Wong’s Nursing Care of Infants and Children, 12th Edition —
Chapter 1: Perspectives of Pediatric Nursing.
1. Chapter & Subtopic: Chapter 1 – The Art of Pediatric Nursing
/ Philosophy of Care
Question Stem: A pediatric nurse is caring for a 7-year-old child
admitted for asthma exacerbation. The nurse involves the child
in care decisions by offering choices, such as which arm to use
for vital signs or which toy to play with after a breathing
treatment. This approach is most consistent with which
philosophy?
Options:
A) Family-centered care
B) Trauma-informed care
C) Atraumatic care
D) Palliative care
Correct Answer: C
Rationales:
• Correct (C): Atraumatic care is the provision of therapeutic
care in settings, by personnel, and through the use of
interventions that eliminate or minimize the psychological
and physical distress experienced by children and their
families. Offering choices provides a sense of control and
minimizes feelings of powerlessness. (Wong's, Ch. 1, The
Art of Pediatric Nursing)
, • Incorrect (A): While family-centered care is crucial, this
scenario specifically focuses on minimizing the child's
distress, which is the core of atraumatic care.
• Incorrect (B): Trauma-informed care involves
understanding the widespread impact of trauma and
resisting re-traumatization, which is a broader concept
than the specific intervention described.
• Incorrect (D): Palliative care is focused on relieving
suffering and improving quality of life for patients with
serious illnesses, which is not the context of this scenario.
Teaching Point: Atraumatic care minimizes distress by
providing choices and maintaining control.
2. Chapter & Subtopic: Chapter 1 – Role of the Pediatric Nurse /
Family Advocacy
Question Stem: A 16-year-old patient with cystic fibrosis tells
the nurse in confidence that they have been skipping their
evening pancreatic enzymes to lose weight. What is the nurse's
most appropriate initial action?
Options:
A) Respect the adolescent's confidentiality and not disclose the
information.
B) Immediately inform the primary provider and the patient's
parents.
C) Educate the patient on the risks of non-adherence and
explore their body image concerns.
D) Document the conversation in the chart and take no further
,action.
Correct Answer: C
Rationales:
• Correct (C): The nurse's role includes health teaching and
support/counseling. The initial action should be
therapeutic communication to understand the reason
behind the non-adherence, provide education on the
consequences, and build trust before potentially breaching
confidentiality for a safety concern.
• Incorrect (A): Confidentiality is important for building trust
with adolescents, but it is not absolute. If the patient is at
risk for serious harm (e.g., malnutrition, worsening lung
function), the information may need to be shared with the
healthcare team and parents.
• Incorrect (B): While ultimately the team and parents may
need to be involved, immediately informing them without
first exploring the issue with the patient can destroy the
therapeutic relationship and trust.
• Incorrect (D): Documentation is necessary, but taking no
action fails in the nurse's role as an advocate and fails to
address a significant health risk.
Teaching Point: Balancing confidentiality with safety
requires therapeutic communication to understand the
root cause of risky behaviors.
, 3. Chapter & Subtopic: Chapter 1 – Health Promotion / Injury
Prevention
Question Stem: A nurse is providing anticipatory guidance to
the parents of a 6-month-old infant. Which instruction is most
important for preventing the leading cause of mortality in this
age group?
Options:
A) Introduce solid foods one at a time to monitor for allergies.
B) Place the infant on their back to sleep on a firm, flat surface.
C) Begin reading to the infant daily to promote cognitive
development.
D) Ensure the home is equipped with working smoke and
carbon monoxide detectors.
Correct Answer: B
Rationales:
• Correct (B): The leading cause of mortality in infants is
congenital anomalies, followed by disorders related to
short gestation/low birth weight. However, the leading
cause of injury-related death is Sudden Unexpected Infant
Death (SUID), which includes SIDS. Back to sleep is the
single most effective nurse-led instruction to prevent SUID.
(Wong's, Ch. 1, Childhood Mortality)
• Incorrect (A): While important for nutrition, this does not
address the leading cause of mortality.
• Incorrect (C): This promotes development but is unrelated
to mortality prevention.
Chapter 1: Perspectives of Pediatric Nursing.
1. Chapter & Subtopic: Chapter 1 – The Art of Pediatric Nursing
/ Philosophy of Care
Question Stem: A pediatric nurse is caring for a 7-year-old child
admitted for asthma exacerbation. The nurse involves the child
in care decisions by offering choices, such as which arm to use
for vital signs or which toy to play with after a breathing
treatment. This approach is most consistent with which
philosophy?
Options:
A) Family-centered care
B) Trauma-informed care
C) Atraumatic care
D) Palliative care
Correct Answer: C
Rationales:
• Correct (C): Atraumatic care is the provision of therapeutic
care in settings, by personnel, and through the use of
interventions that eliminate or minimize the psychological
and physical distress experienced by children and their
families. Offering choices provides a sense of control and
minimizes feelings of powerlessness. (Wong's, Ch. 1, The
Art of Pediatric Nursing)
, • Incorrect (A): While family-centered care is crucial, this
scenario specifically focuses on minimizing the child's
distress, which is the core of atraumatic care.
• Incorrect (B): Trauma-informed care involves
understanding the widespread impact of trauma and
resisting re-traumatization, which is a broader concept
than the specific intervention described.
• Incorrect (D): Palliative care is focused on relieving
suffering and improving quality of life for patients with
serious illnesses, which is not the context of this scenario.
Teaching Point: Atraumatic care minimizes distress by
providing choices and maintaining control.
2. Chapter & Subtopic: Chapter 1 – Role of the Pediatric Nurse /
Family Advocacy
Question Stem: A 16-year-old patient with cystic fibrosis tells
the nurse in confidence that they have been skipping their
evening pancreatic enzymes to lose weight. What is the nurse's
most appropriate initial action?
Options:
A) Respect the adolescent's confidentiality and not disclose the
information.
B) Immediately inform the primary provider and the patient's
parents.
C) Educate the patient on the risks of non-adherence and
explore their body image concerns.
D) Document the conversation in the chart and take no further
,action.
Correct Answer: C
Rationales:
• Correct (C): The nurse's role includes health teaching and
support/counseling. The initial action should be
therapeutic communication to understand the reason
behind the non-adherence, provide education on the
consequences, and build trust before potentially breaching
confidentiality for a safety concern.
• Incorrect (A): Confidentiality is important for building trust
with adolescents, but it is not absolute. If the patient is at
risk for serious harm (e.g., malnutrition, worsening lung
function), the information may need to be shared with the
healthcare team and parents.
• Incorrect (B): While ultimately the team and parents may
need to be involved, immediately informing them without
first exploring the issue with the patient can destroy the
therapeutic relationship and trust.
• Incorrect (D): Documentation is necessary, but taking no
action fails in the nurse's role as an advocate and fails to
address a significant health risk.
Teaching Point: Balancing confidentiality with safety
requires therapeutic communication to understand the
root cause of risky behaviors.
, 3. Chapter & Subtopic: Chapter 1 – Health Promotion / Injury
Prevention
Question Stem: A nurse is providing anticipatory guidance to
the parents of a 6-month-old infant. Which instruction is most
important for preventing the leading cause of mortality in this
age group?
Options:
A) Introduce solid foods one at a time to monitor for allergies.
B) Place the infant on their back to sleep on a firm, flat surface.
C) Begin reading to the infant daily to promote cognitive
development.
D) Ensure the home is equipped with working smoke and
carbon monoxide detectors.
Correct Answer: B
Rationales:
• Correct (B): The leading cause of mortality in infants is
congenital anomalies, followed by disorders related to
short gestation/low birth weight. However, the leading
cause of injury-related death is Sudden Unexpected Infant
Death (SUID), which includes SIDS. Back to sleep is the
single most effective nurse-led instruction to prevent SUID.
(Wong's, Ch. 1, Childhood Mortality)
• Incorrect (A): While important for nutrition, this does not
address the leading cause of mortality.
• Incorrect (C): This promotes development but is unrelated
to mortality prevention.
