Chapter 36: The Child with a Chronic Condition or Terminal Illness My Nursing Test Banks

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

Test Bank

MULTIPLE CHOICE

1. 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

ANS: C

Feedback

A

Feelings of anger and resentment are part of the grieving process, although not usually the initial response.

B

Feelings of sadness and depression are part of the grieving process, although not usually the initial response.

C

According to Kbler-Ross, denial is the initial stage of the grieving process when an individual reacts with shock and disbelief to the diagnosis of chronic illness.

D

Acceptance is the final stage of the grieving process, not the first response.

PTS: 1 DIF: Cognitive Level: Application REF: p. 896

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

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

a.

Pain

b.

Safety

c.

Food intake

d.

Fluid intake

ANS: A

Feedback

A

The primary concern of all parents of dying children is the possibility of their child feeling pain.

B

Although safety is a concern of all parents, it is not the priority concern.

C

Although eating is important, it is not the priority concern.

D

Although hydration is a concern, it is not the priority concern.

PTS: 1 DIF: Cognitive Level: Application REF: p. 909

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

3. 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

ANS: B

Feedback

A

Bodily injury and pain are fears of preschool and school-age children.

B

The major fear of infants during illness and hospitalization are separation from caregivers and fear of strangers.

C

Loss of control is a fear of children from the preschool period through adolescence. Altered body image applies to adolescents.

D

Fear of the unknown and being left alone are applicable to preschoolers.

PTS: 1 DIF: Cognitive Level: Application REF: p. 898 | Box 36-2

OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

4. What corresponds to a 5-year-old childs understanding of death?

a.

Loss of a caretaker

b.

Reversible and temporary

c.

Permanent

d.

Inevitable

ANS: B

Feedback

A

This is the infant/toddler understanding of death.

B

Children in early childhood (2 to 7 years old) view death as reversible and temporary.

C

The school-age child and adolescent understand that death is permanent.

D

The adolescent understands death not only as permanent, but also inevitable.

PTS: 1 DIF: Cognitive Level: Application REF: p. 905 | Table 36-1

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

5. 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 childs understanding of death is, related to theories of growth and development?

a.

Temporary

b.

Permanent

c.

Loss of caretaker

d.

Punishment

ANS: C

Feedback

A

The preschool-age child views death as temporary.

B

The school-age child and adolescent understand the permanence of death.

C

This is the infant/toddler understanding of death.

D

The preschool-age child facing impending death may view his or her condition as punishment for behaviors or thoughts.

PTS: 1 DIF: Cognitive Level: Application REF: p. 905 | Table 36-1

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

6. 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.

ANS: B

Feedback

A

The infant with a chronic illness may have distortion of differentiation of self from parents.

B

Chronic illness may interfere in the development of autonomy, which is the major psychosocial task of the toddler.

C

Chronic illness with frequent hospitalizations can inhibit the acquisition of language, motor, and self-care skills in the preschool-age child.

D

Feelings of inadequacy and inferiority can occur if independence is compromised by chronic illness in the school-age child.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 898 | Box 36-2

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

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

a.

They can lead to feelings of inadequacy.

b.

They can interfere with parental attachment.

c.

They can block the development of identity.

d.

They can prevent the development of imagination.

ANS: C

Feedback

A

Inadequacy and inferiority refer to the school-age period.

B

Parental attachment is a task of the infant.

C

Development of identity is the task of the adolescent.

D

Development of imagination occurs in the preschool period.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 898 | Box 36-2

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

8. 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.

ANS: C

Feedback

A

Nursing care should minimize disruptions but not contact.

B

When a child is dying, fluids should be based on the childs requests, with a focus on comfort and preventing a dry mouth.

C

Families should be encouraged to talk to the child because verbal communication and physical touch are important both for the family and child.

D

The times when the child is alert should be devoted to family contacts.

PTS: 1 DIF: Cognitive Level: Application REF: p. 911

OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

9. 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 cant hear you.

c.

Although she cant 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.

ANS: D

Feedback

A

There is no evidence that the dying process decreases hearing acuity.

B

The sense of hearing is intact before death. The sibling should be encouraged to speak to the child, as well as hold the childs hand.

C

Hearing is the last sense to cease before death. The sibling should be encouraged to sit close and speak to the dying child.

D

Hearing is the last sense to cease before death. Talking to the dying child is important both for the child and the family.

PTS: 1 DIF: Cognitive Level: Application REF: p. 911

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

10. 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

ANS: D

Feedback

A

This is a goal for the family, not specifically the child.

B

This is not a realistic goal because life will continue to present stressors.

C

This is unrealistic because chronic illness by definition is a long-term condition either without a cure or with residual limitations.

D

To obtain the highest level of health and function possible is the priority goal of nursing children with a chronic illness.

PTS: 1 DIF: Cognitive Level: Application REF: p. 899

OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

11. 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

ANS: C

Feedback

A

Maintaining social integration is one of the traits of a resilient family system.

B

Family flexibility is a trait of the resilient family, but not the predominant one.

C

Family cohesiveness is the predominant trait of the resilient family.

D

Clear family boundaries are a trait of the resilient family, but not the predominant one.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 895

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

12. Many parents who have children diagnosed with a chronic illness experience recurrent feelings of grief, loss, and fear related to the childs 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

ANS: B

Feedback

A

Anticipatory grieving is the process of mourning, coping, interacting, planning, and psychosocial reorganization that is begun as a response to the impending loss of a loved one.

B

The stated recurrent feelings define chronic sorrow, which is considered a normal process involving grief that may never be resolved.

C

Bereavement is defined as the objective condition or state of loss.

D

Illness trajectory is defined as the impact of the disease or condition on all family members, physiologic unfolding of the disease, and work organization done by the family to cope.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 897

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

13. 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

ANS: A

Feedback

A

This is the priority nursing diagnosis that is appropriate for the majority of chronic illnesses.

B

Pain is not associated with the majority of chronic illnesses.

C

A chronic illness is one that does not have a cure. It does not mean the child will die prematurely.

D

Frequent hospitalizations are not required for all chronic illnesses.

PTS: 1 DIF: Cognitive Level: Application REF: p. 903

OBJ: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance

14. Identify the most appropriate response for the nurse when parents say, Living with this disease is really hard; its 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.

ANS: A

Feedback

A

The first step in supporting families and helping them deal with chronic sorrow is to listen to and recognize their pain.

B

This comment does not encourage parents to talk about their feelings. Each individuals perception of a situation is different. A nurse can never know exactlyhow parents feel about having a child with a chronic illness.

C

This comment does not address the parents immediate feelings.

D

This response does not address the parents immediate feelings.

PTS: 1 DIF: Cognitive Level: Application REF: p. 897

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

15. Identify the most appropriate nursing response to a parent who tells the nurse, I dont want my child to know she is dying.

a.

I shall respect your decision. I wont say anything to your child.

b.

Dont 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.

Ill answer any questions she asks me as honestly as I can.

ANS: D

Feedback

A

As the caregiver and advocate, the nurse should first meet the childs needs.

B

This is a judgmental response and could affect the nurses relationship with the childs parents.

C

This response does not address the parents statement.

D

Nurses can inform parents that they will not initiate any discussion with the child but that they intend to respond openly and honestly if and when the child initiates such a discussion.

PTS: 1 DIF: Cognitive Level: Application REF: p. 908

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

16. 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

ANS: A

Feedback

A

The developmentally appropriate activity for the hospitalized toddler is to play with a push-pull toy. Chronic illness may interfere in the development of autonomy, which is the major psychosocial task of the toddler.

B

Putting together a puzzle could frustrate the toddler and is appropriate for a preschool or school-age child.

C

Playing a simple card game could frustrate the toddler and is appropriate for a preschool or school-age child.

D

Watching cartoons on television is passive and will not promote autonomy.

PTS: 1 DIF: Cognitive Level: Application REF: p. 898 | Box 36-2

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

17. 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 childs care

d.

Primary care physician and key health professionals involved in the childs care

ANS: C

Feedback

A

The nursing staff can address the nursing care needs of the child with the family, but other involved disciplines must be included.

B

The family must be included in the discharge conferences, which allow them to determine what education they will require and the resources needed at home.

C

A multidisciplinary conference is necessary for coordination of care for children with complex health needs. The family is involved as well as key health professionals who are involved in the childs care.

D

A member of the nursing staff must be included to review the nursing needs of the child.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 902

OBJ: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment

18. 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 childs limitations

ANS: B

Feedback

A

The initial diagnosis of a chronic illness or disability often is often met with intense emotion and characterized by shock and denial.

B

For most families, the adjustment phase is accompanied by several responses that are normally part of the adjustment process. Guilt, self-accusation, bitterness, and anger are common reactions.

C

Social reintegration and acceptance of the childs limitations is the culmination of the adjustment process.

D

Social reintegration and acceptance of the childs limitations is the culmination of the adjustment process.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 896

OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

19. The nurse comes into the room of a child who was just diagnosed with a chronic disability. The childs parents begin to yell at the nurse about a variety of concerns. The nurses 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.

ANS: B

Feedback

A

These responses, although possible, are not the likely reason for this anger.

B

Parental anger after the diagnosis of a child with a chronic disability is a common response. One of the most common targets for parental anger is members of the staff. The nurse should recognize the common response of anger to the diagnosis and allow the family to ventilate.

C

These responses, although possible, are not the likely reason for this anger.

D

These responses, although possible, are not the likely reason for this anger.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 896

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

20. 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

ANS: B

Feedback

A

Toddlers are focused on establishing their autonomy. The illness will foster dependency.

B

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

C

The school-age child will have limited opportunities for achievement and may not be able to understand limitations.

D

Adolescents are faced with the task of incorporating their disabilities into their changing self-concept.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 905

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

21. The nurse is providing support to a family who is experiencing anticipatory grief related to their childs 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.

ANS: A

Feedback

A

When death is imminent, care should be limited to interventions for palliative care.

B

Music may be used to provide comfort to the child.

C

Vital signs do not need to be measured frequently.

D

The nurse should speak to the child in a clear, distinct voice.

PTS: 1 DIF: Cognitive Level: Application REF: p. 910

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

22. At the time of a childs 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 mothers sense of loss

d.

Talking when listening would be better

ANS: B

Feedback

A

The nurse is experiencing a normal grief response to the death of a patient.

B

The death of a patient is one of the most stressful aspects of a critical care or oncology nurse. Nurses experience reactions similar to those of family members because of their involvement with the child and family during the illness. Nurses often have feelings of personal loss when a patient dies.

C

There is no implication that the mothers loss is minimized.

D

The nurse is validating the worth of the child.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 913

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

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.

ANS: A

Feedback

A

The parents should be allowed to remain with their child after the death. The nurse can remove all of the tubes and equipment and offer the parents the option of preparing the body.

B

This is an important part of the grieving process and should be allowed if the parents desire it. It is important for the nurse to ascertain if the family has any special needs.

C

This is an important part of the grieving process and should be allowed if the parents desire it. It is important for the nurse to ascertain if the family has any special needs.

D

This is an important part of the grieving process and should be allowed if the parents desire it. It is important for the nurse to ascertain if the family has any special needs.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 913

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

24. 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.

ANS: C

Feedback

A

The child will know that something is wrong because of the increased attention of health professionals. This interferes with denial as a form of coping.

B

Parents may need professional support and guidance from a nurse or social worker in this process.

C

The child needs honest and accurate information about the illnesses, treatments, and prognosis. Children, even at a young age, realize that something is seriously wrong and that it involves them. The nurse should help understand the importance of honesty.

D

Children will usually tell others how much information they want about their condition.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 906

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

25. 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 childs 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

ANS: D

Feedback

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.

B

It is unrealistic for one individual to make the child feel normal.

C

The child has a chronic illness. It is unacceptable to convince the child that nothing is wrong.

D

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.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 903

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

26. The parents of a child born with disabilities ask the nurse for advice about discipline. The nurses 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

ANS: A

Feedback

A

Discipline is essential for the child. It provides boundaries on which to test out their behavior and teaches them socially acceptable behaviors.

B

The nurse should teach the parents ways to manage the childs behavior before it becomes problematic.

C

The nurse should teach the parents ways to manage the childs behavior before it becomes problematic.

D

Punishment is not effective in managing behavior.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 898-899

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

27. 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

ANS: C

Feedback

A

Preschoolers and young school-age children are too little to have an adult concept of death.

B

Preschoolers and young school-age children are too little to have an adult concept of death.

C

By age 9 or 10 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible.

D

Adolescents have a mature understanding of death.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 905 | Table 36-1

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

28. 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

ANS: D

Feedback

A

Children in these age-groups are too young to have difficulty coping with their own death. They will fear separation from parents.

B

Children in these age-groups are too young to have difficulty coping with their own death. They will fear separation from parents.

C

School-age children will fear the unknown, such as the consequences of the illness and the threat to their sense of security.

D

Adolescents, because of their mature understanding of death, remnants of guilt and shame, and issues with deviations from normal, have the most difficulty coping with death.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 905-906

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

29. 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 Kellys parents attend school at first to prevent teasing.

b.

Prepare Kellys 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.

ANS: B

Feedback

A

A visit by the parents can be helpful, but unless the classmates are prepared for the changes, it alone will not prevent teasing.

B

Attendance at school is an important part of normalization for Kelly. The school nurse should prepare teachers and classmates about her condition, abilities, and special needs.

C

Kellys school experience should be normalized as much as possible. Children need the opportunity to interact with healthy peers, as well as to engage in activities with groups or clubs composed of similarly affected persons.

D

Children with special needs are encouraged to maintain and reestablish relationships with peers and to participate according to their capabilities.

PTS: 1 DIF: Cognitive Level: Application REF: p. 901

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

MULTIPLE RESPONSE

1. 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)

ANS: A, C, D

Feedback

Correct

A chronic illness is defined as a condition that is long term, does not spontaneously resolve, is usually without a complete cure, and affects activities of daily living. Reactive airway disease (asthma), cerebral palsy, diabetes mellitus, and HIV are all chronic illnesses that may occur during childhood.

Incorrect

RSV is a virus that is highly contagious and causes bronchiolitis and pneumonia in children. It does not cause chronic illness.

PTS: 1 DIF: Cognitive Level: Application REF: p. 895 | Box 36-1

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. 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

ANS: C, D, E

Feedback

Correct

These are all major fears of the preschooler.

Incorrect

These are major fears in the adolescent.

PTS: 1 DIF: Cognitive Level: Application REF: p. 898 | Box 36-2

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

3. 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.

ANS: A, C

Feedback

Correct

Indicators of imminent death include heart rate increasing, with a concomitant decrease in the strength and quality of peripheral pulses, respiratory effort declines, as evidenced by rapid, shallow respirations, and extremities are cool and cyanotic.

Incorrect

Increased BP, warm extremities, and strong peripheral pulses are not indicators of imminent death.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 911

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

COMPLETION

1. 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 _______.

ANS:

normalization

During the normalization process, these families make necessary changes in their lives adjusting to the presence of chronic illness. They actively work on responses that will help counteract the illness to maintain social roles that are appropriate and valued.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 895

OBJ: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance

2. 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 ____________.

ANS:

hospice care

Hospice care is a specialized, comprehensive system of care that provides support and assistance to patients in the last phase of terminal illness.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 909

OBJ: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment

TRUE/FALSE

1. 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?

ANS: T

This is correct. The child may also need reassurance that it is safe to die along with a description of what to expect. Children also need to know that the family and friends that are left behind will be alright and will take care of each other.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 906

OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

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