CH38 Nursing Considerations for the Child and Family With a Chronic Condition

The nurse is providing care to several hospitalized pediatric clients. Which child has the greatest risk for a developmental disability? 1. An 18-month-old admitted with a diagnosis of near drowning 2. A school-age child newly diagnosed with type 1 diabetes mellitus 3. An toddler with sepsis 4. A 2-year-old child with a fractured femur

Answer: 1 Explanation: 1. Near drowning indicates a period of time when the child was underwater and not breathing; near drowning can leave a child with a permanent chronic condition. 2. Diabetes is a chronic disease but does not lead to developmental disabilities. 3. Sepsis is treatable and will not result in a developmental disability. 4. A fractured femur is limiting to a child but will not leave the child with a chronic, limiting condition.

The nurse provides care to pediatric clients with chronic disease process. Which diagnoses does the nurse categorize as dependent on medications or special diets? Select all that apply. 1. Diabetes mellitus 2. Epilepsy 3. Celiac disease 4. Down syndrome 5. Traumatic brain injury

Answer: 1, 2, 3 Explanation: 1. A child who is diagnosed with diabetes mellitus is categorized as dependent on medications or special diets. 2. A child who is diagnosed with epilepsy is categorized as dependent on medications or special diets. 3. A child who is diagnosed with celiac disease is categorized as dependent on medications or special diets. 4. A child who is diagnosed with Down syndrome is categorized as having functional limitations. 5. A child who is diagnosed with a traumatic brain injury is categorized as having functional limitations.

The nurse is planning care for the family of a child with a chronic illness. Which activities will the nurse recommend to decrease the risk for compassion fatigue? Select all that apply. 1. Fostering social relationships 2. Exercising 3. Developing a hobby 4. Moving away 5. Sleeping more than 9 hours per 24-hour period

Answer: 1, 2, 3 Explanation: 1. Fostering social relationships contributes to social and mental rest and restoration. 2. Exercising contributes to physical restoration. 3. Developing a hobby contributes to physical, spiritual, social, and mental rest and restoration. 4. Moving away is an avoidance behavior that does not address exhaustion from overwhelming caregiving responsibilities. 5. Sleeping more than the body requires is an avoidance behavior.

The nurse provides care to pediatric clients with chronic disease process. Which diagnoses does the nurse categorize as needing increased use of healthcare services? Select all that apply. 1. Cancer 2. Sickle cell disease 3. Renal failure 4. Cystic fibrosis 5. Autism spectrum disorder

Answer: 1, 2, 4 Explanation: 1. A child who is diagnosed with cancer is categorized as needing increased use of healthcare services. 2. A child who is diagnosed with sickle cell disease is categorized as needing increased use of healthcare services. 3. A child who is diagnosed with renal failure is categorized as being dependent on medical technology. 4. A child who is diagnosed with cystic fibrosis is categorized as needing increased use of healthcare services. 5. A child who is diagnosed with autism spectrum disorder is categorized as having functional limitations.

Which does the nurse include in the plan of care for an adolescent with a chronic condition? 1. Being more concerned for parents 2. Exhibiting less concern about appearance 3. Having an altered body image 4. Portraying a higher self-esteem

Answer: 3 Explanation: 1. As adolescents develop a sense of identity, they are focused on themselves and the present. 2. Adolescents with chronic conditions will have a heightened concern about their appearance. 3. Adolescents with chronic conditions might have inaccurate assessments of their body image. 4. Adolescents with chronic conditions have low self-esteem when comparing their bodies with those of their peers.

The nurse observes that over time, the parents of a child with a chronic condition have experienced a pattern of periodic grieving alternating with denial. Which will the nurse include in the child's updated plan of care? 1. Pathologic Grieving 2. Compassion Fatigue 3. Chronic Sorrow 4. Dysfunctional Parenting

Answer: 3 Explanation: 1. Pathologic Grieving results when persons do not move through the stages of grief to resolution. 2. Compassion Fatigue is experienced by caregivers as their ability to feel compassion is exhausted. 3. Parents experience chronic sorrow as they grieve when their child does not meet developmental milestones or participate in activities of "normal" children. The time between periods of grieving might be times of parental denial, which allows the family to function. 4. Dysfunctional Parenting involves inadequately meeting the needs of children.

The nurse learns that a newborn is diagnosed with phenylketonuria (PKU). Which is the most appropriate way to inform the newborn's parents about this diagnosis? 1. Calling the parents to provide the diagnosis over the phone 2. Mailing a certified letter explaining the diagnosis and requesting the parents make a pediatric office appointment 3. Planning a group meeting for all parents whose children received the diagnosis in the last two months 4. Scheduling an appointment for the parents to see the healthcare provider in person to discuss the diagnosis

Answer: 4 Explanation: 1. Providing the parents information of a chronic health problem of their newborn should not be done over the phone. 2. This information should be provided to the parents in person. 3. This information should be shared on a one-to-one basis. 4. The appropriate environment allows for privacy and freedom from interruptions. The parents should be allowed other support people to be present as they request.

Which nursing action is appropriate when preparing the family of a school-age child with a chronic illness to provide care in the home setting? 1. Teaching the family about appropriate sensory stimuli, such as a mobile 2. Educating the family to allow the child choices, such as which food to eat first 3. Preparing the family for the transition of care into adulthood 4. Encouraging interaction between the child and others with the same diagnosis

Answer: 4 Explanation: 1. Teaching age-appropriate interventions is important; however, a mobile is an age appropriate toy for the infant, not the school-age child. 2. Providing choices is important for the preschool-age child, not the school-age child. 3. Preparing the family for the transition of care into adulthood is important for the adolescent, not school-age, patient. 4. School-age children should be encourages to interact with other child who have the same diagnosis.

A 3-year-old child, recently hospitalized for the exacerbation of a chronic illness, presents for a follow-up appointment at the pediatric clinic. The child's mother states, "He was potty trained before the hospital stay but now he is having daily accidents." Which response by the nurse is most appropriate? 1. "This is probably a reaction to the antibiotics and will disappear when the antibiotics are finished." 2. "Urinary incontinence is a common symptom of progression of cystic fibrosis. Be sure to notify the healthcare provider of this change." 3. "The child may have a urinary tract infection and needs to be evaluated." 4. "Children often regress after hospitalization. Be patient and remind him to go to the bathroom frequently."

Answer: 4 Explanation: 1. Antibiotic therapy does not cause incontinence. 2. Urinary incontinence is not a symptom of cystic fibrosis. 3. There are no symptoms of a urinary tract infection (UTI). 4. Regression is a common response to hospitalization.

The nurse works in a clinic for medically fragile children who require home care. The nurse has noticed that a high percentage of the families parents divorce. In an attempt to reduce the divorce rate among the parents, the nurse creates an educational session for parents of medically fragile children. Which should be the focus of this session? 1. Communication 2. Financial stability 3. Ways to meet the child's physical needs 4. The state laws that have relevance to the medically fragile child.

Answer: 1 Explanation: 1. Both partners need to be able to communicate honestly and frequently to maintain the marriage relationship. 2. Finances will be a problem for the family as the cost of care of medically fragile child can be high. Nurses may refer to community resources but cannot solve all financial problems. 3. The nurse will teach parents how to meet the child's physical needs on a one-to-one basis, not in a group session. 4. This will not reduce the divorce rate.

The nurse is conducting an educational program for parents of children with chronic conditions. Which parental statement indicates the need for further instruction? 1. "I know my child will get better and not have to take any more medication." 2. "I know my child will need assistance with activities of daily living." 3. "I know my child may need specialized education." 4. "I know my child will have to stay on a special diet."

Answer: 1 Explanation: 1. Chronic conditions might require lifetime dependence on medication. 2. Children with chronic conditions typically need assistance with daily living activities. 3. A child with a chronic condition may require specialized education. 4. Depending on the diagnosis, children with chronic conditions might require a special

The mother of an adolescent with multiple medical and developmental issues says to the nurse: "There are times that I think about just walking out of the house and not coming back." Which would be an appropriate nursing diagnosis for this mother? 1. Caregiver Role Strain related to providing 24-hour care for a child with medical and developmental issues 2. Risk for Injury (maternal) related to overwhelming demands of the medically fragile child 3. Knowledge Deficit (maternal) related to nursing care of the child 4. Health-seeking Behaviors (maternal) related to interest in learning to care for her child

Answer: 1 Explanation: 1. This diagnosis describes the effect of this child's care on the mother. 2. There is no indication of a risk for injury in the stem. 3. This question does not indicate a lack of knowledge by the mother but frustration due to the daily demands of caring for her child. 4. There is no indication in the stem that the mother wants to learn more about medical care for her child.

The nurse is caring for a 17-year-old client with a chronic condition who will be transitioning into adulthood. When planning care for this client, which should the nurse consider? Select all that apply. 1. Ability to work 2. Ability to live independently 3. Psychosocial needs 4. Parental needs 5. Sibling needs

Answer: 1, 2, 3 Explanation: 1. The nurse must consider the client's ability to live independently when planning care for a client with a chronic condition who is transitioning into adulthood. 2. The nurse must consider the client's ability to live independently when planning care for a client with a chronic condition who is transitioning into adulthood. 3. The nurse must consider the client's ability to live independently when planning care for a client with a chronic condition who is transitioning into adulthood. 4. The parent's needs are not considered when planning care for a client with a chronic condition who is transitioning into adulthood. 5. The needs of the client's siblings are not considered when planning care for a client with a chronic condition who is transitioning into adulthood.

The nurse of the family who is assuming the role of care coordinator is providing education regarding the use of a healthcare log. Which will the nurse encourage the family to include on this log? Select all that apply. 1. Role of each provider 2. Date of each appointment 3. Prescribed interventions 4. Future treatments 5. Out-of-pocket cost

Answer: 1, 2, 3, 4 Explanation: 1. The nurse will encourage the family to include the role of each provider on the healthcare log. 2. The nurse will encourage the family to include the date of each appointment on the healthcare log. 3. The nurse will encourage the family to include the prescribed interventions on the healthcare log. 4. The nurse will encourage the family to include future treatments on the healthcare log. 5. Out-of-pocket cost is not something the nurse encourages the family to keep on the healthcare log.

The nurse is providing care to a pediatric client who is newly diagnosed with a chronic condition. The parents ask, "When will our child be able to assume more responsibility for managing the disease?" Which age group will the nurse include in the response to the parents? 1. Preschooler 2. School-age 3. Adolescent 4. Toddler

Answer: 2 Explanation: 1. Preschoolers do not have the cognitive and psychomotor skills for these tasks. 2. School-age children are developing a sense of industry and can begin assuming responsibility for self-care. 3. Adolescents should already be well accomplished at self-care. 4. Toddlers do not have the cognitive and psychomotor skills for these tasks.

The nurse is planning care for a school-age child who requires oxygen, enteral tube feedings, and IV medications during the school day. To which category of chronic illness does this child belong? 1. Dependent on special diet 2. Dependent on medical technology 3. Increased use of healthcare services 4. Functional limitations

Answer: 2 Explanation: 1. While this child does have a special diet, this category is not comprehensive enough to describe the child's needs. 2. This child requires oxygen, enteral tube feedings, and IV medications, which indicates the child is dependent on medical technology. 3. While this child does have increased use of healthcare services, this category is not comprehensive enough to describe the child's needs. 4. While this child may have functional limitations, this category is not comprehensiveenough to describe the child's needs.

The nurse is providing care to a toddler-age client newly diagnosed with a chronic condition. Which nursing action will prepare the family for providing care to the toddler once discharged from the hospital setting? 1. Suggesting that the parents use a mobile to provide sensory stimulation 2. Helping the parents recognize their child's capabilities 3. Allowing the child to choose the color of the gown during hospitalization 4. Suggesting the child be enrolled in a special camp to learn about the diagnosis

Answer: 2 Explanation: 1. A mobile is not an appropriate toy to provide sensory stimulation to the toddler. This suggestion is appropriate for an infant. 2. It is important for the nurse to help the parents recognize their child's capabilities and to encourage the parents to allow enough time to practice and learn a new skill. 3. This is an appropriate nursing action when the child is hospitalized; however, this is not a nursing action that will prepare the family for providing care to the toddler with a chronic condition after discharge. 4. Enrollment in a special camp would be appropriate for a school-age child, not the toddler.

After the infant is diagnosed with a chronic health condition, the family is assigned a nurse case manager. Which will the nurse include in the explanation to the infant's parents regarding this role? 1. Limiting the number of visits to the healthcare facility 2. Preventing duplication of services 3. Improving the quality of life for the child and parents 4. Recognizing the equipment needs of the child and providing assistance with equipment acquisition 5. Visiting the child in the home to assist with physical care

Answer: 2, 3, 4 Explanation: 1. Although well-managed care may reduce illnesses and thus visits to the healthcare facility, limiting visits is not a function of the case manager. 2. Because many children who are chronically ill are seen by many healthcare providers and clinics, there is often a duplication of services. Case managing coordinates between the various clinics and healthcare providers to prevent duplication. 3. Case managing has many modes of improving the quality of life for children and parents. By coordinating care, the child can often be seen by several healthcare providers during the same visit, thus improving the quality of life. 4. The case manager will assist the family in meeting the needs of the child, including helping with identifying and acquiring equipment necessary for caring for the child. 5. The case manager does not provide direct client care.

The parents of a 4-month-old child learn that there will be long-term consequences due to the head injury sustained in a motor vehicle accident, including intellectual disability and cerebral palsy. The parents express anger at the diagnosis and project that anger on the nursing staff. Which responses by the nursing staff are appropriate? Select all that apply. 1. Referring the family to the hospital administrator 2. Recognizing that the parents' anger is a normal response to the news 3. Continuing to provide physical and emotional care to the child and family 4. Offering hospital resources to the parents in addition to continued nursing support 5. Explaining to the family that you are sorry about their child's injury but suggest they transfer the child to another hospital for their own comfort

Answer: 2, 3, 4 Explanation: 1. The hospital administrator will be unable to meet their needs or to calm their anger. 2. Parents grieve for the loss of the perfect child. This is a normal reaction. 3. The nursing staff will continue to provide physical and emotional care to the child and family. 4. It is appropriate to offer the hospital chaplain and other mental health workers in addition to continued support from the nursing staff. 5. This option is a resolution for the nursing staff but not for the parents.

The nurse care coordinator is supporting a family who wishes to become their child's care coordinator. Which statements will the nurse include in the teaching session to prepare the family for this task? Select all that apply. 1. "You won't need to set aside much time to properly coordinate your child's care." 2. "Care coordination requires ongoing assessment of your child's needs." 3. "Since you are the parent you will not be required to use cost-efficient strategies when coordination your child's care." 4. "Care coordination requires you to be educated regarding your child's diagnosis." 5. "There is a care coordination workshop provided by hospital educators that will help you to learn this role."

Answer: 2, 4, 5 Explanation: 1. Care coordination is time consuming. This statement is not appropriate for the nurse to include in the teaching session. 2. Care coordination requires ongoing assessment of the child's needs. This statement is appropriate to include in the teaching session. 3. All care coordination efforts should include the implementation of cost-efficient strategies for care. This statement is not appropriate for the nurse to include in the teaching session. 4. In order to be a successful care coordinator it is essential to have an adequate knowledge base regarding the diagnosis. This statement is appropriate to include in the teaching session. 5. When parents wish to assume the role of care coordinator is often necessary that they receive extensive training, which is often provided by hospital educators. This statement is appropriate to include in the teaching session.

The nurse is conducting a nursing assessment of the parent and child with severe cerebral palsy during a routine clinic visit. Which nursing action is appropriate based on the current data? 1. Measuring the urine output 2. Measuring the child's head circumference 3. Observing the parent-child relationship 4. Observing how the child interacts during play

Answer: 3 Explanation: 1. Measuring urine output is not important unless there are problems with the bladder. 2. Measuring the child's head circumference is not an important assessment at this time. 3. Observing the parent-child relationship is important to the success of health supervision for both the child and parents. 4. Playtime is not important during this time.

The nurse is working with the parents of a child with a chronic condition. Which statement made by the child's parents indicates the need for intervention related to overwhelming caregiver burden? 1. "My mother moved in and helps us with the care of our family." 2. "I chose to quit my job to be home with my child, and my husband helps in the evening when he can." 3. "I have to care for my child day and night, which leaves little time for me." 4. "Our health insurer sent us a rejection letter for my child's brand-name medication, and we must fill out forms to get the generic."

Answer: 3 Explanation: 1. The family's pitching in to help indicates family support. 2. The mother chose to care for the child and receives help from the husband. 3. No respite time from caregiving responsibilities could lead to overwhelming caregiver burden. 4. Substituting generic for brand-name medications will not result in caregiver burden.

The nurse is partnering with the family of a hospitalized premature neonate who suffered an intraventricular hemorrhage (IVH). After 3 months in the neonatal intensive care unit (NICU), the infant is being discharged. Which activities will the nurse suggest to the family to help stimulate the infant's development? Select all that apply. 1. Using a day care for stimulation 2. Discouraging sibling interaction 3. Holding and rocking the infant 4. Interacting face to face 5. Talking softly and singing to the infant

Answer: 3, 4, 5 Explanation: 1. A premature infant might not have a mature immune system; therefore, day care might present an infection issue. The needs of this child might not be met in a day care setting with many children. 2. Sibling interaction is important and should be encouraged. 3. Holding and rocking the infant stimulates the infant's sense of motion, facilitating parent-infant bonding. 4. Interacting face to face stimulates the infant's sense of vision, facilitating parent-infant bonding. 5. Talking softly and singing to the infant are activities that stimulate the infant's senses of hearing, touch, and motion, facilitating parent-infant bonding.

The school nurse is reviewing the records of all incoming kindergarten students. Which students will require an individualized education plan (IEP)? 1. The child with diabetes controlled with insulin 2. The child with a casted arm due to a fracture 3. The child with a hearing deficit 4. The child with autism spectrum disorder 5. The child with an IQ of 60

Answer: 3, 4, 5 Explanation: 1. This child may need an individual health plan but does not require an IEP. 2. This is not a chronic problem and does not require an IEP. 3. This child will need modification of the educational plan in order to be successful. 4. The child diagnosed on the autism spectrum will have special educational needs that will be determined by the IEP. 5. The child with an IQ of 60 is intellectually disabled and will require an IEP.

An adolescent diagnosed with type 1 diabetes mellitus (DM) is prescribed dietary restrictions and daily insulin injections. Which behavior does the nurse anticipate from the adolescent upon return to school? 1. Administering medication in front of peers 2. Teaching peers about the diagnosis 3. Acknowledging the condition to classmates 4. Exhibiting poor adherence to the prescribed treatment plan

Answer: 4 Explanation: 1. Most adolescents do not want to be seen as "different" by their peers; therefore, it is unlikely that the adolescent will administer the prescribed insulin in front of the peer group. 2. Most adolescents do not want to be seen as "different" by their peers; therefore, it is unlikely that the adolescent will teach his or her peers about the disease process. 3. Adolescents will attempt to hide their health conditions from their classmates. 4. Adolescents have poorer eating habits than all other age groups, and adolescents with diabetes may not adhere to necessary dietary restrictions.

The nurse is providing care to several pediatric clients in the hospital setting. Which client diagnosis is capable of producing chronic limitations for the child? 1. Pneumonia from the bacillus Haemophilus influenzae 2. Respiratory syncytial virus 3. Streptococcus pneumoniae, a gram-positive diplococcus 4. Congenital heart defect

Answer: 4 Explanation: 1. Pneumonia is not a chronic limitation. 2. Respiratory syncytial virus is a serious infection caused by a virus that affects infants. It does not result in permanent disability. 3. Streptococcus pneumoniae, a gram-positive diplococcus, is treatable and will not cause chronic limitation. 4. A congenital heart defect can leave a child with a permanent chronic condition.

The nurse is assigned as the care coordinator for a child with special healthcare needs. Which actions by the nurse enhance the family's ability to participate in their child's care coordination? Select all that apply. 1. Coordinating the healthcare team 2. Arranging the needed healthcare services 3. Modifying the home for care 4. Helping with decision making for meeting goals of care 5. Educating the family about the diagnosis

Answer: 4, 5 Explanation: 1. Coordinating the healthcare team is one of the responsibilities of the nurse case coordinator. This is not an action that will enhance the family's ability to coordinate care for their child. 2. Arranging needed healthcare services is one of the responsibilities of the nurse case coordinator. This is not an action that will enhance the family ability to coordinate care for their child. 3. Modifying the home for care is one of the responsibilities of the nurse case coordinator. This is not an action that will enhance the family ability to coordinate care for their child. 4. The nurse case coordinator helps the famly with decision making related to meeting the goals of care. This action enhances the family's ability to coordinate care for their child. 5. The nurse case coordinator educations the famly about the child's diagnosis. This action enhances the family's ability to coordinate care for their child.