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. Demonstrating independent dressing is usually not expected at 18 months. Toddlers are still developing fine motor skills and may need assistance with dressing.

B. Using a vocabulary of 300 words is advanced for an 18-month-old. At this age, most children have a more limited vocabulary, typically around 50 words or so.

C. Jump with both feet.

At 18 months of age, children are usually developing their motor skills, including gross motor skills like walking, running, and jumping. Jumping with both feet is an age-appropriate milestone for a toddler of this age.

D. Walking upstairs with one hand held is typically not expected at 18 months. This is a skill that develops later as toddlers gain more confidence in their mobility and coordination.

A. Shunted past the pulmonary circulation, causing pulmonary hypoxia B. Circulated through the lungs again, causing pulmonary circulatory congestion C. Circulated through the ductus from the pulmonary artery to the aorta bypassing the left side of me heart D. Shunted past cardiac arteries, causing myocardial hypoxia

Correct Answer is C

Explanation

A. Shunted past the pulmonary circulation, causing pulmonary hypoxia: This option is not the primary reason for dyspnea in PDA. While there is shunting, it doesn't directly cause pulmonary hypoxia.

B. Circulated through the lungs again, causing pulmonary circulatory congestion: This option is partially correct but does not address the primary reason for dyspnea, which is the bypassing of the left side of the heart.

C. Circulated through the ductus from the pulmonary artery to the aorta, bypassing the left side of the heart.

In patent ductus arteriosus (PDA), a fetal blood vessel called the ductus arteriosus fails to close after birth. This allows oxygenated blood from the left atrium to be shunted directly from the aorta to the pulmonary artery, bypassing the normal route through the left side of the heart and into the systemic circulation. The shunting of oxygenated blood back into the pulmonary circulation can lead to increased pulmonary blood flow and circulatory congestion, causing symptoms such as dyspnea.

D. Shunted past cardiac arteries, causing myocardial hypoxia: PDA primarily affects the pulmonary circulation and left side of the heart, not the coronary arteries. Myocardial hypoxia is not the primary mechanism of dyspnea in PDA.

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Naxlex Comprehensive Predictor Exams

When assessing an 18-month-old toddler, the nurse would expect the child to be able to:

Correct Answer is C

Explanation

An infant is experiencing dyspnea related to patent ductus arteriosus (PDA). The nurse understands dyspnea occurs because blood

Correct Answer is C

Explanation

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