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

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?

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

Answer 1

Family and key health professionals involved in child's care

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:

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 the seriousness of their illness.

Answer 2

Terminally ill children know when they are seriously ill.

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:

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

Answer 3

Child is using 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?

A)Toddlerhood
B)Preschool
C)School-age
D)Adolescence

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:

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 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:

A)Patiently continue to answer 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 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?

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

Question 8

A common parental reaction to a child with special needs is parental overprotection. Parental behavior suggestive of this includes:

A)Giving inconsistent discipline.
B)Providing consistent,strict discipline.
C)Forcing child to help self,even when not capable.
D)Encouraging social and educational activities not appropriate to child's level of capability.

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:

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

Question 10

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

A)Avoiding separation from family during hospitalizations
B)Encouraging independence in as many areas as possible
C)Exposing child to pleasurable experiences as much as possible
D)Helping parents learn special care needs of their child

Question 11

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 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:

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

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:

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

Question 14

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

A)Is very interested in funerals and burials
B)Has little understanding of words such as forever
C)Imagines the deceased person to be still alive
D)Has an idealistic view of world and criticizes funerals as barbaric

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?

A)Is unable to adjust to a progression of the disease or condition
B)Anticipates future problems and seeks guidance and answers
C)Looks for new cures without a perspective toward possible benefit
D)Fails to recognize seriousness of child's condition despite physical evidence

Question 16

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 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:

A)Essential for the child.
B)Too difficult to implement with a special-needs child.
C)Not needed unless child becomes problematic.
D)Best achieved with punishment for misbehavior.

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:

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 19

Most parents of children with special needs tend to experience chronic sorrow. This is characterized by:

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

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:

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 21

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 22

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. The nurse should:

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 23

The loss of a child is often the most difficult and traumatic event that a parent will ever experience. For this reason the parents should never be approached regarding organ donation.

Question 24

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

Question 25

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. The nurse should recognize that:

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 26

An appropriate nursing intervention when providing comfort and support for a child when death is imminent is to:

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