Name: Pediatric Nursing The Critical Components of Nursing Care 1st Edition by Kathryn Rudd - Test Bank
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Sample Questions Posted Below

Chapter 5: End of Life Care

Multiple Choice

1. The pediatric nurse is having a conversation with parents who have children that have recently passed away. The nurse knows the parents understand the difference between bereavement and grief when the participants state:

1. “I am trying to prepare for my daughter’s death, but I just am not ready to do so.”

2. “Bereavement has caused me to experience sorrow for the loss of my daughter.”

3. “I can’t believe my daughter is gone.”

4. “If I make a deal that God takes me, then my daughter could come back to my family.”

ANS: 2

	Feedback
1.	The parents are stating anticipatory grief.
2.	The parents are stating bereavement.
3.	The parents are in the denial phase of grieving.
4.	The parents are bargaining.

2. The medical chart states that the parents are requesting “withdrawal of care” for a child with terminal leukemia. The nurse understands this request to mean:

1. To keep support measures which sustain life for the child.

2. To keep providing comfort care for the child.

3. To stop life-saving measures and allow the child to die naturally.

4. To stop providing comfort measures for the child.

ANS: 3

	Feedback
1.	Support measures are not wanted by the parents.
2.	Comfort care is important, but this addresses the life-sustaining measures.
3.	Withdrawal of care relates to stopping heroic measures to sustain life.
4.	Comfort is essential in the last days of life for the family and the patient.

3. Ashley is a 5-year-old girl who is severely mentally handicapped and has been bedridden for the last 3 years after a near-drowning accident. Ashley has developed pneumonia and sustaining her life would require ventilator support. The staff nurse is to obtain information about legal guardianship because her parents have abandoned her at the hospital. The nurse knows that:

1. Legal guardianship is needed for a person to have medical information released to him/her.

2. The legal guardian must be present to care for the child.

3. Legal guardianship can only be obtained by her parents.

4. The legal guardian must take physical responsibility for the child.

ANS: 1

	Feedback
1.	The medical information and consent needs to be given by someone with the best interests of the child in mind who can legally make decisions. Only information can be released to this person.
2.	The legal guardian does not need to be physically present, but must be reachable to discuss the plan of care.
3.	Legal guardians can be anyone with the best interests of the child in mind.
4.	The legal guardian may be the state, and foster parents would have the physical responsibility of caring for the child.

4. Identify a developmentally-appropriate activity that can be used to speak to a 6 year old about the terminal illness of his sibling.

1. Playing checkers and speaking about the illness.

2. Playing with action figures and discussing how death occurs.

3. Playing with crayons and drawing pictures of how a child views his sibling at this time.

4. All of the above are correct.

ANS: 4

	Feedback
1.	Having a diversional activity allows the child to express themselves without having to look directly at the adult.
2.	Action figures can help act out how death occurs.
3.	Expression through art is a technique that children are able to comprehend and is not threatening to them.
4.	Diversion, acting, and art can help children express and discuss the death process.

5. Palliative care should be considered for a terminally-ill child:

1. Within 1 year of death.

2. Within 2 months of death.

3. When a terminal illness is present.

4. At no time. It is not appropriate for children.

ANS: 3

	Feedback
1.	Planning can occur, but should be started when a terminal diagnosis is present to provide the plan of care for the child.
2.	Planning can occur, but should be started when a terminal diagnosis is present to provide the plan of care for the child.
3.	The knowledge of the terminal illness and letting the family and patient be involved in the decision-making processes facilitates palliative care so that the patient is as comfortable as possible.
4.	Palliative care is appropriate for children with a terminal illness.

6. Palliative care allows the child to:

1. Have a graceful, natural death.

2. Attempt to use every type of medical process possible to sustain life.

3. Abruptly end life.

4. Comfort the family before death.

ANS: 1

	Feedback
1.	Palliative care focuses on the natural death process in the most comforting way possible.
2.	Medical processes to sustain life are not considered important in palliative care.
3.	Palliative care works with patients once a terminal illness is diagnosed in order to have a plan of care.
4.	Palliative care helps comfort the family and the patient.

7. One of the best indicators of pain in a child is:

1. A change in the baseline vital signs.

2. Parents’ input.

3. Restlessness.

4. All of the above can be seen in children with pain.

ANS: 4

	Feedback
1.	A sign of pain in a child
2.	Parents tend to recognize changes in their children before others.
3.	Children in pain can be restless.
4.	Vital signs, parents’ input, and restlessness can all be signs of pain in a child.

8. A nurse is discussing pain management for a child near death. The child does not have an IV, and the parents do not want their child to suffer more pain. The nurse knows medication at this point in the child’s life should:

1. Be given by the quickest route for maximum relief.

2. Be delivered in the most invasive manner.

3. Be given through IV.

4. Be discussed with the doctor because a child near death cannot feel pain.

ANS: 2

	Feedback
1.	The quickest route may be very painful for the child.
2.	The most invasive manner can cause less pain.
3.	The IV is not established.
4.	Children near death can feel pain.

9. Identify an activity that is an alternative pain management technique.

1. Blowing bubbles

2. Holding and rocking the child

3. Playing with puzzles

4. All of the above can be used as alternative pain management techniques.

ANS: 4

	Feedback
1.	A form of alternative pain management, along with other options
2.	A form of alternative pain management, along with other options
3.	A form of alternative pain management, along with other options
4.	Bubbles, rocking, and puzzles are all alternative pain management techniques for children.

10. A staff nurse knows a child’s view of death is influenced by _____________ and __________.

1. Developmental age, mental status

2. Cognition, mental status

3. Developmental age, cognition

4. Physical status, age

ANS: 3

	Feedback
1.	Developmental age does define how the child will understand the process, but mental status does not.
2.	Cognition does define how the child will understand the process, but mental status does not.
3.	Developmental age demonstrates what a child is able to understand, along with cognition.
4.	Physical status does not give an idea of the cognitive level of the child. Age does not determine cognition.

11. A 3 year old is diagnosed with terminal grade four neuroblastoma, which has side effects of balance and hearing issues. The child’s mother asks the nurse about an appropriate, safe activity for the child. The nurse tells the mother that the most appropriate type of play is:

1. No play is good. The child should remain in bed.
2. Play groups with children in the neighborhood.
3. Age appropriate gymnastic classes.
4. Quiet play with minimal stimuli, such as puzzles or books.

ANS: 4

	Feedback
1.	Playing is a normal part of learning and should be considered.
2.	Play groups may cause too much stimulation and cause negative reactions from the child.
3.	A gymnastics class is too much stimulation and the child may have issues with balance.
4.	Quiet play with minimal stimuli is the most appropriate for a child with balance and hearing issues.

12. The nurse is aware that there are two causes of pediatric death. They are:

1. Psychological and physiologic.
2. Trauma and physiologic.
3. Trauma and psychological.
4. Physiologic and external.

ANS: 2

	Feedback
1.	Physiological issues are not a leading cause for death in pediatric patients.
2.	A terminal pediatric diagnosis is categorized into two causes: trauma and physiologic.
3.	Physiological issues are not a leading cause for pediatric death.
4.	External factors are not a reason for death in pediatric patients.

13. A nurse in a maternity unit is providing emotional support to a patient and her husband who are preparing to be discharged from the hospital after the birth of a stillborn, full-term infant. Which statement, if made by the patient, indicates a component of the normal grieving process?

1. “We would really like to attend a support group.”
2. “We are ok. We are going to work on having another baby now.”
3. “We never want to have a baby again or talk about our loss.”
4. “We are filling out the paperwork to adopt a baby.”

ANS: 1

	Feedback
1.	This is the best answer to demonstrate the normal grieving process, but other answers can be true if people are struggling with the grieving process.
2.	The parents are not taking the time to grieve for the child they lost.
3.	The parents are making choices at a highly emotional time. The parents should wait to make this decision.
4.	The parents are making life decisions too early after the death of their child.

14. A nursing instructor asks a nursing student what the leading causes of death for pediatric-age patients are. Which of the following statements demonstrates that the student is aware of the leading causes of death for pediatric patients?

1. “Disease and terminal cancer are the leading causes of death for pediatrics.”
2. “Abuse and SIDS are the leading causes of death for pediatrics.”
3. “Accidents or unintentional injuries are the leading causes of death for pediatrics.”
4. “Accidents and congenital defects are the leading causes of death for pediatrics.”

ANS: 3

	Feedback
1.	Disease and terminal illness are not the leading causes of death in pediatric patients.
2.	Abuse and SIDS are not the leading causes of death for pediatric patients.
3.	Accidents or unintentional injuries are the leading causes of death for pediatric patients.
4.	Congenital defects are not a leading cause of death for pediatric patients.

15. Which, if any, of the following circumstances might incline a nurse to become disengaged or enmeshed rather than therapeutically engaged with a patient/family?

1. 5-year-old child dying of cancer
2. 6-month-old infant in a vegetative state due to an inflicted head injury
3. Dying 10-day-old neonate with anencephaly whose parents do not visit
4. All of the above

ANS: 4

	Feedback
1.	The situation is emotionally charged in a manner that might incline a nurse to distance herself from or become enmeshed with the child and/or the family.
2.	The situation is emotionally charged in a manner that might incline a nurse to distance herself from or become enmeshed with the child and/or the family.
3.	The situation is emotionally charged in a manner that might incline a nurse to distance herself from or become enmeshed with the child and/or the family.
4.	Each of the situations is emotionally charged in a manner that might incline a nurse to distance herself from or become enmeshed with the child and/or the family.

16. The nurse is aware that the purpose of pediatric palliative care is:

1. To speed up the process of death and decrease suffering.
2. To promote patient comfort and family involvement.
3. To increase patient comfort and decrease environmental stimuli.
4. To prevent disease and promote overall health.

ANS: 2

	Feedback
1.	The goal of palliative care is to provide a positive death process.
2.	Palliative care is provided at the end of life to promote patient comfort and family involvement.
3.	The goal is to have family involvement and promote comfort.
4.	Palliative care is provided at the end of life to promote patient comfort and family involvement.

17. The nurse is creating a care plan for a terminal 6-year-old child in the hospital for palliative care. Which of the following should be the goal of the care plan?

1. Pain assessment
2. Developmental needs
3. School needs
4. Discharge planning

ANS: 4

	Feedback
1.	Pain assessment and interventions are essential in end of life care, but not the goal.
2.	The child’s developmental needs are for assessment purposes.
3.	Palliative care does not focus on school needs because the end of life should be the focus.
4.	Discharge planning is the goal of a palliative care so the child can be in a comfortable home environment with the family.

18. Which, if any, of the following is not an example of family-centered care within palliative care?

1. The child’s parents are not invited to participate in medical rounds.
2. Educating the family on the child’s pain assessment and pain care to allow them to assist in keeping the child comfortable.
3. Asking the family to help with daily patient care, such as bathing and positioning when appropriate.
4. Choices 2 and 3

ANS: 1

	Feedback
1.	A child’s family should participate in palliative care planning.
2.	Family education is an important part of family-centered care.
3.	Family involvement in daily care is an example of family-centered care.
4.	Parents/guardians should be encouraged, but not required, to participate in medical rounds, nursing shift changes, patient care, and pain assessment at all times during palliative care.

19. Which of the following pain interventions is appropriate for a pediatric patient receiving palliative care?

1. Assess the patient’s pain using a developmentally appropriate pain scale.
2. Ask the patient’s family to participate and provide input regarding the patient’s pain level assessment.
3. Use a combination of prescribed medications, distraction, and positioning to provide comfort and decrease pain.
4. All of the above

ANS: 3

	Feedback
1.	Assessing the pain is not an intervention.
2.	The family may not have knowledge on the proper pain scale to be used with the patient.
3.	When caring for a patient in palliative care, it is important to use the correct pain scale, involve the patient and family in pain control, and use a combination of methods to increase comfort and decrease pain.
4.	When caring for a patient in palliative care, it is important to use the correct pain scale, involve the patient and family in pain control, and use a combination of methods to increase comfort and decrease pain.

20. The nurse is preparing to assess a 4-week-old infant who is suffering from shaken baby syndrome. The most appropriate pain scale is:

1. CHOPS.
2. The numerical scale.
3. VAS.
4. NIPS.

ANS: 4

	Feedback
1.	CHOPS is not used for a neonate assessment.
2.	A numerical scale is not able to identify pain in a neonate.
3.	VAS is not used to assess pain in a neonate.
4.	NIPS, or Neonatal and Infant Pain Scale, is the most appropriate for a 4-week-old infant.

21. When a child is at the end-stage of life, the nursing priority should be:

1. Restoration of health.
2. Health education.
3. Patient comfort.
4. Developmental assessment.

ANS: 3

	Feedback
1.	Comfort care is needed for the child.
2.	Health education and developmental assessment are both important, but not a priority. Restoration of health is generally not possible.
3.	The nursing priorities during end-of-life care for pediatric patients would focus on patient comfort. Health education and developmental assessment are both important, but not a priority. Restoration of health is generally not possible.
4.	Health education and developmental assessment are both important, but not a priority. Restoration of health is generally not possible.

22. The nurse is working in a post-partum unit and is assigned to care for a woman who experienced fetal demise at 40 weeks. The nurse is not comfortable caring for this type of patient, so the best course action for the nurse to take is to:

1. Take the patient and provide the care needed. No one is good at providing care to patients who experience fetal demise.
2. Talk to the charge nurse and see if there is a nurse with more experience in caring for patients who experience a fetal demise.
3. Take the patient. All nurses need to learn to take care of patients who experience a death.
4. Talk to the charge nurse and refuse to take the patient. It is not fair to take a patient the nurse is not comfortable with caring for.

ANS: 2

	Feedback
1.	It is the responsibility of the nurse to not care for the patient.
2.	The best response for the nurse to have is to see if there is a better option; if a nurse is uncomfortable with providing end-of-life care and there is a better option, it is the responsibility of the nurse to not care for the patient.
3.	It is the responsibility of the nurse to not care for the patient.
4.	The best response for the nurse to have is to see if there is a better option.

23. Organ transplant is overseen by:

1. Physicians.
2. A federal-government-funded agency.
3. No one. There is no oversight of organ transplantation.
4. All of the above.

ANS: 2

	Feedback
1.	Organ transplant is overseen by a federal agency to ensure that there is fairness and equity in the distribution of available organs.
2.	Organ transplant is overseen by a federal agency to ensure that there is fairness and equity in the distribution of available organs.
3.	Organ transplant is overseen by a federal agency to ensure that there is fairness and equity in the distribution of available organs.
4.	Organ transplant is overseen by a federal agency to ensure that there is fairness and equity in the distribution of available organs.

24. What federal laws and regulations must be followed during palliative care?

1. HIPAA
2. The Joint Commission
3. OSHA
4. All of the above

ANS: 4

	Feedback
1.	HIPAA should be provided for all patients, no matter their status.
2.	The Joint Commission is a certification a hospital may want to receive, not a regulation by law.
3.	OSHA is for occupational health standards, not palliative care needs.
4.	Palliative care is no different than all other types of health-care delivery and all laws and regulations must be followed.

25. Which, if any, of the following is the correct type of patient to be assigned to palliative care?

1. A 6-year-old boy with an untreatable stage four brain tumor
2. A 2-month-old child with spina bifida
3. A 12-year-old child with a new diagnosis of leukemia
4. All of the above

ANS: 1

	Feedback
1.	A palliative care patient is generally defined as a patient who is within 6 months of death. An untreatable stage four brain tumor will generally cause death within weeks or months.
2.	Spina bifida is not a terminal disease.
3.	Newly diagnosed leukemia is not a terminal disease.
4.	A palliative care patient is generally defined as a patient who is within 6 months of death. An untreatable stage four brain tumor will generally cause death within weeks or months. Spina bifida and newly diagnosed leukemia are not terminal diseases.

26. You are caring for a child recently admitted to the palliative care unit with end-stage heart disease. Which statement by the parents demonstrates that you need to provide education regarding palliative care?

1. “We want to have our family here with us, are they able to visit outside of visiting hours?”
2. “We want to make sure we are always with our child. Can we sleep in the room?”
3. “We are trying to plan ahead. When do you think our child will be better and able to be discharged?”
4. All of the above

ANS: 3

	Feedback
1.	Parents stating that they want their family available and to be with the child at all times are signs of understanding that the child is going to die.
2.	Parents stating that they want their family available and to be with the child at all times are signs of understanding that the child is going to die.
3.	Palliative care is end-of-life care, and parents may need additional education to help them to come to terms with their child being in palliative care. Gentle education may be needed on an ongoing basis. Parents stating that they want their family available and to be with the child at all times are signs of understanding that the child is going to die.
4.	Palliative care is end-of-life care and parents may need additional education to help them to come to terms with their child being in palliative care.

27. When parents are approached about their child becoming an organ donor, it is important for whom to approach the parents?

1. Anyone can approach the parents and ask for them to donate their child’s organs.
2. Only physicians can approach the parents and ask for them to donate their child’s organs.
3. No one should approach the parents. If they what to donate their child’s organs, they will ask the staff.
4. Only staff trained in approaching should approach the parents and ask for them to donate their child’s organs.

ANS: 4

	Feedback
1.	Organ donation is a very hard subject to approach the parents of a dying child with, and only staff trained in approaching should approach a family.
2.	Organ donation is a very hard subject to approach the parents of a dying child with, and only staff trained in approaching should approach a family.
3.	Organ donation is a very hard subject to approach the parents of a dying child with, and only staff trained in approaching should approach a family.
4.	Organ donation is a very hard subject to approach the parents of a dying child with, and only staff trained in approaching should approach a family.

28. Which of the following is a priority in caring for a patient whose parents have consented to donating the child’s organs?

1. Prepping the patient and family for the surgical procedures to procure the organs
2. Allowing the family as much time as they need to say goodbye to the patient
3. Supporting the family in choosing a funeral home for their child
4. Providing education to the parents about organ donation

ANS: 1

	Feedback
1.	The priority in organ donation patients is to prep them for surgery and organ procurement. The sooner the organs are procured, the more viable the organs. All of the other choices important, but not the top priority.
2.	The sooner the organs are procured, the more viable the organs.
3.	The funeral home choice should only be made by the family.
4.	The parents should have been educated about the donation process prior to the consent being signed.

29. When administering pain medication to a palliative care patient, what needs to be included?

1. Ensure that the correct pain scale is being used.
2. The six rights of medication administration
3. Explanation of medication to the patient and family
4. All of the above

ANS: 4

	Feedback
1.	A correct pain scale will identify the physiological signs of the child.
2.	The six rights should be followed with all patients.
3.	Explanations should occur for all medications.
4.	All of the choices are necessary for correct pain medication administration practice when caring for any patient, including palliative care patients.

30. The nurse responds to a pediatric code in the emergency room. Upon arrival, the nurse finds the parents outside of the room, and they ask if they can go in. The best response the nurse can give is:

1. “Family is not allowed in the room during this type of situation. It is best for you to go to the waiting room.”
2. “You want to remember your child in happier times, not like this. Please wait here.”
3. “Yes, you may go on in, but stay out of everyone’s way so that you do not make it worse.”
4. “Of course. I will go with you. Please do not touch anything until we know what is going on.”

ANS: 4

	Feedback
1.	The family should be escorted to a family room so that the child receives all of the care needed.
2.	This may increase anxiety for the parents and should be avoided.
3.	During a pediatric code situation, it is very important to provide for the safety of the patient’s family
4.	During a pediatric code situation, it is very important to provide for the safety of the patient’s family. Always ensure that a staff member is assigned to be with the family during the entire code.

True/False

31. When death is near for a child, a nurse should be honest about actions the body will do in the last moments.

ANS: T

	Feedback
1.	Informing the family about the involuntary actions at the time of death can help decrease the anxiety and fear around the situation.
2.	Informing the family about the involuntary actions at the time of death can help decrease the anxiety and fear around the situation.

Multiple Response

32. Identify the roles a palliative care member has with other multidisciplinary team members. Select all that apply.

1. Advocate

2. Pharmacy role for comfort

3. Obtain doctors’ orders and carry out procedures

4. Nutrition

5. Child life

ANS: 1, 2, 3, 4, 5

	Feedback
1.	Seeks to advocate for the patient and family’s wants and needs
2.	Works with pharmacy to provide comfort measures that the patient and family want
3.	One person can be designated to speak with the doctor so that information is concise.
4.	The palliative care coordinator can work with the nutritionist to provide for the patient’s wants.
5.	The child life and the palliative care personnel can find ways to engage the child at the end of life.

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