Sherpath Death and Dying

The hospice nurse is caring for a school-aged child who has a glioblastoma with metastasis throughout the body. The toddler has been declining in health for the past 7 days, has had no oral intake, has a labored, irregular respiratory rate of 6 breaths per minute and is bradycardic at 50 bpm. The parents ask the nurse what they can do to help the child through the process. Which is an appropriate response by the nurse? A. "Tell the child it is ok to die." B. "Your child's body is wearing out and will die soon." C. "It's hard to know why your child hasn't died. It should be soon." D. "Your child's condition has plateaued; your child could last for weeks like this."

A (The child may be hanging on to life because the child cannot die without permission by the parents. The parents must convey feelings of love to child, a sense that child will be missed, and finally give the child permission to die.)

A 4-year-old child with chronic sickle cell crisis is terminal and unable to walk, requires continuous oxygen administration, is moaning and crying with position changes, and has refused to eat meals for the last 2 days. The parents ask the nurse how they will care for their child and what they should do now. Which response by the nurse is appropriate? A. "Learning about hospice care services would be appropriate at this time." B. "Initiating home health nursing services will help you care for your child at home." C. "Initiating palliative care services for your child would be important right now." D. "Learning how to care for your child at home would be appropriate at this time."

A (The goal of hospice care is to improve the quality of life and decrease the stress on the child and family members and can be introduced at any time during the child's treatment.)

What is the purpose in allowing family members to interact with the body after the patient dies? A. It allows the family members to say their final good-byes. B. To assist the nurse with preparing the body for the funeral home. C. To make sure the wishes of the family are upheld until the body goes to the funeral home. D. To complete the legal paperwork associated with a child's death prior to the body going to the funeral home.

A (Allowing interaction with the body after the patient dies allows for emotional closure for the family members, which is important for grieving.)

A 12-year-old patient has been in hospice for one month and expresses feelings of discontent and would like to go back to the hospital. The patient states missing being with other children and liking the food there better. How will the nurse respond? A. "It is okay to change your mind." B. "Tell me more about how you are feeling." C. "I'll let your parents know you want to go back to the hospital." D. "I'll call the hospital and see how soon you can be transferred back." E. "Why don't you give this place a little more time before going back to the hospital"

A, B, C (The child should know that they have the right to change health care environments and that there won't be trouble for wanting to change. It is important to allow the child to express emotions regarding hospice care, and therefore this is the best response for the nurse to make. This demonstrates to the child that you are working on accommodating the change from hospice to the hospital setting.)

A parent is taking care of her child dying of cancer and asks the nurse about oral care since the child often complains of a dry mouth. What education on oral care can the nurse provide to this parent? A. "You can moisten her lips with this sponge swab." B. "Use the artificial saliva drops as needed to provide comfort." C. "A mint flavored mouth spray may decrease the dry sensation." D. "Using the mouth swabs every shift will provide comfort for the child." E. "Petroleum jelly on the lips provides moisture for a longer period of time."

A, B, E (Sponge swabs provide moisture for the lips and mouth of the dying child. Artificial saliva drops add moisture to the mouth and provide comfort. Petroleum jelly or lip balm is used to treat dry, chapped lips.)

A child is dying of sickle cell disease and parents are expressing concern over the large amounts of opiates needed to control the child's pain. The father states, "I am worried that my child will become addicted to the medication." Which statement by the nurse addresses this parent's concern? A. "If we observe signs of addiction, we will use other medications to provide comfort to your child." B. "Addiction is a common concern when using opiates, but we don't worry about it in these situations." C. "Addiction occurs over a long period of time. Your child's prognosis is shorter than that time frame." D. "Our goal with your child is to effectively manage the pain and maintain an acceptable comfort level which may include using larger doses of opiates."

D (Parents are often concerned about addiction problems, but when educated on pain management techniques and drug dosages, an understanding related to why large doses of opiates are utilized occurs and the concern about addiction is resolved.)

A four-year-child with 6 months to live tells parents about angels who come to visit her at night. The parents are concerned and ask the nurse how they should handle this. What is the nurse's best response? A. "This response is based on your family's belief in God and should bring you comfort." B. "This response is concerning; you should talk to your child about fantasy versus reality." C. "This response demonstrates that your child may be declining faster than we thought. Let us know if the child says anything else." D. "This is a normal response for a 4-year-old child who is terminally ill. Continue to allow the child to share the experiences with you."

D (The responses and actions of the dying child are affected by such things as visions of angels and are considered to be normal responses for the child.)

10-year-old child with leukemia is dying after a failed bone marrow transplant. The child is anxious when approached by the nurses, expresses fear about going to sleep at night, and cries when the parents are not present in the room. The nurse is concerned with the child's ability to cope with dying. Which actions should the nurse take next? Select all that apply. A. Stay in the room with the child while they fall asleep. B. Have the child life specialist play games with the child. C. Give the child a stuffed animal to cuddle while they go to sleep. D. Have a volunteer stay with the child while the parents are gone. E. Talk with the parents about being present at the hospital around the clock.

A, D (A child who is dying wants to feel safe and not be alone. Staying in the room with the child while they fall asleep assists with the patient in accepting death. A child who is dying will not want to be alone. Having a volunteer stay with the child while the parents are gone prevents the child from being alone.)

A mother discusses options about hospice care for an only child who has three months to live. The child has osteosarcoma (bone cancer) and has had frequent admissions to the hospital for pain control. The mother states they live on a farm 30 miles from the hospital. Which piece of information is most important in influencing the decision for hospital-based hospice care? A. The child has bone cancer. B. The child has 3 months to live. C. The family lives 30 miles from the hospital. D. The patient has been readmitted frequently for pain control.

C (The family lives quite a distance away from the health care facility. This could make home hospice care difficult as resources are limited, and it is a great distance to obtain medical assistance.)

At the end of every shift a nurse feels drained and begins crying, grieving the loss of patients. What can the nurse do to increase coping mechanisms? A. Start taking a multivitamin supplement prior to each shift. B. Ask a more experienced pediatric nurse to mentor the nurse. C. Obtain at least 8 hours of uninterrupted sleep every night. D. Attend monthly social hour events with other nurses from the pediatric floor. E. Meet monthly with other pediatric nurses to discuss the past month's events.

B, C, E (Mentoring provides support to the nurse who is struggling with the grief associated with losing patients. Obtaining the proper number of hours of uninterrupted sleep allows the nurse to take care of own physical health, which assists with increasing coping mechanisms. Expressing feelings with other nurses provides support to the nurse who is struggling with the grief associated with losing patients.)

The nurse is treating a child who is approaching death within hours. Which respiratory responses are likely findings in a child who is approaching death? A. Respiratory rate of 28 breaths per minute B. Relaxed appearance to the face of the child C. Apneic episodes of 40 seconds between respirations D. Retraction of muscles under the sternum and ribcage E. Loud sighing at the end of each respiration with a loud rattle noise

C, D, E (Periods of apnea increase as death approaches, and therefore this can be expected. Increased work of breathing is evident by retractions and is associated with impending death. The death rattle is associated with secretions in the upper airway that cannot be cleared by the child.)

A young nurse developed a friendship with a teenaged patient who died. What can this nurse expect during the grieving process? A. The grieving process for the nurse may take a lot longer to get over. B. The grieving process should be shorter since the nurse works with terminal patients. C. The nurse may become more involved with a new patient that has a similar diagnosis. D. The nurse may experience certain stages of grief repetitively when working through the grieving process.

A (When a nurse becomes more involved with a patient, a more intense response or a delay in the resolution of grief may occur.)

A 7-year-old child has recently died after being treated for leukemia for the past 5 years. The child was unresponsive for days prior to dying and the parents were at the bedside the entire time. The nurse overhears the parents say statements such as, "I feel like this is a dream. I don't know what to do now." "Thank God it is finally over; he's at peace." "Is it wrong to feel this way?" Which emotions or reactions are being expressed? A. Indifference to activities of daily living B. Relief that the child is no longer suffering C. Numbness to any emotions when around others D. Guilt related to being relieved over the death of the child E. Hostility related to the pain experienced during the dying process by the child

A, B, C, D (Indifference to activities of daily livingEmptiness and lack of interest in activities can be displayed as indifference to many aspects of daily living in someone who has experienced a great loss, such as the death of a child. Relief that the child is no longer sufferingParents may be relieved when the child is no longer suffering physically and emotionally, and therefore it is normal for the parents to express these emotions. Numbness to any emotions when around othersNumbness may be displayed by parents whose child has just died. It is an expected emotion for parents who have lost a child. Guilt related to being relieved over the death of the childParents may feel guilt related to the relief experienced when the child died, and therefore this is an expected statement for the parents to make.)

The mother of a 14-year-old child who recently died tells the nurse that the 10-year-old sibling has become very withdrawn, angry, and aggressive. The child has said to the mother, "It should have been me." The mother asks the nurse how to respond to the child. Which responses by the nurse are appropriate? A. "Your child's aggression is concerning. Is there a history of behavioral problems?" B. "A child's response to death is varied because of age and developmental level." C. "Your child is working through the stages of grief. Sometimes a child stays in one stage longer than others." D. "The child's response demonstrates the need for psychologic counseling. I can provide you with a referral.". E. "Your child may be experiencing survivor's guilt related to the death of your child and needs to express feelings."

B, C, E (Children respond to a sibling's death in a variety of ways based on their age and developmental level. Children usually experience all 5 stages of grief, not always in order. They can also experience one stage several times as a way of coping with their feelings. This child is in the anger stage of grief. Siblings often feel guilt for being the child who survived. Allowing the child to express feelings provides a way for those feelings to resolve.)

Administration of diphenhydramine can help with which physiologic response expected near the time of death? A. Apnea B. Bradycardia C. Death Rattle D. cyanosis of the hands and feet

C (Diphenhydramine may be given to decrease the amount of secretions found in the oral airway of the child, which will decrease the death rattle heard with respiration.)

A family has decided to gather in the room of a child who has impending death. A prayer has started and then all the family members begin praying and laying their hands on the patient. What action will the nurse take? A. Ask the chaplain to come and pray with the family. B. Lay hands on the patient and pray with the parents. C. Observe the child for restlessness, moaning, or increased muscle tension. D. Remind the parents that only 2-3 visitors are allowed in the room at a time.

C (Restlessness, moaning, and increased muscle tension demonstrate increased agitation and could negatively impact the child's comfort level.)

A sibling is noticeably upset at the death of a sister. Which is an example of an activity that allows the sibling to assist in the immediate care of the body? A. The sibling gives the sibling a hug before the body leaves the room. B. The sibling brings the nurse the clothes the deceased child will wear to the funeral home. C. The sibling places the child's teddy bear with the body before it goes to the funeral home. D. The sibling washes the hands and face of the sibling alongside the nurse during death care.

D (Care of the body immediately after death includes washing the hands and face of the deceased child.)

Which scenario reflects the type of interaction allowed in the hospital moments after a child passes away? A. The child's body is brought to the morgue for an autopsy. B. The nurse asks the family to leave the room until the body has been cleaned. C. The family spends time with the child but then leaves for the nurse to clean the body and prepare the child for the funeral home. D. The family members remain in the room with the child immediately following the death of the child and the nurse provides privacy.

D (Family members should have the opportunity to spend time with their child, even before the body is cleaned.)

A young nurse who does not deal well with death is looking for support. What is the best way a more experienced nurse can respond? A. The experienced nurse offers to mentor the young nurse. B. Tell the young nurse to exercise every day to "blow it off". C. Explain the need to suppress emotions as this is part of the job. D. Inform the young nurse about availability and time to talk. E. The experienced nurse refers the young nurse to grief programs offered at the hospital.

A, D, E (Mentoring the young nurse provides the support the nurse needs while learning how to deal with death and dying. Meeting with a nurse and taking the time to listen shows support for what that nurse is experiencing. Providing a resource for dealing with grief demonstrates support and concern for the young nurse. Grief programs are important for health care professionals to use to repair, maintain, or enhance their emotional well-being.)

The nurse wishes to educate parents on what to expect as the child is approaching death. Which response regarding the child's breathing pattern is most appropriate? A. The child breathes deeply and rapidly with a fruity odor on the breath. B. The child will have Cheyne-Stokes respirations, leading to respiratory arrest. C. The child breathes shallowly but with a normal rate until respiratory arrest occurs. D. The child may breathe more shallowly and faster than normal, which leads to respiratory arrest.

B (Cheyne-Stokes respirations is a cyclic period of slowing respirations with apnea, followed by an increased respiratory rate to a peak, and then slowing into apnea again. The respirations are associated with impending respiratory arrest.)

A parent of a child who has terminal cancer is concerned with the child's weight loss due to a decrease in appetite. The parent becomes frustrated and expresses to the nurse, "My child needs to be fed; she is starving!" What is the best response? A. "Tell me why you feel your child is starving." B. "Your child's lack of interest in food is a normal part of the dying process." C. "We can use liquid nutritional supplements with your child to help them gain weight." D. "We will have the dietician work with you to create food options that will help your child gain weight."

B (The lack of interest in food and liquids is a normal part of the dying process and a source of great distress for family members. Educating the parent on the reason for the weight loss dispels the misconception that the child is starving to death.)

A nurse is caring for a child and notices that as the child's last days are approaching, the family is becoming more withdrawn. Which action is most important to ensure the child is not left alone during the dying process? A. Discuss utilizing a one-to-one staffing model so the nurse only cares for the child. B. Discuss the withdrawn behavior observed by the nurse and how it impacts the child's last days. C. Discuss the need to talk to the child, touch the child, and remain at the bedside of the child during the last days. D. Discuss the situation with the child life specialist and see if volunteers are available to provide coverage if the parents are gone.

C (The dying child needs to experience complete love and acceptance and know that they will not be left alone to die. Discussing the expectations with the parents provides them with how to interact with their child before the child dies and may decrease their withdrawnness.)

A dying child, who has been unresponsive for the past two days in hospice at the hospital, opens his eyes and softly talks to his mother. He asks his mother how she is and where his siblings are and can he see them. The mother tells the nurse, "I think he is getting better." Which response by the nurse is appropriate? A. "Your child is not going to get better. He is dying." B. "Your child may be improving; we will have to wait and see." C. "Your child is showing signs of strength and may live for a few more weeks." D. "It is not uncommon to be more alert and interested in the family right before a child dies."

D (Children have been noted to have a surge of energy and alertness immediately before they die. Parents must be educated that this is not a sign of improvement.)

The parent of a 15-year-old with terminal cancer approaches the nurse and asks what care options are available for when the child is dying. The parent states the child is very close to family and siblings and loves to be around the pet dogs. Which is the best response? A."Your child could spend the last weeks in the hospital." B. "You could care for your child at home with your family helping." C. "You could use palliative care services to make your child comfortable." D. "You could use home hospice care so the child is in a comfortable and relaxed environment."

D (Hospice care can be provided in the home and allows for a more comfortable and relaxed environment than the hospital setting.)