N3261: Final Exam - Practice Questions (after
midterm) With Accurate Answers
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 childs care
d. Primary care physician and key health professionals involved in the childs
care - ANSWER ANS: C
A multidisciplinary conference is necessary for coordination of care for children
with complex health needs. The family is included, along with key health
professionals who are involved in the childs care. The nursing staff can address
the childs nursing care needs with the family, but other involved disciplines must
be included. The family must be included in the discharge conferences, which
allows them to determine what education they will require and the resources
needed at home. A member of the nursing staff must be included to review the
childs nursing needs.
Which represents a common best practice in the provision of services to
children with special needs?
a. Care is now being focused on the childs chronologic age.
b. Children with special needs are being integrated into regular classrooms.
c. Children with special needs no longer have to be cared for by their families.
d. Children with special needs are being separated into residential treatment
facilities. - ANSWER ANS: B
Normalization refers to behaviors and interventions for the disabled to integrate
into society by living life as persons without a disability would. For children,
normalization includes attending school and being integrated into regular
classrooms. This affords the child the advantages of learning with a wide group
of peers. Care is necessarily focused on the childs developmental age. Home
care by the family is considered best practice. The nurse can assist families by
assessing social support systems, coping strategies, family cohesiveness, and
family and community resources.
Lindsey, age 5 years, will be starting kindergarten next month. She has cerebral
palsy, and it has been determined that she needs to be in a special education
classroom. Her parents are tearful when telling the nurse about this and state
that they did not realize her disability was so severe. The best interpretation of
this situation is that:
a. this is a sign 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 are used to having expectations that are too high. - ANSWER ANS:
B
Parenting a child with a chronic illness can be stressful for parents. There are
anticipated times that 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; they are responding to the childs placement in school. The parents are
not exhibiting signs of a knowledge deficit; this is their first interaction with the
school system with this child.
Approach behaviors are those coping mechanisms that result in a familys
movement toward adjustment and resolution of the crisis of having a child with a
chronic illness or disability. Which is considered an approach behavior?
a. Is unable to adjust to a progression of the disease or condition
b. Anticipates future problems and seeks guidance and answers
c. Looks for new cures without a perspective toward possible benefit
d. Fails to recognize seriousness of childs condition despite physical evidence -
ANSWER ANS: B
The parents who anticipate future problems and seek guidance and answers are
demonstrating approach behaviors. They are demonstrating positive actions in
caring for their child. Being unable to adjust to a progression of the disease or
condition, looking for new cures without a perspective toward possible benefit,
and failing to recognize seriousness of childs condition despite physical
evidence are avoidance behaviors. The parents are moving away from
adjustment (and toward maladaptation) in the crisis of a child with chronic
illness or disability.
Families progress through various stages of reactions when a child is diagnosed
with a chronic illness or disability. After the shock phase, a period of adjustment
usually follows. This is often characterized by which of the following responses?
a. Denial
b. Guilt and anger
c. Social reintegration
d. Acceptance of childs limitations - ANSWER ANS: B
For most families, the adjustment phase is accompanied by several responses.
Guilt, self-accusation, bitterness, and anger are common reactions. The initial
diagnosis of a chronic illness or disability often is met with intense emotion,
characterized by shock and denial. Social reintegration and acceptance of the
childs limitations are the culmination of the adjustment process.
Which nursing intervention is especially helpful in assessing parental guilt when
a disability or chronic illness is diagnosed?
a. Ask the parents if they feel guilty.
b. Discuss guilt only after the parents mention it.
,c. Discuss the meaning of the parents religious and cultural background.
d. Observe for signs of overprotectiveness. - ANSWER ANS: C
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 sacrifice sent by God to test their religious beliefs. The
nurse can help the parents explore their religious beliefs. 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.
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 a:
a. sense of hopefulness.
b. sense of chronic sorrow.
c. belief that procedures are a deserved punishment.
d. belief that procedures are an important part of care. - ANSWER ANS: C
The nurse should be particularly alert to the child who passively accepts all
painful procedures. This child may believe that such acts are inflicted as
deserved punishment. The 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. A child who believes that procedures are an
important part of care would actively participate in care. Nursing interventions
should be used to minimize the pain.
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. Which is the nurses best response?
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. - ANSWER ANS: 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. What is really
wrong?/Yelling at me will not change things/I will come back when you settle
down will place the parents on the defensive and not facilitate communication.
A common parental reaction to a child with special needs is parental
overprotection. Parental behavior suggestive of this includes:
a. giving inconsistent discipline.
b. providing consistent, strict discipline.
c. forcing child to help self, even when not capable.
, d. encouraging social and educational activities not appropriate to childs level
of capability. - ANSWER ANS: A
Parental overprotection is manifested by the parents fear of letting the child
achieve any new skill; they allow the child to avoid all discipline and cater to
every desire to prevent frustration. Overprotective parents: do not set limits and
or institute discipline; prefer to remain in the role of total caregiver; do not allow
the child to perform self-care; and do not encourage the child to participate in
social and educational activities.
Most parents of children with special needs tend to experience chronic sorrow.
This is characterized by:
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 and loss that occur in waves over time. -
ANSWER ANS: D
Chronic sorrow is manifested by feelings of sorrow and loss that recur in waves
over time. The sorrow is in response to the recognition of the childs limitations.
The family should be assessed in an ongoing manner to provide appropriate
support as the needs of the family change. The sorrow is not preventable. The
chronic sorrow occurs during the reintegration and acknowledgment stage.
Which intervention will encourage a sense of autonomy in a toddler with
disabilities?
a. Avoid separation from family during hospitalizations.
b. Encourage independence in as many areas as possible.
c. Expose child to pleasurable experiences as much as possible.
d. Help parents learn special care needs of their child. - ANSWER ANS: B
Encouraging the toddler to be independent encourages a sense of autonomy.
The child can be given choices about feeding, dressing, and diversional
activities, which will provide a sense of control. Avoiding separation from family
during hospitalizations, and helping parents learn special care needs of their
child should be practiced as part of family-centered care. It does not necessarily
foster autonomy. Exposing the child to pleasurable experiences, especially
sensory ones, is a supportive intervention. It does not promote autonomy.
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 - ANSWER 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 will foster dependence. The
school-age child will have limited opportunities for achievement and may not be
midterm) With Accurate Answers
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 childs care
d. Primary care physician and key health professionals involved in the childs
care - ANSWER ANS: C
A multidisciplinary conference is necessary for coordination of care for children
with complex health needs. The family is included, along with key health
professionals who are involved in the childs care. The nursing staff can address
the childs nursing care needs with the family, but other involved disciplines must
be included. The family must be included in the discharge conferences, which
allows them to determine what education they will require and the resources
needed at home. A member of the nursing staff must be included to review the
childs nursing needs.
Which represents a common best practice in the provision of services to
children with special needs?
a. Care is now being focused on the childs chronologic age.
b. Children with special needs are being integrated into regular classrooms.
c. Children with special needs no longer have to be cared for by their families.
d. Children with special needs are being separated into residential treatment
facilities. - ANSWER ANS: B
Normalization refers to behaviors and interventions for the disabled to integrate
into society by living life as persons without a disability would. For children,
normalization includes attending school and being integrated into regular
classrooms. This affords the child the advantages of learning with a wide group
of peers. Care is necessarily focused on the childs developmental age. Home
care by the family is considered best practice. The nurse can assist families by
assessing social support systems, coping strategies, family cohesiveness, and
family and community resources.
Lindsey, age 5 years, will be starting kindergarten next month. She has cerebral
palsy, and it has been determined that she needs to be in a special education
classroom. Her parents are tearful when telling the nurse about this and state
that they did not realize her disability was so severe. The best interpretation of
this situation is that:
a. this is a sign 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 are used to having expectations that are too high. - ANSWER ANS:
B
Parenting a child with a chronic illness can be stressful for parents. There are
anticipated times that 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; they are responding to the childs placement in school. The parents are
not exhibiting signs of a knowledge deficit; this is their first interaction with the
school system with this child.
Approach behaviors are those coping mechanisms that result in a familys
movement toward adjustment and resolution of the crisis of having a child with a
chronic illness or disability. Which is considered an approach behavior?
a. Is unable to adjust to a progression of the disease or condition
b. Anticipates future problems and seeks guidance and answers
c. Looks for new cures without a perspective toward possible benefit
d. Fails to recognize seriousness of childs condition despite physical evidence -
ANSWER ANS: B
The parents who anticipate future problems and seek guidance and answers are
demonstrating approach behaviors. They are demonstrating positive actions in
caring for their child. Being unable to adjust to a progression of the disease or
condition, looking for new cures without a perspective toward possible benefit,
and failing to recognize seriousness of childs condition despite physical
evidence are avoidance behaviors. The parents are moving away from
adjustment (and toward maladaptation) in the crisis of a child with chronic
illness or disability.
Families progress through various stages of reactions when a child is diagnosed
with a chronic illness or disability. After the shock phase, a period of adjustment
usually follows. This is often characterized by which of the following responses?
a. Denial
b. Guilt and anger
c. Social reintegration
d. Acceptance of childs limitations - ANSWER ANS: B
For most families, the adjustment phase is accompanied by several responses.
Guilt, self-accusation, bitterness, and anger are common reactions. The initial
diagnosis of a chronic illness or disability often is met with intense emotion,
characterized by shock and denial. Social reintegration and acceptance of the
childs limitations are the culmination of the adjustment process.
Which nursing intervention is especially helpful in assessing parental guilt when
a disability or chronic illness is diagnosed?
a. Ask the parents if they feel guilty.
b. Discuss guilt only after the parents mention it.
,c. Discuss the meaning of the parents religious and cultural background.
d. Observe for signs of overprotectiveness. - ANSWER ANS: C
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 sacrifice sent by God to test their religious beliefs. The
nurse can help the parents explore their religious beliefs. 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.
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 a:
a. sense of hopefulness.
b. sense of chronic sorrow.
c. belief that procedures are a deserved punishment.
d. belief that procedures are an important part of care. - ANSWER ANS: C
The nurse should be particularly alert to the child who passively accepts all
painful procedures. This child may believe that such acts are inflicted as
deserved punishment. The 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. A child who believes that procedures are an
important part of care would actively participate in care. Nursing interventions
should be used to minimize the pain.
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. Which is the nurses best response?
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. - ANSWER ANS: 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. What is really
wrong?/Yelling at me will not change things/I will come back when you settle
down will place the parents on the defensive and not facilitate communication.
A common parental reaction to a child with special needs is parental
overprotection. Parental behavior suggestive of this includes:
a. giving inconsistent discipline.
b. providing consistent, strict discipline.
c. forcing child to help self, even when not capable.
, d. encouraging social and educational activities not appropriate to childs level
of capability. - ANSWER ANS: A
Parental overprotection is manifested by the parents fear of letting the child
achieve any new skill; they allow the child to avoid all discipline and cater to
every desire to prevent frustration. Overprotective parents: do not set limits and
or institute discipline; prefer to remain in the role of total caregiver; do not allow
the child to perform self-care; and do not encourage the child to participate in
social and educational activities.
Most parents of children with special needs tend to experience chronic sorrow.
This is characterized by:
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 and loss that occur in waves over time. -
ANSWER ANS: D
Chronic sorrow is manifested by feelings of sorrow and loss that recur in waves
over time. The sorrow is in response to the recognition of the childs limitations.
The family should be assessed in an ongoing manner to provide appropriate
support as the needs of the family change. The sorrow is not preventable. The
chronic sorrow occurs during the reintegration and acknowledgment stage.
Which intervention will encourage a sense of autonomy in a toddler with
disabilities?
a. Avoid separation from family during hospitalizations.
b. Encourage independence in as many areas as possible.
c. Expose child to pleasurable experiences as much as possible.
d. Help parents learn special care needs of their child. - ANSWER ANS: B
Encouraging the toddler to be independent encourages a sense of autonomy.
The child can be given choices about feeding, dressing, and diversional
activities, which will provide a sense of control. Avoiding separation from family
during hospitalizations, and helping parents learn special care needs of their
child should be practiced as part of family-centered care. It does not necessarily
foster autonomy. Exposing the child to pleasurable experiences, especially
sensory ones, is a supportive intervention. It does not promote autonomy.
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 - ANSWER 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 will foster dependence. The
school-age child will have limited opportunities for achievement and may not be
