N165 Pediatrics Sherpath W4

A pregnant woman asks the nurse why Down syndrome occurs. Which response by the nurse is appropriate?

“Down syndrome occurs because there is an additional chromosome present on the 21st chromosome.”

Match the clinical manifestations of trisomy 21 with its description.

• Disproportionate shortness of the head

  • Brachycephaly

• Singular transverse creases across the palm and the sole of the foot

  • Palmar crease

• Top of the pinna falls below the outer canthal line and is considered “Low set”

  • Ears

A term newborn female is brought to the newborn nursery for evaluation. The nurse suspects that the newborn has Down syndrome. Which clinical manifestations support the nurse’s suspicion?

Select all that apply.

• The newborn has a protruding tongue.

• The newborn has inner epicanthal folds.

• The newborn presents with a flat nasal bridge.

• The newborn has a single transverse crease across the palmar surface.

The nurse receives the following results of a first trimester prenatal screening: Triple maternal serum screen value—low alpha fetoprotein, low unconjugated estriol, and increased human gonadotropin levels. Which action is most important for the nurse to take?

Educate the patient about amniocentesis or chorionic villi sampling (CVS).

A 3-year-old child with Down syndrome is hospitalized with pneumonia. The child becomes agitated when the parents leave the room and often picks at his arms. He doesn’t respond to the nurse’s questions and stumbles often when walking in his room and the hallway. What does this behavior suggest to the nurse?

Select all that apply.

• The behavior suggests that the child may have sensory deficits.

• The behavior suggests that the child is trying to cope with his hospitalization.

• The behavior suggests that the child may have problems with balance and coordination.

The parents of a newborn diagnosed with fragile X syndrome ask the nurse about the cause of the syndrome. Which response by the nurse is appropriate?

“Fragile X syndrome is caused by one defective gene on the X chromosome.”

The parents of an infant suspected to have fragile X syndrome ask the nurse which testing confirms the suspicions. Which response by the nurse is appropriate?

“DNA testing is the definitive method for diagnosing fragile X syndrome.”

During pediatric care rounds, the nursing staff discusses a toddler with sragile X Syndrome who is nonverbal, unable to hold a crayon, and crawls instead of walks. Which cause and effect relationship does the nurse consider before starting a care plan for this patient?

Fragile X syndrome causes speech and motor dysfunction that affects the child’s ability to speak, write, and move.

A child with fragile X syndrome is unable to walk without stumbling, has uncoordinated limb movement, fails to respond to his name, and does not track eye and hand movement together. Which therapeutic intervention is most appropriate for the patient?

The child requires sensorimotor integration therapy to decrease the symptoms.

The parents of a child with fragile X syndrome tell the nurse that they have researched the disease online and are concerned about their child’s future. They ask the nurse how they will know what services their child will need and where to obtain the services. Which action is appropriate for the nurse to take?

Schedule a multidisciplinary team meeting with the parents.

The parents of a child with cystic fibrosis tell the nurse they are considering having more children and want to know the likelihood of having another child with cystic fibrosis. Which response by the nurse is appropriate?

“Since cystic fibrosis is an autosomal recessive trait, your child has a 1 in 4 chance of having cystic fibrosis.”

The nurse is caring for a patient with cystic fibrosis (CF) and observes a distended abdomen, fever, and weight loss. The parents ask the nurse what is wrong with their infant. Which statement does the nurse use to address the question?

“Your baby’s body may make mucus that is too thick so the intestines become blocked.”

The nurse is assessing a patient with cystic fibrosis (CF). To determine if enzyme replacements are adequate, which assessment detail should the nurse look for?

Select all that apply.

• Dietary intake

• Regularity of stool

• Constancy of stool

The nurse auscultates the lungs of a child with cystic fibrosis and notes coarse crackles and rhonchi. The patient also has a productive cough with thick yellow mucus. Which considerations does the nurse undertake in planning before implementing care for the child?

Select all that apply.

• The child’s pulse oximetry needs to be measured frequently.

• A barrel chest and digital clubbing indicate long-standing respiratory difficulty.

• The child may have pneumonia or bronchitis, and gas exchange may be impaired.

• The child may demonstrate orthopnea and activity intolerance related to the respiratory symptoms.

A 4-year-old child with cystic fibrosis presents to the emergency department with a 1-day history of a productive cough, wheezing, fever, and poor appetite. The child’s oxygen saturation level is 85% on room air, respiratory rate of 22 and shallow, and heart rate of 120. Which action is priority for the nurse to take?

Administer oxygen via nasal cannula.

A 36-year-old newly pregnant patient asks the nurse the mostsignificant risk factor for Down syndrome. Which response by the nurse is appropriate?

“The most significant risk factor is the age of the woman at conception.”

Match the medical conditions associated with Down syndrome to the period during which it occurs.

• Neonatal Period

  • Atrial septal defect

• Infancy

  • Intestinal obstruction

• Childhood

  • Acute leukemias

• Adolescence

  • Intellectual disability

A pregnant patient whose fetus has trisomy 21 asks the nurse which medical conditions are associated with trisomy 21. Which responses by the nurse are appropriate?

Select all that apply.

• “There could be a hole between the right and left side of the baby’s heart.”

• “There could be a problem with the baby’s esophagus, in which it is not completely formed.”

• “There could be a lack of nerves going to the large intestine that would cause it not to work correctly.”

The parents of a 3-year-old child with Down syndrome tell the nurse that their child’s lips and fingertips turn dusky purple when the child runs around the house for more than a few minutes. They also report a persistent cough over the past 4 months. The parents state that their child’s last physical exam was 2 years ago. Which action is most appropriate for the nurse to take?

Alert the health care provider to the symptoms described by the parents.

The parents of a 10-year-old child with Down syndrome tell the nurse that their child currently participates in soccer and basketball. They state that the child will start football in the next month. Which does the nurse consider before advising this patient?

Children with Down syndrome have issues on the cervical area, making them prone to injury.

The parents of a 10-year-old child with Down syndrome tell the pediatric nurse that the child struggles to dress and feed himself, so they perform these tasks for him. They also state that they tie the child’s shoes and the child cannot zip his jacket. Which action by the nurse is appropriate?

Speak with occupational therapy regarding skill building and possible adaptive devices to help the child self button, zip, dress, and feed.

A parent asks the nurse why fragile X syndrome affects boys greater than girls. Which response by the nurse is appropriate?

“Since boys are XY, rather than XX, there is no normal X chromosome to mask the abnormal one.”

Which emotional characteristics might the nurse observe in a patient with fragile X syndrome?

Failure to make eye contact with the nurse

A nurse is presenting an inservice on fragile X syndrome. Which information is important for the nurse to present regarding who should receive diagnostic testing?

Select all that apply.

• Diagnostic testing should be completed on children who have long, narrow faces with large ears.

• Diagnostic testing should be completed on children with learning disabilities that have no known cause.

• Diagnostic testing should be completed on children who stumble when walking and have language delays.

A 1-year-old infant is seen in the pediatric clinic. The parents report that the infant does not babble or coo like other infants. They state that the infant doesn’t attempt to form words or point at objects. In observing these behaviors, which action does the nurse consider next?

The infant should have a speech and language evaluation as soon as possible.

A pediatric patient who has fragile X syndrome is seen in the clinic. The parents tell the nurse that their child displays the following behaviors at home: gaze avoidance, hand flapping, echolalia, and abnormal speech patterns, restlessness, and agitation. Which action is most appropriate for the nurse to take?

The nurse should discuss the need for a referral to remediation services for the child with the health care provider.

The parents of a child with fragile X syndrome ask the nurse how they can prepare their child for school. They state that the child has poor verbal skills, is uncoordinated when walking, and cannot button or zip clothing items. Which response by the nurse is most appropriate?

“Sensorimotor integration therapy would benefit your child.”

The parents of an infant diagnosed with cystic fibrosis ask the nurse to define cystic fibrosis for them. Which response by the nurse is accurate?

“Cystic fibrosis is an autosomal recessive disorder that affects the infant’s lungs, pancreas, and intestines.”

A newborn infant failed to pass meconium in the first twenty-four hours of life. The parents ask the nurse if there is anything wrong. Which response by the nurse is appropriate?

“Failure to pass meconium in the first day of life could be associated with a blockage caused by thick mucus secretions.”

The nurse understands that weight loss occurs in patients with cystic fibrosis due to which pathophysiologic occurrences?

The thick mucus prevents digestive enzymes from being released that are needed to absorb nutrients.

The nurse is forming the plan of care for a child with cystic fibrosis. The child has a productive cough of thick mucus, oxygen saturation levels of 95% on room air, and has lost 4 pounds from the past clinic visit. Which expected outcome is the priority for the nurse?

The child remains able to cough up secretions with clear lung sounds bilaterally.

The parent of a toddler diagnosed with cystic fibrosis tells the nurse that her child continues to lose weight. The toddler has lost 5 lbs. in the last 3 months and takes pancreatic enzymes at every meal. What does the nurse consider before managing this patient?

Select all that apply.

• The nurse should ask the child what is the favorite food is.

• The nurse should encourage high-calorie supplements between meals.

• The pancreatic enzymes should be administered 30 minutes before meals and snacks to be effective.

A child with cystic fibrosis is preparing for discharge after being hospitalized with pneumonia. The parent tells the nurse that this is their 4th admission in the last year and asks the nurse how to prevent infection. Which statements by the nurse are most appropriate?

Select all that apply.

• “Clean and disinfect your child’s nebulizer on a regular basis.”

• “Avoid going to crowded places such as malls, markets, or parks.”

• “Washing your hands before touching your child is very important.”

The student nurse states, “My sister was so worried that her baby might be born with an intellectual disability. She was born healthy. I am so excited that intellectual disability is not even possible anymore.” How should the nurse respond to this statement?

“Childhood conditions and environmental problems can cause intellectual disability. Let’s talk about ways to prevent these from causing intellectual disability.”

The nurse is assessing a 3-year-old child for an intellectual disability. What questions should the nurse ask the parent(s)?

Select all that apply.

• “Does your child have a seizure disorder?”

• “Can your child understand simple directions?”

• “Is your child developing as you would expect?”

• “Is your child able to verbally communicate needs?”

A parent of two children, including a girl with an intellectual disability states, “I have a hard time working with my daughter. She just doesn’t seem to understand what I’m saying like my son does.” What information can the nurse provide to help the parent?

“Let’s talk about how to use simple, concrete explanations and incorporate play while you are teaching her something new.”

The parents of a preschooler with intellectual disability are in the health care provider’s office. The parents seem anxious, disheveled, and tired. What can the nurse do to be most effective when working with this family?

Select all that apply.

• Bring up the aspects of caring for the preschooler that the parents are doing well.

• Provide information about local support groups for parents of children with disabilities.

• Ask the parents about their ability to maintain other roles, such as that of an employee or a significant other.

The parent of a child with autism spectrum disorder (ASD) states, “I knew that I should not have allowed her to get her vaccinations. If I had listened to my sister, this never would have happened.” How can the nurse appropriately respond to this statement?

“Although many people think that vaccinations are linked to ASD, the research has not shown that there is a correlation between the development of ASD and receiving vaccines.”

A parent asks the nurse how her child contracted autism spectrum disorder (ASD). Which is the nurse’s best response?

“ASD has many different proposed causes, so pinpointing the exact cause is likely impossible.”

The nurse is conducting an assessment of a school-aged child who has autism spectrum disorder (ASD). What should the nurse do to best assess the child’s functional abilities?

Select all that apply.

• Ask the child “Can you tell me about your morning routine?”

• Observe the child while the child is performing activities of daily living (ADLs) to see what assistance is needed.

A 2-year-old child has just been diagnosed with autism spectrum disorder (ASD). The parents want to know whether their child has a serious case because it was diagnosed so early. How should the nurse respond?

“Recognizing and treating ASD early does not determine the severity of the disorder, but it increases the chance that your child will maximize his or her potential.”

While assessing an infant with fetal alcohol spectrum disorder (FASD), the nurse does not see many of the characteristics that she expected to see. What is the explanation for this finding?

FASD is a spectrum of disorders, so a variety of signs and symptoms is possible.

A mother of two is adopting an infant with fetal alcohol spectrum disorder (FASD). She asks the nurse. “What can I expect my baby to be like?” What education is important for the nurse to share?

Select all that apply.

• “Your new infant may be more irritable than the average infant.”

• “The new baby is more likely to have a smaller head than the average infant.”

• “The infant may be smaller and grow at a slower rate than your other children did.”

The nurse is trying to feed a newborn with fetal alcohol spectrum disorder (FASD). The nurse is holding the baby in different positions to promote feeding, but the newborn is still spitting up the formula. What should be the nurse’s next action?

The nurse should try only feeding the infant small quantities at a time.

The mother of a newborn with fetal alcohol spectrum disorder (FASD) appears withdrawn and depressed. The mother does not often hold or look at the infant. When she does hold the newborn, she becomes tearful. Which would be appropriate comments for the nurse to make?

“You appear upset when you hold your baby. How are you feeling?”

The parents of a child with a neurologic disorder and severe intellectual disability are concerned about the child’s frequent emotional changes and anger. How might the nurse interpret these changes in emotion?

The child may be frustrated and unable to appropriately express needs.

The nurse received report about a child experiencing early signs of difficulties associated with mild intellectual disability. What behaviors should the nurse anticipate from the child?

The child spends time alone and rarely makes eye contact.

An adolescent with moderate intellectual disability states, “I want to live on my own when I become an adult.” What is the nurse’s best response?

“Let’s talk about how we can work together to prepare you for more independence.”

The parent of a child with intellectual disability states, “I thought she would be doing more by now. They said her condition is only mild. I think she is just difficult on purpose and doesn’t try.” What should be the nurse’s priority assessment question?

“What are your expectations for your child?”

A school nurse is providing education to a group of teachers regarding working with intellectually disabled school-aged children. What information is most important for the nurse to emphasize?

Put a stop sign picture on any object or area that you do not want the children to touch or enter.

The nurse is caring for an adolescent with a moderate intellectual disability. How should the nurse best communicate with the adolescent?

“The floors get very slippery when they are wet, so if you spill or get water on the floor, just let me know, and we can get it cleaned up, so you don’t fall.”

A nursing student asks the instructor, “How can I tell whether someone has autism spectrum disorder (ASD) or intellectual disability?” How should the instructor respond?

Children with intellectual disability usually imitate others, but children with ASD lack imitative skills.

A parent tells the nurse, “My daughter has been diagnosed with autism spectrum disorder (ASD), but she does not act anything like my niece who also has ASD. I don’t understand how they can behave so differently.” How should the nurse respond?

“ASD is a spectrum of disorders with a wide range of manifestations and severity. Each child is unique, and no two children have the exact same symptoms.”

The nurse is caring for a child with autism spectrum disorder (ASD). What should the nurse do to best assist the child’s tolerance of the hospitalization?

Select all that apply.

• Regularly assess for any changes in the child’s behavior, such as withdrawal or self-injury.

• Provide the child with her favorite stuffed animal each time that she needs to recognize that it is time to get ready for bed.

• Speak with the parents about the usual routines the child prefers for getting ready for the day ahead in the morning and going to bed at night.

A nurse is working for the first time with a 17-year-old diagnosed with autism spectrum disorder (ASD). The adolescent seems very attached to a sibling. The parents encourage the 15-year-old sibling to spend the night in the hospital. Allowing a sibling to spend the night is against the policy of the hospital unit. Which is the nurse’s best response?

The nurse should discuss the policy with the parents of the patient and develop a plan that meets the requirements of the facility and the needs of the adolescent.

Parents come to the clinic with their infant who was recently diagnosed with autism spectrum disorder (ASD). The parents state that they think their child is “just fine.” What questions can the nurse ask to assess for signs of ASD?

Select all that apply.

• “Does your infant look at you when you speak to him or her?”

• “Does your infant seem to do the same actions over and over again with toys?”

• “Has your child shown behaviors that indicate that he or she misses you when you are gone?”

• “If your child appears distressed, does he or she come to you and climb on your lap and look for comfort?”

The mother of young child with fetal alcohol spectrum disorder (FASD) asks, “What does this disorder mean for my plan to have a big family?” What would be the most therapeutic response?

“You can have more children. Let’s discuss pregnancy planning and alcohol avoidance in order to prevent having another child with FASD.”

The nurse is assessing an infant with fetal alcohol spectrum disorder (FASD). The nurse performs a thorough head-to-toe assessment. What is the primary reason for this assessment?

A thorough assessment is completed because other abnormalities are often present in an infant with FASD.

A 10-year-old patient with a history of fetal alcohol spectrum disorder (FASD) without any identifiable intellectual or physical impairments comes into the clinic with the parents. The parents want to know what impairments might be expected as their child continues to grow. What information should the nurse share with this family?

The child may start to experience joint pain or stiffness.

A child is brought to the clinic with suspected fetal alcohol spectrum disorder (FASD). What action taken by the nurse will be a priority in caring for this patient and the family?

Prepare the family for the necessity of a workup to determine the symptoms and other conditions associated with the disorder.

The nurse is treating a newborn and the mother confides in the nurse that she drank alcohol socially throughout the pregnancy. The nurse should be careful to assess for which specific signs and symptoms?

Select all that apply.

• Hypotonia

• Weak suck with bottle feeds

• Head circumference below target for age

• Incessant crying despite soothing attempts

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.

• Help the child with incorporating the illness into each stage of life 

• 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

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. 

• 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. 

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?

Have a discussion with the child life specialist

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. 

• 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.

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?

Allow the parent to talk and express emotions.

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?

• 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.

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.”

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?”

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 can be uncomfortable; let’s talk about things you can do to help you through it.”

A 14-year-old patient with cancer asks the nurse about dying. The nurse has had multiple conversations with the parents who have insisted that this information not be shared with the child. Which action would the nurse take next?

Pursue an ethics consult.

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. 

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?

Describe the operation in appropriate terms using dolls and a model of the heart

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?

“There have been great advances in treating type 1 diabetes. Let me share them with you.”

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 related to the illness and current treatment modalities

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 parents to bring the sibling to visit in the next few days when possible.

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.

• Engage child to help support the sibling while visiting.

• Express interest and ask about the extracurricular activities the sibling is involved in.

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. 

A nurse is providing education to parents who have a child recently diagnosed with a chronic illness. Which statement made by the nurse should be helpful for this family trying to cope with the changes the family is experiencing?

“Coping with a chronic illness is not easy, but can be done if the family works to achieve cohesiveness.”

The parents of infant twins, both with developmental delays, ask the nurse about resources for caring for the children as they get a little older. Which information should the nurse share?

“Medical homes can offer holistic and centralized care that include the patient and family as the primary focus.”

The parents of three children, including a toddler with hemophilia, are talking with the nurse and admit that the child with hemophilia is the center of attention in the family since they are more protective of the child who is ill. Which statements by the nurse should be an appropriate response to the parent’s actions toward their child?

Select all that apply.

• “Favoritism toward your toddler can negatively affect important boundaries and should be avoided.” 

• “Making the toddler the center of attention can actually cause some harm by decreasing age-appropriate development.” 

• “It is important for you as parents to spend time together to maintain your relationship as well so that the foundation of your family is strong.” 

• “Let’s talk about ways to ensure that all of your children feel equal attention so that there are not negative feelings towards the ill child or parents.” 

A teenager with leukemia states, “I thought everything about this was going to be terrible, but at least my parents have stopped making me do chores and homework.” The next time the nurse sees the parents, what should be the nurse’s best response?

“Let’s talk about the importance of maintaining age-appropriate expectations with your teenager, even while your teen is battling leukemia.”

A single parent of a child with cancer comes into the care provider’s office and states, “I am so frustrated. Lately the appointments are too much and my child’s behavior has been terrible.” Which statement by the nurse is appropriate?

“Let’s talk about some helpful techniques that can assist you in working through the frustration you are having.”

The parents of an adolescent with a newly diagnosed chronic illness state, “She was a little disrespectful and defiant before, but now things have gotten completely out of control. We feel like we really need some help coping with this.” What can the nurse do to enhance coping in these parents?

Provide education regarding support groups for families of children with special health care needs as a way to get emotional needs met

A husband and wife are speaking to the nurse about their infant who has cerebral palsy. The father seems anxious when interacting with the infant. What is the nurse’s best response to this situation?

Ask the father to assist the nurse with bathing the infant and encourage the father to ask questions

The 12-year-old sibling of an infant born with Down syndrome has been increasingly difficult and lashing out on family and friends. The parents are spending time with the 12-year-old child and do not understand why the child’s behavior has changed so much. What information should the nurse provide?

The 12-year-old is likely experiencing anger as part of a grief response to the infant being born with a chronic illness.

The parent of a school-aged child states, “I am so proud of my daughter. She was diagnosed with asthma and yet she still does everything she was doing before. She processed this diagnosis more quickly than I thought she would.” How should the nurse respond?

“Let’s talk to your daughter and see how she is doing.”

A teenager is having an acute exacerbation of cystic fibrosis. The parents of the teen state, “We were doing so well coping before this episode. We don’t even know what to do.” What should the nurse do to help the parents?

Assist the parents in identifying what usually helps the family to cope to see if that can be used during the exacerbation of the chronic illness

The nurse is working with a family that has two parents and three children. The oldest child was just diagnosed with diabetes mellitus. The parents want to know how they should schedule their health care provider’s appointments. What information should the nurse provide?

The family should try to schedule health care appointments at times that do not interfere with any of the children’s school or extracurricular activities.

The parents of four children, one of which has a chronic illness, state, “My spouse and I spend as much time as we can with our sick child, but our family just seems to be stressed all the time.” What should be the nurse’s best response?

“It is possible to spend too much time with a child who is ill and not enough time with your other children.”

A nurse is preparing discharge instructions for a school-aged child newly diagnosed with an autoimmune disease. What information should the nurse provide to both the child and the parents to prevent behavioral problems at home?

Maintain consistent discipline, which is important to help your child continue to develop socially and emotionally.

A parent of a six- and four-year-old, the youngest one with juvenile arthritis, states, “I feel terrible when I have to discipline the youngest one.” What is the nurse’s best response?

“Although disciplining a child with a chronic illness can be hard, it is important for the development of the child.”

The parents of a toddler newly diagnosed with a chronic illness ask, “Will our little girl develop just like her peers?” How should the nurse respond?

“Development is unique to each child, but can be supported through consistency at home and community resources to help minimize any developmental delays.”

An adolescent going through cancer treatment lost her hair and missed prom six months ago. The teen is coming in for her usual check-up and starts crying. The nurse states, “All of your blood work looks good. You are fine.” Which statement reflects how the nurse should have responded better?

“Tell me what you are thinking about right now.”

An adolescent who has had diabetes mellitus for ten years is able to check his blood glucose and maintain glucose levels while still participating in sports and maintaining a ‘B’ average. The adolescent tells the nurse, “I am so glad that I am finally able to deal with having diabetes.” What is the nurse’s best response?

“It sounds like you feel as though you are coping well with diabetes and have reached acceptance of the illness. Just remember that at times you might struggle, and that it is OK to ask for help.”

A child with a terminal illness has died following complications. The nurse is following-up with the child’s parents. What can the nurse expect to observe in response to their child’s death?

Select all that apply.

• Any emotions that the parents are feeling may be expressed. 

• The grief response will be different for each parent, and that is normal. 

• Symptoms that might indicate one or both parents need a referral to a mental health care provider. 

The parents of a child newly diagnosed with a chronic illness ask the nurse how long the illness will last. How should the nurse respond?

Select all that apply.

• “A chronic illness may have residual aspects that can last a lifetime.” 

• “A chronic illness lasts at least three months and up to a lifetime, depending on the illness.”

Why is it important to identify the special needs for children with chronic and terminal illness?

A clear definition can help families and caregivers obtain the support necessary to adequately care for children with special health care needs.

The nurse is caring for a newborn with Down syndrome. The parents state, “The health care provider just informed us that our daughter has Down syndrome. How long will my child be sick?” How should the nurse respond?

“Down syndrome is a chronic condition, so the child will always have this condition.”