San Jacinto College - RNSG 2201

Chapter 17: Quality of Life for Children Living with Chronic and Complex Diseases Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition

MULTIPLE CHOICE

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?

1. 1. Family and nursing staff
   2. Social worker, nursing staff, and primary care physician
   3. Family and key health professionals involved in the child’s care
   4. Primary care physician and key health professionals involved in the child’s care

2. Which represents a common best practice in the provision of services to children with special

needs?

1. 1. Care is now being focused on the child’s chronologic age.
   2. Children with special needs are being integrated into regular classrooms.
   3. Children with special needs no longer have to be cared for by their families.
   4. Children with special needs are being separated into residential treatment facilities.

3. 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 her disability was so severe. What is the best interpretation of this situation?

1. 1. This is a sign parents are in denial
   2. This is a normal anticipated time of parental stress
   3. The parents need to learn more about cerebral palsy
   4. The parents are used to having expectations that are too high

4. Approach behaviors are those 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. Which is considered an approach behavior?
   1. Is unable to adjust to a progression of the disease or condition
   2. Anticipates future problems and seeks guidance and answers
   3. Looks for new cures without a perspective toward possible benefit
   4. Fails to recognize the seriousness of the child’s condition despite physical evidence

5. 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 of the following responses?
   1. Denial
   2. Guilt and anger
   3. Social reintegration
   4. Acceptance of the child’s limitations

6. Which nursing intervention is especially helpful in assessing parental guilt when a disability or chronic illness is diagnosed?
   1. Ask the parents if they feel guilty.
   2. Discuss guilt only after the parents mention it.
   3. Discuss the meaning of the parents’ religious and cultural background.
   4. Observe for signs of overprotectiveness.

7. The nurse observes that a seriously ill child passively accepts all painful procedures. What should the nurse recognize this child is most likely experiencing?
   1. A sense of hopefulness
   2. A sense of chronic sorrow
   3. A belief that procedures are a deserved punishment
   4. A belief that procedures are an important part of care

8. 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. Which is the nurse’s best response?

1. 1. “What is really wrong?”
   2. “Being angry is only natural.”
   3. “Yelling at me will not change things.”
   4. “I will come back when you settle down.”

9. A common parental reaction to a child with special needs is parental overprotection. What parental behavior is suggestive of this behavior?
   1. Giving inconsistent discipline
   2. Providing consistent, strict discipline
   3. Forcing child to help self, even when not capable
   4. Encouraging social and educational activities not appropriate to child’s level of capability

10. Most parents of children with special needs tend to experience chronic sorrow. What characterizes chronic sorrow?
    1. Lack of acceptance of the child’s limitation
    2. Lack of available support to prevent sorrow
    3. Periods of intensified sorrow when experiencing anger and guilt
    4. Periods of intensified sorrow and loss that occur in waves over time

11. Which intervention will encourage a sense of autonomy in a toddler with disabilities?
    1. Avoid separation from family during hospitalizations.
    2. Encourage independence in as many areas as possible.
    3. Expose child to pleasurable experiences as much as possible.
    4. Help parents learn special care needs of their child.

12. The feeling of guilt that the child “caused” the disability or illness is especially critical in which child?
    1. Toddler
    2. Preschooler

1. 3. School-age child
   4. Adolescent

13. A 9-year-old boy 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. What is the nurse’s best interpretation of this statement?
    1. The father is experiencing denial
    2. The father is expressing his own views
    3. The child is using an adaptive coping style
    4. The child is using a maladaptive coping style

14. 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, “Whom do you talk to when something is worrying you?” How should the nurse’s statement be interpreted?
    1. Inappropriate, because the parent is so upset
    2. A diversion of the present crisis to similar situations with which the parent has dealt
    3. An intervention to find someone to help the parent
    4. Part of assessing the parent’s available support system

15. 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. What is the nurse’s best intervention?
    1. Patiently continue to answer questions.
    2. Kindly refer them to someone else for answering their questions.
    3. Recognize that some parents cannot understand explanations.
    4. Suggest that they ask their questions when they are not upset.

16. Which is the most appropriate nursing intervention to promote normalization in a school-age child with a chronic illness?
    1. Give the child as much control as possible.
    2. Ask the child’s peer to make the child feel normal.
    3. Convince the child that nothing is wrong with him or her.
    4. Explain to parents that family rules for the child do not need to be the same as for healthy siblings.

17. Which nursing intervention should the nurse include to help the siblings of a child with special needs cope?
    1. Explain to the siblings that embarrassment is unhealthy
    2. Encourage the parents not to expect siblings to help them care for the child with

special needs

1. 3. Provide information to the siblings about the child’s condition only as they request it
   4. Suggest to the parents ways of showing gratitude to the siblings who help care for the child with special needs

18. The parents of a child born with disabilities ask the nurse for advice about discipline. What information about disciple should the nurse’s response include?
    1. It is essential for the child.
    2. It is too difficult to implement with a special-needs child.

1. 3. It is not needed unless the child becomes problematic.
   4. It is best achieved with punishment for misbehavior.

19. Kelly, an 8-year-old girl, will soon be able to return to school after an injury that resulted in several severe, chronic disabilities. Which is the most appropriate action by the school nurse?
    1. Recommend that the child’s parents attend school at first to prevent teasing.
    2. Prepare the child’s classmates and teachers for changes they can expect.
    3. Refer the child to a school where the children have chronic disabilities similar to hers.
    4. Discuss with the child and her parents the fact that her classmates will not accept her as they did before.

20. A 16-year-old with a chronic illness has recently become rebellious and is taking risks such as missing doses of his medication. What is the best explanation for this behavior?
    1. Needs more discipline
    2. Needs more socialization with peers
    3. This is part of normal adolescence
    4. This is how he is asking for more parental control

21. Which term best describes a multidisciplinary approach to the management of a terminal illness that focuses on symptom control and support?

1. 1. Dying care
   2. Curative care
   3. Restorative care
   4. Palliative care

22. Which best describes how preschoolers react to the death of a loved one?
    1. A preschooler is too young to have a concept of death.
    2. A preschooler may feel guilty and responsible for the death.
    3. Grief is acute but does not last long at this age.
    4. Grief is usually expressed in the same way in which the adults in the preschooler’s life are expressing grief.

23. A preschooler is found digging upNaUpReStINbGirTdBt.hCaOt Mwas recently buried after it died. What is the best explanation for this behavior?
    1. Has a morbid preoccupation with death
    2. Is looking to see whether a ghost took it away
    3. The loss is not yet resolved, and professional counseling is needed
    4. Reassurance is needed that the pet has not gone somewhere else

24. At what age do most children have an adult concept of death as being inevitable, universal, and irreversible?
    1. 4 to 5 years
    2. 6 to 8 years
    3. 9 to 11 years
    4. 12 to 16 years

25. Which is most descriptive of a school-age child’s reaction to death?
    1. Is very interested in funerals and burials
    2. Has little understanding of words such as forever
    3. Imagines the deceased person to be still alive
    4. Has an idealistic view of the world and criticizes funerals as barbaric

26. At what developmental period do children have the most difficulty coping with death, particularly if it is their own?
    1. Toddlerhood
    2. Preschool
    3. School-age
    4. Adolescence

27. 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 tell the parents?
    1. This will help the child cope effectively by denial.
    2. This attitude is helpful to give parents time to cope.
    3. Terminally ill children know when they are seriously ill.
    4. Terminally ill children usually choose not to discuss the seriousness of their illness.

28. A cure is no longer possible for a young child with cancer. The nursing staff recognizes that the goal of treatment must shift from cure to palliation. Which is an important consideration at this time?
    1. The family is included in the decision to shift the goals of treatment.
    2. The decision must be made by the health professionals involved in the child’s care.
    3. The family needs to understand that palliative care takes place in the home.
    4. The decision should not be communicated to the family because it will encourage a sense of hopelessness.

29. 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 is the nurse’s most appropriate response?
    1. Grant their request
    2. Assess why they feel this is necessary
    3. Discourage this because it will only prolong their grief
    4. Kindly explain that they need to say good-bye to their child now and leave

30. 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. How should the nurse interpret these feelings?
    1. These are normal grief responses
    2. The pain of the loss is usually less by this time
    3. These grief responses are more typical of the early stages of grief
    4. This grieving is essential until the pain is gone and the child is gradually forgotten.

31. At the time of a child’s death, the nurse tells his mother, “We will miss him so much.” What is the best interpretation of this statement?
    1. Pretending to be experiencing grief
    2. Expressing personal feelings of loss

1. 3. Denying the mother’s sense of loss
   4. Talking when listening would be better

32. Which is an appropriate nursing intervention when providing comfort and support for a child when death is imminent?
    1. Limit care to essentials.
    2. Avoid playing music near the child.
    3. Explain to the child the need for constant measurement of vital signs.
    4. Whisper to the child instead of using a normal voice.

33. The nurse is providing support to a family who is experiencing anticipatory grief related to their child’s imminent death. Which of the following is an appropriate nursing intervention?
    1. Be available to the family.
    2. Attempt to “lighten the mood.”
    3. Suggest activities to cheer up the family.
    4. Discourage crying until actual time of death.

34. A new nurse is caring for a child who will require palliative care. Which statement made by the new nurse would indicate a correct understanding of palliative care?
    1. “Palliative care serves to hasten death and make the process easier for the family.”
    2. “Palliative care provides pain and symptom management for the child.”
    3. “The goal of palliative care is to place the child in a hospice setting at the end of life.”
    4. “The goal of palliative care is to act as the liaison between the family, child, and other health care professionals.”

35. Parents are asking about an early intervention program for their child who has special needs. The nurse relates that this program is for which age of child?
    1. Birth to 1 year of age
    2. Birth to 3 years of age
    3. Ages 1 to 4
    4. Ages 4 and 5

36. A nurse is planning palliative care for a child with severe pain. Which should the nurse expect to be prescribed for pain relief?
    1. Opioids as needed
    2. Opioids on a regular schedule
    3. Distraction and relaxation techinques
    4. Nonsteroidal anti-inflammatory drugs

37. The home health nurse is caring for a child who requires complex care. The family expresses frustration related to obtaining accurate information about their child’s illness and its management. Which is the best action for the nurse?
    1. Determine why the family is easily frustrated.
    2. Refer the family to the child’s primary care practitioner.
    3. Clarify the family’s request, and provide the information they want.
    4. Answer only questions that the family needs to know about.

38. A mother of a 5-year-old child, with complex health care needs and cared for at home, expresses anxiety about attending a kindergarten graduation exercise of a neighbor’s child.

The mother says, “I wish it could be my child graduating from kindergarten.” What should the nurse recognize the mother is experiencing?

1. 1. Abnormal anxiety
   2. Ineffective coping
   3. Chronic sorrow
   4. Denial

MULTIPLE RESPONSE

1. Which describes avoidance behaviors parents may exhibit when learning that their child has a chronic condition?
   1. Refuses to agree to treatment
   2. Shares burden of disorder with others
   3. Verbalizes possible loss of child
   4. Withdraws from outside world
   5. Punishes self because of guilt and shame

2. Which are appropriate statements the nurse should make to parents after the death of their child?
   1. “We feel so sorry that we couldn’t save your child.”
   2. “Your child isn’t suffering anymore.”
   3. “I know how you feel.”
   4. “You’re feeling all the pain of losing a child.”
   5. “You are still young enough to have another baby.”

3. Which are adaptive coping patterns used by children with special needs?
   1. Feels different and withdraws
   2. Is irritable, moody, and acts out
   3. Seeks support

1. 4. Develops optimism

4. A child dependent on medical technology is preparing to be discharged from the hospital to home. Which predischarge assessments should the nurse ensure?
   1. Emergency care and transport plan
   2. Reliance on private duty nurses to teach the family infection control practices
   3. Financial arrangements
   4. Individualized home plan to be completed within the first month of the child’s discharge