Chapter 19: Family-Centered Care of the Child with Chronic Illness or Disability My Nursing Test Banks

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

MULTIPLE CHOICE

1. 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

ANS: B

An estimated 18% of children in the United States have a chronic illness or disability that warrants health care services beyond those usually required by children. Chronic illness has surpassed acute illness as the major health concern for children. Congenital disabilities exist from birth but may not be hereditary. These represent a portion of the number of children with chronic illnesses. Mental and nervous system disorders account for approximately 17% of chronic illnesses in children.

DIF: Cognitive Level: Understanding REF: p. 761 TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

2. 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 childs care.

c.

Parents are the experts in caring for their child.

d.

Decisions are made for the family to reduce stress.

ANS: C

As parents become increasingly responsible for their children, they are the experts. It is essential that the health care team recognize the familys expertise. In family-centered care, consistent attention is given to the effects of the childs chronic illness on all family members, not just the child. Nurses are adjuncts in the childs care. The nurse builds alliances with parents. Family members are involved in decision making about the childs physical care.

DIF: Cognitive Level: Analyzing REF: p. 762

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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

a.

Focus on the childs 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.

ANS: D

It is important that the parents learn how to care for their infant so they feel competent. The nurse facilitates this by teaching special holding techniques, supporting breastfeeding, and encouraging frequent visiting and rooming in. The focus should be on the infants capabilities and positive features. Infants do not usually require discipline. As the child gets older, this is necessary, but it is not a priority intervention at this time. The nursing staff negotiates with the family about the need for respite care.

DIF: Cognitive Level: Analyzing REF: p. 763

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

4. The potential effects of chronic illness or disability on a childs development vary at different ages. What developmental alteration is a threat to a toddlers normal development?

a.

Hindered mobility

b.

Limited opportunities for socialization

c.

Childs sense of guilt that he or she caused the illness or disability

d.

Limited opportunities for success in mastering toilet training

ANS: A

Toddlers are acquiring a sense of autonomy, developing self-control, and forming symbolic representation through language acquisition. Mobility is the primary tool used by toddlers to experiment with maintaining control. Loss of mobility can create a sense of helplessness. Toddlers do not socialize. They are sensitive to changes in family routines. A sense of guilt is more likely to occur in a preschooler. Toilet training is not usually mastered until the end of the toddler period.

DIF: Cognitive Level: Understanding REF: p. 768 TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

5. 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

ANS: B

Preschoolers are most likely to be affected by feelings of guilt that they caused the illness or disability or are being punished for wrongdoings. Toddlers are focused on establishing their autonomy. The illness fosters dependency. School-age children have limited opportunities for achievement and may not be able to understand limitations. Adolescents face the task of incorporating their disabilities into their changing self-concept.

DIF: Cognitive Level: Understanding REF: p. 769

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

6. 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.

ANS: C

Peer interaction is especially important in relation to cognitive development, social development, and maturation. Cognitive development is facilitated by interaction with peers, parents, and teachers. The identification with those outside the family helps the child fulfill the striving for independence. Sensory experiences are beneficial, especially for younger children. School-age children are too young for abstract thinking. Giving school-age children choices is always an important intervention. Providing structured choices allows for a feeling of control.

DIF: Cognitive Level: Applying REF: p. 763

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

7. 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

ANS: B

Risk taking, rebelliousness, and lack of cooperation are normal parts of adolescence, during which young adults are establishing independence. If the parents increase the amount of discipline, he will most likely be more rebellious. More socialization with peers does not address the problem of risk-taking behavior.

DIF: Cognitive Level: Applying REF: p. 767

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

8. 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 childs 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.

ANS: A

The school-age child who is ill may be forced into a period of dependency. To foster normalcy, the child should be given as much control as possible. It is unrealistic for one individual to make the child feel normal. The child has a chronic illness, so it would be unacceptable to convince the child that nothing is wrong. The family rules should be similar for each of the children in a family. Resentment and hostility can arise if different standards are applied to each child.

DIF: Cognitive Level: Applying REF: p. 769

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

9. 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

ANS: C

The nurse should be particularly alert to a child who withdraws and passively accepts all painful procedures. This child may believe that such acts are inflicted as deserved punishment for being less worthy. A child who is hopeful is mobilized into goal-directed actions. This child would actively participate in care. Chronic sorrow is the feeling of sorrow and loss that recurs in waves over time. It is usually evident in the parents, not in the child. The seriously ill child would actively participate in care. Nursing interventions should be used to minimize the pain.

DIF: Cognitive Level: Analyzing REF: p. 774

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

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

a.

Essential for the child

b.

Not needed unless the childs behavior becomes problematic

c.

Best achieved with punishment for misbehavior

d.

Too difficult to implement with a special needs child

ANS: A

Discipline is essential for the child. It provides boundaries on which she can test out her behavior and teaches her socially acceptable behaviors. The nurse should teach the parents ways to manage the childs behavior before it becomes problematic. Punishment is not effective in managing behavior.

DIF: Cognitive Level: Applying REF: p. 777

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

11. 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 childs condition only as requested.

d.

Invite the siblings to attend meetings to develop plans for the child with special needs.

ANS: D

Siblings should be invited to attend meeting to be part of the care team for the child. They can learn about an individualized education plan and help design strategies that will work at home. Embarrassment may be associated with having a sibling with a chronic illness or disability. Parents must be able to respond in an appropriate manner without punishing the sibling. The parents may need assistance with the care of the child. Most siblings are positive about the extra responsibilities. Parents need to inform the siblings about the childs condition before a nonfamily member does so. The parents do not want the siblings to fantasize about what is wrong with the child.

DIF: Cognitive Level: Analyzing REF: p. 780

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

12. 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 childs condition despite physical evidence

ANS: B

The parents who anticipate future problems and seek guidance and answers are demonstrating approach behaviors. These are positive actions in caring for their child. Being unable to adjust, looking for new cures, and failing to recognize the seriousness of the childs condition are avoidance behaviors. The parents are moving away from adjustment or exhibiting maladaptation to the crisis of a child with chronic illness or disability.

DIF: Cognitive Level: Analyzing REF: p. 783

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

13. 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.

ANS: D

Guilt may be associated with cultural or religious beliefs. Some parents are convinced that they are being punished for some previous misdeed. Others may see the disorder as a trial sent by God to test their religious beliefs. The nurse can help the parents explore their religious beliefs. On direct questioning, the parents may not be able to identify the feelings of guilt. It would be appropriate for the nurse to explore their adjustment responses. Overprotectiveness is a parental response during the adjustment phase. The parents fear letting the child achieve any new skill and avoid all discipline.

DIF: Cognitive Level: Analyzing REF: p. 784

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

14. 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 childs limitations

ANS: B

For most families, the adjustment phase is accompanied by several responses, including guilt, self-accusation, bitterness, and anger. The initial diagnosis of a chronic illness or disability often is met with intense emotion and characterized by shock and denial. Social reintegration and acceptance of the childs limitations are the culmination of the adjustment process.

DIF: Cognitive Level: Understanding REF: p. 785 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

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

a.

Gives inconsistent discipline

b.

Facilitates the childs 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 childs level of capability

ANS: A

Parental overprotection is manifested when the parents fear letting the child achieve any new skill, avoid all discipline, and cater to every desire to prevent frustration. Overprotective parents do not allow the child to assume responsibility for self-care of the illness. The parents prefer to remain in the role of total caregiver. The parents do not encourage the child to participate in social and educational activities.

DIF: Cognitive Level: Analyzing REF: p. 785

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

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

a.

Lack of acceptance of childs 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 childs development

ANS: D

Chronic sorrow is manifested by feelings of sorrow and loss that recur in waves over time. The sorrow is a response to the recognition of the childs limitations. The family should be assessed in an ongoing manner to provide appropriate support as their needs change. The sorrow is not preventable. The chronic sorrow occurs during the reintegration and acknowledgment stage.

DIF: Cognitive Level: Analyzing REF: p. 785

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

17. 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.

ANS: B

Parenting a child with a chronic illness can be stressful. At certain anticipated times, parental stress increases. One of these identified times is when the child begins school. Nurses can help parents recognize and plan interventions to work through these stressful periods. The parents are not in denial; rather, they are responding to the childs placement in school. The parents are not exhibiting signs of a remembering deficit; this is their first interaction with the school system with this child.

DIF: Cognitive Level: Analyzing REF: p. 778

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

18. 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.

ANS: A

Veteran parents share experiences that cannot be supplied by other support systems. They have known the stress related to diagnosis, have weathered the many transition times, and have a practical remembering of resources. The parents can be mutually supportive during times of crisis. Nursing staff cannot provide the type of support that is realized from other parents who are experiencing similar situations. Friction should not exist between the nursing staff and the family of the child who is critically ill.

DIF: Cognitive Level: Applying REF: p. 787 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

19. 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.

ANS: A

Appropriate information to give to a parent who wants to support the siblings of a child with special needs includes helping the siblings see the differences and similarities between themselves and the child with special needs to promote an understanding environment. The parent should be encouraged to allow the siblings to participate in activities that do not always include the child with special needs, to limit caregiving responsibilities, and to allow the children to settle their own differences rather than step in all the time.

DIF: Cognitive Level: Applying REF: p. 779 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

20. 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

ANS: B

Asthma is the single most prevalent cause of disability in children and has been largely responsible for much of the recent increase in childhood disability.

DIF: Cognitive Level: Understanding REF: p. 762

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

21. 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.

ANS: A

Home care requires the family to manage the childs illness, including providing daily hands-on care, monitoring the childs medical condition, and educating others to care for the child. The childs home environment with the childs family is perceived as the best place for the child to be cared for. If the family does not want to or is not able to assume these responsibilities, other arrangements need to be investigated. The family is an essential part of the decision-making process. Without family involvement and support, the technology-dependent child will not be well cared for at home.

DIF: Cognitive Level: Understanding REF: p. 763 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

22. 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

ANS: D

This type of groundwork is essential for the family. Adequate family training and preparation will assist in the childs transition home. The nursing staff in the hospital is responsible for the childs care. The family will provide the care with assistance as needed. Although parents are eager to be involved, the purpose of this intervention is the development of family competency and confidence that they are capable. Arrangements for respite care are important for the family both during hospitalizations and while the child is at home.

DIF: Cognitive Level: Understanding REF: p. 778 TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment

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

ANS: A

Nursing case managers are ideally suited to provide the care coordination necessary. Care coordination is most effective if a single person works with the family to accomplish the many tasks and responsibilities that are necessary. The family retains the role as primary decision maker. Most likely the insurance company will have a case manager focusing on the financial aspects of care. This does not include coordination of care to assist the family.

DIF: Cognitive Level: Understanding REF: p. 782 TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment

24. 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 adolescents care involves physical therapy, occupational therapy, and speech therapy in addition to medical and nursing care. Who should be the decision maker in the adolescents care?

a.

Adolescent

b.

Nurse case manager

c.

Adolescent and family

d.

Multidisciplinary health care team

ANS: C

The extent to which children are involved in their own care and decision making depends on many factors, including the childs developmental age, level of interest, physical ability, and parental support. If the adolescent is developmentally age appropriate, then decision making should be the responsibility of child and family. Family needs to be involved because they will be caring for the adolescent in the home. Health care providers have necessary input into the care of the child, but ultimate decision making rests with the adolescent and family.

DIF: Cognitive Level: Applying REF: p. 767 TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment

25. The nurse has been assigned as a home health nurse for a child who is technology dependent. The nurse recognizes that the familys background differs widely from the nurses 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.

ANS: B

Respect for varied family structures and for racial, ethnic, cultural, and socioeconomic diversity among families is essential in home care. The nurse must assess and respect the familys background and lifestyle choices. It is not appropriate to attempt to change the family. The nurse is a guest in the home and care of the child. The family and the values held by the cultural group prevail. The nurse may assess why the family is different to help the nurse and other health professionals understand the differences. It is not appropriate to determine whether the family is dysfunctional.

DIF: Cognitive Level: Applying REF: p. 774

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe and Effective Care Environment

26. A childs parents ask the nurse many questions about their childs 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 dont 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.

ANS: A

Questions from parents should be answered in a straightforward manner. Stating I dont know or Ill find out is better than pretending to know or giving excuses. Suggesting that they ask the physician these questions is not supportive of the family. The nurses role is to assist the parents in obtaining accurate information about their childs illness and its management. Although the nurse cannot be expected to know everything, it is an unprofessional attitude to state this. Nurses must provide accurate information to the extent possible. Vague answers are not helpful to the family.

DIF: Cognitive Level: Applying REF: p. 775

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Safe and Effective Care Environment

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

ANS: D

In the home, the family is a partner in each step of the nursing process. The family priorities should guide the planning process. Both short- and long-term goals should be outlined and agreed on by the child, family, and professionals involved. Elimination of any one of these groups can potentially create a care plan that does not meet the needs of the child and family.

DIF: Cognitive Level: Analyzing REF: p. 777 TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment

28. 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.

ANS: C

The nurse needs to share, through both oral and written communication, clinically relevant information with other involved health professionals. Asking others what they want to know and sharing everything known about the family are inappropriate measures. Patients have a right to confidentiality. Confidentiality permits the disclosure of information to other health professionals on a need-to-know basis.

DIF: Cognitive Level: Applying REF: p. 761

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

29. The nurse has been visiting an adolescent with recently acquired tetraplegia. The teens mother tells the nurse, Im 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 nurses initial response?

a.

Refer the mother for counseling.

b.

Listen and reflect the mothers feelings.

c.

Ask the father in private why he does not help.

d.

Suggest ways the mother can get her husband to help.

ANS: B

It is appropriate for the nurse to reflect with the mother about her feelings, exploring solutions such as an additional home health aide to help care for the child and provide respite for the mother. It is inappropriate for the nurse to agree with the mother that her husband is not helping enough. This judgment is beyond the role of the nurse and can undermine the family relationship. Counseling, if indicated, would be necessary for both parents. A support group for caregivers may be indicated. The nurse should not ask the father in private why he does not help or suggest way the mother can get her husband to help. These interventions are based on the mothers perceptions; the father may have a full-time job and other commitments. The parents may need an unbiased third person to help them through the negotiation of their new parenting responsibilities.

DIF: Cognitive Level: Applying REF: p. 763

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Psychosocial Integrity

30. 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.

ANS: A

A major principle for developmental support in children with complex medical issues is that it should be flexible and tailored to the individual childs abilities, interests, and needs. This child is exhibiting readiness for ambulation. It is an appropriate time to provide activities that encourage mobility, for example, longer oxygen tubing. Parents should provide decreasing amounts of assistance with self-care as he is able to develop these skills. The boy is receiving oral foods and is eating finger foods. He has acquired this skill. Mobility is a new developmental task. Opportunities for socialization should be ongoing.

DIF: Cognitive Level: Applying REF: p. 763 TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

31. 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

ANS: C

Preschoolers thrive on being independent and are in the phase of gaining autonomy, so they want to perform as many self-care tasks as possible. If a preschooler is refusing to participate in self-care activities, then the home health nurse should address this. Infants are uncooperative by nature, and toddlers do not understand the concept of loneliness, so these are not observations that would need to be addressed. Adolescents are always striving for independence, so this is a normal observation; if the adolescent were becoming more dependent on family, it might require intervention.

DIF: Cognitive Level: Applying REF: p. 768

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

32. 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 dont 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.

ANS: C

Communication with the family should not be invasive. The nurse needs to explain the importance of collecting the information, its applicability to the childs care, and who will have access to the information. The mother is not being suspicious and is not necessarily withholding important information. She has a right to understand how the information she provides will be used. The nurse will need to share, through both oral and written communication, clinically relevant information with other involved health professionals.

DIF: Cognitive Level: Applying REF: p. 773

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Safe and Effective Care Environment

33. 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

ANS: A

Quality assessment and improvement activities are essential for virtually all organizations. Family involvement in evaluating a home care plan can occur on several levels. The nurse can ask the family open-ended questions at regular intervals to assess their opinion of the effectiveness of care. Families should also be given an opportunity to evaluate the individual home care nurses, the home care agency, and other service providers periodically. Evaluation of the provision of care to the patient and family requires evaluation of the care provider, that is, the nurse. Quality-monitoring activities are required by virtually all health care agencies. During the evaluation process, the family is asked to provide their perceptions of care.

DIF: Cognitive Level: Applying REF: p. 763

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Safe and Effective Care Environment

MULTIPLE RESPONSE

1. The nurse is planning to use an interpreter with a nonEnglish-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 familys culture.

d.

The nurse should speak only a few sentences at a time.

e.

The nurse should speak to the interpreter during interactions.

ANS: B, C, D

When parents who do not speak English are informed of their childs chronic illness, interpreters familiar with both their culture and language should be used. The nurse should speak slowly and only use a few sentences at a time. Children, family members, and friends of the family should not be used as translators because their presence may prevent parents from openly discussing the issues. The nurse should speak to the family, not the interpreter.

DIF: Cognitive Level: Applying REF: p. 765

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Health Promotion and Maintenance

2. 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 childs illness.

c.

Establish a support system.

d.

Learn to care for the childs illness one day at a time.

e.

Do not share information with the child about the illness.

ANS: A, B, C, D

Coping strategies for parents caring for a child with a chronic illness include listening to the child, accepting the childs illness, establishing a support system, and learning to care for the childs illness one day at a time. Information should be shared with the child about the illness.

DIF: Cognitive Level: Applying REF: p. 782

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

3. 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.

ANS: A, B, D

To develop trust, consistent caretakers and parents rooming in should be encouraged. To develop a sense of separateness from parents, periodic respites from caregiving should be encouraged. All members of the family, not one primary caretaker, should be encouraged to participate in care. Age-appropriate developmental tasks should be encouraged, not withheld until an older age.

DIF: Cognitive Level: Analyzing REF: p. 766

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. 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 childs condition

e.

Does not share the burden of the disorder with others

ANS: A, B, D

Approach coping behaviors include planning realistically for the future, verbalizing possible loss of a child, and realistically perceiving the childs behavior. Using magical thinking and fantasy is an avoidance behavior. The family should share the burden of the disorder with others as an approach behavior.

DIF: Cognitive Level: Analyzing REF: p. 783

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

5. 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.

ANS: A, B, E

To encourage autonomy, choices should be given and independence encouraged in as many areas as possible. Sensory experiences should be encouraged to help the toddler to learn through sensorimotor experiences. Age-appropriate discipline and limit setting should be initiated. Negative and ritualistic behaviors are normal and should be allowed.

DIF: Cognitive Level: Analyzing REF: p. 766

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

6. 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

ANS: A, B, C, E

Avoidance coping behaviors include refusing to agree to treatment; avoiding staff, family members, or child; unable to discuss possible loss of the child; and making no change in lifestyle to meet the needs of other family members. Recognizing ones own growth through a passage of time is an approach behavior.

DIF: Cognitive Level: Analyzing REF: p. 783

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

7. 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 childs illness is not his or her fault.

e.

Discuss planning for the future and how the condition can affect choices.

ANS: A, B, C, D

To encourage initiative, mastery of self-help skills should be encouraged, and devices should be provided that make tasks easier. To develop peer relationships, socialization should be encouraged. To develop body image, the fact that the cause of the childs illness is not the fault of the child should be emphasized. Discussing planning for the future and how the condition can affect choices is appropriate for an adolescent.

DIF: Cognitive Level: Analyzing REF: p. 766

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

8. 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 childs condition.

d.

Do not initiate any playful interaction with the child.

e.

Demonstrate competence and gentleness when delivering care.

ANS: B, C, E

To foster hopefulness, the nurse should convey a personal interest in the child, be honest when reporting on a childs condition, and demonstrate competence and gentleness when delivering care. The nurse should introduce conversations on neutral, nondisease-related, or less sensitive topics (discuss the childs favorite sports, tell stories). The nurse should be lighthearted and initiate or respond to teasing or other playful interactions with the child.

DIF: Cognitive Level: Applying REF: p. 767

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

9. 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 childs condition.

ANS: A, C, E

To develop a sense of accomplishment, school attendance should be encouraged, and teachers and classmates should be educated about the childs condition. To form peer relationships, socialization should be encouraged. Sports activities should be encouraged (e.g., Special Olympics), not discouraged. Providing instructions on assertiveness is appropriate for adolescence.

DIF: Cognitive Level: Analyzing REF: p. 766

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

10. 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.

ANS: A, C, D

To achieve independence from family, instruction on interpersonal and coping skills should be provided. To promote heterosexual relationships, activities appropriate for age should be encouraged, and a good appearance and wearing of stylish clothes should be emphasized. Plans for the future should be discussed, and the adolescent will have the same sexual needs as adolescents without a chronic illness.

DIF: Cognitive Level: Analyzing REF: p. 767

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

MATCHING

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

a.

Chronic illness

b.

Congenital disability

c.

Developmental disability

d.

Impairment

e.

Special needs

1. A loss or abnormality of structure or function

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

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

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

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

1. ANS: C DIF: Cognitive Level: Understanding REF: p. 762

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

2. ANS: D DIF: Cognitive Level: Understanding REF: p. 762

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

3. ANS: B DIF: Cognitive Level: Understanding REF: p. 762

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

4. ANS: A DIF: Cognitive Level: Understanding REF: p. 762

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

5. ANS: E DIF: Cognitive Level: Understanding REF: p. 762

TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

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