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Assuming the nurse has not provided enough support is inaccurate. While professional support is important, peer support adds a unique dimension that nurses cannot replace.

Viewing the relationship as potentially unhealthy is incorrect. Unless it becomes exclusive or fosters dependency, peer support is beneficial, not harmful.

Confidentiality is not a concern here as long as families willingly share their own experiences. The nurse must only safeguard protected health information.

The health care professionals should make the decision about the child’s care excludes the family, undermines trust, and disregards their role as the child’s advocate. Ethical pediatric care requires family participation in all major decisions.

Continuing aggressive treatment without benefit may increase suffering, prolong distress, and is not consistent with palliative principles. Hope can be reframed toward comfort, quality of life, and meaningful moments.

Safe and compassionate care during the transition from curative to palliative treatment in pediatric oncology emphasizes supporting both the child and family. Nurses play a key role in ensuring that families remain central to decision-making, honoring their values, preferences, and cultural beliefs.
 

Incorporating the mother’s assistance in care when convenient minimizes her role and implies she is only helpful occasionally. Her involvement should be central, not optional.

While caregiver rest is important, dismissing her may cause anxiety and reduce continuity of care. Instead, the nurse should support her presence and encourage breaks as appropriate.

While providing family-centered care since the mother is there is correct in principle, it is too general. True family-centered care requires specifically acknowledging the mother’s expertise and integrating her knowledge, making option 2 the best choice.

“Do you need some time alone to collect yourself?” This may come across as dismissive and does not directly validate her emotions. It could shut down communication instead of fostering support.

“You’ve known for a while this time would come.” This response is non-therapeutic, potentially judgmental, and invalidates her feelings by suggesting she should be prepared.

“Can I call your husband or a friend for you?” While offering support is helpful, this bypasses the opportunity for the nurse to provide direct emotional support and validation. It shifts responsibility away instead of first acknowledging her feelings.

Supporting families of children with developmental disabilities requires empathy, validation, and encouragement. Starting school can be an emotional milestone for any parent, and even more so when additional needs are involved. The nurse’s best response is one that normalizes the mother’s feelings, showing understanding and compassion without judgment.

Rationale for correct answer:
D. “It is normal to feel stressed or sad at this time.” This statement validates the mother’s emotions, reassures her that her reaction is expected, and opens the door for further supportive discussion. It reflects therapeutic communication, which acknowledges feelings without dismissing or minimizing them.

Rationale for incorrect answers:

A. “Do you need some time alone to collect yourself?” This may come across as dismissive and does not directly validate her emotions. It could shut down communication instead of fostering support.

B. “You’ve known for a while this time would come.” This response is non-therapeutic, potentially judgmental, and invalidates her feelings by suggesting she should be prepared.

C. “Can I call your husband or a friend for you?” While offering support is helpful, this bypasses the opportunity for the nurse to provide direct emotional support and validation. It shifts responsibility away instead of first acknowledging her feelings.

Take home points

• Therapeutic communication involves validating emotions, showing empathy, and encouraging expression.
• Parents of children with disabilities often experience added stress during developmental milestones, nurses should provide reassurance and support.
• Avoid dismissive, judgmental, or minimizing statements; instead, acknowledge feelings as normal and offer continued guidance.
• Validation builds trust and strengthens the nurse-family relationship.

“Children like this really can’t follow directions, so they may be very hard to discipline.” This is discouraging, non-therapeutic, and untrue. Children with developmental disabilities can follow directions with structure, patience, and consistency.

“Punish your child only for socially unacceptable or offending behaviors.” Discipline should focus on teaching, guiding, and reinforcing positive behavior, not solely punishment. Limiting discipline to punishment misses the opportunity for positive reinforcement and skill development.

“Spanking works well for this type of child, as they really don’t like pain.” Corporal punishment is inappropriate and harmful. It does not teach desired behaviors, may cause fear or aggression, and is not recommended in pediatric nursing practice.

Crying and begging the parents to stay represents separation anxiety, not detachment. It reflects active emotional attachment and protest.

Waving good bye and asking the parents when they would return is a healthy coping behavior, showing trust and security in the parents’ return. It is not detachment.

Grabbing the legs of the parents and refusing to let them go reflects protest behavior, not detachment. The child is still strongly attached and resists separation.

The presence of extra digits is associated more with trisomy 13 (Patau syndrome), not trisomy 2A.

A transient skin color change (half red, half pale) due to immature blood vessel regulation in newborns. It is a benign and temporary finding, not specific to Down syndrome.

Benign bluish pigmentation commonly found on the sacral area of infants with darker skin tones. These are unrelated to chromosomal abnormalities.

Strabismus may occur in many children but is not a defining or common feature of fragile X syndrome.

Vision deficit is not a hallmark feature of fragile X. Visual problems can occur in any child but are not specifically linked to this condition.

Nevus flammeus, also known as a “port-wine stain,” this is a vascular birthmark unrelated to fragile X syndrome.

Children with ASD may have difficulty with social interactions and overstimulation in busy playrooms. Play therapy can be helpful, but it should be individualized and not forced.

Keeping all of the room lights on throughout the night is not appropriate; it may worsen sleep disturbances is already common in autism and cause sensory overload.

Providing the child with sugar-free juice at snack time is not specific to autism management. Unless the child has diabetes or dental concerns, this intervention is not related to autism care.

Asking about the extended family’s views may provide some information, but it does not directly address the parents’ own beliefs and perceptions, which are essential for guiding care.

Exploring alternative therapies is important but comes after understanding the family’s overall view of the illness. It is one aspect of cultural care, not the starting point.

Acknowledging language barriers is necessary, but it does not justify health care professionals making decisions without family input. Professional interpreters should be used to ensure communication and respect for family values.