Deck 34: Caring for the Child With a Chronic Condition or the Dying Child

Question 1

The parents of a chronically ill 8-year-old do not want him to go outside and play or to attend his friends' birthday parties for fear he will become ill.What response by the nurse is most appropriate?

A)"Can you let one or two friends come over to play?"
B)"Children his age need to maintain friendships."
C)"He can go outside if he wears a mask all the time."
D)"You are right to be concerned that he will get sick."

Answer 1

"Can you let one or two friends come over to play?"

Question 2

The pediatric nurse understands that with a sudden catastrophic loss,family members can experience physical symptoms such as rapid respirations,agitation,nausea,and diarrhea.According to Epperson,which stage of grief are these individuals experiencing?

A)Anger
B)Denial
C)High anxiety
D)Remorse

Answer 2

High anxiety

Question 3

A nurse notes that a patient with cystic fibrosis develops difficult breathing.The nurse calls the father to report his condition.The father,who has been continually present,cannot be there because the patient's sister has influenza and the father stayed at home to care for his daughter.In the morning,the nurse sees the patient's father and approaches him to talk.Which statement by the nurse is most appropriate at this time?

A)"I feel sorry that you were not here when your son got so sick last night."
B)"Please sit down.I want to update you about your son's condition."
C)"Your son had a difficult night.It is too bad you were not here with him."
D)"Your son might die.Come with me now and see him before it's too late."

Answer 3

"Please sit down.I want to update you about your son's condition."

Question 4

During a pediatric nursing orientation session to a new unit,the child-life specialist is introduced as an important member of the heath-care team.What is an important role of the child-life specialist?

A)Accompany children on their way to procedures
B)Assist with family counseling regarding hospitalization
C)Describe normal growth and development to families
D)Provide opportunities for therapeutic play

Question 5

The pediatric nurse providing nursing care for a 12-year-old girl listens as her mother describes her family situation.She states that the patient's 10-year-old sister is asking many questions about the patient's illness.The patient's mother feels that it is best not to talk about the patient with her sister.Which response by the nurse is the most appropriate?

A)"Having a child in the hospital and having another daughter at home must be challenging.Focusing on the future when your child goes home would be best."
B)"It must be challenging to balance the needs of both of your children.Both children need information about her illness and hospitalization."
C)"It must be difficult for you to balance everyone's needs at this time.Doing what you think is best is most important."
D)"You and your husband know your children best.I am sure that you will decide the best way to handle this situation."

Question 6

A preschool-age child with a chronic condition is brought to the clinic for a checkup.During the visit she throws things,yells at her mother,and attempts to hit the nurse.The mother sighs and says "I'm afraid yelling at her will make her sicker." What response by the nurse is the most appropriate?

A)Explain that without limits,preschoolers do not feel secure.
B)Inform the mother that she needs to institute some discipline.
C)Re-educate the mother on the progression of the child's illness.
D)Tell the mother that yelling at the child will not make her sick.

Question 7

The pediatric nurse attends a debriefing session following the death of a young child who was hospitalized for several months with cancer.The nurse developed a strong relationship with the child and even worked overtime to care for the child.The nurse now describes feelings of sadness,insomnia,fatigue,helplessness,and frustration.Which type of suffering is this nurse experiencing?

A)Burnout
B)Compassion fatigue
C)Family empathy
D)Moral distress

Question 8

The nurse is teaching the parents of a child with a severe,chronic condition ways to promote growth and development.Which suggestion by the nurse is the most appropriate?

A)Allow interaction with peers,family,and community members.
B)Ensure that the child is getting a nutritious diet and plenty of exercise.
C)Insist that the public school include the child in all activities.
D)Plot the child's growth and weight gain on growth charts monthly.

Question 9

The pediatric nurse is familiar with Kübler-Ross's stages of grief.Parents who are feeling guilty and try to find any cause for their child's illness or blame others for the illness are in which stage of grief?

A)Acceptance
B)Bargaining
C)Denial
D)Grief

Question 10

A 4-year-old girl diagnosed with leukemia will begin palliative care.The 6-year-old brother does not visit often.The parents worry their son will remember his sister as a "sad,thin,child in the hospital" rather than as his playful sister.Which response by the nurse is the most appropriate?

A)"Your son can handle a visit to see his sister with your help because children are emotionally strong."
B)"Your son needs to say good-bye to his sister prior to her death;you should bring him to visit immediately."
C)"Your son will have these sad memories for the rest of his life;therefore,keeping him away is a good idea."
D)"Your son needs preparation about the change in his sister's appearance,but for his own grieving process,he needs to visit her before her death."

Question 11

A pediatric nurse advocates for the children's oncology clinic by initiating a fundraising project that will help pay for expansion of the bathrooms to accommodate wheelchairs.The nurse's motivation is in response to an awareness of which of concept?

A)Chronic illnesses of the patients
B)Disabilities of the patient population
C)Handicaps of the patient population
D)Work of the clinic nurse and other staff

Question 12

The pediatric nurse is caring for an adolescent with cancer.The parents are interested in exploring complementary and alternative (CAM)therapies.Which response by the nurse is the most appropriate?

A)"Be careful;many CAM providers prey on desperation."
B)"CAM therapies have worked well for many cancer patients."
C)"These treatments only provide relief through a placebo effect."
D)"Although many people like CAM,many therapies have not been researched."

Question 13

A teenager with a chronic medical condition requiring frequent hospitalizations has the nursing diagnosis of impaired self-esteem.Which action by the adolescent best indicates that outcomes for this diagnosis have been met?

A)Complies politely with hospital rules and routines
B)Makes choices as to when to bathe or eat meals
C)States understanding of the need for hospitalization
D)Uses social media sites to maintain contact with peers

Question 14

The parents of a chronically ill child confide in the nurse that they are increasingly frustrated with the ill child's younger sibling,who has become very negative toward the ill child and occasionally even hostile.What response by the nurse is the most appropriate?

A)"She is too young to understand;you just have to wait for this phase to pass."
B)"This is really common,unfortunately;the best you can do is to ignore the behavior."
C)"This is a common reaction by siblings;can she help you with your other child?"
D)"You need to spend more time with the younger child so she doesn't feel left out."

Question 15

The nurse is caring for the parents of a chronically ill child,who display chronic sorrow.Which action by the nurse would be most beneficial for this family?

A)Encourage the parents to use resources such as respite care.
B)Help the parents establish a routine for school and bedtime.
C)Offer the parents resources to deal with their grieving.
D)Refer the parents to a community center for counseling.

Question 16

An infant has been hospitalized since birth.What nursing intervention takes priority for this child?

A)Keeping the parents updated every day
B)Maintaining a set visiting schedule for family
C)Providing a soft crib and cuddly toys
D)Soothing and providing physical touch

Question 17

A child with a severe,chronic illness is hospitalized and the staff finds it difficult to deal with the mother,who is overbearing and controlling.What action by the nursing manager would be most appropriate to help the situation?

A)Ensure consistent caregiver staffing.
B)Explain that the mom is trying to regain control.
C)Request a social work consultation.
D)Set strict limits on the mother's behavior.

Question 18

A nurse has to perform a brief procedure on a toddler.What action by the nurse is the most developmentally appropriate for this patient?

A)Demonstrate the procedure on a stuffed animal.
B)Offer a choice as to when the procedure is done.
C)Perform the procedure with no advance explanation.
D)Tell the child about other kids who had this done.

Question 19

The pediatric nurse is caring for a child who has been in a motor vehicle collision.The doctor explains to the family that there are serious physical disabilities.The father is upset and states: "I don't know how we will be able to cope.We have two other children.What can we do?" Which response by the nurse is the most appropriate?

A)"Don't worry.You will be able to manage."
B)"Don't worry.You will get through the crisis."
C)"Many parents find the initial news overwhelming."
D)"The doctor can explain it to you again."

Question 20

As part of therapeutic play for the patients,the pediatric nurse reads a book about children receiving injections.For which age group is this nursing intervention most appropriate?

A)Adolescents
B)Preschoolers
C)School-aged children
D)Toddlers

Question 21

A nurse wants to participate in community service by providing education on the leading causes of death for various age groups coupled with appropriate preventative measures.When discussing deaths in teenagers,which topic does the nurse focus prevention on?

A)Appropriate prenatal care
B)Exposure to carcinogens
C)Genetic testing
D)Violence and injury prevention

Question 22

A nurse is working in the emergency department when a child who was involved in a motor vehicle crash is admitted.The child is critically injured and,despite heroic efforts,does not survive.The nurse finds the family in the waiting room and several family members are agitated and do not listen to the nurse describe the child's injuries.One family member feels faint and another has vomited.What does the nurse understand about the current situation based on Epperson's theory of grieving? (Select all that apply.)

A)It is important to be patient and identify one person to communicate with.
B)Most of the members are totally dysfunctional and should be sent home.
C)Signs of emotional upheaval and physical symptoms are a result of great stress.
D)The nurse should call security,as some family members may become violent.
E)This family is reacting normally to a catastrophic loss,according to one theory.

Question 23

An experienced nurse is acting as preceptor to a new graduate and is discussing ways to develop a trusting relationship with the families of children who have chronic or terminal conditions.Which are helpful suggestions by the experienced nurse? (Select all that apply.)

A)Ask if and how the parents would like to participate in care.
B)Do not judge the parents' reactions to the child's condition.
C)Follow the child's home routine while hospitalized,if possible.
D)Treat each child as an individual and do not label the child.
E)Work predominantly with the parents;they will include siblings.

Question 24

The nurse caring for infants and children understands that which are the scariest aspects of being hospitalized for a 3-year-old? (Select all that apply.)

A)Anxiety
B)Being different from peers
C)Pain
D)Punishment in the form of illness
E)Separation from parents

Question 25

A nurse is working with a school-age child who is dying.The child is hostile and uncooperative.Which action by the nurse is the most appropriate?

A)Ask the child what she knows about what is wrong with her.
B)Give the child time to herself and then return to complete tasks.
C)Offer the child a reward for cooperative or pleasant behavior.
D)Tell the child to cooperate with treatments in order to get better.

Question 26

A hospice nurse is working with the family of a child who has died.Which statement by the parent indicates that further action by the nurse is needed?

A)"I have not been able to function at work since my son died."
B)"Some days I wonder if I could have done anything differently."
C)"There are times when I still get so angry that this happened."
D)"You know,I have had some pretty good days recently."

Question 27

A nurse is caring for a dying child.What intervention by the nurse would be best to promote hope and peace in the family?

A)Ask the family to participate in providing physical care.
B)Ensure the family members eat so they maintain their strength.
C)Help the family members arrange child care for their other children.
D)Tell the family members what is possible for them to do as the child dies.

Question 28

A nurse is evaluating how well the family of a dying child understands the concept of hospice care in the home.Which statement by the family indicates the need for further instruction?

A)"If she gets short of breath,I will call 911 right away."
B)"It will be great that she can play with her sister at home."
C)"Pain control will be very important even near death."
D)"We should look into respite care so we can get a break."

Question 29

A nurse is explaining the connection between family caregivers of chronically ill children and illness to a group of nursing students.What information about caregivers increases their risk of becoming ill? (Select all that apply.)

A)Depression
B)Financial worries
C)Lack of sleep
D)Over-exercising
E)Poor eating habits

Question 30

A nurse is teaching the parents of a dying child how to recognize impending death.Which manifestations does the nurse tell the parents to expect? (Select all that apply.)

A)Changes in breathing patterns
B)Decreased desire to eat or drink
C)Increased blood pressure
D)Pale,cool skin
E)Restlessness or agitation