Chapter 36 RNSG 2201

The nurse is caring for an 8-year-ld child who has a chronic illness. The child has a tracheostomy, and a parent is rooming-in during this hospitalization. The parent insists on providing almost all of the child's care and tells the nurses how to care for the child. When planning the child's care, what should the primary nurse recognize about the parent?

The parent is the expert in care of the child

The parents of a terminally ill child are speaking with the nurse to learn about palliative care and how it differs from hospice care. What should the nurse tell them?

Palliative care is provided when no effective cure is available

The nurse is caring for a terminally ill child who is in the final stages of dying. What steps should the nurse take to control pain in the child?

Administer both opioid and nonnarcotic analgesics for severe pain

A terminally ill male adolescent is being admitted to the hospital because of lack of pain relief. When communicating with this patient about his feelings on death, which actions should the nurse incorporate into the plan of care?

Allow the adolescent to participate in the treatment decisions as much as possible

A child who was terminally ill died. What intervention should the nurse provide for the child and the family?

Allow the family be with and hold or rock the child

A baby is diagnosed with Turner syndrome shortly after birth. The parent is showing signs of depression and is finding it difficult to bond with the baby. Which characteristics indicate that the parent is in the adjustment stage? Select all that apply.

Believes the disability is a punishment from God Assumes that the disability is genetically inherited Believes the disability happened during pregnancy

The nurse is caring for a child dying from cancer. Physical signs that the child is approaching death include what?

Change in respiratory pattern

Which approaches should the nurse adopt to provide support and guidance to a grieving family?SATA

Provide a referral to a support group Recommend bereavement counseling Follow up regularly with telephone calls

The nurse is caring for an 11-year-old child diagnosed with a malignant tumor in the leg. The child suffered complications after treatment and lapsed into a coma. What are the physical signs of approaching death that the nurse recognizes in this child? SATA

Decreases in urinary output Cheyne-Stokes respirations Progressive loss of sensation

An infant is born at 28 weeks of gestation. Which current trend in health care might best illustrate the focus of are in this situation

Developmental focus

The parent of a newborn baby diagnosed with Down syndrome after birth is unable to accept the baby. The parent is very upset and is finding it difficult to develop a bond with the baby. What specific step taken by the nurse can help the parent develop a bond?

Emphasize healthy and perfect qualities of infant

The nurse is caring for a 10-year-old chkld diagnosed with a terminal illness. What interventions should the nurse include a to provide effective care to the patient and family?SATA

Encourage all family members to participate in the child's care Discuss the plan of treatment with the patient and the family together

An adolescent who has been diagnosed with metastatic bone cancer has failed to respond to treatment. The patient has begun to need more pain medication. The nurse tells the patient that too much will affect respiration and could be fatal. The patient, who has been very withdrawn, responds "Cancer is fatal, I'd just as soon die now from an overdose." Which action conveys greatest empathy from the nurse?

Encourage further expression of emotion

Which behavior should the nurse identify as maladaptive coping behavior in a child diagnosed with a chronic illness.

The child feels different from peers

The nurse is teaching a group of students about ways to improve communication with families of children with chronic illnesses. What is the most important information that should be included?

Ensure that the parents' and child's needs are met during this hospitalization

The nurse is caring for a child who is in the final stages of death. What can the nurse do to provide comfort for the parents?

Have the parents focus on the quality of the child's remaining life.

The senior nurse is providing an education in-service to a group of nurses on managing the care of the dying patient. What information should the nurse include in the teaching plan?

Help the family according to what they need

Which factors may influence how a family resolves a crisis? SATA

Other stressors coping mechanisms perception of the event Available support systems

The parents of a terminally ill child ask the nurse how hospice care is different from hospital care. What information should the nurse give them? SATA

No extraordinary efforts would be made to prolong the child's life. Pain and control of symptoms are the primary concerns of treatment Family members are the principal caregivers supported by the hospice team

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 with the nurse. What should the nurse recognize is true?

Parent-to-parent support is valuable

The parents of a 12-year-old child are informed that the child is in the terminal stages of osteosarcoma. The nurse explains to the parents about the care that needs to be provided for the child. Which characteristics of the parents indicate that they are in denial?

Refuse to believe the results of the tests Pleased to receive the medical diagnosis Insist that nobody is telling the truth Want the child to be admitted for more treatment

Which age group of children is the earliest that children view death as a permanent state?

School-age children

Which behaviors of the family members indicate avoidance behavior. SATA

Seeks cures from faith healers Demonstrates anger and hostility Refuse to agree to the treatment

The nurse is reviewing the plan of care with the parent of a child with Crohn's disease. Which statement made by the parent indicates a need for further education?

This illness is God's way of testing our religious faith

The nurse is caring for a child who is in the terminal stage of acute lymphocytic leukemia. What should be the goals of palliative care in the child? SATA

To support the family and the child To provide effective pain management To strive for the best possible quality of life

The parents of a child who died of leukemia are grieving in the hospital. What response by the nurse appropriate?

You are feeling the pain of losing a child

The mother of a child with bronchiectasis informs the nurse that the child's father comes home only twice a week. The father spends more time at the office and seems depressed. What is the Most appropriate response of the nurse.

informing the mother that fathers commonly work extra hours to escape the situation

The parents of a child who is dying of leukemia are grieving their impending loss. What intervention should the nurse perform to provide effective care for the family?

provide the child and family with time to share memories

What information should the nurse provide to a group of nursing students when teaching them about the analgesic stepladder for pain management in children with terminal illness?SATA

It outlines the principles of analgesic selection and titration It was implemented by the Would Health Organization (WHO) It provides for the use of adjunctive drug therapy to ease pain

A child who is terminally ill with bone cancer is in severe pain. What should nursing interventions be based on?

Large doses of opioids are justified when there are no other treatment options

A child has been diagnosed with a chronic and debilitating illness with a poor prognosis. The child has an older sibling who has begun acting out in school. In coordination with the parents, what can the nurse do for the sibling? SATA

Legitimize reasonable anger Invite the child to offer solutions for problems Let the child's teacher know about the situation

A child diagnosed with end-stage leukemia denies having a serious condition, but agrees to undergo treatment. What should be the most appropriate step to be taken by the nurse?

Let the child be in denial stage as long as agreeing to have the treatment

The parents of a child diagnosed with lymphoma inform the nurse that they feel guilty because of the changes in the family dynamics. What coping skills can the nurse provide that would help the parents manage stress? SATA

Make sure you take time for your own needs Break problems into small, manageable parts Depend on your family members and friends

A newborn baby is diagnosed with cerebral palsy. The parents of the baby do not understand English. Who can the nurse use as an interpreter in the given situation?

Professional language interpreters

A child is in the final stages of dying and has death rattle. The parents are finding it very difficult to see their child in this condition. What steps taken by the nurse could this experience less distressing?

Telling the family it is a normal sign of the process of death

A 9-year-old child has several physical disabilities. His father explains to the nurse that his sone concentrates on what her can (rather than cannot) do and is as independent as possible. What is the nurse's best interpretation of this?

The child is using an adaptive coping style

A preschooler is diagnosed with terminal stage bronchial carcinoma. What would the child consider the most probable reason for the condition?

The child would consider it to be a punishment for his or her own actions

The nurse working in a pediatric oncology department witnessed the death of a patient for the first time. The nurse is very upset and seeks the advice of a colleague regarding coping strategies. What advice should be given to the nurse? SATA

The nurse should take time off from work for some rest. The nurse should try to cultivate the capacity to empathize The nurse should focus on positive aspects of caregiver role

The nurse finds that the parents of a terminally ill child is unusually optimistic about the child's condition. What should the nurse interpret from this?

The parent is in the denial stage of grief

The nurse is working with a family who has a child with a chronic illness. The nurse notices that the parents watch television and play on their electronic devices instead of spending time with the child. The parents are frequently reprimanding the child. What should the nurse interpret from these findings?

The parents are displaying rejection

A terminally ill child is visited by the home hospice nurse. The mother informs the nurse that her husband will not spend time with anyone and verbalizes suicidal intent. What other behaviors would indicate that the father is using avoidance to manage his emotions? SATA

Uses excessive amounts of alcohol or drugs to avoid problems Continually looking for new cures with no hope of possible benefit Withdraws from the outside world and chooses not to interact with anybody

A child is brought to the clinic for a routine check-up. The parent informs the nurse that the child wants to go to school, but the parent does not want the child to go. What other characteristics in the parent would indicate that the parent is overprotective? SATA

continually helps child even if the child is capable Puts restrictions on child's play due to fear of injury Sets high goals without understanding child's abilities

Which behavior would characterize a child adequately coping with a chronic illness? SATA

Identification with other similarly affected people Taking responsibility for his or her own physical are Acceptance of his or her limitations and coping accordingly

A 5-year-old girl's sibling dies from sudden infant death syndrome. The parents are concerned because she showed more outward grief when her car died than she is showing now. What should the nurse explain?

The death may be so painful and threatening that the child must deny it for now.

The nurse is caring for a family that is grieving the loss of their child. Which statement made by the nurse helps comfort the family?

You must be going through a difficult time. How may I help?

The student nurse is caring for a 10-year-old child in the terminal stages of acute lymphocytic leukemia. Which instructions should the nursing instructor provide to the student nurse when caring for the child? SATA

You should urge the parents to accept the truth and spend time together You should encourage the child's parents to ask for help when they need it

The potential effects of chronic illness or disability on a child's development vary at different ages. What is a threat to a toddler's normal development?

Hindered mobility

The nurse is caring for a child who is nearing death. What should the nurse do at the time of death for the child and the family?

Allow the parents to stay with the child and the time of death

A patient's parents confronted the nurse by stating, "if you had been here, you could have done more to prevent our child from dying today." Based on this information, what stage of the grieving process are the parents exhibiting?

Anger

A 14-year-old patient with Ewing's sarcoma is scheduled for an amputation of the right leg. The patient has been grieving about the loss ever since the health are provider prescribed the surgery. What type of grief does the nurse identify in the patient?

Anticipatory grief

Several nurses tell their nursing supervisor that they want to be able to attend the funeral of a child for whom they had cared. They say they felt especially close to both the child and the family. The supervisor should recognize that attending the funeral is what?

Appropriate because it can assist in the resolution of personal grief

A child diagnosed with a congenital heart problem is brought to the hospital for a routine checkup. The mother informs the nurse that her husband is sad and depressed and has angry outbursts frequently. What other characteristics noted in the husband indicate that he is using approach behaviors to manage his emotions?SATA

Asks for help and support from others Verbalizes the possible loss of the child Makes realistic plans for the near future

The parents of a child are grieving the loss of their child. The mother of the child has disturbed sleep. The father informs the nurse that the mother can hear their child talk. The mother wants to be left alone and does not speak to any of the family members. What should be the most appropriate response of the nurse?

Inform the father that it is a normal part of grief and will subside over time

The parents of a child diagnosed with terminal stage cancer request the nurse not to inform their child about the condition. What should be the most appropriate response of the nurse?

Inform the parents that being honest with the child is important

The parents of a 10-year-old child are informed that the child is in the terminal stage of acute lymphocytic leukemia. The nurse explains to the parents about the care to be taken for the child. Which characteristic in the parents indicate that they are in the denial stage? SATA

Insisting that no one is telling the truth to them Delayed consent for treatment and procedures Attributing the symptoms of the child to tonsillitis Asking no questions about treatment or prognosis

The parents of a 5-year old child with terminal leukemia talk to the nurse about the sibling's behavior. This behavior started when their child with leukemia became ill. and it has gotten worse. What interventions should the nurse provide to help the sibling cope? SATA

Instruct the parents that they should treat both siblings equally Tell the parents that it is a normal behavior for siblings to act out Encourage the parents to spend time with their healthy children

Which child behaviors indicate maladaptive coping toward chronic illness? Select all that apply.

Is irritable both at home and during school Expresses feelings of worthlessness to others Demonstrates feelings of pessimism and inadequacy

A nursing professor is teaching a group of graduate nurses about anticipatory grief reactions. What information should be included in the presentation

It can happen when the death is expected

Denial is a common reaction to the diagnosis of a disability or chronic illness. The nurse knows what about the use of denial as a defense mechanism

It is a necessary cushion to prevent disintegration

A senior nurse is teaching complicated grief reaction to a group of newly recruited nurse. What information should be given to them? SATA

It is seen more than 1 year after the loss It can result in unusual sleep disturbances It can result in feelings of excessive loneliness