Question 1

The nurse caring for infants and children understands that which are the scariest aspects of being hospitalized for a 3-year-old?

Accepted Answer

The most frightening aspects of hospitalization for toddlers are pain,anxiety,and separation from the parents.Being different from peers is an issue for older children.Fear that illness is punishment is characteristic of the preschooler.

Question 2

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?

Accepted Answer

There are many ways for the nurse to develop a trusting relationship with the family of a child who is chronically or terminally ill.In addition to the four correct options listed above,the nurse should also remember to include the siblings of the patient whenever possible.Siblings often feel left out and isolated.

Question 3

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?

Accepted Answer

Many caregivers describe their health as poor,and many factors may contribute to poor caregiver health.Some factors include insomnia,depression,poor eating,lack of exercise,lack of the ability to take time off for personal health issues/wellness activities,and financial burdens.All of these issues increase the chances of the family caregiver becoming ill.

Question 4

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?

Accepted Answer

School-age children often know and understand more than parents want to believe.Attempting to shield the child in this age group from the realities of his or her condition can create an atmosphere of distrust.An angry and uncooperative child often is displaying that distrust.The nurse should open up a conversation with the child and find out what she already knows (or thinks she knows)about her condition.This can help create trust.The child may need some time alone,but this by itself will not improve the situation.Rewards for good behavior may be helpful,especially if the parents use this technique at home,but,again,this is not the best answer.Simply telling the child to behave is not likely to be helpful.

Question 5

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?

Accepted Answer

Kübler-Ross identified five stages of grief: denial and isolation,anger,bargaining,depression,and acceptance.People do not go through these stages in a linear fashion.It is important also for the nurse to understand that people will have good days and bad days,no matter what stage of grief they are in.However,in each stage,there are warning signs that indicate further action should occur.The inability to function normally is one of these warning signs,and the nurse should ensure the parent has appropriate follow-up.

Question 6

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?

Accepted Answer

There are many manifestations of impending death,including changes in breathing patterns,decreased oral intake,pale or cool skin,and restlessness or agitation.Blood pressure will decrease.

Question 7

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

Accepted Answer

Everyone needs something to hope for,even if that hope is for a good death.Giving the family options based on what is actually possible helps them maintain some sense of control and allows them to provide caring measures they feel are important.They may or may not want to participate in providing physical care.They may or may not want other siblings present as the child dies.They may or may not want to eat at particular times.

Question 8

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?

Accepted Answer

The leading causes of death in adolescents are accidents,homicide,suicide,and cancer.Preventative measures directed toward violence and injury prevention would have the greatest impact.Prenatal care and genetic testing would most affect the death rate in infants,the leading causes of which are prematurity and congenital defects.Decreasing exposure to carcinogens might have the greatest impact on school-age children,in whom the most frequent cause of death is cancer and accidents.

Question 9

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?

Accepted Answer

Once hospice care has been chosen,it is important to not make drastic changes in the care plan,especially as the end of life approaches.Hospice care recognizes that death is part of life and is focused on symptom control and quality of life,not cure.The parent who plans to call 911 for shortness of breath does not understand this concept,nor does he or she understand manifestations of approaching death.The other statements are compatible with hospice care in the home.

Question 10

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?

Accepted Answer

According to Epperson's theory of grieving,people experiencing a sudden or catastrophic loss experience the grief process differently than do others.There are six phases to this process: high anxiety,denial,anger,remorse,grief,and reconciliation.This family appears to be in the high-anxiety stage,with physical manifestations.The nurse should be patient with the family,find one person to communicate with primarily,and understand that this is a normal response to a great emotional upheaval.The family is not dysfunctional and should not be sent home.Violence is always a possibility in the emergency department,but the nurse should not assume that these family members will become violent.The family should be moved to a private waiting room if possible to avoid disrupting the rest of the department,but the nurse should act as if this behavior is understandable,not something to be controlled.

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