Chapter 35: Communication and Teaching with Children and Families

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

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

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

A nursing student is learning about teaching and how to evaluate is effectiveness. Which of the following statements made by the student identifies a need for further instruction?

"Evaluation is done as a final step of teaching only."

An adolescent who plays catcher on the baseball team begins shouting at the nurses, slams the doors, and refuses to talk to anyone after being given the news that the right arm will require surgery. Which response by the nurse would be the most appropriate in this situation?

"I understand you are angry, but please don't shout or slam doors."

Which statement is most appropriate when initiating a nursing action with a preschooler?

"These sticky snaps are for your chest."

Which statement by the nurse is most appropriate when discussing general anesthesia with a 6-year-old?

"This will be a very special sleep."

The child with cancer spends time watching TV and talking very little about a new chemotherapy regime 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 enlisting the parents' assistance for therapeutic hugging prior to an otoscopic examination. What should the nurse emphasize to the parents?

"You will need to keep his hands down and his head still."

A nursing student learning pediatrics and the development of language correctly identifies the age when children are able to put together two-word (noun-verb) sentences to be:

2 years

Which situation may be enhanced by the use of drawings to elicit feelings from a child?

A 4-year-old scheduled for surgery

A nurse is providing some basic hygiene teaching to a preschooler who is continually developing upper respiratory infections from his time spent in day care. What is an example of assessing the child's learning needs?

Asking him what germs are

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 who needs education about a gluten-free diet for the treatment of celiac disease?

Assessing the child's current level of understanding

A nurse is showing a 9 year old a video about why insulin is needed. The nurse then plans to discuss a booklet with the child on the same topic after the video. Of what type of learning is this an example?

Cognitive learning

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 nurse is talking with a 10 year old who is saying that his "stomach has been hurting for several days and is worse when he drinks milk." The nurse asks the child, "Let me be sure I understand. The pain gets worse when you drink milk?" What type of therapeutic communication technique is the nurse using?

Clarifying

The nurse notes that a school-age child does not participate in any teaching or demonstrate any learning identified in the plan of care as priority problems. What action should the nurse implement?

Change the plan of care to include the problem that is more consistent with the child's priority problems.

The nurse is teaching the parents how to provide enteral feedings to their child. Place in order the steps the nurse would teach the parents to accomplish this task. Use all options.

Check for correct tube placement Set the pump rate Wash hands Check for residual Fill the feeding bag Begin feeding

A nurse is teaching a young patient about the importance of good nutrition for wound healing. When the patient states, "I will eat more protein and take my vitamins so I will get better faster," this patient is demonstrating which type of learning?

Cognitive

Infants learn best by affective learning.

False

Why does the nurse complete a process recording?

For self-evaluation of therapeutic communication

A nurse is caring for a 10 year old with asthma. The child states, "I hate school because I am always sick. Nobody will ever choose me to be on their team." What level of communication is the child displaying?

Fourth Level: Shared Feelings

A 4-year-old is scheduled for major abdominal surgery. Which teaching should the nurse provide regarding pain?

Information on expected pain and ways to allieviate pain

Which element is a characteristic of therapeutic communication?

Is constructive

A nurse is talking with a 9-year-old about a procedure that will be done in the morning. The child is expressing fear. What listening skills does the nurse exhibit that makes it clear the nurse is actively listening? Select all that apply.

Nodding in response to comments the child makes Sitting at the level of the child Maintaining eye contact while the child is talking

A 9-year-old with rheumatoid arthritis has difficulty moving her painful hands as well as her other joints. She refuses to participate in ordered physical therapy. What would be the best way for the nurse to make sure she continues to exercise her joints?

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

Which teaching strategy would be most effective for a 7-year-old who is learning how to check blood sugars?

Re-demonstration

The child states, "I never want to be a nurse or a doctor." The nurse recognizes this statement as reflecting what level of communication?

Shared personal ideas and judgments

An 8-year-old 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 clinic nurse is assessing an 8 year old who comes in with a parent for a well-child visit. The child is slouching and moving very slowly into the room. What does the nurse suspect may be occurring with this child?

The child may be depressed or insecure.

A 16-year-old girl confides in the nurse that her parents are difficult to deal with and that it stresses her out. The nurse responds by saying, "You think that's stressful, you should see some of the patients I have to deal with in here!" Which barrier to communication is this nurse demonstrating?

Topping up

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

demonstration

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

A student nurse walks into a patient's room and states, "I am a student nurse who is going to take care of you today." Which level of communication is the student using?

first level

A nurse is teaching a 7 year old what to expect during an upcoming tonsillectomy. In this situation related to teaching, which of the following is the encoder?

nurse

A nursing instructor informs students that when teaching children, they need to establish expected outcomes that are which of the following? (Select all that apply.)

specific concrete measurable

A child who has had several surgeries to correct a congenital defect is found crying after receiving the news another surgery will be needed. The nurse could best assist this child through what form of communication?

touch

The nurse is preparing a 5-year-old for a radiograph. What would be the best communication to prepare the child for the procedure?

"We are going to use a big camera to take pictures inside your body."

Which statement by the nurse encourages therapeutic communication from a child scheduled for surgery?

"What are you worried about?"

When caring for hospitalized teens, nurses should choose their words and actions carefully since adolescents typically are concerned about:

Appearing out of control of the situation and/or themselves

A 5-year-old girl tenses up when the nurse approaches to examine her. "Are you afraid?" the nurse asks her. The girl shakes her head in denial. As the nurse lifts the stethoscope to auscultate the girl's chest, however, the nurse notices that the girl tenses up again and grips the edge of the examination table tightly. "Oh—you are afraid of the stethoscope, aren't you?" the nurse replies. "It's okay—it doesn't hurt; see—reach out and touch it." Which communication technique is the nurse demonstrating here?

Empathy

Which example shows the nurse incorporating informal teaching while caring for a child?

Explaining the importance of adequate fluid intake while playing "tea party"

A nurse is demonstrating dressing changes for a 12 year old so that the child will be able to perform the skill when discharged. What is important for the nurse to do prior to demonstration?

Be sure that all necessary equipment is present to demonstrate the technique.

The nurse is using nonverbal communication techniques including the appropriate use of distance. Which situation best demonstrates the appropriate action by the nurse?

Explaining the use of the stethoscope before entering the intimate space of a 16-year-old

A nurse caring for a preschooler scheduled for abdominal surgery the next day needs to teach about the dressing and drainage tube that the child will have after surgery. Which would be the best technique for the nurse to use?

Dolls and puppets

What is the most positive benefit that effective therapeutic communication has in the nurse-client relationship?

Helps develop trust between nurse and the child.

The nurse has given an adolescent a pamphlet about sexually transmitted infections (STIs). Which documentation by the nurse shows that the teaching has been effective?

Named two methods used to reduce the risk of STIs

A nursing instructor informs a student to record her interaction with a child who has osteogenesis imperfecta to determine if the conversation was therapeutic. What form of evaluation is this?

Process recording

A 6-year-old child is learning how to draw insulin into a syringe and becomes frustrated, throwing himself on the floor. What is the best action by the nurse?

Provide positive reinforcement for the steps achieved, ignoring the temper tantrum

A nurse greets a 14-year-old boy in the waiting room of the hospital. He approaches the nurse and stops about 5 feet away. He nods his head in response but does not say anything. Which best describes the distance the client has positioned himself from the nurse?

Social space

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

Speak directly to the teen and consider his input in the decisions about care and education.

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

Standing beside the child when doing the teaching

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

A nurse is talking to a mother concerned about her 5-year-old son. She informs the nurse that he eats only cereal and peanut butter every day and fears that he is not getting proper nutrition. The nurse reassures the mother that even though he is eating a limited variety of foods, he is likely getting enough nutrition. Which type of teaching is this nurse practicing?

informal teaching

A nurse is teaching children about proper nutrition and shows them the USDA "My Plate." The nurse discusses the importance of diet and daily exercise. This is an example of which type of health care?

preventive

A preschool child will require the placement of a peripherally inserted central catheter (PICC) for extended antibiotic treatment. Based on the child's developmental age, what methods of teaching could the nurse best utilize to help the child understand care for the PICC? Select all that apply.

puppets dolls handling the equipment

A nurse caring for a young patient with sickle-cell crisis always establishes eye contact, uses a gentle tone of voice, listens carefully to whatever the patient says, and uses touch appropriately. Which of the following is the nurse demonstrating by these actions?

warmth

What can be perceived by the child when a nurse sits by the bedside to obtain a health history? Select all that apply.

concern warmth comfort The space between 18 inches to 4 feet (46 cm to 1.2 m) is sensed by most people as personal space. When the nurse sits by the side of the crib or bed or sits next to a person at home, the nurse is within this space. Warmth is an innate quality some people manifest more spontaneously than others. Basic ways that warmth is conveyed are direct eye contact, use of a gentle tone of voice, listening attentively, approaching the child within a comfortable space, and using touch appropriately. Any action that lets the nurse know a person better (e.g., taking a health history, talking about school or family or how a child feels about the present situation) not only lets the nurse plan care but allows the nurse to become increasingly comfortable with the child. Lack of trust or fear are negative experiences and would not be present in an attitude of warmth.