Nokea
The family and child have decided that hospice care best meets their needs during the terminal phase of illness. The nurse recognizes that the parents understand the principles of this care when they make which statement?
- A. It will be good to be at home and care for our child.
- B. What a relief it will be not to need any more medicines.
- C. We are going to miss the support of the hospice team when our child dies.
- D. We know that once hospice care starts, we will not be able to return to the hospital if the care is difficult.
Correct Answer: A
Rationale: Hospice care emphasizes family as primary caregivers supported by professionals, aligning with the statement about caring at home. Medications continue for symptom management, hospice support extends post-death, and hospital readmission is possible if needed.
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The nurse is often the individual who is in the optimum position to suggest tissue donation to a family (after consultation with the practitioner). What will occur if a family chooses organ or tissue donation?
- A. The funeral will be delayed.
- B. Cremation is the preferred method of burial.
- C. Written consent is required for tissue or organ donation.
- D. An open casket cannot be used subsequent to this procedure.
Correct Answer: C
Rationale: Written informed consent is required for organ or tissue donation, ensuring legal and ethical compliance. Funerals are not typically delayed, cremation is not required, and an open casket is possible as donation does not cause visible disfigurement.
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.
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.
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.