Nokea
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.
Correct Answer: A
Rationale: Supporting both parents and child in resolving this conflict respects the child?s autonomy, especially given the poor prognosis. Twelve-year-olds can assent or refuse under certain conditions, oncologists guide but don?t decide, and parental authority may be limited if the child?s decision is informed and verified.
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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.
Correct Answer: D
Rationale: Visions of loved ones, like the grandfather, are common near death and indicate the child?s acceptance and lack of fear. These are not opiate side effects, attempts to comfort parents, or due to brain anoxia, as there?s no evidence of hypoxia.
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.
Correct Answer: A
Rationale: Limiting care to essentials prioritizes comfort and palliative interventions, reducing distress. Music can be soothing, whispering may be unclear, and frequent vital sign checks are unnecessary and intrusive at this stage.
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
Correct Answer: D
Rationale: Difficulty swallowing is a physical sign of approaching death, reflecting declining bodily functions. Appetite and fluid intake decrease, and the pulse slows, not quickens, in the final stages.
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.
Correct Answer: B
Rationale: Helping parents manage the child?s anger constructively addresses her loss of control and promotes communication and coping. Explaining anger is unhelpful, finding the cause may be difficult for the child, and ignoring anger dismisses her emotional needs.
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.
Correct Answer: B
Rationale: Providing information on the grief process helps parents navigate their loss, offering support and resources. Contraceptive information is inappropriate, reassuring about SIDS recurrence is premature and false, and investigating the home is not the nurse?s role post-death.