CHP 13: End of Life Care: BOOK – Flashcards
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The nurse is providing care to an adolescent client who is dying. Which assessment findings indicate the client is experiencing a decrease in peripheral circulation? Standard Text: Select all that apply. 1. Cool skin 2. Mottled appearance 3. Cheyne-Stokes respirations 4. Increased agitation 5. Increased urine output
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Correct Answer: 1,2 Rationale 1: A client who is experiencing decreased peripheral circulation will have cool, mottled skin. While Cheyne-Stokes respirations may indicate death is approaching, this is not indicative of a decrease in peripheral circulation. Increased agitation indicates decreased perfusion to the brain. A client will not experience increased urine output near the end life.
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The parents of a toddler-age child who sustained severe head trauma from falling out a second-story window are arguing in the pediatric intensive-care unit (PICU) and blaming each other for the child's accident. Which nursing diagnosis is most appropriate for this family? 1. Parental Role Conflict Related to Protecting the Child 2. Hopelessness Related to the Child's Deteriorating Condition 3. Anxiety Related to the Critical-Care-Unit Environment 4. Family Coping: Compromised, Related to the Child's Critical Injury
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Correct Answer: 4 Rationale 1: The parents are displaying ineffective coping behaviors as a family. Parental role conflict does not refer to the parents' argument in the PICU, but means a parent is conflicted or confused about some aspect of the parental role. Each parent may be experiencing hopelessness, frustration, and anxiety, but they are not coping well as a family unit.
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The emergency-room nurse receives a preschool-age child who was hit by a car. Which nursing interventions are a priority for this child? Select all that apply. 1. Performing a rapid head-to-toe assessment 2. Recording the parents' insurance information 3. Assessing airway, breathing, and circulation 4. Asking the parents about organ donation 5. Asking the parents if anyone witnessed the accident
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Correct Answer: 1,3 Rationale 1: Assessing airway, breathing, and circulation and performing a rapid head-to-toe assessment are the priority nursing interventions. Asking the parents about organ donation is insensitive until the extent of the child's injuries is known. Recording insurance information is necessary but should never come before lifesaving assessment and intervention. Detailed information about the accident is helpful in determining the child's point of impact with the car and mechanism of injury, but this is not the initial priority.
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A young school-age child is in the pediatric intensive-care unit (PICU) with a fractured femur and head trauma. The child was not wearing a helmet while riding his new bicycle on the highway and collided with a car. Which nursing diagnoses may be appropriate for this family? Select all that apply. 1. Guilt Related to Lack of Child Supervision and Safety Precautions 2. Family Coping: Compromised, Related to the Critical Injury of the Child 3. Parental Role Conflict Related to Child's Injuries and PICU Policies 4. Knowledge Deficit Related to Home Care of Fractured Femur 5. Anger Related to Feelings of Helplessness
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Correct Answer: 1,2,3,5 Rationale 1: All of these nursing diagnoses except Knowledge Deficit are possible in this situation. Although planning for discharge begins with admission, it is too early to begin teaching the parents about home care. The astute and experienced PICU nurse is prepared to recognize current problems and intervene appropriately.
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The nurse must prepare parents to see their adolescent daughter in the pediatric intensive-care unit (PICU). The child arrived by life flight after experiencing multiple traumas in a car accident involving a suspected drunk driver. At this time, which statement by the nurse to the family is the most appropriate? 1. "Don't worry; everything will be okay. We will take excellent care of your child." 2. "You should press charges against the drunk driver." 3. "Your child's leg was crushed and may have to be amputated." 4. "Your child's condition is very critical; her face is swollen, and she may not look like herself."
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Correct Answer: 4 Rationale 1: The priority is to prepare the parents for the child's changed appearance. The nurse must not offer false reassurance nor project future stressful events. Truthful statements about the child's condition can be introduced after the parents have seen the child and grasped the situation. The nurse supports the family but remains nonjudgmental about accident details.
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An adolescent with cystic fibrosis is intubated with an endotracheal tube. Which nursing diagnosis is most appropriate for this adolescent? 1. Potential for Imbalanced Nutrition, More Than Body Requirements Related to Inactivity 2. Anxiety Related to Leaving Chores Undone at Home 3. Potential for Fear of Future Pain Related to Medical Procedures 4. Powerlessness (Moderate) Related to Inability to Speak to or Communicate with Friends
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Correct Answer: 4 Rationale 1: The adolescent values communication with peers and may feel frustrated that he cannot speak to them while intubated. The adolescent is present-oriented and is unlikely to worry about household chores or future unknown procedures. The adolescent with cystic fibrosis is likely to be underweight and is unlikely to take in more calories than needed while intubated.
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An adolescent client has a stiff neck, a headache, a fever of 103 degrees Fahrenheit, and purpuric lesions noted on the legs. Although the adolescent's physical needs take priority at the present time, the nurse can expect which to be the most significant psychological stressor forthis adolescent? 1. Separation from parents and home. 2. Separation from friends and permanent changes in appearance 3. Fear of painful procedures and bodily mutilation 4. Fear of getting behind in schoolwork
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Correct Answer: 2 Rationale 1: Adolescents are developing their identity and rely most on their friends. They are concerned about their appearance and how they look compared to their peers. Separation from parents and home is the main psychological stressor for infants and toddlers. Preschoolers fear pain and bodily mutilation. School-age children are developing a sense of industry and fear getting behind in schoolwork.
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A school bus carrying children in grades K-12 crashed into a ravine. The critically injured children were transported by ambulance and admitted to the pediatric intensive-care unit (PICU). The nurse is concerned about calming the frightened children. Which nursing intervention is most appropriate to achieve the goal of calming the frightened children? 1. Tell the children that the physicians are competent. 2. Assure the children that the nurses are caring. 3. Explain that the PICU equipment is state of the art. 4. Call the children's parents to come into the PICU.
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Correct Answer: 4 Rationale 1: A sense of physical and psychological security is best achieved by the presence of parents. Children at all developmental levels look first to their parents or whoever acts as their parents for safety and security. Healthcare providers, no matter how competent or caring, cannot substitute for parents. Children often neither recognize nor care about state-of-the-art equipment.
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A school-age child with congenital heart block codes in the emergency department (ED). The parents witness this and stare at the resuscitation scene unfolding before them. Which nursing intervention is most appropriate in this situation? 1. Ask the parents to leave until the child has stabilized. 2. Ask the parents to call the family to come into watch the resuscitation. 3. Ask the parents to sit near the child's face and hold her hand. 4. Ask the parents to stand at the foot of the cart to watch.
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Correct Answer: 3 Rationale 1: Parents should be helped to support their child through emergency procedures, if they are able. Parents should never be asked to take part in emergency efforts unless absolutely necessary. Merely watching the resuscitation serves no purpose for the child. If the parents interfere with resuscitation efforts or they are unable to tolerate the situation, they can be asked to leave later.
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A child is admitted to the neonatal intensive care unit (NICU). The parents are concerned because they cannot stay for long hours to visit. Which statement made by the nurse is most appropriate? 1. "One of you might take a leave of absence to be here more." 2. "Parents often feel this way; would you be interested in talking with others who have experienced having a child in the NICU?" 3. "Perhaps the grandparents can make the visits for you." 4. "Why can't you visit after work every day?"
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Correct Answer: 2 Rationale 1: "Parents often feel this way; would you be interested in talking with others who have experienced having a child in the NICU?" is therapeutic; it focuses on feelings and offers support to the parents. The other options do not focus on how the parents feel and attempt to solve the issue rather than allow for the parents to deal with their feelings and form solutions.
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A school-age client is admitted to the pediatric intensive care unit (PICU) in critical condition after a motor vehicle accident. Which intervention should be implemented at this time? 1. Maintain consistent caregivers. 2. Turn the lights off at night. 3. Keep alarm levels low. 4. Consult the hospital play therapist.
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Correct Answer: 1 Rationale 1: The intensive care environment is fast-paced, overwhelming, and frightening. Maintaining consistent caregivers is invaluable in developing a familiar and trusting relationship with the child. Turning off the lights in an intensive care environment is not feasible. Keeping alarm levels low could increase risk of injury if an alarm is not heard by staff. Consulting the play therapist is not appropriate at this time.
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Parents of a child in the pediatric intensive care unit (PICU) have been experiencing shock and disbelief regarding their situation. Which statement by the parents indicates they are moving forward into the next stage of coping? 1. "Why not me instead of my child?" 2. "It is hard for me to have others take care of my child." 3. "I feel like life is suspended in time." 4. "I am glad I can help with his care."
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Correct Answer: 1 Rationale 1: The parents initially enter the stage of shock and disbelief. Asking "Why not me instead of my child?" shows they are moving into the next stage, which is anger and disbelief. Having feelings about others caring for their child is the third stage of deprivation and loss. The feeling of being suspended in time is the fourth stage, which is anticipatory guidance.
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A child is on a ventilator in the pediatric intensive care unit (PICU). Which nursing intervention would best meet the psychosocial needs of this child? 1. Allow the parents to remain at the bedside. 2. Touch and talk to the child often. 3. Provide the child with a blanket from home. 4. Provide consistent caregivers.
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Correct Answer: 2 Rationale 1: Touch and verbal exchanges will aid in psychosocial support. The other responses provide a sense of security.
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Which client in the pediatric intensive care unit (PICU) would most benefit from palliative care? 1. A child with end-stage leukemia. 2. A child with a broken arm after a motor vehicle accident. 3. A child with burn injuries to the legs. 4. A child with recurrent asthma.
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Correct Answer: 3 Rationale 1: A child with burn injuries to the legs will benefit most from palliative care to help control pain, anxiety, sleep disturbances, etc. The child with end-stage leukemia will benefit from hospice care. The child with a broken arm or recurrent asthma will not need palliative care.
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Siblings of a client in pediatric intensive care unit (PICU) are preparing to visit their brother, who was hit by a car while riding his bike. Which intervention by the nurse will assist the siblings in preparing for the visit? 1. Spend time developing a relationship with the siblings. 2. Have the parents go with the siblings when they visit. 3. Encourage the siblings to talk to a social worker before seeing their brother. 4. Explain what the siblings will hear and see when they visit.
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Correct Answer: 4 Rationale 1: Explaining what the siblings will hear and see when they visit will best prepare them for the visit with their brother. The other responses are good ways to help alleviate stress but won't help prepare the siblings for the visit.
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A toddler-age client is in end-stage renal failure. Which nursing intervention will assist this child most? 1. Maintain the child's normal routines. 2. Explain body changes that will take place. 3. Encourage friends to visit. 4. Allow the child to talk about the illness.
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Correct Answer: 1 Rationale 1: A toddler has no real concept of death, but does sense changes in routine and parent behavior. Maintaining normal routines is the best intervention to assist this child. A toddler will not understand the body changes; this approach would be more appropriate for a school-age child. Encouraging friends to visit and allowing the child to talk about the illness are more appropriate for older children.
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Which nursing interventions would be best for the nursing diagnosis of Powerlessness Related to Relinquishing Control to the Healthcare Team? Select all that apply. 1. Provide a primary nursing care model. 2. Prepare the child in advance for procedures. 3. Provide optimal pain relief. 4. Explain procedures in developmentally appropriate terms. 5. Incorporate home rituals when possible.
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Correct Answer: 2,4,5 Rationale 1: Preparation in advance—and in terms that are developmentally appropriate—and incorporating home rituals provide some degree of control, and might reduce the feeling of powerlessness. Providing a primary nursing care model will help decrease anxiety, and providing pain relief will decrease pain.
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Which intervention is considered supportive care for a family whose infant has died from sudden infant death syndrome (SIDS)? 1. Interviewing parents to determine the cause of the SIDS incident 2. Allowing parents to hold, touch, and rock the infant 3. Sheltering parents from the grief by not giving them any personal items of the infant, such as footprints 4. Advising parents that an autopsy is not necessary
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Correct Answer: 2 Rationale 1: The parents should be allowed to hold, touch, and rock the infant, giving them a chance to say good-bye to their baby. The other options are nontherapeutic. The death of an infant without a known medical condition is an indication for an autopsy.
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The nurse is providing care to an adolescent client who is dying. Which assessment findings indicate the client is experiencing a decrease in peripheral circulation? Select all that apply. 1. Cool skin 2. Mottled appearance 3. Cheyne-Stokes respirations 4. Increased agitation 5. Increased urine output
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Correct Answer: 1,2 Rationale 1: A client who is experiencing decreased peripheral circulation will have cool, mottled skin. While Cheyne-Stokes respirations may indicate death is approaching, this is not indicative of a decrease in peripheral circulation. Increased agitation indicates decreased perfusion to the brain. A client will not experience increased urine output near the end life.
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A novice nurse in the newborn intensive care unit (NICU) has just performed post-mortem care on a premature infant who passed away. The novice nurse asks to be excused near the end of the shift. Which interventions can be implemented to support this nurse? Select all that apply. 1. Schedule additional education on bereavement care 2. Ask a seasoned nurse to talk with the novice nurse 3. Tell the nurse it is ok to grieve with the family 4. Recommend that the nurse transfer to another unit 5. Assign the nurse to stable clients only
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Correct Answer: 1,2,3 Rationale 1: Appropriate interventions for this nurse include scheduling additional education on bereavement care, asking a seasoned nurse to talk about the situation with the novice nurse, and telling the nurse it is ok to grieve with the family. Recommending a transfer and assigning the nurse to only stable clients are not appropriate interventions to support the novice nurse.
