The nurse is speaking with the parents of a 4 year old child following a family discussion with the health care provider about the child's terminal condition and the possibility to transition to end-of-life care. The parents state, "We don't think we can make this decision right now. What would you do? Choose the nurse's BEST response.

You seem overwhelmed, I'll contact the chaplain to come and talk with you about the options

I find it helpful to investigate the options. I will get you a pamphlet about end-of-life care

Its hard to say what the best decision is, but I know the end-of-life team provides wonderful care

These decisions are challenging. Tell me about your beliefs and understanding about end-of life

Answer and Explanation

The Correct Answer is D

A. You seem overwhelmed, I'll contact the chaplain to come and talk with you about the options: While offering chaplain support is valuable, it's essential to engage in a conversation with the parents first to understand their needs and concerns.

B. I find it helpful to investigate the options. I will get you a pamphlet about end-of-life care: Providing information is valuable, but in this case, the parents are expressing their emotional distress, and they may need a more empathetic and personalized approach.

C. It's hard to say what the best decision is, but I know the end-of-life team provides wonderful care: While reassuring, this response doesn't actively engage with the parents or explore their feelings and beliefs, which are crucial for making this challenging decision.

D. These decisions are challenging. Tell me about your beliefs and understanding about end-of-life.

This response acknowledges the parents' difficulty with the decision and opens the door for a deeper conversation. It allows the nurse to understand the parents' perspectives, values, and concerns, which is crucial in providing holistic and patient-centered care. This information will help the nurse support the family and guide them through the decision-making process, addressing their specific needs and preferences.

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Correct Answer is C

Explanation

A. "That big soft spot will be covered in bone by the end of the second month" is not accurate. The closure usually occurs later than the second month.

B. "The big soft spot will close at around 24 months of age" is an overestimation of the typical closure time. It is usually closed earlier than 24 months.

C. "The big soft spot is usually closed between 12 and 18 months of age."

The anterior fontanel is the soft spot located on the baby's head, and its closure is a natural part of an infant's development. The timing of closure can vary from one child to another. However, the typical range for the closure of the anterior fontanel is between 12 and 18 months of age. This information provides a general guideline for parents while acknowledging the natural variability in child development.

D. "Babies' soft spots close at different times depending on their growth rate" is true to some extent, but providing a general range (option C) is more informative for parents.

A. Inspect the mouth weekly for ulcerations B. Use a potent commercial mouthwash C. Clean the teeth manually with a soft toothbrush D. Visit a dental professional only during episodes of excessive bleeding or pain

Correct Answer is C

Explanation

A. Inspecting the mouth weekly for ulcerations is not sufficient. Children receiving chemotherapy should be encouraged to perform daily oral care, and any concerning symptoms should be reported promptly to the healthcare provider.

B. Using a potent commercial mouthwash is not recommended, as many commercial mouthwashes contain alcohol or other potentially irritating ingredients. A healthcare provider should recommend a suitable oral rinse if needed.

C. Clean the teeth manually with a soft toothbrush.

Children receiving chemotherapy are at risk of developing mouth sores (mucositis) and other oral complications. It is essential to maintain good oral hygiene to minimize the risk of infection and reduce discomfort. Using a soft toothbrush for gentle manual cleaning is recommended, as it helps to prevent injury to the sensitive oral tissues that can occur with a hard toothbrush.

D. Visiting a dental professional only during episodes of excessive bleeding or pain is not recommended. Regular dental check-ups are important for children receiving chemotherapy to monitor and address oral health issues. Waiting for symptoms of bleeding or pain may result in a delay in addressing potential problems.

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Naxlex Comprehensive Predictor Exams

The nervous parent asks when the big "soft spot" (anterior fontanel) will be closed. The nurse's most informative response would be

Correct Answer is C

Explanation

The nurse would include in a teaching plan about mouth care for a child receiving chemotherapy to:

Correct Answer is C

Explanation

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