Chapter 36: Impact of Chronic Illness, Disability, or End-of-Life Care for the Child
and Family
Perry: Maternal Child Nursing Care, 7th Edition
MULTIPLE CHOICE
1. 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. Whom 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 child's care
d. Primary care physician and key health professionals involved in child's care
ANSWER: C
A multidisciplinary conference is necessary for coordination of care for children with complex
health needs. The family and key health professionals who are involved in the child's care are
included. The nursing staff can address the nursing care needs of the child with the family, but
other involved disciplines must be included. 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. A member of the nursing staff must be included to review the
nursing needs of the child.
PTS: 1 DIF: Cognitive Level: Analysis OBJ: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
.
2. Lindsey, age 5 years with a diagnosis of cerebral palsy, will be starting kindergarten next
month and will be placed in a special education classroom. The parents are tearful when
telling the nurse about this and state that they did not realize that their child's disability was so
severe. How should the nurse interpret this parental response?
a. This is a sign that 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: B
Parenting a child with a chronic illness can be very 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 child's placement in
school. The parents are not exhibiting signs of a knowledge deficit or expectations that are too
high; this is their first interaction with the school system with this child.
PTS: 1 DIF: Cognitive Level: Analysis
OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
3. Which behavior is considered an approach behavior in parents of chronically ill children?
a. Inability to adjust to a progression of the disease or condition.
b. Anticipation of future problems and seeking guidance and answers.
c. Looking for new cures without a perspective toward possible benefit.
,
, d. Failing to recognize seriousness of child's condition despite physical evidence.
ANSWER: B
Approach behaviors are coping mechanisms that result in a family's movement toward
adjustment and resolution of the crisis of having a child with a chronic illness or disability.
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.
Avoidance behaviors include 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 the seriousness of the child's condition despite physical evidence. These behaviors
would suggest that the parents are moving away from adjustment or adaptation in the crisis of
a child with chronic illness or disability.
PTS: 1 DIF: Cognitive Level: Analysis
OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
4. 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 that may be
characterized by what reaction?
a. Anger
b. Overprotectiveness
c. Social reintegration
d. Guilt
ANSWER: B
For most families, the adjustment phase is accompanied by several responses that are
normally part of the adjustment process. Overprotectiveness, rejection, denial, or gradual
acceptance are common reactionsN . TUhReSIiNnG
itiTaBl .dCiOa gMno s is of a chronic illness or disability often
is often met with intense emotion and characterized by guilt and anger. Social reintegration is
the culmination of the adjustment process.
PTS: 1 DIF: Cognitive Level: Comprehension OBJ: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
5. The nurse comes into the room of a child who was just diagnosed with a chronic disability.
The child's parents begin to yell at the nurse about a variety of concerns. What is the nurse's
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: 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 express their
feelings and emotions. “What is really wrong?” “Yelling at me will not change things,” and “I
will come back when you settle down” are all possible responses, but they are not addressing
the parent's need to express their anger effectively.
PTS: 1 DIF: Cognitive Level: Analysis
and Family
Perry: Maternal Child Nursing Care, 7th Edition
MULTIPLE CHOICE
1. 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. Whom 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 child's care
d. Primary care physician and key health professionals involved in child's care
ANSWER: C
A multidisciplinary conference is necessary for coordination of care for children with complex
health needs. The family and key health professionals who are involved in the child's care are
included. The nursing staff can address the nursing care needs of the child with the family, but
other involved disciplines must be included. 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. A member of the nursing staff must be included to review the
nursing needs of the child.
PTS: 1 DIF: Cognitive Level: Analysis OBJ: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
.
2. Lindsey, age 5 years with a diagnosis of cerebral palsy, will be starting kindergarten next
month and will be placed in a special education classroom. The parents are tearful when
telling the nurse about this and state that they did not realize that their child's disability was so
severe. How should the nurse interpret this parental response?
a. This is a sign that 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: B
Parenting a child with a chronic illness can be very 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 child's placement in
school. The parents are not exhibiting signs of a knowledge deficit or expectations that are too
high; this is their first interaction with the school system with this child.
PTS: 1 DIF: Cognitive Level: Analysis
OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
3. Which behavior is considered an approach behavior in parents of chronically ill children?
a. Inability to adjust to a progression of the disease or condition.
b. Anticipation of future problems and seeking guidance and answers.
c. Looking for new cures without a perspective toward possible benefit.
,
, d. Failing to recognize seriousness of child's condition despite physical evidence.
ANSWER: B
Approach behaviors are coping mechanisms that result in a family's movement toward
adjustment and resolution of the crisis of having a child with a chronic illness or disability.
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.
Avoidance behaviors include 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 the seriousness of the child's condition despite physical evidence. These behaviors
would suggest that the parents are moving away from adjustment or adaptation in the crisis of
a child with chronic illness or disability.
PTS: 1 DIF: Cognitive Level: Analysis
OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
4. 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 that may be
characterized by what reaction?
a. Anger
b. Overprotectiveness
c. Social reintegration
d. Guilt
ANSWER: B
For most families, the adjustment phase is accompanied by several responses that are
normally part of the adjustment process. Overprotectiveness, rejection, denial, or gradual
acceptance are common reactionsN . TUhReSIiNnG
itiTaBl .dCiOa gMno s is of a chronic illness or disability often
is often met with intense emotion and characterized by guilt and anger. Social reintegration is
the culmination of the adjustment process.
PTS: 1 DIF: Cognitive Level: Comprehension OBJ: Nursing Process: Planning
MSC: Client Needs: Psychosocial Integrity
5. The nurse comes into the room of a child who was just diagnosed with a chronic disability.
The child's parents begin to yell at the nurse about a variety of concerns. What is the nurse's
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: 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 express their
feelings and emotions. “What is really wrong?” “Yelling at me will not change things,” and “I
will come back when you settle down” are all possible responses, but they are not addressing
the parent's need to express their anger effectively.
PTS: 1 DIF: Cognitive Level: Analysis
