PrepUs for Pediatrics Chapter 32

A 5-year-old girl with sickle-cell disease has had a temper tantrum in the office waiting room, and the mother has dealt with it inadequately. How should the nurse address the parent's apparent lack of discipline when the pair is in the examination room?

"How did feel about your daughter's behavior in the waiting room?" It is common for parents of children with a chronic condition to spoil their children. The nurse should use an open-ended question to elicit the mother's feelings about the girl's behavior in order to open a dialogue about appropriate discipline. Commenting on the tantrum is not helpful. Asking a yes or no question is less likely to elicit the necessary information.

The nurse is conducting a health assessment of a 6-year-old girl with spinal bifida. During the interview, the girl keeps interrupting and shouting to get her mother's attention. The mother instantly responds to every interruption and attempts to placate her with promises of a trip to the ice cream store. Which response by the nurse would be most appropriate to address the mother's response to her daughter's demands?

"How do you feel when your daughter interrupts you?" It is common for parents of children with a chronic condition to spoil their children and allow them to have anything that they wish. The nurse should try to elicit the mother's feelings about the girl's behavior in order to open a dialogue about appropriate discipline. The open-ended question is the best way to gather information and evaluate the mother's feelings. Simply commenting about her behavior is not helpful. Asking a yes or no question is less likely to elicit the necessary information

The nurse assesses the family of a child with a chronic condition. Which statements by the sibling of a child with a chronic condition demonstrate negative behaviors and responses? Select all that apply.

"I do not want to be seen with my sister, so I want to stay home." "I have to always wait until my sister finishes in the bathroom." "I am mad at my sister for being sick all the time." Both positive and negative behaviors and responses can be found in behaviors of well siblings of children with a chronic condition. Negative behaviors and responses include statements mixed with anger, hostility, jealousy, or increased competition of attention. They can be expressed as viewing the sibling as getting special treatment (e.g, making the sibling wait for activities), not wanting to be seen in public with their sibling, and being frustrated with the duration of the condition. Positive responses include caring responses, protecting the sibling from reactions of others, and including the sibling in activities.

The nurse is caring for a school-aged client with a chronic pediatric endocrine condition. Which client statement provides the best teaching opportunity?

"I have this problem because I am being punished for being bad." When identifying a teaching opportunity, look for the area where there is a needed to clarify statements. It is most important for the client to understand that the condition is not a punishment. Children have thoughts that their actions result in illness. The other options may be correct statements so they do not afford the teaching opportunities.

Which statement made by the mother of an infant who is born with severe intellectual disability indicates an appropriate understanding of her infant's long-term needs?

"I understand my child will grow up but needs to develop as much independence as possible." Children who are physically challenged or intellectually disabled need to have independence so they can grow to achieve as much as is possible.

The nurse has cared for a family of two girls, ages 15 and 13, for many years. The older sister has short stature with associated incontinence and respiratory complications. The younger sister has recently begun her freshman year at the same high school and has a very active social life. The 15-year-old girl confides that she has no friends and that she fears she will never have a boyfriend. She whispers that she is afraid she will never get to experience sex because of her problems with incontinence. Which response by the nurse would be most effective?

"Let's talk about whether your condition may affect your sexual relationships." The nurse should address the specifics of her case to clear up any misinformation and lack of knowledge. Telling her she is a wonderful girl or assuring her that she will find a partner is not helpful and does not address her concerns. Asking her how long she has been concerned about this issue is not helpful and does not elicit necessary information.

The nurse is talking to a 12 year old sibling of a child with a chronic condition in the waiting room at the pediatrician's office. The sibling states, "I hate coming here and waiting. It is such a long car ride. I just want to get home." Which nursing response is best?

"That must be hard for you." Stating "That must be hard for you" accepts the sibling's feelings and potentially elicits more information. It is a method of therapeutic communication. Stating that the nurse understands how the sibling feels or saying that's too bad closes communication. It is nice to attempt to raise the child's spirits but it changes the topic of the way the sibling is feeling.

A 15-year-old girl has had type I diabetes since she was 2 years old. She recently began dialysis and is also struggling with exhaustion. She has been hospitalized with an infection and confides to the nurse that she feels hopelessness due to her failing health. Which response by the nurse would be most effective?

"What do you think would help you feel better or improve your situation?" It is important to ask the child how she views her situation and what might improve it. Using open-ended questions elicits the girls' thoughts and fears and helps the nurse assess the issues at hand. It can also help the nurse determine whether the girl's hopelessness characterizes depression. Questions that can be answered with "yes" or "no" are less effective. Assuring her that she'll feel better soon does not address her concerns.

A nurse is working with an older child who has a chronic condition. When assessing the impact of the condition on the child, which question would the nurse most likely ask first?

"What does your condition mean to you?" The first task when working with older children and adolescents with chronic conditions is to find out what the condition means to them. What is their concept of the chronic condition and how do they think it affects their life? From there the nurse would gather additional specific information related to the child, the condition, ability to function and issues.

The nurse is reviewing the medical record of a child with a chronic condition. When reviewing nursing documentation, the nurse expects the parent statements to be in which order? Use all options.

"Why my child? How did this happen?" "I should have gotten more rest when I was pregnant." "I am so afraid that I will not be able to care for my child." "I will do whatever I can to get the best care." "Why my child? How did this happen?" This is usually the first reaction to the news of a chronic condition. The parent is in denial. Next is "I should have gotten more rest when I was pregnant." This is an example of guilt. The nurse should use active listening techniques and clarify any misconceptions. Next is the expression of fear with statements such as, "I am so afraid that I will not be able to care for my child." Lastly, the parent expresses acceptance with a statement of, "I will do whatever I can to get the best care."

The nurse has been caring for an 8-year-old girl with asthma. Her parents are compliant with her treatment regimen, and the girl has experienced no exacerbation of her symptoms in over 12 months. When the nurse inquires about her participation in sports or other extracurricular activities, the girl says that she can't participate because she is sick with asthma. Which response by the nurse would be most appropriate?

"Your activity is not limited; what types of things would you like to do?" The primary goal for the child's plan of care is to normalize the child's life as much as possible and promote the optimal health of the child. The nurse should remind the girl that her activity is not limited by her asthma and then elicit the types of activities the girl might enjoy. This will allow the nurse to address the specific considerations with each activity in relation to the girl's asthma. Telling her she is not sick, asking if she knew her condition doesn't limit exercise, and stating that many Olympic swimmers have asthma would be less likely to engage the girl in a dialogue about what she would like to do.

A nurse is interacting in conversation with the parents of an 8-year-old child with intellectual disability who wants to join a scout club at school. The parents explain that they are uncertain if this would be a good experience for their child. Which would be the best response by the nurse?

"Your child has the same socialization needs as other children who don't have an intellectual disability." Children with a diagnosis of intellectual disability or chronic illness have the same need for socialization as other children. Encouragement should be given to participation in activities with children of the same developmental age group. Children with intellectual disability should not be restricted to interactions with kids with a similar disability because it could limit their socialization.

The nurse has been caring for a 15-year-old boy who requires extensive home care. The mother is the primary caregiver and states, "I'm just drained, physically and emotionally. My husband tries to help but he has to work long hours to pay the bills." Which of the following would be most helpful to do first to provide the mother some relief?

Urge the mother to discuss her feelings and identify causative factors. The nurse should first encourage the mother to discuss her feelings and identify the specific stresses or changes that are exceeding her resources. Talking about her feelings can help decrease frustrations and help the nurse determine the appropriate course of action to decrease stress. Identifying past coping mechanisms and referral to respite care would be appropriate after the specific stresses are identified. Determining other family members who may be able to help may not address the specific needs and concerns.

The nurse at a specialty clinic has developed a therapeutic relationship with the family of a child with a chronic condition. Which family suggestion would the nurse reinforce as helpful to maintaining the family structure?

Use family to assist with care and spend time together as a couple. There are many struggles and joys when caring for a child with a chronic condition. There can be a toll on a marriage, making it important that the parents spend time together as a couple. Having the parents work separate shifts or having one babysitter is not helpful in maintaining the family structure. Hiring household help is not realistic for most families.

When would be the best time for the nurse to begin planning for home care for the child with a chronic illness?

When the child is admitted to the health care facility. Home care planning begins when the child is admitted to the health care facility and continues until discharge.

The nurse is coordinating a camp for children with chronic conditions. The goals of the camp include providing a support group for the children and respite time for the caregivers. Which activity is encouraged for the caregivers?

A caregiver-selected activity or rest Respite care is care of the child with chronic conditions provided by others, affording everyday caregivers a period of rest and refreshment. Having the caregiver select an enjoyable activity or allowing for additional sleep or rest is beneficial to the caregiver. This time should not be focused on the chronic condition or parent-child interactions. While it is helpful to have time to complete home maintenance projects, this time should be focused on something enjoyable for the caregiver.

What does the nurse understand as constituting a chronic illness?

A chronic illness progresses slowly, shows little change, and interferes with daily functioning. Chronic illness is of long duration or progresses slowly, shows little change, and often interferes with daily functioning. Chronic illness during childhood may affect a child's physical, psychosocial, and cognitive development.

To help the school-age child achieve his or her self-care goals, what intervention could the nurse use?

A contract School-age children often respond well to contracts. For instance, a special privilege or other incentive is awarded when the child earns a set number of stickers.

The nurse is completing a psychosocial assessment on a child with a chronic condition. The child states that he is sad because his brother does not say "Hi" in school or offer to walk home together. As the nurse is developing a teaching plan for the family, which will be included?

A family discussion on stigma Siblings may feel that having a brother or sister with a chronic condition is a stigma or embarrassment. Siblings may choose to not tell others about their brother/sister with a chronic condition, or may not want to interact with others in public. Having a family discussion can bring to light feelings that can then be addressed. The sibling is not showing behaviors of sibling rivalry or discrimination. It is difficult to role play as this situation takes place in public.

A group of students are studying for an examination on chronic conditions. The students demonstrate a need for additional study when they identify which of the following as an example of a chronic condition?

Cancer Cancer is an example of an acute illness. Cerebral palsy, asthma, and sickle-cell disease are examples of chronic conditions. These conditions are not illnesses from which the person can recover.

What major goals can the nurse assist the child with chronic illness in accomplishing? Select all that apply.

Decrease anxiety Perform self-care tasks Experience social interaction Accomplish growth and development milestones Major goals for the chronically ill child are to achieve growth and development milestones, perform self-care tasks, decrease anxiety, and experience more social interaction.

A 12-year-old with juvenile rheumatoid arthritis has pain and swelling of the hands. During a visit with the occupational therapist, the parent states, "I want her to become involved with volleyball at school. She won't participate in any sports like her sister." What caregiver response is the parent exhibiting?

Denial Caregivers in denial behave as though the condition does not exist, and they encourage the child to overcompensate for any disabilities.

The nurse is planning care for the child with a chronic condition. To establish a realistic goal related to increasing child socialization, which information is most helpful?

Determining what opportunities are available To establish a realistic goal, it is most helpful to determine what opportunities are available for socialization. Goals must be able to be accomplished. Determining if relatives live in the area, family interests with friends, and the level of interest in educational programs can provide activities for consideration and opportunities that are available.

The nurse is working with a 15-year-old hospitalized with a chronic illness. Which action by the nurse might help the chronically ill teen thrive while hospitalized?

Encourage the teen to talk to friends on the phone and connect with friends on the computer by email The chronically ill child of any age should be encouraged to participate in age-appropriate activities. Contact with peers and friends are an important aspect of normal adolescent growth and development.

The nurse is caring for a 12-year-old girl with a chronic endocrine condition that has resulted in weight gain, facial hair, and acne. During a routine examination, the girl confides that she doesn't participate in any extracurricular activities or have any social life because she is so unattractive. She feels it is pointless to get involved with anything or anyone because she is always going to be "fat and ugly." When responding to the girl, which of the following would be the priority?

Exploring the girl's perception of her body image and health status Obtaining information about how the child perceives herself provides a baseline from which to develop a teaching plan to address the child's inaccurate beliefs and then develop strategies to highlight good feelings. Assisting the girl with methods to enhance physical appearance is helpful after the nurse addresses the child's perceptions. Referral to a counselor might be appropriate after exploring the child's feelings.

When the caregiver of a child with a chronic illness helps the child set realistic goals for self-care and independence, the caregiver is responding with which of the following?

Gradual acceptance Caregivers who respond with gradual acceptance take a common-sense approach to the child's condition; they help the child to set realistic goals for self-care and independence and encourage the child to achieve social and physical skills within his or her capability.

When caring for an adolescent with a disability, it is best for the nurse to promote which of the following?

Have the child socialize with peers with and without disabilities. An older child benefits from social interaction with peers with and without disabilities. Adolescents should be encouraged to join in age-appropriate activities. To improve their appearance, it may be necessary to help them with dressing or using makeup.

A nurse is speaking to a group of parents who have children with chronic illnesses. One thing the nurse should include in the talk is how chronic illness affects siblings. What should the nurse tell the group?

How well siblings react to the ill child depends on how the family copes and how they feel about one another There is always some degree of sibling rivalry. Chronic illness in one member can disrupt the entire family, leading to anger, resentment, and jealousy in healthy siblings. Some family caregivers unknowingly create feelings of guilt in healthy children by overemphasizing the ill child's needs. How well siblings react to a chronically ill sibling may depend on how the family copes and how its members feel about one another.

What goals can the nurse help the parents of a child with cerebral palsy achieve? Select all that apply.

Increase their social interaction. Decrease feelings of grief, anger, and guilt. Increase adjustment to living with a chronically ill child. Goals for the caregiver or family are to increase their social interaction; decrease their feelings of grief, anger, and guilt; increase their adjustment to living with a chronically ill child, and teach them about caring for the chronically ill or disabled child.

A nurse is caring for a 3-year-old child with a chronic disease. Which of the following actions by the nurse will encourage therapeutic communication with the child's caregivers?

Listening to the family express positive and negative feelings during the journey of the illness In family-centered care, the nurse should build a trusting relationship by using positive communication skills. Listening and acknowledging family's feeling regarding caring for a chronic child shows support. The reduction of health costs and provision of resources is helpful, but listening builds trust.

A nurse understands that it is important to help a family adjust to a child's chronic health condition. This is best done by doing which of the following?

Making adjustments in care by doing ongoing interviews It is important to help the family adjust to the chronically ill child's condition. This is done best by doing an initial assessment and ongoing interviews. The nurse should never tell a family how to cope but instead give them suggestions about ways to cope. The nurse should encourage the caregivers to discuss needs of the well siblings as well as the sick child. He or she should never tell a family that it will get better over time; doing so is inappropriate and can give false hope.

Which part of the nursing process is most altered when caring for a child with a chronic illness?

Nursing interventions/planning care Nursing interventions are most altered when caring for a client with a chronic condition as the interventions must be individualized to meet the unique needs of the client. The data collection process of vital signs and assessment remains consistent. The nurse reviews the testing and refers abnormal results to the health care provider. Nursing diagnoses are NANDA-based and follow a consistent pattern.

When the nurse is caring for a child with a chronic condition, which is most important when planning care?

Realistic child goals All parts of planning nursing care are important; however, developing realistic client goals are most important. Without realistic goals, the interventions planned with scientific rationale will not be successful. Priority NANDA diagnoses can be developed with unrealistic goals but the plan of care will not be successful.

A single parent of a child with leukemia tells the nurse that exhaustion has set in and she would love the opportunity to have a day to just visit with a friend and relax. For what type of care could the nurse make a referral?

Respite care Respite care is care of the ill child so that caregivers can have a period of rest and refreshment. It is often desperately needed but not readily available in many communities.

The nurse is caring for a 3-year-old with an exacerbation of a chronic condition that was diagnosed at birth. The nurse assesses that the caregiver is a single parent and she appears frustrated and angry with the nursing staff. She states that she has other children at home that she had to get the neighbor to watch. What is an appropriate nursing diagnosis to include in the plan of care for this patient?

Risk for caregiver role strain related to no other caregivers Families that have a child with a chronic condition meet many obstacles in the adjustment of the child's illness. The disruption within the family can cause stress on the caregiver and the family relationships, and may impact the siblings based on the degree of interruption of family life. This may be exhibited in the emotions expressed by the caregiver. In this scenario, the caregiver is a single parent and she states that she had to seek help from a neighbor; therefore, she has a risk for caregiver role strain. The other nursing diagnosis are not appropriate for this family at this time because there is not enough information to support them.

The nurse is caring for a family who has twins and one twin has a chronic condition. The parent states that both children require discipline but are unsure which approach is best. Which nursing suggestion is most helpful?

Set appropriate limits for both and hold them to those limits. When instructing on discipline, it is understood that the two children may have different functional abilities but a common factor is that appropriate limits/boundaries need to be set with both children. These boundaries establish a comfort zone and, if crossed, allow the parent to initiate discipline. All children require boundaries to be established. This information is most helpful to the parents. The parent realizes that the children are unique and flexibility in parenting is sometimes needed. Assigning chores does not refer to discipline.

Which educational topic is often overlooked when teaching an adolescent about living with a chronic condition?

Sexuality All aspects of an adolescent's development must be addressed when instructing on living with a chronic condition. Health care providers are comfortable with topics of smoking, drinking alcohol, and drugs but uncomfortable with talking about sex.

Which initial response does the nurse anticipate receiving from parents of a client who is newly diagnosed with a chronic condition?

Shock at the news of the condition Initial response to the news that the child has a chronic condition is typically shock, disbelief and denial. It is common to wish that this is not happening and possibly want a second opinion. Refusal to follow the medical treatment is not an initial response.

The school nurse is observing a middle school child with a chronic condition participating in a group activity in school. As the child is moving his/her wheelchair to find a partner, which situation would the nurse note as encouraging social exclusion? Select all that apply.

Small spaces where a wheelchair cannot fit Allowing students to partner without including the client An activity which is difficult for the client to do Social exclusion is when the client is unable to be included due to the chronic condition or being excluded by the other participants. If the client cannot fit into a space, that excludes the client from the activity. If the chronic condition makes it difficult to participate in an activity, the child may not want to participate or be excluded by peers. Allowing students to partner while not including the child encourages social isolation.

Who does the nurse identify as the primary advocate for the child with a chronic condition?

The caregivers The caregivers are the primary advocates. The caregivers know the client best and can advocate for as much normalcy in the client's life. The other individuals know a portion of the client's life but not the complete person.

The parents of a child who has just been diagnosed with a chronic illness state that they are "shocked" and "dismayed" at the diagnosis. They make the following statement to the nurse: "We have an appointment with another specialist closer to our home to have our child seen by that provider." Which of the following would most likely be a reason the caregivers might make a statement like this?

The caregivers are hoping to find the diagnosis is incorrect. The caregivers may seek advice from other professionals and actually may go "shopping" for another health-care provider, hoping to find the diagnosis is incorrect or not as serious as they have been told.

The nurse is helping develop a plan of care for a 10-year-old child with a chronic illness. Which goal would be the priority for this child?

The child will achieve the highest level of growth and development. Major goals for the chronically ill child are to accomplish growth and development milestones, perform self-care tasks, decrease anxiety, and experience more social interaction. The highest priority goal is to accomplish the highest level possible in growth and development milestones. An absence of stress of unrealistic.

When a child is in the physician's office for a blood draw, the nurse notices that it has been several months since the child's last visit. The child is to have monthly labs for a chronic illness. What would be a rationale for this?

The parents are having a difficult time grieving with the idea of the child's illness. The parents of a child with a long-term illness may not adhere to instructions or keep health visits consistently. They still may be in the beginning grieving stages and have not accepted their child's illness yet. Each appointment is a reminder of the child's continued illness.

The specialty clinic nurse is caring for an 8-year-old with a chronic respiratory condition. When collaborating with other professionals that interact with the child, which professional is most important?

The school nurse

When documenting a chronic condition, which groups of illness would be considered? Select all that apply.

Accidents resulting in spinal injury Congenital anomalies Degenerative disorders Chronic conditions are a leading health problem in the United States. Chronic conditions include degenerative disorders, individuals who survive accidents leaving spinal cord injuries, and those with congenital anomalies. Viral infections and communicable diseases typically do not create chronic conditions.

When caring for a child with a chronic illness, a high priority goal that the nurse should establish for the patient is which of the following?

Accomplish growth and development milestones. Major goals for the chronically ill child are to accomplish growth and development milestones, perform self-care tasks, decrease anxiety, and experience more social interaction. Goals for the caregiver are to increase social interaction; decrease feelings of grief, anger, and guilt; and increase their adjustment to living with a child with a chronic illness. The nurse would never prevent feelings of grief or anxiety, because these are normal processes. Rather, the nurse would help the patient and family deal with these feelings. Overprotection is not a goal but a result of the grief process.

The mother of a child just diagnosed with a chronic condition tells the nurse, "I knew something was wrong, but nobody believed me." The nurse interprets the mother's statement as which of the following?

Anger "The mother's statement reflects anger. Grief would be evidenced by statements such as "why did this happen?" or "why our family?" Denial would be evidenced by statements such as "everything will be okay, there's nothing really wrong." Guilt would be evidenced by statements such as "I should have picked on the symptoms" or "I should have asked for a second opinion."

Which parental action identified by the nurse potentially delays the ability of the child with a chronic condition to exhibit signs of appropriate growth and development?

Being overprotective The family caregivers may become overprotective and prevent the child from exhibiting growth and development appropriate for age and disability. It is the role of the nurse to help the family recognize the child's potential and set realistic growth and development goals. Group activities are encouraged for engaging in social interaction. Exercising with the child is good for both child and parent and promotes physical development. Maintaining a calorie-based diet is useful in healthy weight gain.

A 12-year-old sibling of a child with Down syndrome is overheard telling a friend from school on the telephone, "I don't have any brothers or sisters. I am an only child." What does this child feel about the sibling with Down syndrome?

By having a sibling with Down syndrome, a stigma is attached to him or her. Siblings may feel that having a brother or sister with a chronic illness is a stigma, a mark of embarrassment or shame, especially if the ill child has a physical disfigurement or apparent cognitive deficit. Siblings may choose not to tell others about the ill child or may be selective in whom they tell, choosing to tell only those they can trust.

Parents of a chronically ill child can expect siblings to react in which of the following ways? Select all that apply.

anger jealousy hostility protecting the ill child from negative reactions of others helping to care for ill child Both positive and negative influences can be found in the behaviors of well siblings. Some siblings react with anger, hostility, jealousy, social withdrawal, or poor school performance. On the other hand, many siblings demonstrate positive behaviors such as caring and concern for the ill sibling, cooperating with family caregivers in helping care for the child, and protecting the ill child from negative reactions of others.

A woman has just been told that her 5-year-old has leukemia. She says, "How can this be?" The mother is exhibiting signs of which of the following?

denial When anyone suffers a loss, a grief reaction occurs. This is true when a parent learns of a diagnosis of a chronic illness. Denial is usually the first reaction to the diagnosis and is exemplified when a parent states, "How could this be?" or "Why my child?"

When caring for the child with a chronic condition, the nurse provides education to the parents

on an ongoing basis. Teaching parents about their child's chronic condition is not something that is done only once; rather, parent and family teaching should be an ongoing process. This education enhances the parents' ability to manage the child's chronic condition. Doing so is often easier for the parents when they feel knowledgeable about the condition, competent in the skills needed to care for the condition, aware of what symptoms indicate problems and which do not, and supported by the healthcare community should they have a problem.

When planning for the care of the hospitalized child with a long-term illness, the best pattern to use for staffing of nurses would be:

primary or case-management nursing. So that children do not have to keep adjusting to caregivers, the best health care pattern is for caregivers to be consistent.

A nurse observes the mother of a child newly diagnosed with leukemia yelling at the patient for taking too long to brush his teeth, eat his breakfast, and even color a page in his new book. The nurse realizes that this is an example of which of the following?

rejection Caregivers in rejection distance themselves emotionally from the child. Although they provide physical care, they tend to scold and correct the child continuously.

The nurse is working with a child who has a chronic illness. The nurse observes that the child's parent scolds and corrects the child continuously. The nurse should recognize the presence of:

rejection. Caregivers in rejection distance themselves emotionally from the child: although they provide physical care, they tend to scold and correct the child continuously. Discipline, character building and confusion are not evidenced by excessively frequent scolding and correcting.