Carman Essentials of Pediatric Nursing 3rd Ed - Ch. 8 Atraumatic Care of Children and Families

The nurse is caring for a 3-year-old boy who must have a lumbar puncture. Which action provides the greatest contribution toward atraumatic care? a. Having a child-life nurse practitioner play with the child b. Explaining the lumbar puncture procedure c. Letting the child take his teddy bear with him d. Keeping the parents calm in front of the child

Answer: a Having a child life specialist play with the child would provide the greatest support for the child and make the greatest contribution to atraumatic care. It is important to explain the procedure to the child and parents, let the child have a favorite toy and keep the parents calm, but these interventions are not as effective for atraumatic care.

The nurse is assessing the teaching needs of the parents of an 8-year-old boy with leukemia. Which assessment should the nurse explore as a potential issue with the parent's health literacy? a. The parents missed the last scheduled appointment. b. The entire family is fluently bilingual. c. The parents are taking notes on answers to their questions. d. The mother seems to ask most of the questions regarding care.

Answer: a Missing appointments is one of the red flags to health literacy problems as the parents may not have understood the importance of the appointment or may not have been able to read or understand appointment reminders. Being bilingual does not indicate health literacy issues. Taking notes or one parent being the primary leader of the child's health care are not unusual practices.

The nurse is teaching a 7-year-old girl about her upcoming tonsillectomy. Which techniques would be appropriate for this child? Select all that apply. a. Allowing the child to do as much self care as possible b. Explaining the procedure that will happen later in the day c. Offering choices of drinks and gelatin after the procedure d. Explaining that anesthesia is a lot like falling asleep e. Using plays or puppets to help explain the procedure

Answer: a, c, d School-age children better understand about and participate in their own care than preschoolers and toddlers. They need time to prepare themselves mentally for the procedure and should be given 3 to 7 days. Plays and puppets are more appropriate for preschoolers. Active involvement in self-care will help them adjust and learn. Giving them choices to make allows them control and involvement in the process.

The child and her mother are receiving discharge instructions from the nurse. Which statements by the child's mother are "red flags" that the mother may have poor literacy skills? Select all that apply. a. "I forgot my glasses today and can't seem to read this form." b. "I'm going to take a few notes while you're teaching us." c. "The receptionist told me that we missed another appointment." d. "I guess I just forgot to give her the medication the way you told me to." e. "I'm going to take these instructions home to read them."

Answer: a, c, d, e Taking notes is an indicator that the mother is literate. All of the other options are "red flags" that indicate the mother may not be literate.

The nurse is educating a young child about what to expect during an upcoming procedure. Which statements are appropriate for the nurse to use? Select all that apply. a. "This little tube will go in your nose and down into your belly." b. "I'm going to give you this shot and it will put you to sleep." c. "You'll end up in 'ICU' where you'll wake up with some electrodes on your thorax." d. "When they come to get you, you'll get on a special rolling bed." e. "They're going to give you some special medicine to help the doctor see what's happening inside your belly."

Answer: a, d, e It is appropriate to use the word "tube" and not a "catheter." It is appropriate to call a "gurney" a "rolling bed." It is better to call "dye" special medicine. Terms used in the other options may be misunderstood by the child.

The child life nurse practitioner has been assigned to assist the hospitalized child and the child's parents. Which interventions are appropriate for the child life specialist to perform? Select all that apply. a. Talking to the family about a scheduled diagnostic test b. Giving the child an influenza vaccination c. Starting the child's intravenous line d. Showing the child where the pediatric play room is located e. Speaking to the physician as the child's advocate

Answer: a, d, e The child life specialist commonly assists with nonmedical preparation for diagnostic testing, provides tours, assists in play therapy, and is the child's advocate. The child's nurse gives medication, vaccines, and starts intravenous lines.

The nurse is educating a 15-year-old girl with Graves disease and her family about the disease and its treatment. Which method of evaluating learning is least effective? a. Having the child and family demonstrate skills b. Asking closed-ended questions for specific facts c. Requesting the parent to teach the child skills d. Setting up a scenario for them to talk through

Answer: b Asking questions is a valid way to evaluate learning. However, it is far more effective to ask open-ended questions because they will better expose missing or incorrect information. As with teaching, evaluation of learning that involves active participation is more effective. This includes the child and family demonstrating skills, teaching skills to each other, and acting out scenarios.

The child has been admitted to a pediatric unit in a hospital. Which nursing interventions use atraumatic care principles? Select all that apply. a. Requesting that parents assist the nurse by "holding the child down" b. Applying a numbing cream prior to starting the child's intravenous line c. Asking the child if he would like to take a bath before or after he takes his medication d. Encouraging the family to bring in the child's favorite stuffed animal from home e. Showing the parent how to unfold the chair in the child's room into a bed

Answer: b, c, d, e When following the principles of atraumatic care, it is appropriate to apply numbing cream prior to starting the child's intravenous line. It is appropriate to empower the child with choices about care, if possible. It is appropriate for the child to have a security item present in the hospital. It is helpful for the family if the parent is able to stay with the child because it helps make the environment less stressful. The nurse should avoid using the phrase "holding the child down" and replace this with "therapeutic hugging."

The nurse is preparing to educate the child about a procedure scheduled for the following morning. Which techniques should the nurse use when communicating with this child? Select all that apply. a. Standing at the foot of the child's bed while teaching the child b. Using terms that the child will likely understand c. Looking for nonverbal cues d. Requesting that the parents leave the room during the education e. Being patient with the child

Answer: b, c, e The nurse should position himself or herself at the child's level. The nurse should ensure that the child's parents are present during education. It is appropriate to use words that the child will understand. It is appropriate to show patience during the interaction and to look for nonverbal cues that indicate understanding or confusion.

The nurse is educating the family of a 2-year-old boy with bronchiolitis about the disorder and its treatment. The family parents speak only Chinese. Which action, involving an interpreter, can jeopardize the family's trust? a. Allowing too little appointment time for the translation b. Using a person who is not a professional interpreter c. Asking the interpreter questions not meant for the family d. Using an older sibling to communicate with the parents

Answer: c Asking questions or having private conversations with the interpreter may make the family uncomfortable and destroy the child-nurse relationship. Translation takes longer than a same-language appointment, and must be considered so that the family is not rushed. Using a nonprofessional runs the risk that they won't be able to adequately translate medical terminology. Using an older sibling can upset the family relationships or cause legal problems.

The nurse is assessing the learning needs of the parents of 5-year-old girl who is scheduled for surgery. Which nonverbal cue should the nurse use to show interest in what the family members are saying? a. Sit straight with feet flat on the floor b. Look at child when the father is talking c. Nod head while the mother speaks d. Stand several steps away from parents

Answer: c Nodding the head while the other person speaks indicates interest in what they are saying. When children and parents feel they are being heard, it builds trust. Sitting straight with feet flat on the floor, looking away from the speaker, and keeping distance from the family may send a message of disinterest.

The nurse is caring for a 14-year-old boy, and his parents, who has just been diagnosed with a malignant tumor on his liver. Which intervention is most important to this child and family? a. Arranging an additional meeting with the nurse practitioner b. Discussing treatment options with the child and parents c. Involving the child and family in decision making d. Describing postoperative home care for the child

Answer: c Since the child has just been diagnosed, concerns about postoperative home care would be least important. Arranging an additional meeting with the specialist and discussing treatment options may be necessary at some point, but involving the child and family in decision making is always a goal and is a part of family-centered care.

The nurse is caring for a 14-year-old girl with terminal cancer and her family. Which intervention provides the best therapeutic communication? a. Recognizing the parent's desire to use all options b. Supporting the child's desires for treatment c. Presenting options for treatment d. Informing the child in terms she can understand

Answer: d Informing the child in terms that she can understand is the best example of therapeutic communication, which is goal, focused, purposeful communication. Recognizing the parents' and child's desire regarding treatment options is part of family-entered care. Presenting options for treatment is vague.