her from
the sense of being different. dying up.

c. Limit visiting hours of family and friends to b. Have the child lift hands weights every two
prevent overtiring the child. hours to strengthen muscles.

d. suggests the child write letters to friends or c. Originate board games and crossword puzzles
call family members. to help the child learn about heath teaching.

3. Alice, age 2 years, is in the intense care unit d. Place an incentive spirometry machine in front
with multiple tubes and bandages. Her parents of the child and instruct him or her in deep
are present frequently but appear reluctant to breathing.
handle Alice’s tubes and bandages, although they
Activity I ALTERNATE FORMAT QUESTIONS
asked to feed her at meals. You should do which
of the following? Multiple-Answer Multiple-Choice Questions
a. informs the parents that it is important that Circle the letter(s) corresponding to the
they learned to change Alice’s dressing and appropriate answer(s). Select all that apply.
perform this procedure often.
1. Which of the following nursing inventions
b. encourages the parents to irrigate Alice’s would be appropriate when providing
tubing to make feel them more involved in her care for an ill child?
plan of care. 1. Saying grace before administering a tube
feeding if the child commonly says grace
c. Allow the parents to feed Alice and do other
before meals
care measures as they express interest and
2. Standing close to the child, at full adult
comfort.
height, during admission to establish a
d. Limit the parents from performing any care for rapport with the child
Alice so they will understand that nurses are 3. Calling the child “sugar” or “sweetie”
capable of fully caring for her. when addressing him or her to create a
warm environment and close relationship
4. When preparing a child for procedures or
surgery, you might do which of the following?
4. Determining the child’s routines and therapeutic techniques are discussed. The use of
attempt to adapt the hospital routine as the nursing process to plan and provide care for
much as possible the hospitalized child and the family is explored.
5. Letting the child wear his or her own
LEARNING OBJECTIVES
clothes if possible rather than change to a
After mastering the content of this chapter, you
hospital gown
should be able to:
6. Limiting the number of readmissions and
length of stay by teaching parents how to 1. Describe common nursing interventions
safely monitor their child after a used in the health care of children to aid
procedure diagnosis and therapy
2. Which of the following activities would be 2. Identify 2020 National Health Goals
most appropriate for you to provide play related to diagnostic and therapeutic
opportunities for a preschooler? procedures for children that nurses can
1. Making a mobile from roller gauze to help the nation achieve.
hang over the child’s bed 3. Assess children regarding their
2. Making puzzle pieces from a picture from developmental stage and knowledge level
a magazine before beginning diagnostic or
3. Singing nursery rhymes with the child therapeutic procedures.
4. Making a puppet out of a paper bag 4. Formulate nursing diagnosis related to
5. Getting papers and markers for coloring common diagnostic or therapeutic
6. Making a deck of cards to play “go fish” procedures used with children.
3. Which of the following would you expect 5. Identify expected outcomes for a child
to include when conducting therapeutic who needs a diagnostic or therapeutic
play? procedures as well as help families
1. Choosing the articles that the child will manage seamless transitions across
use differing health care settings.
2. Allowing the play to be unstructured 6. Using the nursing process, plan nursing
3. Not criticizing the child’s play care that includes the six competencies of
4. Using real equipment Quality & Safety Education for Nurses
(QSEN): Patient-Centered Care,
Teamwork & Collaboration, Evidence-
Based Practice (EBP), Quality
Improvement (QI), Safety, and
CHAPTER 37 Informatics.
7. Implement nursing care relevant to
NURSING CARE OF A FAMILY diagnostic or therapeutic procedures,
such as preparing a child for magnetic
WHEN A CHILD NEEDS resonance imaging.
DIAGNOSTIC OR 8. Evaluate expected outcomes for
achievement and effectiveness of care.
THERAPEUTIC MODALITIES 9. Integrate knowledge of common
diagnostic and therapeutic procedures
CHAPTER OVERVIEW
with the interplay of nursing process, the
Chapter 37 provides an overview of the nursing
six competencies of QSEN, and family
care required for the child and family during
nursing to promote quality maternal and
diagnostic and therapeutic procedures.
child health nursing care.
Adaptation required for children when
undergoing therapeutic procedures and various KEY TERMS
1. Aspiration studies s 2. Radioactive-
2. Bronchoscopy combined
3. Clean-catch urine specimen substances that
4. Colonoscopy when given
5. Computed tomography(CT) orally or by
6. Electrical impulse studies injection flow
to designated
7. Endoscopy
body organs
8. Magnetic resonance imaging (MRI)
for a diagnostic
9. Position emission tomography (PET) picture
10. Radiopharmaceuticals 3. Direct
11. Single-photon emission computed visualization of
tomography (SPECT) larynx, trachea,
12. Total parenteral nutrition (TPN) and bronchi
13. Ultrasound through a fiber
optic tube
MASTERING THE INFORMATION 4. Use of the
radiopaque dye
Activity A FILL IN THE BLANKS
to outline the
Supply the missing term or the information gastrointestina
requested. l tract
5. Provision of
1. Restraints should be checked every adequate
________ minutes to ensure that insulation nutrition
is intact. through a
2. When securing a dressing on infants and nasogastric
young children, use tape that is both tube
________ and ________ to protect it.
3. A _______ specimen involves collecting
urine with usual voiding after the external Activity C SHORT ANSWER
meatus has been cleaned.
Supply the missing term or the information
requested.
1. Name two problems associated with the
Activity B MATCHING use of an ostomy appliance for an infant.
2. Discuss the psychological and physical
Match the terms in column I with a definition, preparation needed for a child
example, or related statement from column II. undergoing surgery.
Place the letter corresponding to the answer in 3. List four common types of restraints used
the space provided. with children.
Column I Column II 4. Describe two ways in which nurses can
____1. Barium contrast 1. Infusion of help achieve 2020 National Health Goals
studies concentrated related to reducing the length of hospital
____2. Gavage feedings hypertonic stay for children.
____3. Total parenteral solution into a
APPLYING YOUR KNOWLEDGE
nutrition (TPN) central or
____4. Bronchoscopy peripheral Activity D CASE STUDY
____5. intravenous
Radiopharmaceutical site.
Iesha Jackson, age 2 years, is admitted to your 3. Emancipated minor must have parental
care after stabilization of a sickle-cell crisis. She permission to sign a consent form.
is screaming for her mother and trying to get out 4. In single-parent families, the custodial
of bed. Her mother, age 18 years, is in waiting parent must sign the consent form.
room making a call. She says Iesha’s father is the 2. The nurse’s role in assisting with
custodial parent and this crisis happened on “her diagnostic procedures includes which of
weekend” with Iesha. She does not want to call the following?
Iesha’s father for fear he will blame her. 1. Helping the child to forget the experience
of the procedure as quickly as possible
1. Iesha will require several invasive
2. Using complex medical terms to explain
procedures during her stay. What
procedures to children and parents
teaching responsibilities do you have in
3. Explaining the preparation and actual
this situation?
procedure before beginning either.
2. How will the fact that Iesha’s parents are
4. Sending mature children to different test
separated affect your discharge teaching
departments without supervision
plan?
3. Which of the following is appropriate
Activity E CRITICAL INQUIRY EXERCISE when modifying procedures for children?
1. Parents should be asked to restrain
1. Review five skills listed in the
infants when indicated
fundamentals text that were not
2. Toddlers should be given procedures
discussed in this chapter, and note ways
quickly and without warning to decrease
in which those skills might need to be
resistance.
adjusted for infant or child.
3. Adolescent should be expected to tolerate
2. Plan a schedule for a 4-year-old child who
procedures maturely and without fear.
must have blood drawn for lab work, an
4. School-aged children should be given an
abdominal radiograph, a CT scan, and an
explanation about reasons for the
endoscopy during her 2-day hospital stay.
procedures.
Activity F CRITICAL EXPLORATION 4. When performing contrast dye studies
with children, you should
Tour a pediatric unit and observe the procedures 1. Tell the child the flavoured barium will
being performed. Compare the techniques used taste like a milkshake to increase
with those noted on an adult floor, and note any cooperation.
variations. 2. Isolate the child after the test until the
PRACTICING FOR NLE radioactivity resolves.
3. Restrict all activity for the duration of the
Activity G MULTIPLE-CHOICE QUESTIONS procedure to prevent distracting the
Circle the letter that corresponds to the best child.
answer for each question. 5. When teaching parents about
temperature reduction in children, you
1. When a procedure is being performed should include which of the following
that requires a consent form, which of the interventions?
following is true? 1. Administering acetylsalicylic acid every 4
1. A consent form can be omitted if the hours to reduce temperature
procedures involves only a minimal risk. 2. Dressing the child in warm flannel night
2. The nurse must explain the procedure clothes to prevent chilling
and obtain signed consent if the physician 3. Giving the age-appropriate dose of
does not. ibuprofen (Motrin) to reduce temperature
4. Place an ice cloth on the child’s forehead 5. Irrigate the ostomy with 100 ml of tap
and refresh it every hour water daily.
Activity H ALTERNATE FORMAT QUESTIONS
Multiple-Answer Multiple-Choice Questions
Circle the letter(s) corresponding to the
appropriate answer(s). Select al that apply.
1. Which of the following intervention(s) are
appropriate?
1. Allowing the child to look at the incision
during a dressing change
2. Taking a radial pulse for children under 1
year of age
3. Ensuring that an infant is calm before
assessing respiratory rate
4. Sponging children with cold water to
lower the temperature
5. Assessing blood pressure in routine
assessment of children over 3 years of age
6. Instructing adolescents on the cleaning
procedure for clean-catch specimens
2. Regarding an upper gastrointestinal
endoscopy study, which of the following
interventions would be most important?
1. Checking for gag reflex before giving any
oral fluids after procedure
2. Maintaining child’s NPO status 4 to 6
hours before procedure
3. Applying a warm compress to the neck to
reduce spasm
4. Administering atropine to reduce
pulmonary secretions
5. Verifying allergy to iodine or shellfish
3. Which of the following instructions would
you include when teaching the parents
about their child’s ostomy care?
1. Check the appliance for stool at least
every 4 hours.
2. Remove a self-adhering bag if it becomes
full.
3. Rinse the bag with clear water after
flushing it will warm water and soup
solution.
4. Use a solvent to remove sealant from the
old appliance when applying a new
appliance.
 regarding medication administration and
intravenous therapy. Adaptions required for
children during the preparation and
administration of medications and when
planning and implementing intravenous therapy
are discussed. The use of the nursing process to
plan and provide care for the child and the family
involved in medication administration and
intravenous therapy is explored.
LEARNING OBJECTIVES
After mastering the contents of this chapter, you
should be able to:
1. Describe common methods of medication
and intravenous (IV) therapy used in the
health care of children.
2. Identify 2020 national health goals
related to medication of IV therapy that
nurses can help the nation achieve.
3. Asses the developmental stage and
knowledge level of children and
adolescents before beginning medication
or IV therapy.
4. Formulate nursing diagnoses related to
medication or IV therapy with children.
5. Identify expected outcomes to meet the
needs of children receiving medication or
IV therapy as well as manage seamless
transitions across differing health care
settings.
6. Using the nursing process, plan nursing
care that includes the six competencies of
Quality & Safety Education for Nurses
(QSEN): Patient-Centered Care,
CHAPTER 38 Teamwork & Collaboration, Evidence-
Based Practice (EBP), Quality
NURSING CARE OF A FAMILY Improvement (QI), Safety, and
Informatics.
WHEN A CHILD NEEDS 7. Implement nursing interventions
MEDICATION concerned with medication and IV
therapy and children, such as introducing
ADMINISTRATION OR patient-controlled analgesia or calculating
INTRAVENOUS THERAPY weight-based dosing of medications with
a milligram per kilogram system.
CHAPTER OVERVIEW 8. Evaluate expected outcomes for
Chapter 38 provides an overview of the nursing achievement and effectiveness of care.
care required for the ill child and family
9. Integrate knowledge of medication and to prevent
IV therapy with the interplay of nursing drug toxicity
process, the six competencies of QSEN, 2. Conversion of
and family nursing to promote quality the drug into
maternal and child health nursing care. an active form
or inactive
KEY TERMS form
1. Absorption 3. Movement of
2. Distribution the drug
3. Excretion through the
4. Intermittent infusion devices bloodstream to
5. Intracath a specific site
6. Metabolism of action
7. Pharmacokinetics 4. Transfer of the
drug from its
8. Vascular access ports (VAP’s)
point of entry
9. Weight-based dosage
into the
MASTERING THE INFORMATION bloodstream

Activity A FILL IN THE BLANKS

Supply the missing term or the information Activity C SHORT ANSWER
requested.
Supply the missing term or the information
1. When administering nose drops, place the requested.
child on his or her ___________.
1. Identify four routes by which medications
2. The mandatory site for intramuscular
are given to children.
injections in infants is the ________ ________
2. State what is used for determining the
muscle.
correct dosage of drugs for most children.
3. __________ therapy is the quickest and most
3. What can be used to obtain frequent
effective means of administering fluid or
venous blood samples?
medicine to the ill infant or child.
4. List three fluid infusion safety measures
4. The _________ of body systems in infants
to be used with children.
and children plays a major role in drug
5. Identify the critical “rights” to follow
action.
when administering drugs safely to
5. To administer ear drops to a child less
children.
than 2 years old, straighten the ear canal
by pulling the pinna _________ and _________. APPLYING YOUR KNOWLEDGE
Activity B MATCHING Activity D CASE STUDY
Match the terms in column I with a definition, India Jeilhal is admitted to your care after a play-
example, or related statement from column II. ground accident. The 5-year-old is sitting up in
Place the letter corresponding to the answer in bed holding her mother’s hand. The doctor has
the space provided. ordered intravenous antibiotics and oral pain
Column I Column II medication. India’s mother is asking you to give
___1. Absorption 1. Removal of the India something for pain.
___2. Distribution drug or 1. What would you need to do when
___3. Excretion metabolites
responding to India’s request?
___4. Metabolism from the body
2. What will you prepare for the initiation of 1. A child weighting 20 is to begin fluid
intravenous therapy? therapy. On the basis of caloric
3. What measures will you take to prepare expenditure per 24 hours, the child
India and her mother for the procedure? should receive how many ml of
maintenance IV solution?
Activity E CRITICAL INQUIRY EXERCISE
1. 1500 ml
1. Discuss ways in which you might need to 2. 1725 ml
alter your approach when administering 3. 2000 ml
an intramuscular injection to a 1-month- 4. 2300 ml
old, a 1-year-old, a 5–year-old, a 10-year- 2. Which action can you take to be
old, or a 16-year-old child. instrumental in helping the nation
2. Plan instructions for the parents of a 4- achieve national health goals related to
year-old child who must administer an children drugs and medication
oral medication that comes in tablet form administration?
only. 1. Stress the importance of giving
medications to treat every discomfort
Activity F CRITICAL EXPLORATION
2. Educate parents regarding the
Tour a neonatal unit and pediatric unit and importance of steroids used to treat acne
observe intravenous therapy in place with in adolescent
children of various ages. Compare the techniques 3. Teach parent and age appropriate
and equipment used with the different age children in importance of medication
groups. dosing
4. Instruct parents to keep medication at the
PRACTICING FOR NLE bedside for ease of access
Activity G MULTIPLE-CHOICE QUESTIONS 3. Under which condition would a 3-year-
old child receive a medication dosage
Circle the letter that corresponds to the best consistent with the dosage usually given
answer for each question. to a 1-year-old child?
1. Sites frequently used for intravenous 1. The child was developmentally delayed
insertion in young children or infants 2. The child was tall for his /her age
include which of the following? 3. The child has a surface body of a 1-year-
1. Veins in the antecubital space and on the old child
extensor surface of the wrist 4. The child weighed more than 1-year-old
2. Jugular vein and veins on the ventral child
surface of the hand 4. When assessing a child before medication
3. Veins located in the hand, wrists, leg or administration it is important to
foot determine which of the following?
4. Radial or ulnar surface veins or the 1. The child’s dosage preference
subclavian vein 2. Past medication taking experience
1. You are preparing to initiate IV therapy 3. Parental development status
with a newborn infant. Which of the 4. Whether the medication is having the
following size of catheters would you desired effect
obtain?
1. 16
2. 18
3. 22
4. 25
 Chapter 39 discusses the management of pain in
children. The causes of pain as well as the
assessment and measurement of pain are
discussed, with emphasis on developmental
considerations. Varied pain management
strategies are reviewed, including pharmacologic
and non-pharmacologic measures. The use of the
nursing process to plan and provide appropriate
care and teaching to promote appropriate pain
management in children is discussed.
LEARNING OBJECTIVES
After mastering the contents of this chapter, you
should be able to:
1. Describe the major methods and techniques of
pain management for children.
2. Identify 2020 National Health Goals related to
pain management in children that nurses can
help the nation achieve.
3. Assess a child regarding whether pain
management is needed or adequate.
4. Formulate nursing diagnosis for a child in
pain.
5. Identify expected outcomes associated with
management of pain in children as well as help
families manage seamless transitions across
differing health care settings.
6. Using the nursing process, plan nursing care
that includes the six competencies of Quality &
Safety Education for Nurses (QSEN): Patient-
Centered Care, Teamwork & Collaboration,
Evidence-Based Practice (EBP), Quality
Improvement (QI), Safety, and Informatics.
7. Implement nursing care related to a child in
pain, such as suggesting an alternative therapy.
8. Evaluate expected outcomes for achievement
CHAPTER 39 and effectiveness of care.
9. Integrate knowledge of pain management in
PAIN MANAGEMENT IN children with the interplay of nursing process,
CHILDREN the six competencies of QSEN, and family nursing
to promote quality maternal and child health
CHAPTER OVERVIEW nursing care.
KEY TERMS Place the letter corresponding to the answer in
1. acute pain the space provided.
2. Chronic pain
3. Conscious sedation Column I Column II
1. Distraction a. A technique where
4. Cutaneous pain
2. Gate control theory by children are
5. Distraction
3. Patient-controlled thought to substitute
6. Epidural analgesia analgesia a positive or relaxing
7. Gate control theory 4. Thought stopping thought for an
8. Nociceptors 5. Transcutaneous anxious thought
9. Pain electrical nerve b. Use of current to
10. Pain threshold stimulation interfere with the
11. Pain tolerance transmission of the
12. Patient-controlled analgesia (PCA) pain impulse across
13. Referred pain small nerve fibers
14. Somatic pain c. A premise of pain
15. Substitution of meaning impulses traveling
16. Thought stopping between a site of
injury and the brain,
17. Transcutaneous electrical nerve
where the impulse is
stimulation (TENS)
registered
18. Visceral pain d. The cells of the
MASTERING THE INFORMATION brain stem that
register a pain
Activity A FILL IN THE BLANKS impulse becoming
preoccupied with
Supply the missing term or the information other stimuli so the
requested. pain impulse cannot
register
1. The technique that allows the child to be both
e. Self-administering
pain free and sedated for a procedure and leaves of intravenous opiate
protective reflexes intact is called __________ boluses with a
___________. medication pump to
2. A numerical or _________ ________ Scale uses a control pain
straight line with endpoints marked O for no
pain on the left and 10 for worst pain on the
right. Activity C SHORT ANSWER
3. _________ __________ or guided imagery is a Supply the missing term or the information
distraction technique that helps a child place requested.
another, no painful meaning on a painful
1. Discuss two or three reasons that nurses do
procedure.
not provide adequate pain relief to children.
4. To reduce the pain of procedures such as
2. Explain why pain assessment might be difficult
venipuncture or lumbar puncture, a _________
with children.
_________ cream may be applied.
3. Briefly discuss the gate control theory.
Activity B MATCHING
APPLYING YOUR KNOWLEDGE
Match the terms in Column I with a definition,
example, or related statement from Column II. Activity D CASE STUDY
Patricia Walters, age 4, is admitted onto your 3. An infant can indicate if he or she has pain
unit after having abdominal surgery. Her mother and exactly where the pain is located.
is concerned that Patricia might have pain but 4. Because infants think concretely, they
says her daughter is afraid of injections. may associate words like “sharp" with
knives.
1. Patricia's mother asks if you will need to hold
Patricia down because she hates needles but 2. Which of the following is true about pain
needs something for pain. What are some assessment for the school-aged child and
responses you might give? adolescent?
2. What are some methods you might use to 1. A scale of 1 to 10 should be used for
assess Patricia's pain? Which pain assessment younger children to provide the child
tools would be inappropriate? with maximum choices.
2. Some children may require pre
Activity E CRITICAL INQUIRY EXERCISE
assessment work to evaluate if they
1. What key points would you address in a understand incremental measurements.
teaching plan for a school-aged child and parents 3. School-aged children use mechanisms for
when the child is discharged home after a painful controlling pain that are unique and
day surgery? In addition to pain medication, different from adult mechanisms.
what other pain relief measures might you 4. Preadolescents think very concretely, so
include in this teaching plan? they can describe pain with little
difficulty.
2. What should you do if a school-aged child or
adolescent, who is 1-day post-surgery and has 3. Which of the following tools allows the health
had no pain medication since surgery, denies care provider to rate pain without the need of
pain but shows signs of discomfort? self-report input by the child and evaluates
behaviors usually seen with pain?
Activity F CRITICAL EXPLORATION
1. Logs and diaries of pain episodes
Visit a pediatric cancer unit and a postoperative
2. Ocher pain-rating scale
inpatient care unit at a pediatric hospital.
3. FLACC pain assessment tool
Compare the pain control methods used on each
4. Porker chip tool
unit. Note the route of administration and the
types of analgesics used. 4. The patient is having analgesia instilled in the
space just outside the spinal canal. You correctly
PRACTICING FOR NLE
identify this as which type of analgesia?
Activity G MULTIPLE-CHOICE QUESTIONS 1. Local
Circle the letter that corresponds to the best 2. Epidural
answer for each question 3. Intranasal
4. Intravenous
1. When assessing the pain of an infant, you
should consider which of the following?
1. Infants are preverbal, so cues such as
tears or guarding a body part can be Activity H ALTERNATE FORMAT QUESTIONS
helpful.
2. Infants will be comforted completely Drag & Drop Questions
solely by a parent if the pain is very Place the events in the proper sequence from
intense. first to last.
1. When preparing a teaching plan about the NURSING CARE OF A FAMILY
physiology of pain, you include the following
events: WHEN A CHILD HAS A
1. Pain impulse perceived as pain RESPIRATORY DISORDER
2. Pain stimulus occurs CHAPTER OVERVIEW
3. Activation of non-receptors Respiratory diseases are serious in children
4. Interpretation of the sensation by the because the lumens of respiratory structures are
brain small in children and likely to become obstructed
5. Sensation is routed to the spinal cord in disease. Nurses need good assessment skills to
assess clinical status. This chapter presents the
Multiple-Answer Multiple-Choice questions most common disorder of the upper and lower
Circle the letters corresponding to the respiratory tract, along with their management.
appropriate answer(s). Select all that apply. Care that incorporates the maintenance of
airway patency and promotion of oxygenation
2. A child is using distraction to assist with pain via therapeutic techniques such as
relief. Which of the following would be administration of aerosols and bronchodilators,
appropriate? chest physiotherapy for infection is also
1. Blowing soap bubbles addressed.
2. Using the fingers to count down from 5 to
1 LEARNING OBJECTIVES
3. Applying EMLA cream to the sight After mastering the contents of this chapter, you
4. Playing a handheld computer game should be able to:
5. Reciting a list of positive things 1. Describe the common respiratory
disorders in children.
3. You are using the COMFORT behavior scale to 2. Identify 2020 National health Goals
assess pain in a young infant. Which of the related to the children with respiratory
following would you evaluate? disorders that nurses can help the nation
1. Alertness achieve.
2. Physical movement 3. Assess a child with a respiratory disorder.
3. Facial expression 4. Formulate nursing diagnoses related to
4. Leg movement respiratory disorders in children.
5. Consol ability 5. Identify expected outcomes that address
6. Need for oxygen administration the priority needs of a child with a
respiratory disorder to help him or her
manage seamless transition across
differing health care settings.
6. Using the nursing process, plan nursing
care that includes the six competencies of
Quality and Safe Education for Nurses
(QSEN): Patient-Centered Care,
Teamwork and Collaboration, Evidence-
Based Practice (EBP), Quality
CHAPTER 40 Improvement (QI), Safety, and
Informatics.
7. Implement nursing care for a child with a
respiratory disorder, such as
administering oxygen.
8. Evaluate expected outcomes for 3. The most dangerous periods following a
achievement and effectiveness of care. tonsillectomy are the ____________ hrs., and
9. Integrated knowledge of respiratory days ___________________ to __________________.
disorders in children with the interplay of 4. If a child has no complications following a
nursing process, the six competencies of tonsillectomy, he or she is discharge the
QSEN, and Family Nursing to achieve same day of the following morning. Three
quality maternal and child health nursing danger since you would tell the parents to
care. watch for are ____________________
KEY TERMS __________________, _________________
1. Adventitious sound _____________________, and ___________________
2. Anoxia ______________________.
3. Arterial blood gases (ABG’s) 5. Children with symptoms of epiglottitis
4. aspiration should never be examined with a tongue
5. atelectasis blade because the gagging might cause
6. clubbing ______________ _______________
7. cyanosis __________________.
8. expiration 6. The first indicator of airway obstruction
9. hypoxemia in children is ___________________.
10. hypoxia
11. inspiration Activity B MATCHING TYPE
12. paroxysmal coughing Match the terms in Column 1 with a definition,
13. percussion example, or related statement from Column ii.
14. pneumothorax Place the letter corresponding to the answer in
15. rales the space provided
16. retraction Column 1 Column II
17. steatorrhea ____1. Hypoxia 1. Lack of
18. stridor ____2. Cyanosis respiration
19. tachypnea ____3. Hypoventilation 2. Rapid deep
20. tracheostomy ____4. Apnea breathing
21. tracheotomy ___5. Hyperventilation 3. Bluish tint to
22. vibration ____6. Anoxia the skin
____7. Tachypnea 4. Decreased
23. wheezing
____8. Hypoxemia oxygen in body
____9. Broncho- cells
MASTERING THE INFORMATION pulmonary dysplasia 5. Lack of oxygen
Activity A FILL IN THE BLANKS ____10. Stridor in tissue
Supply the missing terms or the information ____11. Rales 6. Increased
requested. ____12. Wheezing respiratory
1. The upper respiratory tract function to rate
________________, _____________________, and 7. Deficit
__________________ air. oxygenation of
the blood
2. Identify the normal values for each of
8. Shallow
these blood gas components: a) Po2 breathing;
_______________; b) Pco2 _________________; c) inability to
O2 saturation ______________; d) Ph expire freely
_________________; e) HCO3 ______________; f) 9. Fine crackling
base excess _____________. sound
10. High pitched
 crowing sound 1. Spend a day at the cystic fibrosis clinic at a
heard on local hospital to observe follow up care and
aspiration treatment.
11. A chronic lung 2. Spend a day with a respiratory therapist on a
condition seen pediatric unit to observe various treatments and
in infants with modalities.
acute
respiratory
PRACTICING FOR NLE
distress at
birth Activity G MULTIPLE CHOICE QUESTIONS
12. Expiratory Circle the letter that corresponds to the best
whistling answer for each question.
sound due to 1. Which of the following actions would be
air being most appropriate when assessing a
pushed though newborn for choanal atresia?
constricted 1. Make the newborn cry; gently compress
bronchioles one nostril, then the other.
2. Compress both nostrils at the same time
and open the newborns mouth
Activity C SHORT ANSWER
3. Hold the newborn’s mouth closed;
Supply the missing term or information requested.
compress one nostril then the other
1. List three symptoms of epiglottitis.
4. Have the newborn suck on a bottle as you
________________________________________________________
compress the nostrils
________________________________________________________
2. Baby Jane was diagnosed with acute naso-
_______________________________________________________.
pharyngitis (common cold). Her mother is
2. What important independent nursing
being taught how to use a bulb syringe
interventions should be used in caring for a child
and vaporizer to clear the congestion.
with respiratory dysfunction?
Which of the following would you include
________________________________________________________
in the teaching plan?
________________________________________________________
1. The bulb should be compressed before
________________________________________________________
inserting the syringe into the child’s
3. how might community agencies be beneficial
nostril.
in assisting Rebecca and her mother?
2. The vaporizer should be kept at the
________________________________________________________
bedside so the mist will be close to the
________________________________________________________
child’s face
________________________________________________________
3. The vaporizer will not require cleaning
since the steam is very hot and sterile
Activity E CRITICAL INQUIRY EXERCISE
4. The bulb syringe filled with saline nose
1. In what way, if any, would you need to alter
drops should be squeezed into the
your approach and process when practicing
nostrils
respiratory assessment on a child compared with
3. Baby John was admitted with
an adult?
streptococcal pharyngitis. When he was
2. Develop a discharge teaching a plan for
discharged, his mother was told to return
parents of infants or children with an upper
to the doctor’s office in 2 weeks with a
respiratory infection.
urine specimen. The rationale for this
instruction is that the urine would be
Activity F CRITICAL EXPLORATION
examined most likely
1. For fat and lipids to see if the kidneys are 2. Keeping room air cool and dry
working 3. Encouraging shallow inspiration to
2. For protein to determine if acute decrease chest pain
glomerulonephritis is developing 4. Using expectorants and coughing to clear
3. To determine if the child is developing secretions
otitis media 9. A 5 months old child is admitted to your
4. To determine whether to increase the unit with bronchiolitis. Assessment
child’s diet from liquid to soft. reveals the following: temperature, 102 F;
4. Which of the following would be apical pulse, 154 bpm; respirations, 68
inappropriate to include in the plan of cpm; and irritability. Oxygen therapy is
care for a child who has a tonsillectomy? ordered. What do you understand as the
1. Observing for signs of bleeding rationale for this therapy?
2. Encouraging the child to eat ice cream 1. Liquefy secretions
hourly to soothe the child’s throat 2. Promote rest
3. Placing the child on his or her abdomen 3. Relieve hypoxemia
with a pillow under the chest 4. Decrease coughing
4. Observing for excessive swallowing and 10. When developing a teaching plan for a
throat clearing group of parents about cystic fibrosis, you
5. If bleeding occurs in a child following a would be least likely to include which
tonsillectomy you should perform which statement?
nursing action? 1. It is inherited as an autosomal recessive
1. Elevate the child head and turn him of her trait.
on his or her side 2. It occurs in about 1 in 2, 000 births,
2. Place a child in a prone position mostly among whites.
3. Place a child in a Trendelenburg position 3. Symptoms include patchy consolidations
4. Elevate the child feet and turn him or her and tumors throughout the lungs.
in a prone position 4. It has an improved mortality, with 50% of
6. Which of the following would be the most children now living to the age of 21 years.
appropriate to give to a child following a
tonsillectomy? Activity H ALTETNATE FORMAT QUESTIONS
1. Sips of clear liquid Multiple answer multiple choice questions circle
2. Milkshake the letter(s) corresponding to the appropriate
3. French fries answer(s). Select all that apply.
4. Popcorn 1. Which of the following test results would
7. Elisa, a 14-month old child, is admitted to you expect to find in a child with cystic
the hospital with fibrosis?
laryngotracheobronchitis (croup). Which 1. Decreased level of pancreatic enzymes in
would you expect to find on assessment? duodenal secretions
1. Cyanosis and dyspnea 2. Elevate plasma cholesterol
2. Productive coughing and a high fever 3. Elevate chloride in sweat
3. Pale laryngeal tissue and dyspnea 4. Increase fat content in the stool
4. Barking cough and inspiratory stridor 5. Decreased chloride in sweat
8. Which of the following would you include 2. It is very important that you prevent
in the plan of care for a child with aspiration following bronchoscopy. Which
bronchitis? of the following interventions would be
1. Ensuring bed rest with minimal fluid appropriate?
intake 1. Feed the client slowly for the first hour
2. Keep NPO until the gag reflex has 13. Formulate nursing diagnoses for a child
returned with a cardiovascular disorder.
3. Provide postural drainage for the first 14. Established outcome based on the
postoperative day priority needs of a child with a
4. Keep head elevated at 90 degrees for the cardiovascular disorder that can help a
first postoperative day family manage seamless transitions
5. Maintain the bed flat and the client prone across different health care settings.
for the first hour. 15. Using the nursing process, plan nursing
3. Which of the following medications would care that includes the six competencies of
you expect the physician to order for a Quality and Safe Education for Nurses
child with asthma? (QSEN): Patient-Centered Care,
1. Cough suppressant Teamwork and Collaboration, Evidence-
2. Long acting bronchodilators Based Practice (EBP), Quality
3. Inhaled corticosteroid Improvement (QI), Safety, and
4. Mast cell stabilizer Informatics.
5. Leukotriene receptor antagonist 16. Implement nursing care for a child with a
cardiovascular disorder, such as teaching
about the importance of taking prescribed
medication.
17. Evaluate expected outcomes for
CHAPTER 41 achievement and effectiveness of care.
NURSING CARE OF A CHILD 18. Integrated knowledge of cardiovascular
disorders with the interplay of nursing
HAS A CARDIOVASCULAR process, the six competencies of QSEN,
DISORDER and Family Nursing to promote quality
CHAPTER OVERVIEW maternal and child health nursing care.
Chapter 41 provides an overview of various KEY TERMS
cardiovascular condition found in children. The 1. A cyanotic heart disease
potential effects of these conditions on the 2. Afterload
physical and psychological growth and 3. Balloon angioplasty
development of the child are discussed. The use 4. Cardiac catheterization
of the nursing process to plan and provide care 5. Congestive heart failure
for the client and for the family coping with a 6. Contractility
cardiovascular disorder is explored. The case 7. Cyanosis
study describes preparation and management of 8. Cyanotic heart disease
a client undergoing a cardiac catheterization. 9. Diastole
LEARNING OBJECTIVES 10. Innocent heart murmur
After mastering the contents of this chapter, you 11. Organic heart murmur
should be able to: 12. Polycythemia
10. Describe the common cardiovascular 13. Post-cardiac surgery syndrome
disorders of childhood. 14. Post-perfusion syndrome
11. Identify 2020 National health Goals 15. Preload
related to the children with 16. Systole
cardiovascular disorders that nurses can 17. Vasculitis
help the nation achieve. MASTERING THE INFORMATION
12. Assess a child with a cardiovascular Activity A FILL IN THE BLANKS
dysfunction.
Supply the missing terms or the information 4. Rejection after cardiac transplant can
requested. occur in __________, __________, or _________
1. In heart defects in which a connection forms.
exists between the right and left heart, the 5. __________ refers to a structural or
blood through the connective structure functional abnormality of the ventricular
flows from _________ to __________. myocardium that occurs after an
2. The pump on the left side of the heart infection and results in severe dilation of
moves __________ blood to peripheral the left or both ventricles.
tissues. 6. ____________________, ____________________ is the
3. Chest tubes inserted in a child during most frequent causes of cardiac arrest in
open heart surgery will include an upper children.
tube draining __________ and a lower tube
draining ________.
7. Identify the name of the congenital heart disorder described.
1. Includes pulmonary artery stenosis, ventricular septal defect, dextroposition of the aorta and right
ventricular hypertrophy.
2. The aorta rises from right ventricle instead of the left ventricle; usually accompanied by atrial and
septal defects; ___________________.
3. The tricuspid valve is closed and the foramen ovale and ductus arteriosus remain patent;
_______________.
8. One of the first signs of congenital heart failure in children is _______________________.

Activity B MATCHING TYPE

Match the terms in Column 1 with a definition, example, or related statement from Column ii. Place the
letter corresponding to the answer in the space provided
Column I Column II
1. Endocarditis 1. Agent used to increase heart contractility, which also
2. Dyslipidemia slows the heart rate.
3. Patent ductus Arteriosus 2. An extreme increase in RBC in an attempt to increase
4. Polycythemia tissue oxygenation.
5. Post perfusion Syndrome 3. Fever, splegomegaly, general malaise, and a
6. Chest radiography maculopapular rash that occurs after open heart surgery
7. Atrial septal defects 4. Condition involving increased fatty acid level in the
8. Phonocardiography blood
9. Echocardiography 5. Infection of the valves of the heart, generally caused by
10. Pulmonary stenosis streptococci.
11. Truncus arteriosus 6. Abnormal communication between the two atria where
12. Congestive heart failure blood flows from left to right.
13. Kawasaki syndrome 7. Left to right shunting of blood due to the connection of
14. Digoxin the pulmonary artery to the aorta.
15. Rheumatic fever 8. Autoimmune condition that typically manifests in
slowed impulse conductions and a systolic murmur
9. Condition that involves narrowing of the pulmonary
valve.
10. One major artery arises from the left and right ventricles
instead of separate vessels.
11. Condition resulting when the myocardium of the heart
cannot circulate and pump enough blood to supply the
tissues of the body
 12. Mucocutaneous lymph node syndrome occurring almost
exclusively in children before puberty.
13. A diagram of heart sounds translated into electrical
energy by a microphone placed on the child test
14. An ultrasound produced by high frequency sound waves
used to locate and study the movement and dimensions
of cardiac structures
15. Study that furnishes an accurate picture of the heart size
and contour, size of the heart chambers, whether fluid is
collecting.

Activity C SHORT ANSWER are assigned to care for her during the
Supply the missing term or information requested. procedure.
1. In addition to fever, name 3 other criteria 1. Mrs. Borders as instructed not to allow
for the diagnosis of Kawasaki Syndrome. Harriette to eat or drink fluids after
________________________________________________ midnight the morning before the
________________________________________________ procedure. What was the reasoning for
_____. these instructions?
2. List the prenatal and birth information ____________________________________________________
that should be discussed while obtaining ____________________________________________________
a nursing history for a child with a 2. What was the purpose of the cardiac
cardiovascular disorder. catheter?
____________________________________________________ ____________________________________________________
________________________________________________. ____________________________________________________
3. Relate two major areas of information to 3. The child undergoing this procedure
be discussed with parents when they are receives conscious sedation. It is likely
taking home their child who has heart that she would be anxious, afraid, and
disorder. uncooperative if not prepared
____________________________________________________ appropriately. What are some measures
___________________________________________________. you can use to reduce Harriette’s anxiety?
4. Discussed the preparatory teaching ____________________________________________________
necessary for a child and family before ____________________________________________________
open heart surgery. 4. You inform Mr. Border that Harrriette
____________________________________________________ must lie flat in bed for 3 hrs. After
____________________________________________________. returning to her room. Explain the
5. Describe how innocent and organic physiologic rationale for this statement.
murmurs differ relative to timing, ____________________________________________________
duration, quality, and intensity. ____________________________________________________
____________________________________________________ Activity E CRITICAL INQUIRY EXERCISE
____________________________________________________ 1. Prepare a plan to teach cardiopulmonary
APPLYING YOUR KNOWLEGDE resuscitation to family members of a child
Activity D CASE STUDY with a cardiac anomaly.
Harriette Borders, age 5, has been complaining of 2. Prepare a teaching plan to instruct the
headaches and fatigue. She also experienced family on how exercising and modifying
syncope at school. She was seen at the nutritional intake can improve
pediatrician’s office and refers to the children’s cardiovascular health. Include the 2020
hospital for cardiac catheterization. Mr. and Mrs. National Health Goals in your plan.
Border brings Harriette to the hospital, and you
3. Prepare for a class presentation an 4. That prolonged hiccupping is a harmless
outline contrasting the hemodynamics of side effect from peacemaker leads
cyanotic and acyanotic heart disease. 4. Which of the following findings maybe
Activity F CRITICAL EXPLORATION noted in a child with coarctation of the
Visit a neonatal intensive care unit and assess aorta?
various infants. Identify heart sounds, 1. Low blood pressure in the upper
differences in vital signs, and feeding problems. extremities
PRACTICING FOR NLE 2. High blood pressure in the lower
Activity G MULTIPLE CHOICE QUESTIONS extremities
Circle the letter that corresponds to the best 3. A history of headache and nosebleeds
answer for each question. 4. A capillary refill of less than 5 seconds
1. A child with coarctation of the aorta might 5. Which of the following would be most
require which of the following nursing effective in reducing the workload of the
interventions? heart of a child with heart failure?
1. Assisting the child and parents with 1. Bed rest in a semi Fowler’s position
coping with this terminal illness 2. Digoxin administration daily, IV or orally
2. Informing females with the condition that 3. Oxygen therapy by mask, cannula, or tent
pregnancy seldom causes problems 4. IV infusion of 2,000 to 3,000 ml/day
3. Reassuring the child and parents that 6. Which of the following is true about
postoperative abdominal pain will congestive heart failure?
subside 1. Edema is an early symptom of heart
4. Scheduling the surgery during early failure in children
infancy to prevent complication 2. Irritability and restlessness may indicate
2. Nursing care of the child with an atrial abdominal pain from hepatomegaly
septal defect would involve which of the 3. Left heart failure initially presents with
following? jugular vein distention
1. Reporting splitting of the second heart 4. Right heart failure results in pulmonary
sound immediately as a serious edema as an initial sign
complication 7. Reduction of complications from
2. Preparing the child and family for cardiac rheumatic fever can be accomplished
catheterization through which of the following
3. Monitoring the diastolic murmur over the interventions?
apical area that is diagnostic of the 1. Administration of penicillin to children
condition with strep throat or impetigo
4. Teaching parents about the lifelong 2. Beginning speech therapy to reverse
medications required to control the damage after antibiotics are completed.
condition 3. Pushing children with chorea to perform
3. You will be educating the parents of a activities requiring fine motor movement
child with a peace maker. Which to strengthen muscles
instruction should you include? 4. Withholding salicylates to prevent joint
1. The procedure for cardiac defibrillation in hemorrhage
case a dysrhythmia occurs 8. Nursing interventions for a child with
2. How to count the child’s pulse accurately Kawasaki disease may include which of
to determine peacemaker function the following?
3. To change the pacemaker battery every 1. Maintaining heavy bed coverings and
year if symptoms indicate the need clothing to keep the child warm and
comfortable
2. Palpating skin temperature and assessing 19. Furosemide
capillary refilling in fingers and toes 20. An ACE inhibitor
3. Performing range of motion exercises to 21. Digoxin
joint hourly to prevent contractures. 22. Propranolol
4. Withholding all aspirin containing 23. Captopril
medications to prevent platelet 24. A beta blocker
agglutination 3. After teaching a group of nursing students
9. The 6 years old has been diagnosed with about the different congenital heart
hypertension. You recognize what about defects, the instructor determines that
this condition? teaching was successful when the
1. It manifests frequent severe symptoms students identify which of the following
2. It cannot be treated with diet and daily as examples of a disorder with increased
exercise pulmonary blood flow?
3. It results as a secondary manifestation of 1. Ventricular septal defect
another diseases 2. Aortic stenosis
4. It will resolve before adolescence without 3. Patent ductus arteriosus transposition of
treatment if it is primary hypertension the great arteries
Activity H ALTETNATE FORMAT QUESTIONS 4. Total anomalous pulmonary venous
Multiple answer multiple choice questions circle return
the letter(s) corresponding to the appropriate 5. Truncus arteriosus
answer(s). Select all that apply.
1. Which of the following would be
appropriate for a child with a
cardiovascular disorder?
1. Assessing the skin surface of all black
children to determine if cyanosis is
present
2. Loosening the dressing on the cardiac
catheter site to promote comfort
3. Bringing the parents of a child awaiting
open heart surgery to the intensive care
unit before surgery to prepare them
4. Administering IV fluid liberally and
rapidly to a child after open heart surgery
to replace massive blood loss
5. Reassuring the parents of a child with a
ventricular septal defect than surgical
repair is rarely required, even in large
defects
6. Preparing an infant who has just been
diagnosed with pulmonary stenosis, as
well as his or her parents, for immediate
surgery
2. A child with heart failure is receiving
medications to decrease afterload. Which
CHAPTER 42
of the following would you expect to
administer as ordered?
NURSING CARE OF A FAMILY 2. Anaphylaxis
3. Antigen
WHEN A CHILD HAS AN 4. Atopic dermatitis
IMMUNE DISORDER 5. Autoimmunity
6. Cell-mediated immunity
CHAPTER OVERVIEW
7. Chemo taxis
Chapter 42 discusses the immune process as it
8. Complement
relates to childhood illnesses. Immune disorders
9. Cytotoxic response
noted in childhood are reviewed. The use of the
10. Delayed hypersensitivity
nursing process to plan and provide care for the
11. Environmental control
child and the family coping with an immune
12. Humoral immunity
disorder is explored.
13. Hypersensitivity response
LEARNING OBJECTIVES
After mastering the contents of this chapter, you 14. Hyposensitization
should be able to: 15. Immune response
1. Describe the immune process as it relates to 16. Immunity
childhood illnesses. 17. Immunogenic
2. Identify 2020 National Health Goals related to 18. Immunoglobulin
immune disorders in the children that nurses can 19. Lymphokines
help the nation achieve. 20. Lysis
3. Asses a child with disorder of the immune 21. Macrophages
system. 22. Phagocytosis
4. Formulate nursing diagnoses for a child with a 23. Tolerance
disorder of the immune system. MASTERING THE INFORMATION
5. Establish outcomes for a child with a disorder Activity A FILL IN THE BLANKS
of immune system that can help the family Supply the missing terms or the information
manage seamless transitions across different requested.
health care settings. 1. Provide the type of the primary
6. Using the nursing process, plan nursing care immunodeficiency for each description.
that includes the six competencies of Quality and 1. Cellular immune response remains
Safe Education for Nurses (QSEN): Patient - adequate ; child has resistance to viral,
Centered Care, Teamwork and Collaboration, fungal, and parasitic infection, but all
Evidence - Based Practice (EBP), Quality levels of immunoglobulin’s are
Improvement (QI), and informatics for the child abnormally low: ____________
with an immune system disorder. 2. Infection of surfaces exposed to the
7. Implement nursing care for a child with an external environment and normally
immune disorder, such as teaching about protected by mucus are common along
environmental control. with atopic diseases : ________________
8. Evaluate expected outcomes for achievement 2. Human immunodeficiency virus (HIV) is
and effectiveness of care. spread by two primary routes in the adult
9. Integrate knowledge of immune disorders population: _______________ contact and _____________
with the interplay of nursing process, the six contact.
competencies of QSEN, and Family Nursing to 3. ________________ results from an inability to
achieve quality maternal and child health distinguish self from oneself, causing the
nursing care. immune system to carry out immune responses
against normal cells and tissue.
KEY TERMS
1. Allergen
4. Assessment of the exact symptoms of an antigen or
allergy is important in helping to identify the drug.
underlying ________________. 6. A non-
5. Identify the specific allergies in a child with antigenic
food allergies is the use of a _____________ substance
____________ or an elimination diet. that becomes
antigenic
6. Congenital immunodeficiency usually manifest
when
after the first ___________ months of life.
combined
7. When a child is stung by a bee, the immediate with a higher
action should to be apply ________________ to the weight
site to minimize the absorption of the venom. molecule
7. T cells that
Activity B MATCHING reduces the
Match the terms in the column I with a definition, production of
example, or related statement from column II. immunoglobu
Place the letter corresponding to the answer in lin against a
the space provided. specific
Column I Column II antigen,
1. Antigen 1. The preventing
2. Cell - mediated neutralization overproducti
immunity of pathogens on.
3. Hapten through 8. An antigen
formation ingestion by that can be
4. Immunocompet white blood readily
ent cells cells destroyed by
5. Immunogenic 2. Secretion by an immune
6. Lymphokines cytotoxic cells response
7. Memory cells that contain 9. When
8. Phagocytosis prevent antibodies
9. Serum sickness migration of are formed in
10. Suppressor cells antigens response to a
3. Foreign particular
substance antigen;
capable of acquired
stimulating through T-
an immune lymphocytes
response. activity.
4. Responsible 10. Cells capable
for retaining of resisting
the formula foreign
or ability to invaders.
produce
specific Activity C SHORT ANSWER
immunoglobu Supply the missing terms or the information
lin requested.
5. An 1. State two measures a parent can take to
inflammatory decrease allergies in the bedroom, living room
reaction to a and at school.
foreign serum
________________________________________________________ contact dermatitis because the nurse fears
________________________________________________________ becoming infected?
2. Compare seborrhea dermatitis and atopic
dermatitis in terms of the presence of itching,
age of onset, length of disease, and mood of the Activity F CRITICAL EXPLORATION
child. During a clinical experience, monitor care
________________________________________________________ provided to a client with AIDS. Note the
________________________________________________________ precautions used in care and the client's
3. Differentiate between congenital and acquired emotional response to the care and care
immunodeficiency disorder. providers. Note the care that you felt was
________________________________________________________ particularly good, as well as ways in which care -
________________________________________________________ physical and emotional - might have been
4. Discuss the purpose and use of skin testing improved.
when assessing allergies in children. PRACTICING FOR NLE
________________________________________________________
________________________________________________________ Activity G MULTIPLE CHOICE QUESTIONS
5. Describe the three goals for therapy in 1. Nurses can help the nation achieve health
childhood allergy situations. goals related to HIV by doing which of the
________________________________________________________ following?
________________________________________________________ 1. Instructing young people that intravenous
APPLYING YOUR KNOWLEDGE drugs are safer than oral drugs, although
both are bad
Activity D CASE STUDY 2. Encouraging drug addicts to share
Jose is a 4 year old child with primary B cell, IgA needles primarily with friends, if they
type immune efficiency disorder. His is admitted must use drugs
to your unit with an upper respiratory tract 3. Educating children about the importance
infection. His parents are concerned that his of using condoms or practicing
brothers and sisters will also contract the abstinence.
immune deficiency, so they have not been letting 4. Avoiding discussions related to sex
their children play with Jose. around adolescents younger than 18
1. What is the most important concepts you must years old.
include in a teaching plan for Jose’s parents? 2. Janice has a deficiency that affects her humeral
________________________________________________________ immunity. You know your teaching about this
________________________________________________________ condition has been successful when Janice states
2. How would you approach his parents which of the following?
regarding their fears about Jose's siblings? 1. "My condition result from inadequate B
________________________________________________________ cells."
________________________________________________________ 2. " My body produces inadequate antigens"
3. What areas would be a priority when caring 3. " My conditions results from inadequate T
for Jose? cells"
________________________________________________________ 4. "My body produces inadequate allergens"
________________________________________________________ 3. When teaching a group of parents about atopic
Activity E CRITICAL INQUIRY EXERCISE disorders, which of the following would you be
1. Prepare a teaching plan on the diagnosis of least likely to include in the discussion?
allergic rhinitis for a child and his or her family. 1. Asthma
2. What would your response to be a fellow 2. High fever
nurse who refuses to care for a client with 3. Atopic dermatitis
4. Serum sickness 3. Which of the following statements by the
4. Which of the following actions would be parents of a child who has an insect sting allergy
appropriate when providing care to a child with indicates effective teaching?
a hypersensitivity condition? 1. " She needs to wear socks when walking
1. Having syringe filled with 1:5 dilution of outside"
the antigen on hand to counteract an 2. " We won't let him take out the trash"
unexpected anaphylactic reaction from 3. "We will make sure she doesn't use any
skin testing scented products"
2. Keeping the child at the health care 4. "He can move the lawn as long as he does
settings for 30 minutes after the hypo it after dusk"
sensitization process. 5. "We'll tell him to avoid drinking from an
3. Excluding the child with allergies from open soda can when outside."
planning method of environmental
control to avoid resistance to change
4. Encouraging parents who know of
familial allergy patterns to bottle feed
infants
Activity H ALTERNATE FORMAT QUESTIONS
Multiple - Answer Multiple - Choice Questions.
Circle the letter corresponding to the correct
answer. Select all that apply.
1. Which of the following interventions would be
appropriate when caring for a child with an
immune disorder?
1. Anticipate treating a child who faints but
does not respond to amyl nitrate for
possible anaphylaxis
2. Administer a smaller than normal dosage
of foreign serum to a child known to
manifest serum sickness.
3. Do not allow children who develop
urticarial as a result of exposure to
extreme temperatures to swim in cold
water
4. Instruct parents of children with atopic
dermatitis to cover the area with wet
dressing containing Burrows solution
5. Teach parents that all of the solutions in
an Epi-Pen must be ejected on injection
2. You are preparing for a presentation about the
primary and secondary immunodeficiency’s?
1. T-lymphocytes deficiencies
2. HIV
3. severe combined immunodeficiency
syndrome
4. Hypogammaglobulinemia
5. B-lymphocyte deficiencies
 quality maternal and child health nursing
CHAPTER 43 care.
Nursing Care of a Family KEY TERMS
1. Catarrhal stage
When a Child has an 2. Chain of infection
Infectious Disorder 3. Convalescent period
4. Enanthem
CHAPTER OVERVIEW
Chapter 43 discusses common infectious 5. Exanthem
disorders of childhood. The nursing techniques 6. Exotoxin
required in addressing the need of children and 7. Fomites
their families when coping with an infectious 8. Incubation period
diseases are reviewed. The use of the nursing 9. Interferon
process to plan and provide care for the child 10. Koplik spots
with an infectious diseases and his or her family 11. Mode of transmission
is explored. 12. Portal of entry
LEARNING OBJECTIVES 13. Portal of exit
After mastering the contents of this chapter, 14. Prodromal period
you should be able to: 15. Reservoir
1. Describe the causes and course of 16. Septicemia
common infectious disorder of childhood. 17. Susceptible host
2. Identify 2020 National Health Goals MASTERING THE INFORMATION
related to infectious disorders in children
that nurses could help the nation achieve. Activity A FILL IN THE BLANKS
3. Assess a child with an infectious disorder. Supply the missing terms or the information
4. Formulate nursing diagnosis for a child requested.
with an infectious disorder. 1. _______________________ is the time between
5. Establish outcomes to help a family the invasion of an organism and the onset
manage an infectious disorder as well as of the symptoms of infection.
manage seamless transitions across 2. _______________________ is a common
differing health care settings. rickettsial disease transmitted by a tick.
6. Using the nursing process, plan nursing 3. _____________________ enters the body
care that includes the six competencies of through the skin, migrates to the
Quality and Safe Education for Nurses intestinal tract, and thrives on blood,
(QSEN): Patient Centered Care, causing severe anemia.
Teamwork and Collaboration, Evidence 4. ___________________ is highly contagious viral
Based Practice (EBP), Quality infection that spreads by direct or
Improvement (QI), Safety, and indirect contact of saliva or vesicles,
Informatics. possibly being reactivated at a later time.
7. Plan nursing care for a child with an 5. ___________________, caused by the
infectious disorder, such as helping him papillomavirus, represent one of the most
or her understand infectious precautions. common dermatologic diseases in
8. Evaluate expected outcomes for children.
achievement and effectiveness of care. 6. A serious complication from mumps
9. Integrate knowledge of childhood occurring in males over the age of
disorders of the blood with the interplay puberty is ________________________.
of nursing process, the six competencies Activity B MATCHING
of QSEN, and Family Nursing to promote
Match the terms in Column I with a definition, host to more
example, or related statement from Column II. than one virus
Place the letter corresponding to the answer at a time
in the space provided. 11. An infection of
the hair
Column I Column II follicle; a boil
1. Pathogen 1. a rash on the
2. Prodromal skin Activity C SHORT ANSWER
period 2. organisms that Supply the five missing terms or the
3. Chain of causes disease information requested.
infection in children 1. Name the five types of microorganisms
4. Reservoir 3. a time between that can cause disease or illness.
5. Fomites the beginning ____________________________________________________
6. herpes labialis of non-specific ____________________________________________________
7. exanthema symptoms 2. Identify the most likely outcome once the
8. illness 4. the stages rabies disease process begins.
9. interferon during which ____________________________________________________
10. furuncle specific
____________________________________________________
11. vector symptoms are
3. State the incubation period and period of
evident
5. The method by communicability for mumps.
which ____________________________________________________
organisms ___________________________________________________
spread and 4. Discuss the method through which
enter a new organisms are spread, listing the elements
individual to necessary to complete the chain of
cause diseases. infection.
6. The container ____________________________________________________
or place in ____________________________________________________
which 5. Discuss the circumstances that cause a
organisms child to be susceptible to infection.
grow and
____________________________________________________
reproduce
____________________________________________________
7. Inanimate
objects such as 6. Describe the universal precaution health
soil, food, or care providers should take in all clinical
water settings.
8. Living carriers ____________________________________________________
such as insects, ____________________________________________________
that causes the 7. List the signs and symptoms of the scarlet
spread of fever.
infection ____________________________________________________
9. A cold sore, ____________________________________________________
representing a
type 1 APPLYING YOUR KNOWLEDGE
herpesvirus
invasion
10. A lymphokine; Activity D CASE STUDY
prevent cells Pedro Juan, age 17 years, is admitted to your unit
from being with infectious mononucleosis. Pedro is
complaining tiredness but his parents are 1. Belinda, age 6 years, has been diagnosed
encouraging him to be more active to regain his with infectious mononucleosis. You
strength should do which of the following?
1. What are some factors that contributed to 1. Encourage Belinda to return to school and
Pedro being a susceptible (at risk) host normal physical activity after 10 days
for infection? 2. Limit Belinda’s fluids to decrease the
____________________________________________________ workload of the spleen
____________________________________________________ 3. Keep Belinda in bed for a week or more
____________________________________________________ with a quit games and books
2. What would be your response to Pedro’s 4. Deeply palpate Belinda’s upper stomach
parents regarding their approach to daily and report any complaints of
Pedro’s treatment? tenderness.
____________________________________________________ 2. When a child is scratched by a cat, the
____________________________________________________ parents should be instructed to do which
____________________________________________________ of the following?
3. What factors should be included in the 1. Destroy the animal to prevent subsequent
nutritional plan of care? attacks
____________________________________________________ 2. Submit the animal for a blood test to
____________________________________________________ diagnose cat scratches
____________________________________________________ 3. Monitor the child for irritability and
changes in level of consciousness
Activity E CRITICAL INQUIRY EXERCISE 4. Place ice on enlarged nodes to control and
1. If your patient was on infection control decrease swelling.
precautions and you observed another 3. To prevent exposure to Lyme disease, an
health care professional entering the individual should do which of the
patient’s room without wearing following?
protective items, what would you do? 1. Wear dark colored clothing to avoid
2. A patient is admitted to your unit, and you attracting ticks.
suspect from his history that he has had a 2. Inspect the skin of children exposed to
recent exposure to a person with an wooden areas for tick bites.
active cause of varicella. Your hospital 3. Apply calamine lotion to tick bites areas
requires a physician’s order before immediately to remove poison
placing a patient on respiratory isolation. 4. If a tick as noted on the skin, remove it
What actions would you take? quickly using your finger nails.
Activity F CRITICAL EXPLORATION Activity H ALTERNATE FORMAT QUESTIONS
While on a clinical unit, provide care for a child Multiple-Answer Multiple – Choice Questions
on various types of transmission – based Circle the letters corresponding to the
precautions. Compare precautions taken with appropriate answer. Select all that apply.
each patient when emptying urine, providing the 1. Which of the following interventions
bedpan, or collecting and testing blood specimen. would be appropriate for a child with an
infectious disorder?
PRACTICING FOR NLE 1. Instruct parents to wash impetigo skin
crusts daily with half strength peroxide.
Activity G MULTIPLE CHOICE QUESTIONS 2. Explain to parents that the child with
Circle the letter that corresponds to the best pertussis (whooping cough) must be
answers for each question. watched closely for airway obstruction.
3. Inform parents that a temperature of 101
degrees to 102 degrees fareignheit is an CHAPTER 44
expected symptoms in children with Nursing Care of a Family
tetanus
4. Instruct parents to monitor children with When a Child Has a
possible tick bites for signs and symptoms Hematologic Disorder
of Rocky Mountain spotted fever. CHAPTER OVERVIEW
5. Instruct parents of school aged children The disease process of some blood disorders in
with head lice that lice infestation can the children may be insidious; presenting
occur regardless of personal hygiene. symptoms in the early stage of the disease may
6. Examine a child’s oral area to detect the not alert parents. However, many of this illnesses
presence of pinworms. can become life threatening. The nurse must be
2. After teaching a group of students about able to synthesize knowledge of the findings
the chain of infection, the instructor from systems assessments with the signs and
determines that the teaching was symptoms of Hematologic disorders. Chapter 44
successful when the students identify provides the students with the knowledge to
which of the following as a component? care for the child and family with a Hematologic
1. Reservoir disorder. The case study addresses the altered
2. Prodromal period Hematologic processes in a sickle cell crisis.
3. Means of transmission
4. Exit of portal LEARNING OBJECTIVES
5. Exanthem After mastering the contents of this chapter, you
6. Incubation should be able to:
3. You are preparing a presentation for a 1. Describe the major hematologic disorders of
local parent leader – teacher group on childhood.
common fungal infections occurring in 2. Identify 2020 National Health Goals related to
children. Which of the following would children with hematologic disorder that nurses
you include? could help the nation achieve.
1. Lyme disease 3. Assess a child with a hematologic disorder
2. Tinea capitis such as sickle cell anemia.
3. Impetigo 4. Formulate nursing diagnoses related to a child
4. Candidiasis with a hematologic disorder.
5. Scabies 5. Identify expected outcomes for a child with a
hematologic disorder to help parents manage
seamless transitions across differing health care
settings.
6. Using the nursing process, plan nursing care
that includes the six competencies of Quality and
Safe Education for Nurses (QSEN): Patient
Centered Care, Teamwork and Collaboration,
Evidence Based Practice (EBP), Quality
Improvement (QI), Safety, and Informatics.
7. Implement nursing care related to a child with
a hematologic disorder, such as reducing the
possibility of infection.
8. Evaluate expected outcomes for achievement
and effectiveness of care.
9. Integrate knowledge of childhood disorders of Activity B MATCHING
the blood with the interplay of nursing process, Match the terms in column I with a definition,
the six competencies of QSEN, and Family example, or related statement from column II.
Nursing to promote quality maternal and child Place the letter corresponding to the answer
health nursing care. in the space provided.
KEY TERMS Column I Column II
1. Allogeneic transplantation 1. Heinz bodies 1. Acquired
2. Autologous transportation 2. Neutropenia disorder of
3. Blood dyscrasias 3. Dissiminated blood clotting
4. Erythroblasts intravascular that results
5. Erythrocytes coagulation from excessive
6. Erythropoletin 4. Plethora trauma or
5. Allogeneic acute infection
7. Granulocytes
transplantatio 2. Transfer of
8. Hemochromatosis
n bone marrow
9. Hemolysis 6. Purpura from an
10. Hemosiderosis 7. Normochromic immune
11. Leukocytes anemia compatible
12. Megakaryocytes 8. Hypochromic donor via
13. Pancytopenia anemia intravenous
14. Petechiae 9. Erythropoietin infusion to the
15. Plethora 10. Poikilocytic recipient
16. Poikilocytes 3. Food shape
17. Priapism particles in
18. Purpura RBC
19. Reticulocyte 4. Impaired
production of
20. Synergeneic transplantation
erythrocytes
21. Thrombocytes
by the bone
22. Thrombocytopenia marrow or
MASTERING THE INFORMATION abnormal/
uncompensate
Activity A FILL IN THE BLANKS d loss of
Supply the missing terms or information circulatory
requested. RBC
1. The ultimate therapy for treating acquired a 5. Marked
plastic anemia is __________________. reddened
appearance of
the skin
2. ______________ is excessive destruction of red
6. RBC that are
blood cells irregular in
3. _________________________ is a potentially lethal shape
immunologic response of donor T cells against 7. Reduced
the tissue of the recipient. number of
4. _______________ are round non nucleated bodies WBC
formed by bone marrow; normal range in count 8. A hormones
is 150,000 to 300,000/mm produced by
5. _______________ are cells used to transport the kidneys
oxygen to body cells and carry carbon dioxide that stimulate
away from body cells. the formation
 of RBC ________________________________________________________
9. Hemorrhagic ________________________________________________________
rash or small ________________________________________________________
hemorrhages
occurring in Activity D CRITICAL INQUIRY EXERCISE
the superficial 1. Develop a nursing care plan that addresses the
layer of the
nursing process to care for the patient aplastic
skinInadequate
anemia.
hemoglobin
synthesis 2. Create a list of foods that would be most
accompanied appropriate for a school aged child with iron
by a reduction deficiency anemia.
in the diameter
of cells when Activity E CRITICAL EXPLORATION
hemoglobin Attend a camp for children with a sickle cell
synthesis is anemia. Assess the program's objectives and
inadequate goals for camp participants.

APPLYING YOUR KNOWLEDGE PRACTICING FOR NLE

Activity C CASE STUDY Activity F MULTIPLE CHOICE QUESTIONS

Phyllis, age 12 years, has been experiencing Circle the letter that corresponds to the best
problems from sickle cell anemia since she was 1 answer for each question.
year old. She has been admitted to the pediatric 1. Which of the following foods supplies the
ward of a children's hospital with an admitting better source of iron for the infant?
diagnosis of sickle cell crisis. 1. Human breast milk
2. Iron fortified cereals
1. Since Phyllis has previously been diagnosed 3. Vegetables
with sickle cell anemia, what characteristics 4. Fruits
would most likely be assessed? 2. Which of the following drugs is
________________________________________________________ contraindicated for a child who is diagnosed as
________________________________________________________ deficient in glucose 6 phosphate dehydrogenase
________________________________________________________ (G6PD)?
2. What are the primary nursing outcomes when 1. Acetylsalicylic acid
caring for Phyllis? 2. Acetaminophen
________________________________________________________ 3. Ampicillin
________________________________________________________ 4. Tetracycline
________________________________________________________ 3. Mrs. Hill brings her 10 month old son, Keith, to
3. What precautionary measures would you need the emergency room with a temperature of 104.6
to consider when administering intravenous F. He is dehydrated and has edema of the right
fluids to Phyllis? ankle. He is admitted to the pediatric unit. The
________________________________________________________ assessment revealed a diagnosis of sickle cell
________________________________________________________ crisis. You explain to Mrs. Hill that Keith's signs
________________________________________________________ and symptoms are a result of a(n)
4. What findings on the assessment would 1. Pain in the joints of the hands
suggests that Phyllis needs oxygen 2. Amino acid deficiency
supplementation? 3. Inborn erroe of metabolism
4. Stasis of abnormal RBC in the vessels
4. Which of the following might you assess in a 1. Since she doesn't like meat, we'll try to
child experiencing sickle cell crisis? get her to eat some eggs or cheese
1. Elevated serum sodium and decreased 2. We will give her the iron with milk to
WBC increase its effectiveness
2. Dry mucous membranes and priapism 3. She'll need to eat some more green leafy
3. Loss of appetite and diarrhea vegetables now that she's taking iron
4. Hematuria and flank pain 4. We'll have her play actively before meals
5. A mother of a 9 month old child diagnosed so that she is hungry and wants to eat
with sickle cell anemia asks why the disorder 5. We have an appointment for a blood test
had not been diagnosed earlier. You would in about a week to check her count
integrate an understanding of which of the
following when responding to the mother?
1. A child had increased protection from
maternal antibodies CHAPTER 45
2. The liver was immature and not fully Nursing Care of a Family
functioning
3. The child still had fetal hemoglobin When a Child Has a
present Gastrointestinal Disorder
4. Circulatory blood volumes were increased CHAPTER OVERWIEW
for the first 6 to 8 months Chapter 45 describes the child with a disorder of
Activity G ALTERNATE FORMAT QUESTIONS the gastrointestinal system and addresses the
Multiple Answer Multiple Choice Questions importance of the gastrointestinal system to the
Circle the Letter corresponding to the entire body's ability to grow and develop in a
appropriate answer. Select all that apply. healthy manner. The use of the nursing process
1. Which of the following would you expect to to plan and provide care for the child and family
find in a child with idiopathic thrombocytopenia? coping with a gastrointestinal disorder is
1. Epistaxis explored.
2. Asymmetrical ecchymosis on the legs LEARNING OBJECTIVES
3. Increase megakaryocytes After mastering the contents of this chapter, you
4. Leukocytosis should be able to:
5. Hemolysis 1. Describe common gastrointestinal disorders
6. More than two petechial with the seen in children
tourniquet test 2. Identify 2020 National Health Goals related to
2. What type of laboratory test might be ordered gastrointestinal disorders in children that nurses
to determine if a child has a hematologic could help the nation achieve
disorder? 3. Assess a child with a gastrointestinal disorder
1. 24 hour urine specimen 4. Formulate nursing diagnoses for a child with a
2. Clot retraction gastrointestinal disorder
3. Prothrombin time 5. Identify expected outcomes for a child with a
4. Plasma fibrinogen gastrointestinal disorder as well as how to
5. Free T manage seamless transition across differing
6. Thromboplastic generation time health care settings
3. After teaching the parents of a 5 year old child 6. Using the nursing process, plan nursing care
diagnosed with iron deficiency anemia about the that includes the six competencies of Quality and
disorder and its management, which of the Safe Education for Nurses (QSEN) : Patient
following statements indicates that the parents Centered Care, Teamwork and Collaboration,
have understood the instructions?
Evidence Based Practice (EBP), Quality
Improvement (QI), Safety, and Informatics. Activity B MATCHING
7. Implement nursing care for a child with a Match the terms in Column I with a definition,
gastrointestinal disorder, such as preparing the example, and related statement from column
child for surgery II. Place the letter corresponding to the
8. Evaluate expected outcomes for achievement answer in the space provided.
and effectiveness of care Column I Column II
9. Integrate knowledge of gastrointestinal 1. Gastro 1. Loss of body
disorders in children with the interplay of esophageal water and salt
nursing process, the six competencies of QSEN, reflex in proportion
and Family Nursing to achieve quality maternal 2. Aganglion to each other
and child health nursing care. megacolon 2. Hirschsprung
3. Inguinal hernia disease, the
4. Isotonic absence of
KEY TERMS
dehydration nerve cells and
1. Beriberi
5. Kwashiorkor peristaltic
2. Dehydration 6. Marasmus waves in a
3. Gastro esophageal reflux 7. Celiac disease section of the
4. Inguinal hernia 8. Hypertonic bowel
5. Insensible loss dehydration 3. Disorder due
6. Intussusception to a
7. Keratomalacia neuromuscular
8. Kwashiorkor disturbance
9. McBurneys point that causes a
10. Meckels diverticulum lax cardiac
11. Neceoticizing enterocolitis sphincter and
12. Nutritional marasmus lower
esophagus
13. Over hydration
4. A disease
14. Pellagra
caused by
15. Rickets protein
16. Scurvy deficiency seen
17. Streatorrhea more
18. Volvulus frequently in
19. Xerophthalmiaa children ages 1
MASTERING THE INFORMATION to 3 years.
5. A disease
Activity A FILL IN THE BLANKS caused by
Supply the missing term or the information deficiency of
all food groups
requested.
6. Loss of body
1. Metabolic __________________ is indicated when
water out of
the arterial blood pH is less than 7.35 and HCO3 proportion to
is below 22 mEq/L. salt
2. A patient who is dehydrated with an arterial 7. Protrusion of
blood pH >7.45 and a bicarbonate level greater the bowel into
than 28 mEq/L is experiencing metabolic the abdomen,
___________________. appearing as a
3. Fluid loss that occurs from evaporation from lump in the
the skin and lungs is called _____________ fluid loss. right or left
 groin 2. Describe a process for determining if a
8. Sensitivity or patients dehydration is isotonic, Hypertonic or
abnormal hypotonic
immunologic Activity F CRITICAL EXPLORATION
response to Visit a day care center. Ask what the rules are
protein, regarding care of the child with diarrhea, fever,
usually the
or vomiting. Observe the staff as they implement
gluten factor.
the infection control guidelines and determine if
these techniques are sufficient.
PRACTICING FOR NLE
Activity C SHORT ANSWER
Supply the missing terms or the information
requested Activity G MULTIPLE CHOICE QUESTIONS
1. Describe the spitting up associated with Circle the letter that corresponds to the best
infants experiencing Gastro esophageal reflux answer for each question.
________________________________________________________ 1. A mother brings her 12 year old daughter to
________________________________________________________ the clinic for evaluation of complaints of a
2. Identify the most common cause of abdominal gnawing epigastria pain before meals. When
surgery in children. questioned further, the child reports that the
________________________________________________________ pain subsides after eating and she has had some
_______________________________________________________ episodes of vomiting. Examination reveals
3. Name the most reliable diagnostic test used to epigastric tenderness. You interpret these
confirm peptic ulcer disease. findings as suggesting which of the following?
________________________________________________________ 1. Peptic ulcer diseases
________________________________________________________ 2. Inflammatory bowel diseases
APPLYING YOUR KNOWLEDGE 3. Hepatitis
4. Pyloric stenosis
2. Which of the following laboratory results
Activity D CASE STUDY
would lead you to suspect a child is experiencing
Aaron is 8 months old. His birth was uneventful
liver problems?
and he has exhibited no previous health
1. Bile pigments present in stool specimen
problems. Today, his mother brings him to the
2. Decreased serum albumin levels
emergency room exhibiting symptoms of
3. Total serum bilirubin level of 1.5 mg/ 100
dehydration.
ml
1. What would be the major sources and minor
4. Urine negative for bilirubin
sources of fluid loss for Aaron?
3. Which of the following nursing interventions
________________________________________________________
might allay any guilt felt by parents of a child
________________________________________________________
with gasoesophageal reflux?
2. What are the major history and physical
1. Suggest the parents step outside the room
assessment you would make for Aaron?
while you feed the child so they do not
________________________________________________________
view the spitting up
________________________________________________________
2. Offers suggestions in positioning because
Activity E CRITICAL INQUIRY EXERCISE
success through this measure builds
1. Create a teaching plan for the parents of a
confidence
child with pyloric stenosis. Include preparation
3. Tell the parents that they were preparing
for hospitalization, surgery, and the recovery
the formula wrong and that this caused
period.
the condition.
4. Reassure parents that this condition is
usually due to dysentery and is not their
fault CHAPTER 46
4. When assessing an infant suspected of having Nursing Care of a Family
pyloric stenosis, which of the following would
you expect to find? When a Child Has a Renal or
1. Periodic non projectile vomiting Urinary Tract Disorder
2. Moist mucous membranes CHAPTER OVERVIEW
3. Sour smelling emesis without bile Chapter 46 discusses common renal and urinary
4. Bulging fontanels tract disorders that occurs in children and the
Activity H ALTERNATE FORMAT QUESTIONS nursing care needed for these children and their
Multiple Answer Multiple Choice Questions families. The normal function of the renal system
Circle the letter that corresponds to the is reviewed. The use of the nursing process to
appropriate answers. Select all that apply. plan and provide care for the child and family
1. Warren is a 6 month old infant presenting in with a renal or urinary tract disorder is explored.
the emergency department with poob intake LEARNINGN OBJECTIVES
over last 3 days and severe diarrhea. Which of After mastering the content of this chapter, you
the following would you expect to assess? should be able to:
1. Rapid respiration 1. Describe common renal and urinary disorders
2. Bulging fontanel that occurs in the children
3. Dependent edema 2. Identify 2020 national health goals related to
4. Dry mucous membranes renal and urinary tract disorder in the children
5. Rapid, thready pulse that nurses can help the nation achieve
6. Poor skin turgor 3. Assess a child for a renal or urinary tract
2. which of the following are glands denoted to disorder
secrete saliva? 4. Formulate nursing diagnoses related to renal
1. Parotid or urinary disorder in children
2. Apocrine 5. Develop expected outcomes for a child with a
3. Pituitary renal or urinary disorder to help the family
4. Sublingual manage seamless transitions across differing
5. Submandibular helath care settings.
3. When discussing the difference between 6. Using the nursing process, plan nursing care
Chrohn disease and ulcerative colitis to a that includes the six competencies of Quality and
parental support group, which of the following Safe Education for Nurses (QSEN) : Patient
would you include when describing Crohn Centered Care, Teamwork and Collaboration,
disease? Evidence Based Practice (EBP), Quality
1. Rectum primarily affected Improvement (QI), Safety, and Informatics.
2. Intermittent lesions 7. Implement nursing care for a child with a renal
3. Severe anorexia or urinary disorder, such as preparing a child for
4. Anal lesion common a peritoneal dialysis
5. Commonly associated with cancer 8. Evaluate expected outcomes for achievement
6. Severe bloody diarrhea and effectiveness of care
9. Integrate knowledge of renal and urinary tract
disorders with the interplay of nursing process,
the six competencies of QSEN, and Family
Nursing to promote quality maternal and child
health nursing care.
 6. _______________ refers to a retrograde flow
KEY TERMS of urine from the bladder into the ureters
1. Alport syndrome that may lead to a urinary tract infection.
2. Azotemia
3. Dialysis Activity B MATCHING
4. Enuresis Match the terms in Column I with a definition,
5. Epispadias example, or related statement from column II.
6. Exstrophy of the bladder Place the letter corresponding to the answer
7. Glomerular filtration rate in the space provided.
8. Glumerulonephritis Column I Column II
9. Hydronephrosis 1. Prune belly 1. An autosom
10. Hypospadias syndrome dominant
11. Nephrosis 2. Azotemia inherited
12. Patent urachus disorders with
3. Cystoscopy
13. Polycystic kidney chronic renal
4. Cryptorchidis failure
14. Postural proteinuria m 2. A fistula
15. Prune belly syndrome
5. Enuresis between the
16. Vesicoureteral reflux
6. Hypospadias bladder and
MASTERING THE INFORMATION the umbilicus
7. Dialysis
8. Acute 3. The opening of
Activity A FILL IN THE BLANKS the urethra
transplant
Supply the missing terms or the information onto ventral or
rejection
requested lower surface
1. Glumerulonephritis involves the
of the penis
obstruction of the glomeruli because of
4. Direct viewing
the complement fixation activated by a
of the bladder
___________-___________ reaction, stimulated
or ureter
most often by a streptococcal infection.
2. The four characteristics symptoms of opening for
nephrotic syndrome are _________, examination
__________, _____________, and ___________. 5. Undescended
3. Children with the hemolytic – uremic testes, often
syndrome usually have ____________ skin noted
coloring as well as the major symptoms of hypospadias
_____________ with proteinuria, ___________, 6. Involuntary
and urinary casts in urine. voiding past
4. A __________ kidney is a condition involving the age when a
abnormal development of the collecting child is
tubules in which fluid cyst instead of expected to
kidney tissue, form in utero; it may be have bladder
unilateral or bilateral.
control
5. An increase in blood levels of the
7. Condition
products of cell metabolism such as
manifested by
_________ may indicate poor kidney
function. fever,
proteinuria,
oliguria,
 weight gain, 3. Discuss the primary difference in the etiology
and of acute and chronic renal failure
hypertension ________________________________________________________
developing ________________________________________________________
within 3 4. Discusses the dietary restrictions of salt in a
months child with chronic renal failure.
________________________________________________________
following
________________________________________________________
transplant
8. Severe urinary
APPLYING YOUR KNOWLEDGE
tract dilatation
that can
Activity D CASE STUDY
developed in
Rebecca, age 2, is admitted to your unit with
utero resulting dehydration and acute strep throat. After 3 days
in kidney of treatment and intravenous fluids, you notice
destruction that Rebecca's urine output has remained low
9. Separation and and her blood levels of nitrogen and creatinine
removal of are elevated.
solutes from 1. What type of renal failure has Rebecca
body fluids by probably developed? What other symptoms of
diffusion renal failure might you notice?
through a ________________________________________________________
semipermeabl ________________________________________________________
e membrane ________________________________________________________
10. The 2. How would you explain Rebecca's rebel
condition to her parents?
accumulation
________________________________________________________
of nitrogen
________________________________________________________
waste in the
________________________________________________________
blood stream, 3. What activity level would you expect to be
often due to ordered for Rebecca, and how would you help
oliguria. her maintain it?
________________________________________________________
________________________________________________________
Activity C SHORT ANSWER ________________________________________________________
Supply the missing term or the information Activity E CRITICAL INQUIRY EXERCISE
requested. 1. Prepare a teaching plan for a child discharged
1. Explain why girls are at high risks for urinary on continuous ambulatory peritoneal Dialysis
tract infection than are boys. 2. Your patient, admitted after an automobile
________________________________________________________ accident, has just being diagnosed as brain dead.
________________________________________________________ What would your response be if the doctor asked
2. Compare and contrast the symptoms and you to approach the family regarding donating
treatment for nephritic syndrome and acute the patient's kidneys? When and how would you
glomerulonephritis. choose to approach the family?
________________________________________________________
________________________________________________________ Activity F CRITICAL EXPLORATION
Visit a Dialysis unit; review 3 or 4 charts and d. Preparing the child and parents for the
note the various causes of renal failure. frequently terminal outcome of the disease
5. Which of the following would be an
PRACTICING FOR NLE appropriate explanation to provide to the
Circle the letter that corresponds to the best parents of a child with severe hypertension who
answer for each question. is awaiting a renal transplant?
1. Which of the following intervention might be a. After the child non-functioning kidneys are
most effective in preventing glomerulonephritis? removed, the child will have no food restrictions
a. Daily administration of children's b. Removal of only one kidney is necessary to
multivitamins and iron provide room for the new kidney
b. An increase in all children's fluid intake to 3L c. Reluctant youngster siblings can still serve as a
daily kidney donor as long as the parents signs both
c. Prompt evaluation of childhood complaint of surgery consent forms
sore throat d. The transplanted kidney will be placed in the
d. Teaching children to void promptly when the abdomen, not in the usual kidney space.
urge id felt
2. Which of the following would you expect to
assess in the child with acute Activity H ALTERNATE FORMAT QUESTIONS
glomerulonephritis? Multiple Answer Multiple questions Circle the
a. Blood pressure of 90/40 letters corresponding to the appropriate
b. Hypovolemia and signs of dehydration answers. Select all that apply.
c. Hematuria and pulmonary edema 1. De' Anya is a nursing student preparing a
d. Severe, foul smelling diarrhea clinical plan of care for her next day of practice in
3. You could implement any of the following the hospital. She has been assigned several
measures for a child who demonstrated Enuresis patients hospitalized with altered functioning of
with no apparent organic cause? the urinary system. Which of the following would
a. Encourage the child to discuss concerns be appropriate to include De' Anya's plan of care
relative to changes in his or her environment or for her patients?
life a. Instruct the parents of the child with
b. Instruct the parents never to let the child drink exstrophy of the bladder to give the infant a tub
after dinner bath daily to remove sediments and maintain
c. Limit the fluids of children with sickle cell good Hygiene.
anemia because they are most prone to this b. Stress the importance repairing hypospadias
condition before the child's maturity to prevent fertility
d. Teach parents to strictly enforce bladder problems.
training with the child c. Prepare the parents of the infant with urinary
4. Bobby, age 10, has a diagnosis of acute tract infection for diagnostic procedures to rules
nephrotic syndrome. Which of the following out urethral stenosis
nursing intervention would be most d. Teach girls to wipe from back to front after
appropriate? voiding or stooling
a. Administering liberal IV and oral fluids to e. Encourage a child with a UTI to drink liberal
offset the accompanying dehydration amounts of fluids
b. Discussing the cushingold effects of prescribe 2. When caring for the patient with chronic renal
steroid therapy with the child and parents failure undergoing hemodialysis, which of the
c. Reassuring the child and parents that diuretic following would be appropriate?
will quickly reduce the edema
a. Instruct the parent of the child with chronic
renal failure how to prepare a diet low in CHAPTER 47
protein, potassium, and phosphorus Nursing Care of a Family
b. Administer aluminum hydroxide, alternating
with milk, to prevent ulcers formation When a Child Has a
c. Encourages the child receiving corticosteroids Reproductive Disorder
to discuss angry feelings regarding their changes CHAPTER OVERVIEW
of appearance Reproductive Disorder in children range from
d. Monitor the child frequently during mild infection to serious anatomic
hemodialysis to detect changes in cerebral tissue malformations. All require prompt treatment to
perfusion prevent later disruption in Sexual or
e. Encourage the parent to seek out time for reproductive health. Sensitive and careful
themselves and voice frustration and fears questioning when assessing children with
3. The mother of a 6 year old girl diagnosed with reproductive health. This chapter address the
a UTI asks you what she can do to help prevent a illness affecting external reproductive structures
recurrence. Which of the following would be and reproductive organs. The case study afford
important for you to include in the teaching? the students that opportunity to plan the nursing
a. Have your daughter wide from front to back care for a male adolescents with concerns about
after urinating or moving her bowels. possible alteration in his reproductive systems.
b. Buy the child synthetic underwear to decrease LEARNING OBJECTIVES
perineal irritation 1. Describe common reproductive disorder in
c. Make sure that she doesn't use any bubble children
bath for bathing 2. Identify 2020 National Health Goals related to
d. Check to make sure your daughter deinks reproductive disorder
plenty of fluids, especially if it's warm outside 4. Formulate nursing diagnoses for a child with a
e. Encourage her to use the bathroom to urinate reproductive disorder
every 6 to 8 hours 5. Establish expected outcome for a child with a
f. Help your daughter to wash her perineal area reproductive disorder that help children and
every day parents manage seamless transition across
differing health care settings
6. Using the nursing process, plan nursing care
that includes the six competencies of Quality and
Safe Education for Nurses (QSEN) : Patient
Centered Care, Teamwork and Collaboration,
Evidence Based Practice (EBP), Quality
Improvement (QI), Safety, and Informatics.
7. Implement nursing care for a child with a
reproductive disorder, such as preparing a child
for a peritoneal dialysis
8. Evaluate expected outcomes for achievement
and effectiveness of care
9. Integrate knowledge of renal and urinary tract
disorders with the interplay of nursing process,
the six competencies of QSEN, and Family
Nursing to promote quality maternal and child
health nursing care.
KEY TERMS Activity B MATCHING
1. Amenorrhea Match the terms in column I with a definition,
2. An ovulatory example, or related statement from column II.
3. Cryptorchidism Place the letter corresponding to the answer
4. Dysmenorrhea in the space provided.
5. Endometriosis Column I Column II
6. Fibrocystic breast disease 1. Endometriosis 1. Abnormally
2. Amenorrhea heavy
7. Gynecomastia
3. Anovulatory menstruation
8. Hermaphrodite 4. Hydrocele 2. Removal of
9. Hydrocele 5. Metrorrhagia testes
10. Menorrhagia 6. Orchiectomy 3. Menstrual
11. Metrorrhagia 7. Pseudointersexe cycles that
12. Mittelochmerz d occur
13. Orchiectomy 8. Toxic shock without the
syndrome release of egg
14. Orchiopexy
9. Imperforate 4. Infant with
15. varicocele hymen some
16. Vulvovaginitis 10. Pelvic external
MASTERING THE INFORMATION inflammatory features of
disease both sexes,
Activity A FILL IN THE BLANKS 11. Menorrhagia although only
Supply the missing terms or the information ovaries or
testes are
requested
present
1. A _________________ is abnormal dilatation of
5. Infection
the veins of the spermatic cord frequent
2. ________________ is an enlargement of the caused by
male breast gonorrheal or
3. ___________ is a failure of one or both testes chlamydial
to descend from the abdominal cavity to pathogens
the scrotum 6. Abnormal
4. Testicular cancer has symptoms of growth of the
heaviness of the _______. It is ___________ and extrauterine
___________ rapidly endometrial
5. ____________ is defined as experiencing cells
abdominal pain during ovulation. The 7. An infection
caused by
discomfort is felt on one side of the
toxin
____________, near ovary.
producing
6. ____________ is a n inflammation of the strains of
glands and prepuse of the penis. staphylococci
s aureus
8. Fluid
collection in
the space
called the
processus
vaginalis
9. A
 membranous active. What differences, if any, would the
ring of the gender of the adolescent make in the
tissue totally planning?
occluding the
vagina
10. Absence of Activity E CRITICAL EXPLORATION
menstrual
Arrange with your instructor to visit a health
flow; may
clinic that provides health care for adolescent
suggests
pregnancy who are sexually active. Note the health
11. Bleeding presented by the clients and identify the
between preventive measures provided by the
menstrual professionals as they teach and counsel these
periods clients.

PREPARING FOR NLE

APPLYING YOUR KNOWLEDGE
Activity F MULTIPLE CHOICE QUESTIONS
Activity C CASE STUDY Circle the letter that corresponds to the
Peter, age 14 years, is seen in your clinic. He best answer for each question
states he had sex with a girl who recently told 1. Baby J., 1 day old, is born with ambiguous
him that she was diagnosed with syphilis. He genetalia. You would incorporate teaching to
insists that nobody else know about his visit to help the parents as their child undergoes
the clinic because he can pay the clinic because which of the following tests to determine
he can pay for the medicine himself gender?
1. What symptoms would you question 1. Blood cultures
Peter about and what diagnostic 2. Colposcopy
procedure would you prepare for him? 3. Karyotyping
____________________________________________________ 4. Sedimentation rate
______________________________. 2. A young female who has trichomoniasis may
2. What information would you include on exhibit which if the following?
your teaching plan for peter? 1. Greenish vaginal discharge
____________________________________________________ 2. Cream cheese like vaginal discharge
____________________________________________________ 3. Patchy white lesions on vaginal wall
3. What obligations would you, as a health 4. Frothy white or grayish – green vaginal
care provider, have to keep peters discharge
condition strictly confidential? 3. Which of the following would you interpret as
____________________________________________________ a symptoms of the final stage of syphilis?
____________________________________________________ 1. Blindness
Activity D CRITICAL INQUIRY EXERCISE 2. Chancre
1. Create a poster board illustrating the 3. Low grade fever
female and male reproductive systems. 4. Lymphadenopathy
Indicate the reproductive disorders 4. After teaching an adolescent with fibrocystic
common to both sexes and those specific breast disease about measures to reduce
to one gender or the other. discomfort, you determine that the client needs
2. Write a teaching plan addressing the additional teaching when the client needs
learning needs of a 13 years old who additional teaching when the client reports that
indicates a desire to become sexually
which of the following as the most common
method by which the organisms enter the body?
1. Acetaminophen CHAPTER 48
2. Oral contraceptives Nursing Care of a Family when
3. Caffeine
4. Danocrine a Child has an Endocrine or a
5. When taking to a group of adolescents about Metabolic Disorder
toxic shock syndrome, you would include
damage to which of the following as the most CHAPTER OVERVIEW
common method by which the organisms enter Chapter 48 reviews the care of a child with an
the body? endocrine or metabolic disorder. The chapter
1. Deep buccal tissue addresses the function of each hormone, the
2. Vaginal wall tissue result of altered endocrine function, and a plan
3. Urethral meatus for nursing intervention. The case study
4. Nasal mucous membranes demonstrates the principle for assessing a child
Activity G ALTERNATE FORMAT QUESTIONS with an endocrine disorder.
Multiple answer multiple choice Questions LEARNING OBJECTIVES
Circle the letter corresponding to the After mastering the contents of this chapter, you
appropriate answer. Select all that applies should be able to:
1. When preparing a teaching plan for a group of 1. Describe the structure and function of the
adolescent about pelvic inflammatory disease, endocrine glands and why metabolic
you would include which anatomical structures disorder occur.
as being involved? 2. Identify 2020 National Health Goals
1. Fallopian tubes related to childhood endocrine or
2. Vagina metabolic disorders that nurses can help
3. Uterus the nation achieve.
4. Ovaries 3. Assess a child with a disorder of
5. Ovarian support structures endocrine or metabolic function.
2. Which of the following are possible theories 4. Formulate nursing diagnosis for a child
about the cause of premenstrual dysphoric with altered endocrine or metabolic
disorder? function.
1. Drop in progesterone 5. Establish expected outcomes for a child
2. Vitamin B complex deficiency with a disorder of vision or hearing to
3. Decreased ovarian blood supply help parents manage seamless transitions
4. Hyperglycemia across differing health care settings.
5. Low calcium levels 6. Using the nursing process, plan nursing
3. An adolescents is diagnosed with care that includes the six competencies of
endometriosis. Which of the following would you Quality &Safety Education for Nurses
expect to be included as conservative treatment (QSEN): Patient-Centered Care,
for this condition? Teamwork & Collaboration, Evidence-
1. Estrogen only oral contraceptives Based Practice (EBP), Quality
2. Synthetic androgen Improvement(QI), Safety and,
3. Gonadotropin releasing hormone agonist Informatics.
4. Laparotomy for excision 7. Implement nursing care such as teaching
5. Intrauterine device long-term medicine administration to a
6. Prostaglandin inhibitor child with an endocrine or metabolic
disorder.
8. Evaluate expected outcomes for
achievement and effectiveness of care. Activity B MATCHING
9. Integrate knowledge of endocrine and Match the terms in Column I with a definition,
metabolic disorder with the interplay of example, or related statement from Column II.
nursing process, the six competencies of Place the letter corresponding to the answer
QSEN, and family nursing to ensure in the space provided.
quality maternal and child health nursing Column I Column II
care. ____ 1. Cushing 1. Excessive thirst
syndrome 2. Oversecretion
KEY TERMS ____2. Latent tetany of thyroid
1. Carpopedal spasm ____3. Polydipsia hormone
2. Exophthalmos ____4. Galactosemia 3. Hormone
3. Glycosuria ____5. Grave disease necessary for
____6. Kussmaul sodium fluid
4. Hormones
Breathing balance
5. Hyperglycemia
____7. PKU 4. Overproduction
6. Hypoglycemia ____8. Aldoseterone of the adrenal
7. Hypothalamus hormone
8. Ketoacidosis cortisol
9. Latent tetany 5. Deep and rapid
10. Pedal spasm respiration
11. Manifest tetany 6. Neuromuscular
12. Polydipsia irritability
13. Polyuria 7. Disorder of
14. Sella turcica carbohydrate
15. Somogyi phenomenon metabolism

MASTERING THE INFORMATION Activity C SHORT ANSWER

Supply the missing terms or the information
requested.
Activity A FILL IN THE BLANKS
1. What is the primary function of the
Supply the missing terms or the information
endocrine system?
requested.
____________________________________________________
1. Type 1 (insulin dependent) diabetes in
____________________________________________________
characterized by almost no _______________
2. For each hormone listed, identify the
secretion. This lack of secretion
glands/ organ that secrete it?
contributes to a build up of ________________
1. Thyroxine ______________________________
in the blood stream. If exogenous insulin
2. Somatotropin __________________________
is not administered, this person will
3. Insulin __________________________________
develop ____________ and _______________.
4. Antidiuretic hormone _________________
2. Humulin-R insulin begins to work
5. Aldosterone ____________________________
approximately _____________ minutes after
6. Corticotropin __________________________
administration.
3. State the onset of action and time to pass
3. Hypertrophy of the thyroid gland in
effect for humulin N (NPH), insulin.
response to TSH secretion is called
____________________________________________________
______________.
____________________________________________________
 Activity F CRITICAL EXPLORATION
1. Attend a camp for a children with
diabetes and offer to be a new counselor
APPLING YOUR KNOWLEDGE in one of the cabins.
2. Attend a meeting of the American
Activity D CASE STUDY association of diabetes educators. Ask one
Ashley, age 5, is admitted to the children hospital of the certified diabetes educators about
after her mom reports to the pediatrician that his / her job. How was certification
she has been urinating frequently and has loss obtained? Visit a diabetes education
weight. Her mom also reports that she had program that has been nationally
several incidents of incontinence while playing recognized by the American diabetes
on the playground. A careful history taking by association advisory council. Observe
the nurse revealed that Ashley’s appetite had patient instruction and follow up visits.
also increased. On admission to the hospital,
laboratory studies were ordered. The results PRACTICING FOR NLE
revealed a blood glucose of 400 mg/dl. Ashley’s
mother states “I should have never let her all Activity G MULTIPLE CHOICE QUESTIONS
those sweats.” Circle the letter that corresponds to the best
1. Based on the mother’s comment, what answer for each question.
teaching would you need to do? 1. You explain the purpose of insulin to a
____________________________________________________ child who is a newly diagnosed with
____________________________________________________ diabetes and her parents. You correctly
____________________________________________________ state the condition causes which effect on
2. What measures can be taken to lessen the blood glucose?
discomfort for a child with diabetes when 1. Increase
frequent blood samples are needed? 2. Decrease
____________________________________________________ 3. Remain the same throughout
____________________________________________________ 4. Increase then decrease
____________________________________________________ 2. You check a blood glucose level before
bed time and finds it to be 50 mg/dl. You
Activity E CRITICAL INQUIRY EXERCISE would assess Shajun for which of the
1. Create a blood glucose monitoring flow following?
sheet. Be sure to include the date, blood 1. Thirst
glucose level before each meal and 2. Flushing
bedtime, insulin glucose (both sugar and 3. Dehydration
NPH taken daily), and an explanation 4. Sweating
column were the patients can identify the 3. A child is to begin using an insulin pump.
reason for fluctuation in blood glucose You instruct the child’s parent to test the
level. child for hypoglycemia at 2 am. Which
2. Role play what it is like to check your statement by the parents indicates
blood glucose level four times per day and successful teaching has occurred?
record the amounts on your monitoring 1. Blood glucose may drop at this time
sheet. On the next day, change the because of insufficient food intake
numbers to indicate hyperglycemia all 2. Insufficient exercise at this time may
day. Indicate what may have contributed cause a drop in blood glucose
to the problem. 3. Blood glucose may drop at this time
because of insufficient fluid intake
4. Insufficient sodium intake at this time 3. polydipsia
may cause a drop in blood glucose. 4. high urine specify gravity (1.001 to 1.005)
4. A child who receives a split dose of 5. polyuria
regular and NPH insulin twice a day is 3. You are preparing a presentation for a
planning to play soccer at 3:00 in the group of middle school students about the
afternoon. Which action should you endocrine system, glands and associated
instruct the patient would be best? hormones. You would include which of
1. Take no insulin that morning the following as being secreted by the
2. Decrease regular insulin dosage in the pituitary gland
morning 1. Growth hormone
3. Decrease NPH insulin glucose in the 2. Corticotropin
morning 3. Antidiuretic hormone
4. Increase NPH insulin glucose in the 4. Insulin
morning 5. Cortisol
5. After teaching a child newly diagnosed 6. aldosterone
with diabetes and her parents about
causes of hypoglycemia, you determine
that the teaching was effective when they
state which of the following as a cause?
1. Missing an insulin injection
2. Missing a meal /snack
3. Too small an insulin dosage
4. Too large a meal or snack

Activity H ALTERNATE FORMAT QUESTIONS

Multiple answer multiple choice questions.
Circle the letter corresponding to the
appropriate answer. Select all that applies.
1. Which of the following reflects accurate
information about endocrine disease
processes?
1. Growth hormone deficiency is a pituitary
disorder
2. Hashimoto disease interferes with thyroid
gland function
3. Cushing syndrome is an underproduction
of cortisol by the adrenal gland
4. The most frequent occurring pancreatic
disorder in children is type 2 diabetes
5. Dysfunction of the parathyroid gland can
cause calcium imbalances.
2. Diabetes insipidus is a disease described
as involving which of the following?
1. an excessive release of the antidiuretic
hormone (ADH)
2. trauma to the pituitary gland as a possible
cause
 promote quality maternal and child health
CHAPTER 49 nursing care.
Nursing Care of a Family
KEY TERMS
When a Child Has a Neurologic
Disorder 1. astereognosis
2. automatisms
CHAPTER OVERVIEW
3. autonomic dysreflexia
Chapter 49 discusses the care of the child with a
4. choreoathetosis
neurologic disorder. The physiologic and 5. choreoid
psychological impact of common neurologic 6. deceberate posturing
conditions on children at various stages of 7. decorticate posturing
growth and development are discussed. The use 8. diplegia
of the nursing process to plan and provide care 9. dyskinetic
for the child with a neurologic disorder and his 10. graphestesia
or her family is explored. The case study 11. hemiplegia
presents the nursing care of the child with a 12. pulse pressure
potentially life threatening neurologic infection. 13. quadriplegia
14. status epilepticus
LEARNING OBJECTIVES 15. stereognosis
After mastering the contents of this chapter, you
MASTERING THE INFORMATION
should be able to:
1. Describe common neurologic disorders in
children. ACTIVITY A FILL IN THE BLANKS
2. Identify 2020 National Health Goals related to Supply the missing term or the information
neurologic disorders of children that nurses requested.
could help the nation achieve. 1. The nervous system consists of two
3. Asses a child who has a neurologic disorder separate systems, the ____________ and the
4. Formulate nursing diagnoses for a child with a ________________ nervous systems.
neurologic disorder. 2. Test for cerebellar function involve
5. Establish expected outcomes for a child with a testing for normal _________________ and
neurologic disorder to help parents manage ______________.
seamless transitions across differing health care 3. Signs of _______________, in which a child is
settings. unsure of time and place, may be the first
6. Using the nursing process, plan nursing care indication of increased intracranial
that includes the six competencies of Quality pressure.
&Safety Education for Nurses (QSEN): Patient- 4. Cerebellar perfusion pressure is
Centered Care, Teamwork & Collaboration, calculated by subtracting the mean
Evidence-Based Practice (EBP), Quality intracranial pressure from the mean
Improvement(QI), Safety and, Informatics. ________________ pressure.
7. Implement nursing care, such as monitoring 5. The major cause of meningitis in
medicine effectiveness, for a child with a newborns is the group B ________________
neurologic disorder. organisms.
8. Evaluate expected outcomes for achievement 6. The treatment of the infants’ botulism
and effectiveness of care. consists of ________________ _______________.
9. Integrate knowledge of neurologic disorders 7. Seizure associated with high fever are
with the interplay of nursing process, the six most common in ______________ aged
competencies of QSEN, and family nursing to children.
8. Indicate if the following action test shape that has
sensory, motor, or cerebellar function. been traced on
a. asking a child to touch ear finger on one the skin
hand with the thumb of that hand in rapid 4. Reflection of
succession: ____________________ electrical
b. asking a child to resist your action as you patterns of the
brain
push down or up on his or her hands:
5. The ability to
_________________.
distinguish
c. touching the Childs elbow with a vibrating movement
tuning fork: ______________________. 6. Child’s arms
9. Identify the seizure described below as are abducted
psychomotor, absence, tonic-clonic, or and flexed
simple partial. 7. Spastic
a. generalized seizure with a prodromal, cerebral palsy
aural, tonic, and clonic stages: involvement
___________________. affecting
b. involves only one area of the brain; no primary the
altered level of consciousness: lower
__________________. extremities
8. The ability to
c. may begin with a sudden change in
recognize an
posture, circumoral pallor, or a 5-minute loss
object by touch
of consciousness without a postictal stage: 9. Indication of
________________. non-functional
d. “Petit mal”, generalized seizure involves midbrain with
staring spells lasting for a few seconds: rigid extension
________________. and adduction
of arms and
ACTIVITY B MATCHING wrist
Match the terms in Column I with a definition, pronation
example, or related statement from column II. 10. Radiographic
Place the letter corresponding to the answer study of spinal
in the space provided. cord involving
the use of arms
Column I Column II
and wrist
____1. Electron 1. Awkward
pronation.
cephalogram ward based
____2. graphestesia gait
____3. kinesthesia 2. Subcutaneous
____4. Ataxic tumors along APPLYING YOUR KNOWLEDGE
____5. Neuro- nerve
fibromatosis pathways, with ACTIVITY C CASE STUDY
____6. Diplegia excessive skin Mrs. Vereen has brought Shawn to the
____7. Stereognosis pigmentation emergency room with an elevated temperature.
____8. Decorticate and possible Shawn is 14 years old and has had a cold for
posture optic or several days. Shawn’s temperature on
____9. Deceberate acoustic nerve assessment was 1040 F orally. He began to have a
Posture degeneration
seizure during admission and was immediately
____10. Muelography 3. The ability to
taken to the treatment room. After some initial
recognize a
testing, he was diagnose with H. influenzae ACTIVITY F MULTIPLE-CHOICE QUESTIONS
meningitis. Circle the letter that corresponds to the best
1. How was the diagnosis confirmed? answer for each question.
1. Melle, age 7, is admitted to your unit after an
automobile accident. You would suspect
increased intracranial pressure if your
assessment revealed which of the following.
2. What treatment would you expect to
a. Bradycardia
administer? What might occur if this
b. Decreased pulse pressure
condition is left untreated?
c. Hypotensive blood pressure
d. Tachypnea

3. Why should there be a concern for 2. You understand what about a doll’s eye
siblings and family members of the child reflect?
with bacterial meningitis? What measure a. It can be used to asses a comatose child who
should you expect to be initiated? cannot respond to a light.
b. it indicates increased intracranial pressure if
present.
c. It result when a child turns his or her eyes to
ACTIVITY D CRITICAL INQUIRY EXERCISE the left as his or her head is turned to the left
1. Develop an abbreviated assessment for a rapidly.
soccer coach to asses an injured child with a d. It results when a child turns his or her eyes to
mobility problem. Include advice the coach must the left as his/ her head is turned to the left
give the person who may want to assist him or rapidly.
her before professional help arrives. 3. Billy, age 2, has been diagnosed with the
2. Prepare a teaching plan stressing the cerebral palsy. You should explain which of the
importance of health care to prevent accident; following to Billy’s parents?
customize this plan to teach a parent group in a a. Cerebral palsy involves progressive nerve
day care setting. Include the 2020 National degeneration.
Health Goals as they relate to upper respiratory b. Contractures are unavoidable since
infections, the relationship of a disease and age ambulation is impossible.
frequency, and bike riding on streets. c. Brain damage that occurred at birth can be
repaired with surgery when the child is older.
ACTIVITY E CRITICAL EXPLORATION d. Two children with cerebral palsy may exhibit
1. While on a pediatric clinical unit, perform a totally different symptoms and abilities.
neurologic assessment on a client with no known 4. Which of the following nursing interventions
neurologic conditions and on a client with a would be appropriate for a child with Guillan-
neurologic condition affecting neuromuscular or Barre syndrome?
celebral function. Note the differences in a. Feeding the child orally to maintain the
findings. muscles of mastication
2. Observe the room of a client who has a history b. Explaining to parents that steroids will be
of seizure or areas in which precautions should effective in halting the paralysis
be taken, and note the seizure precautions taken c. immobilizing extremities to decrease
for that client’s safety. stimulation of muscle spasm
d. inserting an indwelling catheter into the
PRACTICING FOR NLE bladder to monitor the urine output.
5. To decrease the incidence of spinal cord injury c. Removes any hard head coverings and replace
in children and adolescents, you should do which with a support neck brace
of the following? d. Maintain spinal immobilization during
a. Caution children and adolescents against neurologic assessment
diving into shallow water 10. Nursing care of the child who has suffered a
b. encourages the intake of vitamins A and C to spinal cord injury may include which of the
minimize spinal cord injury following interventions?
c. Instruct adolescents to ride motorcycle instead a. Pushing carbonated beverages during the first
of driving cars phase of recovery to acidify urine
d. teaches back exercises to children to b. Using credes maneuver to stablish a defecation
strengthen their weak vertebrae pattern
6. A child with a cervical spinal injury should be c. Helping the child and family adjust to
watched very carefully for which of the permanent mobility loss during the first
following? recovery phase
a. Hypoactive bowel sounds during the second d. supporting the child and family during the
recovery phase grieving process after the second recovery phase
b. hyperreflexia of the bladder during the first
recovery phase ACTIVITY G ALTERNATIVE FORMAT
c. profuse diaphoresis during the second QUESTIONS
recovery phase Multiple-Answer Multiple-Choice Questions
d. respiratory distress during the first recovery Circle the letter(s) corresponding to the
phase appropriate answer(s). Select all that apply.
7. Which of the following should lead you to 1. Which of the following would you expect to
suspect that a child with a spinal cord injury is assess in a child with migraine headache?
developing autonomic dysreflexia 1. Bilateral pain under both eyes
a. bradycardia and flushed face 2. Pain aggravated by routine activity
b. headache and hypertension 3. Family history of migraine headache
c. hypotension and pallor 4. Report of blurred vision prior to head
d. pale skin and dizziness ache
8. Which of the following is true about the third 5. Relief commonly obtained with
phase of spinal cord recovery? acetaminophen
a. Autonomic dysreflexia is a common 2. Which of the following agents would you
occurrence expect could be prescribed for a child with tonic
b. Spasticity of muscles and reflexes is noted – clonic seizures?
c. Flaccid paralysis of the diaphragm and skeletal 1. Phenobarbital
muscle is present 2. Valproic acid
d. permanent limitation of motor and sensory 3. Phenytoin
function can be assessed. 4. Dexamethasone
9. Benje, age 7, is admitted to the emergency 5. Carbamazepine
room with suspected spinal cord injury after an 3. Which of the following would indicate to you
automobile accident. Which of the following that a child has increased intracranial pressure?
nursing intervention would be appropriate? 1. Dilated pupils
a. Move the child from the admission stretcher to 2. Hypertension
a firm examining table on admission. 3. Tachycardia
b. Hyperextend the head if respiratory 4. Tachypnea
resuscitations is necessary 5. Oriented to time
6. Decreased deep tendon reflexes
 9. Integrate knowledge of childhood disorders of
Chapter 50 the eyes or ears with the interplay of nursing
Nursing care of a family when process, the six competencies of QSEN, and
family nursing to promote quality maternal and
a child has a vision or hearing child health nursing care.
disorder
CHAPTER OVERVIEW KEY TERMS
Chapter 50 discusses the eyes and ears as
essential sensory organs. Disorders involving 16. accommodation
5. Amblyopia
these organs in childhood may retard normal
6. Astigmatism
growth and development and, if untreated, may
7. Diplopia
lead to long-term illness. This chapter addresses 8. Enucleation
the structure of the eyes and ears, the physiology 9. Fovea centralis
of vision and hearing, and common vision and 10. Goniotomy
hearing disorders, as well as the nurse's role in 11. Hyperopia
health promotion and management of vision and 12. Light refraction
hearing disorders. 13. Myopia
LEARNING OBJECTIVES 14. Nystagmus
After mastering the contents of this chapter, you 15. Orthoptics
should be able to: 16. Photopobia
1. Describe the structure and function of the eyes 17. Ptosis
and ears and disorders of these organs as they 18. Stereopsis
affect children. 19. Strabismus
20. Tympanocentesis
2. Identify 2020 National Health Goals related to
MASTERING THE INFORMATION
vision and hearing disorders of children that
nurses could help the nation achieve.
3. Asses a child who has a disorder of vision or ACTIVITY A FILL IN THE BLANKS
hearing Supply the missing term or the information
4. Formulate nursing diagnoses related to a child requested.
with a disorder of vision or hearing. 1._______ is the ability to locate an object in space
5. Establish expected outcomes for a child with a relative to other objects.
disorder of vision or hearing to help parents 2. Eyes exercise are referred to us ______…
manage seamless transitions across differing 3._______ is a reflected error (farsightedness) in
health care settings. which vision is blurry at close range.
6. Using the nursing process, plan nursing care 4. _______ is a congenital incomplete closure of
that includes the six competencies of Quality that facial cleft.
&Safety Education for Nurses (QSEN): Patient- ACTIVITY B MATCHING
Centered Care, Teamwork & Collaboration, Match the terms in Column I with a definition,
Evidence-Based Practice (EBP), Quality example, or related statement from column II.
Improvement(QI), Safety and, Informatics. Place the letter corresponding to the answer
7. Implement nursing care to meet the specific in the space provided.
needs of a child who has a disorder of the eyes or Column I Column II
ears, such as educating parents about the ____1. Accommodation a. Turning of both
____2. Chalazion eyes medially
symptoms of otitis media.
____3. Dacryostenosis b. infection of the
8. Evaluate expected outcomes for achievement
____4. Cerumen eyelid margin
and effectiveness of care. ____5. Ptosis c. Inflammation of the
____6.Blepharitis nasolacrimal duct
 marginalia e. the inability to raise ACTIVITY D CRITICAL INQUIRY EXERCISE
____7. Amblyopia the upper eyelid 1. Prepare an interaction program for a school-
____8. Nystagmus normally aged child who is hospitalized for a scheduled
____9. Convergence f. Interruption of the eye surgery. Focus on anticipatory guidance
____10. Dacryocystitis tear flow; block-age of before and after surgery. Incorporate measures
the lacrimal drainage to reduce anxiety, promote independence, and
system.
facilitate parental participation.
g. Has chief function
2. Prepare a list of key points for parents to
of cleaning the
external ear remember when interacting with their school-
h. Constriction of the aged child in the hospital environment.
pupil as it adjusts ACTIVITY E CRITICAL EXPLORATION
from focusing on a 1. Make an appointment to visit the local support
distant point to a near chapter for citizens with a hearing challenge.
point Identify the support groups organized in
i. Low-grade cooperation with this agency. Note the teaching
granulation tissue materials and classes made available to support
tumor of the the parents of the child with a hearing challenge.
meibomian or tarsal 2. Visit a health clinic and participate in the
gland on the eyelid hearing and vision screening for children
j. Reduction in vision
entering school. Observe the steps taken when a
due to disuse of a
child is found to have a vision or hearing
structurally normal
eye; "lazy eye" challenge.

PRACTICING FOR NLE

APPLYING YOUR KNOWLEDGE ACTIVITY F MULTIPLE-CHOICE QUESTIONS

Circle the letter that corresponds to the best
ACTIVITY C CASE STUDY answer for each question.
Ms. Jone's foster daughter Sally, age 6, was 1. You should expect which of the following
admitted to the hospital for surgery on the left findings when assessing a child with acute otitis
eye. The presurgical diagnosis was a cataract of media?
the left eye. The history and physical a.Excessive cerumen in the outer ear
examination revealed that Sally's birth mother is b.Recent respiratory tract infection
a teenager and Sally has been in foster care since c. Increased mobility on the pneumatic
age 2. There was no medical history, and the examination
laboratory and examination report stated that d. Copious amount of tenacious fluid
the lens of the left eye was opaque at the adges. 2. You recognize what as the primary cause of
1. What might you suspect as the etiology of the visual impairment in children?
cataract? a. Ocular trauma
2. Postoperatively, Sally complains of thirst; the b. Exposure to elevated oxygen levels during
postoperative orders read, " may have fluids infancy
when fully awake." when would you allow Sally c. Congenital malformations
to have fluids, and why? d. Eye infection
3. When teaching Ms. Jones postoperative care, 3. To visualize the inner surface of child's lower
what preventive measures would you want to eyelid and most of the bottom globe, what
address? procedure would you use?
a. Pull the top eyelid outward and up
b. Invert the top eyelid with a special apparatus ACTIVITY G ALTERNATIVE FORMAT
c. Press on the lower lid with a fingertip QUESTIONS
d. Use a cotton-tipped applicator to flip the lower Multiple-Answer Multiple-Choice Questions
lid Circle the letter(s) corresponding to the
4. If the ciliary body of the eye is involved with a appropriate answer(s). Select all that apply.
penetration injury, sympathetic ophthalmia may 1. Which of the following statements about ear
occur. How do you describe this condition to the disorders is (are) accurate?
child's parents? a. In the assessment of swimmer's ear,
a. It is hemographic paralysis pseudomonas and candida are often found to be
b. It is inflammation of the opposite eye agents involved in the infection.
c. It is a global contusion b. An internal ear canal altered by a fungal
d. It is an infectious process of the globe disease may appear brown or black.
5. You should suspect which of the following if a c. There is a higher incidence of otitis media in
child is scheduled for tonometry? infants who are breastfed than in those who are
a. Cataracts formula-fed.
b. Diplopia d. A myringotomy is a surgical procedure used to
c. Retinal detachment drain purulent fluids from an infected middle
d. Glaucoma ear.
6. A child is to undergo a goniotomy procedure to e. The inner ear canal should be cleaned
provide an opening to the canal of schlemm. regularly with a cotton-tipped swab to prevent
Preoperatively, which of this drugs would you the accumulation of drainage and cerumen.
expect to administer to this child? 2. Which of the following would you suspect as a
a. Ampicillin (amoxil) possible cause of conductive hearing loss?
b. Cefazolin (Ancef) a. Impacted cerumen
c. Acetazolamide (diamox) b. Immobile tympanic membrane
d. Atropine c. Drug therapy
7. Which of the following conditions is likely to d. Meningitis
occur as a sequela to untreated cataracts in e. Serous otitis media
infants? 3. You are providing anticipatory guidance about
a. Amblyopia preventing hearing loss to parents of a young
b. Dacryostenosis child. Which of the following would you include?
c. Astigmsatism a. “try to avoid exposing the child to loud noises,
d. Keratitis like the television or radio."
8. Which of the following would be important for b." clean the child's ear daily with a cotton swab."
you to include in the plan of care for a child who c. “get the child threated quickly if he develops a
is being prepared to undergo eye surgery? sore throat and fever."
a. Showing the child a doll with patches over d. "make sure that the child's immunizations are
both eyes keep up-to-date."
b. Restraining the child at the wrist bilaterally for e. "instill full-strength hydrogen peroxide at least
24 hours weekly into the ear canal."
c. Avoiding discussion of the impending surgery
d. Introducing child to other child on the unit
 and Family Nursing to promote quality maternal
CHAPTER 51 and child health nursing care.
NURSING CARE OF A FAMILY KEY TERMS
10. apposition
WHEN A HAS 11. Arthroscopy
12. Cartilage
MUSKULOSKELETAL 13. Compartment syndrome
DISORDER 14. Diaphysis
CHAPTER OVERVIEW 15. Distraction
Chapter 51 discusses the common 16. Epiphyseal plate
musculoskeletal disorders experienced in 17. Epiphysis
18. Fracture
childhood and the potential effects of these
19. Malleoli
disorders on the child's growth and
20. Metaphysis
development. The use of the nursing process to 21. Myopathy
plan and provide age-appropriate nursing care 22. Periosteum
addressing the physiologic and psychological 23. Remodeling
needs of the child with musculoskeletal 24. Resorption
disorders and of family members is explored. 25. Sequestrum
LEARNING OBJECTIVES 26. Traction
After mastering the contents of this chapter, you MASTERING THE INFORMATION
should be able to
1. Describe common musculoskeletal disorders ACTIVITY A FILL IN THE BLANKS
in children. Supply the missing term or the information
2. Identify 2020 National Health Goals related to requested.
musculoskeletal disorders in children that 1. A bone injury occurring at the _______ ________ of
nurses can help the nation achieve. the long bone may result in irregular or
3. Asses a child with a musculoskeletal disorder. abnormal bone length, and injury to the _______ of
4. Formulate nursing diagnoses related to a child the bone may result in irregular bone width.
with a musculoskeletal disorder. 2. Proper fitting of crutches requires a space of
5. Establish expected outcomes for a child with a _______ to _______ inches between the axilla crutch
musculoskeletal disorder that help children and pad and the child's axilla and elbow flexion of
parents manage seamless transitions across abou_______ degrees.
differing health care settings. 3. Osgood-Schlatter disease is a ________ and
6. Using the nursing process, plan nursing care ________ of the tibia tuberosity occurring in
that includes the six competencies of Quality & children who are athletic and at the ________ or
Safety Education for Nurses (QSEN): Patient- ________ stage of development.
Centered Care, Teamwork and Collaboration, 4. Apophysitis occurs most commonly in _______
Evidence-Based Practice (EBP), Quality who are growing rapidly. Pain produce by this
Improvement (QI), Safety and, Informatics. condition can be threaten by adding a _________ to
7. Implement nursing care, such as helping a the shoe heel to reduce tension on the heel cord.
child with a musculoskeletal disorder meet 5. Although juvenile arthritis primarily involves
optimal ambulation capacity. one's joints, it also affects _______ _________ and
8. Evaluate expected outcomes for achievement other ________ __________.
and effectiveness of care. 6. Muscular dystrophies are inherited disorders,
9. Integrate knowledge of children's apparently caused by a defective gene necessary
musculoskeletal disorders with the interplay of for _______ _______.
nursing process, the six competencies of QSEN,
Activity B MATCHING corrected with
Match the terms in Column I with a definition, stretching exercises
example, or related statement from Column II.
Place the letter corresponding to the answer
in the space provided. Activity C SHORT ANSWER
Column I Column II Supply the missing term or the information
1. Apposition a. Acquired or requested.
2. Diaphysis inherited disease of 1. Discuss why a child with a condition requiring
3. Epiphyseal plate the muscular system a leg brace might have a nursing diagnosis of
4. Genu varum b. The type of muscle "Disturbed body image".
5. Metaphysis responsible for 2. What nursing measures could be taken to help
6. Metatarsus gastrointestinal a school-aged child on complete bed rest with
adductus peristalsis traction meet his or her developmental tasks?
7. Myopathy c. The predominant 3. Discuss two measures for managing itching
8. Osteogenesis type of muscle in the
underneath a cast and measures that should not
9. Skeletal traction body
10. Striated muscle d. The cartilage be used.
11. Smooth muscle segment at which 4. Discuss three exercises used to strengthen the
12. Periosteum increase in long bone foot arches of a child with flat feet.
length occurs 5. Compare and contrast the causes of and the
e. The thin area treatment for structural and functional scoliosis.
between the long 6. Describe the following types of braces and
bone shaft and the traction and the appropriate use of each:
rounded end of the Milwaukee brace, halo traction, Bryant's traction,
bone Buck's traction, and skeletal traction.
f. The long central
shaft of the long bone APPLYING YOUR KNOWLEDGE
g. Evident when
malleoli are touching
and medial knee Activity D CASE STUDY
surfaces are more Evelyn Demark, 10 years old, has osteogenesis
than 2 inches apart. imperfecta and is admitted to your unit with a
h. The passing of a pin fracture of the right forearm due to an injury in
or wire through the gymnastics class.
skin into the end into 1. What would you need to discuss during your
the end of the long teaching session with Evelyn and her parents
bone to immobilize a related to activity choices.
fracture 2. How would Evelyn's plan of care differ if she
i. Outer sensitive layer did not have osteogenesis imperfecta?
of the bone
j. The amount of end-
Activity E CRITICAL INQUIRY EXERCISE
to-end contact of the
bone fragments 1. Write a care plan for a school-aged child
k. Connective tissue hospitalized with bilateral leg traction after an
disorder accident. Include age-appropriate activities.
characterized by the 2. What safety and development issues would
formation of brittle you include in a teaching plan for a 7-month-old
bones child with a broken femur due to a fall down the
l. Turning in the stairs at home?
forefoot; can be
Activity F CRITICAL EXPLORATION c. Carry books and other items in a backpack to
Walk through your home and the home of a keep her hands free.
friend. Note any circumstances that could d. Use a two-point gait when no weight bearing is
represent a danger to a child. allowed.
4. Marla, age 12 years, has a cast on her left leg.
PRACTICING FOR NLE During a follow-up phone call, Marla states she is
experiencing occasional numbness in her left
Activity G MULTIPLE-CHOICE QUESTIONS foot and the foot feels cool. You should respond
Circle the letter that corresponds to the best in which of the following ways?
answer for each question. a. Explain to Marla that she needs to wiggle her
1. Benji, age 11 years, has been diagnosed with toes frequently to prevent the return of the
osteomyelitis after a right leg injury 2 months numbness and coolness.
ago. He and his parents were told that he must b. Inform Marla and her mother of the need to
be admitted to the hospital for treatment. You elevate the extremity to promote good
should explain which of the following to Benji circulation.
and his parents? c. Instruct Marla and her mother to return to the
a. Benji will need to ambulate immediately after doctor for possible removal of the cast.
surgery, although it may be uncomfortable. d. Teach Marla isometric exercises to use when
b. Blood will be drawn for culture to determine numbness and coolness occur.
the specific medication for treatment of the 5. You would determine that the plan of care for
infection. a child with juvenile arthritis had been effective
c. Infection control measures are necessary to if which of the following findings was noted?
prevent the spread of this condition to the entire a. The parents state the need to avoid aspirin
family. administration to prevent Reye syndrome.
d. The antibiotic therapy Benji will need must be b. Eighty percent of meals are eaten when
administered intravenously and will be complete offered after periods of rest and administration
before discharge. of pain medication.
2. Amy, 3 years old, has been diagnose with c. Splints are applied during the day and
osteogenesis imperfecta. When planning her removed at night by parents to promote sleep.
care, you should consider which of the following? d. Ice packs are applied to the affected joints by
a. Active range-of-motion and weight-lifting parents twice daily.
exercises will be necessary to strengthen weak 6. A plan of care for a girl suspected of having
long bone shafts. myasthenia gravis may include which of the
b. Amy's parents should be encouraged to following?
facilitate her development by not restricting her a. Administering cholinergic drugs to suppress
activities. the hyperactivity actions of acetylcoline
c. Genetic counseling will be appropriate if Amy's b. Inquiring if the child has had difficulty in
condition is congenital or late occurring. school recently due to difficulty in reading or in
d. The treatment for this condition requires seeing the board
lifelong oral intake or calcium supplements. c. Reassuring the adolescent female that
3. When teaching Sheila, 13 years old, to walk myasthenia gravis will not affect her
with crutches, how should you instruct her? childbearing potential
a. Move one crutch forward at a time when using d. Scheduling medications after mealtime to
a three-point swing-through gait. decrease gastrointestinal symptoms, choking,
b. Rest the crutch pad on the upper arm to bear and possible aspiration
her weight on the axilla crutch pad. 7. Congenital muscular dystrophy differs from
Duchenne disease and facioscapulohumeral
muscular dystrophy in which of the following b. "We should give the drug with food or milk so
ways? her stomach doesn't get upset."
a. Congenital muscular dystrophy results in c. "Exposing her to stress will actually help her
regeneration of muscle fibers. muscles from becoming weak."
b. Congenital muscular dystrophy can result in d. "We can expect her muscle weakness to
problems with parental bonding. become progressively worse as time goes on."
c. In facioscapulohumeral muscular dystrophy, e. "We will talk to her school to see if we can get
the predominant symptom is facial weakness. her a modified schedule to allow her to rest."
d. Victims of Duchenne disease experience
periods of exacerbation and remission.

Activity H ALTERNATE FORMAT QUESTION

Multiple-Answer Multiple-Choice Questions
Circle the letter(s) corresponding to the
appropriate answer(s). Select all that apply.
1. A child has had spinal instrumentation for
treatment of scoliosis. Which of the following
nursing interventions would be appropriate?
a. Maintain the head of the bed at a 45-degree
elevation.
b. Logroll the child to a side-lying position every
2 hours depending on types of rods used.
c. Monitor the neurologic and vascular functions
of the extremities every hour for the first 24
hours.
d. Explain the need to keep the child NPO until
bowel sounds are audible.
e. Instruct the parents not to touch the child
during the early postoperative period.
f. Explain to parents that even severe scoliosis
can be completely corrected with surgery.
2. A child is diagnosed with polyarticular
arthritis. When assessing this child, which of the
following would you expected to find?
a. High spiking fever
b. Nodules on pressure-sensitive body areas
c. Affected finger and hand joints
d. Iridocyclitis
e. Enlarged lymph nodes
3. After teaching the parents of an 11-year-old
girl with myasthenia gravis about the disorder
and treatment with neostigmine, which of the
following statements indicates successful
teaching?
a. "We need to notify her health care provider if
her weakness suddenly increases."
 9. Integrate knowledge of unintentional injury in
CHAPTER 52 children with the interplay of nursing process,
NURSING CARE OF A FAMILY the six competencies of QSEN, and family nursing
to achieve quality maternal and child health
WHEN A CHILD HAS AN nursing care.
UNINTENTIONAL INJURY
CHAPTER OVERVIEW KEY TERMS
Accidents are a major cause of childhood
morbidity and mortality, and prevention is a goal 25. allografting
26. Autografting
to which nurses and other health care providers
27. Contrecoup injury
always strive. Not all accidents can be prevented,
28. Debridement
however. Chapter 52 describes the principles of 29. Drowning
nursing care for the child with an unintentional 30. Escharotony
injury. The uses of the nursing process to assess, 31. Near drowning
plan, and provide appropriate nursing care and 32. Otorrhea
to address the physiologic and psychological 33. Plumbism
needs of the child and family involved with an 34. Rhinorrhea
unintentional injury are discussed. 35. Sprain
LEARNINNG OBJECTIVES 36. Strain
After mastering the contents of this chapter, 37. Stupor
you should be able to:
1. Describe the causes and consequences of MASTERING THE INFORMATION
common unintentional injuries in childhood and
measures to prevent them. Activity A FILL IN THE BLANKS
2. Identify 2020 National Health Goals related to Supply the missing term or the information
children who have experienced trauma that requested.
nurses can help the nation achieve. 1. The extent of a child's injury depends on the
3. Assess a child who has been unintentionally _______ _______, the _______ ______ that was injured,
injured. and the _______ _____ child received.
4. Formulate nursing diagnoses related to an 2. Full thickness or _______ degree burns are not
unintentionally injured child. extremely painful.
5. Established expected outcomes for an 3. Equipment used to care for a severely burned
unintentionally injured child that can help child must be ________ to prevent wound infection.
parents manage seamless transitions across 4. Second- or third-degree burns may receive
differing health care settings. ________ treatment, which involves leaving the
6. Using the nursing process, plan nursing care burned area exposed to air.
that includes the six competencies of Quality
&Safety Education for Nurses (QSEN): Patient- Activity B MATCHING
Centered Care, Teamwork and Collaboration, Match the terms in Column I with a definition,
Evidence-Based Practice(EBP), Quality example, or related statement from Column II.
Improvement (QI), Safety, and Informatics. Place the letter corresponding to the answer
7. Implement nursing care for a child with an in the space provided.
unintentional injury, such as providing pain Column I Column II
relief. 1. Allografting a. Cutting into the
8. Evaluate expected outcomes for achievement 2. Chelating agents tough leathery scab
and effectiveness of care. 3. Contrecoup injury over a burned area to
4. Contusion release a tight band
5. Escharotomy around an extremity Supply the missing term or the information
6. Xenografting b. Placing of skin from requested.
7. Leptomeningeal cadavers or a donor 1. Identify the three areas assessed with the
cyst on a cleaned burn site Glasgow Coma Scale.
8. Plumbism c. A tearing of ________________________________________________________
9. Rhinorrhea laceration of brain ________________________________________________________
10. Stupor tissue, with symptoms
2. Discuss the appropriate method for discharge
11. Autografting specific to the brain
teaching of parents of injured children
area affected
e. Lead poisoning; discharged from the emergency room.
usually occurs in ________________________________________________________
toddlers and pre- ________________________________________________________
school children 3. Explain why the "rule of nines" cannot be used
f. Clear fluid draining to determine the extent of burns on infant and
from the nose; if it is children.
cerebrospinal fluid, it ________________________________________________________
will be positive for ________________________________________________________
glucose 4. Discuss the reason why burn injuries to the
g. A concussion on the face and throat can be more hazardous than
side of the brain other burn injuries.
opposite that which
________________________________________________________
was struck; occurs as
________________________________________________________
the brain recoils from
the force of the blow 5. Describe the infection control measures used
h. Skin from a for burn victims.
nonhuman source, ________________________________________________________
such as porcine (pig), ________________________________________________________
used to promote skin 6. Describe the appropriate emergency
after a burn treatment for the indicated burn injuries: first-,
i. Skin taken from an second-, and third-degree burn; electrical burn.
unburned area of a ________________________________________________________
burn victim's body ________________________________________________________
and placed on a
prepared burned area APPLYING YOUR KNOWLEDGE
to facilitate healing
j. Substances that act
to remove lead from Activity D CASE STUDY
soft tissue and bone Mr. and Mrs. Chin come to your emergency room
and eliminate it in the with their 3-year-old son, jay. Jay is an active
urine child who has broken his arm and sprained a
k. Results from wrist climbing on furniture. Jay likes to ride his
projection of the tricycle around the house and yard and once
arachnoid membrane nearly drank a liquid cleaner that was not placed
into the fracture site; out of reach in the kitchen. Jay's arm is placed in
may cause symptoms a cast.
of increased 1. What safety issues would you need to address
intracranial pressure
with the Chin family, and what further
assessment would you make?
2. What is the rationale for scheduling a series of
follow-up appointments?
Activity C SHORT ANSWER
 3. Jan, age 13, is admitted with third degree
Activity E CRITICAL INQUIRY EXERCISE burns over 25% of her body. Which of the
1. What safety suggestions could you give to a following would be the priority concerns in Jan's
couple who have open fireplaces and space plan of care?
heaters in their home and three active children a. Liberal medication to control Jan's severe pain
ages 18 months, 3 years, and 5 years? b. Arranging age-appropriate diversional
________________________________________________________ activities
________________________________________________________ c. Preventing hypovolemia and circulatory
________________________________________________________ collapse
2. Prepare a plan of care addressing outdoor d. Increasing oral intake of proteins to build
summer activities and dress for parents of a child tissue
who lives on a ranch in the southwest. 4. Which would you expect as a realistic outcome
________________________________________________________ for the parents of a child who is the victim of
________________________________________________________ unintentional injury?
Activity F CRITICAL EXPLORATION a. Parents admit responsibility for the child’s
1. Visit a burn center and observe the care trauma
measures taken for clients at various ages and b. Parents allow the child to perform household
with various types and degrees of burns. chores without supervision to strengthen self-
2. Locate the names and phone numbers of the esteem
emergency medical system and the poison c. Parents prevent all future accidental childhood
control center in your neighborhood. injury.
d. Parents state measures they can take to
PRACTICING FOR NLE prevent common accidents from occurring.

Activity G MULTIPLE-CHOICE QUESTIONS Activity H ALTERNATE FORMAT QUESTIONS

Circle the letter that corresponds to the best Multiple-Answer Multiple-Choice Questions
answer for each question. Circle the letter(s) corresponding to the
1. Which of the following would you recognize as appropriate answer(s). Select all that apply.
a serious danger sign if noted in a child after 1. Which of the following would be appropriate
head trauma? interventions for a child who has experienced an
a. Complaint of headache along the area of unintentional injury?
trauma a. Subdural hematoma: Monitors for seizures,
b. Blood pressure changing from 120/80 to vomiting, or hyperirritability for up to 20 days
110/70 after the trauma.
c. Memory deficit with inability to recall time or b. Acetaminophen poisoning: administer acetyl
date cysteine in a carbonated drink.
d. Pupils equal and briskly reactive to light c. Caustic poisoning: Administer syrup of ipecac
2. Which of the following would you include in followed by cold water or milk.
the plan of care for a child in a coma? d. Hydrocarbon ingestion: Monitor the child for
a. Encouraging parents to be positive because respiratory irritation.
coma is often short term in children e. Iron poisoning: Monitor for initial nausea,
b. Performing passive range-of-motion exercises diarrhea, and abdominal pain followed by
to maintain muscle tone melena and hematemesis and shock 12 hours
c. Feeding a child with a spoon and fork to later.
stimulate memories of normal activity f. Plant poisoning: Reassure parents that this is
d. Maintaining the child in a flat, supine position not serious and requires no treatment.
to stimulate normal sleeping position
2. After teaching a group of students about Nursing Care of a Family
unintentional injuries and their treatment, which
of the following (if describe by the group as When a Child Has a
appropriate) indicates successful teaching? Malignancy
a. Concussion: Instruct parents not to allow the
CHAPTER OVERVIEW
child to sleep for 24 hours after the trauma.
The diagnosis of a malignancy (cancer) in a child
b. Foreign body obstruction: Irrigate the child's
can be devastating to a family. However, the
ear canal with saline to remove a peanut.
prognosis of children is continually improving.
c. Frostbite: Place the affected body part in hot
Chapter 53 provides an overview of the special
water to restore circulation immediately.
care needs of a child with a malignancy. The
d. Snake bite: Apply a cold compress to the site
physical and psychological effects of various
immediately and keep the site in a dependent
types of childhood cancers are discussed. The
position to slow venom spread; monitor for
use of the nursing process to plan and provide
bruising and bleeding.
care for the child and the family coping with a
e. Facial burn: Monitor for stridor or other signs
malignancy is explored.
of respiratory tracts obstruction.
LEARNING OBJECTIVES
f. Third degree burn over 10% of the body: After mastering the contents of this chapter, you
Decrease fluid intake to facilitate filtration of should be able to:
waste and concentration of urine. 1. Describe usual cellular growth and theories
3. You are preparing a presentation for a local that explain why cells alter to become malignant
parent group about accidents and injuries in in children.
children. Which of the following would you 2. Identify 2020 National Health Goals related to
include as a "most common accident" in children the care of the child with a malignancy that
between the ages of 10 and 14 years? nurses can help the nation achieve.
a. Drowning 3. Assess a child with a common malignant
b. Poisoning process, such as a rhabdomyosarcoma,
c. Burns neuroblastoma, nephroblastoma, or leukemia.
d. Motor vehicles 4. Formulate nursing diagnoses related to a child
e. Firearms with a malignancy.
f. Foreign object inhalation 5. Establish expected outcomes for child with a
malignancy to help parents manage seamless
transitions across differing health care settings.
6. 6. Using the nursing process, plan nursing care
that includes the six competencies of Quality
&Safety Education for Nurses (QSEN): Patient-
Centered Care, Teamwork & Collaboration,
Evidence-Based Practice (EBP), Quality
Improvement(QI), Safety and, Informatics.
7. Implement nursing care for a child with a
malignancy, such as explaining why
chemotherapy is important.
8. Evaluate expected outcomes for achievement
and effectiveness of care.
9. Integrate knowledge of malignancy in children
with the interplay of nursing process, the six
CHAPTER 53 competencies of QSEN, and family nursing to
promote quality maternal and child health 9. c. Hair loss; occurs
nursing care. Rhabdomyosarcoma secondary to almost
10. Staging all chemotherapeutic
KEY TERMS cancer drugs
d. A transplant
1. biopsy between a
2. Chemotherapeutic agents histocompatible
3. Ewing sarcoma person and a child
4. Leukemia with cancer
5. Lymphoma e. Designating the
6. Matastasis extent of a malignant
7. Neoplasm process
8. Nepphroblastoma f. Show-growing
9. Neuroblastoma cystic tumor arising
10. Oncogenic virus from the glial tissue of
11. Osteogenic sarcoma the neural cells
12. Rhabdomyosarcoma g. Fast-Growing tumor
13. Sarcoma found most commonly
14. Tumor staging in the cerebellum
h. A tumor of striated
MASTERING THE INFORMATION muscle
i. A tumor arising
from the cells of the
ACTIVITY A FILL IN THE BLANKS sympathetic nervous
Supply the missing term or the information system
requested. j. A malignant tumor
1. Because cells lining the stomach are fast of long bone involving
growing, _______ and ______ are common side rapidly growing bone
effects of chemotherapy. tissue
2. _________ is a malignant tumor occurring most
often in the bone marrow of the midshaft of long ACTIVITY C SHORT ANSWER
bones. Supply the missing term or the information
3. __________ is a rare malignant tumor of the eye. requested.
4. __________ may be required for a large malignant 1. Name the three phases of chemotherapy for
tumor of the eye. acute lymphocytic leukemia.
________________________________________________________
ACTIVITY B MATCHING ________________________________________________________
Match the term in Column I with a definition, 2. Identify how Hodgkin disease is confirmed.
example, or related statement from Column II. ________________________________________________________
Place the letter corresponding to the answer in ________________________________________________________
the space provided. 3. Describe the action of five of the common
COLUMN I COLUMN II categories of chemotherapeutic cancer agents.
1. Alopecia a. A term commonly ________________________________________________________
2. Allogeneic used for a new ________________________________________________________
3. Astrocytoma abnormal growth that 4. Discuss factors that may contribute to
4. Medulloblastoma does not respond to decreased nutritional status in a child with
5. Neoplasm growth control cancer.
6. Neuroblastoma mechanisms ________________________________________________________
7. Oncogenic b. Cancer-causing
________________________________________________________
8. Osteogenic sarcoma agent
 b. Childhood cancer usually instills immunity to
APPLYING YOUR KNOWLEDGE cancer.
c. Children surviving one cancer have a greater
ACTIVITY D CASE STUDY risk for a second cancer.
Mr. and Mrs. Morell have been advised that d. Cancer onset is unpredictable and carries no
Joseph a brain tumor. He was admitted 2 days pattern of recurrence.
ago for preoperative lab work. Today is the day 2. Children with cancer would be most
of the surgery, and you are assigned as Joseph's vulnerable for skeletal side effects from radiation
operating room nurse. When reading the surgical therapy at which of the following ages?
checklist, you found that Joseph had not received a. 2 years
an enema or any methods to evacuate the bowel. b. 4 years
1. What would be your response after learning of c. 6 years
this situation? d. 12 years
________________________________________________________ 3. Which of the following is true about radiation
________________________________________________________ therapy?
________________________________________________________ a. The skin areas at which the radiotherapy is
2. What would be the priority areas to address directed should be washed daily with soap and
when providing postoperative care for Joseph? water.
________________________________________________________ b. Creams and lotions should not applied to the
________________________________________________________ radiation site until a radiation series is complete.
________________________________________________________ c. Sedatives and analgesics should be withheld
during radiotherapy
Activity E CRITICAL INQUIRY EXERCISE d. Radiation may result in excessive salivary
1. Prepare a teaching plan for a child diagnosed gland function.
with a leukemia or her parents. 4. Which of the following nursing interventions is
2. Develop a tool to contrast the presenting most important when caring for a child recieving
symptoms that may be seen on the assessment vincristine?
for the child presenting with leukemia. The tool a. Administering salicylates to relieve nerve pain.
should help you determine the type of b. Encouraging intake of high-fiber foods for a
malignancy based on the clinical picture. few days before administration
c. Monitoring for frequent diarrheal stools for
Activity F CRITICAL EXPLORATION weeks after administration
Visit a pediatric cancer ward. Note the varied d. Planning age-appropriate coloring or drawing
types of childhood cancer and the types of activities
medical and nursing treatments being provided. 5. The decreased platelet production from
leukemia's effects of a child's bone marrow
PRACTICING FOR NLE would result in which of the following
symptoms?
Activity G MULTIPLE-CHOICE QUESTIONS a. Flushed skin
Circle the letter that corresponds to the best b. Epistaxis
answer for each question. c. Hyperthermia
1. Mrs. Peters states she's glad her son Tim's d. Tachycardia
cancer was caught early and now he is safe from 6. Children who have a brain tumor will have
cancer. You should respond with which of the which of the following symptoms?
following principles in mind? a. Abdominal pain
a. Cancer is less likely to strike Tim again. b. Diarrhea
c. Hypotension
d. Vomiting e. Pathologic fracture
.7. Which of the following interventions may be 3. The parent of a 17-year-old bring the
needed for the parents of a child diagnosed with adolescent to the clinic to evaluate a mole on the
a brain tumor? child's back. The parents are concerned that the
a. Allowing the parents to delay treatment for child may have malignant melanoma. Which of
weeks if needed until the denial stage resolves the following would lead you to suspect that the
b. Explaining that removal of a small peripheral mole is benign rather than indicated of
tumor is a minor surgical procedure malignant melanoma?
c. Reinforcing preoperative explanations about a. Symmetrical shape
the nature of the child's diagnosis after the b. Irregular border
surgery is over. c. Light brown pigmentation
d. Reassuring parents that radiation and d. Size of 3 mm
chemotherapy can cure brain tumors and e. Ulcerated
prevent metastasis f. Scaly white appearance

Activity H ALTERNATIVE FORMAT

QUESTIONS
Multiple-Answer Multiple-Choice Question
Circle the letter(s) corresponding to the
appropriate answer(s). Select all that apply.
1. Which of the following would be appropriate
to include in the plan of care for a child with a
malignancy?
a. Encouraging children receiving chemotherapy
to take clear fluids, even if they are nauseated, to
prevent uric acid buildup in the kidney
b. Using ice packs to the clap of the children with
leukemia to decrease alopecia
c. Placing a warm compress on a site of
infiltration of a chemotherapeutic agent
d. Administering live virus vaccines to
immunosuppressed children to achieve
maximum protection against infection
e. Monitoring a child receiving chemotherapy for
leukemia for nuchal rigidity, headache,
irritability, and vomiting
f. Encouraging normal activity and regular school
for children in the maintenance phase of
leukemia therapy
2. Which of the following would you expect to
assess in a child with estrogenic sarcoma?
a. Progressively increasing pain in the abdomen
b. Onion skin like reaction on radiographic
examination
c. Swelling of the effective extremity near the
knee
d. Elevated level of serum alkaline phosphatase
 8. Evaluate expected outcomes for achievement
CHAPTER 54 and effectiveness of care.
NURSING CARE OF A FAMILY 9. Integrate knowledge of a cognitive challenge
or mental illness in children with the interplay of
WHEN A CHILD HAS A nursing process, the six competencies of QSEN,
COGNITIVE OR MENTAL and family nursing to promote quality maternal
and child health nursing care.
HEALTH DISORDER
CHAPTER OVERVIEW KEY TERMS
Children who are cognitively challenged or have
a mental health disorder have the same 1. anhedonia
fundamental needs as other children. The nurse 2. Binge eating
has a responsibility to provide the families of this 3. Catatonia
children with skills to observe, solve problems, 4. Choreiform movements
make decisions, and prevent illness. This chapter 1. Complex vocal tics
presents common illnesses, identifies behaviors, 2. Coprolalia
and explores methods of helping the family. 3. Dyslexia
4. Echolalia
5. Flat affect
LEARNING OBJECTIVES
6. Graphesthesia
After mastering the contents of this chapter, you
7. Hyperactivity
should be able to:
8. Labile mood
1. Describe common cognitive and mental health 9. Motor tics
disorders that occur in children. 10. Palilalia
2. Identify 2020 National Health Goals related to 11. Purging
cognitive or mental health disorders that nurses 12. Stereognosis
can be instrumental in helping the nation 5. Vocal tics
achieve.
3. Assess a child for a cognitive or mental health MASTERING THE INFORMATION
disorder
4. Formulate nursing diagnoses related to the Activity A FILL IN THE BLANKS
cognitive or mental health disorders of Supply the missing term or the information
childhood. requested.
5. Establish expected outcomes for a child with a 1. ________ is the term that describes the eating of
cognitive or mental health disorder that help nonfood substances such as dirt, clay, and
parents manage seamless transitions across crayons.
differing health care settings. 2. _______ ________ ________ is a perplexing condition
6. Using the nursing process, plan nursing care that parents may view as the child rejecting
that includes the six competencies of Quality them.
&Safety Education for Nurses (QSEN): Patient- 3. Complex vocal tics include the repeated use of
Centered Care, Teamwork & Collaboration, words or phrases out of context, including
Evidence-Based Practice (EBP), Quality ________ (use of socially unacceptable words) and
Improvement(QI), Safety and, Informatics. _______ (repeating one's own words).
7. Implement nursing care for a child with a
cognitive or mental health disorder, such as
explaining ways to remember to take medicine
long term.
Activity B MATCHING APPLYING YOUR KNOWLEDGE
Match the terms in Column I with a definition,
example, or related statement from Column II. Activity D CASE STUDY
Place the letter corresponding to the answer Stephen is 2 1/2 years old; his mother brings
in the space provided. him to the health clinic with an ear infection. The
Column I Colum II history and physical exam reveal that Stephen's
1. Encopresis a. Muscle movements behavior is quite different from that of the other
2. Motor tics such as rapid siblings. The mother reports that he hates to be
3. Catatonia repetitive eye held, only utter sounds when trying to talk, gets
4. Dyslexia blinking or facial upset easily, and screams constantly. You notice
5. Tourette syndrome twitching
that Stephen has excoriated lesions on his
b. Inherited syndrome
thumbs.
of facial and complex
vocal tics 1. Based on the information, what would be a
c. Passing feces in probable diagnosis for Stephen and why?
culturally ________________________________________________________
unacceptable places ________________________________________________________
d. A learning disorder 2. How can you assist the parents in bonding
involving a reading with Stephen and providing developmental
disability support?
e. Behaviors seen in ________________________________________________________
children with ________________________________________________________
schizophrenia,
characterized by Activity E CRITICAL INQUIRY EXERCISE
withdrawal and
1. Arrange with your instructor to invite to your
stupors depression
classroom the mother of an 8-year-old or older
child with a cognitive or mental health disorder.
Activity C SHORT ANSWER Ask her to explain how she prepares the child for
Supply the missing term or the information health visits and what she does in the household
requested. to protect the child form injury.
1. List the criteria for cognitive challenge as 2. Develop an assessment tool to be used in a
described by DSM-IV-TR. clinical setting to help the health care
________________________________________________________ professional recognize the signs and symptoms
________________________________________________________ of adolescent depression.
2. Define labile mood. Activity F CRITICAL EXPLORATION
________________________________________________________ Attend a school that has academic or vocational
________________________________________________________ curriculum for cognitively challenged students.
3. Describe graphesthesia, stereognosis, and Research activities in the curriculum that will
choreiform movements. facilitate students becoming as functionally
________________________________________________________ independent as possible in his or her community
________________________________________________________ and society.
4. Children with schizophrenia may reveal what
type of affect?
________________________________________________________
________________________________________________________
PRACTICING FOR NLE a. Morbid obesity
b. Ingesting copious amount of water
Activity G MULTIPLE-CHOICE QUESTIONS c. Body mass index above 85% of expected
Circle the letter that corresponds to the best d. Binge eating and purging
answer for each question. 6. A child with an IQ of 44 would be categorized
1. After teaching the parents of a child diagnosed as having which type of cognitive challenge?
with ADHD about the disorder, you determine a. Mild
that more teaching is needed if the parents b. Moderate
identify which of the following as a c. Severe
characteristics of this disorders? d. Profound
a. Hyperactivity Activity H ALTERNATE FORMAT QUESTIONS
b. Inattentiveness Multiple-Answer Multiple-Choice Questions
c. Impulsiveness Circle the letter(s) corresponding to the
d. Conscientiousness appropriate answer(s). Select all that apply.
2. When providing anticipatory guidance to 1. Which of the following statements about
parents of a hyperactive child, you would bulimia nervosa are correct?
encourage them to a. Girls with bulimia may be slightly underweight
a. Assign chores appropriate to the child's age. or at normal weight.
b. Be flexible and lenient regarding limits. b. Abuse of purgatives, laxatives, and diuretics
c. give instructions to this child in the group are used to control weight.
setting with the other siblings. c. Counseling focuses on having the girl
d. Delay punishing the child to allow the child relinquish control.
time to think about mistakes. d. Erosion of tooth enamel from vomiting occurs
3. Baby girl Franshon, 12 months old, is admitted less frequently.
to the hospital for electrolyte imbalance and to e. The individual with bulimia views food as
rule intestinal obstruction. After careful revolting.
assessment it is determined that Baby Franshon 2. A child is diagnosed with Tourette syndrome.
is regurgitating her food after ingestions and While assessing the child, you observe motor
then re swallowing it. Research postulates that tics. Which of the following might you observe?
this is a form of self-stimulation by the infant a. Eye blinking
termed b. Coughing
a. Encopresis c. Throat clearing
b. Rumination d. Neck jerking
c. Anhedonia e. Facial grimacing
d. Bulimia f. Snorting
4. Felecia is 15 years old and is admitted to the 3. Which of the following would you expect to
hospital with anorexia nervosa. She is a model assess in a child with schizoprenia?
and often spoken of as an overachiever. As you a. Flat affect
interview Felicia and her Family, she may b. Hallucinations
discover other findings such as c. Hyperactivity
a. Early development of secondary sex d. Rambling speech
characteristics e. Vocal tics
b. Permissive parenting f. Anhedonia
c. Amenorrhea
d. Hyperglycemia
5. Which of the following is commonly seen in
children with an eating disorder?
 9. Integrate knowledge of family child
Chapter 55 maltreatment or intimate partner violence with
Nursing Care of a family crisis: the interplay of nursing process, the six
competencies of QSEN, and family nursing to
maltreatment and violence in promote quality maternal and child health
the family nursing care.
CHAPTER OVERVIEW
Maltreatment and violence are national KEY TERMS
problems with serious consequences for
children. Chapter 55 describes the physiologic •failure to thrive
and psychological effects of maltreatment in the • hebephile
family. The use of the nursing process to identify, • Incest
plan, and provide appropriate nursing care to • Intimate partner violence
help victims and thief family members or • learned helplessness
significant others cope with trauma of • Maltreatment
maltreatment and violence is discussed. • Mandatory reporters
LEARNING OBJECTIVES • Molestation
After mastering the contents of this chapter, you • munchausen syndrome by proxy
should be able to: • Pedophile
1. Discuss the types of child maltreatment or • Permissive reporters
intimate partner violence seen in families and • Rape trauma syndrome
the theories explaining their occurrence. •shaken baby syndrome
2. Identify 2020 National Health Goals related to • Silent rape syndrome
child maltreatment or intimate partner violence
that nurses can help the nation achieve. MASTERING THE INFORMATION
3. Assess a family that has experienced physical
or emotional child maltreatment or intimate ACTIVITY A FILL IN THE BLANK
partner violence. Supply the missing term or the information
4. Formulate nursing diagnoses related to a requested.
family in which child maltreatment or intimate 1. The _____________ is often the first person to
partner violence is present. identify the symptoms of possible child
5. Develop expected outcomes for a family that maltreatment.
has experienced child maltreatment or intimate 2. Excessive use of _____________ is strongly
partner violence to help them manage seamless associated with maltreatment of others.
transition across differing health care settings. 3. ______________ _____________ __________ is a
6. Using the nursing process, plan nursing care syndrome where an infant is falling in
that includes the six competencies of Quality & percentiles on a growth chart, from either
Safety Education for Nurses (QSEN): Patient- organic or non-organic causes.
Centered Care, Teamwork & Collaboration, ACTIVITY B MATCHING
Evidence-Based Practice(EBP), Quality Match the terms in column I with a definition,
Improvement (QI), Safety, and Informatics. example, or related statement from Column II.
7. Implement nursing care for a family in which Place the letter corresponding to the answer
child maltreatment or intimate partner violence in the space provided.
has occurred, such as ways to role model better COLUMN I COLUMN II
parenting. 1. Maltreatment a. Sexual activity
8. Evaluate expected outcomes for effectiveness 2. Disorganization between family
and achievement of care. phase members
3. Incest b. A form of child ACTIVITY C SHORT ANSWER
4. Mandatory neglect occurring Supply the missing term or the information
reporters because of a requested.
5. Molestation disturbance in the 1. Identify the triad of circumstances that
6. Munchausen parent child generally combine to result in child
syndrome by proxy relationship maltreatment.
7. Pedophile c. Parent who
________________________________________________________
8. Failure to thrive repeatedly bring a
________________________________________________________
9. Shaken baby child to a health care
syndrome facility reporting 2. Discuss why children in a maltreating family
10. Reorganization symptoms of illness situation might have other undiagnosed medical
phase when, in fact, the child problems.
is well ________________________________________________________
d. Willful injury of one ________________________________________________________
person by another 3. Discuss one major reason why victims of child
e. The first stage of maltreatment might grow to be abusers
rape trauma themselves.
syndrome; lasts about ________________________________________________________
3 days ________________________________________________________
f. The second stage of 4. Discuss one method of flagstaff differentiating
rape trauma
between organic and nonorganic failure to
syndrome; may last
thrive.
months or years
g. People who are ________________________________________________________
legally required to ________________________________________________________
notify the authorities 5. Lists symptoms of infants demonstrating
of suspected failure to thrive relative to physical and social
maltreatment; nurses development.
fall into this category ________________________________________________________
h. Sexual ________________________________________________________
maltreatment
between an adult and APPLYING YOUR KNOWLEDGE
child, such as oral
genital contact or
ACTIVITY D CASE STUDY
viewing genitals
i. An adult who seeks Alissa, age 26, appears in your emergency room
out children for with her 4-year-old daughter, Daisy. She stated,
sexual gratification "He’s hurting her. See, he's made her bleed."
J. Condition involving alissa is pointing at Daisy’s underpants, which
whiplash injury to the are soiled with a dark red stain.
neck, edema to the 1. What should be your initial action?
brain stem, retinal 2. How should you proceed in care planning for
hemorrhages, and Daisy?
potential respiratory
arrest ACTIVITY E CRITICAL INQUIRY EXERCISE
1. Describe your feelings about a report or rape
made by a female child 5 years of age who says,
"Daddy hurt me."
________________________________________________________ b. Discuss with Bob the fact that his clumsiness is
________________________________________________________ probably a part of his adolescence and that he
________________________________________________________ will outgrow it.
2. What would your response be to a male c. Instruct Bob the importance of exercise and
adolescent who report that his coach sexually good nutrition to avoid easy bruising.
maltreated him, or to a wife who says her d. Tell Bob you do not believe him and you want
husband raped her? to know if his parents caused his injuries.
________________________________________________________ 4. Sheila, 11 years old, is admitted with vaginal
________________________________________________________ bleeding. You notice that Sheila and her mother
________________________________________________________ are very nervous but state that they are "sure it's
ACTIVITY F CRITICAL EXPLORATION just menstrual blood." you should initially do
Visit a rape crisis center in your neighborhood. which of the following?
Note three activities performed by the nurse in a. Accept the fact that Sheila is probably
that setting. beginning menses; do not jump to conclusions.
b. Explain to Sheila and her mother that
PRACTICING FOR NLE menstrual bleeding does not occur at this early
age.
ACTIVITY G MULTIPLE-CHOICE QUESTIONS c. Insist that Sheila's mother tell if someone is
Circle the letter that corresponds to the best maltreating Sheila.
answer for each question. d. Gently examine Sheila for torn perineal tissue
1. Because maltreatment involves and affects all or lacerations.
the members of a family, you should include 5. Which of the following would place a parent at
which of the following as part of the expected high risk for maltreating their infant?
outcomes? a. Being poor and a member of a minority group
a. Disrupting the dysfunctional family b. Choosing to have a baby without being
b. Improving overall family functioning married
c. Punishing the abusive family member c. Having less than a high school education
d. Removing the abusive victim from the family d. Severe disappointment with the sex of a new
2. When planning a strategy to address child and baby
intimate partner maltreatment, you should do 6. Daryl, age 7, states he cannot tell about his
which of the Following? father's beating him because the beating will get
a. Lecture parents suspected of child abuse on worse. You should remember which of the
the evils violence following when replying to Daryl?
b. report suspected child whenever a child with a. Daryl might be angry with his parents and
bruises is admitted. making up this story.
c. stop parental visitation immediately if child b. Daryl's mother can protect him from the father
abuse is suspected. is necessary.
d. Work with pregnant teen groups to teach c. Most institutions can hold a child for 72 hours
parenting skills. for protection.
3. At his first physical, Bob, 14 year old, stated d. Seven-year-olds are not reliable witnesses of
that the multiple long whip-like scars on his back child maltreatment.
occurred as a result of falling backward against a 7. A realistic outcome for a woman admitted with
rough bedroom floor when he was playing with a a broken collarbone caused by a husband with a
friend. You should respond in which of the history of violence would be that the woman
following ways? might do which of the following?
a. Ask additional questions regarding the cause a. Fight back the next time he hurts her
of the injury and any other injuries noted.
b. Identify what she does that causes her d. Protect the child's or victim's modesty as
husband to become violent much as possible.
c. Leave the man responsible for her e. Do not try to nurture the infant with failure to
maltreatment immediately and never see him thrive because this will interfere with family-
again child bonding.
d. State the names of two shelters she can go to f. Take photographs of injuries and bruises.
when necessary 2. Which of the following would characterize
8. The nurse caring for a maltreated child or intimate partner violence at level III?
woman should do which of the following? a. Occasionally episodes of violence
a. Allow the family members to remain alone b. Beating sustained with fractures
together as much as possible, regardless of the c. Daily event of abuse
situation, to facilitate family stability. d. Use of a weapon for the abuse
b. Assume that the maltreatment was malicious e. Resulting in permanent disability
and isolate the victim from family members. 3. You are preparing a presentation for a
c. Become emotionally involve in the situation to community group about age rape. Which of the
demonstrate empathy for the victims. following would you expect to include in the
d. Stay with a child or woman throughout the discussion?
examination process and questioning sessions to a. Rape victims typically experience symptoms
offer needed support. that can last for several weeks.
9. Which of the following would be most accurate b. Rape is considered a crime of violence.
about maltreatment? c. A person can be accused of statutory rape even
a. Neglect can be an unintentional form of child if the victim consisted to the sexual activity.
maltreatment. d. The incidence of date rape is gradually
b. Psychological abuse is not as damaging as decreasing.
physical maltreatment. e. The typical rape victim is an adolescent female.
c. Keeping families together throughout therapy
is essential.
d. Maltreatment victims experience guilt only if
they caused the person responsible for the
maltreatment to become violent.

ACTVITY H ALTERNATE FORMAT QUESTIONS

Multiple-Answer Multiple-Choice Questions
Circle the letter(s) corresponding to the
appropriate answer(s). Select all that apply
1. Which of the following would be appropriate
for a patient with maltreatment or violence in
the family?
a. Inform the parent you suspect child
maltreatment as soon as you note suspicious
signs.
b. Interview the victim in front of the person
responsible for the maltreatment to make them
confess to the crime.
c. Examine the child or suspected victim in a fully
undressed state whenever possible.
 the six competencies of QSEN, and family nursing
to promote quality maternal and child health
nursing care.
Chapter 56
Nursing care of a family when KEY TERMS

a child has a long-term or 21. anticipatory grief

terminal illness 22. Death
23. Grief process
CHAPTER OVERVIEW 24. Vulnerable children
Chapter 56 discusses the physiologic and
emotional concerns related to caring for a family MASTERING THE INFORMATION
coping with a long term or fatal illness. The
emotional effects of chronic and terminal illness
ACTIVITY A FILL IN THE BLANKS
on the entire family as well as on the nursing
Supply the missing term or the information
care provider are reviewed. The use of the
requested.
nursing process to plan and provide care for the
1. The reactions a nurse may have to the
family involved with long-term or terminal
terminal illness of a child include______, a sense of
illness is explored.
failure, and grief.
LEARNING OBJECTIVES
2. Most school-age children ________ what is
After mastering the contents of this chapter,
happening to them when their disorder has a
you should be able to:
fatal prognosis.
1. Describe common concerns of parents of
3. A parent's usual response to the diagnosis of a
children with a long term or terminal illness.
terminal illness in a child is ________.
2. Identify 2020 National Health Goals related to
Children with long term or terminal illnesses
ACTIVITY B MATCHING
that nurses could help the nation achieve.
Match the terms in Column I with a definition,
3. Assess the adjustment of a child or family to a
example, or related statement from Column II.
long-term or terminal illness.
Pace the letter corresponding to the answer in
4. Formulate nursing diagnoses for a child with a
the space provided.
long-term or terminal illness to help him or her
manage seamless transitions across differing Column I Column II
1. Infant a. May think of death
health care settings.
2. Preschooler as something which
5. Identify expected outcomes for a child with a
3. Toddler only happens to
long-term or terminal illness. 4. School-ager adults
6. Using the nursing process, plan nursing care 5. Adolescent b. Upon caretaker
that includes the six competencies of Quality and death, experience
Safety Education for Nurses (QSEN): Patient- death loss which can
Centered Care, Teamwork and Collaboration, interfere with future
Evidence-Based Practice(EBP), Quality trust development
Improvement(QI), Safety and, Informatics. c. Have no
7. Implement nursing care for a child with a long- understanding of
term or terminal illness, such as helping parents their impending death
with time management. d. Have adults
8. Evaluate expected outcomes for effectiveness concerns or death but
view themselves as
and achievement of care.
basically
9. Integrate knowledge of long-term or terminal
indestructible; need
illness with the interplay of the nursing process, to remain as active as
 possible in a homelike setting
e. Perceived death as i. Parents beginning to
temporary, as in really think about the
cartoons child's impending
death
j. Parents possibly
ACTIVITY C ADDITIONAL MATCHING criticizing the nurse
QUESTIONS or scolding the child
Match the terms in Column I with a definition, frequently
example, or related statement from Column II.
Place the letter corresponding to the answer
in the space provided. ACTIVITY D SHORT ANSWER
Supply the missing term or the information
Column I Column II
1. Anticipatory grief a. Absence of requested.
2. Bargaining stage respirations, no 1. Describe the factors that affect how people
3. Depression audible heart sounds, cope with situations.
4. Denial stage absence of body ________________________________________________________
5. Anger stage movement or reflexes, ________________________________________________________
6. Hospice and dilated fixed 2. Briefly compare the possible effects on a
7. Death pupils family of a chronic illness such as diabetes with
8. Organ Donation b. The experience that the effect of a chronic illness such as muscular
9. Autopsy occurs when news of dystrophy.
10. Grief reaction chronic illness or ________________________________________________________
impending death is
________________________________________________________
received
3. Discuss how the age of the parent might affect
c. Action that may
provide a comfort for their ability to care for a child with a physical
parents to know a challenge.
part of their child has ________________________________________________________
helped another child ________________________________________________________
to live 4. Why would healthy parents of a chronically ill
d. Parents possibly or physically challenged child need to have a well
promising to do good prepared?
deeds so the ________________________________________________________
terminally ill child ________________________________________________________
will get well 5. How might evaluating the plan of care for a
e. Parents need to family with a terminally ill child after the child's
think about preparing
death be beneficial for a nurse?
siblings for ill child's
________________________________________________________
expected outcome
f. Mandatory if ________________________________________________________
homicide, suicide, or 6. List three of the seven approaches to
harmful death is communicating with dying children.
suspected ________________________________________________________
g. A third opinion ________________________________________________________
regarding the disease
or prognosis may be
requested
h. Option for children
allowing them to die
 ________________________________________________________
APPLYING YOUR KNOWLEDGE ________________________________________________________
________________________________________________________
ACTIVITY E CASE STUDY PRACTICING FOR NLE
Patricia, age 10 years, is involved in an
automobile accident that results in multiple ACTIVITY H MULTIPLE-CHOICE QUESTIONS
injuries, including a spiral cord injury. Her Circle the letter that corresponds to the best
parents arrived an hour ago and have been told answer for each question.
that she will most likely be paralyzed from the 1. Bobby, age 10 years, has a diagnosis of type 1
waist down. diabetes. His mother has expressed plan to tutor
1. What reactions might you expect from Bobby at home and design a comfortable, quite
Patricia’s parents? What factor may affect their life to help him cope with his condition. Which of
coping? the following nursing diagnoses would best
________________________________________________________ address this situation?
________________________________________________________ a. Readiness for enhanced parenting related to
2. How might Patricia respond? chronic illness
________________________________________________________ b. Risk for complicated grieving related to loss of
________________________________________________________ child's expected activity level
c. Risk for delayed growth and development
ACTIVITY F CRITICAL INQUIRY EXERCISE related to lack of age-appropriate stimulation
1. How might you feel if a patient you cared for d. Disabled family coping related to parent's
over several weeks died on your day off? How inability to accept child's illness
would those feeling differ, if at all, if the patient 2. Polly, age 5 years, is admitted to the hospital
was elderly and terminally ill; a young adult with cystic fibrosis and pneumonia. Polly's
automobile accident victim; a child; or mother tells you that Polly must have good
recovering well when you left the day before? pulmonary therapy before breakfast to eat a
2. How would you approach differ, if at all, when good meal. You should respond in which of the
providing care for the family members of a following ways?
patient who died suddenly and providing care a. Assume Polly's mother that the hospital staff is
for a family members of a patient who died after very competent and will take good care of the
a long hospitalization during which the patient child.
wasted away and experienced pain? b. Inform Polly's mother of the visiting hours and
insist she go home and rest because Polly is in
ACTIVITY G CRITICAL EXPLORATION good hands.
1. Spend a day with a chronically ill child and his c. Listen to the mother and note the schedule and
or her family. Record interactions and determine procedures that Polly is accustomed to at home.
if any mal adaptive coping behaviors are present. d. Nod, and after the mother has gone, plan
________________________________________________________ Polly's care according to the hospitals schedule.
________________________________________________________ 3. Mr. and Mrs. Peters have 4-years-old son,
________________________________________________________ Bryan, who has diagnosed with a terminal
2. Spend a day with a terminally ill child and his illness. You should be concerned if which of the
or her family. Note the family dynamics following plans were made by the family?
(reactions of the child and parents). Record your a. Arrangements were being made to find a
reaction to the situation, the child, and the consistent sitter who could care for Bryan while
family. Mrs. Peters works 4 hours a day.
b. Mr. Peters states he plans to stay home with a. the nurse should encourage the parents of a
Bryan in the evening so that Mrs. Peters can go to child in the "dying phase" to stay close to the
her exercise class. room because the child will not live more than 2
c. Mrs. Peters states she intends to care for Bryan to 3 days.
around the clock and will need no assistance b. The family living with a child who is dying
from anyone. should be provided time to talk about physical
d. The Peters family intends to take Bryans home and emotional difficulties they might be having.
and care for him there so he will died c. At the onset of death, metabolism increases
surrounded by family members. and the child may become flushed because
4. David, 14 years old, has leukemia and is in the cardiac stroke volume increases.
hospital for the fourth time. When assessing his d. Medications are best delivered intravenously
mother to determine if she is progressing as the child nears death to promote absorption
through the stages of grief over her teenage son's and improve onset of drug action.
terminal illness, you would find which of the e. The nurse should avoid focusing on self-
following to be signs of maladaptive coping? awareness when preparing to work with a dying
a. David's mother seem very sad at times and child because the focus should be on the child
occasionally walks out of his room crying. and family.
b. David's mother shows the same signs of denial 2. The statements below represent the various
she showed when he was admitted to the stages of grief. Place the statements in the proper
hospital the first time. sequence from the first to last.
c. David's mother speaks of how good a son he is a. "I'm sad that this is happening"
and how she is really going to miss him. b. "its okay that this is happening"
d. David's mother spends a lot of time with David c. "I'll devote my life to volunteering if he gets
and brings him all his favorite foods from home. well"
5. You note that a terminally ill child's parents d." This is just not fair that he is so sick"
are not visiting very frequently or providing e. “How can this be? He's such a healthy child."
needed support. Which of the following could 3. You are preparing a plan of care for the
you do? parents of a toddler who is diagnosed with a
a. Call the parents in and have them explain to terminal illness and is dying. You would need to
the child why they are not visiting as often as integrate an understanding of which of the
they should. following into the plan of care?
b. Spend as much time with the child as possible, a. Toddlers understand death as a separation.
recognizing that the parents may need to b. They realize that death is final.
withdraw temporarily to cope. c. Toddlers have a need for routines
c. Tell the child it is good to have time alone to d. Toddlers need to feel comfortable and secure.
think about death and to prepare for this new
e. They have difficulty relating death to what
experience.
they are experiencing.
d. Warn the parents that if they do not visit the
child frequently now, they may experience f. They feel sad about being away from their
intense guilt feelings after death. parents.

ACTIVITY I ALTERNATE FORMAT QUESTIONS

Multiple-Answer Multiple-Choice Questions
Circle the letter(s) corresponding to the
appropriate answer(s). Select all that apply.
1. Which of the following would be appropriate
when caring for a child with a terminal illness?