Nokea
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.
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A preschooler is found digging up a pet bird that was recently buried after it died. What is the best explanation for this behavior?
- A. He has a morbid preoccupation with death.
- B. He is looking to see if a ghost took it away.
- C. He needs reassurance that the pet has not gone somewhere else.
- D. The loss is not yet resolved, and professional counseling is needed.
Correct Answer: C
Rationale: Preschoolers struggle with the permanence of death and may dig up the pet to confirm its presence, a normal developmental response. This is not a morbid preoccupation, not about ghosts, and does not immediately indicate a need for counseling unless persistent.
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.
At which age do most children have an adult concept of death as being inevitable, universal, and irreversible?
- A. 4 to 5 years
- B. 6 to 8 years
- C. 9 to 11 years
- D. 12 to 16 years
Correct Answer: C
Rationale: By ages 9 to 11, children develop an adult-like understanding of death as inevitable, universal, and irreversible. Younger children have less mature concepts, and adolescents have a fully mature understanding.
A critically injured child has died and is being removed from a ventilator in the pediatric intensive care unit. What is a priority nursing intervention for the family at this time?
- A. Ensure that parents are in the waiting room while the ventilator is removed.
- B. Help the parents understand that the child is already dead and no further interventions are necessary.
- C. Control the environment around the child and family to provide privacy.
- D. Encourage them to wait to see their child until the funeral home has prepared the body.
Correct Answer: C
Rationale: Controlling the environment to provide privacy respects the family?s need for dignity and space during this sensitive time. Forcing parents to the waiting room, stating no further interventions are needed, or delaying their time with the child disregards their emotional needs.
What is a principle of palliative care that can be included in the care of children?
- A. Maintenance of curative therapy
- B. Child and family as the unit of care
- C. Exclusive focus on the spiritual issues the family faces
- D. Extensive use of opiates to ensure total pain control
Correct Answer: B
Rationale: Palliative care for children emphasizes a multidisciplinary approach focusing on symptom control and support for the family as the unit of care, rather than cure when it is no longer possible. Curative therapy is transitioned away from, spiritual issues are one aspect among others, and opiate use is balanced to manage pain while minimizing side effects.