Chapter 30: Atraumatic Care of Children and Families
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 type 1 diabetes on how to administer insulin. Which finding best indicates the nurse's education was successful?
The child demonstrates good technique in self-injection of insulin.
The nurse is planning interventions for a child being evaluated at the health clinic. How will therapeutic communication benefit the child?
Therapeutic communication enhances the development of trust between the nurse and the child.
The father of a child hospitalized after a fire questions the use of therapeutic play. He reports he does not understand the purpose. What information can be provided to him?
This type of play gives the child an outlet to deal with stress.
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 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 having recently moved to the area and living with an aunt and her parents. The nurse determines this client resides in which type of family structure?
extended
The nurse is caring for a toddler who is scheduled for an outpatient lumbar puncture. Which action by the nurse would be appropriate?
having a child life specialist interact with the toddler before and during the procedure
The nurse is caring for a 14-year-old boy 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
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.
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 to teach a 15-year-old adolescent about recently diagnosed diabetes. What question(s) asked by the nurse will be of assistance in determining the adolescent's needs for learning? Select all that apply.
"How has your diabetes impacted your family?" "Prior to seeing the health care provider for your condition, what did you do to manage it?" "What do you know about the diets recommended for a person with diabetes?" "Who do you think should receive teaching about your diabetes?"
The nurse suspects poor literacy skills in a child's family member when which statement is made?
"I forgot my glasses, so I'll read this when I get home and let you know if I have questions."
When planning to teach a toddler about coughing and deep breathing, which would be most effective?
Playing a game with coughing and breathing
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 nurse is providing teaching on safety to a group of parents whose children are diagnosed with hemophilia. Which statement made by a parent requires follow-up by the nurse?
"Our child always wears a helmet and body padding when playing football."
A 2-year-old child is hospitalized for asthma exacerbation. The parents tell the nurse that they have been treating the wheezing with traditional herbal medicines. How should the nurse respond?
"Please tell me about how you use the herbal medications so we can assess for herb-drug interactions."
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"
A nurse is preparing a 7-year-old child for abdominal computed tomography (CT) scanning with intravenous contrast. What statement would be most appropriate to explain the injection of the contrast dye to the child?
"The doctor is going to put a special medicine in your tube so that she will be able to see your stomach better."
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.
"This little tube will go in your nose and down into your belly." "When they come to get you, you will get on a special rolling bed." "They are going to give you some special medicine to help the doctor see what is happening inside your belly."
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 nurse is preparing to administer medication to a preschool-age child. 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.
The nurse notes a 2-year-old toddler with pneumonia is breathing shallow. Which method is best for the nurse to use to teach the toddler how to perform deep breathing exercises?
Allow the toddler to blow bubbles in the room
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 parent brings a toddler to the clinic for treatment of a possible ear infection. How will the nurse communicate effectively with this child?
Approach the toddler while the toddler is being held by the parent.
The nurse is caring for an 8-year-old client admitted to the hospital for an appendectomy. The client is an immigrant newly arrived in the country. How can the nurse determine the best foods to provide in the postoperative diet?
Ask the family and child about preferred foods.
A nurse is attempting to reduce pain that a child is experiencing after an emergency appendectomy. What intervention can the nurse provide to meet this goal?
Assess the child frequently and use pharmacologic and nonpharmacologic methods of pain relief as needed.
The nurse is caring for a 15-year-old client following an open reduction and internal fixation (ORIF) of the humerus after an injury and fracture. The client is wincing, diaphoretic, and staying very still in bed to avoid moving the injured arm. The nurse asks if the client has pain, and the client says "it is okay" (above). What should the nurse do for this client?
Assess the client's pain using a 0 to 10 scale.
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
The nurse is caring for a parent of a 10-month-old infant. The parent is upset and states, "I have so many questions, but the doctor seems too busy to answer my questions." What is the best action by the nurse?
Assist the parent in preparing a list of questions for the health care provider's next visit.
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 6-year-old reports pain in the stomach upon eating. The nurse replies, "Let me see if I have this right. Every time you eat anything, you get a pain in your tummy?" The nurse is using which technique of therapeutic communication?
Clarifying
A family is anxious for information about the status of their ill infant. The parents do not understand the dominant language, but their 14-year-old child is competent in the language, both spoken and written. The health care provider is present, but an interpreter is unavailable. What should the nurse do?
Coordinate health care provider 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.
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.
Elevate the casted arm on a pillow today and tomorrow. Wiggle the fingers throughout the day and evening. Report any persistent numbness of the fingers.
The nurse is teaching the caregivers of a child with cystic fibrosis. What is most important for the nurse to teach this family?
Encourage everyone in the family to use good handwashing techniques.
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 preparing to assess the pain of a postoperative 9-year-old client from a different culture. The charge nurse says, "Those people never admit to pain or take pain medications. You should just mix the medication in with their food." What should the nurse do?
Explain to the charge nurse that this is a stereotype and treatment without consent; then go and assess the client's pain.
A 7-year-old child with sickle cell anemia who comes to the hospital frequently appears withdrawn and depressed. The client refuses to talk to anyone or even admit to feeling sad. What would be the best thing for the nurse to do that might help the child deal with his or her feelings?
Get the client to draw a picture.
A nurse is providing care for a child diagnosed with beta-thalassemia who is receiving a blood transfusion. The child reports being bored and asks to go to the playroom. What is the best action for the nurse to take?
Have a child-life specialist find an appropriate activity to occupy the child during the transfusion.
The nurse is caring for a hospitalized pediatric client. Which intervention will the nurse include to encourage family-centered care?
Have a team meeting with the client, family, and involved health care providers.
The nurse is caring for an adolescent with a newly diagnosed disease process. The adolescent refuses to learn about the disease. Which technique should the nurse use to encourage the adolescent to be actively involved in education about this disease?
Help the adolescent understand how new information about the disease will improve health status now.
A 13-year-old adolescent with leukemia expresses concern to the nurse over the numerous recent hospital admissions required. The adolescent states a feeling of powerlessness. Which action by the nurse is most appropriate?
Include the adolescent in discussions about health care decisions.
A 7-year-old child who has recently immigrated with the family is brought to the school nurse because the child refuses to eat lunch. Which response should the nurse prioritize?
Investigate for potential cultural issues.
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.
The parent of an infant does not speak the dominant language. The parent's 8-year-old child speaks the dominant language, and the parent wants to communicate with the nurse through the child. How should the nurse best handle teaching the parent?
Obtain an interpreter.
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 many families.
The nurse is admitting a child to the pediatric medical unit. Upon entering the room the nurse realizes that the child and family speak another language than the nurse (the nurse speaks only English). What actions should the nurse take to address this situation? Select all that apply.
Secure the help of the hospital's interpreter immediately before proceeding with the admission process. When utilizing the interpreter's help keep conversations to a maximum of 20 to 30 minutes. Determine if the child and family are able to read English accurately before giving written directions or information.
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 to the infant.
The nurse has worked diligently with an adolescent to meet the adolescent's teaching-learning needs and promote the adolescent's use of adaptations for managing the illness that suit preferences and lifestyle. Even so, there is evidence of noncompliance. How does the nurse interpret this situation?
Some noncompliance should be expected due to the adolescent's desire for independence, expression of personal values, and peer acceptance.
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.
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 nurse is teaching injection techniques to a school-aged child newly diagnosed with type 1 diabetes. Which observation would be the best evaluation that learning was successful?
The child needs occasional cueing during return demonstration of the injection technique.
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 assessing the learning needs for a 12-year-old boy with a chronic health condition, as well as his parents. Which aspect would be least pertinent to a learning needs assessment?
The family belongs to a mainline traditional faith community.
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.
Based on school-aged cognitive development, which teaching technique would the nurse anticipate as being received the best?
Using containers of water to demonstrate how hemorrhage leads to decreased body fluid
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 school-age child with a new colostomy will require teaching by the nurse to learn to care for the ostomy. In order for the nurse to teach the child effectively, what is most important for the nurse to know about the child?
learning style
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 with the child
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."
Which is most likely to encourage parents to talk about their feelings related to the poor prognosis their child has been given?
using open-ended questions