Deck 20: Family-Centered Palliative Care

Question 1

A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. The nurse should provide which explanation?

A) This attitude is helpful to give parents time to cope.
B) This will help the child cope effectively by denial.
C) Terminally ill children know when they are seriously ill.
D) Terminally ill children usually choose not to discuss the seriousness of their illness.

Answer 1

Terminally ill children know when they are seriously ill.

Question 2

A 12-year-old child has failed several courses of chemotherapy. An experimental drug is available that his parents want him to receive. He has told his parents and the oncologists that he is ready to die and does not want any more chemotherapy. The nurse recognizes what to be true?

A) Parents and child both need support in the decision making.
B) Twelve-year-olds are minors and cannot give consent or refuse treatments.
C) The oncologists needs to make the decision because the parents and child disagree.
D) The parents have the right and responsibility to make decisions for their children younger than age 18 years.

Answer 2

Parents and child both need support in the decision making.

Question 3

At which age do most children have an adult concept of death as being inevitable, universal, and irreversible?

A) 4 to 5 years
B) 6 to 8 years
C) 9 to 11 years
D) 12 to 16 years

Answer 3

9 to 11 years

Question 4

At which developmental period do children have the most difficulty coping with death, particularly if it is their own?

A) Toddlerhood
B) Preschool
C) School age
D) Adolescence

Question 5

What explanation best describes how preschoolers react to the death of a loved one?

A) Grief is acute but does not last long at this age.
B) Children this age are too young to have a concept of death.
C) Preschoolers may feel guilty and responsible for the death.
D) They express grief in the same way that the adults in the preschoolers' life are expressing grief.

Question 6

What statement is most descriptive of a school-age child's reaction to death?

A) Very interested in funerals and burials
B) Little understanding of words such as "forever"
C) Imagine the deceased person to be still alive
D) Can explain death from a religious or spiritual point of view

Question 7

What is a principle of palliative care that can be included in the care of children?

A) Maintenance of curative therapy
B) Child and family as the unit of care
C) Exclusive focus on the spiritual issues the family faces
D) Extensive use of opiates to ensure total pain control

Question 8

A 12-year-old boy is in the final phase of dying from leukemia. He tells the nurse who is giving him opiates for pain that his grandfather is waiting for him. How should the nurse interpret this situation?

A) The boy is experiencing side effects of the opiates.
B) The boy is making an attempt to comfort his parents.
C) He is experiencing hallucinations resulting from brain anoxia.
D) He is demonstrating readiness and acceptance that death is near.

Question 9

The nurse is making a home visit 48 hours after the death of an infant from sudden infant death syndrome (SIDS). What intervention is an appropriate objective for this visit?

A) Give contraceptive information.
B) Provide information on the grief process.
C) Reassure parents that SIDS is not likely to occur again.
D) Thoroughly investigate the home situation to verify SIDS as the cause of death.

Question 10

When is an autopsy required?

A) In the case of a suspected suicide
B) When a person has a known terminal illness
C) With a hospice patient who dies at home
D) With the victim of a motor vehicle collision

Question 11

An 8-year-old girl has been uncooperative and angry since the diagnosis of cancer was made. Her parents tell the nurse that they do not know what to do "because she is always so mad at us." What nursing action is most appropriate at this time?

A) Explain to child that anger is not helpful.
B) Help the parents deal with her anger constructively.
C) Ask the parents to find out what she is angry about.
D) Encourage the parents to ignore the anger at this time.

Question 12

A critically injured child has died and is being removed from a ventilator in the pediatric intensive care unit. What is a priority nursing intervention for the family at this time?

A) Ensure that parents are in the waiting room while the ventilator is removed.
B) Help the parents understand that the child is already dead and no further interventions are necessary.
C) Control the environment around the child and family to provide privacy.
D) Encourage them to wait to see their child until the funeral home has prepared the body.

Question 13

The nurse is providing support to a family that is experiencing anticipatory grief related to their child's imminent death. What statement by the nurse is therapeutic?

A) "Your other children need you to be strong."
B) "You have been through a very tough time."
C) "His suffering is over; you should be happy."
D) "God never gives us more than we can handle."

Question 14

The nurse is often the individual who is in the optimum position to suggest tissue donation to a family (after consultation with the practitioner). What will occur if a family chooses organ or tissue donation?

A) The funeral will be delayed.
B) Cremation is the preferred method of burial.
C) Written consent is required for tissue or organ donation.
D) An open casket cannot be used subsequent to this procedure.

Question 15

A 7-year-old child is in the end stages of cancer. The parents ask you how they will know when death is imminent. What physical sign is indicative of approaching death?

A) Hunger
B) Tachycardia
C) Increased thirst
D) Difficulty swallowing

Question 16

The family and child have decided that hospice care best meets their needs during the terminal phase of illness. The nurse recognizes that the parents understand the principles of this care when they make which statement?

A) "It will be good to be at home and care for our child."
B) "What a relief it will be not to need any more medicines."
C) "We are going to miss the support of the hospice team when our child dies."
D) "We know that once hospice care starts, we will not be able to return to the hospital if the care is difficult."

Question 17

A child in the terminal stage of cancer has frequent breakthrough pain. Nonpharmacologic methods are not helpful, and the child is exceeding the maximum safe dose for opiate administration. What approach should the nurse implement?

A) Add acetaminophen for the breakthrough pain.
B) Titrate the opioid medications to control the child's pain as specified in the protocol.
C) Notify the practitioner that immediate hospitalization is indicated for pain management.
D) Help the parents and child understand that no additional medication can be given because of the risk of respiratory depression.

Question 18

What factor is most important for parents implementing do not resuscitate (DNR) orders?

A) Parents' beliefs about euthanasia
B) Presence of other children in the home
C) Experiences of the health care team with other children in this situation
D) Acknowledgment by health care team that child has no realistic chance for cure

Question 19

What nursing intervention is most appropriate when providing comfort and support for a child when death is imminent?

A) Limit care to essentials.
B) Avoid playing music near the child.
C) Whisper to the child instead of using a normal voice.
D) Explain to the child the need for constant measurement of vital signs.

Question 20

A preschooler is found digging up a pet bird that was recently buried after it died. What is the best explanation for this behavior?

A) He has a morbid preoccupation with death.
B) He is looking to see if a ghost took it away.
C) He needs reassurance that the pet has not gone somewhere else.
D) The loss is not yet resolved, and professional counseling is needed.

Question 21

The nurse understands that a school-age child may react to death with what reaction?

A) Joking
B) Having no reaction
C) Fearing the unknown
D) Seeing it as a distant event

Question 22

A health care provider prescribes morphine sulfate, 0.2 mg/kg IV every 2 to 4 h as needed for pain for a child with a terminal illness. The child weighs 10 kg. The medication label states: "Morphine sulfate 5 mg/ml." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using one decimal place.
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Question 23

How might the quality of life for a terminally ill child and his family be enhanced by nurses?

A) Tell the family what is best.
B) Leave the family alone to deal with their tragedy.
C) Remain objective and uninvolved with family grieving.
D) Advocate for and implement pain and symptom relief measures.

Question 24

What characterizes an infant's concept of death? (Select all that apply.)

A) Death is seen as temporary.
B) Death is seen as a departure, a kind of sleep.
C) Death has no significance before 6 months of age.
D) They believe that death is a consequence of their thoughts.
E) Anxiety is not created by death but by loss, even temporary, of the parent.

Question 25

Several nurses tell their nursing supervisor that they want 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 serves what purpose?

A) It is improper because it increases burnout.
B) It is inappropriate because it is unprofessional.
C) It is proper because families expect this expression of concern.
D) It is appropriate because it can assist in the resolution of personal grief.

Question 26

What characterizes a toddler's concept of death? (Select all that apply.)

A) They are unable to comprehend an absence of life.
B) They may recognize the fact of physical death.
C) They understand the universality and inevitability of death.
D) The are affected more by the change in lifestyle than the concept of death.
E) They can only think about events in terms of their own frame of reference-living.

Question 27

A health care provider prescribes morphine sulfate (Roxanol), 10 mg PO every 4 h as needed for pain for a child with a terminal illness. The medication label states: "Morphine sulfate (Roxanol) 20 mg/1 ml." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using one decimal place.
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Question 28

What characterizes a school-aged child's concept of death? (Select all that apply.)

A) Have a mature understanding of death
B) Can respond to logical explanations of death
C) Personify death as the devil or the bogeyman
D) Have a deeper understanding of death in a concrete sense
E) Fear the mutilation and punishment associated with death

Question 29

The sibling of a 4-year-old girl dies from sudden infant death syndrome. The parents are concerned because the 4-year-old girl showed more outward grief when her cat died than now. How should the nurse explain this reaction to the parents?

A) The child is not old enough to have a concept of death.
B) This suggests maladaptive coping, and referral is needed for counseling.
C) The death may be so painful and threatening that the child must deny it for now.
D) The child is not old enough to have formed a significant attachment to her sibling.

Question 30

What are common respiratory symptoms dying children experience? (Select all that apply.)

A) Cough
B) Eupnea
C) Wheezing
D) Shortness of breath
E) Decrease in secretions

Question 31

Parents tell the nurse they do not want to let their school-age child know his illness is terminal. What response should the nurse make to the parents?

A) "Have you discussed this with your health care provider?"
B) "I would do the same thing in your position; it is better the child doesn't know."
C) "I understand you want to protect your child, but often children realize the seriousness of their illness."
D) "I praise you for that decision; it can be so difficult to be truthful about the seriousness of your son's illness."

Question 32

When communicating with dying children, what should the nurse remember?

A) Adolescent children tend to be concrete thinkers.
B) Games, art, and play provide a good means of expression.
C) When children can recite facts, they understand the implications of those facts.
D) If children's questions direct the conversation, the assessment will be incomplete.

Question 33

What does the nurse recognize as physical signs of approaching death? (Select all that apply.)

A) Mottling of skin
B) Decreased sleeping
C) Cheyne-Stokes respirations
D) Loss of the sense of hearing
E) Decreased appetite and thirst

Question 34

Parents ask the nurse, "When should palliative care be initiated?" What is the best response by the nurse?

A) "When curative care is not feasible."
B) "When the child's prognosis is uncertain."
C) "It should be included along the continuum of care."
D) "It should begin when curative treatments are no longer appropriate."

Question 35

A terminally ill child is receiving morphine sulfate (Morphine) and is experiencing respiratory depression. A health care provider prescribes naloxone (Narcan), 0.5 mcg/kg IV in 2 minute increments until breathing improves. The medication label states: "Naloxone 400 mcg/1 ml." The child weighs 60 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using two decimal places.
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Question 36

The nurse has attended a professional development program about palliative care for the pediatric population. What statement by the nurse should indicate a correct understanding of the program?

A) "Palliative care provides interventions that hasten death."
B) "Palliative care promotes the optimal functioning and quality of life."
C) "Palliative care does not provide pain and symptom management like hospice care."
D) "Palliative care is not well received in hospitals that provide end-of-life care for children."

Question 37

A health care provider prescribes OxyContin (oxycodone), 3 mg PO every 4 to 6 h as needed for pain for a child with a terminal illness. The medication label states: "OxyContin 5 mg/1 ml." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using one decimal place.
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Question 38

What characterizes a preschooler's concept of death? (Select all that apply.)

A) Belief their thoughts can cause death.
B) They have a concrete understanding of death.
C) Death is seen as temporary and gradual.
D) Death is seen as a departure, a kind of sleep.
E) They usually have some sense of the meaning of death.