Free Pediatric CCRN Psychosocial Question and Answers — Questions and Answers
Question 1: The ICU is caring for a patient with an end-stage pituitary adenoma who also has diabetes insipidus and aspiration pneumonia. The mother is giving the patient water and soft beverages despite being aware that there is a plan for transpyloric tube feedings and nothing by mouth. What action should the nurse take in this circumstance?
- Ask the mother to explain why she is giving fluids to her son (Correct answer)
- Request a modification to the diet plan so that oral fluids are included.
- Request that the mother's access to the ICU be limited by security
- Report the mother's interference with the treatment plan to the social worker.
Correct answer: Ask the mother to explain why she is giving fluids to her son
The nurse's initial action should always be to engage in therapeutic communication to understand the parent's perspective and reasoning. Asking the mother why she is giving fluids allows the nurse to assess her understanding of the NPO status and the child's condition, identify any cultural beliefs, or address potential misinformation. This approach fosters trust and provides an opportunity for education before escalating the situation.
Question 2: A 2-year-old who is on a ventilator has spent her entire life in a hospital. The patient will be sent home in a week with a gastrostomy and tracheostomy, according to the doctor. As a way to assess the discharge requirements of the patient, the nurse must arrange for:
- An outreach educator to determine the learning needs of the family
- Home nursing care for the first few days following discharge
- A multidisciplinary care conference before discharge
- A social worker to meet with the family and assess adequacy of the home environment (Correct answer)
Correct answer: A social worker to meet with the family and assess adequacy of the home environment
For a child with complex medical needs like a ventilator, gastrostomy, and tracheostomy, a social worker is essential for assessing the home environment's adequacy. They evaluate the family's resources, support systems, and ability to manage the child's care at home. This assessment ensures a safe and successful transition from hospital to home, addressing practical and psychosocial challenges.
Question 3: A bowel management program is established for a child with myelomeningocele. The nurse will acknowledge that additional knowledge is necessary when the mother states, My child:
- will be unable to control his bowel movements.
- tends to be more prone to diarrhea. (Correct answer)
- needs to have a bowel movement every day.
- will require more activity to increase bowel movements.
Correct answer: tends to be more prone to diarrhea.
Children with myelomeningocele often have neurogenic bowel, which typically leads to chronic constipation and fecal incontinence due to impaired nerve function. They are generally not prone to diarrhea, unless there is an underlying infection or specific dietary issue. Therefore, the mother's statement about her child tending to be more prone to diarrhea indicates a need for further education on the typical bowel patterns associated with myelomeningocele.
Question 4: A school-aged autistic child who has a fractured femur and a suspected brain injury is admitted. Which of the following factors is crucial to encouraging hospital setting adjustment?
- Initiate new activities to keep the patient occupied
- Assign a child life therapist per shift
- Encourage lots of visitors
- Adhere to a home schedule (Correct answer)
Correct answer: Adhere to a home schedule
Children with autism spectrum disorder thrive on routine and predictability, and deviations can cause significant anxiety and distress. Adhering to a home schedule as much as possible provides a sense of familiarity and control in the unfamiliar hospital environment. This consistency helps reduce agitation and promotes better adjustment and cooperation with care.
Question 5: A patient is admitted who is incapable of understanding English. Some recommendations for employing a translator include?
- Having the translator ask questions that you don't feel comfortable asking.
- Allowing time for the translator to decode the medical jargon used in the teaching.
- Standing next to the translator and as close to the patient as possible. (Correct answer)
- Providing all of the information, then allowing translation and asking of questions
Correct answer: Standing next to the translator and as close to the patient as possible.
When using a translator, standing next to them and facing the patient allows the nurse to maintain direct eye contact and observe the patient's non-verbal cues. This positioning fosters a more direct and personal connection with the patient, even though the words are being translated. It emphasizes that the conversation is primarily between the nurse and the patient, with the translator as a conduit.
Question 6: Family members of a recently deceased patient are sobbing and wailing loudly. The outbursts are making the staff angry. The ideal response from the nurse is to acknowledge the loudness and:
- Tell the family they must quiet down, or they will have to leave the unit
- Ask a security officer to remove the family from the unit
- Tell the other staff they are being insensitive to the family's expression of grief
- Guide the family to a nearby room where they can express their emotions (Correct answer)
Correct answer: Guide the family to a nearby room where they can express their emotions
Grieving families need a safe and private space to express their emotions without feeling judged or constrained. Guiding the family to a nearby room acknowledges their need for emotional release while also respecting the environment for other patients and staff. This demonstrates empathy and provides appropriate support during a difficult time.
Question 7: The amount of hemolyzed blood samples that have been recorded by the lab, from the perspective of a nurse it is overwhelming. The nurse's best course of action would be to:
- Request a staff meeting to discuss the problem and ask for feedback
- Create a poster and post-test demonstrating the proper method of drawing blood samples
- Track the number of blood samples drawn, by what method and the number reported as hemolyzed (Correct answer)
- Develop an educational in-service on the proper blood-sampling technique for the staff
Correct answer: Track the number of blood samples drawn, by what method and the number reported as hemolyzed
The first step in addressing a quality improvement issue, such as a high rate of hemolyzed blood samples, is to gather objective data. Tracking specific details like the method of blood draw (e.g., venipuncture vs. IV line) and the number of hemolyzed samples helps identify patterns, potential root causes, and areas for targeted intervention. This data-driven approach is essential for effective problem-solving.
Question 8: Due to staffing patterns, the respiratory therapist is not always present on the unit to place patients on the ventilator, so a nursing unit needs to be able to put patients back on ventilator support as directed, when patients are napping. The nurse should respond in the following ways:
- Ask the parent to be responsible for this task.
- Question the current policy that only respiratory therapists can manage the ventilator. (Correct answer)
- Place the patient on the ventilator when needed, despite current policy
- Wait for the therapist to intervene.
Correct answer: Question the current policy that only respiratory therapists can manage the ventilator.
Nurses are patient advocates and should question policies that create barriers to timely and safe patient care. If nurses are competent to place patients on ventilators and delays by respiratory therapists compromise patient safety, questioning the policy is appropriate. This initiates a dialogue to review protocols and potentially expand nursing scope of practice to ensure optimal patient outcomes.
Question 9: A family meeting is scheduled to go over the family's ethical worries about keeping a child on life support who has terminal cancer. The nurse's duties should include:
- Assist the parents in articulating their questions and concerns. (Correct answer)
- Provide the legal standpoint regarding end-of-life decisions for children.
- Coordinate the meeting to ensure that everyone has the opportunity to speak
- Articulate the reason for the child's poor prognosis and anticipated life expectancy
Correct answer: Assist the parents in articulating their questions and concerns.
The nurse's role in an ethical family meeting is to act as a facilitator and advocate for the patient and family. Assisting parents in articulating their questions and concerns ensures their voice is heard and understood by the healthcare team. This empowers the family to participate meaningfully in decision-making regarding their child's end-of-life care.
Question 10: A family whose child has cerebral palsy and will be receiving a baclofen (Lioresal) pump to treat spasticity is receiving patient education from the nurse. Which of the following should the nurse emphasize in the conversation?
- The child will have a normal gait after insertion of the pump.
- Parents must bring the child back to the clinic to have medicine added to the pump. (Correct answer)
- Gamma-aminobutyric acid (GABA), a neurotransmitter, is inhibited by the drug.
- Parents can be taught to regulate the dosage based on symptoms.
Correct answer: Parents must bring the child back to the clinic to have medicine added to the pump.
Intrathecal baclofen pumps deliver medication directly into the spinal fluid, requiring specialized knowledge and sterile technique for refills. Parents cannot regulate the dosage or refill the pump themselves due to the complexity and risk of infection or overdose. Therefore, regular clinic visits for pump refills by trained professionals are essential for safe and effective management of spasticity.
Question 11: An adolescent who has previously been admitted for chronic status asthmaticus is getting ready to go home. Because taking his prescription "makes him feel too different" from his peers, the nurse concludes that the patient has not been taking his drugs as prescribed. The nurse needs to:
- Refer the patient to a support group for adolescents with asthma (Correct answer)
- Arrange for the patient's school nurse to monitor compliance
- Advise the parents to withhold privileges if the patient remains non-compliant.
- Provide the patient with articles on the relationship of hospitalization and medication compliance.
Correct answer: Refer the patient to a support group for adolescents with asthma
Adolescents often struggle with medication adherence due to peer pressure and a desire to fit in. Referring the patient to a support group for adolescents with asthma can provide a safe space to share experiences and coping strategies with peers facing similar challenges. This can help reduce feelings of isolation and improve motivation for medication compliance by normalizing their condition.
Question 12: A nurse is interested in integrating other academic fields into the NICU's educational program for developmental care. The best strategy to persuade management that this project is profitable is to:
- Invite members of administration to attend the classes.
- Present a report summarizing research relating developmental care to decrease length of stay. (Correct answer)
- Request that the neonatologist present the plan.
- Present case studies demonstrating favorable outcomes for developmental care.
Correct answer: Present a report summarizing research relating developmental care to decrease length of stay.
To persuade management, it is crucial to demonstrate the tangible benefits of the proposed project, especially in terms of cost-effectiveness and improved outcomes. Presenting research that links developmental care to a decreased length of stay directly shows financial savings and increased efficiency. This evidence-based approach is highly effective in gaining administrative support for new initiatives.
Question 13: Which of the following comments made by staff would worry the nurse most who is leading the charge to reduce catheter-associated urinary tract infections (CAUTI) on his or her unit?
- "It is so much easier to monitor hourly output with a catheter in place."
- "I found the catheter disconnected from the collection device during my hourly assessment."
- "The urinary catheter was placed last night in the emergency department during trauma resuscitation."
- "The patient is transferring to the floor today. They can discontinue the urinary catheter once they get him settled." (Correct answer)
Correct answer: "The patient is transferring to the floor today. They can discontinue the urinary catheter once they get him settled."
The comment, 'The patient is transferring to the floor today. They can discontinue the urinary catheter once they get him settled,' is most concerning because it indicates a delay in catheter removal. Urinary catheters should be removed as soon as they are no longer medically necessary, regardless of unit transfer, to minimize the risk of catheter-associated urinary tract infections (CAUTI). Any unnecessary delay increases the duration of catheterization and thus the risk of infection.
Question 14: Each profession now keeps track of its discharge instruction on its own flow sheet, including respiratory therapists, physical therapists, occupational therapists, and nurses. In order to optimally coordinate instruction, there should be:
- Each discipline distribute copies of its flow sheet to each team member.
- Nurses review the flow sheets of all disciplines during shift change.
- All disciplines document patient teaching on the same flow sheet. (Correct answer)
- Daily care conferences to review and discuss patient teaching and the flow sheets
Correct answer: All disciplines document patient teaching on the same flow sheet.
Documenting patient teaching from all disciplines on a single flow sheet ensures a comprehensive and unified record. This approach prevents duplication of information, streamlines communication among the healthcare team, and allows all members to quickly see what education has been provided and what still needs to be covered. It ultimately enhances coordination of care and improves patient understanding and safety.
Question 15: A patient with type 1 diabetes mellitus who has been hospitalized several times in the past year for diabetic ketoacidosis (DKA) is being cared for by a nurse. What certain setup should the nurse make before releasing the patient from this episode of DKA?
- For the patient and family to join a diabetes support group.
- To teach the patient how to administer sliding scale insulin when blood glucose levels are high.
- To teach the patient to avoid sugar and foods high in carbohydrates.
- For the patient and family to meet with social worker to discuss challenges they face with management of the disease. (Correct answer)
Correct answer: For the patient and family to meet with social worker to discuss challenges they face with management of the disease.
Recurrent hospitalizations for DKA in a patient with Type 1 diabetes often indicate underlying psychosocial, financial, or adherence challenges that go beyond medical knowledge deficits. Meeting with a social worker allows for a comprehensive assessment of these barriers, enabling the identification of resources and support systems. Addressing these root causes is crucial for improving long-term disease management and preventing future DKA episodes.
Question 16: A new diagnosis of hypertrophic cardiomyopathy has been made in an adolescent who experienced cardiac arrest. The parents worry about what to do if their son passes out once more. The best response from the nurse would be:
- "Would teaching you CPR help ease your anxieties?" (Correct answer)
- "Do you know how to access the EMS system?"
- "I will have your son's cardiologist speak with you."
- "Now that your son has been diagnosed and treated, you need not worry."
Correct answer: "Would teaching you CPR help ease your anxieties?"
The parents' anxiety stems from the fear of their son passing out again and not knowing how to respond. Teaching them CPR directly addresses this fear by empowering them with a life-saving skill. This provides a sense of control and preparedness for potential emergencies, which is vital for coping with a child's serious cardiac condition.
Free Pediatric CCRN Psychosocial Question and Answers
The ICU is caring for a patient with an end-stage pituitary adenoma who also has diabetes insipidus and aspiration pneumonia.
The mother is giving the patient water and soft beverages despite being aware that there is a plan for transpyloric tube feedings and nothing by mouth.
What action should the nurse take in this circumstance?