Deck 39: Nursing Considerations for the Child and Family With a Chronic Condition

Question 1

The three-year-old child with cystic fibrosis has just been discharged from the hospital following a two-week stay due to a respiratory infection. The child has a post-discharge office visit the next day. During the office visit, the mother mentions that the child was toilet trained before hospitalization but now is having accidents. Which response by the nurse would be most appropriate?

A)"This is probably a reaction to the antibiotics and will disappear when the antibiotics are finished."
B)"Urinary incontinence is a common symptom of progression of cystic fibrosis.Be sure to notify the physician of this change."
C)"The child may have a urinary tract infection and needs to be evaluated."
D)"Children often regress after hospitalization.Be patient and remind him to go to the bathroom frequently."

Answer 1

"Children often regress after hospitalization.Be patient and remind him to go to the bathroom frequently."

Question 2

All of the following children are inpatients on the pediatric unit. Which child is likely to be left with a developmental disability?

A)An 18-month-old admitted with a diagnosis of near drowning
B)A school-age child newly diagnosed with type 1 diabetes mellitus
C)A toddler with sepsis
D)A two-year-old child with a fractured femur

Answer 2

An 18-month-old admitted with a diagnosis of near drowning

Question 3

After the infant is diagnosed as a child with a chronic health condition, the family is assigned a nurse working as a case manager. The nurse would explain that as a case manager, the nurse's role will include:

A)Limiting the number of visits to the health care facility.
B)Preventing duplication of services.
C)Improving the quality of life for the child and parents.
D)Recognizing the equipment needs of the child and providing assistance with equipment acquisition.
E)Visiting the child in the home to assist with physical care.

Answer 3

Preventing duplication of services.
Improving the quality of life for the child and parents.
Recognizing the equipment needs of the child and providing assistance with equipment acquisition.

Question 4

The nurse in the long-term care clinic is reviewing the charts of a group of children being seen for follow-up visits in the pediatric clinic. The nurse recognizes that chronic limitations might result from which diagnosis?

A)Pneumonia from Haemophilus influenzae virus
B)Respiratory syncytial virus
C)Streptococcus pneumoniae, a gram-positive diplococcus
D)Congenital heart defect

Question 5

The nurse is working with the parents of a child with a chronic condition. The nurse concludes that the parents' caregiver burden might become overwhelming when the mother states which of the following?

A)"My mother moved in and helps us with the care of our family."
B)"I chose to quit my job to be home with my child, and my husband helps in the evening when he can."
C)"I have to care for my child day and night, which leaves little time for me."
D)"Our health insurer sent us a rejection letter for my child's brand-name medication, and we must fill out forms to get the generic."

Question 6

The school nurse is reviewing the records of all incoming kindergarten students. The nurse recognizes that an individualized education plan (IEP) will be required for which children?

A)The child with diabetes controlled with insulin
B)The child with a casted arm due to a fracture
C)The child with a hearing deficit
D)The child with autism
E)The child with an IQ of 60

Question 7

The nurse is working with a child with a chronic condition. The nurse observes that over time, the parents have experienced a pattern of periodic grieving alternating with denial. The nurse would recognize this pattern as:

A)Pathologic grieving.
B)Compassion fatigue.
C)Chronic sorrow.
D)Dysfunctional parenting.

Question 8

The nurse is working in an adolescent medical clinic. When comparing adolescents in the clinic who have chronic conditions with their peers, the nurse would expect chronically ill adolescents to have:

A)More concern for their parents.
B)A decreased concern about their appearance.
C)An altered body image.
D)Higher self-esteem.

Question 9

Shortly after birth, all newborns are tested for phenylketonuria. The test results are not available before mother and baby are discharged from the hospital. When the diagnosis of PKU is made, the most appropriate means of informing the parents would be:

A)Immediately in a phone call requesting a follow-up office visit
B)In a certified letter explaining the diagnosis and requesting the parents make a pediatric office appointment.
C)In a group meeting of all parents whose children tested positive for phenylketonuria during the last two months.
D)In person with the physician and both parents present.

Question 10

The nurse is partnering with the family of a hospitalized premature infant who suffered an intraventricular brain hemorrhage. After three months in the neonatal intensive care unit (NICU), the infant is being discharged. Which activities will the nurse suggest to the family to help stimulate the infant's development?

A)Using a day care for stimulation
B)Discouraging sibling interaction
C)Holding and rocking the infant
D)Interacting face to face
E)Talking softly and singing to the infant

Question 11

The school nurse completes an assessment of a six-year-old child to determine the services this child will need in the classroom. The child needs respiratory support with oxygen. The child requires enteral tube feedings and intravenous medications during the school day. With these needs, the school nurse evaluates the child to be:

A)Medically fragile.
B)Developmentally delayed.
C)Mentally retarded.
D)Socially withdrawn.

Question 12

The nurse is conducting an educational program for parents of children with chronic conditions. Which statement by a parent requires additional nursing interventions?

A)"I know my child will get better and not have to take any more medication."
B)"I know my child will need assistance with activities of daily living."
C)"I know my child may need specialized education."
D)"I know my child will have to stay on a special diet."

Question 13

A family actively participates in school functions with all their children, one of whom is paraplegic and requires a wheelchair for mobility. The nurse evaluates this family to be working on the process of:

A)Stagnation.
B)Isolation.
C)Normalization.
D)Interaction.

Question 14

The nurse is working with a 20-year-old who is medically fragile. It is the policy of the clinic to only see patients from birth to 21 years of age. The nurse is responsible for assisting the individual and family to transition to adult health care. The nurse recognizes that the individual may face difficulties related to:

A)No longer qualifying for the state's child health insurance program and becoming uninsured.
B)Wanting to start fresh with the new healthcare provider and refusing to allow transfer of their records to the new agency.
C)Adult clinics being unwilling to accept this chronically ill individual into their practice.
D)The parents choosing an adult clinic that is not the one the individual would like to attend.
E)Being unwilling to transition to the adult clinic due to the relationships they have with the pediatric clinic.

Question 15

The mother of a 16-year-old child with multiple medical and developmental issues says to the nurse: "There are times that I think about just walking out of the house and not coming back." Which would be an appropriate nursing diagnosis for this mother?

A)Caregiver role strain related to providing 24-hour care for a child with medical and developmental issues
B)Risk for injury (maternal) related to overwhelming demands of the medically fragile child
C)Knowledge deficit (maternal) nursing care of the child
D)Health seeking behaviors (maternal) related to interest in learning to care for her child

Question 16

The nurse can instruct parents to expect children in which age group to begin to assume more independent responsibility for their own management of a chronic condition, such as blood glucose monitoring, insulin administration, intermittent self-catheterization, and appropriate inhaler use?

A)Preschoolers
B)School-age children
C)Adolescents
D)Toddlers

Question 17

The nurse works in a clinic for medically fragile children who require constant home care. The nurse has noticed that a high percentage of the families wind up divorcing. In an attempt to reduce the divorce rate among the parents, the nurse creates an educational session for parents of medically fragile children that focuses on the need for:

A)Communication.
B)Financial stability.
C)Meeting the child's physical needs.
D)The state laws that have relevance to the medically fragile child.

Question 18

In working with parents of children with chronic diseases, the nurse is concerned with helping the parents to protect themselves from compassion fatigue. The nurse would encourage which activities?

A)Fostering social relationships
B)Exercising
C)Developing a hobby
D)Moving away
E)Sleeping more than 9 hours per 24-hour period

Question 19

An adolescent has recently been diagnosed with type 1 diabetes mellitus and is on dietary restrictions and daily insulin. The nurse is teaching the adolescent's family members about the disease and treatment. The nurse will warn the family that the adolescent, upon returning to school, may:

A)Recognize that there is no difference between her and her classmates.
B)Not experience social stigma.
C)Acknowledge her condition to her classmates.
D)Not adhere to dietary recommendations.

Question 20

The nurse is conducting a nursing assessment of the parent and child with severe cerebral palsy during a routine clinic visit. Which of the following is important for the nurse to include on this assessment?

A)Measuring the urine output
B)Measuring the child's head circumference
C)Observing the parent-child relationship
D)Observing how the child interacts during play

Question 21

Following an automobile accident in which the child received a traumatic head injury, the child has been hospitalized for two weeks. The parents have just been informed that their four-month-old child will have long-term consequences due to the injury, including intellectual disability and cerebral palsy. The parents express anger at the diagnosis and project that anger on the nursing staff. The response by the nursing staff should include:

A)Referring the family to the hospital administrator.
B)Recognizing that the parents' anger is a normal response to the news.
C)Continuing to provide physical and emotional care to the child and family.
D)Offering hospital resources to the parents in addition to continued nursing support.
E)Explaining to the family that you are sorry about their child's injury but suggest they transfer the child to another hospital for their own comfort.