Chapter 20: Family-Centered Palliative Care

Chapter 20: Family-Centered Palliative Care

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. 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

 

 

ANS:  B

The principles of palliative care involve a multidisciplinary approach to the management of a terminal illness or the dying process that focuses on symptom control and support rather than on cure or life prolongation in the absence of the possibility of a cure. In pediatric palliative care, the focus of care is on the family. Palliative care requires the transition from curative to palliative care. The transition occurs when the likelihood of cure no longer exists. Spiritual issues are just one of the foci of palliative care. The multidisciplinary team focuses on physical, emotional, and social issues as well. Pain control is a priority in palliative care. The use of opiates is balanced with the side effects caused by this class of drugs.

 

DIF:    Cognitive Level: Applying               REF:   p. 792             TOP:   Nursing Process: Planning

MSC:  Client Needs: Psychosocial Integrity

 

2. 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

 

 

ANS:  D

Earlier implementation of DNR orders, use of less aggressive therapies, and greater provision of palliative care measures are associated with an honest appraisal of the child’s condition. Euthanasia involves an action carried out by a person other than the patient to end the life of the patient suffering from a terminal condition. DNR orders do not involve euthanasia but give permission for health care providers to allow the child to die without intervention. Parents state that regardless of the number of children they have, the death of a child is a new experience and nothing can prepare them for it. Health professionals may base their discussions with families on prior experiences, but families base their decision on an honest appraisal of their child’s condition.

 

DIF:    Cognitive Level: Applying               REF:   p. 794

TOP:   Nursing Process: Implementation     MSC:  Client Needs: Psychosocial Integrity

 

3. 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.

 

 

ANS:  C

The child needs honest and accurate information about the illness, treatments, and prognosis. Because of the increased attention of health professionals, children, even at a young age, realize that something is seriously wrong and that it involves them. Thus, denial is ineffective as a coping mechanism. The nurse should help parents understand the importance of honesty. Parents may need professional support and guidance from a nurse or social worker in this process. Children will usually tell others how much information they want about their condition.

 

DIF:    Cognitive Level: Analyzing             REF:   p. 795

TOP:   Nursing Process: Implementation     MSC:  Client Needs: Psychosocial Integrity

 

4. 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.

 

 

ANS:  A

This is a family issue that requires support to help both parents and child resolve the conflict. Because the child has little chance of survival, many institutions support the child’s right to refuse or assent to therapy. The institution can obtain a court order to support the child’s decision if verified by the oncologists. Twelve-year-olds can give consent for therapy under certain conditions, including being an emancipated minor and receiving therapy for birth control and sexually transmitted infections. Right to self-determination is also accepted if the child is fully aware of the consequences of the actions. The practitioners cannot take the responsibility for decision making from the parent or child. Parents have the responsibility for decision making, but certain circumstances do limit their authority.

 

DIF:    Cognitive Level: Applying               REF:   p. 795

TOP:   Nursing Process: Implementation     MSC:  Client Needs: Psychosocial Integrity

 

5. 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.

 

 

ANS:  C

Because of egocentricity, the preschooler may feel guilty and responsible for the death. Preschoolers may need to distance themselves from the loss. Giggling or joking and regression to earlier behaviors may help them until they incorporate the loss. The preschooler’s concept of death is more a special sleep or departure.

 

DIF:    Cognitive Level: Understanding       REF:   p. 798

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Psychosocial Integrity