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.

Accepted Answer

Chronic illness may interfere in the development of autonomy,which is the major psychosocial task of the toddler.The infant with a chronic illness may have distortion of differentiation of self from parents.Chronic illness with frequent hospitalizations can inhibit the acquisition of language,motor,and self-care skills in the preschool-age child.Feelings of inadequacy and inferiority can occur if independence is compromised by chronic illness in the school-age child.

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

Accepted Answer

To obtain the highest level of health and function possible is the priority goal of nursing children with a chronic illness.Maintaining intactness of the family is a great goal,but it is for the family,not the child.Eliminating all stressors and achieving complete wellness are not realistic.

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."

Accepted Answer

Nurses can inform parents that they will not initiate any discussion with the child but that they intend to respond openly and honestly if and when the child initiates such a discussion.As the caregiver and advocate,the nurse should first meet the child's needs.Asking the parent if the child has the right to know is judgmental and could affect the nurse's relationship with the child's parents.Having the provider speak with the child does not address the parent's concerns or the nurse's responsibility.

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.

Accepted Answer

Families should be encouraged to talk to the child because verbal communication and physical touch are important both for the family and child.Nursing care should minimize disruptions but not contact.When a child is dying,fluids should be based on the child's requests,with a focus on comfort and preventing a dry mouth.The times when the child is alert should be devoted to family contacts.

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

Accepted Answer

The primary concern of all parents of dying children is the possibility of their child feeling pain.The nurse works vigilantly to assess and treat the child's pain.The other options are also important considerations but usually not the priority concern.

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

Accepted Answer

Preschoolers are most likely to be affected by feelings of guilt that they caused the illness/disability or are being punished for wrongdoings.

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.

Accepted Answer

Development of identity is the task of the adolescent.Inadequacy and inferiority refer to the school-age period.Parental attachment is a task of the infant.Development of imagination occurs in the preschool period.

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

Accepted Answer

A multidisciplinary conference is necessary for coordination of care for children with complex health needs.The family is involved as well as key health professionals who are involved in the child's care.The nursing staff can address the nursing care needs of the child with the family,but other involved disciplines must be included.The family must be included in the discharge conferences,which allow them to determine what education they will require and the resources needed at home.A member of the nursing staff must be included to review the nursing needs of the child.

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

Accepted Answer

Infants and toddlers view death as loss of a caretaker.The preschool-age child views death as temporary.The school-age child and adolescent understand the permanence of death.The preschool-age child facing impending death may view his or her condition as punishment for behaviors or thoughts.

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

Accepted Answer

According to Kübler-Ross,denial is the initial stage of the grieving process when an individual reacts with shock and disbelief to the diagnosis of chronic illness.The other responses are also part of the grieving process although not usually the initial response.

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

Accepted Answer

This is the priority nursing diagnosis that is appropriate for the majority of chronic illnesses.The child may or may not have frequent injections and invasive procedures.A chronic illness is one that does not have a cure.It does not mean the child will die prematurely.Frequent hospitalizations are not required for all chronic illnesses.

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

Accepted Answer

Children in early childhood (2 to 7 years old)view death as reversible and temporary.Loss of a caretaker corresponds to the infant/toddler understanding of death.The school-age child and adolescent understand that death is permanent.The adolescent understands death not only as permanent but also 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."

Accepted Answer

Hearing is the last sense to cease before death.Talking to the dying child is important both for the child and the family.The sense of hearing is intact before death and there is no need to speak loudly.The sibling should be encouraged to speak to the child,as well as hold the child's hand.The sibling should be encouraged to sit close and speak to the dying child.

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

Accepted Answer

The major fear of infants during illness and hospitalization are separation from caregivers and fear of strangers.Bodily injury and pain are fears of preschool and school-age children.Loss of control is a fear of children from the preschool period through adolescence.Altered body image applies to adolescents.Fear of the unknown and being left alone are applicable to preschoolers.

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.

Accepted Answer

The stated recurrent feelings define chronic sorrow,which is considered a normal process involving grief that may never be resolved.Anticipatory grieving is the process of mourning,coping,interacting,planning,and psychosocial reorganization that is begun as a response to the impending loss of a loved one.Bereavement is defined as the objective condition or state of loss.Illness trajectory is defined as the impact of the disease or condition on all family members,physiologic unfolding of the disease,and work organization done by the family to cope.

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."

Accepted Answer

The first step in supporting families and helping them deal with chronic sorrow is to listen to and recognize their pain.Each individual's perception of a situation is different.A nurse can never know exactly how parents feel about having a child with a chronic illness.The family may welcome involvement in a support group or meeting with a counselor,but that should not be the first action.

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

Accepted Answer

Providing play gives the toddler some time to work on growth and development skills and normalizes hospitalization at least for that time.Toddlers typically don't play together in groups.Art supplies may or may not be too advanced for the toddler,but in any case,this would be a form of play.Watching cartoons on television is passive and will not promote autonomy.

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."

Accepted Answer

Parental anger after the diagnosis of a child with a chronic disability is a common response.One of the most common targets for parental anger is members of the staff.The nurse should recognize the common response of anger to the diagnosis and allow the family to ventilate.The other responses do not validate the parents' feelings and concerns and may hamper a therapeutic nurse-family relationship.

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

Accepted Answer

After the initial shock has worn off,families often respond to a chronic illness diagnosis with anger.Social reintegration and acceptance may or may not ever occur but if they do it is the culmination of the grief process.

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

Accepted Answer

Family cohesiveness is the predominant trait of the resilient family.Social integration,not separation is another trait.Family flexibility and clear family boundaries are other traits of the resilient family but not the predominant one.

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

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

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

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

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

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

The feeling of guilt that the child "caused" the disability or illness is especially critical in which child?

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

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?

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?

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?

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

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

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

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

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

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?

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

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

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?

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