Deck 36: The Child with a Chronic Condition or Terminal Illness

Question 1

How can chronic illness and frequent hospitalizations affect the psychosocial development of a toddler?

A) They can create a distortion or differentiation of self from parent.
B) They can interfere with the development of autonomy.
C) They can interfere with the acquisition of language, fine motor, and self-care skills.
D) They can create feelings of inadequacy.

Answer 1

They can interfere with the development of autonomy.

Question 2

What is the priority goal for the child with a chronic illness?

A) To maintain the intactness of the family
B) To eliminate all stressors
C) To achieve complete wellness
D) To obtain the highest level of wellness

Answer 2

To obtain the highest level of wellness

Question 3

Identify the most appropriate nursing response to a parent who tells the nurse,"I don't want my child to know she is dying."

A) "I shall respect your decision. I won't say anything to your child."
B) "Don't you think she has a right to know about her condition?"
C) "Would you like me to arrange for the provider to speak with your child?"
D) "I'll answer any questions she asks me as honestly as I can."

Answer 3

"I'll answer any questions she asks me as honestly as I can."

Question 4

What is an important focus of nursing care for the dying child and his or her family?

A) Nursing care should be organized to minimize contact with the child.
B) Adequate oral intake is crucial to the dying child.
C) Families should be taught that hearing is the last sense to stop functioning before death.
D) It is best for the family if nursing care takes place during periods when the child is alert.

Question 5

A nurse is caring for a dying child.What action by the nurse best meets the the primary concern of the parents?

A) Giving the child pain medication on a schedule
B) Placing the child on fall and safety precautions
C) Providing the child with favorite foods when requested
D) Ensuring the child gets the minimum fluid requirement

Question 6

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 7

How can chronic illness and frequent hospitalizations affect the psychosocial development of an adolescent?

A) They can lead to feelings of inadequacy.
B) They can interfere with parental attachment.
C) They can block the development of identity.
D) They can prevent the development of imagination.

Question 8

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?

A) Family and nursing staff
B) Social worker, nursing staff, and primary care physician
C) Family and key health professionals involved in the child's care
D) Primary care physician and key health professionals involved in the child's care

Question 9

The nurse is counseling the family of a 12-month-old child who has lost his mother in a car accident.How should you explain to the father what the child's understanding of death is,related to theories of growth and development?

A) Temporary
B) Permanent
C) Loss of caretaker
D) Punishment

Question 10

The parents of a school-age child are told that their child is diagnosed with leukemia.As the nurse caring for this child,what is the expected first response of the parents to the diagnosis of chronic illness in their child?

A) Anger and resentment
B) Sorrow and depression
C) Shock and disbelief
D) Acceptance and adjustment

Question 11

What is a priority nursing diagnosis for the preschool child with chronic illness?

A) Risk for delayed growth and development related to chronic illness or disability
B) Chronic pain related to frequent injections and invasive procedures
C) Anticipatory grieving related to impending death
D) Anxiety related to frequent hospitalizations

Question 12

What corresponds to a 5-year-old child's understanding of death?

A) Loss of a caretaker
B) Reversible and temporary
C) Permanent
D) Inevitable

Question 13

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

A) "You need to talk 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 14

In order to minimize the negative effects of illness and hospitalization on an infant,the nurse focuses care on which of the following?

A) Bodily injury and pain
B) Separation from caregivers and fear of strangers
C) Loss of control and altered body image
D) The unknown and being left alone

Question 15

Many parents who have children diagnosed with a chronic illness experience recurrent feelings of grief,loss,and fear related to the child's condition and loss of the ideal healthy child.The nurse recognizes this process as

A) anticipatory grieving.
B) chronic sorrow.
C) bereavement.
D) illness trajectory.

Question 16

The parents of a chronic illness say,"Living with this disease is really hard; it's not fair." What response by the nurse is best?

A) "Tell me about what is hard for you."
B) "I know exactly how you must feel."
C) "I know a local support group for families."
D) "I am going to ask the grief counselor to meet with you."

Question 17

Which activity should the nurse implement for the toddler hospitalized with a chronic illness to promote autonomy?

A) Provide opportunities for play
B) Making play dates with other toddlers in the unit
C) Give the toddler art supplies
D) Turn the television on to cartoons

Question 18

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

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 19

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 response?

A) Denial
B) Anger
C) Social reintegration
D) Acceptance of child's limitations

Question 20

What is the predominant trait of the resilient family associated with chronic illness?

A) Social separation
B) Family flexibility
C) Family cohesiveness
D) Clear family boundaries

Question 21

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 response by the nurse is best?

A) Grant their request.
B) Assess why they feel 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 22

The home health care nurse is working with a family with three children,one of whom has a chronic condition.What statement by a parent indicates that goals for a primary nursing diagnosis have been met?

A) "We take turns going to soccer practice with our other two kids."
B) "Each sibling has one night when he or she is in charge so we can go out."
C) "We are looking into local support groups for parents."
D) "We can't afford home health care, so one of us will quit our job."

Question 23

A parent of a child with a chronic illness is complaining about "all these care planning meetings." What response by the home health care nurse is best?

A) "Our plan will change with your child's growth and development."
B) "We have legal regulations and company policies to follow."
C) "Do you want to change the frequency of our meetings?"
D) "If you don't want to come to the meetings you don't have to."

Question 24

Which indicators of imminent death in a child should the nurse expect to assess? (Select all that apply.)

A) Heart rate increases.
B) Blood pressure increases.
C) Respirations become rapid and shallow.
D) The extremities become warm.
E) Peripheral pulses become stronger.

Question 25

What should the nurse identify as major fears in the preschool 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 26

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 27

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

A) essential for the child.
B) too difficult to implement with special-needs child.
C) not needed unless the child becomes problematic.
D) best achieved with punishment for misbehavior.

Question 28

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 29

The nurse is providing support to a family who is experiencing anticipatory grief related to their child's imminent death.An appropriate nursing intervention is to

A) be available to family.
B) attempt to "lighten the mood."
C) not allow visitors at this time.
D) discourage crying because the child can hear it.

Question 30

Kelly,age 8 years,will soon be able to return to school after an injury that resulted in several severe,chronic disabilities.What action by the school nurse is most appropriate?

A) Recommend that Kelly's parents attend school at first to prevent teasing.
B) Prepare Kelly's classmates and teachers for changes they can expect.
C) Refer Kelly to a school where the children have chronic disabilities similar to hers.
D) Discuss the fact that her classmates will not accept her as they did before.

Question 31

What intervention will best help the siblings of a child with special needs?

A) Explaining to the siblings that embarrassment is unhealthy
B) Encouraging the parents not to expect siblings to help them care for the child with special needs
C) Providing information to the siblings about the child's condition only as they request it
D) Suggesting to the parents ways of maintaining the siblings' usual routine and participation in activities

Question 32

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 explain to the 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 their illness.

Question 33

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

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

The student nurse learns the stages of grief according to Kübler-Ross.What stages does this include? (Select all that apply.)

A) Shock
B) Denial
C) Anger
D) Bargaining
E) Acceptance

Question 35

Which should a nurse identify as common chronic illnesses of childhood? (Select all that apply.)

A) Reactive airway disease (asthma)
B) Respiratory syncytial virus (RSV)
C) Cerebral palsy
D) Diabetes mellitus
E) Human immunodeficiency virus infection (HIV)