A 10-year-old child requires daily medications for a chronic ...

[LaDunn]

A 10-year-old child requires daily medications for a chronic illness. Her mother tells the nurse that the child continually forgets to take the medicine unless reminded. What nursing action is most appropriate to promote adherence to the medication regime
 
  a. Establish a contract with her, including rewards.
  b. Suggest time-outs when she forgets her medicine.
  c. Discuss with her mother the damaging effects of her rescuing the child.
  d. Ask the child to bring her medicine containers to each appointment so they can be counted.

Question 2

A 7-year-old is identified as being at risk for skin breakdown. What intervention should the nursing care plan include?
 
  a. Massaging reddened bony prominences
  b. Teaching the parents to turn the child every 4 hours
  c. Ensuring that nutritional intake meets requirements
  d. Minimizing use of extra linens, which can irritate the child's skin

[ashely1112]

Answer to Question 1

ANS: A
Many factors can contribute to the child's not taking the medication. The nurse should resolve those issues such as unpleasant side effects, difficulty taking medicine, and time constraints before school. If these factors do not contribute to the issue, then behavioral contracting is usually an effective method to shape behaviors in children. Time-outs provide negative reinforcement. If part of a contract, negative consequences can work, but they need to be structured. Discussing with her mother the damaging effects of her rescuing the child is not the most appropriate action to encourage compliance. For a school-age child, parents should refrain from nagging and rescuing the child. This child is old enough to partially assume responsibility for her own care. If the child brings her medicine containers to each appointment so they can be counted, this will help determine if the medications are being taken, but it will not provide information about whether the child is taking them by herself.

Answer to Question 2

ANS: C
Children who are hospitalized and NPO (taking nothing by mouth) for several days are at risk for nutritional deficiencies and skin breakdown. If NPO status is prolonged, parenteral nutrition should be considered. Massaging bony prominences can cause deep tissue damage. This should be avoided. Although parents can participate, turning the child is the nurse's responsibility. If the child is alert and can move, position shifts should be done more frequently. If the child does not move, the nurse should reposition every 2 hours. The number of linens is not an issue. The child should not be dragged across the sheet. Children should be lifted and moved to avoid friction and shearing.