Deck 40: Chronic Illness, Complex Conditions, and End-of-Life Care

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 behaviour?

A) He has a morbid preoccupation with death.
B) He is looking to see if a ghost took it away.
C) The loss is not yet resolved,and professional counselling is needed.
D) Reassurance is needed that the pet has not gone somewhere else.

Answer 1

Reassurance is needed that the pet has not gone somewhere else.

Question 2

A father explains to the nurse that his 9-year-old,who has several physical limitations,concentrates on what he can do rather than what he cannot do,and is as independent as possible.What is the best way for the nurse to interpret of this information?

A) The father is experiencing denial.
B) The father is expressing his own views.
C) The child is using an adaptive coping style.
D) The child is using a maladaptive coping style.

Answer 2

The child is using an adaptive coping style.

Question 3

The parents of a child born with disabilities ask the nurse for advice about discipline.What information about discipline should the nurse's response be based on?

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

Answer 3

It is essential for the child.

Question 4

At which 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 5

Most parents of children with special needs tend to experience chronic sorrow.What is one characteristic of chronic sorrow?

A) Lack of acceptance of the child's limitation
B) Lack of available support to prevent sorrow
C) Periods of intensified sorrow while experiencing anger and guilt
D) Periods of intensified sorrow and loss that occur in waves over time

Question 6

Families progress through various stages of reactions when a child is diagnosed with a chronic illness or complex condition.Which characterizes the period of adjustment that usually follows the shock phase?

A) Denial
B) Bitterness and anger
C) Social reintegration
D) Acceptance of child's limitations

Question 7

Approach behaviours 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 complex condition.Which is considered an approach behaviour?

A) The parent is unable to adjust to the progression of the disease or condition.
B) The parent anticipates future problems and seeks guidance and answers.
C) The parent looks for new cures without thinking of the possible benefit.
D) The parent fails to recognize the seriousness of child's condition despite physical evidence.

Question 8

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

A) 4 to 5 years of age
B) 6 to 8 years of age
C) 9 to 11 years of age
D) 12 to 16 years of age

Question 9

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

A) The child is very interested in funerals and burials.
B) The child has little understanding of words such as forever.
C) The child imagines the deceased person to be still alive.
D) The child has an idealistic view of world and criticizes funerals as barbaric.

Question 10

The feeling of guilt that the child "caused" the disability or illness is especially important in children from which age group?

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

Question 11

The nurse case manager is planning a care conference for 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) The 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 12

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

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 children have chronic disabilities similar to hers.
D) Discuss with Kelly and her parents the fact that her classmates will not accept her as they did before.

Question 13

A 16-year-old boy with a chronic illness has recently become rebellious and is taking risks,such as missing doses of his medication.What should the nurse explain about this behaviour to his parents?

A) He needs more discipline.
B) He needs more socialization with peers.
C) This is part of normal adolescence.
D) This is how he is asking for more parental control.

Question 14

A common parental reaction to a child with special needs is overprotection.Which is suggestive of this type of behaviour?

A) Providing inconsistent discipline
B) Providing consistent,strict discipline
C) Forcing the child to help him- or herself,even when not capable
D) Encouraging social and educational activities not appropriate to the child's level of capability

Question 15

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

A) Avoid separation from the family during hospitalizations.
B) Encourage independence in as many areas as possible.
C) Expose the child to pleasurable experiences as much as possible.
D) Help parents learn the special care needs of their child.

Question 16

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 should the nurse do?

A) Grant their request.
B) Assess why they feel that 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 17

A 5-year-old with cerebral palsy will be starting kindergarten next month,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 condition was so severe.What is the best way for the nurse to interpret this situation?

A) This is a sign that parents are in denial.
B) This is a normal,anticipated time of parental stress.
C) The parents need to learn more about cerebral palsy.
D) The parents are used to having expectations that are too high.

Question 18

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 denial will help the child cope effectively.
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 the seriousness of their illness.

Question 19

The nurse is providing support to parents when their child has just been diagnosed with chronic complex conditions.What should the nurse do when the parents keep asking the same questions over and over?

A) Patiently continue to answer their questions.
B) Kindly refer them to someone else to answer their questions.
C) Recognize that some parents cannot understand explanations.
D) Suggest that they ask their questions when they are not upset.

Question 20

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,"Who do you talk to when something is worrying you?" What is the nurse's intention when asking this question?

A) Inappropriate,because the parent is so upset
B) A diversion from the present crisis to similar situations the parent has dealt with
C) An intervention to find someone to help the parent
D) Part of assessing the parent's available support system

Question 21

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

A) Be available to the family.
B) Attempt to "lighten the mood."
C) Suggest activities to cheer up the family.
D) Discourage crying until the actual time of death.

Question 22

When assessing the family with a child that has a severe complex condition,which will the nurse document as characteristic of parental overprotection? Select all that apply.Express answer in small letters followed by a comma and a space-e.g. ,a,b,c

A) Inconsistent discipline
B) Sets appropriate age-related goals
C) Restricts play activities
D) Encourages wide network of friends and playmates
E) Focuses on school attendance
F) Alteration in sleep pattern
G) Flat affect

Question 23

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.What should the nurse recognize about this situation?

A) These are normal grief responses.
B) The pain of the loss is usually less by this time.
C) These grief responses are more typical of the early stages of grief.
D) This grieving is essential until the pain is gone and the child is gradually forgotten.

Question 24

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

A) Limit care to essentials.
B) Avoid playing music near the child.
C) Explain to the child the need for the constant measurement of vital signs.
D) Whisper to the child instead of using a normal voice.

Question 25

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

A) The nurse is pretending to be experiencing grief.
B) The nurse is expressing personal feelings of loss.
C) The nurse is denying the mother's sense of loss.
D) The nurse is talking when listening would be better.