Chapter 40: Chronic Illness, Complex Conditions, and End-of-Life Care
MULTIPLE CHOICE
1. The nurse case manager is planning a care conference for 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. The social worker, nursing staff, and
primary care physician
c. Family and key health professionals
involved in the child’s care
d. Primary care physician and key health
professionals involved in the child’s
care
ANS: C
A multidisciplinary conference is necessary to coordinate care for a child with complex health
needs. The family and key health professionals who are involved in the child’s care should thus
be included. The nursing staff can address the nursing care needs of the child with the family,
but other involved disciplines must be included to cover all aspects of care. The family must be
included to gain the education they will require and prepare the resources needed at home.
DIF: Cognitive Level: Analysis REF: p. 1184
OBJ: Nursing Process: Planning
2. A 5-year-old with cerebral palsy will be starting kindergarten next month, 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 condition was so severe. What
is the best way for the nurse to interpret this situation?
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.
ANS: B
, Parenting a child with a chronic illness or complex condition 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. They are also not exhibiting signs of a knowledge deficit; this is
their first interaction with the school system with this child.
DIF: Cognitive Level: Analysis REF: p. 1186 | Box 40-3 OBJ:
Nursing Process: Assessment
3. Approach behaviours 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 complex
condition. Which is considered an approach behaviour?
a. The parent is unable to adjust to the
progression of the disease or condition.
b. The parent anticipates future problems
and seeks guidance and answers.
c. The parent looks for new cures without
thinking of the possible benefit.
, d. The parent fails to recognize the
seriousness of child’s condition
despite physical evidence.
ANS: B
Parents who anticipate future problems and seek guidance and answers are demonstrating
approach behaviours. They are demonstrating positive actions in caring for their child.
Avoidance behaviours include being unable to adjust to the progression of the disease or
condition, looking for new cures without a thinking of the possible benefit, and failing to
recognize the seriousness of the child’s condition despite physical evidence. These behaviours
would suggest that the parents are moving away from adjustment, or showing maladaptation
to the crisis of a child with chronic illness or complex condition.
DIF: Cognitive Level: Analysis REF: p. 1188 |Guidelines box OBJ:
Nursing Process: Assessment
4. Families progress through various stages of reactions when a child is diagnosed with a chronic
illness or complex condition. Which characterizes the period of adjustment that usually
follows the shock phase?
a. Denial
b. Bitterness and anger
c. Social reintegration
d. Acceptance of child’s limitations
ANS: B
For most families, the adjustment phase is accompanied by several responses that are
considered normal. A large portion of this phase is one of grief for a loss. The initial diagnosis of
a chronic illness or complex condition is often met with intense emotion and characterized by
shock and denial. Social reintegration and acceptance of the child’s limitations is the
culmination of the adjustment process.
DIF: Cognitive Level: Comprehension REF: p. 1189 OBJ: Nursing
Process: Planning
5. A common parental reaction to a child with special needs is overprotection. Which is
suggestive of this type of behaviour?
a. Providing inconsistent discipline
b. Providing consistent, strict discipline
c. Forcing the child to help him- or herself,
even when not capable
MULTIPLE CHOICE
1. The nurse case manager is planning a care conference for 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. The social worker, nursing staff, and
primary care physician
c. Family and key health professionals
involved in the child’s care
d. Primary care physician and key health
professionals involved in the child’s
care
ANS: C
A multidisciplinary conference is necessary to coordinate care for a child with complex health
needs. The family and key health professionals who are involved in the child’s care should thus
be included. The nursing staff can address the nursing care needs of the child with the family,
but other involved disciplines must be included to cover all aspects of care. The family must be
included to gain the education they will require and prepare the resources needed at home.
DIF: Cognitive Level: Analysis REF: p. 1184
OBJ: Nursing Process: Planning
2. A 5-year-old with cerebral palsy will be starting kindergarten next month, 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 condition was so severe. What
is the best way for the nurse to interpret this situation?
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.
ANS: B
, Parenting a child with a chronic illness or complex condition 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. They are also not exhibiting signs of a knowledge deficit; this is
their first interaction with the school system with this child.
DIF: Cognitive Level: Analysis REF: p. 1186 | Box 40-3 OBJ:
Nursing Process: Assessment
3. Approach behaviours 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 complex
condition. Which is considered an approach behaviour?
a. The parent is unable to adjust to the
progression of the disease or condition.
b. The parent anticipates future problems
and seeks guidance and answers.
c. The parent looks for new cures without
thinking of the possible benefit.
, d. The parent fails to recognize the
seriousness of child’s condition
despite physical evidence.
ANS: B
Parents who anticipate future problems and seek guidance and answers are demonstrating
approach behaviours. They are demonstrating positive actions in caring for their child.
Avoidance behaviours include being unable to adjust to the progression of the disease or
condition, looking for new cures without a thinking of the possible benefit, and failing to
recognize the seriousness of the child’s condition despite physical evidence. These behaviours
would suggest that the parents are moving away from adjustment, or showing maladaptation
to the crisis of a child with chronic illness or complex condition.
DIF: Cognitive Level: Analysis REF: p. 1188 |Guidelines box OBJ:
Nursing Process: Assessment
4. Families progress through various stages of reactions when a child is diagnosed with a chronic
illness or complex condition. Which characterizes the period of adjustment that usually
follows the shock phase?
a. Denial
b. Bitterness and anger
c. Social reintegration
d. Acceptance of child’s limitations
ANS: B
For most families, the adjustment phase is accompanied by several responses that are
considered normal. A large portion of this phase is one of grief for a loss. The initial diagnosis of
a chronic illness or complex condition is often met with intense emotion and characterized by
shock and denial. Social reintegration and acceptance of the child’s limitations is the
culmination of the adjustment process.
DIF: Cognitive Level: Comprehension REF: p. 1189 OBJ: Nursing
Process: Planning
5. A common parental reaction to a child with special needs is overprotection. Which is
suggestive of this type of behaviour?
a. Providing inconsistent discipline
b. Providing consistent, strict discipline
c. Forcing the child to help him- or herself,
even when not capable
