Clinical Nurse Specialist in Pediatrics Practice Questions

1. A practice change in a pediatric emergency department mandates that rectal temperatures are taken in patients under 6 months of age with a reported fever. The emergency department has six pediatric rooms and one rectal thermometer available. The most likely barrier to the practice change in this case is a lack of:

A. an opinion leader.
B. nursing skill.
C. staff motivation to change.
D. appropriate resources.

2. During a conversation with a patient who is resistant to the care team's recommendations, the clinical nurse specialist should use which of the following communication skills?

A. Project an air of authority so that the patient views the team as the experts.
B. Ask "yes or no" questions rather than open-ended questions.
C. Attempt to elicit the patient's perspective and expectations.
D. Focus on what the patient is saying rather than his or her body language.

3. An important assumption underlying the "family systems theory" is:

A. problems in the family can be traced back to individual family members.
B. family dysfunction is best addressed by emphasizing past (rather than current) family dynamics.
C. the family is a closed system, which does not interact with its environment.
D. changes in one part of the family affect all other parts of the family system.

4. The pediatric clinical nurse specialist evaluates an injured pediatric patient and suspects that the patient's injuries were caused by abuse. The clinical nurse specialist should:

A. report the suspected abuse only if the patient's family is acting suspiciously.
B. report the suspected abuse to the appropriate state agency.
C. report the suspected abuse to the appropriate state agency only if the physician agrees.
D. document his or her concerns in the patient's chart without reporting the suspected abuse.

5. A pediatric oncology patient receives ten times the intended dose of a chemotherapeutic agent. Which of the following actions would be consistent with conducting a root-cause analysis in response to this event?

A. Issue a formal explanation and apology to the patient's family. B. Publicly identify the provider who administered the incorrect dose.
C. Implement a computerized medication ordering system.
D. Identify and analyze each step of the process that led up to administration of the medication

Clinical Nurse Specialist in Pediatrics Answer Key

1. D: There are many potential barriers to change in the health care setting. Lack of awareness of evidence-based research or lack of the appropriate skills to enact the change may be overcome with staff education. Personal factors, such as a lack of motivation to change one's practice or an individual's personal attitudes and beliefs about the recommended change, may also lead to difficulty during a time of change. Practicalities, such as a lack of appropriate resources, personnel, or space, are frequent barriers to change and can be addressed with increasing supplies or changing use of available supplies or staff to improve efficiency.

2. C: The clinical nurse specialist should develop competence with advanced communication skills; he or she will be called on to communicate in a variety of settings and with a variety of people. When communicating with patients, it is most effective for the clinical nurse specialist to convey a nonhierarchical, open-minded, culturally competent attitude and to demonstrate caring by expressing concern and eliciting information about the impact an illness or treatment is having on that particular patient. It is valuable to notice and respond to both the verbal and nonverbal communication that patients convey.

3. D: Understanding how a pediatric patient's family structure and functioning affect the health of an individual patient is an important part of pediatric assessment. Family systems theory is based on the idea that interactions and changes in one member of the family system and environment affect other family members. Problems in the family are viewed primarily as originating from the interaction of family members, rather than from one individual. Family systems theory places emphasis on current problems and interactions, rather than past dynamics.

4. B: All 50 states have laws mandating the reporting of suspected child abuse or neglect. There is some variation among the state laws regarding the specific definition of abuse and neglect and the conditions under which health care providers are obligated to report suspected abuse. Licensed nurses are among the health care providers who are legally obligated to report suspected child abuse or neglect to the appropriate child protective service. Nurses are obligated to report child abuse whenever a reasonable suspicion of abuse exists, regardless of how the patient's family is acting or whether other medical providers agree.

5. D: The Joint Commission defines a sentinel event as "an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof." Root-cause analysis describes the process of systematically identifying and analyzing the factors involved in the specific event (e.g., human error, equipment function, patient care process, environmental factors). Root-cause analysis focuses less on the specific performance of an individual and more on processes and systems. Once the root causes have been identified and analyzed, changes can be made on a systems level to decrease the likelihood of similar events occurring in the future.