Pediatric CCRN Exam Pediatric CCRN Psychosocial 5 — Questions and Answers
Question 1: A PICU nurse identifies that a family has not left their critically ill child's bedside for 36 hours and appears exhausted. The most appropriate nursing intervention is to:
- Require the family to leave for mandatory rest to prevent caregiver burnout
- Acknowledge their dedication, assess their support needs, and explore options for rest (Correct answer)
- Contact social work to document the family's inability to self-care
- Provide sedatives to family members who are too distressed to leave
Correct answer: Acknowledge their dedication, assess their support needs, and explore options for rest
A family-centered approach first acknowledges the family's commitment, then assesses barriers to rest and collaboratively problem-solves options such as shift rotation or nearby lodging.
Question 2: Which statement by a nurse BEST demonstrates understanding of the concept of moral distress in pediatric critical care?
- 'I feel guilty when I cannot cure my patients.'
- 'I know what is ethically right but am constrained from doing it, which causes me suffering.' (Correct answer)
- 'I find it difficult to communicate with families of diverse backgrounds.'
- 'I am overwhelmed by the amount of documentation required in the PICU.'
Correct answer: 'I know what is ethically right but am constrained from doing it, which causes me suffering.'
Moral distress is specifically defined as suffering that occurs when one knows the ethically correct action but is prevented from taking it by institutional, legal, or hierarchical constraints.
Question 3: A 15-year-old with a new diagnosis of Type 1 diabetes mellitus admitted to the PICU expresses shame about the diagnosis and refuses to learn self-care. Erikson's framework suggests this response reflects conflict in which stage?
- Trust vs. Mistrust
- Industry vs. Inferiority
- Identity vs. Role Confusion (Correct answer)
- Autonomy vs. Shame and Doubt
Correct answer: Identity vs. Role Confusion
Adolescents are in Erikson's Identity vs. Role Confusion stage; a chronic illness diagnosis threatens the developing sense of self and peer identity, leading to shame and withdrawal.
Question 4: When a critically ill child's parents come from a culture where the father is the sole medical decision-maker, but the mother is the primary caregiver, the nurse should:
- Communicate exclusively with the father to respect cultural norms
- Include both parents in all communications and facilitate their internal process (Correct answer)
- Insist both parents share decision-making authority equally per US law
- Refer the family to social work to address the power imbalance
Correct answer: Include both parents in all communications and facilitate their internal process
Culturally competent care involves including all caregivers in communication while respecting family dynamics, allowing the family to make decisions according to their own cultural process.
Question 5: A 4-year-old in the PICU believes she is being punished for being 'bad' because she is sick. This type of thinking is characteristic of which cognitive stage?
- Formal operational thought with abstract reasoning
- Preoperational thought with magical thinking and egocentrism (Correct answer)
- Concrete operational thought with logical cause-and-effect reasoning
- Sensorimotor thought with object permanence development
Correct answer: Preoperational thought with magical thinking and egocentrism
Preschool-age children are in Piaget's preoperational stage, characterized by magical thinking and egocentrism, which leads them to interpret illness as punishment for perceived bad behavior.
Question 6: A PICU patient's grandmother, who is the legal guardian, is making care decisions that the primary nurse believes are not in the child's best interest. The nurse's FIRST action should be to:
- Override the grandmother's decisions citing nursing judgment
- Consult with the interdisciplinary team and document the concern (Correct answer)
- Contact law enforcement to report medical neglect
- Carry out the grandmother's decisions without question
Correct answer: Consult with the interdisciplinary team and document the concern
When a nurse has concerns about guardian decision-making, the appropriate first step is to consult the interdisciplinary team, including social work and the attending physician, and document the concern before escalating.
Question 7: Which of the following is the BEST indicator that a PICU family has achieved effective coping after receiving a child's poor prognosis?
- The family stops asking questions and accepts all treatment recommendations without discussion
- The family demonstrates acceptance of uncertainty while maintaining presence and involvement in care (Correct answer)
- The family plans a funeral before the child's death to demonstrate preparedness
- The family ceases to express negative emotions such as sadness and anger
Correct answer: The family demonstrates acceptance of uncertainty while maintaining presence and involvement in care
Effective coping is characterized by the ability to tolerate uncertainty, remain engaged in the child's care, and maintain family functioning, not by absence of emotion or passive acceptance.
Pediatric CCRN Exam Pediatric CCRN Psychosocial 5
A PICU nurse identifies that a family has not left their critically ill child's bedside for 36 hours and appears exhausted.
The most appropriate nursing intervention is to: