Deck 18: Chronic Illness, Disability, or End-Of-Life Care for the Child and Family

Question 1

The nurse comes into the room of a child who was just diagnosed with a chronic disability. The child's parents begin to yell at the nurse about a variety of concerns. Which of the following is the nurse's best response?

A)"What is really wrong?"
B)"Being angry is only natural."
C)"Yelling at me will not change things."
D)"I will come back when you settle down."

Answer 1

"Being angry is only natural."

Question 2

The nurse is providing support to parents at the time their child is diagnosed with chronic disabilities. The nurse notices that the parents keep asking the same questions. The nurse should do which of the following?

A)Patiently continue to answer questions.
B)Kindly refer them to someone else for answering their questions.
C)Recognize that some parents cannot understand explanations.
D)Suggest that they ask their questions when they are not upset.

Answer 2

Patiently continue to answer questions.

Question 3

Which of the following interventions will encourage a sense of autonomy in a toddler with disabilities?

A)Avoid separation from family during hospitalizations.
B)Encourage independence in as many areas as possible.
C)Expose child to pleasurable experiences as much as possible.
D)Help parents learn special-care needs of their child.

Answer 3

Encourage independence in as many areas as possible.

Question 4

Which of the following is the most appropriate nursing intervention to promote normalization in a school-age child with a chronic illness?

A)Give child as much control as is possible.
B)Ask child's peer to make child feel normal.
C)Convince child that nothing is wrong with him or her.
D)Explain to parents that family rules for child do not need to be the same as for healthy siblings.

Question 5

Approach behaviors are those coping mechanisms that result in a family's movement toward adjustment and resolution of the crisis of having a child with a chronic illness or disability. Which of the following is considered an approach behavior?

A)Is unable to adjust to a progression of the disease or condition
B)Anticipates future problems and seeks guidance and answers
C)Looks for new cures without a perspective toward possible benefit
D)Fails to recognize seriousness of child's condition despite physical evidence

Question 6

Chris, age 9 years, has several physical disabilities. His father explains to the nurse that his son concentrates on what he can, rather than cannot, do and is as independent as possible. The nurse's best interpretation of this is which of the following?

A)The father is experiencing denial.
B)The father is expressing his own views.
C)Child is using an adaptive coping style.
D)Child is using a maladaptive coping style.

Question 7

The nurse is talking with the parent of a child newly diagnosed with a chronic illness. The parent is very upset and tearful. The nurse asks, "Whom do you talk to when something is worrying you?" This should be interpreted as which of the following?

A)Inappropriate, because parent is so upset
B)Diverting the present crisis to similar situations with which parent has dealt
C)Intervention to find someone to help parent
D)Part of assessing parent's available support system

Question 8

The nurse case manager is planning to have a care conference about a young child who has complex health care needs and will soon be discharged home. Who should the nurse invite to the conference?

A)Family and nursing staff
B)Social worker, nursing staff, and primary care physician
C)Family and key health professionals involved in child's care
D)Primary care physician and key health professionals involved in child's care

Question 9

The nurse observes that a seriously ill child passively accepts all painful procedures. The nurse should recognize that this is most likely an indication that the child is experiencing which of the following?

A)Sense of hopefulness
B)Sense of chronic sorrow
C)Belief that procedures are a deserved punishment
D)Belief that procedures are an important part of care

Question 10

Lindsey, age 5 years, will be starting kindergarten next month. She has cerebral palsy, and it has been determined that she needs to be in a special education classroom. Her parents are tearful when telling the nurse about this and state that they didn't realize her disability was so severe. The best interpretation of this situation is that:

A)This is a sign parents are in denial.
B)This is a normal anticipated time of parental stress.
C)The parents need to learn more about cerebral palsy.
D)The parents are used to having expectations that are too high.

Question 11

A common parental reaction to a child with special needs is parental overprotection. Parental behavior suggestive of this includes which of the following?

A)Gives inconsistent discipline
B)Provides consistent, strict discipline
C)Forces child to help self, even when not capable
D)Encourages social and educational activities not appropriate to child's level of capability

Question 12

Most parents of children with special needs tend to experience chronic sorrow. This is characterized by which of the following?

A)Lack of acceptance of child's limitation
B)Lack of available support to prevent sorrow
C)Periods of intensified sorrow when experiencing anger and guilt
D)Periods of intensified sorrow and loss that occur in waves over time

Question 13

Which of the following represents a common best practice in the provision of services to children with special needs?

A)Care is now being focused on the child's chronologic age.
B)Children with special needs are being integrated into regular classrooms.
C)Children with special needs no longer have to be cared for by their families.
D)Children with special needs are being separated into residential treatment facilities.

Question 14

The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse's response should be based on knowledge that discipline is:

A)Essential for the child.
B)Too difficult to implement with special-needs child.
C)Not needed unless child becomes problematic.
D)Best achieved with punishment for misbehavior.

Question 15

Families progress through various stages of reactions when a child is diagnosed with a chronic illness or disability. After the shock phase, a period of adjustment usually follows. This is often characterized by which of the following responses?

A)Denial
B)Guilt and anger
C)Social reintegration
D)Acceptance of child's limitations

Question 16

The feeling of guilt that the child "caused" the disability or illness is especially critical in which of the following children?

A)Toddler
B)Preschooler
C)School-age child
D)Adolescent

Question 17

Nursing interventions to help the siblings of a child with special needs cope include which of the following?

A)Explain to the siblings that embarrassment is unhealthy.
B)Encourage the parents not to expect siblings to help them care for the child with special needs.
C)Provide information to the siblings about the child's condition only as they request it.
D)Suggest to the parents ways of showing gratitude to the siblings who help care for the child with special needs.

Question 18

Which of the following nursing interventions is especially helpful in assessing parental guilt when a disability or chronic illness is diagnosed?

A)Ask the parents if they feel guilty.
B)Discuss guilt only after the parents mention it.
C)Discuss the meaning of the parent's religious/cultural background.
D)Observe for signs of overprotectiveness.

Question 19

Which of the following interventions is most appropriate for encouraging the development of a school-age child with disabilities associated with cerebral palsy?

A)Provide sensory experiences.
B)Help develop abstract thinking.
C)Encourage socialization with peers.
D)Give choices to allow for feeling of control.

Question 20

Kelly, age 8 years, will soon be able to return to school after an injury that resulted in several severe, chronic disabilities. Which of the following is the most appropriate action by the school nurse?

A)Recommend that Kelly's parents attend school at first to prevent teasing.
B)Prepare Kelly's classmates and teachers for changes they can expect.
C)Refer Kelly to a school where the children have chronic disabilities similar to hers.
D)Discuss with Kelly and her parents the fact that her previous classmates will not accept her as they did before.

Question 21

A cure is no longer possible for a young child with cancer. The nursing staff recognizes that the goal of treatment must shift from cure to palliation. Which of the following is an important consideration at this time?

A)The family is included in the decision to shift the goals of treatment.
B)The decision must be made by the health professionals involved in the child's care.
C)The family needs to understand that palliative care takes place in the home.
D)The decision should not be communicated to the family because it will encourage a sense of hopelessness.

Question 22

Which of the following is most descriptive of a school-age child's reaction to death?

A)Very interested in funerals and burials
B)Little understanding of words, such as forever
C)Imagines the deceased person to be still alive
D)Have an idealistic view of world and criticize funerals as barbaric

Question 23

A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. The nurse should explain that:

A)This will help the child cope effectively by denial.
B)This attitude is helpful to give parents time to cope.
C)Terminally ill children know when they are seriously ill.
D)Terminally ill children usually choose not to discuss the seriousness of their illness.

Question 24

The nurse is providing support to a family who is experiencing anticipatory grief related to their child's imminent death. Which of the following is an appropriate nursing intervention?

A)Be available to family.
B)Attempt to "lighten the mood."
C)Suggest activities to cheer up the family.
D)Discourage crying until actual time of death.

Question 25

The nurse is caring for a child who has just died. The parents ask to be left alone so that they can rock their child one more time. The nurse should do which of the following?

A)Grant their request.
B)Assess why they feel this is necessary.
C)Discourage this because it will only prolong their grief.
D)Kindly explain that they need to say good-bye to their child now and leave.

Question 26

Which of the following is an appropriate nursing intervention when providing comfort and support for a child when death is imminent?

A)Limit care to essentials.
B)Avoid playing music near child.
C)Explain to child need for constant measurement of vital signs.
D)Whisper to child instead of using normal voice.

Question 27

A 16-year-old boy with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication. The nurse should explain to his parents that:

A)He needs more discipline.
B)He needs more socialization with peers.
C)This is part of normal adolescence.
D)This is how he is asking for more parental control.

Question 28

A preschooler is found digging up a pet bird that was recently buried after it died. The best explanation for this behavior is which of the following?

A)He has a morbid preoccupation with death.
B)He is looking to see if a ghost took it away.
C)The loss is not yet resolved, and professional counseling is needed.
D)Reassurance is needed that the pet has not gone somewhere else.

Question 29

At the time of a child's death, the nurse tells his mother, "We will miss him so much." The best interpretation of this is that the nurse is doing which of the following?

A)Pretending to be experiencing grief
B)Expressing personal feelings of loss
C)Denying the mother's sense of loss
D)Talking when listening would be better

Question 30

Which of the following terms best describes a multidisciplinary approach to the management of a terminal illness that focuses on symptom control and support?

A)Dying care
B)Curative care
C)Restorative care
D)Palliative care

Question 31

At what developmental period do children have the most difficulty coping with death, particularly if it is their own?

A)Toddlerhood
B)Preschool
C)School-age
D)Adolescence

Question 32

At what age do most children have an adult concept of death as being inevitable, universal, and irreversible?

A)4 to 5 years
B)6 to 8 years
C)9 to 11 years
D)12 to 16 years

Question 33

Which of the following best describes how preschoolers react to the death of a loved one?

A)Preschooler is too young to have a concept of death.
B)Preschooler may feel guilty and responsible for the death.
C)Grief is acute but does not last long at this age.
D)Grief is usually expressed in the same way in which the adults in the preschooler's life are expressing grief.

Question 34

The nurse is talking with the parents of a child who died 6 months ago. They sometimes still "hear" the child's voice and have trouble sleeping. They describe feeling "empty" and depressed. The nurse should recognize which of the following?

A)These are normal grief responses.
B)The pain of the loss is usually less by this time.
C)These grief responses are more typical of the early stages of grief.
D)This grieving is essential until the pain is gone and the child is gradually forgotten.