Deck 36: Impact of Chronic Illness, disability, or End-Of-Life Care for the Child and Family

Question 1

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

A) Attempting to avoid frustrating situations.
B) Providing consistent, strict discipline.
C) Forcing child to help self, even when not capable.
D) Encouraging social and educational activities not appropriate to child's level of capability.

Answer 1

Attempting to avoid frustrating situations.

Question 2

Lindsey,age 5 years with a diagnosis of cerebral palsy,will be starting kindergarten next month and will be placed in a special education classroom.The parents are tearful when telling the nurse about this and state that they did not realize that their child's disability was so severe.How should the nurse interpret this parental response?

A) This is a sign that 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.

Answer 2

This is a normal anticipated time of parental stress.

Question 3

The father,of a 9 year old diagnosed with several physical disabilities,explains to the nurse that his child concentrates on what he/she can do rather than cannot do and is as independent as possible.How should the nurse's best interpret this statement?

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

Answer 3

The child is using an adaptive coping style.

Question 4

The nurse case manager is planning a care conference about a young child who has complex health care needs and will soon be discharged home.Whom 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 5

The nurse,providing support to parents of a child newly diagnosed with a chronic disability,notices that they keep asking the same questions.How should the nurse respond to best meet their needs?

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

Question 6

Which behavior is considered an approach behavior in parents of chronically ill children?

A) Inability to adjust to a progression of the disease or condition.
B) Anticipation of future problems and seeking guidance and answers.
C) Looking for new cures without a perspective toward possible benefit.
D) Failing to recognize seriousness of child's condition despite physical evidence.

Question 7

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 8

Most parents of children with special needs tend to experience chronic sorrow.How may chronic sorrow be characterized?

A) Lack of acceptance of the 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 9

Which intervention will encourage a sense of autonomy in a toddler with disabilities?

A) Avoiding separation from family during hospitalization
B) Encouraging age appropriate independence in as many areas as possible
C) Exposing child to pleasurable experiences as much as possible
D) Helping parents learn special care needs of their child

Question 10

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 11

The parents of a child who has just died ask to be left alone so that they can rock their child one more time.In response to their request,what intervention should the nurse implement?

A) Grant their request.
B) Assess why they feel that 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 12

An 8 year old will soon be able to return to school after an injury that resulted in several severe,chronic disabilities.What is the most appropriate action by the school nurse to help assure a smooth transition back to school?

A) Recommending that the child's parents attend school at first to prevent teasing
B) Preparing the child's classmates and teachers for changes they can expect
C) Referring the child to a school where the children have chronic disabilities similar to hers
D) Discussing with both the child and the parents the fact that classmates will not likely be as accepting as before

Question 13

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 that may be characterized by what reaction?

A) Anger
B) Overprotectiveness
C) Social reintegration
D) Guilt

Question 14

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

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

Question 15

A 16 year old diagnosed with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication.What information should the nurse provide the parents to help explain their child's behavior?

A) The child at this age requires more discipline.
B) At this age, children need more socialization with peers.
C) This behavior is seen as a normal part of adolescence.
D) This is how the child is asking for more parental involvement in managing stress.

Question 16

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.What information should the nurse provide to these parents?

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 17

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

A) Appropriate disciple is essential for the child.
B) It may be too difficult to implement appropriate discipline for a special-needs child.
C) Discipline is not needed unless the child becomes problematic.
D) Discipline is best achieved with punishment for misbehavior.

Question 18

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

A) Is very interested in funerals and burials
B) Has little understanding of words such as forever
C) Imagines the deceased person to be still alive
D) Has an idealistic view of the world and criticizes funerals as barbaric

Question 19

The nurse,talking with the tearful parent of a child newly diagnosed with a chronic illness,asks,"Who do you talk with when something is worrying you?" What is the purpose of this statement?

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

Question 20

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.What 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."

Question 21

Which describe avoidance behaviors a parent may exhibit when learning that his or her child has a chronic condition? (Select all that apply.)

A) Refuses to agree to treatment
B) Shares burden of disorder with others
C) Verbalizes possible loss of child
D) Withdraws from outside world
E) Punishes self because of guilt and shame

Question 22

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 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 23

Which are appropriate statements the nurse should make to parents after the death of their child? (Select all that apply.)

A) "We feel so sorry that we couldn't save your child."
B) "Your child isn't suffering anymore."
C) "I know how you feel."
D) "You're feeling all the pain of losing a child."
E) "You are still young enough to have another baby."

Question 24

A nurse is caring for a child who is near death.Which physical signs indicate the child is approaching death? (Select all that apply.)

A) Body feels warm
B) Tactile sensation decreasing
C) Speech becomes rapid
D) Change in respiratory pattern
E) Difficulty swallowing

Question 25

A nurse is planning palliative care for a child with severe pain.Which should the nurse expect to be prescribed for pain relief?

A) Opioids as needed
B) Opioids on a regular schedule
C) Distraction and relaxation techniques
D) Nonsteroidal antiinflammatory drugs

Question 26

What should the nurse identify as major fears in the school-age child who is hospitalized with a chronic illness? (Select all that apply.)

A) Altered body image
B) Separation from peer group
C) Bodily injury
D) Mutilation
E) Being left alone

Question 27

Which is the most appropriate response to a school-age child who asks if she can talk to her dying sister?

A) "You need to speak loudly so she can hear you."
B) "Holding her hand would be better because at this point she can't hear you."
C) "Although she can't hear you, she can feel your presence so sit close to her."
D) "Even though she will probably not answer you, she can still hear what you say to her."

Question 28

Which represents a common best practice in the provision of services to children with chronic or complex conditions?

A) Care is focused on the child's chronologic age.
B) Children with complex conditions are integrated into regular classrooms.
C) Disabled children are less likely to be cared for by their families.
D) Children with complex conditions are placed in residential treatment facilities.

Question 29

Which statement made by the nurse would indicate a correct understanding of palliative care?

A) "Palliative care serves to hasten death and make the process easier for the family."
B) "Palliative care provides pain and symptom management for the child."
C) "The goal of palliative care is to place the child in a hospice setting at the end of life."
D) "The goal of palliative care is to act as the liaison between the family, child, and other health care professionals."

Question 30

Which term 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

Which 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 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 the child do not need to be the same as for healthy siblings.

Question 32

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 that:

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.

Question 33

At the time of a child's death,the nurse tells his mother,"We will miss him so much." What does this statement indicate about the nurse?

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 34

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

A) The preschooler is too young to have a concept of death.
B) A preschooler is likely to 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.