Deck 36: The Child With a Chronic Condition or Terminal Illness

Question 1

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
C) Anticipatory grieving related to impending death
D) Anxiety related to frequent hospitalizations

Answer 1

Risk for delayed growth and development related to chronic illness or disability

Question 2

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

Answer 2

Shock and disbelief

Question 3

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

Answer 3

To obtain the highest level of wellness

Question 4

What is the primary concern for the parents of a dying child?

A) Pain
B) Safety
C) Food intake
D) Fluid intake

Question 5

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 physician to speak with your child?"
D) "I'll answer any questions she asks me as honestly as I can."

Question 6

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) Guilt and anger
C) Social reintegration
D) Acceptance of child's limitations

Question 7

You are 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

Question 8

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

Question 9

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

A) Playing with a push-pull toy
B) Putting together a puzzle
C) Playing a simple card game
D) Watching cartoons on television

Question 10

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 11

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.

Question 12

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

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."

Question 14

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 made aware 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.

Question 15

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.

Question 16

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

Question 17

An important nursing goal in caring for the hospitalized child is to minimize the negative effects of illness and hospitalization.On what should the nurse focus while caring for a hospitalized infant?

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

Question 18

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 19

Identify the most appropriate response for the nurse when parents say,"Living with this disease is really hard; it's not fair."

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."

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

Question 21

Which indicators of imminent death in a child should the nurse expect to assess? Select all that apply.

A) Heart rate increases.
B) Blood pressure increases.
C) Respirations become rapid and shallow.
D) The extremities become warm.
E) Peripheral pulses become stronger.

Question 22

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 23

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 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 24

Which should a nurse identify as common chronic illnesses of childhood? Select all that apply.

A) Reactive airway disease (asthma)
B) Respiratory syncytial virus (RSV)
C) Cerebral palsy
D) Diabetes mellitus
E) Human immunodeficiency virus infection (HIV)

Question 25

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 special-needs child
C) Not needed unless the child becomes problematic
D) Best achieved with punishment for misbehavior

Question 26

Kelly,age 8 years,will soon be able to return to school after an injury that resulted in several severe,chronic disabilities.The most appropriate action by the school nurse is to

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

Question 27

Nursing interventions to help the siblings of a child with special needs cope include

A) Explaining to the siblings that embarrassment is unhealthy
B) Encouraging the parents not to expect siblings to help them care for the child with special needs
C) Providing information to the siblings about the child's condition only as they request it
D) Suggesting to the parents ways of showing gratitude to the siblings who help care for the child with special needs

Question 28

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 29

For many terminally ill children and their families,being at home or in a special facility may be the preferred choice for meeting their complex needs during the dying process.This is commonly known as ____________.

Question 30

Dying children often experience a sense of heightened awareness and understanding.Accordingly some children,particularly those who are very young,may need verbal "permission" to die.Is this statement true or false?

Question 31

What should the nurse identify as major fears in the preschool child who is hospitalized with a chronic illness? Select all that apply.

A) Altered body image
B) Separation from peer group
C) Bodily injury
D) Mutilation
E) Being left alone

Question 32

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

Question 33

Resilient families are those that are able to recover from the adversities associated with caring for a child with a chronic illness.They do this through a process known as _______.

Question 34

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 35

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.