Chap 56

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Chapter: Chapter 56: Nursing Care of a Family when a Child has a Long Term or Terminal
Illness
Multiple Choice
1. The parents of a 6-year-old have just been told that their child will die shortly. The age at
which the average child is capable of understanding death is:
A) 3 years.
B) 6 years.
C) 9 years.
D) 12 years.
Ans: C
Client Needs: Psychosocial Integrity
Cognitive Level: Remember
Page: 1591
Feedback: Most children are around age 9 before they are able to comprehend that death is final
and cannot be reversed.
2. A child who knows his disease is terminal tells you that when he gets better he is going to be
a doctor and cure everyone in the whole world. This statement is most likely a manifestation of:
A) his poor opinion of the care he has received.
B) immature magical thinking.
C) a bargaining stage of grief.
D) anxiety over his illness.
Ans: C
Cognitive Level: Apply
Page: 1591
Feedback: The bargaining stage of grief involves making promises or “deals” to try to
accomplish a better outcome.
3. The intravenous infusion line infiltrates on a child who is terminally ill, and his mother tells
you that the nursing care in this hospital is the worst she has ever seen. What is your best
response to her?
A) “Tell me with what you are comparing the care here.”
B) “You seem angrier today than before. Is something going on?”
C) “I think you should talk to a nursing supervisor.”
D) “You're right, but we're trying to improve.”
Ans: B
Page: 1588
Feedback: Anger is a common stage of grief. Recognizing this improves parent–nurse relations
and helps the parent work through stages of grief.
4. The nurse is caring for a preschooler who knows she is dying. Her reaction to her impending
death is most likely to be demonstrated through:
A) outbreaks of anger.
B) fear of being separated from her parents.
C) bargaining for another chance.
D) verbalization of her feelings.
Ans: B
Page: 1591
Feedback: Fear of separation is almost a universal fear of preschoolers.
5. To be an effective nurse with a female child who is dying, it is first necessary to:
A) explain the stages of grief to her parents.
B) assess at which stage of grief the parents are.
C) help the child understand the grieving process.
D) identify your own reactions and feelings about death.
Ans: D
Page: 1593
Feedback: It is difficult to help children and parents deal with dying and grief until you
understand it yourself.
6. After several weeks of caring for a child who is dying, a nurse finds herself hoping that the
child will die on the weekend she is scheduled to be off work. This behavior is consistent with
which stage of grief?
A) Acceptance
B) Bargaining
C) Anger
D) Depression
Ans: B
Page: 1593
Feedback: Bargaining as a stage of grief is making conditions or “deals” to hope to achieve a
better outcome.
7. During a child's last stage of dying, her parents ask, “Is she able to hear us?” What is your
best response?
A) “Yes, she is able to hear and fully comprehend everything that is said.”
B) “No, now that she is semicomatose, she is unable to hear you.”
C) “No one really knows whether one can hear at this stage; it probably is a good idea not to
speak too loudly.”
D) “Yes, she can hear and may also understand most of what is being said.”
Ans: D
Client Needs: Physiological Integrity: Physiological Adaptation
Page: 1595
Feedback: Hearing is one of the last senses lost with dying.
8. A parent asks the nurse what the philosophy or purpose of a hospice program is. What is the
nurse's best response?
A) “A hospice is a facility that provides long-term care.”
B) “A hospice provides care with the belief that death is an extension of life.”
C) “A hospice allows for open visiting and homelike care.”
D) “A hospice is a facility for the terminally ill.”
Ans: B
Client Needs: Safe, Effective Care Environment: Management of Care
Page: 1593
Feedback: Hospices not only provide care for people who are dying, but also individualize care
to make it an extension of the person's life.
9. The nurse is caring for an infant born with a congenital anomaly. Which of the following
factors is likely to have the most influence on the mother's ability to cope with the infant's
handicap?
A) The mother's age
B) The gender of the infant
C) The parents' amount of support
D) The fact that this is a mental and not a physical challenge
Ans: C
Client Needs 2: Safe, Effective Care Environment: Safety and Infection Control
Cognitive Level: Analyze
Page: 1582
Feedback: Availability of support people to help the mother cope with the infant's handicap will
have a major influence. A family that has few close friends and lives some distance from
relatives is apt to have more difficulty adjusting to illness in a child than a family that has close
support people. People who can locate secondary support systems in their community usually do
better than parents who are without these resources. The mother's age, gender of the infant, and
type of handicap will not have the most influence on the mother's ability to cope with the infant's
needs.
Multiple Selection
10. The hospice nurse is planning a community program that emphasizes the 2020 National
Health Goals to reduce long-term illness and early death in children. Which information should
the nurse include in this program? Select all that apply.
A) Strategies to prevent unintentional injury
B) Seeking early prenatal care when pregnant
C) Following recommended immunization schedules
D) Supporting childhood physical activity expectations
E) Following recommended dietary intake requirements
Ans: A, B, C
Client Needs: Health Promotion and Maintenance
Client Needs 2: Physiological Integrity: Basic Care and Comfort
Page: 1581
Feedback: Nurses can help the nation achieve the 2020 National Health Goals to reduce long-
term illness and early death in children by educating women to seek care during pregnancy so
that congenital anomalies are less frequent and to teach unintentional injury prevention and the
importance of immunizations so unintentional injuries and infectious diseases that can lead to
long-term illness can be reduced. Physical activity expectations and dietary intake requirements
are not strategies to achieve the 2020 National Health Goals to reduce long-term illness and early
death in children.
Multiple Choice
11. The community nurse is caring for a family who has a child with a long-term illness. At
which point in life should the nurse anticipate the parents having the least difficult time
accepting the child's condition?
A) On the child's first birthday
B) The day the child starts kindergarten
C) The day the child is toilet trained
D) The day the child would have graduated college
Ans: D
Page: 1582
Feedback: A child's illness usually appears to be more acute at times when the child would
normally reach developmental milestones. When the child does not reach these traditional
milestones, it reminds parents about their child's illness in a particularly painful way. The first
birthday, starting kindergarten, and being toilet trained are momentous occasions for families
raising children. The family may or may not view attending college as a priority.
12. The parents of a school-age child are informed that their child has muscular dystrophy and
will be wheelchair bound going forward. Which nursing diagnosis should the nurse identify as
appropriate for the parents at this time?
A) Hopelessness related to steady progression of child's disease
B) Interrupted family processes related to recent diagnosis of chronic illness in a child
C) Decisional conflict related to treatment options and choice of setting for child's final care
D) Risk for delayed growth and development related to lack of age-appropriate stimulation
because of disability
Ans: B
Client Needs 2: Safe, Effective Care Environment: Management of Care
Page: 1581
Feedback: Because the parents are just learning of the diagnosis of muscular dystrophy, this
news will interrupt family processes. There is no enough information to determine if the parents
are hopeless. The child is not diagnosed with a terminal illness. There is no enough information
to determine if the child is at risk for delayed growth and development.
13. The parents of a 6-year-old have just been told that their child will die shortly. At which age
does the nurse realize that children are capable of understanding death?
A) 3 years
B) 6 years
C) 9 years
D) 12 years
Ans: C
Page: 1592
Feedback: As children near 8 or 9 years of age, they begin to appreciate that death is permanent.
Younger children are not able to conceptualize the permanence of death. A 12-year-old child is
able to conceptualize the permanence of death.
14. A child who knows about her terminal disease tells the nurse of plans to recover and become
a doctor to cure everyone in the whole world. What is the child demonstrating to the nurse?
A) Anxiety about the illness
B) Bargaining stage of grief
C) Immature magical thinking
D) Poor opinion of the care received
Ans: B
Page: 1588
Feedback: Bargaining, a stage of the grief process, is attempting to work out a deal to prevent
death from occurring. This child is not demonstrating anxiety, immature thinking, or a poor
opinion of the care that has been received.
15. A terminally ill child is awake at 2 AM and continues to put on the call light. What should
the nurse do regarding this child's behavior?
A) Provide with a sleeping aid.
B) Encourage the child to sleep.
C) Sit with the child until sleep comes.
D) Put on the television and dim the lights.
Ans: C
Page: 1592
Feedback: Many children assume that they will die at night. A child may talk more freely at
night about fears or an unfulfilled life ambition than during the day. Children may also be more
frightened at night and enjoy having someone sit beside them until they fall asleep. The nurse
should not provide with a sleeping aid. Encouraging the child to sleep will not meet the child's
needs at this time. Putting on the television with dim lights in the room will not meet the child's
needs at this time.
16. The nurse is caring for a preschool-age child who is aware of impending death. What
behavior should the nurse expect the child to demonstrate at this time?
A) Outbreaks of anger
B) Verbalization of feelings
C) Bargaining for another chance
D) Fear of being separated from parents
Ans: D
Page: 1591
Feedback: Preschoolers fear separation. If able to grasp the concept of dying, this child's major
worry is being alone and separated. These children may need someone to stay with them
constantly to reassure them that they are loved and people are caring for them. Anger,
verbalization of feelings, and bargaining are not behaviors typically associated with a preschool
age-child who is facing death.
17. The mother of a terminally ill child stays with the child day and night. Which statement
indicates that the mother is in the chronic sorrow of depression stage?
A) “I will never accept that my child is dying.”
B) “I know that there is nothing that can be done for my child.”
C) “There must be another doctor somewhere that can help my child.”
D) “I will go to church every week if this will keep my child from dying.”
Ans: A
Page: 1588
Feedback: In the stage of depression, parents begin to face what is happening. They feel sad and
unprotected. Some parents never reach the stage of acceptance and will always remain in the
chronic sorrow of the depression stage. Saying that the child's dying will never be accepted
indicates the chronic sorrow of depression stage. Knowing that nothing can be done for the child
is acceptance. Looking for another doctor to help the child is the stage of anger. Going to church
every week to prevent the child from dying is bargaining.
Multiple Selection
18. The nurse is planning care to help young parents adjust to their newborn's long-term illness.
Which assessment findings about the parents will help the nurse plan for their care? Select all
that apply.
A) Parents belong to a local church.
B) Parents have strong ties with their parents and siblings.
C) Parents are strong in their marriage and frequently hold hands.
D) Parents state issues with having to spend time at the hospital instead of working.
E) Parents are overheard discussing the cost of the medical care and if insurance will cover it.
Ans: A, B, C
Page: 1584
Feedback: Factors that ease parental adjustment to a child's long-term illness include having a
strong religious faith, having a good relationship with their parents, having support people
available such as siblings, and having a good marital bond. Having concerns about missing work
and having enough money for medical care are not findings that will help the parents adjust to
their newborn's long-term illness.
Multiple Choice
19. During a child's last stage of dying, the parents ask if the child is able to hear. How should
the nurse respond to the parents?
A) “No, now that she is semicomatose, she is unable to hear you.”
B) “No one really knows, so it is a good idea not to speak too loudly.”
C) “Yes, she is able to hear and fully comprehend everything that is said.”
D) “Yes, she can hear and may also understand most of what is being said.”
Ans: D
Page: 1595
Feedback: A loss of consciousness occurs as children grow closer and closer to death; although,
they may remain perfectly alert until seconds before death. Because hearing is one of the last
senses lost, the nurse may need to remind family members and other health care personnel that
the child may not be able to respond but may be able to hear. Continue to explain procedures to
unconscious children as if they were conscious because they undoubtedly do hear. Never make
any comment in the child's presence that would not be made if the child were alert.
20. The nurse notes that a chronically ill child has not been seeing the health care provider for
several months, although monthly checkups and blood work are needed to help maintain the
illness. What should the nurse realize as a reason for the child missing appointments?
A) The parents have been too busy to bring the child.
B) The family does not have the money to pay for multiple visits.
C) The child is afraid of having the blood drawn, so the parents do not bring him.
D) The parents are having a difficult time grieving with the idea of the child's illness.
Ans: D
Page: 1589
Feedback: Most parents of a chronically ill child adhere well to instructions and keep health care
appointments consistently. Sometimes, however, parents do not follow this pattern. This inability
to adhere usually is related to their stage of adjustment to the illness. As long as denial, anger,
bargaining, or depression is functioning, coming in for health care or evaluation is viewed as a
major demand. Each visit is more of a reminder of the child's illness than a time of reassuring
health assessment. This behavior does not indicate that the parents are too busy. There is no
enough information to determine if the visits are cost prohibitive for the family. There is no
enough information to determine if the child is afraid of having blood tests performed.
21. The parents of a terminally ill child do not want the child dying in the hospital. What can the
nurse suggest to help the parents' needs?
A) Admit to a long-term care facility.
B) Have hospice provided through home care.
C) Discharge the child to home right before death.
D) Have family stay with the child around-the-clock in the hospital.
Ans: B
Page: 1592-1593
Feedback: Many families prefer that a child die at home, surrounded by family and familiar
possessions, rather than in a hospital. For many children, hospice care is furnished as part of
home care, so that they are not separated from their families. This would be the best suggestion
for the nurse to make to the parents of the dying child. A long-term care facility is similar to a
hospital and would not meet the family's needs. Discharging the child to home prior to death will
not meet the needs of the family. Having the family stay with the child around-the-clock in the
hospital definitely will not meet the family's needs.
22. During a home visit with a family, the nurse learns that the oldest adolescent son has been
arrested for shoplifting and has been skipping school for months. Which information within the
family's health history could help explain this child's behavior?
A) Father works out of the home.
B) Mother works out of the home.
C) Adolescent did not die as expected as a child.
D) Parents have other children that need time and attention.
Ans: C
Page: 1589
Feedback: Parents who engage in anticipatory grief only to have the ill child survive may have
problems reversing the feelings. The parents begin to treat the child in a cold, unfeeling way.
This child is a vulnerable child or a fragile child and may develop behavioral problems later such
as shoplifting. It is unknown if this child's behavior is linked to the mother and father working
outside of the home or if the behavior is because of the other children's needs.
23. The nurse caring for children on a pediatric oncology care area delays entering some of the
children's rooms unless to provide medication or perform a procedure. Which stage of the
grieving process is influencing this nurse's ability to provide patient care?
A) Anger
B) Denial
C) Bargaining
D) Depression
Ans: B
Page: 1593
Feedback: There is a danger that a nurse who is in a stage of denial may care for children by
avoiding going into a child's room unless an important procedure must be done. Nurses who are
angry might provide care that is sharp and abrupt. Bargaining is promising to do something in
exchange for the child not dying. Nurses who are in the depression stage may be ineffective
caregivers because problem solving and decision making becomes a chore.
Multiple Selection
24. The nurse is preparing the parents for the death of their child. Which signs will the nurse
include in the teaching session? Select all that apply.
A) Diarrhea may occur and abdomen may be distended.
B) Skin may feel cool and appear mottled or cyanotic.
C) Respirations slow and lungs may have more secretions.
D) Child may lose gag reflex and be unable to swallow.
E) Hearing is absent when child appears to be in a coma.
F) Dehydration occurs with mouth and eyelid dryness.
Ans: B, C, D, F
Client Needs: Physiological Integrity: Physiological Adaptation
Page: 1595
Feedback: Stroke volume of the heart decreases, so the power to circulate blood is reduced. The
child's skin feels cool and may appear mottled or cyanotic because blood can no longer be
pushed to distal sites. Slowed respirations lead to increased secretions in the lungs and the
appearance of rales, the sound of air being pulled through fluid in the alveoli. As the throat
muscles become lax, the child may lose the gag and swallowing reflex. Dehydration with dry
mucous membranes and conjunctivae will occur unless intravenous fluid replacement is initiated.
Diarrhea is incorrect, as constipation occurs due to slowed peristalsis. Hearing is one of the last
senses to go, even if the child is in a coma.
Multiple Choice
25. The parents of a child who died of sudden infant death syndrome at home are refusing to
allow an autopsy. What is the nurse's best response?
A) You have every right to refuse and we will abide by your wishes.
B) Most states require an autopsy when a child passes away at home.
C) It is important to agree to an autopsy to advance medical science.
D) Let me have you discuss this further with the health care provider.
Ans: B
Page: 1596
Feedback: State laws vary, but generally, if a child's death is a result of homicide, suicide, death
within 24 hours after a hospital admission, suspected harmful death, or death in an institution or
home where the child was not under the care of a primary health care provider, an autopsy is
required by law and parents have no input regarding whether this is done or not.
26. The parents of a newborn have been told that their infant has suffered a brain injury. Which
initial question will help the nurse plan care for this family?
A) Can you tell me what you were told about your child's condition?
B) Would you like me to explain what happened to your baby's brain?
C) Is this your first child or do you have other children at home?
D) Would you be interested in joining a support group for parents?
Ans: A
Page: 1582
Feedback: It is important to assess what the parents have been told prior to beginning a plan of
care. It is not the nurse's responsibility to explain what happened to the baby's brain. Although it
is helpful to know if the parents have other children, it is not the initial question that needs to be
asked. Asking about a support group is appropriate later in the process, but not when first
learning about the child's condition.
27. The nurse has gotten report on four hospitalized children. Which child needs to be seen first?
A) The child with leukemia getting ready to start chemotherapy.
B) The child with cystic fibrosis with an oxygen saturation of 92.
C) The child in the final stages of dying with his family at bedside.
D) The child with diabetes who has a fasting blood sugar of 110.
Ans: B
Page: 1595
Feedback: The first child to be seen is the one with cystic fibrosis and the low oxygen saturation
level. Although it is anticipated that their level may be low, 92 indicates that there is something
going on with the respiratory status. The other children are stable at this time, and can be seen
next.
Multiple Selection
28. The nurse is planning activities on the pediatric oncology unit. Select which activities can be
delegated to the nursing assistant. Select all that apply.
A) Answering the call bells
B) Taking vital signs on stable children
C) Delivering fresh water and meals
D) Checking the IV bags for amount remaining
E) Emptying Foley bags and measuring output
F) Consoling a mother whose child is dying
Ans: A, B, C, E
Page: 1590-1591
Feedback: Nursing assistants are able to answer call bells, take vital signs, deliver water and
meals, and empty Foley bags and measure output. They are not able to check IV bags or be
expected to console the mother of a dying child. Nursing assessment and therapeutic
communication are considered roles of the professional nurse, not of a nursing assistant.
29. The nurse is caring for a dying child. Which respiratory assessment findings indicate that the
child is approaching death? Select all that apply.
A) Kussmaul respirations
B) Dyspnea
C) Excess secretions
D) Tachypnea
E) Adventitious breath sounds
F) Cheyne Stokes breathing
Ans: B, C, E, F
Client Needs: Physiological Integrity: Basic Care and Comfort
Page: 1595
Feedback: Slowed respirations lead to increased secretions in the lungs and the appearance of
rales, the sound of air being pulled through fluid in the alveoli. To compensate for a few minutes
of very slow respirations, a child may take several quick or extremely deep inhalations
periodically. This is known as Cheyne Stokes breathing. All of these signs signal impending
death. Kussmaul respirations is related to diabetes and not to dying. Tachypnea is incorrect, as
the breathing slows down instead of getting faster.
Multiple Choice
30. One of the 2020 National Health Goals is to reduce the infant death rate. Which nursing
action will support this goal?
A) Educating pregnant women to seek early prenatal care.
B) Provide information about immunizations in newborns.
C) Counsel pregnant women about nutrition in pregnancy.
D) Provide information about childbirth classes in the area.
Ans: A
Client Needs: Health Promotion and Maintenance
Page: 1581
Feedback: Early prenatal care is one of the best ways to prevent complications and decrease the
rate of infant deaths. Information about nutrition, immunizations and childbirth are useful, but
prenatal care is the most important preventative.

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