Deck 13: The Child With a Life-Threatening Condition and End-Of-Life Care

Question 1

A child is admitted to the neonatal intensive care unit (NICU). The parents are concerned because they cannot stay for long hours to visit. Which statement made by the nurse is most appropriate?
1) "One of you might take a leave of absence to be here more."
2) "Parents often feel this way; would you be interested in talking with others who have experienced having a child in the NICU?"
3) "Perhaps the grandparents can make the visits for you."
4) "Why can't you visit after work every day?"

Answer 1

2

Question 2

A novice nurse in the newborn intensive care unit (NICU) has just performed postmortem care on a premature infant who passed away. The novice nurse asks to be excused near the end of the shift. Which interventions can be implemented to support this nurse? Select all that apply.
1) Schedule additional education on bereavement care
2) Ask a seasoned nurse to talk with the novice nurse
3) Tell the nurse it is OK to grieve with the family
4) Recommend that the nurse transfer to another unit
5) Assign the nurse to stable clients only

Answer 2

1, 2, 3

Question 3

The nurse is providing care to an adolescent client who is dying. Which assessment findings indicate the client is experiencing a decrease in peripheral circulation? Select all that apply.
1) Cool skin
2) Mottled appearance
3) Cheyne-Stokes respirations
4) Increased agitation
5) Increased urine output

Answer 3

1, 2

Question 4

Which intervention is considered supportive care for a family whose infant has died from sudden infant death syndrome (SIDS)?
1) Interviewing parents to determine the cause of the SIDS incident
2) Allowing parents to hold, touch, and rock the infant
3) Sheltering parents from the grief by not giving them any personal items of the infant, such as footprints
4) Advising parents that an autopsy is not necessary

Question 5

A young school-age 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. Which nursing diagnoses may be appropriate for this family? Select all that apply.
1) Guilt Related to Lack of Child Supervision and Safety Precautions
2) Family Coping: Compromised, Related to the Critical Injury of the Child
3) Parental Role Conflict Related to Child's Injuries and PICU Policies
4) Knowledge Deficit Related to Home Care of Fractured Femur
5) Anger Related to Feelings of Helplessness

Question 6

Parents of a child in the pediatric intensive care unit (PICU) have been experiencing shock and disbelief regarding their situation. Which statement by the parents indicates they are moving forward into the next stage of coping?
1) "Why not me instead of my child?"
2) "It is hard for me to have others take care of my child."
3) "I feel like life is suspended in time."
4) "I am glad I can help with his care."

Question 7

A school-age child with congenital heart block codes in the emergency department (ED). The parents witness this and stare at the resuscitation scene unfolding before them. Which nursing intervention is most appropriate in this situation?
1) Ask the parents to leave until the child has stabilized.
2) Ask the parents to call the family to come into watch the resuscitation.
3) Ask the parents to sit near the child's face and hold her hand.
4) Ask the parents to stand at the foot of the cart to watch.

Question 8

Which client in the pediatric intensive care unit (PICU) would most benefit from palliative care?
1) A child with end-stage leukemia
2) A child with a broken arm after a motor vehicle accident
3) A child with burn injuries to the legs
4) A child with recurrent asthma

Question 9

The nurse must prepare parents to see their adolescent daughter in the pediatric intensive-care unit (PICU). The child arrived by life flight after experiencing multiple traumas in a car accident involving a suspected drunk driver. At this time, which statement by the nurse to the family is the most appropriate?
1) "Don't worry; everything will be okay. We will take excellent care of your child."
2) "You should press charges against the drunk driver."
3) "Your child's leg was crushed and may have to be amputated."
4) "Your child's condition is very critical; her face is swollen, and she may not look like herself."

Question 10

An adolescent with cystic fibrosis is intubated with an endotracheal tube. Which nursing diagnosis is most appropriate for this adolescent?
1) Potential for Imbalanced Nutrition, More Than Body Requirements Related to Inactivity
2) Anxiety Related to Leaving Chores Undone at Home
3) Potential for Fear of Future Pain Related to Medical Procedures
4) Powerlessness (Moderate) Related to Inability to Speak to or Communicate with Friends

Question 11

Which nursing interventions would be best for the nursing diagnosis of Powerlessness Related to Relinquishing Control to the Healthcare Team? Select all that apply.
1) Provide a primary nursing care model.
2) Prepare the child in advance for procedures.
3) Provide optimal pain relief.
4) Explain procedures in developmentally appropriate terms.
5) Incorporate home rituals when possible.

Question 12

An adolescent client has a stiff neck, a headache, a fever of 103 degrees Fahrenheit, and purpuric lesions noted on the legs. Although the adolescent's physical needs take priority at the present time, the nurse can expect which to be the most significant psychological stressor for this adolescent?
1) Separation from parents and home
2) Separation from friends and permanent changes in appearance
3) Fear of painful procedures and bodily mutilation
4) Fear of getting behind in schoolwork

Question 13

The emergency-room nurse receives a preschool-age child who was hit by a car. Which nursing interventions are a priority for this child? Select all that apply.
1) Performing a rapid head-to-toe assessment
2) Recording the parents' insurance information
3) Assessing airway, breathing, and circulation
4) Asking the parents about organ donation
5) Asking the parents if anyone witnessed the accident

Question 14

A school-age client is admitted to the pediatric intensive care unit (PICU) in critical condition after a motor vehicle accident. Which intervention should be implemented at this time?
1) Maintain consistent caregivers.
2) Turn the lights off at night.
3) Keep alarm levels low.
4) Consult the hospital play therapist.

Question 15

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 nursing intervention is most appropriate to achieve the goal of calming the frightened children?
1) Tell the children that the physicians are competent.
2) Assure the children that the nurses are caring.
3) Explain that the PICU equipment is state of the art.
4) Call the children's parents to come into the PICU.

Question 16

A child is on a ventilator in the pediatric intensive care unit (PICU). Which nursing intervention would best meet the psychosocial needs of this child?
1) Allow the parents to remain at the bedside.
2) Touch and talk to the child often.
3) Provide the child with a blanket from home.
4) Provide consistent caregivers.

Question 17

Siblings of a client in pediatric intensive care unit (PICU) are preparing to visit their brother, who was hit by a car while riding his bike. Which intervention by the nurse will assist the siblings in preparing for the visit?
1) Spend time developing a relationship with the siblings.
2) Have the parents go with the siblings when they visit.
3) Encourage the siblings to talk to a social worker before seeing their brother.
4) Explain what the siblings will hear and see when they visit.

Question 18

A toddler-age client is in end-stage renal failure. Which nursing intervention will assist this child most?
1) Maintain the child's normal routines.
2) Explain body changes that will take place.
3) Encourage friends to visit.
4) Allow the child to talk about the illness.

Question 19

A school-aged child is admitted with pneumococcal meningitis. The child weighs 44 pounds. The physician orders: ceftriaxone (Rocephin) 50 mg/kg/dose IV every 12 hours three times and then every 24 hours.
Calculate how many mg/dose of ceftriaxone the child will receive and then calculate mL/hr to infuse via pump. Supply on hand is: a premix of ceftriaxone 1 g/50 mL, administer over 30 minutes.

Question 20

The parents of a toddler-age child who sustained severe head trauma from falling out a second-story window are arguing in the pediatric intensive-care unit (PICU) and blaming each other for the child's accident. Which nursing diagnosis is most appropriate for this family?
1) Parental Role Conflict Related to Protecting the Child
2) Hopelessness Related to the Child's Deteriorating Condition
3) Anxiety Related to the Critical-Care-Unit Environment
4) Family Coping: Compromised, Related to the Child's Critical Injury