Deck 41: The Child With a Life-Threatening Condition and End-Of-Life Care

Question 1

A 16-year-old has a stiff neck, headache, fever of 103°F, and the nurse notes purpuric lesions on the child's legs. Although the adolescent's physical needs take priority at the present time, the nurse can expect which psychologic stressor to be the most significant for this adolescent?
1) Fear of getting behind in schoolwork
2) Separation from friends and permanent changes in appearance
3) Separation from parents and home
4) Fear of painful procedures and bodily mutilation

Answer 1

2

Question 2

Which is the most appropriate nursing diagnosis for the adolescent diagnosed with cystic fibrosis who is intubated with an endotracheal tube?
1) Anxiety related to leaving chores undone at home
2) Fear of future pain related to medical procedures
3) Risk for Overweight related to inactivity
4) Powerlessness (moderate) related to inability to speak or communicate with friends

Answer 2

4

Question 3

Which strategies would be helpful for nurses who work with terminally ill children to avoid burnout? Select all that apply.
1) Participating in a mentoring relationship with experienced hospice nurses
2) Participating in support groups with mental health professionals
3) Participating in team decisions regarding the dying child's plan of care
4) Declining the family's invitation to attend the child's funeral
5) Planning the child and family's care alone as the primary nurse

Answer 3

1, 2, 3

Question 4

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?
1) Impaired Parenting related to protecting the child
2) Anxiety related to the critical care unit environment
3) Hopelessness related to the child's deteriorating condition
4) Compromised Family Coping related to the child's critical injury

Question 5

A female client arrived by life flight to the hospital after experiencing multiple traumas in a .motor vehicle crash involving a suspected drunk driver. Which statement is most important for the nurse to make to the parents before they see their child?
1) "You should press charges against the drunk driver."
2) "Your child's condition is very critical; her face is swollen, and she might not look like herself."
3) "Your child's leg was crushed, and might have to be amputated."
4) "Don't worry, everything will be okay. We will take excellent care of your child."

Question 6

The mother of a dying 3-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." Which stage of grieving, according to Kubler-Ross, is the mother experiencing?
1) Denial
2) Acceptance
3) Bargaining
4) Depression

Question 7

Which topics should the nurse include in a discussion with parents of a terminally ill child regarding parental feelings that may occur upon the child's death? Select all that apply.
1) Loneliness
2) Guilt
3) Anger
4) High energy
5) Depression

Question 8

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. Which is the mother experiencing based on these data?
1) Actual loss
2) Perceived loss
3) Anticipatory loss
4) Loss

Question 9

The nurse is speaking with a preschool-age child whose sibling recently died. Which feelings should the nurse anticipate from the preschool-age child?
1) The child may feel that his or her bad behavior caused the sibling's death as a punishment.
2) The child may feel that the sibling died as a result of a fight.
3) The child may feel that having bad thoughts about the sibling caused the death.
4) The child may feel that the sibling died because the parents did not like that sibling.

Question 10

Which nursing intervention should the nurse include in the plan of care for a child who is sedated, unconscious, and on a mechanical ventilator?
1) Out-of-bed transfer to wheelchair
2) Whirlpool baths
3) Maintenance of intravenous (IV) hydration
4) Active range-of-motion (ROM) exercises

Question 11

The nurse is leading a recovery group of parents who have lost a child. As the opening topic for the night's discussion, the nurse reviews information about the grief process to the parents and talks about how different people grieve. Which parental statement indicates the need for more education regarding the grieving process?
1) "I understand that everyone grieves differently."
2) "Looking back, I realize why I became so angry when the doctors didn't cure my daughter."
3) "It's been 6 months since my son died, so why isn't my wife ready to move on with our lives?"
4) "I'm glad you described some common grief reactions. I thought I was going crazy for a while."

Question 12

The emergency department (ED) nurse is talking with a preschooler about the death of the child's parents in a motor vehicle crash. Which should the nurse take into consideration when formulating the client's plan of care?
1) Preschool-age children often believe that death is their fault.
2) Preschool-age children believe death is permanent.
3) Preschool-age children engage in reality-based thinking.
4) Preschool-age children may believe the parents will not come back home.

Question 13

The nurse is providing care to a child who is nearing death. Which nursing actions may offer the family support?
1) Using active listening techniques
2) Looking the parents in the eye when talking
3) Refusing to cry while in the child's room
4) Offering to call and notify family
5) Avoiding being in the room to allow the family to grief

Question 14

A school bus carrying children in grades K-12 crashed into a ravine. The critically injured children are transported by ambulance and admitted to the pediatric intensive care unit (PICU). Which is the most effective nursing intervention to calm the frightened children?
1) Explain that the equipment being used is state-of-the-art.
2) Tell the children that the providers are competent.
3) Call the children's parents to come to the unit.
4) Assure the children that the nurses are caring.

Question 15

A school-age child diagnosed 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?
1) Asking the parents to help bag the child
2) Asking the parents to sit near the child's face and touch their child
3) Asking the parents to stand at the foot of the cart to watch
4) Asking the parents to leave the room

Question 16

An adolescent experiencing status asthmaticus is 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. Which is the best action by the triage nurse at this time?
1) Ask the parents to please take a seat in the waiting room.
2) Immediately escort the parents to a quiet, private room.
3) Tell the parents that they must wait because only the healthcare provider can talk with them.
4) Immediately tell the parents, "I'm sorry, but your child didn't make it."

Question 17

A school-age child is admitted to the hospital with a fractured femur and head trauma. The child was not wearing a helmet while riding a new bicycle on the highway, and collided with a car. Which nursing diagnoses should the nurse include in the plan of care with regard to the child's parents? Select all that apply.
1) Compromised Family Coping related to the critical injury of the child
2) Parental Role Conflict related to child's injuries and pediatric intensive care unit (PICU) policies
3) Guilt related to lack of child supervision and safety precautions
4) Knowledge Deficit related to home care of fractured femur
5) Anger related to feelings of helplessness

Question 18

The nurse is having difficulty coping with the impending death of a child. Who is the best resource for the nurse to consult during this difficult situation?
1) Other staff nurses
2) Hospice nurses
3) Unit nurse manager
4) Nurse's spouse

Question 19

A 10-year-old child is transported to the emergency department (ED) by ambulance from the scene of a motor vehicle crash. The child is alert and oriented ×3; pulse, respirations, and blood pressure are stable; 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." Which injury does the nurse suspect based on the current data?
1) Spinal cord injury
2) Traumatic shock
3) Traumatic brain injury
4) Ruptured spleen

Question 20

A preschool-age age child with severe head trauma is intubated and on a respirator. The child has three flat electroencephalograms (EEGs) completed 24 hours apart. The electrocardiogram (ECG) shows a rate of 90 beats per minute in a normal sinus rhythm. Which term should the nurse use when documenting these findings?
1) Imminent death
2) Brain death
3) Natural death
4) Heart-lung death

Question 21

Which respiratory findings assessed by the nurse indicate that a child is close to death? Select all that apply.
1) Tachypnea
2) Dyspnea
3) Diaphoresis
4) Confusion
5) Accumulation of secretions in the throat

Question 22

Which support groups should the nurse include in a bereavement package for a family who suddenly lost an adolescent in a motor vehicle crash? Select all that apply.
1) Compassionate Friends
2) First Candle
3) Al Anon
4) Infant Loss Support
5) Rachel's Vineyard

Question 23

Which assessment findings may indicate to the nurse that the child is experiencing renal failure and is close to death? Select all that apply.
1) Decreased oral fluid intake
2) Decreased urine production
3) Increased urinary incontinence
4) Urinary stones noted
5) Increased diaphoresis

Question 24

Which defense mechanisms should the nurse include in the parental teaching session regarding common pediatric responses to a life-threatening illness? Select all that apply.
1) Regression
2) Anticipating
3) Denial
4) Repression
5) Bargaining

Question 25

The nurse is providing care to a child who was admitted to the pediatric intensive care unit (PICU) after a motor vehicle crash. Which interventions should the nurse include in the plan of care to allow the parents to participate in their child's care? Select all that apply.
1) Encouraging the parents to brush the child's hair
2) Teaching the parents how to perform range of motion exercises with their child
3) Allowing the parents to read to their child
4) Explaining the child's condition to the parents
5) Providing permission for the parents to remain at the child's bedside

Question 26

The nurse is taking care of a child who is showing signs of imminent death. Which manifestations should the nurse expect to assess related to the cardiovascular system?
1) An increase in the volume of Korotkoff sounds
2) Cool and clammy skin, mottling
3) Peripheral pulses will remain when the heart beat is not heard on auscultation.
4) An increase in cardiac output

Question 27

The nurse is doing a follow-up home visit to a family who lost their 3-month-old infant to SIDS 8 weeks ago. The mother answers 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." Which stage of grief will the nurse document based on the current data?
1) Recovery
2) Yearning, pining
3) Hostile
4) Disorganization