Question 1

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

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.

Question 2

A mother of a 5-year-old child, with complex health care needs and cared for at home, expresses anxiety about attending a kindergarten graduation exercise of a neighbor's child. The mother says, "I wish it could be my child graduating from kindergarten." What should the nurse recognize the mother is experiencing?

Accepted Answer

Home care nurses should be aware that parents may experience chronic sorrow as a parental stressor. Chronic sorrow as a normal grief response is associated with a living loss (the loss of a healthy child) that is cyclical in nature. This is a normal response and does not indicate abnormal anxiety, ineffective coping, or denial.

Question 3

Which describes avoidance behaviors parents may exhibit when learning that their child has a chronic condition? (Select all that apply.)

Accepted Answer

A parent who refuses to agree to treatment, withdraws from the outside world, and punishes self because of guilt and shame is exhibiting avoidance coping behaviors. A parent who shares the burden of disorder with others and verbalizes possible loss of child is exhibiting approach coping behaviors.

Question 4

The home health nurse is caring for a child who requires complex care. The family expresses frustration related to obtaining accurate information about their child's illness and its management. Which is the best action for the nurse?

Accepted Answer

The philosophic basis for family-centered practice is the recognition that the family is the constant in the child's life. It is essential and appropriate that the family have complete and accurate information about their child's illness and management. The nurse may first have to clarify what information the family believes has not been communicated. The family's frustration arises from their perception that they are not receiving information pertinent to their child's care. Referring the family to the child's primary care practitioner does not help the family. The home health nurse should have access to the necessary information. Questions about what they need and want to know concerning their child's care should be addressed.

Question 5

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

Accepted Answer

Adolescents, because of their mature understanding of death, remnants of guilt and shame, and issues with deviations from normal, have the most difficulty coping with death.

Question 6

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

Accepted Answer

A patient's death is one of the most stressful aspects of critical care or oncology nursing. Nurses experience reactions similar to those of family members because of their involvement with the child and family during the illness. Nurses often have feelings of personal loss when a patient dies.

Question 7

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?

Accepted Answer

One of the most important nursing interventions of death is the availability of the nurse for the family.

Question 8

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

Accepted Answer

The school-age child is interested in post-death services and may be inquisitive about what happens to the body.

Question 9

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?

Accepted Answer

When the child reaches the terminal stage, the nurse and physician should explore the family's wishes. The family should help decide what interventions will occur as they plan for their child's death.

Question 10

Parents are asking about an early intervention program for their child who has special needs. The nurse relates that this program is for which age of child?

Accepted Answer

A variety of supplemental programs have been designed in the school system to accommodate special needs, both at school age and younger, through early intervention, which consists of any sustained and systematic effort to assist children from birth to age 3 years with disabilities and those who are developmentally vulnerable.

Question 11

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. What is the nurse's most appropriate response?

Accepted Answer

The parents should be allowed to remain with their child after the death. The nurse can remove all the tubes and equipment and offer the parents the option of preparing the body.

Question 12

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 should the nurse tell the parents?

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 the parents understand the importance of honesty.

Question 13

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

Accepted Answer

When death is imminent, care should be limited to interventions for palliative care.

Question 14

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

Accepted Answer

Because of egocentricity, the preschooler may feel guilty and responsible for the death.

Question 15

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

Accepted Answer

Pain medications, for children in palliative care, should be given on a regular schedule, and extra doses for breakthrough pain should be available to maintain comfort. Opioid drugs such as morphine should be given for severe pain, and the dose should be increased as necessary to maintain optimal pain relief. Techniques such as distraction, relaxation techniques, and guided imagery should be combined with drug therapy to provide the child and family strategies to control pain. Nonsteroidal anti-inflammatory drugs are not sufficient to manage severe pain for children in palliative care.

Question 16

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

Accepted Answer

This is one of the definitions of palliative care. The goal of palliative care is the achievement of the highest possible quality of life for patients and their families.

Question 17

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

Accepted Answer

By age 9 to 11 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible.

Question 18

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. How should the nurse interpret these feelings?

Accepted Answer

These are normal grief responses. The process of grief work is lengthy.

Question 19

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

Accepted Answer

By saying, "We feel so sorry that we couldn't save your child," the nurse is expressing personal feeling of loss or frustration, which is therapeutic. Stating, "You're feeling all the pain of losing a child," focuses on a feeling, which is therapeutic. The statement, "Your child isn't suffering anymore," is a judgmental statement, which is nontherapeutic. "I know how you feel" and "You're still young enough to have another baby" are statements that give artificial consolation and are nontherapeutic.

Question 20

A new nurse is caring for a child who will require palliative care. Which statement made by the new nurse would indicate a correct understanding of palliative care?

Accepted Answer

One of the goals of palliative care is to provide pain and symptom management.

Quiz 17: Quality of Life for Children Living with Chronic and Complex Diseases