Chapter 34 PEDS CP

The child has been diagnosed with vulnerable child syndrome. Which statements by the child's parent are associated with the presence of this syndrome? Select all that apply.

"For the first few weeks of his life, he was so yellow I was afraid he would glow.""When she was a toddler she developed meningitis and the doctors told me they didn't think she'd make it.""She was born with a cleft lip and palate I was so afraid she wasn't getting enough formula."

The parents of a 6-month-old boy, born 8 weeks' prematurely, ask the visiting home nurse when they should consider starting the infant on solid foods. What would the nurse's bestresponse be?

"I suggest you wait until he is 8 months old."

A nurse who cares for the parents with a child with special health care needs is acting in the role as advocate when making which statement?

"I understand you are considering physical therapy. I will let your physician know as well."

The parent of a hospitalized child diagnosed with special health care needs tells the nurse, "I love my child, but providing care is very hard and I feel inadequate most of the time. Is there something I can do to cope?" Which response by the nurse is most appropriate?

"I will give you information on local support groups you can attend."

The nurse is speaking with the parents of a terminally ill child about organ donation. Which statement by a parent indicates a need for further education?

"If I choose to donate my child's organs, we will need to have a closed casket at the funeral."

The parents of an adolescent with special health care needs express to the nurse that they feel guilty for considering respite care for a week to attend their older child's destination wedding. What would be the best response by the nurse?

"Let's explore several choices for care so you can feel comfortable and trust the care provider."

The child with special health care needs returns to a health care setting regularly for multiple assessments and interventions, along with their parents. Which statement by the parent alerts the nurse that certain changes are needed?

"Our shild had the same x-rays here as were done last week at another clinic."

The nurse is assessing a 9-month-old child that was born at 32 weeks' gestation. The nurse is aware that the child's growth and development expectations would be at what age group?

7 months old

The nurse is caring for a child admitted to the hospital with a diagnosis of failure to thrive. The nurse is aware that the child will require how many kilocalories per day to demonstrate proper weight gain?

120 kcal/kg/day

The nurse is caring for a child who is nearing death. When assisting the child and family to make end-of-life decisions, what practices should be incorporated? Select all that apply.

Ask the child what concerns or fears he or she may have. Assess the family's cultural requests. Ask the child what things he or she would like to see done.

The nurse is planning interventions for an infant. The infant has been hospitalized for several weeks due to a chronic illness. Which intervention will assist the infant in developing a sense of trust?

Assess family to determine if nurturing is consistent, and if parental attachment has occurred.

The nurse is caring for a 15-year-old adolescent with bronchopulmonary dysplasia (chronic lung disease). Which intervention(s) is appropriate for this adolescent? Select all that apply.

Assist the adolescent in developing effective interpersonal skills. Urge the adolescent to make up missed schoolwork. Promote participation in afterschool activities. Educate school staff about the adolescent's special health care needs.

The parents of a 9-year-old girl who is dying from cancer are distraught and guilt-ridden when they find that treatment is no longer successful. What is the best way for the nurse to respond?

Assure the parents that expert care of their child will continue.

A group of nurses discusses a mother who has inaccurately accused several of them of "being late with medications" and "acting impatient and uncaring with my child." How might these remarks and similar others best be interpreted?

Unmet needs of the mother need to be determined and addressed.

The student nurse has completed a class presentation on vulnerable child syndrome. Which statement by a peer would suggest the need for further education?

""When a child has vulnerable child syndrome, the child exhibits separation anxiety whenever he or she is not with one of the parents."

A 6-month-old girl is significantly underweight. Which assessment finding points to an inorganic cause of failure to thrive?

child avoids eye contact

The nurse is caring for the family of a medically fragile 2-year-old girl. Which activity is mosteffective in building a therapeutic relationship?

listening to parents' triumphs and failures

A mother calls a clinic nurse to ask if her infant born prematurely should receive the seasonal influenza vaccine. The nurse's next question should be:

"How old is your baby?"

Which statement by the parent of a 5-year-old child with a developmental delay indicates to the nurse additional teaching is needed?

"I do not take my child to the park when other kids are there because they tend to stare."

The nurse is talking with the older sibling of a young child with special health care needs. The nurse would be concerned about the effects of the young child's health needs on the older sibling when the sibling makes which statement?

"I sometimes tell mom and dad I am fine staying home when I really want to go and be with my friends."

The nurse is discussing hippotherapy with the parents of a child with a spinal cord injury. Which statement(s) indicate an understanding of the information provided? Select all that apply.

"It promotes the development of balance and better muscle strength." "Children commonly feel more confident with this type of therapy." "A physical therapist will work closely with my child during this therapy."

The parents of a terminally ill child are collaborating with the case management team and discussing care options related to going home to die. Which statement by the parent indicates the need for further discussion?

"Most children fear going home to die."

When caring for a child who is newly diagnosed as "special health care needs," which nursing action is priority?

answering the caregiver's questions

The nurse is caring for a 1-year-old boy who was a premature infant. What must the nurse do to attain accurate developmental assessment data?

Assess for developmental progress based on the child's corrected or adjusted age.

Nurses explain that before the parents of a premature infant leave the hospital with their baby, the child must:

maintain oxygenation in a car seat.

The nurse is admitting a medically fragile child. When planning care for the child and the family, what is the priority for the nurse?

to develop a trusting relationship with the family

Nurses on the unit are discussing their interactions with parents of children with special health care needs. Which comment made by a nurse will the nursing supervisor address first?

"That parent just does not appreciate how much nurses know about working with children with special health care needs."

A 10-year-old girl with bone cancer is near death. Which action should best minimize her 8-year-old sister's anxiety?

Explaining how the morphine drip works.

The health care provider is on a tight time schedule and wishes to share information about a child with special health care needs with the parent currently at the provider's office. The other parent is not currently available. What will be the nurse's next action?

Indicate to the provider when the other parent will be available, and make plans for the three to talk then

What intervention should the nurse use to assist the family with a child with special health care needs to function in as healthy a manner as possible?

Involve both parents in explanations and teaching.

A 3-month-old boy was diagnosed with failure to thrive. What action will be most helpful in assisting the nurse to determine if there is an inorganic cause?

Observing the mother-child interaction during feeding and hygiene activities.

When working with a child who has special health care needs, the nurse frequently consults the parents, asking how they handle various aspects of care. What guiding principle is the nurse following?

Parents are the experts in their child's care.

The nurse is caring for a dying child. Which factors should the nurse incorporate into the care provided? Select all that apply.

Patience is necessary as parents often have difficulty making decisions during this time. It is important to withhold judgment of parents.

The nurse caring for a hospitalized child with failure to thrive (FTT) will focus first on:

assisting the child to attain adequate nutrition to demonstrate weight gain.

The nurse is caring for an infant who was born prematurely. After completing the assessment and discussing the infant's activities at home with her mother, it is clear that the child is not meeting her developmental milestones. When reporting this in the medical record, what term would be appropriate?

developmental delay

The nurse is caring for the family of a medically fragile child in the hospital. Which intervention is most important to the parents?

educating the parents about the course of treatment

The nurse is caring for a newborn that is scheduled to be discharged from the NICU. The nurse is aware that the child must be tested for what potential complication prior to discharge?

oxygen desaturation while seated in the car seat

The nurse assesses for sources of anxiety for parents of a child with special health care needs. Which situation would the nurse identify as a source of anxiety for the parents?

The parents are investigating respite care for the child for a weekend.

The nurse cares for a hospitalized child with special health care needs. What indicator will alert the nurse that the family is not ready to assume home care?

The parents are new to the community, lack knowledge of its resources, and have no friend/family support.

The nurse at a hospice care facility is caring for a 13-year-old adolescent. Which intervention best meets the needs of this adolescent?

Urging the client to invite friends to visit

The parent of a child with cerebral palsy asks how therapeutic horseback riding might benefit his adolescent. What benefits would the nurse describe? Select all that apply.

Flexibility, balance, and muscle strength tend to improve. Self-esteem and confidence usually get a boost.

The nurse is caring for a dying child. The parents have been discussing changes in their child's appetite. Which statement indicates that the parents require more education about the care of their child?

"We had to force her to eat all of her breakfast this morning."

A 15-year-old adolescent with special health care needs is attending high school. Which nursing intervention will be beneficial to the adolescent's education?

serving on the adolescent's individualized education plan (IEP) committee

The nurse is caring for a premature infant who is demonstrating poor weight gain secondary to difficulty with feedings and sucking. What referral would the nurse consider for the infant?

speech therapy

The parents of a newborn diagnosed with a chronic illness ask the nurse, "How will this effect our newborn's growth and development?" Which nursing response is most appropriate?

"It is common for newborn with chronic illnesses to grow and develop at a slower pace."

The nurse is talking with the mother of a 6-month-old who was born at 32 weeks' gestation about nutrition-related concerns. The mother questions the nurse about when additional foods may be added to the diet. She remarks that her older child was started on additional foods between 4 and 6 months of age. What response by the nurse is most appropriate?

"The addition of foods to your baby's diet may be slightly delayed because of his prematurity."

The nurse is caring for the family of a 9-year-old child with cerebral palsy. Which intervention will best improve communication between the nurse and the family?

using reflective listening techniques

The nurse is caring for a school-aged child with a terminal diagnosis. The parents and health care provider have discussed the child's condition and agreed that resuscitation efforts will be withheld when the child experiences cardiopulmonary arrest. What notation will be made in the chart by the provider?

AND (allow natural death)

The nurse is discussing growth and development with the parents of an adolescent with a chronic illness. Which comment indicates further education is necessary?

"It is common for adolescents to be very compliant with the planned medication therapies with little parental oversight."

The parents of a a-year-old boy with cystic fibrosis restrict him from camping, sleepovers with friends, and school field trips. They time his respiratory treatments and log his diet, choosing most foods for him. They have him seen medically between scheduled appointments and call their physician frequently with concerns. The nurse considers these behaviors indicative of:

vulnerable child syndrome.

The caregivers of a child with special health care needs have been giving of themselves in almost unending ways. The nurse will assist the parents by:

helping them develop workable health-promoting activities for themselves.

The nurse is caring for a child with cerebral palsy who is preparing for hippotherapy. The nurse is aware that this is what type of therapy?

horse movements for neuromuscular reeducation

The nurse is conducting home visits for several families with children born prematurely. When screening for growth and development of the children, the nurse would use the infant's corrected age for which child?

the 24-month-old born at 28 weeks' gestation

How can the nurse best meet the developmental needs of school-age child who is frequently hospitalized with a chronic illness?

Provide fun, competitive games and/or contests with the child's peers on the pediatric unit.

The nurse is caring for a family of premature infant boy. The parents asks the nurse, "Why do we need to bring in the car seat we bought for him? He isn't going home for another week." What is the best response by the nurse?

"The baby will be tested for oxygen desaturation while seated in the car seat"

Which findings would alert the nurse to the risk for vulnerable child syndrome developing during a family assessment?

The parent reports a near drowning when the child was 18 months old

The nurse is speaking with the parent of a premature infant who is 6 months old. The parent asks the nurse when to begin feeding the infant solid food. The infant was born at 28 weeks. What is the best response by the nurse?

"You can start feeding solid food to your infant when the infant turns 9 months old."

The nurse is helping with the health assessment of a school-age child with special health care needs for attendance at summer camp. The parent tears up, saying that they wish their child would not attend. What is the best response by the nurse?

"It is not unusual for you to have strong feelings about this."

An infant has been newly diagnosed with chronic condition requiring high-tech treatments and equipment. The parents ask the nurse, "Where is the optimal place for our infant to be cared for?" Which response by the nurse is appropriate?

in your home

A 6-month-old infant, who was born 8 weeks premature, is seen in the clinic for a well-child visit. Which statement by the parent is evidence further education is needed?

"My infant should begin solids now, because my infant is 6 months old."

The nurse is caring for a family with a chronically ill adolescent. The parents are frustrated that the adolescent will not complete the treatment plan during the school day. Which approach by the nurse will be most appropriate?

Explaining to the parents that the adolescent may be struggling to fit in with his peers.

A 14-year-old client has died from drowning. The client's parents have decided to donate the child's organs and ask the nurse, "What will our child look like after organs are taken out?" What is the best way for the nurse to respond?

Explain that there will be no visible signs of organ donation.