Chapter 30: Atraumatic Care of Children and Families

A parent wants to wait outside the room while a procedure is completed on his young child, saying, "I don't think I can stand to see you do this!" The nurse's best response is:

"Certainly. I will stay with your child during the procedure."

The nurse is preparing a 4-year-old to go visit his older sibling in the pediatric intensive care unit (PICU). What teaching method would best help in this child's preparation?

dolls

The nurse is preparing a hospitalized child for a lumbar puncture. The health care provider states the procedure will be performed in the child's hospital room. To advocate for the child, what should the nurse inform the health care provider?

"I will have the procedure prepared in the treatment room, so that the child may view the hospital room as safe and secure."

Nursing students are learning about the importance of therapeutic communication in their pediatric course. The nursing instructor identifies a need for further teaching when a student makes which statement?

"It is best to stand when listening to a child to demonstrate knowledge."

The parents of a 2-month-old infant have learned that their infant has hemophilia. The parents are visibly upset and ask how this could have happened to them. What is the nurse's best response?

"News like this is difficult to hear. Let's talk about what this means for your child."

A parent calls the pediatric clinic and tells the nurse "I think my child is having a sickle cell crisis. Should I bring the child to the office?" What is the nurse's best response?

"Tell me about the symptoms your child is experiencing"

The child with cancer spends time watching TV and talking very little about a new chemotherapy regimen that is to start next week. What is the best statement the nurse could use to help the child discuss feelings about the new treatment?

"You haven't said anything about your feelings toward the new treatment plan."

The nurse is caring for a 7-year-old child scheduled for a tonsillectomy the next day. The client states, "I really wish I was not having surgery tomorrow. I am not excited about this. Maybe I will be better by tomorrow." Which response by the nurse is most appropriate?

"You sound worried. Let's talk about tomorrow."

A 6-year-old child who does not speak the dominant language is in the hospital for an appendectomy. It is late at night when the nurse needs to catheterize the child for a distended bladder. Which action by the nurse would be most helpful in relaying this information?

Draw a picture of the procedure using an anatomically correct figure.

The nurse is educating a 4-year-old child about what to expect during an upcoming procedure. Which statement(s) is appropriate for the nurse to use? Select all that apply.

-"When they come to get you, you'll get on a special rolling bed." -"This little tube will go in your nose and down into your belly." -"They're going to give you some special medicine to help the doctor see what's happening inside your belly."

A couple reveals that they are going to tell both their biological children and adoptive children they are filing for divorce. Prior to having this family discussion, they met with a counselor about the possible impact this may have on the children. The counselor suggests to be on the lookout for which possible consequences on the adoptive children related to the divorce? Select all that apply.

-Adoptive children may feel they are the cause of the divorce. -Adoptive children experience insecurity for a second time.

A 4-year-old adopted child has begun to ask questions about when she was born. Which suggestions by the clinic nurse would be considered the most appropriate answer for this child related to her birth? Select all that apply.

-Explain to the child that she grew inside another woman, but after the birth she was given to her adoptive mom and dad to raise. -Avoid criticizing the biological parents but reinforce how much the adoptive mom and dad love them.

A mother of a 9-year-old child newly diagnosed with diabetes is struggling to comes to terms with all the blood monitoring and medications the child will need to maintain a normal quality of life. The mother works full-time and is the primary wage earner for the family. Which interventions suggested by the nurse can possibly help this family? Select all that apply.

-Explore how other family members can help with a portion of the responsibility for medication administration. -Suggest that a nearby grandparent help with healthy meal preparation while the mother is at work. -Provide education for the child in regards to testing blood glucose levels.

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.

-Talking to the family about a scheduled diagnostic test -Showing the child where the pediatric play room is located -Speaking to the physician as the child's advocate

During the change of shift report, the nurse reports concerns about the parents of a hospitalized child understanding the written literature provided concerning the child's plan of treatment. Which observations would provide support to this concern? Select all that apply.

-The child's mother provides little responses to information provided. -The child's medical record contains information indicating the family frequently misses appointments. -The child's mother asks the nurse to complete paperwork for her.

The nurse is providing discharge instructions to a 12-year-old child and parents after the application of a fiberglass cast placed to manage a fracture of the humerus. What information should be included in the teaching provided? Select all that apply.

-Wiggle the fingers throughout the day and evening. -Report any persistent numbness of the fingers. -Elevate the casted arm on a pillow today and tomorrow.

When both parents are working outside the home, there may be a need for additional rules in the household. Which topics should the nurse address with the parents when both parents are away from the home after school has finished for the day? Select all that apply.

-acceptable amount of screen time (TV, cell phone, computer) allowable after school for each child -adequate time to spend with friends after school -when homework should be done

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?

Asking closed-ended questions for specific facts

When teaching an adolescent about home care after hospitalization, what is most important for the nurse to do?

Allow opportunity for the adolescent to express feelings.

A nurse is preparing to administer medication to a preschooler. What can the nurse do to ensure communication with the child is effective?

Allow the child to choose between juice, water, or soda to take the medication.

A child is hospitalized with complications related to hemophilia. The health care provider has discussed the child's plan of care with the parents, but they continue to ask questions. What action will the nurse take?

Answer the parents' questions as completely as possible.

A young child has been brought to the emergency department (ED) groaning & crying with pain located, "in their tummy." The parent states the child did not want to eat supper and was lethargic all evening. When the parent went to pick the child up at bedtime, the child was, "burning up with a fever" and reporting nausea. On admission, WBCs are elevated. The child also guards the abdomen when it is palpated and cries when hands are removed from the abdomen (rebound tenderness). The nurse begins paperwork for potential emergency surgery. Knowing this is a single-parent family due to divorce, which precautions should the nurse implement?

Ask to clarify which parent has the legal, custodial rights to consent for procedures.

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?

Asking the interpreter questions not meant for the family

The nurse is caring for a child who appears fearful and is reluctant to talk. The nurse uses therapeutic communication skills to interact with the child. What initial goal does the nurse accomplish when using these skills to communicate with the child?

Assess the perception of the problem.

What should be the first step in developing a teaching plan for a 9-year-old child who needs education about a gluten-free diet for the treatment of celiac disease?

Assessing the child's current level of understanding

A nurse manager on a pediatric unit is making assignments for the day. The nurse's goals are atraumatic care for pediatric clients and minimizing parent-child separation. What method of care delivery should the nurse implement?

Assign a core primary nurse.

A child is admitted for treatment of a congenital cardiac disorder. The parents are extremely upset and ask, "How could this happen? Will our child die?" What can the nurse do to help the family meet the health care needs of the child?

Be honest with the family and allow them to express concerns and ask questions.

A family is anxious for information about the status of their ill infant. The parents do not understand English, but the 14-year-old daughter is competent in spoken and written English. The physician is present, but an interpreter is unavailable. The nurse should:

Coordinate physician and interpreter schedules and arrange an information-sharing session for later in the day.

The nurse is preparing to teach a 9-year-old child how to do active range-of-motion exercises. Which technique would be most appropriate to use?

Demonstrate the technique by performing it the same way each time.

An adolescent remarks rather sarcastically that she feels like a "lab rat." What is the priority nursing action?

Ensure information is shared and decisions about care are made with the teen and not for the teen.

The nurse from a rural area moves to a large city to work in a family clinic where there are families from a variety of different cultures. The nurse should prioritize which goal as she begins working in this new environment?

Examine her own feelings concerning cultures

The nurse is providing care for a 2-year-old girl with a chronic respiratory disease present since birth. Which of the following would be of least help in working effectively with the parents?

Expect parents to perform procedures precisely as taught.

The nurse is providing tertiary care to a young, uninsured family who has a child with frequent seizures. Which action by the nurse would demonstrate tertiary care?

Finding a company to provide a helmet for the child to wear daily.

The nurse is preparing to reduce a young parent's anxiety about a child needing hospitalization. Which action should the nurse prioritize?

Include the parent in the medical decision-making.

The nurse is caring for a 14-year-old girl with terminal cancer and her family. Which intervention provides the best therapeutic communication?

Informing the child in terms she can understand

A family with a 13-year-old child who has cystic fibrosis is having a stressful time since the father is currently unemployed while the mother works full-time. The ill child has been acting out at school. He is "sick of taking medications and doing chest expansion exercises" and "just wants to be like all the other kids." There are two stepbrothers living in the home creating problems of their own. At the moment, the ill child has a respiratory rate of 32 breaths/minute and has a productive cough with bilateral rales in both lung bases. The nurse assessing this family will document which priority NANDA related to the current family dynamics?

Interrupted family processes

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?

Involving the child and family in decision making

A 10-year-old child with sickle-cell anemia is frequently in the pediatric center of a hospital. What intervention can the nurse provide that will allow the child the sense of control that meets the goals promotes atraumatic care?

Maintain the child's home routine related to activities of daily living.

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?

Nod head while the mother speaks

A home care nurse is teaching a parent how to administer a clotting factor infusion to their child. How can the nurse best evaluate the effectiveness of the teaching?

Observe the parent set up and administer the infusion.

A high school nurse has noticed a trend in the reading ability of the freshman class. This high school is located in a poor, urban area where there is a high proportion of single mothers raising their children with minimal financial support. Young children many times do not have adult supervision with homework. The local school nurses discuss issues within the school area. Which suggestion by a high school nurse would be a realistic solution to the problem described in this scenario?

Organize a group of local high school students to begin a reading program in the grade school to increase interest in reading.

A 9-year-old child with rheumatoid arthritis has difficulty moving the hands as well as other joints due to pain. The child refuses to participate in the prescribed physical therapy. What would be the best way for the nurse to make sure the child continues to exercise the joints?

Play a game like "Simon Says" to introduce exercises.

When planning to teach a toddler about coughing and deep breathing, which would be most effective?

Playing a game with coughing and breathing

The nurse is teaching the parents of a newborn with a metabolic problem about the disorder and its treatment. What is the least effective teaching technique?

Provide literature for the parents to read and then have them ask questions.

When developing the plan of care to promote health for a client and family, what would the nurse focus on first?

Reinforcing family strengths

A nursing instructor is teaching a class about the basic functions of families. The instructor determines the class is successful when the students correctly choose which statement as a basic function of the family?

Reproduction remains an important function of all families.

A nurse is providing teaching on the medication regimen for beta-thalassemia to an adolescent. What is the best way for the nurse to determine if the teaching was successful?

Request that the adolescent teach the information to the nurse.

A 15-year-old client with type 1 diabetes has been noncompliant with the dietary regimen. When educating the adolescent, what is the most important thing the nurse can do to allow the adolescent to be in control and involved in the decision-making process?

Speak directly to the adolescent and consider the client's input in the decisions about care and education.

The nurse is teaching a 6-year-old girl and parent about home care for an eye infection. Which communication techniques would be least effective with this child?

Standing beside the child when doing the teaching.

A school-aged child learns how to do range-of-motion exercises but has been unable to perform them correctly from day to day. Which approach is best for the nurse to take to encourage compliance by the child?

State "Good job" to the child when performing the range-of-motion exercises correctly.

An 8-year-old child is scheduled to have a tonsillectomy and adenoidectomy in 2 weeks. What intervention can the nurse provide to help the child and family adjust to the hospitalization?

Take the child on a tour of the facility and surgical suite and explain what to expect preoperatively and postoperatively.

A nurse is teaching a 6-year-old child and parents about an outpatient surgical procedure the child will have the next day. The child is "shy" and does not maintain eye contact with the nurse. What is the best way for the nurse to approach the child?

Talk to the parents first to give the child a chance to "warm up."

The registered nurse (RN) and licensed practical nurse (LPN) are caring for a hospitalized child. Which action by the LPN will cause the RN to intervene?

The LPN holds down the child while another nurse starts an IV

The nurse is educating an 8-year-old client newly diagnosed with diabetes mellitus on how to administer insulin. Which finding indicates the nurse's education was successful?

The child demonstrates good technique in self-injection of insulin.

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?

The parents missed the last scheduled appointment.

During assessment for a child with cystic fibrosis who is new to the practice, the nurse notes that the father keeps asking about costs and if there is a "cheaper" way of providing the care that the child needs without compromising health. For example, instead of buying prepackaged normal saline for breathing treatments, he asks if they can boil water (and containers with lids) and add the salt to the water in proper portions. When documenting this assessment, the nurse would identify the father as playing which role in the family based on the aforementioned questions?

allocation of resources

A nurse is preparing to teach an 8-year-old child recently diagnosed with diabetes how to give an insulin injection. Which is the best technique for the nurse to use?

demonstration

A preschool child fell off a tricycle and broke an arm that will require surgical repair. The nurse wants to prepare the child for surgery. Which is the best technique the nurse could use to teach the child about what to expect?

dolls

The nurse is having trouble communicating with a hospitalized child. Which communication technique would be the most beneficial for the nurse to offer the child?

drawing pictures

The community health nurse is assessing a new client who reports he has recently moved to the area and is living with an aunt and her parents. The nurse determines this client resides in which type of family structure?

extended

A family in the second phase of divorce are actually separating and moving to new homes and perhaps new schools. The school-age children may experience which type of feeling at this phase in the divorce?

grief for the missing parent

The nurse is teaching a 15-year-old boy with type 2 diabetes and his parents how to monitor glucose levels. Which communication technique is least effective?

ignoring the adolescent's tirade about his therapy

The mother of an infant child only speaks Spanish. The 8-year-old sibling speaks English, and the mother wants to communicate through the sibling. How should the nurse best handle teaching to the mother?

obtain an interpreter

Which is most likely to encourage parents to talk about their feelings related to the poor prognosis their child has been given?

open ended questions

A 9-year-old child is newly diagnosed with asthma. The nurse plans to teach the child about triggers related to the diagnosis. What would be the best approach for this child?

play an allergy trivia game

Two previously divorced people are getting married and becoming a blended family. They each have two children from prior marriages. They have met with a family counselor to discuss potential problems of blended families and ways to deal with the problems. Which potential problem will likely occur at some early point in the marriage?

rivalry for attention

A nurse is assigned to care for a 6-month-old infant hospitalized with diarrhea and dehydration. Because the infant does not have developed speech, what can the nurse do to communicate with the infant?

sing

A couple is arguing and bickering all the time. This couple has not told the children yet that they are planning to get a divorce. When the couple discusses this with the school nurse, the nurse shares that at this early phase, children likely experience what type of feelings?

take blame for their parents quarreling and try to behave better

An urgent care nurse is cleaning a forehead laceration on a 7-year-old. The mother is present. The child is crying and screaming. The nurse should:

tell the child, "It's OK to cry, but I need you to hold still."

The nurse is communicating with a family about their child's illness. Which communication technique would be considered a block to effective communication with the family?

using clichés