Deck 5: End-Of-Life Care

Question 1

The nurse assesses the pain level of a school-age patient who is receiving end-of-life care and determines a need for pain medication. The physician has prescribed morphine sulfate to be administered either orally or rectally. For which reason will the nurse decide to administer the medication orally?

A)To prevent the patient from being embarrassed by rectal administration
B)To ensure the pain medication is absorbed as quickly as possible
C)To avoid stimulation of rectal spasms during insertion of the medication
D)To decrease the risk of respiratory suppression

Answer 1

To prevent the patient from being embarrassed by rectal administration

Question 2

Identify one or more choices that best complete the statement or answer the question.
The nurse is providing end-of-life education to parents of a child diagnosed with a terminal illness. Which topics of education are important for the nurse to provide? Select all that apply.

A)Explain how the progression of the disease will affect their child.
B)Describe the physical changes that will occur during the dying process.
C)Suggest several funeral homes to be contacted before death.
D)Explain that pain management will interfere with communication.
E)Describe what to expect after death including how the child will look.

Answer 2

Explain how the progression of the disease will affect their child.
Describe the physical changes that will occur during the dying process.
Describe what to expect after death including how the child will look.

Question 3

The nurse is presenting information to pregnant couples about the "safe to sleep" campaign to prevent SIDS. One attendee states, "Babies sleep best on their bellies. What difference does position make?" Which answer by the nurse is best?

A)"Positioning on the back opens the airway fully."
B)"Sleeping face down increases the risk of aspiration."
C)"The most dangerous time is 2 to 4 months of age."
D)"Of greater importance is not using blankets."

Answer 3

"Positioning on the back opens the airway fully."

Question 4

The coroner is informed of the unexpected death of an infant at 3 months of age. The infant died during the night in the home of the parents. Which expectation does the nurse have regarding follow-up to the infant's death?

A)The hospital will pay for an autopsy if requested by the physician.
B)The coroner's office will not charge the parents if they request an autopsy.
C)The coroner can legally request an autopsy without the parent's consent.
D)The parents must give consent before an autopsy is performed for any reason.

Question 5

The nurse is providing care for a pediatric patient and family during the time when death of the patient seems imminent. The family is of American Indian culture and has summoned tribal members to come and chant and pray at the bedside. Which behavior by the nurse is culturally correct?

A)Move the patient, family, and tribal members to an isolated location.
B)Ask the family to respect other patients by keeping the volume of chanting low.
C)Ask if the family has any additional needs, close the door, and provide privacy.
D)Call the nursing supervisor and ask for assistance in managing the situation.

Question 6

Identify one or more choices that best complete the statement or answer the question.
The parents of a dying child have decided to withdraw medical treatment and allow their child to die peacefully. Which nursing actions will occur after the withdrawal is implemented? Select all that apply.

A)Monitoring equipment is turned off.
B)All invasive lines are disconnected.
C)Periodic validation is sought from the family regarding the decision to end care.
D)A comfortable, peaceful environment is created for the patient and family.
E)The family is provided with undisturbed privacy.

Question 7

The pediatric nurse is providing care for a terminally ill patient who is 17 years of age. The patient has been resistant to aggressive chemotherapy because of undesirable side effects. The patient states, "I have finally convinced my parents to sign a DNR order. It is my life, and I should be able to decide how I want to live." Which legal consideration causes the nurse greatest concern?

A)A DNR order can be reversed at any time by the legal guardians.
B)The primary physician can deny a DNR if the patient is a minor.
C)The patient does not understand all aspects of the DNR order.
D)A DNR can be written to provide partial life-sustaining interventions.

Question 8

A 16-year-old patient is approaching the terminal stage of a brain tumor. The nurse notices the patient is calling friends and making plans for a social gathering several months away. When friends are present the patient assures them of a full recovery because of a new doctor. The nurse recognizes the patient is experiencing which stage of grief?

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

Question 9

The nurse is providing care for a pediatric patient who is 11 years of age. The patient is diagnosed with an aggressive form of cancer and is scheduled to begin chemotherapy. The patient tells the nurse, "I think I am going to die, but I also think I will get much sicker first." Which communication by the nurse is most appropriate for this patient?

A)Explain to the patient the importance of maintaining a hopeful outlook.
B)Encourage the patient to ask the doctor to explain what is going to happen.
C)Use basic terms to explain the disease progression and side effects of treatment.
D)Provide information about the different options that can be considered for the patient.

Question 10

The nurse is providing care for a pediatric patient who is receiving end-of-life care at the age of 12 years. In addition to the patient, the nurse is caring for the family members from a Middle Eastern culture, including younger siblings of the patient. Which comment by the nurse exemplifies appropriate communication?

A)"Please let me know if you have pain so that I can make you more comfortable."
B)"I know your son is going to heaven and all of you will be together in the future."
C)"Your brother is suffering, and you need to be strong and brave for him now."
D)"I understand you will be ready to move away from this life and on to the next."

Question 11

Identify one or more choices that best complete the statement or answer the question.
The nurse works on a pediatric unit where patients are on life support. Frequently, death is delayed for the benefit of organ donation and procurement. Which protocols for organ donation and procurement does the nurse always need to follow? Select all that apply.

A)The nurse approaches the family of a patient who is a viable candidate.
B)The best matched pediatric patients on the transplant list are notified.
C)The consent for organ donation can be given only by legal guardians.
D)The facility pediatric surgical team will procure the organs for transplant.
E)The parents only can accompany the patient to the operating room.

Question 12

Identify one or more choices that best complete the statement or answer the question.
A pediatric patient with a terminal disease is placed in hospice care. In addition to patient care, which other services provided by a multidisciplinary team will meet the needs of the patient and family? Select all that apply.

A)Social work
B)Child-life specialist
C)Community programs
D)Physician
E)Grief counselor

Question 13

With endorsement from the family, the physician initiates hospice care for an adolescent patient who is terminally ill. For which family expectation about hospice care will the nurse provide additional information?

A)The patient will have a graceful, natural death.
B)The patient will die in the hospital.
C)Compassionate care will be focused on patient comfort.
D)The family can be involved in care as much as desired.

Question 14

Identify one or more choices that best complete the statement or answer the question.
The nurse works on a pediatric unit that allows parents to remain in the room if the patient is coded. The nurse is aware that having persons in the room other than medical personnel can present safety issues. Which concerns are important to address? Select all that apply.

A)The possibility of an accidental shock during cardiac shock delivery
B)The possibility of accidental contamination of sterile fields and procedures
C)The possibility of medical staff being blocked from access to the patient
D)The possibility of medical staff being interrupted by emotional verbalization
E)The possibility of overcrowding interfering with needed medical equipment

Question 15

The nurse works in a pediatric hospice unit in an acute care facility. The nurse is currently providing care to an infant. Which assessment tool does the nurse use to identify the infant's level of pain?

A)Faces scale
B)FLACC
C)Visual analogy scale
D)NIPS

Question 16

The nurses on a unit that cares for terminal pediatric patients wish to implement a change in facility policy to allow parents/guardians to remain during a patient code. Which is the most powerful reason that nurses can present to administration?

A)Family-centered care can be continued during a very stressful situation.
B)The family knows everything possible was done to save the patient.
C)The family experiences greater communication and decreased confusion.
D)Family may desire to stay during specific interventions that seem inappropriate.

Question 17

A 2-year-old has recently been diagnosed with a terminal type of cancer but is not experiencing any severe symptoms of the illness at this time. The mother of the patient is depressed and feels guilt over the illness. She admits to mentally planning the funeral and expecting to be devastated. The nurse identifies the mother as experiencing which stage of grief?

A)Anticipatory
B)Anger
C)Denial
D)Bargaining

Question 18

The nurse is presenting information to a group of parents regarding pediatric safety and the most common causes of death. One attendee states, "I am so happy that my youngest child is now 16." Which information does the nurse present in response to this comment?

A)The 16-year-old child is at high risk for death related to cancer.
B)Life expectancy with congenital or genetic defects is 13 to 19 years.
C)Adolescents between 5 and 19 years of age most commonly die from suicide.
D)Between 15 and 19 years of age the death rate is 45.5 deaths/100,000.

Question 19

The parents of a toddler, diagnosed to be in the end stage of a terminal illness, are concerned about how to manage pain without the sedation effects of pain medications. Which suggestion by the nurse is likely to meet the needs of both the parents and the patient?

A)Encourage the parents to bring favorite toys and books.
B)Initiate playtime in the playroom with other patients.
C)Provide age-appropriate videos for patient distraction.
D)Suggest a parent hold the patient and perform gentle massage.

Question 20

The nurse is providing end-of-life care to a pediatric patient and family. The nurse understands the need for communicating with the multidisciplinary care team regarding the patient and family needs. For which reason is multidisciplinary communication with the patient's nurse so important?

A)The nurse has the most contact with the patient and family and acts as an advocate and voice for their care.
B)The multidisciplinary team relies on the nurse to provide appropriate education to the patient and family during end-of-life care.
C)As the sole communicator, the nurse can make sure that all members of the multidisciplinary team are equally informed.
D)The patient and family can communicate with the nurse with whom they have built a trusting relationship.