Quiz 11: End-of-life care

Please choose the one, most correct answer to each question or statement.

1. What is end-of-life care?
   • The same as palliative care
   • Care of a child who is likely to die soon
   • Care during the last months of a child’s life
   • Care that starts when a fatal diagnosis is made
2. What is the purpose of end-of-life care?
   • To speed up the dying process
   • To prolong the dying process
   • To achieve a good death
   • To reduce the stress on the family and staff
3. When working with a dying child and family:
   • Be sure to fill the awkward silences by talking to the family
   • It does not matter what you say as long as you keep the family’s mind off the dying child
   • Just be present even if you do not know what to say
   • You should offer advice or read a section from a holy book
4. What is a barrier to providing good end-of-life care?
   • Not recognising that a child is dying
   • Mistaking a stable child for one who is dying
   • ‘Difficult’ families
   • Lack of ICU beds
5. How easy or difficult is it to know when a child will die?
   • It is easy
   • It is easier than in an adult
   • It is easy if you have known the child for a long time
   • It is often difficult
6. Indicators of impending death include:
   • Increased interaction and playfulness
   • Passing lots of urine
   • Clingy behaviour
   • Stable vital signs
7. What is important for a ‘good death’?
   • Delaying death until everyone is ready
   • The focus is on the dying child
   • The focus is on the surviving family members
   • A quick and sudden death reduces staffing demands
8. The place of death for a child depends on:
   • The wishes of the family and available resources
   • The provincial policy
   • The choice of the healthcare team
   • The reason the child is dying
9. When discussing the child’s death with the family:
   • The doctor’s religion should decide what needs to be done
   • The hospital rules must always be followed even if the family disagree
   • All families need a lot of guidance and instruction
   • Health carers should work sensitively, at the family’s pace
10. An advance care plan:
    • Is strictly confidential
    • Should be drawn up when the child is dying
    • Should be drawn up in a time of calm
    • Should not be modified at any time
11. What is a terminal care plan?
    • A plan to stop all symptom management
    • A plan that deals specifically with end-of-life concerns and issues
    • Assessing the cost of hospitalisation
    • A plan that is used before the dying phase
12. The main aim of end-of-life symptom control is to:
    • Speed up the dying process
    • Keep the child awake and aware
    • Minimise the child’s pain and fear
    • Prolong life for as long as possible
13. When managing pain at the end-of-life:
    • There is no maximum dose of opioids
    • Opioids are to be used only as a last option
    • Opioids commonly cause respiratory depression
    • The morphine dose should be increased slowly
14. What does the management of shortness of breath at the end-of-life include?
    • Intubation and ventilation
    • Oxygen via a face mask
    • Ensuring the child lies flat in bed
    • Opening a window, or directing a fan towards the child
15. Restlessness and agitation:
    • Could be due to constipation or urinary retention
    • Indicates psychiatric problems
    • Should be conservatively managed without sedation
    • Should only be managed with morphine
16. Airway secretions at the end-of-life:
    • Are very distressing to the patient
    • Should be managed with increased intravenous fluids
    • Can be treated with hyoscine butylbromide (Buscopan)
    • Should be regularly suctioned
17. Seizures at the end-of-life:
    • Should always be treated in hospital
    • Buccal midazolam (Dormicum) can be given at home
    • Underlying causes should be ignored
    • Rarely happen, so it is wasteful to prepare for them
18. Massive haemorrhage at the end-of-life:
    • Can be managed with white towels
    • Is generally not distressing
    • Is managed with an emergency blood transfusion
    • Sedation should be given if the child is awake and afraid
19. When providing fluid and food at the end-of-life:
    • Only give food if the child is hungry
    • Ensure the child is fed, by whichever route is best
    • Intravenous fluids should be a given rather than oral fluids
    • Supplements still play an important role
20. What information does the family need to know that death has occurred?
    • That the child has stopped moving both arms and legs
    • There is no breath, heartbeat and pupils will be fixed
    • There may still be a few gasps of air even though the heart has stopped beating
    • Rigor mortis will start immediately