Review Practice Exercise 1

Health Supervision In Children > Child Health

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Practice Exercise 1

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Total Questions : 6

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Question 1:

Which of the following is an example of a normalization strategy for a child with a chronic illness?

A. Restricting the child's social interactions to prevent infection. B. Allowing the child to attend school and participate in school activities when possible. C. Encouraging the child to focus solely on their illness and treatment. D. Keeping the child isolated at home to reduce stress.

Answer and Explanation

Choice A:

Restricting the child's social interactions to prevent infection is overly restrictive and isolates the child. It may cause social and emotional harm, unless specifically required during immune suppression.

Choice B:

Allowing the child to attend school and participate in age-appropriate activities promotes independence and self-esteem, encourages peer interaction and social development, helps maintain a sense of routine and normalcy despite medical challenges.

Choice C:

Encouraging the child to focus solely on their illness and treatment reinforces the “sick role” and limits opportunities for growth, play, and socialization.

Choice D:

Keeping the child isolated at home to reduce stress increases loneliness and delays normal developmental experiences. Stress is better managed through coping strategies and supportive environments, not isolation.

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Question 2:

A nurse is working with a family struggling to cope with their child's chronic illness. What is the most effective initial nursing intervention?

A. Telling them to be strong for their child. B. Referring them to a psychologist without discussion. C. Actively listening to their concerns and validating their feelings. D. Providing them with a list of all available resources without explanation.

Answer and Explanation

Choice A:

Telling them to be strong for their child minimizes the family’s emotions. It is not therapeutic and may make them feel guilty for expressing distress.

Choice B:

Referring them to a psychologist without discussion is premature. The family may feel dismissed or abandoned. Referral can be helpful later, but not as an initial step.

Choice C:

Families of children with chronic illness often experience stress, grief, guilt, and helplessness. The most effective initial nursing intervention is to provide emotional support through therapeutic communication. Actively listening and validating feelings builds trust between the nurse and family, helps the family feel heard and understood, and opens the door for further teaching, coping strategies, and resource referral.

Choice D:

Providing them with a list of all available resources without explanation may overwhelm the family. Resources should be explained after establishing rapport and understanding needs.

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Question 3:

When caring for a 4-year-old with a disability, the nurse notes that while encouraging the child to take part in his care, the mother constantly gives into the child, allowing him to have his own way. What anticipatory guidance can the nurse give to promote normalization in this relationship?

A. “Giving in” is not a detriment to the child when he or she has a disability and limitations. B. Explain that when parents establish reasonable limits, children are likely to develop independence that is appropriate for their age and achievement equal to their limitations. C. Advise the parent to wait to explain any procedure to the child until they are at the health care setting or just before the procedure to avoid unduly upsetting the child. D. Have the parent realize that it would be unfair to the siblings to expect similar rules to apply to all of the children in the family.

Answer and Explanation

Choice A:

Telling parents that “giving in” is not a detriment is inaccurate. Constantly giving in may foster dependency, behavioral problems, and hinder independence.

Choice B:

Explaining to parents that establishing reasonable limits fosters independence and age-appropriate responsibility is the best anticipatory guidance. This approach allows the child to grow within their abilities, preventing over-dependence while encouraging self-esteem and confidence.

Choice C:

Advising parents to wait until just before procedures to explain them is not developmentally appropriate. Children should be prepared according to their level of understanding, which reduces anxiety and builds trust.

Choice D:

Suggesting that siblings should not have similar rules undermines family consistency. While accommodations may be necessary, children with disabilities should still be part of the family unit with expectations tailored but not completely exempt.

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Question 4:

Children with disabilities or chronic illness and their families may have different methods of coping than those of healthy children. Often they have a resilience that is to be admired. Which of these statements reflect ways that they foster this resilience? Select all that apply

A. Protect the child from having to learn about his or her disability or illness on a repeated basis. B. Develop relationships with other children and their families with similar circumstances to build support. C. The parents set long-term goals to create a sense of hope. D. Focus on the child’s strengths and encourage independence. E. Accept that chronic illness is part of living.

Answer and Explanation

Choice A:

Protecting the child from learning about their illness is not adaptive. Age-appropriate education about the illness fosters coping, trust, and empowerment. Shielding the child may increase anxiety and hinder self-management skills.

Choice B:

Developing relationships with other families in similar circumstances provides social support, reduces isolation, and fosters shared understanding.

Choice C:

Parents who set long-term goals instill a sense of hope and direction, helping the child and family look beyond daily struggles.

Choice D:

Focusing on the child’s strengths and encouraging independence promotes self-esteem and helps the child achieve developmental milestones within their abilities.

Choice E:

Accepting that chronic illness is part of living allows families to move forward, adapt routines, and maintain quality of life instead of remaining stuck in denial or grief.

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Question 5:

Which of the following factors should a nurse consider when managing the pain of a terminally ill child? Select all that apply

A. Pain medications are given on an as-needed schedule, and extra doses for breakthrough pain are available to maintain comfort. B. Opioid drugs, such as morphine, are given for severe pain, and the dosage is increased as necessary to maintain optimum pain relief. C. Addiction is a factor in managing terminal pain in a child, and the nurse plays an important role in educating parents that their child may become addicted. D. Nurses often express concern that administering dosages of opioids that exceed those with which they are familiar will hasten the child’s death; in the principle of double effect. E. In addition to pain medication, techniques such as music therapy, distraction, and guided imagery should be combined with medications to provide the child and family strategies to control pain.

Answer and Explanation

Choice A:

Breakthrough pain is common in terminal illness, and timely administration of additional doses is essential for relief.

Choice B:

Opioid drugs such as morphine are the mainstay for severe pain in terminal illness. Doses are titrated upward as needed to maintain optimal comfort, without a ceiling limit in palliative care.

Choice C:

Addiction is not a concern in terminal pediatric pain management. The focus is on comfort, not long-term dependence. Educating parents about this distinction is essential to reduce fear and ensure the child receives appropriate relief.

Choice D:

Nurses may fear that high opioid doses hasten death, but according to the principle of double effect, the intent is comfort, not hastening death. When administered appropriately, opioids relieve suffering without intentionally causing death.

Choice E:

Non-pharmacologic interventions (music therapy, distraction, guided imagery, relaxation techniques) complement medications and give the child and family a sense of control, improving quality of life.

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Question 6:

It is important to consider the child’s developmental understanding of death when working with that child. Which option is the preschool child’s developmental stage?

A. Children of this age believe their thoughts are sufficient to cause death. B. They are still very much influenced by remnants of magical thinking and are subject to feelings of guilt and shame. C. They have a deeper understanding of death in a concrete sense. D. They can perceive events only in terms of their own frame of reference—living.

Answer and Explanation

Choice A:

Preschoolers believe their thoughts are sufficient to cause death due to magical thinking and egocentrism. They may think, “If I was mad at Mommy and she got sick, I made it happen.” This belief is developmentally normal but can cause distress and guilt if not addressed with reassurance.

Choice B:

While preschoolers do have magical thinking, the key distinction is their specific belief that their own thoughts or actions can directly cause death, making option 1 the more precise answer.

Choice C:

A concrete understanding of death develops later, in school-age children, who begin to grasp death’s permanence and universality.

Choice D:

Viewing events only in their own frame of reference (living) describes toddlers, who do not comprehend death but react to separation and changes in routine.

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Practice Exercise 1

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