Deck 19: Family-Centered Care of the Child with Chronic Illness or Disability

Question 1

The nurse notes that the parents of a critically ill child spend a large amount of time talking with the parents of another child who is also seriously ill. They talk with these parents more than with the nurses. How should the nurse interpret this situation?

A) Parent-to-parent support is valuable.
B) Dependence on other parents in crisis is unhealthy.
C) This is occurring because the nurses are unresponsive to the parents.
D) This has the potential to increase friction between the parents and nursing staff.

Answer 1

Parent-to-parent support is valuable.

Question 2

What nursing intervention is most appropriate in promoting normalization in a school-age child with a chronic illness?

A) Give the child as much control as possible.
B) Ask the child's peer to make the child feel normal.
C) Convince the child that nothing is wrong with him or her.
D) Explain to parents that family rules for the child do not need to be the same as for healthy siblings.

Answer 2

Give the child as much control as possible.

Question 3

A 5-year-old child 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?

A) This is a sign the parents are in denial.
B) This is a normal anticipated time of parental stress.
C) The parents need to learn more about cerebral palsy.
D) The parents' expectations are too high.

Answer 3

This is a normal anticipated time of parental stress.

Question 4

What is the major health concern of children in the United States?

A) Acute illness
B) Chronic illness
C) Congenital disabilities
D) Nervous system disorders

Question 5

What should the nurse determine to be the priority intervention for a family with an infant who has a disability?

A) Focus on the child's disabilities to understand care needs.
B) Institute age-appropriate discipline and limit setting.
C) Enforce visiting hours to allow parents to have respite care.
D) Foster feelings of competency by helping parents learn the special care needs of the infant.

Question 6

The nurse is assessing the coping behaviors of the parents of a child recently diagnosed with a chronic illness. What behavior should the nurse consider an "approach behavior" that results in movement toward adjustment?

A) Being unable to adjust to a progression of the disease or condition
B) Anticipating future problems and seeking guidance and answers
C) Looking for new cures without a perspective toward possible benefit
D) Failing to recognize the seriousness of the child's condition despite physical evidence

Question 7

What intervention is most appropriate for fostering the development of a school-age child with disabilities associated with cerebral palsy?

A) Provide sensory experiences.
B) Help develop abstract thinking.
C) Encourage socialization with peers.
D) Give choices to allow for feeling of control.

Question 8

What manifestation observed by the nurse is suggestive of parental overprotection?

A) Gives inconsistent discipline
B) Facilitates the child's responsibility for self-care of illness
C) Persuades the child to take on activities of daily living even when not able
D) Encourages social and educational activities not appropriate to the child's level of capability

Question 9

What is the single most prevalent cause of disability in children and responsible for the recent increase in childhood disability?

A) Cancer
B) Asthma
C) Seizures
D) Heart disease

Question 10

The nurse is talking to the parent of a child with special needs. The parent has expressed worry about how to support the siblings at home. What suggestion is appropriate for the nurse to give to the parent?

A) "You should help the siblings see the similarities and differences between themselves and your child with special needs."
B) "You should explain that your child with special needs should be included in all activities that the siblings participate in even if they are reluctant."
C) "You should give the siblings many caregiving tasks for your child with special needs so the siblings feel involved."
D) "You should intervene when there are differences between your child with special needs and the siblings."

Question 11

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 to his parents?

A) That he needs more discipline
B) That this is a normal part of adolescence
C) That he needs more socialization with peers
D) That this is how he is asking for more parental control

Question 12

What nursing intervention is especially helpful in assessing feelings of parental guilt when a disability or chronic illness is diagnosed?

A) Ask the parents if they feel guilty.
B) Observe for signs of overprotectiveness.
C) Talk about guilt only after the parents mention it.
D) Discuss the meaning of the parents' religious and cultural background.

Question 13

What finding by the nurse is most characteristic of chronic sorrow?

A) Lack of acceptance of child's limitation
B) Lack of available support to prevent sorrow
C) Periods of intensified sorrow when experiencing anger and guilt
D) Periods of intensified sorrow at certain landmarks of the child's development

Question 14

The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse's response should be based on remembering that discipline is which?

A) Essential for the child
B) Not needed unless the child's behavior becomes problematic
C) Best achieved with punishment for misbehavior
D) Too difficult to implement with a special needs child

Question 15

Parents ask for help for their other children to cope with the changes in the family resulting from the special needs of their sibling. What strategy does the nurse recommend?

A) Explain to the siblings that embarrassment is unhealthy.
B) Encourage the parents not to expect siblings to help them care for the child with special needs.
C) Provide information to the siblings about the child's condition only as requested.
D) Invite the siblings to attend meetings to develop plans for the child with special needs.

Question 16

The nurse observes that a seriously ill child passively accepts all painful procedures. The nurse should recognize that this is most likely an indication that the child is experiencing what emotional response?

A) Hopefulness
B) Chronic sorrow
C) Belief that procedures are a deserved punishment
D) Understanding that procedures indicate impending death

Question 17

The potential effects of chronic illness or disability on a child's development vary at different ages. What developmental alteration is a threat to a toddler's normal development?

A) Hindered mobility
B) Limited opportunities for socialization
C) Child's sense of guilt that he or she caused the illness or disability
D) Limited opportunities for success in mastering toilet training

Question 18

What is a major premise of family-centered care?

A) The child is the focus of all interventions.
B) Nurses are the authorities in the child's care.
C) Parents are the experts in caring for their child.
D) Decisions are made for the family to reduce stress.

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 what response?

A) Denial
B) Guilt and anger
C) Social reintegration
D) Acceptance of the child's limitations

Question 20

A feeling of guilt that the child "caused" the disability or illness is especially common in which age group?

A) Toddler
B) Preschooler
C) School-age child
D) Adolescent

Question 21

The nurse has been visiting an adolescent with recently acquired tetraplegia. The teen's mother tells the nurse, "I'm sick of providing all the care while my husband does whatever he wants to, whenever he wants to do it." What reaction should be the nurse's initial response?

A) Refer the mother for counseling.
B) Listen and reflect the mother's feelings.
C) Ask the father in private why he does not help.
D) Suggest ways the mother can get her husband to help.

Question 22

The parents of a child on a ventilator tell the nurse that their insurance company wants the child to be discharged. They explain that they do not want the child home "under any circumstances." What principle should the nurse consider when working with this family?

A) Desire to have the child home is essential to effective home care.
B) Parents should not be expected to care for a technology-dependent child.
C) Having a technology-dependent child at home is better for both the child and the family.
D) Parents are not part of the decision-making process because of the costs of hospitalization.

Question 23

For case management to be most effective, who should be recognized as the most appropriate case manager?

A) Nurse
B) Panel of experts
C) Multidisciplinary team
D) Insurance company

Question 24

What are supportive interventions that can assist a preschooler with a chronic illness to meet developmental milestones? (Select all that apply.)

A) Encourage socialization.
B) Encourage mastery of self-help skills.
C) Provide devices that make tasks easier.
D) Clarify that the cause of the child's illness is not his or her fault.
E) Discuss planning for the future and how the condition can affect choices.

Question 25

A child with a serious chronic illness will soon go home. The case manager requests that the family provide total care for the child for a couple of days while the child is still hospitalized. How should the request be viewed?

A) Improper because of legal issues
B) Supportive because families are usually eager to get involved
C) Unacceptable because the family will have to assume the care soon enough
D) Important because it can be beneficial to the transition from hospital to home

Question 26

The nurse has been assigned as a home health nurse for a child who is technology dependent. The nurse recognizes that the family's background differs widely from the nurse's own. The nurse believes some of their lifestyle choices are less than ideal. What nursing intervention is most appropriate to institute?

A) Change the family.
B) Respect the differences.
C) Assess why the family is different.
D) Determine whether the family is dysfunctional.

Question 27

The nurse outlines short- and long-term goals for a 10-year-old child with many complex health problems. Who should agree on these goals?

A) Family and nurse
B) Child, family, and nurse
C) All professionals involved
D) Child, family, and all professionals involved

Question 28

The nurse is assessing coping behaviors of a family with a child with a chronic illness. What indicates approach coping behaviors? (Select all that apply.)

A) Plans realistically for the future
B) Verbalizes possible loss of the child
C) Uses magical thinking and fantasy
D) Realistically perceives the child's condition
E) Does not share the burden of the disorder with others

Question 29

When communicating with other professionals about a child with a chronic illness, what is important for nurses to do?

A) Ask others what they want to know.
B) Share everything known about the family.
C) Restrict communication to clinically relevant information.
D) Recognize that confidentiality is not possible in home care.

Question 30

The nurse is planning to use an interpreter with a non-English-speaking family. What should the nurse plan with regard to the use of an interpreter? (Select all that apply.)

A) Use a family member.
B) The nurse should speak slowly.
C) Use an interpreter familiar with the family's culture.
D) The nurse should speak only a few sentences at a time.
E) The nurse should speak to the interpreter during interactions.

Question 31

A child's parents ask the nurse many questions about their child's illness and its management. The nurse does not know enough to answer all the questions. What nursing action is most appropriate at this time?

A) Tell them, "I don't know, but I will find out."
B) Suggest that they ask the physician these questions.
C) Explain that the nurse cannot be expected to know everything.
D) Answer questions vaguely so they do not lose confidence in the nurse.

Question 32

The nurse is assessing coping behaviors of a family with a child with a chronic illness. What indicates avoidance coping behaviors? (Select all that apply.)

A) Refuses to agree to treatment
B) Avoids staff, family members, or child
C) Is unable to discuss possible loss of the child
D) Recognizes own growth through a passage of time
E) Makes no change in lifestyle to meet the needs of other family members

Question 33

The nurse is planning care for a 3-year-old boy who has Down syndrome and is on continuous oxygen. He recently began walking around furniture. He is spoon fed by his parents and eats some finger foods. What goal is the most appropriate to promote normal development?

A) Encourage mobility.
B) Encourage assistance in self-care.
C) Promote oral-motor development.
D) Provide opportunities for socialization.

Question 34

What are supportive interventions that can assist an infant with a chronic illness to meet developmental milestones? (Select all that apply.)

A) Encourage consistent caregivers.
B) Encourage periodic respite from demands of care.
C) Encourage one family member to be the primary caretaker.
D) Encourage parental "rooming in" during hospitalization.
E) Withhold age-appropriate developmental tasks until the child is older.

Question 35

An adolescent with long-term, complex health care needs will soon be discharged from the hospital. The nurse case manager has been assigned to the teen and family. The adolescent's care involves physical therapy, occupational therapy, and speech therapy in addition to medical and nursing care. Who should be the decision maker in the adolescent's care?

A) Adolescent
B) Nurse case manager
C) Adolescent and family
D) Multidisciplinary health care team

Question 36

The nurse is teaching coping strategies to parents of a child with a chronic illness. What coping strategies should the nurse include? (Select all that apply.)

A) Listen to the child.
B) Accept the child's illness.
C) Establish a support system.
D) Learn to care for the child's illness one day at a time.
E) Do not share information with the child about the illness.

Question 37

The nurse asks the mother of a child with a chronic illness many questions as part of the assessment. The mother answers several questions, then stops and says, "I don't know why you ask me all this. Who gets to know this information?" The nurse should respond in what manner?

A) Determine why the mother is so suspicious.
B) Determine what the mother does not want to tell.
C) Explain who will have access to the information.
D) Explain that everything is confidential and that no one else will know what is said.

Question 38

What are supportive interventions that can assist a toddler with a chronic illness to meet developmental milestones? (Select all that apply.)

A) Give choices.
B) Provide sensory experiences.
C) Avoid discipline and limit setting.
D) Discourage negative and ritualistic behaviors.
E) Encourage independence in as many areas as possible.

Question 39

What behavior seen in children should be addressed by the nurse who is providing care to a child with a chronic illness?

A) An infant who is uncooperative
B) A toddler who expresses loneliness
C) A preschooler who refuses to participate in self-care
D) An adolescent who is showing independence

Question 40

One of the supervisors for a home health agency asks the nurse to give a family of a child with a chronic illness a survey evaluating the nurses and other service providers. How should the nurse recognize this request?

A) Appropriate to improve quality of care
B) Improper because it is an invasion of privacy
C) Inappropriate unless nurses and other providers agree to participate
D) Not acceptable because the family lacks remembering necessary to evaluate professionals

Question 41

MATCHING
Match the concepts related to children with special health care needs to their definitions.

A loss or abnormality of structure or function

A)Chronic illness
B)Congenital disability
C)Developmental disability
D)Impairment
E)Special needs

Question 42

What are supportive interventions that can assist an adolescent with a chronic illness to meet developmental milestones? (Select all that apply.)

A) Encourage activities appropriate for age.
B) Avoid discussing planning for the future.
C) Provide instruction on interpersonal and coping skills.
D) Emphasize good appearance and wearing of stylish clothes.
E) Understand that the adolescent will not have the same sexual needs.

Question 43

What are supportive interventions that can assist a school-age child with a chronic illness to meet developmental milestones? (Select all that apply.)

A) Encourage socialization.
B) Discourage sports activities.
C) Encourage school attendance.
D) Provide instructions on assertiveness.
E) Educate teachers and classmates about the child's condition.

Question 44

MATCHING
Match the concepts related to children with special health care needs to their definitions.

A disability that has existed since birth but may not be hereditary

A)Chronic illness
B)Congenital disability
C)Developmental disability
D)Impairment
E)Special needs

Question 45

MATCHING
Match the concepts related to children with special health care needs to their definitions.

A condition requiring assistance for disabilities that may be medical, mental, or psychological

A)Chronic illness
B)Congenital disability
C)Developmental disability
D)Impairment
E)Special needs

Question 46

The parent of a child with a chronic illness tells the nurse, "I feel so hopeless in this situation." The nurse should take which actions to foster hopefulness for the family? (Select all that apply.)

A) Avoid topics that are lighthearted.
B) Convey a personal interest in the child.
C) Be honest when reporting on the child's condition.
D) Do not initiate any playful interaction with the child.
E) Demonstrate competence and gentleness when delivering care.

Question 47

MATCHING
Match the concepts related to children with special health care needs to their definitions.

Any mental or physical disability that is manifested before the age of 18 years

A)Chronic illness
B)Congenital disability
C)Developmental disability
D)Impairment
E)Special needs

Question 48

MATCHING
Match the concepts related to children with special health care needs to their definitions.

A long-lasting or recurrent condition that interferes with daily functioning that persists for more than 3 months

A)Chronic illness
B)Congenital disability
C)Developmental disability
D)Impairment
E)Special needs