Question 1

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

Accepted Answer

Normalization refers to behaviors and interventions for the disabled to integrate into society by living life as persons without a disability would.For children,normalization includes attending school and being integrated into regular classrooms.This affords the child the advantages of learning with a wide group of peers.Care is necessarily focused on the child's developmental age.Home care by the family is considered best practice.The nurse can assist families by assessing social support systems,coping strategies,family cohesiveness,and family and community resources.

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.What is the nurse's best intervention?

Accepted Answer

Diagnosis is one of the anticipated stress points for parents.The parents may not hear or remember all that is said to them.The nurse should continue to provide the kind of information they desire.This is a particularly stressful time for the parents; the nurse can play a key role in providing necessary information.Parents should be provided with oral and written information.The nurse needs to work with the family to ensure understanding of the information.The parents require information at the time of diagnosis.Other questions will arise as they adjust to the information.

Question 3

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 a:

Accepted Answer

The nurse should be particularly alert to the child who passively accepts all painful procedures.This child may believe that such acts are inflicted as deserved punishment.The child who is hopeful is mobilized into goal-directed actions.This child would actively participate in care.Chronic sorrow is the feeling of sorrow and loss that recurs in waves over time.It is usually evident in the parents,not in the child.A child who believes that procedures are an important part of care would actively participate in care.Nursing interventions should be used to minimize the pain.

Question 4

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:

Accepted Answer

Risk taking,rebelliousness,and lack of cooperation are normal parts of adolescence.

Question 5

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

Accepted Answer

These are important data for the nurse to obtain.This question will provide information about the marital relationship (whether the parent speaks to the spouse),alternate support systems,and ability to communicate.By assessing these areas,the nurse can facilitate the identification and use of community resources as needed.It is an important part of assessment information to determine the parent's support network.The nurse is obtaining information to help support the parent through the diagnosis.The parent is not in need of additional parenting help at this time.

Question 6

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

Accepted Answer

Encouraging the toddler to be independent encourages a sense of autonomy.The child can be given choices about feeding,dressing,and diversional activities,which will provide a sense of control.Avoiding separation from family during hospitalizations,and helping parents learn special care needs of their child should be practiced as part of family-centered care.It does not necessarily foster autonomy.Exposing the child to pleasurable experiences,especially sensory ones,is a supportive intervention.It does not promote autonomy.

Question 7

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 is considered an approach behavior?

Accepted Answer

The parents who anticipate future problems and seek guidance and answers are demonstrating approach behaviors.They are demonstrating positive actions in caring for their child.Being unable to adjust to a progression of the disease or condition,looking for new cures without a perspective toward possible benefit,and failing to recognize seriousness of child's condition despite physical evidence are avoidance behaviors.The parents are moving away from adjustment (and toward maladaptation)in the crisis of a child with chronic illness or disability.

Question 8

Which nursing intervention is especially helpful in assessing parental guilt when a disability or chronic illness is diagnosed?

Accepted Answer

Guilt may be associated with cultural or religious beliefs.Some parents are convinced that they are being punished for some previous misdeed.Others may see the disorder as a sacrifice sent by God to test their religious beliefs.The nurse can help the parents explore their religious beliefs.The parents may not be able to identify the feelings of guilt.It would be appropriate for the nurse to explore their adjustment responses.Overprotectiveness is a parental response during the adjustment phase.The parents fear letting the child achieve any new skill and avoid all discipline.

Question 9

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

Accepted Answer

The school-age child who is ill may be forced into a period of dependency.To foster normalcy,the child should be given as much control as possible.It is unrealistic to expect one individual to make the child feel normal.The child has a chronic illness.It would be unacceptable to convince the child that nothing is wrong.The family rules should be similar for each of the children in a family.Resentment and hostility can arise if different standards are applied to each child.

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 did not realize her disability was so severe.The best interpretation of this situation is that:

Accepted Answer

Parenting a child with a chronic illness can be stressful for parents.There are anticipated times that parental stress increases.One of these identified times is when the child begins school.Nurses can help parents recognize and plan interventions to work through these stressful periods.The parents are not in denial; they are responding to the child's placement in school.The parents are not exhibiting signs of a knowledge deficit; this is their first interaction with the school system with this child.

Question 11

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.Who should the nurse invite to the conference?

Accepted Answer

A multidisciplinary conference is necessary for coordination of care for children with complex health needs.The family is included,along with key health professionals who are involved in the child's care.The nursing staff can address the child's nursing care needs with the family,but other involved disciplines must be included.The family must be included in the discharge conferences,which allows them to determine what education they will require and the resources needed at home.A member of the nursing staff must be included to review the child's nursing needs.

Question 12

Most parents of children with special needs tend to experience chronic sorrow.This is characterized by:

Accepted Answer

Chronic sorrow is manifested by feelings of sorrow and loss that recur in waves over time.The sorrow is in response to the recognition of the child's limitations.The family should be assessed in an ongoing manner to provide appropriate support as the needs of the family change.The sorrow is not preventable.The chronic sorrow occurs during the reintegration and acknowledgment stage.

Question 13

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 is the nurse's best response?

Accepted Answer

Parental anger after the diagnosis of a child with a chronic disability is a common response.One of the most common targets for parental anger is members of the staff.The nurse should recognize the common response of anger to the diagnosis and allow the family to ventilate."What is really wrong?"/"Yelling at me will not change things"/"I will come back when you settle down" will place the parents on the defensive and not facilitate communication.

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:

Accepted Answer

Discipline is essential for the child.It provides boundaries on which to test out their behavior and teaches them socially acceptable behaviors.The nurse should teach the parents ways to manage the child's behavior before it becomes problematic.Punishment is not effective in managing behavior.

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?

Accepted Answer

For most families,the adjustment phase is accompanied by several responses.Guilt,self-accusation,bitterness,and anger are common reactions.The initial diagnosis of a chronic illness or disability often is met with intense emotion,characterized by shock and denial.Social reintegration and acceptance of the child's limitations are the culmination of the adjustment process.

Question 16

A 9-year-old boy 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 that the:

Accepted Answer

The father is describing a well-adapted child who has learned to accept physical limitations.These children function well at home,at school,and with peers.They have an understanding of their disorder that allows them to accept their limitations,assume responsibility for care,and assist in treatment and rehabilitation.The father is describing his child's behavior.He is not denying the child's limitations.The father is exhibiting an adaptive coping style.

Question 17

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

Accepted Answer

Preschoolers are most likely to be affected by feelings of guilt that they caused the illness or disability or are being punished for wrongdoings.Toddlers are focused on establishing their autonomy.The illness will foster dependence.The school-age child will have limited opportunities for achievement and may not be able to understand limitations.Adolescents face the task of incorporating their disabilities into their changing self-concept.

Question 18

Nursing interventions to help the siblings of a child with special needs cope include:

Accepted Answer

The presence of a child with special needs in a family will change the family dynamic.Siblings may be asked to take on additional responsibilities to help the parents to care for the child.The parents should show gratitude,such as an increase in allowance,special privileges,and verbal praise.Embarrassment may be associated with having a sibling with a chronic illness or disability.Parents must be able to respond in an appropriate manner without punishing the sibling.The parents may need assistance with the care of the child.Most siblings are positive about the extra responsibilities.The siblings need to be informed about the child's condition before a nonfamily member does so.The parents do not want the siblings to fantasize about what is wrong with the child.

Question 19

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

Accepted Answer

Parental overprotection is manifested by the parents' fear of letting the child achieve any new skill; they allow the child to avoid all discipline and cater to every desire to prevent frustration.Overprotective parents: do not set limits and or institute discipline; prefer to remain in the role of total caregiver; do not allow the child to perform self-care; and do not encourage the child to participate in social and educational activities.

Question 20

Kelly,an 8-year-old girl,will soon be able to return to school after an injury that resulted in several severe,chronic disabilities.Which is the most appropriate action by the school nurse?

Accepted Answer

Attendance at school is an important part of normalization for Kelly.The school nurse should prepare teachers and classmates about her condition,abilities,and special needs.A visit by the parents can be helpful,but unless the classmates are prepared for the changes,it alone will not prevent teasing.Kelly's school experience should be normalized as much as possible.Children need the opportunity to interact with healthy peers,as well as to engage in activities with groups or clubs composed of similarly affected persons.Children with special needs are encouraged to maintain and reestablish relationships with peers and to participate according to their capabilities.

Quiz 18: Quality of Life for Children Living with Chronic or Complex Diseases