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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.
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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.
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.
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.
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.
The nurse is providing support to a family that is experiencing anticipatory grief related to their childs imminent death. What statement by the nurse is therapeutic?
- A. Your other children need you to be strong.
- B. You have been through a very tough time.
- C. His suffering is over; you should be happy.
- D. God never gives us more than we can handle.
Correct Answer: B
Rationale: Acknowledging the family?s tough experience validates their grief in a nonjudgmental way. Suggesting strength for other children, implying happiness over the death, or referencing God may dismiss their emotions or conflict with their beliefs.