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Flashcards in Chapter 18 Deck (10):
1

The nurse is caring for an 8-year-old child hospitalized with a chronic illness. The child has a tracheostomy and a parent is rooming-in. 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, the primary nurse should recognize that the parent is
a. controlling and demanding.
b. assuming the nurse's role.
c. the expert in care of the child.
d. afraid to allow the nurses to function independently.

Ans: C
The nurse recognizes that the philosophy of family-centered care states that the parents are the experts in the care of their child.
Because these parents care for their child with complex health needs at home, they are most familiar with the care requirements and routines that work best for their child. They are in no way being controlling or demanding.
The nurse's role includes assessment and evaluation, not just the implementation phase; therefore the parents are not assuming the nurse's role. In fact, they are participating in the care of the child in their role as parents.
In family-centered care, it is critical that the nurse works collaboratively with the family in caring for the child. No evidence supports that the parents are afraid to allow the nurses to function in their role.

2

Denial is a common reaction to the diagnosis of a disability or chronic illness. Which applies to denial as a defense mechanism?
a. Denial is maladaptive.
b. Denial is a necessary cushion to prevent disintegration of the family's psyche.
c. Denial prevents a sense of hope.
d. Denial prevents the mobilization of energies toward goal-directed, problem-solving behavior.

Ans: B
Adaptive denial is effective as the family learns the impact that the diagnosis of a disability will have on their family.
Denial is not maladaptive until it interferes with the treatment goals and regimen.
Denial may allow a sense of hope while the family is overwhelmed by the diagnosis.
Denial enables families to mobilize energies toward goal-directed problem solving.

3

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?
a. Hindered mobility
b. Poorly defined body image
c. Limited opportunities for socialization
d. Limited opportunities to achieve and accomplish

Ans: A
The inability to move about and master the environment will inhibit the toddler's developing autonomy, the critical task of toddlerhood.
A sense of body image begins to develop in the preschool years.
The task of socialization occurs during the preschool years as the child begins to develop peer relationships.
A child's sense of achievement and accomplishment begins to develop during the school-age years.

4

A 9-year-old boy has several physical disabilities. His father explains to the nurse that his son concentrates on what he can do, rather than what he cannot do, and is as independent as possible. Based on the nurse’s knowledge of family-centered care and various disabilities, the nurse interprets the child’s behavior and father’s attitude as that the
a. father is experiencing denial.
b. child is using an adaptive coping style.
c. child is using a maladaptive coping style.
d. father is expressing his own fears about his child's disability.

Ans: B
The behaviors and attitude described are characteristic of a child using an adaptive coping style. The child learns to accept physical limitations but finds achievements in a variety of compensatory motor and intellectual pursuits.
The father is describing his child using adaptive coping strategies.
The behaviors and attitude described are those of an adaptive coping style, not a maladaptive style.
The father is not expressing fear but is presenting a positive view of his son's adaptive skills.

5

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 than with the nurses. The nurse should recognize that this behavior indicates
a. that parent-to-parent support is valuable.
b. that parent-to-parent dependence is unhealthy.
c. the situation has developed because the nurses are unresponsive to the parents.
d. the situation is unusual and has the potential to increase friction between the parents and nursing staff.

Ans: A
Parent-to-parent support is unique and not available from other sources. Being with other parents who have shared similar experiences (such as hospitalization) allows a mutually supportive environment.
Rather than being a dependent relationship, parents provide support for each other, and this is a healthy strategy for assisting parents in working through similar psychosocial issues related to their child's illness, treatment, and prognosis.
The nurses cannot provide the same type of support as another parent who has had the "lived experience." There are no data to support that this type of relationship between parents occurs because of the nursing staff and their lack of responsiveness to the parents or child.
It is increasingly common for hospitals to facilitate parent-to-parent interaction. Parental support groups often meet in hospital settings and are encouraged to provide care to parents in similar circumstances.

6

A 4-year-old’s concept of death is that
a. death is temporary.
b. death is permanent.
c. death is personified in various forms.
d. death is inevitable at some age.

Ans: A
Death is seen as a temporary departure, and the child assumes that the individual who has "died" will be back soon.
The preschooler thinks of death as being an impermanent state. The 4-year-old believes that life and death can change places with each other.
The concept of death as being personified in various forms is more typical of the beliefs of school-age children.
The concept of the inevitability of death is more representative of the understanding of 9- and 10-year-olds.

7

A 5-year-old child’s sibling dies from sudden infant death syndrome (SIDS). The parents are concerned because the child showed more outward grief when their cat died than for the sibling's death. Based on the nurse’s knowledge of development, the nurse explains that
a. this behavior suggests maladaptive coping, and a referral is needed for counseling.
b. the child is not old enough to have a concept of death.
c. the child is not old enough to have formed a significant attachment to her sibling.
d. the death may be so painful and threatening that the child must deny it for now to protect her psyche.

Ans: D
A child at this age has limited defense mechanisms. Often, the child will react with more overt grief to a less significant loss than to the loss of a significant person.
The child's behavior is suggestive of limited defense mechanisms, not maladaptive coping.
The child is beginning to understand the permanence of death.
At age 5 years, the child will have formed relationships, including with a sibling.

8

The nurse is caring for a child dying from cancer. A physical sign that the child is approaching death is
a. rapid pulse.
b. change in respiratory pattern.
c. sensation of cold although body feels hot.
d. loss of hearing followed by loss of other senses.

Ans: B
In the final hours of life, the respiratory pattern may become labored, with periods of apnea.
In the hours nearing death, the pulse becomes weak and slowed, not rapid.
When nearing death, the opposite is true; there is a sensation of heat, although the body feels cold.
When nearing death, hearing is the last sense to fail.

9

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 that they felt especially close to both the child and the family. The supervisor should recognize that attending the funeral is
a. appropriate because families expect this expression of concern.
b. appropriate because it can assist in the resolution of personal grief.
c. inappropriate because it is considered unprofessional behavior on the part of the nurses.
d. inappropriate because it increases burnout of the nursing staff.

Ans: B
Nurses should attend the funeral of a child if they were close to the family. This will help the nurses grieve and gain closure.
Families may or may not expect this expression of concern.
The behavior is appropriate if a relationship existed between the nurses and family.
Attending the funeral of a child with whom they have developed a relationship may provide nurses a means of grieving and thus may prevent burnout.

10

The nurse working with families of children with chronic diseases is concerned with helping the parents and siblings avoid compassion fatigue. Which activities would the nurse encourage for the families? (Select all that apply.)
a. Exercising
b. Moving away to another city
c. Fostering social relationships in their community
d. Developing a hobby, either individually or as a family
e. Getting more than 10 hours of sleep in a 24-hour period

Ans: A, C, D