Quiz 4: Care and support during the neonatal period

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

1. Neonatal palliative care is:
   • The same as older children’s or adult palliative care
   • Only end-of-life care for newborn babies who are dying
   • Care that is provided to those babies who survive delivery and require palliative care in the neonatal period
   • Only provided in hospitals that have neonatal units
2. Which babies may need neonatal palliative care?
   • Babies who have been diagnosed antenatally or at delivery with a life-limiting condition
   • Only newborn babies diagnosed antenatally with life-limiting conditions
   • Only babies diagnosed after delivery with life-threatening conditions
   • Only babies born extremely preterm
3. What type of care needs to be provided if a decision is made to focus on palliative care only?
   • Care measures that include aggressive treatment and interventions
   • Care that can only be provided in a neonatal intensive care unit with palliative care beds
   • Care that includes routine observations and procedures such as heel pricks and injections
   • Comfort care measures such as pain and symptom management and care that meets the basic needs of the baby
4. Setting goals of care are to ensure:
   • The comfort of the baby and to minimise distress for both the baby and the family
   • That the doctors’ orders are followed and no extended family be allowed to visit
   • That the nurses know what routine procedures must be performed
   • That all decisions made are in the best interest of the parents
5. The core of palliative care planning is to help and support parents:
   • Decide when they should sedate and stop feeding their baby
   • Identify and establish goals of care and, at the same time, help them work through any fears they may have
   • Prolong the withdrawal of artificial ventilation
   • Make decisions based only on what the healthcare team have decided is best for their baby
6. How should babies receiving palliative care be fed?
   • They should not be fed as this only prolongs life and suffering
   • They should only receive intravenous fluid to prevent dehydration
   • They can be fed by nasogastric tube but not by mouth
   • They can be offered oral feeds such as breast or cup feeding if these are tolerated
7. Providing physical comfort care includes:
   • Incubator care, bathing and aggressive suctioning when necessary
   • Allowing a pastor to bless the baby
   • Care in the nursery only
   • Bonding, positioning, temperature maintenance, skin care, mouth care and skin-to-skin contact
8. All procedures, investigations and monitoring must be done:
   • Daily
   • Only if they are in the baby’s best interests and are likely to improve the quality of the baby’s life
   • When the doctors order them
   • If the baby is in the Neonatal Intensive Care Unit (NICU)
9. Which pain assessment scales are appropriate to use when assessing a baby’s pain?
   • Wong-Baker Faces
   • Numerical Sliding Scale
   • Neonatal Infant Pain Scale (NIPS) or Premature Infant Pain Profile (PIPP)
   • QUESSTT assessment tool
10. To manage a baby’s pain and discomfort you need to use which of the following?
    • Both non-pharmacological and pharmacological measures
    • Only non-nutritive sucking
    • Only pain medicines such as paracetamol
    • Distraction techniques
11. Breastfeeding and kangaroo care are:
    • Pharmacological treatments for pain
    • The parents’ responsibilities
    • What the parents should not do if their baby is likely to die
    • Non-pharmacological measures to manage pain
12. Which medicine is used to treat a baby’s pain that is mild to moderate?
    • Paracetamol
    • Anti-inflammatories
    • Morphine
    • Opioids
13. Morphine is used to treat:
    • Mild pain
    • Moderate pain
    • Severe pain
    • All pain
14. What additional supportive care must be provided to the mother?
    • Routine post-natal obstetric care only
    • Emotional support with lactation and breast care advice
    • A healthy diet
    • A visit from the psychiatrist to assess her mental wellbeing
15. Ways to support the family include:
    • Allowing them time to spend with the baby and encouraging memory-making opportunities
    • Advising them not to visit
    • Suggesting they immediately go for counselling
    • Prescribing sedatives to help them sleep
16. Which of the following symptoms is the baby likely to experience at the end of life?
    • A dying baby will have no symptoms
    • Nausea, vomiting and diarrhoea
    • Pain, difficulty in breathing, agitation and restlessness, excessive secretions
    • Constipation
17. Who needs to make the decision to withdraw or withhold life-sustaining treatment?
    • A team of experienced healthcare providers in agreement with the parents
    • The doctors and nurses only
    • The parents only
    • The hospital’s ethical committee
18. After the baby has died the staff should:
    • Avoid speaking to the parents about their baby
    • Force the parents to hold baby
    • Allow the parents to spend time making memories and saying goodbye, for example, they may wish to keep a memento of their baby such as the name band
    • Take the baby’s body away
19. What should you say to the parents after their baby has died?
    • ‘Time will heal the sadness.’
    • ‘I am so sorry’ or ‘I wish things had turned out differently’
    • ‘It is for the best.’
    • ‘You can have another baby.’
20. How can you assist the parents once the baby has died?
    • Encourage the family not to express their emotions
    • Ask them not to discuss the death in front of their other children
    • Discuss aspects that they will need to make decisions about such as a post-mortem, funeral arrangements and ongoing support
    • Encourage the family to be strong and move on quickly with the grieving process