Deck 42: The Child With a Life-Threatening Condition and End-Of-Life Care

Question 1

A 3-year-old child with severe head trauma is intubated and on a respirator. The child has three flat electroencephalograms (EEG) completed 24 hours apart. The electrocardiogram (EKG) shows a rate of 90 beats per minute in a normal sinus rhythm. Which of the following describes these findings?

A)Imminent death
B)Cerebral death
C)Natural death
D)Heart-lung death

Answer 1

Cerebral death

Question 2

A 10-year-old child is transported to the Emergency Department by ambulance from the scene of a car accident. He is alert and oriented × 3. His pulse, respirations, and blood pressure are stable, and his neck and back are immobilized on a backboard. The nurse sees no obvious bleeding. The child states," I can't move or feel my legs." What injury is most likely?

A)Spinal cord injury
B)Traumatic shock
C)Traumatic brain injury
D)Ruptured spleen

Answer 2

Spinal cord injury

Question 3

A 16-year-old boy has a stiff neck, headache, fever of 103°F, and purpuric lesions on his legs. He is admitted to the hospital for treatment of suspected meningococcemia. Although the adolescent's physical needs take priority at the present time, the nurse can expect which psychological stressor to be the most significant for this adolescent?

A)Fear of getting behind in schoolwork
B)Separation from friends and permanent changes in appearance
C)Separation from parents and home
D)Fear of painful procedures and bodily mutilation

Answer 3

Separation from friends and permanent changes in appearance

Question 4

The hospital nurses, after attending a conference on nursing burnout, discuss among themselves strategies to use when working with families of dying children. Which of the following would be helpful? Select all that apply.

A)Participating in a mentoring relationship with experienced hospice nurses
B)Participating in support groups with mental health professionals
C)Participating in team decisions regarding the dying child's plan of care
D)Declining the family's invitation to attend the child's funeral
E)Planning the child and family's care alone as the primary nurse

Question 5

An adolescent experiencing status asthmaticus was rushed to the Emergency Department by ambulance. The parents arrive and ask to see their child. The triage nurse at the reception desk knows that the adolescent was pronounced dead on arrival. At this moment, the triage nurse's best intervention is to do which of the following?

A)Ask the parents to please take a seat in the waiting room.
B)Immediately escort the parents to a quiet, private room.
C)Tell the parents that they must wait because only the doctor can talk with them.
D)Immediately tell the parents, "I'm sorry, but your child didn't make it."

Question 6

The Emergency Department nurse is talking with a preschooler about the death of the child's parents in an airplane crash. The preschooler asks, "Can I talk to my mommy and daddy?" The nurse responds, "They were killed, and cannot talk to you anymore." However, the nurse realizes that preschoolers might:

A)Believe deaths are their fault.
B)Believe death is permanent.
C)Engage in reality-based thinking.
D)Believe the parents will not come back home.

Question 7

The nurse is working with children in hospice care. The mother of a young child with cancer talks with the nurse about the future holiday celebrations she will miss with her child. The nurse assesses that the mother is experiencing:

A)Actual loss.
B)Perceived loss.
C)Anticipatory loss.
D)Loss.

Question 8

A school bus carrying children in grades K-12 crashed into a ravine. The critically injured children were transported by ambulance and admitted to the Pediatric Intensive Care Unit (PICU). The nurse is concerned about calming the frightened children. Which is the most effective nursing intervention to achieve this goal?

A)Explain that the PICU equipment is state-of-the-art.
B)Tell the children that the physicians are competent.
C)Call the children's parents to come into the PICU.
D)Assure the children that the nurses are caring.

Question 9

A 6-year-old child is in the Pediatric Intensive Care Unit (PICU) with a fractured femur and head trauma. The child was not wearing a helmet while riding his new bicycle on the highway, and collided with a car. The nurse can expect which nursing diagnoses to apply to the parents of this child? Select all that apply.

A)Family coping: compromised, related to the critical injury of the child
B)Parental role conflict related to child's injuries and PICU policies
C)Guilt related to lack of child supervision and safety precautions
D)Knowledge deficit, home care of fractured femur
E)Anger related to feelings of helplessness

Question 10

The nurse is leading a recovery group made up of parents who have lost a child. As the opening topic for the night's discussion, the nurse has again reviewed information about the grief process to the parents and talked about how different people grieve. During the discussion phase, several fathers speak. The nurse recognizes that the father who needs more time to understand the grief process is the father who says:

A)"I understand that everyone grieves differently."
B)"Looking back, I realize why I became so angry when the doctors didn't cure my daughter."
C)"It's been six months since my son died, so why isn't my wife ready to move on with our lives?"
D)"I'm glad you described some common grief reactions.I thought I was going crazy for a while."

Question 11

The nurse is counseling some parents on how they will feel after the death of a child. The nurse understands that the parents might feel which of the following?

A)Loneliness
B)Guilt
C)Anger
D)High energy
E)Depression

Question 12

The nurse is speaking with a preschool-age child whose sibling recently died. The nurse understands that preschool-age siblings might feel that the death was due to:

A)The child's being bad, and the sibling is being punished.
B)The child's having a fight with their sibling.
C)The child's having thoughts about their sibling dying.
D)Their parents' not liking that sibling.

Question 13

The nurse is working with a 3-year-old child in Bryant's traction for a fractured femur. A pain assessment scale, such as the Oucher scale, can be useful to the nurse caring for this child because the pain assessment scale:

A)Increases the child's comfort level.
B)Reduces the child's fear of painful procedures.
C)Decreases anxiety in the child.
D)Provides continuity and consistency in assessing and monitoring the child's pain.

Question 14

An adolescent with cystic fibrosis is intubated with an endotracheal tube. Which is the most appropriate nursing diagnosis?

A)Anxiety related to leaving chores undone at home
B)Potential for fear of future pain related to medical procedures
C)Potential for imbalanced nutrition, more than body requirements related to inactivity
D)Powerlessness (moderate) related to inability to speak or communicate with friends

Question 15

The mother of a dying three-year-old child posts on Facebook: "Family and friends. Michael's heart is giving out. Looks like it will be tonight. He is surrounded by family and not in pain. I treasure every minute of being his mother. Pray for us." The nurse who has worked with the family recognizes that Michael's mother is in which stage of grieving according to Kubler-Ross?

A)Denial
B)Acceptance
C)Bargaining
D)Depression

Question 16

The nurse is having difficulty coping with the impending death of a child. Which would most likely be the best resource for the nurse at this time?

A)Co-workers
B)Hospice nurses
C)Unit manager
D)Spouse

Question 17

A 12-year-old child with congenital heart block codes in the Emergency Department. The parents witness this and stare at the resuscitation scene unfolding before them. Which is the best nursing intervention in this situation?

A)Ask the parents to help bag the child.
B)Ask the parents to sit near the child's face and hold his hand.
C)Ask the parents to stand at the foot of the cart to watch.
D)Ask the parents to leave.

Question 18

The nurse caring for a child who is sedated, unconscious, and on a mechanical ventilator can expect to include which nursing intervention in the nursing care plan?

A)Out-of-bed transfer to wheelchair
B)Whirlpool baths
C)Maintenance of intravenous (IV) hydration
D)Active range-of-motion (ROM) exercises

Question 19

The parents of a 2-year-old child who sustained severe head trauma from falling out of a second-story window are arguing in the Pediatric Intensive Care Unit (PICU), and are blaming each other for the child's accident. Which is the best nursing diagnosis for this family?:

A)Parental role conflict related to protecting the child
B)Anxiety related to the critical care unit environment
C)Hopelessness related to the child's deteriorating condition
D)Family coping: compromised, related to the child's critical injury

Question 20

The hospital unit is very busy and nursing is understaffed. The nurse recognizes that death is imminent in one of her assigned patients. Nursing behaviors to offer family support would include:

A)Using active listening techniques when in the child's hospital room.
B)Sitting in the room as time permits and looking the parents in the eye.
C)Avoiding tears in the child's room.
D)Offering to call and notify family.
E)Recognizing that these parents' needs are greater than the other patients and staying with the parents.

Question 21

The nurse is doing a follow-up home visit to a family who lost their three-month-old infant to SIDS eight weeks ago. The mother s the door in her nightgown with hair uncombed. During the interview, the mother states: "I don't see the point of getting dressed each day." The nurse recognizes that the mother is demonstrating which stage of grief behavior?

A)Recovery
B)Yearning, pining
C)Hostile
D)Disorganization

Question 22

The nurse is taking care of a child who is showing signs of imminent death. What changes should the nurse expect to see related to the cardiovascular system?

A)An increase in the volume of Korotkoff's sounds
B)Mottling, cool and clammy skin
C)Peripheral pulses will remain when the heart beat is not heard on auscultation.
D)Increase in cardiac output