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?

Accepted Answer

The preschooler can recognize that the pet has died but has difficulties with the permanence of death.Digging up the bird gives reassurance that the bird is still present.A morbid preoccupation with death and the child looking to see if a ghost took it away are not expected responses.If they persist,intervention may be required.

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?

Accepted Answer

The father is describing a well-adapted child who has learned to accept physical limitations.These children function well at home,at school,and with peers.They have an understanding of their condition that allows them to accept their limitations,assume responsibility for care,and assist in treatment and rehabilitation.The parent is not denying his child's limitations.His statement is descriptive of an adaptive coping style,not a maladaptive one.

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?

Accepted Answer

Discipline is essential for the child.It provides boundaries and teaches the child socially acceptable behaviours.The nurse should teach the parents ways to manage the child's behaviour before it becomes problematic.Punishment is not effective in managing behaviour.

Question 4

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

Accepted Answer

Because of their mature understanding of death,remnants of guilt and shame,and issues with deviations from what is normal,adolescents have the most difficulty coping with death.Toddlers and preschoolers are too young to have difficulty coping with their own death.They will fear separation from their parents.School-age children will fear the unknown,such as the consequences of the illness and the threat to their sense of security.

Question 5

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

Accepted Answer

Chronic sorrow is manifested by feelings of sorrow and loss that recur in waves over time.The sorrow comes in response to the recognition of the child's limitations.The family should be assessed on a regular basis in order to provide appropriate support as their needs change.The sorrow is not preventable and occurs during the reintegration and acknowledgement stage.

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?

Accepted Answer

For most families,the adjustment phase is accompanied by several responses that are considered normal.A large portion of this phase is one of grief for a loss.The initial diagnosis of a chronic illness or complex condition is often met with intense emotion and characterized by shock and denial.Social reintegration and acceptance of the child's limitations is the culmination of the adjustment process.

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?

Accepted Answer

Parents who anticipate future problems and seek guidance and answers are demonstrating approach behaviours.They are demonstrating positive actions in caring for their child.Avoidance behaviours include being unable to adjust to the progression of the disease or condition,looking for new cures without a thinking of the possible benefit,and failing to recognize the seriousness of the child's condition despite physical evidence.These behaviours would suggest that the parents are moving away from adjustment,or showing maladaptation to the crisis of a child with chronic illness or complex condition.

Question 8

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

Accepted Answer

By age 9 or 10 years of age,children have an adult concept of death.They realize that it is inevitable,universal,and irreversible.Preschoolers and young school-age children are too young to have an adult concept of death.Adolescents have a mature understanding of death.

Question 9

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

Accepted Answer

The school-age child is very interested in post-death services and may be inquisitive about what happens to the body.School-age children have an established concept of forever and a deeper,concrete understanding of death.Adolescents may be idealistic in their views and criticize funerals.

Question 10

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

Accepted Answer

Preschoolers are most likely to be affected by feelings of guilt that they caused the illness or disability or are being punished for wrongdoings.Toddlers are focused on establishing their autonomy,while illness or disability will often require dependency.The school-age child will have limited opportunities for achievement and may not be able to understand limitations.Adolescents are faced with the task of incorporating their disabilities into their changing self-concept.

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?

Accepted Answer

A multidisciplinary conference is necessary to coordinate care for a child with complex health needs.The family and key health professionals who are involved in the child's care should thus be included.The nursing staff can address the nursing care needs of the child with the family,but other involved disciplines must be included to cover all aspects of care.The family must be included to gain the education they will require and prepare the resources needed at home.

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?

Accepted Answer

Attendance at school is an important part of normalization for Kelly.The school nurse should prepare teachers and classmates with information about her condition,abilities,and special needs.A visit by the parents can be helpful,but unless the classmates are prepared for the changes,that alone will not prevent teasing.Children need the opportunity to interact with healthy peers and engage in activities with groups or clubs composed of similarly affected persons.Children with special needs are encouraged to maintain and re-establish relationships with peers and participate according to their capabilities.

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?

Accepted Answer

Risk-taking,rebelliousness,and lack of cooperation are normal parts of adolescence,during which the young adult is establishing independence.If the parents increase the amount of discipline,the boy will most likely become more rebellious.Socialization with peers should be encouraged.

Question 14

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

Accepted Answer

Overprotection manifests in the parents' fear of letting the child achieve any new skill,avoiding all discipline,and catering to the child's every desire in order to prevent frustration.Overprotective parents usually do not set limits or institute discipline,and they prefer to remain in the role of total caregiver.They do not allow the child to perform self-care or encourage the child to try new activities.

Question 15

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

Accepted Answer

Encouraging the toddler to be independent whenever possible fosters a sense of autonomy.The child can be given choices about feeding,dressing,and choice of diversional activities,which will provide a sense of control.These interventions should be practised as part of family-centred care,but they do not particularly foster autonomy.Exposing the child to pleasurable experiences,especially sensory ones,is a supportive intervention that does not particularly support autonomy.

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?

Accepted Answer

The parents should be allowed to remain with their child after death.The nurse can remove all of the tubes and equipment and offer the parents the option of preparing the body.This is an important part of the grieving process and should be allowed if the parents desire it.It is important for the nurse to ascertain if the family has any special needs.

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?

Accepted Answer

Parenting a child with a chronic illness or complex condition can be very stressful for parents.There are anticipated times that parental stress increases.One of these identified times is when the child begins school.Nurses can help parents recognize and plan interventions to work through these stressful periods.The parents are not in denial,they are responding to the child's placement in school.They are also not exhibiting signs of a knowledge deficit;this is their first interaction with the school system with this child.

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?

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 parents understand the importance of honesty.The child will know that something is wrong because of the increased attention of health professionals.This would interfere with denial as a form of coping.Parents may need professional support and guidance from a nurse or social worker in this process.Children will usually tell others how much information they want about their condition.

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?

Accepted Answer

Diagnosis is one of the anticipated stress points for parents.The parents may not hear or remember all that is said to them.The nurse should continue to provide the kind of information that they desire.This is a particularly stressful time for the parents,so they should be provided with oral and written information.The nurse needs to work with the family to ensure they understand the information provided at the time of diagnosis.Other questions will arise as they adjust to the information.

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?

Accepted Answer

This is very important information for the nurse to obtain and constitutes an appropriate part of an accurate assessment.This question will provide information about the marital relationship (does the parent speak to the spouse?),alternate support systems,and the parent's ability to communicate.By assessing these areas,the nurse can facilitate the parent's identification and use of community resources,as needed.The nurse is obtaining information to help support the parent through the diagnosis.The parent is not in need of additional parenting help at this time.

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