CH 25 DAVIS EDGE PEDS

A child with juvenile rheumatoid arthritis is hospitalized after secretly discarding her medication. Which consequences of noncompliance with her medication regimen previously taught by the RN would be reinforced by the nurse? Select all that apply.

-The child is subject to profound pain. -Additional joint damage is possible. -The presence of inflammation worsens symptoms.

A child with chronic asthma complains to the nurse about his parent's attitude of him being sick all the time. The child states, "I am in middle school, and they still treat me like a baby." Which information would the nurse offer the parents to address the child's issues? Select all that apply.

-The developmental milestone for the child's age group -The importance for the child to gain and maintain normalcy in life -The effects of unhappiness, anxiety, and stress on their child -The child's risk for unhappiness and emotional stress

The LPN/LVN is assisting with the care of a child who is 12 years of age and hospitalized for management of unstable type 1 diabetes mellitus. During hospitalization, the child's blood glucose levels have been difficult to regulate. Which comment by the child would the LPN/LVN report to the RN?

"I feel lonely because everyone thinks I am sick and nobody wants to spend time with me. Research has shown that when children with chronic illness are distressed, anxious, and unhappy, their medical condition is harder to control and manage. Social status is beginning to be important to a child of this age. This comment conveys some emotional stress that should be reported to the RN.

The pediatric nurse is aware that the management of symptoms is important for the child diagnosed with a chronic illness. Which nursing activity would help the nurse adequately observe symptoms? Select all that apply.

-Use behavioral stress scales to assess for pain in infants. -Look for behavioral indications of nausea in younger children -Review care schedules to identify reasons for child sleep disorders.

The nurse is preparing a presentation to family members who are providing care for children with chronic illnesses. The main focus of the presentation is the prevention of secondary problems. Which physiological secondary problems would the nurse discuss as common risks to children with chronic illnesses?

-Weight loss -Skin injuries -Aspiration pneumonia -Urinary tract infections

The parents are told their newborn has a heart deformity that will require surgery when the baby gets older. The parents express feeling overwhelmed with worry for their baby and concern about financial strain. For which primary reason would the nurse recommend joining a local support group?

The parents can learn through the experiences of other parents. Many organizations offer support groups either online or in person, with opportunities to connect with other families for emotional support, education, and ideas for adaptation and acceptance.

The LPN/LVN is aware that a chronic illness can interfere with expected psychosocial development of the affected child. Which interventions would the LPN/LVN perform to help the child reach the goals of normalcy and increased autonomy? Select all that apply.

-Encourage the activities of peers with modifications. -Minimize the disruptions of exacerbations and hospitalizations. -Provide support for the child to reach developmental milestones

The health care team and parents of a child with a chronic illness focus on the developmental well-being of the child. Which factor would be important for the health care team to reinforce with the parents?

The parents need to focus on developmental growth and maturity. Both the family and the health care team working together to concentrate on the child's developmental growth and maturity rather on the child's chronological age.

A child with cystic fibrosis is brought from home to the hospital for readmission. The admitting nurse asks the family for a history of previous hospitalizations. The parent becomes upset and states, "She has been here four times in the past 6 months, and you still need all the details." Which response by the nurse would be appropriate?

"Asking each time will help prevent mistakes in your child's care." This is the correct response by the nurse. The family needs to be aware that all precautions are taken to provide safe and effective care to their child.

A child who is 12 years of age is experiencing worsening of a chronic illness, and death is imminent. Which questions would the child likely ask about expectations? Select all that apply.

-"What will it be like when I die?" -Will I be buried close to grandma?" -"What will you do with all my stuff when I die?"

A college student who is 19 years old is recovering from a severe case of encephalitis. The nurse's observations include signs of pronounced physical and mental disabilities. Which definition would the nurse expect to be applied to the patient's condition?

Developmental disability A physical or mental disability that manifests before the child's 22nd birthday and is very likely to continue throughout the child's adulthood. This definition fits the parameters of the patient exactly.

A family with a child diagnosed with a progressively debilitating chronic illness is socially connected to a support group whose children have the same condition. Which factor would the nurse share with the family of this child?

Monitor the chronically ill child frequently for signs of distress Knowing other children with the same disorder who are in the hospital or clinics with relapses, complications, or symptoms associated with the illness can be distressing.

The nurse on a pediatric unit is assigned multiple patients admitted with either complications or exacerbations related to a chronic illness. With which patient's family would it likely be the most difficult for the nurse to establish a therapeutic relationship?

The infant with cerebral palsy from a ventilator-related respiratory infection Cerebral palsy in infants is most commonly caused by an oxygen deficit during birth. The parents of this child may feel their child's condition is related to a medical error. This is the most difficult therapeutic relationship to be established.

A newborn is immediately diagnosed after birth with a genetic disorder, which will develop into a chronic illness. The parents are devastated to learn that they are both carriers of the disorder. Which initial focus by the health care team would best promote a therapeutic relationship with the parents?

Understand that the parents need effective listeners. The nurse and health care provider working with the family need to understand that the family needs an effective listener, someone who is engaged and attentive to the parents' concerns and needs.

An older school-age child with type 1 diabetes is hospitalized to help regulate blood glucose levels. Which comment by the child would cause the nurse to suspect intentional medical noncompliance?

"I am tired of being so different from everyone." The child is at an age when children want to fit in with their peers. All the manifestations and requirements to manage diabetes make the child feel different, which can lead to noncompliance.

Numerous children with the same chronic illness are seen at a specialized clinic. One of the children dies, and another tells the nurse, "Just tell me what happened so I can watch if the same thing is happening to me!" Which response by the nurse would be appropriate

"I understand that you are sad and afraid." The best response is the one that acknowledges the child's feelings without violating patient privacy.

The LPN/LVN is reviewing information taught by the RN to the parents of a child born with Down syndrome. Which comment by the parents would prompt the LPN/LVN to report to the RN a need for additional teaching?

"Special education is our primary concern for our child's future." Special education is needed; however, the child with Down syndrome is at risk for a multitude of other health issues. The child will need a team of health care providers to keep the child at a level of optimal health. This comment requires additional teaching.

A 16-year-old male patient had a chronic illness diagnosed as a child. With the parent's consent, the nurse is discussing the parent's concern about the patient's lack of involvement with self-care. Which comment by the nurse would likely be most helpful in beginning a conversation about this concern?

"Tell me about your daily routine." The first action is for the nurse to perform an assessment about the patient's perception of his daily routine.

New parents seem concerned about taking their premature infant home after a long hospitalization. The infant is on a ventilator, tube feedings, and uses an apnea alarm. Which comment by the parents would assure the nurse that parent teaching has been effective?

"We know we can bring the baby right back here if we can't handle this at home." If the family perceives that they are not ready or able to care for the child at home, they may bring the child right back to the emergency department or pediatric inpatient unit. This comment indicates that teaching has been effective.

The nursing team is including the family of a child hospitalized with a chronic illness in the child's care conference. Which comments from family members would be indicative of negative effects on the family? Select all that apply.

-"Our teenage child has begun to throw tantrums." -"No one in our house sleeps through the night." -"I think some help at home would be a good thing." -"We just recently stopped going to the movies and eating out." -We are making sure one of us is at the hospital all the time."

The nurse is providing care for the family of a child who was diagnosed with a chronic illness shortly after birth. The child is now 13 years old, and the nurse is concerned about the development of depression. Which factors would the nurse recognize as placing the child at a higher risk for depression? Select all that apply.

-A parent previously attempted suicide. -The child has extreme facial deformities. -The family is subject to frequent military transfers.

A mother of a child with a chronic illness states feeling that she has abandoned her healthy children. Which verbal cues would the nurse share that would indicate a clear negative effect on the healthy children? Select all that apply.

-An older toddler states, "I wish I was sick, too." -A preschooler states, "If I get mad, my brother goes to the hospital." -An older school-age child states, "It is so irritating that he drools everywhere."

The parents of a child hospitalized with a severe exacerbation of a chronic illness are attending a multidisciplinary team meeting about the child's care. During the meeting, one of the parents states, "I can't take this anymore" and leaves. Which action would the team perform?

Activate the team's specialties to provide help for the parent. The team will see the parent's behavior as an indication of severe stress and will activate the specialties of any team member who can provide help to the parent and other family members.

The nurse is visiting a family who has a 3-year-old child with a chronic central nervous system (CNS) disorder caused by a brain bleed during a premature birth. The child is cared for at home, is on mechanical breathing, receives tube feedings, and is completely dependent for physical care. Which focus would be most important for the nurse during a home visit?

Adequate care and related safety measures The most important focus of the nurse is on adequacy of care and related safety measures. The child is technology- and care-dependent; the nurse must assess the overall safety of care in order to prevent health and medical complications.

The LPN/LVN is assisting a family with a 10-year-old child with a long-term illness. A parent shares, "Our older child is feeling cheated and ignored because of the time spent with our sick child." Which organization would the LPN/LVN recommend to the family to address the older child's needs?

American Academy of Pediatrics This organization provides information on support for siblings of children with chronic illnesses, which is the exact information this family needs.

A teenage patient is confined to a wheelchair following a fall. While hospitalized, the teen has frequent outbursts of anger, throws things at nurses and visitors, and cries frequently. Which action by the nurse would be most appropriate?

Ask for a referral to a mental health professional. The most appropriate action for the nurse is to ask the health care provider for a referral to a mental health professional. The patient is exhibiting emotional instability and anger.

The nurse is providing care for a child who is 5 years of age who experienced a closed-head injury in an accident. Medical personnel have just determined the child will have a chronic disorder affecting physical and mental functioning. The family has strong cultural ties to a different country. After this diagnosis, which behavior by the nurse would demonstrate cultural sensitivity?

Assist the family in making arrangements for cultural support and rituals. Cultural sensitivity involves assisting families or patients to accommodate arrangements needed for cultural support and/or rituals.

A child of 15 years of age is admitted to acute care for complications related to a chronic disease diagnosed at birth. The parent states, "They have made great strides in managing this condition, I cannot understand why he is hospitalized so often." Which conclusion would the nurse draw before answering the parent?

Children in this specific population are experiencing more comorbidities and new morbidities as they age. Children with chronic conditions are now experiencing increased survival rates, but with longer lives they experience more comorbidities and new morbidities, which may require hospitalizations. This child is admitted because of complications.

The RN is teaching a family about how to care for their technology-dependent child after discharge. On which topic would it be most important for the LPN/LVN to focus during reinforcement of this teaching?

Confirm that the family knows how and when to respond to an emergency The most important topic for the nurse to focus on during the teaching is how and when the family responds to an emergency at home.

A couple approaches a pediatric nurse about a personal dilemma. The couple are parents to a child who is technology dependent. The couple wants to go on a cruise with their extended family. Which recommendation would the nurse provide to meet the needs of both the couple and their child?

Contact a care center staffed by skilled health care providers. Contact a care center where a technology-dependent child can spend time safely with knowledgeable and skilled health care providers.

The nurse is gathering medical history on a child with a chronic illness who has been frequently hospitalized for respiratory infections. The mother states, "Whenever we go home from the hospital, we have to deal with serious behavior issues for weeks after." Which suggestion by the nurse would be appropriate?

Continue with discipline and boundaries in the hospital. Parents need to understand that the child still needs discipline and boundaries when ill. Consistency is very important for the well-being of the child.

A single parent of four children is staying at the bedside of a child hospitalized with complications from a chronic illness. When the nurse asks about the care of the children at home, the parent states, "My oldest is 12 and very capable of caring for the younger children." Which action would the nurse perform first based on this information?

Inform the facility social worker of the situation. Informing the facility social worker of the situation is the nurse's first action. The social worker is aware of agencies and programs that can assist the parent during a health crisis of the hospitalized child. The greatest need is for the safety of the children at home.

The LPN/LVN is assisting with the care of a child admitted for an exacerbation of a chronic disease. Which manifestation would be critical for the LPN/LVN to report to the RN immediately?

Lack of cooperation with the medical plan Not cooperating with the medical treatment plan, nursing care plan, and illness self-management is a manifestation the LPN/LVN will report immediately to the RN. This behavior can interfere with recovery.

The parents of a 7-year-old child with diabetes mellitus are focused on providing their child with a normal childhood. The child is interested in playing soccer. Which accommodation would the nurse suggest to the parents to promote and manage this activity?

Make sure the child has carbohydrate snacks during the game. A child with diabetes will need an adequate meal before the game and carbohydrate snack during the game in order to maintain a healthy blood glucose level.

The nurse is providing care for a child with a chronic illness, which causes intermittent periods of dyspnea. Which action would likely be most effective in reducing the sensations of dyspnea?

Medicate with prescribed narcotic medication. Medications such as narcotics, anxiolytics (antianxiety drugs), and sedatives may be necessary to reduce the sensation of dyspnea.

The hospice nurse is attending a child who is in the terminal phase of a chronic illness. The family tells the nurse they do not know what to expect while their child progresses through the stages of dying. Which information would the nurse provide?

Mottling of the skin occurs and touching may be rejected. The nurse will prepare the family for mottling of the skin and the fact that the child may not want to be touched.

The nurse is developing a handout to assist parents of chronically ill children in recognizing depression in children. Which information would the nurse include?

Orthopedic disorders are most likely to be the source of depression. The most severe rates of depression for children with chronic illness are those with orthopedic disorders.

A family of a hospitalized, chronically ill child asks the LPN/LVN about the condition of another child. For which reason would the LPN/LVN ask the RN for a consultation with a child-life specialist?

The LPN/LVN is seeking suggestions about how to communicate therapeutically. Consultation with a social worker, child psychologist, or child-life specialist will allow the LPN/LVN to get suggestions on how to communicate therapeutically without violating HIPAA.

A child is hospitalized for multiple exacerbations of sickle cell anemia. The family is very concerned about greater amounts of pain medication administered during this hospitalization. For which reason would the nurse administer increasing amounts of medication?

The child is sensitized to the pain. Children with chronic pain become more sensitized to the experience and require greater pain-relieving measures. The experience of high levels of pain will influence the interpretation of future pain

The LPN/LVN assists with the care of children who have chronic neurological conditions. Which results of a chronic neurological illness would the LPN/LVN recognize as being completely avoidable?

The injuries from shaken baby syndrome All injuries from shaken baby syndrome are completely avoidable through effective parenting skills and behavioral management.

The parents of a 7-year-old with chronic illness express concern about the behavior of their 12-year-old toward the ill sibling. Which behavior shared by the parents would indicate the possibility of abuse by the older sibling?

The older sibling no longer acknowledges or interacts with the younger sibling. Signs of abuse include avoiding or ignoring the ill child, which is a source of emotional abuse for the younger sibling.

A chronically ill child who has difficulty swallowing appears to be choking but lacks the ability to cough effectively. The parent feeding the child attempts to suction the child's oral airway but is unsuccessful, and signs of cyanosis are noticed. Effective education regarding home care for this child would most strongly be indicated by taking which step first?

The parent calls for emergency backup. The adults in the home need to know how to assess for complications and have a plan for rapid access to health care if the child's condition becomes acute and a higher level of care is needed.

The LPN/LVN on a pediatric oncology unit is providing care for a school-age girl who is receiving chemotherapy. The patient's hair, eyebrows, and eyelashes have fallen out. The child has a picture of herself before chemotherapy in her room. With an understanding of the psychology of chronically ill children, which conclusion would the LPN/LVN most likely draw from the display of this picture?

The patient wants people to see her and not her cancer. Sometimes a chronically ill child will display a photograph taken before becoming ill and say, "This is a picture of me, who I really am."

The LPN/LVN is discussing the effects of a child's chronic illness with a parent. The parent states, "I don't think she will ever be better. It's just one hospitalization after another, and each time it's worse." Which report would the LPN/LVN make to the RN regarding the parent's feelings and emotional state?

The parent is experiencing chronic sorrow. Chronic sorrow is a set of feelings experienced by parent(s) of a child with a chronic illness or disability that recurs in waves over time.

A child who is 4 months of age is diagnosed with cystic fibrosis. The RN provides teaching about the child's condition being chronic to child's parents. Which options would reflect important information for the LPN/LVN to reinforce with the parents? Select all that apply.

-Care must be taken to facilitate the child's autonomy. -The illness exhibits both active and quiet periods. -The condition will require special medical care. -The severity of manifestations may change over time. -The condition is expected to last over the child's lifetime.

A child with a chronic illness that involves multiple visible manifestations is angry with his family members. The child tells the nurse, "They all think I am stupid. I know I have a serious condition." When the nurse approaches the family members, they are shocked by the child's perception. Which cues would the nurse identify for the family members?

-Children interpret the concerned looks on parent's faces. -Children are aware of hushed responses between family and friends. -Children will draw conclusions about why they spend time with children who are sick.

An adolescent boy is a recovering from an accident that caused a spinal cord injury. The boy is now confined to a wheelchair and requires assistance with daily care. The boy appears to be angry or sorrowful at times. Which suggestions would the nurse make to the patient and family to provide emotional support? Select all that apply.

-Provide guidelines for appropriate displays of feelings -Make sure all adults in the adolescent's life understand his limitations. -Encourage the adolescent to set a routine for self-care and medical needs

The LPN/LVN is assisting with the care of a child who is in the terminal phase of a chronic illness. A parent tells the LPN/LVN, "He doesn't want me to leave but gets so grumpy and tells me I am hovering." Based on the parent's comments, which information would the LPN/LVN share with the parent? Select all that apply.

-The child is likely to understand the situation. -Some children do not want to be touched or to talk -It is common for the child to not want to be alone.

The nurse in a pediatric office is discussing symptom management with a child recently diagnosed with asthma and their family. Which outcomes would the nurse address related to symptoms associated with the diagnosis? Select all that apply.

-The child's physical experience related to the symptoms of asthma -The strategies to use to promote positive responses to asthmatic events -The emotional and functional status influenced by the symptoms of asthma

A child with chronic asthma complains to the nurse about his parent's attitude of him being sick all the time. The child states, "I am in middle school, and they still treat me like a baby." Which information would the nurse offer the parents to address the child's issues? Select all that apply.

-The developmental milestone for the child's age group -The importance for the child to gain and maintain normalcy in life -The child's risk for unhappiness and emotional stress -The effects of unhappiness, anxiety, and stress on their child

The nurse is visiting homes where children with chronic conditions are technologically supported. Which observations would prompt the nurse to reinforce previous RN teaching on home safety related to technological support with the families? Select all that apply.

-The nurse finds a home where an oxygen source is in the room with an open flame heater. -The nurse finds a newborn with apnea sleeping prone without the apnea monitor.