Nokea
A child in the terminal stage of cancer has frequent breakthrough pain. Nonpharmacologic methods are not helpful, and the child is exceeding the maximum safe dose for opiate administration. What approach should the nurse implement?
- A. Add acetaminophen for the breakthrough pain.
- B. Titrate the opioid medications to control the childs pain as specified in the protocol.
- C. Notify the practitioner that immediate hospitalization is indicated for pain management.
- D. Help the parents and child understand that no additional medication can be given because of the risk of respiratory depression.
Correct Answer: B
Rationale: Titrating opioids per protocol manages breakthrough pain effectively, as tolerance may require higher doses, and the principle of double effect prioritizes pain relief. Acetaminophen is inadequate, hospitalization is unnecessary, and limiting medication ignores pain control needs.
You may also like to solve these questions
What explanation best describes how preschoolers react to the death of a loved one?
- A. Grief is acute but does not last long at this age.
- B. Children this age are too young to have a concept of death.
- C. Preschoolers may feel guilty and responsible for the death.
- D. They express grief in the same way that the adults in the preschoolers life are expressing grief.
Correct Answer: C
Rationale: Due to egocentric thinking, preschoolers may feel guilty, believing they caused the death. They have a limited concept of death as a temporary state, their grief may involve regression or joking, and their expressions differ from adults, reflecting their developmental stage.
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.
At which developmental period do children have the most difficulty coping with death, particularly if it is their own?
- A. Toddlerhood
- B. Preschool
- C. School age
- D. Adolescence
Correct Answer: D
Rationale: Adolescents, with their mature understanding of death, struggle most with their own mortality due to guilt, shame, and identity challenges. Toddlers fear separation, preschoolers feel guilt, and school-age children fear the unknown, but these are less intense than adolescent struggles.
A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. The nurse should provide which explanation?
- A. This attitude is helpful to give parents time to cope.
- B. This will help the child cope effectively by denial.
- C. Terminally ill children know when they are seriously ill.
- D. Terminally ill children usually choose not to discuss the seriousness of their illness.
Correct Answer: C
Rationale: Children, even young ones, sense the seriousness of their illness due to increased medical attention, making honesty essential. Denial is an ineffective coping mechanism, protecting the child does not primarily serve parental coping, and children may want to discuss their condition if given the opportunity.
What factor is most important for parents implementing do not resuscitate (DNR) orders?
- A. Parents beliefs about euthanasia
- B. Presence of other children in the home
- C. Experiences of the health care team with other children in this situation
- D. Acknowledgment by health care team that child has no realistic chance for cure
Correct Answer: D
Rationale: An honest appraisal by the health care team that the child has no realistic chance for cure facilitates earlier DNR orders and appropriate palliative care. DNR orders are distinct from euthanasia, the presence of other children is not directly relevant, and the health care team?s prior experiences inform discussions but are secondary to acknowledging prognosis.