Nursing Care of Children with Special Health Care Needs

A 10-year-old patient with scoliosis comes to the clinic and asks the nurse a question about an uncomfortable medical procedure. Which is the nurse's most appropriate response? "The procedure isn't too bad; you'll be fine." "The procedure may be uncomfortable, but we all feel things differently." "The procedure is somewhat uncomfortable, but you have nothing to worry about." "The procedure can be uncomfortable; let's talk about things you can do to help you through it."

"The procedure can be uncomfortable; let's talk about things you can do to help you through it." An honest answer allows the patient to trust the nurse and staff and therefore would be the most appropriate response for the nurse to make. Additionally, it is important to involve the patient as much as possible.

Parents of a child with type 1 diabetes tell the nurse, "Our child will never have the life we dreamed for him." Which response by the nurse is appropriate? "Your child will be able to live whatever life they choose." "You must remain positive or your child will become discouraged." "You are grieving the loss of your 'perfect' child. Tell me more about how you feel." "There have been great advances in treating type 1 diabetes. Let me share them with you."

"There have been great advances in treating type 1 diabetes. Let me share them with you." Education decreases fears and misconceptions and encourages appropriate interactions between family members, the child, and health care providers. This is an appropriate response by the nurse.

A nurse is caring for a child with a chronic illness who was recently hospitalized due to complications of the illness. After leaving the patient's room, the nurse notices a sibling standing outside the room looking very angry. The sibling says, "Today is my birthday and nobody even cares." Which response from the nurse is best? "You sound upset. Tell me more about how you are feeling." "Happy Birthday! Let's find you something to celebrate with." "Your parents care about you; let's try to be positive in this situation." "Let's go see your brother since he is sick, and then we can celebrate your birthday."

"You sound upset. Tell me more about how you are feeling." This statement acknowledges the feelings of the sibling and allows the opportunity for discussion of those feelings.

The healthy sister of a 9-year-old male with cystic fibrosis approaches the nurse and states, "I feel so guilty my brother is sick and I'm not." Which response by the nurse is appropriate? "Could you tell me a little more about how you are feeling?" "Feeling guilty is normal for someone your age, it will go away." "I know you feel bad, but you should be thankful that you aren't sick." "It's okay to feel guilty, you are able to do things your brother can't."

"Could you tell me a little more about how you are feeling?" This response provides the sibling with the ability to express feelings to the nurse and work through the guilt being experienced. This will assist the sibling in resolving the feelings and not carrying them forward into the adult years.

The mother of a 4-year-old child with a heart defect is feeling overwhelmed with explaining an upcoming surgery to the child. What should the nurse do to help the parent's communication in this circumstance? Encourage the parent to show the child a picture of the heart Describe the operation in appropriate terms using dolls and a model of the heart Provide a pamphlet to the parents on congenital heart defects to review with the child Advise the parent to read a book about being in the hospital to the child and answer any questions

Describe the operation in appropriate terms using dolls and a model of the heart Describing the operation using age-appropriate terms and props provides the information necessary for the child to understand what is going to happen.

A nurse is discussing disease management options with a family who is coping with chronic illness. The nurse notices a sibling who is withdrawn. What should the nurse do to help the sibling feel more involved? Select all that apply. Engage with and ask if the sibling has any questions. Enquire about how much time the sibling spends with the parents. Ask whether the sibling would like to help change the child's bandage. Encourage the sibling to discuss any negative feelings with the child who is ill. Express interest and ask about the extracurricular activities the sibling is involved in.

Engage with and ask if the sibling has any questions. Engaging with the sibling by asking if there are any questions demonstrates an interest in the sibling and helps to develop a good rapport and helps the sibling to feel more involved. Correct Enquire about how much time the sibling spends with the parents. Assessing how much time the sibling spends with the parents provides information as to whether the sibling's needs are being met. Correct Ask whether the sibling would like to help change the child's bandage. By asking the sibling to assist with providing treatment to the ill child, the sibling can become more involved. Express interest and ask about the extracurricular activities the sibling is involved in. Asking about sibling activities demonstrates an interest and gives the sibling a chance to talk about personal accomplishments.

An 8-year-old patient is having problems adjusting to daily radiation treatments. Which is the most appropriate action for the nurse to take to help with the adjustment? Collaborate with the oncology radiologist. Encourage the parents to comfort the child. Have a discussion with the child life specialist. Educate the child on the importance of the treatments.

Have a discussion with the child life specialist. Use of the child life specialist uses methods that are age-appropriate, educational, supportive, and therapeutic and may include medical play and art and therapeutic play and art. Therefore, this would be the most appropriate action.

The nurse senses sadness in a parent with a child who has terminal cancer. Which action is the most appropriate for the nurse take in this situation? Place a referral to the hospital's chaplain. Allow the parent to talk and express emotions. Place a referral to a psychotherapist for grief counseling. Provide the parent with a list of support groups in the area.

Allow the parent to talk and express emotions. Allowing the parent to talk and express emotions provides the opportunity for the parent to grieve and express grief in a comfortable manner, and therefore this is the most appropriate action for the nurse to take.

A child with sickle cell disease expresses a desire to spend more time with a sibling who has not been seen because the family lives far away from the hospital. Which actions by the nurse should be most appropriate? Ask the health provider for a day pass so the ill child can visit the sibling. Ask the parents for a picture of the sibling to keep at the ill child's bedside. Ask the parents to bring the sibling to visit in the next few days when possible. Provide the child with books and movies to distract the ill child from thinking about the sibling.

Ask the parents to bring the sibling to visit in the next few days when possible. It is important to attempt to maintain the sibling relationships. Bringing the sibling to visit allows them to reconnect and maintain their sibling relationship.

A 16-year-old patient with cerebral palsy is having a birthday party and receiving a lot of attention from family and the home health care staff. A younger sibling is at the birthday party but looking unhappy. Which actions by the home health nurse are appropriate in this situation? Select all that apply. Ask the sibling about a special personal birthday event. Talk with the parents about reading a book to the sibling every night. Talk with the parents about taking the sibling to a movie later that day. Encourage the sibling to help cut the birthday cake and scoop ice cream. Encourage the sibling to avoid being negative and to be a positive support for the sibling.

Ask the sibling about a special personal birthday event. This action provides sibling-centered interactions that foster communication and sense of importance in the sibling because it acknowledges important events valued by the sibling. Correct Talk with the parents about reading a book to the sibling every night. Reading a book together daily provides a consistent time for interaction with the parents. This fosters positive relationships between the parents and the sibling. Correct Talk with the parents about taking the sibling to a movie later that day. Encouraging the parents to spend some time every day with the sibling is essential for the family to maintain positive relationships. Correct Encourage the sibling to help cut the birthday cake and scoop ice cream. Becoming involved with activities allows the sibling to interact with the parents and ill child. It is a source of attention for the sibling.

A patient is learning to cope with a newly diagnosed chronic illness. To help the patient adjust, which actions should the nurse take? Select all that apply. Initiate a standardized plan of care for the child Help the child with incorporating the illness into each stage of life Provide nursing interventions during acute exacerbations of the illness Provide support as the child accepts the illness as a part of each stage of life Educate the child in a way that there is an understanding that illness will be present long-term

Help the child with incorporating the illness into each stage of life Helping the child incorporate the illness appropriately into each stage of growth and development will be a necessary part of nursing care. Provide support as the child accepts the illness as a part of each stage of life Assisting the child and family to accept the illness appropriately into each stage of growth and development, regardless of the child's age at diagnosis, is important for the nurse to address. Educate the child in a way that there is an understanding that illness will be present long-term Nursing care includes assisting the child and family to accept, understand, and incorporate the illness appropriately into each stage of growth and development, regardless of the child's age at diagnosis.

In evaluating a child with a chronic illness, which additional actions by the nurse assist in identifying the child's expected developmental process? Select all that apply. Observe for the presence of developmental delays. Observe for age-appropriate responses by the ill child. Observe errors in the child's perception of the chronic illness. Monitor for miscommunication between family members regarding the child's illness. Evaluate the influence of the family's cultural beliefs on the child's cognitive milestone.

Observe for the presence of developmental delays. Evaluating for developmental delays provides information regarding the child's progress in growth and development. Correct Observe for age-appropriate responses by the ill child. Observing for age-appropriate responses by the child provides information regarding the child's progression in growth and development. Correct Observe errors in the child's perception of the chronic illness. Observing for errors in the child's perception of the illness identifies can be helpful for understand the child's progress in emotional growth and development. Correct Monitor for miscommunication between family members regarding the child's illness. Caring for the child will include knowing how well the family understands the illness. Any miscommunication or misunderstanding about the illness could have an impact on the child's growth and development.

Parents of a 3-year-old patient are expressing fear over treatments used for their child's illness. What action by the nurse should be most effective for reducing fear in the parents? Provide information on support groups related to the illness Initiate a referral to a psychotherapist for grief counseling services Assess the parent's spiritual beliefs and practices related to the illness Provide information related to the illness and current treatment modalities

Provide information related to the illness and current treatment modalities Education about the child's condition and treatment often reduces fear.

Parents of a child with asthma are feeling overwhelmed and worried about how to access care to meet their child's health care needs. What should the nurse do to help the parents in this situation? Select all that apply. Provide the parent with the clinic hours of operation. Provide the parent with information about after-hour clinic provider coverage. Gently remind the parents that excessive worry can have a negative effect on the child. Utilize nursing resources to provide information on asthma and when to seek medical attention. Provide the parent with the address and telephone number of the closest emergency department.

Provide the parent with the clinic hours of operation. Providing the parents with clinic hours of operation will decrease problems accessing the health care system and should decrease frustration. undefined Provide the parent with information about after-hour clinic provider coverage. Providing the parents with after-hour clinic and provider coverage decreases problems accessing the health care system and should decrease frustration. Utilize nursing resources to provide information on asthma and when to seek medical attention. Utilizing nursing resources to provide information on asthma for the parents may decrease their frustration as they will know when medical care is necessary. undefined Provide the parent with the address and telephone number of the closest emergency department. Providing information regarding emergency access to health care services assists in eliminating a barrier to health care services.

A 14-year-old patient with cancer asks the nurse about dying. The nurse knows that the parents don't want that information shared with the child. What should the nurse do? Pursue an ethics consult. Discuss the situation with the parents. Discuss the situation with the nurse manager. Be honest with the child and answer the question.

Pursue an ethics consult. When faced with conflict regarding upholding the desires of the parent and being honest with the patient, the nurse should consider consulting the ethics committee for assistance in developing an agreeable solution.

A parent confides in the nurse and states, "I believe it's my fault that my child is sick." The parent is crying and also admits to not sleeping well at night. Which actions by the nurse are most appropriate? Select all that apply. Discuss the concept of "survivor guilt" with the parent. Educate the parent on over-the-counter sleep medicine. Recommend a referral to a psychologist specializing in grief therapy. Talk with the child's health care provider regarding the parent's statements. Provide the parent with the date and time of the next grief support meeting in the area.

Recommend a referral to a psychologist specializing in grief therapy. A referral to a psychologist is appropriate based on the statements of the parent, the crying, and lack of sleep expressed by the parent. undefined Talk with the child's health care provider regarding the parent's statements. Talking with the health care provider will alert the provider to check on the parent's coping with the child's illness and provides the opportunity for addressing the parent's concerns through a variety of treatment modalities. undefined Provide the parent with the date and time of the next grief support meeting in the area. Grief support groups provide a way for the parent to express grief. Expressing emotions is beneficial for most individuals.

Parents of a two-year-old child with type 1 diabetes are concerned about their child's diabetes and its impact over time. How should the nurse respond to their concerns? Select all that apply. Teach and help the parents adjust and cope with the child having type 1 diabetes. Formulate a plan of care based on the manifestations and pathophysiology of type 1 diabetes. Inform the parents how treatment for type 1 diabetes will be incorporated into their daily lives. Inform the parents that care needs and approaches will likely change as the child grows and develops. Help prepare the parents to care for the child by letting them know what future school accommodations to expect with type 1 diabetes.

Teach and help the parents adjust and cope with the child having type 1 diabetes. Teaching the parents provides information that will help them adjust and cope with the child's chronic illness. This creates the necessary psychosocial environment that will positively influence the child's growth and development. Inform the parents how treatment for type 1 diabetes will be incorporated into their daily lives. Informing the parents of the treatment regime for type I diabetes and how it fits into their lives allows for normalization of the family unit and maximized function throughout the illness. undefined Inform the parents that care needs and approaches will likely change as the child grows and develops. Because type 1 diabetes is a chronic illness and will be present for the rest of the child's life, care must incorporate changes in the child's growth and development. undefined Help prepare the parents to care for the child by letting them know what future school accommodations to expect with type 1 diabetes. Informing the parents regarding what to expect when the child enters school with type 1 diabetes allows them to develop a plan of care and aids in achieving and maintaining the highest level of health and social functioning for the child.