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?
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

Accepted Answer

The presence of purpuric lesions suggests the adolescent may have meningococcemia, a serious bacterial infection that can cause permanent changes in appearance from scarring. This can be a significant psychologic stressor for any adolescent, especially when combined with separation from friends due to hospitalization. Fear of getting behind in schoolwork or undergoing painful procedures may also be present but are typically secondary to concerns about appearance and social relationships. Separation from parents and home may also be a stressor, but in this case, the severity of the physical illness likely overshadows these concerns.

Question 2

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

Accepted Answer

Powerlessness (moderate) related to inability to speak or communicate with friends is the most appropriate nursing diagnosis for an adolescent with cystic fibrosis who is intubated with an endotracheal tube. The inability to speak or communicate with friends can lead to feelings of powerlessness and loss of control, which can impact their psychological well-being.

Question 3

Which strategies would be helpful for nurses who work with terminally ill children to avoid burnout? 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

Accepted Answer

Participating in a mentoring relationship with experienced hospice nurses, attending support groups with mental health professionals, and participating in team decisions regarding the dying child's plan of care are all helpful strategies for nurses who work with terminally ill children to avoid burnout. Declining the family's invitation to attend the child's funeral may result in feelings of guilt and isolation, while planning the child and family's care alone as the primary nurse may lead to overwhelming responsibility and lack of support.

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?
A) Impaired Parenting related to protecting the child
B) Anxiety related to the critical care unit environment
C) Hopelessness related to the child's deteriorating condition
D) Compromised Family Coping related to the child's critical injury

Accepted Answer

The family is struggling to cope with the child's critical injury, and they are blaming each other for the accident. This indicates that they may have difficulty working together as a family unit to support the child's recovery. Therefore, Compromised Family Coping is the most appropriate diagnosis for this family. Impaired Parenting may be a contributing factor, but it is not the primary issue at hand. Anxiety and hopelessness may also be present, but they are not the most relevant diagnoses given the family dynamics in this situation.

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?
A) "You should press charges against the drunk driver."
B) "Your child's condition is very critical; her face is swollen, and she might not look like herself."
C) "Your child's leg was crushed, and might have to be amputated."
D) "Don't worry, everything will be okay. We will take excellent care of your child."

Accepted Answer

It is important for the nurse to prepare the parents for what they will see when they enter their child's room. The parents may not recognize their child due to facial swelling, or other injuries sustained during the crash. The nurse must also be honest about the critical state of the child's condition. False reassurance can be harmful to the parents' trust in the healthcare team, and their ability to make informed decisions regarding their child's care.

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

Accepted Answer

The mother's message reflects acceptance of her child's impending death, indicating she has come to terms with the reality of the situation, which aligns with the Acceptance stage of Kubler-Ross's stages of grieving.

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

Accepted Answer

It is important for the nurse to discuss the wide range of emotions that parents may experience following the death of their child. These emotions may include loneliness, guilt, anger, and depression. Though some parents may experience an increase in energy during this time, it is important to focus on the emotions that are most commonly experienced by bereaved parents.

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

Accepted Answer

The mother is experiencing anticipatory loss, which refers to the feelings of grief and mourning that occur in advance of an actual loss, such as a loved one's impending death. In this case, the mother is already grieving the holiday celebrations she will miss with her child, even though the child is still alive.

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?
A) The child may feel that his or her bad behavior caused the sibling's death as a punishment.
B) The child may feel that the sibling died as a result of a fight.
C) The child may feel that having bad thoughts about the sibling caused the death.
D) The child may feel that the sibling died because the parents did not like that sibling.

Accepted Answer

The answer of The nurse is speaking with a preschool-age...

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

Accepted Answer

Maintenance of IV hydration is important for a child who is sedated, unconscious, and on a mechanical ventilator to ensure adequate fluid balance and prevent dehydration. The other interventions (out-of-bed transfer, whirlpool baths, active ROM exercises) are not appropriate for a child who is sedated, unconscious, and on a mechanical ventilator, as they may cause harm or disrupt the ventilator.

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?
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 6 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."

Accepted Answer

The statement suggests that the parent still holds unrealistic expectations about the grieving process and timeline. The nurse may need to educate the parent about the normalcy of grief and how it may vary between individuals.

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?
A) Preschool-age children often believe that death is their fault.
B) Preschool-age children believe death is permanent.
C) Preschool-age children engage in reality-based thinking.
D) Preschool-age children may believe the parents will not come back home.

Accepted Answer

Preschool-age children often engage in magical thinking and may believe that their thoughts or actions caused events, such as the death of their parents. They do not fully understand the permanence of death and may not engage in reality-based thinking.

Question 13

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

Accepted Answer

Active listening techniques such as acknowledging and validating the family's emotions can offer comfort and support during this difficult time. Looking the parents in the eye when talking conveys a sense of empathy, compassion, and understanding. Offering to call and notify other family members allows the family to focus on being present with their child and saying their goodbyes without having to worry about making phone calls. Refusing to cry or avoiding being in the room can be seen as dismissive of the family's emotions and is not supportive.

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?
A) Explain that the equipment being used is state-of-the-art.
B) Tell the children that the providers are competent.
C) Call the children's parents to come to the unit.
D) Assure the children that the nurses are caring.

Accepted Answer

Calling the children's parents to come to the unit is the most effective nursing intervention to calm frightened children, as the presence of a parent or guardian can provide significant emotional support and reassurance during a stressful and scary time.

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?
A) Asking the parents to help bag the child
B) Asking the parents to sit near the child's face and touch their child
C) Asking the parents to stand at the foot of the cart to watch
D) Asking the parents to leave the room

Accepted Answer

The best nursing intervention in this situation is to ask the parents to sit near the child's face and touch their child. This will promote a sense of comfort and security for the child, as well as providing emotional support for the parents during this stressful situation. It is important to involve the parents in the resuscitation process, but asking them to help bag the child may be too overwhelming for them. Standing at the foot of the cart to watch may not provide the parents with the emotional support they need, and asking them to leave the room may cause unnecessary distress for everyone involved.

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?
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 healthcare provider can talk with them.
D) Immediately tell the parents, "I'm sorry, but your child didn't make it."

Accepted Answer

The best action by the triage nurse is to immediately escort the parents to a quiet, private room to provide them with the news of their child's passing. The news should be delivered in a sensitive and compassionate manner. The waiting room is not an appropriate location, and telling the parents to wait or immediately providing the news without privacy and sensitivity could be detrimental to their emotional well-being.

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.
A) Compromised Family Coping related to the critical injury of the child
B) Parental Role Conflict related to child's injuries and pediatric intensive care unit (PICU) policies
C) Guilt related to lack of child supervision and safety precautions
D) Knowledge Deficit related to home care of fractured femur
E) Anger related to feelings of helplessness

Accepted Answer

The parents may experience compromised family coping due to the stress of their child's critical injury. They might face role conflict due to the child's needs and hospital policies. Guilt could arise from not ensuring the child's safety, and anger may stem from feeling helpless in the situation.

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?
A) Other staff nurses
B) Hospice nurses
C) Unit nurse manager
D) Nurse's spouse

Accepted Answer

Hospice nurses are specialized nursing professionals who have experience dealing with end-of-life situations, death and dying, and grief counseling. They can offer the nurse valuable guidance, support, and advice on how to cope with the situation. Other staff nurses and the unit nurse manager may be able to offer support, but they may not have the same level of expertise as a hospice nurse. While the nurse's spouse may provide emotional support, they may not have the knowledge and expertise necessary to guide the nurse through the grieving process.

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

Accepted Answer

The child's inability to move or feel their legs suggests a potential spinal cord injury, which could be caused by the motor vehicle crash. The immobilization of the neck and back on a backboard further supports this suspicion. The absence of obvious bleeding and stable vital signs make traumatic shock and ruptured spleen less likely. While traumatic brain injury is a possibility with any head trauma, there is no indication of this based on the current data provided.

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?
A) Imminent death
B) Brain death
C) Natural death
D) Heart-lung death

Accepted Answer

The combination of severe head trauma, intubation, and three flat EEGs completed 24 hours apart is consistent with brain death. The normal sinus rhythm on the ECG is not relevant to the diagnosis of brain death, as the heart can continue to function even after brain death has occurred. Therefore, the term "brain death" should be used when documenting these findings.

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

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?

Which is the most appropriate nursing diagnosis for the adolescent diagnosed with cystic fibrosis who is intubated with an endotracheal tube?

Which strategies would be helpful for nurses who work with terminally ill children to avoid burnout? Select all that apply.

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 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?

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.

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?

The nurse is speaking with a preschool-age child whose sibling recently died. Which feelings should the nurse anticipate from the preschool-age child?

Which nursing intervention should the nurse include in the plan of care for a child who is sedated, unconscious, and on a mechanical ventilator?

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?

The nurse is providing care to a child who is nearing death. Which nursing actions may offer the family support?

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?

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?

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?

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?