Question 1

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 and key health professionals who are involved in the child's care are included. The nursing staff can address the nursing care needs of the child with the family,but other involved disciplines must be included. The family must be included in the discharge conferences,which allow 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 nursing needs of the child.

Question 2

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:

Accepted Answer

The child needs honest and accurate information about the illness,treatments,and prognosis. Children,even at a young age,realize that something is seriously wrong and that it involves them. The nurse should help parents understand the importance of honesty. The child will know that something is wrong because of the increased attention of health professionals. This would interfere with denial as a form of coping. Parents may need professional support and guidance from a nurse or social worker in this process. Children will usually tell others how much information they want about their condition.

Question 3

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:

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. He is not denying the child's limitations. This is descriptive of an adaptive coping style.

Question 4

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

Accepted Answer

Because of their mature understanding of death,remnants of guilt and shame,and issues with deviations from normal,adolescents have the most difficulty coping with death. Toddlers and preschoolers are too young to have difficulty coping with their own death. They will fear separation from parents. Children in these age groups are too young to have difficulty coping with their own death. They will fear separation from parents. School-age children will fear the unknown such as the consequences of the illness and the threat to their sense of security.

Question 5

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. The nurse's best response is:

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," and "I will come back when you settle down" are all possible responses,but they are not the likely reasons for this anger.

Question 6

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:

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 that 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 7

Kelly,age 8 years,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?

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 and 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 participate according to their capabilities.

Question 8

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,avoiding all discipline,and catering to the child's every desire to prevent frustration. The overprotective parents usually do not set limits and or institute discipline,and they usually prefer to remain in the role of total caregiver. They do not allow the child to perform self-care or encourage the child to try new activities.

Question 9

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,"With whom do you talk when something is worrying you?" This should be interpreted as:

Accepted Answer

These are very important data for the nurse to obtain and an appropriate part of an accurate assessment. This question will provide information about the marital relationship (does the parent speak 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. 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 10

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 choice of diversional activities,which will provide a sense of control. These interventions should be practiced as part of family-centered care. They do not particularly foster autonomy. Exposing the child to pleasurable experiences,especially sensory ones,is a supportive intervention. It does not particularly support autonomy.

Question 11

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

Accepted Answer

By age 9 or 10 years,children have an adult concept of death. They realize that it is inevitable,universal,and irreversible. Preschoolers and young school-age children are too little to have an adult concept of death. Adolescents have a mature understanding of death.

Question 12

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:

Accepted Answer

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

Question 13

A preschooler is found digging up a pet bird that was recently buried after it died. The best explanation for this behavior is that:

Accepted Answer

The preschooler can recognize that the pet has died but has difficulties with the permanence. Digging up the bird gives reassurance that the bird is still present. A morbid preoccupation with death and the child looking to see if a ghost took it away are expected responses. If they persist,intervention may be required.The preschooler is seeking reassurance that the pet is present.

Question 14

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

Accepted Answer

The school-age child is very interested in postdeath services and may be inquisitive about what happens to the body. School-age children have an established concept of forever and have a deeper understanding of death in a concrete manner. Adolescents may respond to death in this manner.

Question 15

Approach behaviors are 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. What 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. Avoidance behaviors include 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 the seriousness of the child's condition despite physical evidence. These behaviors would suggest that the parents are moving away from adjustment or maladaptation in the crisis of a child with chronic illness or disability.

Question 16

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/disability or are being punished for wrongdoings. Toddlers are focused on establishing their autonomy. The illness will foster dependency. The school-age child will have limited opportunities for achievement and may not be able to understand limitations. Adolescents are faced with the task of incorporating their disabilities into their changing self-concept.

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 knowledge that discipline is:

Accepted Answer

Discipline is essential for the child. It provides boundaries within which to test 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 18

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 that her disability was so severe. The best interpretation of this situation is that:

Accepted Answer

Parenting a child with a chronic illness can be very 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 19

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 acknowledgement stage.

Question 20

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. If the parents increase the amount of discipline,he will most likely be more rebellious. Socialization with peers should be encouraged as a part of adolescence. It is a normal part of adolescence during which the young adult is establishing independence.

Quiz 41: Chronic Illness, Disability and End of Life Care