CH 8
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: a) "This will only take a few minutes. You should be with your child." b) "Stay. It will be less scary for your child." c) "Certainly. I will stay with your child during the procedure." d) "Come, stand by his head. You won't see much up there" e) "Good. That is what the team doing the procedure would prefer."
"Certainly. I will stay with your child during the procedure." Explanation: Excusing the parent from the procedure is the best response. The parent's needs and abilities need to be respected and supported. Children usually receive the most support from parents. However, others can provide effective support including nurses and child life personnel. Consider, also, that an anxious parent usually means an anxious child. Assist the parent to comfort the child after the procedure.
A nurse is teaching an 11 year old about the use of incentive spirometry prior to abdominal surgery. The child yells, "I am not going to use this stupid thing, and I wish you would just leave me alone!" What is the priority therapeutic response by the nurse? a) "If you yell at me, I will leave the room and call your parents." b) "I understand that you are angry and nervous about your surgery, but please don't yell." c) "Is this how you talk to your parents at home?" d) "Yelling at me is very disrespectful when all I am doing is trying to help you."
"I understand that you are angry and nervous about your surgery, but please don't yell." Explanation: The typical response at hearing an angry outburst is to imitate it. This is not therapeutic, however. Make a point of not allowing yourself to be drawn into children's anger, while at the same time acknowledging it is all right to be angry (I understand that you're angry but please don't shout"). Help them to focus their anger if at all possible so they can better understand it and begin to deal with it.
A nurse is preparing a hospitalized child for a lumbar puncture. The physician states that he will perform the procedure in the child's hospital room. What should the nurse inform the physician to advocate for the child? a) "I will have the procedure prepared in the treatment room, so that the child may view the hospital room as safe and secure." b) "I will prepare the hospital room for the child, because that room is where the child will feel most comfortable." c) "The parents want to be present during the procedure, and I informed them that this isn't the policy of our facility." d) "We will have to have the parents hold the child down because there is not enough assistance on the floor."
"I will have the procedure prepared in the treatment room, so that the child may view the hospital room as safe and secure." Explanation: In the hospital, all invasive procedures should be performed in the treatment room or a room other than the child's room. The child's room should remain a safe and secure area.
The nurse is preparing to do an altered family function risk assessment on a patient. Which question should the nurse ask first? a) "Are you able to cope with family health problems?" b) "Tell me about your family's eating habits?" c) "How would each member describe this family?" d) "What are the potential sources of stress in your family?" e) "What is the general sleep pattern in your family?"
"What are the potential sources of stress in your family?" Explanation: History taking to identify areas of risk or potential problems requires both open-ended and focused questioning. Questions related to potential sources of stress in the areas of roles, finances, lifestyle, previous experience, and general health are crucial. Follow a general question, such as "What are the potential sources of stress in your family?" with more specific questions.
A nurse is preparing to administer medication to a preschooler. What can the nurse do to ensure communication with the child is effective? a) Show the child a video about medication administration. b) Use medical terminology when discussing the medication with the child. c) Allow the child to determine if he or she wants to take the medication at that time. d) Allow the child to choose between juice, water, or soda to take the medication.
Allow the child to choose between juice, water, or soda to take the medication. Explanation: Preschool children should be allowed to have choices as appropriate.
A nurse is providing some basic hygiene teaching to a preschooler who is continually developing upper respiratory infections from his time spent in daycare. Which of the following is an example of assessing the child's learning needs? a) Selecting a fun video for him to watch about how sicknesses are spread b) Demonstrating how to wash his hands after using the bathroom c) Establishing a goal that he will be able to demonstrate proper use of a tissue for blowing his nose by the end of the teaching session d) Asking him what germs are
Asking him what germs are Explanation: Designing a plan begins with assessment of the individual child's needs and how the new knowledge will meld with the child's and family's lifestyle, the child's intellectual and language level, current knowledge level, physical/cognitive capabilities, sociocultural values, and attention span. By asking this boy what germs are, the nurse will elicit his current knowledge level on the subject, along with his intellectual and language levels. The other answers pertain to other aspects of developing and implementing a teaching plan.
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? a) Have the child turn every 2 hours prior to administering pain medication. b) Provide diversional activities postoperatively so the child will not focus on the pain. c) Assess the child frequently and use pharmacologic and nonpharmacologic methods of pain relief as needed. d) Encourage oral fluids after surgery.
Assess the child frequently and use pharmacologic and nonpharmacologic methods of pain relief as needed. Explanation: Using the principles of atraumatic care, the nurse may attempt to control pain via frequent assessments and use of pharmacologic and nonpharmacologic interventions.
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? a) Collecting data of current dietary likes and dislikes b) Giving the child a pamphlet about the reason for a gluten-free diet c) Assessing the child's current level of understanding d) Developing outcome standards for the nutritional aspect of the plan
Assessing the child's current level of understanding Explanation: Important areas for assessment include a child's current level of understanding; cognitive, physical, psychosocial aspects; and how the new knowledge will meld with the child's and family's lifestyle.
A mother rooming-in with her 10-month-old infant appears upset following the visit of a consultant physician. The mother has questions but states, "The doctor is always so busy." The nurse will: a) Explain to the mother the limits on the consultant's time. b) Assist the mother in preparing a list of questions for the physician's next visit. c) Ask the mother for her questions so that the nurse can relay them to the medical team. d) Encourage the mother to remain at the infant's bedside so as not to miss any future consultant visits.
Assist the mother in preparing a list of questions for the physician's next visit. Explanation: Empowering parents so that they can be active partners in their child's care is part of family-centered care. Helping the mother state and write her questions will provide information to which the nurse can respond plus help the mother interact more effectively with the consultant and other health team members. Relaying the mother's questions may be helpful on limited occasions but places the nurse between the parent and provider relaying information in a "third party" manner. Keeping the mother at the bedside watching and waiting causes unnecessary watchfulness and stress. Supporting the "busyness" of the consultant burdens the mother further.
A nurse is preparing to start an intravenous (IV) line on a child and knows that it will cause pain. The nurse obtains EMLA cream to decrease the sensation of the injection. What type of care is the nurse providing? a) Painless care b) Expert care c) Atraumatic care d) Aseptic care
Atraumatic care Explanation: Atraumatic care is therapeutic care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system.
A nurse is caring for a small child with leukemia who will be hospitalized frequently for chemotherapy. What type of referral can the nurse make that will help the child and family through this time? a) Child psychologist b) Child life specialist c) Occupational therapist d) Play therapist
Child life specialist Explanation: A child life specialist (CLS) is a specially trained individual who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful. The CLS is a member of the multidisciplinary team and works in conjunction with health care providers and parents to foster an atmosphere that promotes the child's well being.
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? a) Clarifying b) Perception checking c) Paraphrasing d) Reflecting
Clarifying Explanation: Clarifying consists of repeating statements others have made so both of you can be certain you understand them. This is particularly helpful if a child has been describing a set of symptoms or series of actions.
Question: The five levels of communication are listed below. Put them in the correct order, from first level to fifth: Shared personal ideas and judgments Peak communication Cliché conversation Shared feelings Fact reporting
Cliché conversation Fact reporting Shared personal ideas and judgments Shared feelings Peak communication Explanation: Not every conversation you engage in has the same depth level, nor should it. Throughout a day, a person may use as many as five levels, from clichés to peak communication: 1) cliché conversation, 2) fact reporting, 3) shared personal ideas and judgments, 4) shared feelings, and 5) peak communication.
A child with leukemia has had several hospital admissions for treatment and complications. What can the nurse do to foster a feeling of empowerment for this child? a) Communicate directly with and include the child in discussions. b) Encourage the child to allow the healthcare team to initiate treatments without question. c) Ask the child questions about the disease. d) Talk to the parents and have the parents communicate the specifics of treatment to the child.
Communicate directly with and include the child in discussions. Correct Explanation: Children feel empowered when health care professionals communicate directly with them. They should include children in discussions and avoid talking about them in their presence.
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: a) Coordinate physician and interpreter schedules and arrange an information-sharing session for later in the day. b) Develop a written account of the infant's status with the physician that the daughter can read and explain to her parents. c) Have the teenage daughter and physician discuss the information thoroughly and help her share this data with her parents. d) Support the 14-year-old while she interprets for her parents and the physician at the bedside.
Coordinate physician and interpreter schedules and arrange an information-sharing session for later in the day. Explanation: An interpreter is essential. Explanations need to be given and questions relayed and answered. The interpreter needs understanding of the healthcare environment, not just the language. The parents are anxious for information and "not knowing" is difficult. However, children in the family should not be used as interpreters. This may upset family dynamics giving a great deal of power to a child.
You are going to teach a 9-year-old how to do active range-of-motion exercises. Which of the following techniques would be most appropriate to use? a) Allow her to listen to the radio as you are teaching her. b) Tell her about different ways to perform the technique so that she can vary them as she chooses. c) Demonstrate the technique by performing it consistently the same each time. d) Suggest she tell you how she wants her range-of-motion exercises to be done.
Demonstrate the technique by performing it consistently the same each time. Explanation: Children respond best to consistent techniques.
The nurse is teaching home care to the parents of a 4-year-old girl with asthma. Which information would be least important to the family's immediate needs? a) Explaining what kinds of things can trigger an attack b) Demonstrating how to administer medication with a nebulizer c) Having emergency instructions and phone numbers d) Determining if the child should enroll in a preschool
Determining if the child should enroll in a preschool Explanation: Enrolling in preschool is presently of least priority. Should the child enroll, the nurse can assist in meeting the asthma education needs of the preschool staff through counseling the mother and providing access to sound asthma education materials. The important immediate information for the family is knowing how and when to properly use the nebulizer, knowing about and avoiding triggers, and being well prepared to deal with a possible emergency.
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 of the following communication techniques is the nurse most demonstrating here? a) Attentive listening b) Genuineness c) Warmth d) Empathy
Empathy Explanation: Empathy is the ability to put yourself in another person's place and experience a feeling the same as that person is experiencing. People who are capable of empathy are the best support people because they can anticipate a child's reactions or fears. Genuineness is a quality of projecting sincerity or being yourself. Warmth is an innate quality some people manifest more spontaneously than others. Basic ways in which warmth is demonstrated are direct eye contact, use of a gentle tone of voice, listening attentively, approaching a child within a comfortable space of 1 to 4 feet, and using touch appropriately. No one likes to talk to someone who does not appear to be listening or responding. Good listening, therefore, like speaking, is not passive but active.
An adolescent remarks rather sarcastically that she feels like a "lab rat." What is the priority nursing action? a) Enable the teen to stay in contact with peers electronically. b) Ensure information is shared with and decisions about care are made with and not for the teen. c) Arrange for additional bedside activities of the adolescent's choice. d) Provide more physical privacy for this teenager. e) Share with the adolescent that everyone on the unit enjoys working with teenagers.
Ensure information is shared with and decisions about care are made with and not for the teen. Explanation: Sharing information openly and honestly plus including the adolescent in all decision making is the priority action. Parents or staff should not be seen as in complete charge. More privacy, connection with peers, and additional diversional activity all support the teen developmentally and need to be part of her care. Telling the adolescent the staff enjoys teens is hollow unless the girl experiences this behavior.
When the nurse is teaching the child how to self-administer insulin, what should the final step of the process include? a) Assessing the child's willingness to learn b) Recognizing the actions of the teaching process c) Evaluating the teaching that has occurred d) Teaching the principles of insulin administration
Evaluating the teaching that has occurred Explanation: The only way to determine the effectiveness of teaching is to test or evaluate if learning has occurred. Structure the time and method of evaluation when first establishing a teaching plan.
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? a) Maintain complete honesty with the parents. b) Expect parents to perform procedures precisely as taught. c) Consider parents equal partners in care. d) Provide positive feedback to mother and father for care and parenting well done.
Expect parents to perform procedures precisely as taught. Explanation: Parents often modify procedures to better suit the child/family situation and routine. Parents are not new to this child's care—they have been managing it since birth. However, it is essential that safe physical and psychosocial conditions are maintained. Parents often devise creative approaches to the child's care from which nurses can learn. The other strategies are sound and support a good nurse-family-child working relationship.
It is best to emotionally prepare a child for a major surgery all at once rather than in stages. a) True b) False
False Explanation: It is best to prepare a child for a major experience like this in stages rather than all at once because it is difficult to absorb so much information in a short time span.
A 7 year old with sickle-cell disease who comes to the hospital frequently appears withdrawn and depressed. He refuses to talk to anyone or even admit that he is sad. What would be the best thing for the nurse to do that might help the patient deal with his feelings? a) Play a happy song for him. b) Leave him alone. c) Tell him a joke. d) Get him to draw a picture.
Get him to draw a picture. Explanation: A useful nonverbal technique to learn how children feel about a frightening experience is to ask them to draw a picture. Humor will not fill the void--usually children are looking for a firm support person to be with them, not amusing ones. Using music can be helpful, but the child should pick the type of music that will then convey the mood. The nurse should not leave the child alone; doing so will only add to further isolation.
The nurse is teaching a 15-year-old boy with diabetes mellitus and his parents how to monitor glucose levels. Which of the following communication techniques is least effective? a) Using reflection to clarify the parents' understanding b) Paraphrasing the parents' comments before responding c) Using the adolescent's words during the conversation d) Ignoring the adolescent's tirade about his therapy
Ignoring the adolescent's tirade about his therapy Explanation: The least effective technique is ignoring the adolescent's tirade about his therapy. He is expressing frustration over his lack of control, and his emotions should be acknowledged. Paraphrasing the parents' comments recognizes their feelings. Using the teen's words during the conversation indicates active listening and interest. Reflection clarifies the parents' understanding and point of view.
A group of nursing students are reviewing risk factors for alterations in family processes. The students demonstrate understanding of this information when they identify which of the following as a risk factor? a) Lack of stress b) Realistic expectations of others c) Limited support systems d) Multiple role models
Limited support systems Explanation: Characteristic risk factors for alterations in family processes include unrealistic expectations of self or others, lack of role models, inadequate support systems, and presence of stress.
A 10 year old with sickle-cell disease is frequently a patient in the pediatric center of a hospital. What intervention can the nurse provide that will allow the child a sense of control that promotes atraumatic care? a) Maintain the child's home routine related to activities of daily living. b) Promote family-centered care. c) Advocate for minimal laboratory blood draws. d) Provide appropriate pain management.
Maintain the child's home routine related to activities of daily living. Explanation: To promote a sense of control that meets the goals of atraumatic care, the nurse would attempt to maintain the child's home routine related to activities of daily living. In the hospital, the nurse would use primary nursing. He or she would encourage the child to have a security item present if desired. Other measures include involving the child and family in planning care from the moment of the first encounter, empowering them by providing knowledge, allowing them choices when available, and making the environment more inviting and less intimidating.
A 9-year-old patient 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 that the patient continues to exercise her joints? a) Give the patient a pamphlet about the importance of exercise. b) Give the patient a coloring book about arthritis. c) Show a video about exercising. d) Play a game like "Simon Says" to introduce exercises.
Play a game like "Simon Says" to introduce exercises. Explanation: School-aged children love to play games. By playing "Simon Says" and introducing different exercises to help with movement, the nurse may help stimulate the patient to want to be active.
When planning to teach a toddler about coughing and deep breathing, which would be most effective? a) Showing an audiovisual b) Discussing the importance of coughing c) Playing a game with coughing and breathing d) Demonstrating the technique
Playing a game with coughing and breathing Explanation: Toddlers respond best to teaching techniques that include games so they feel as if they are playing instead of learning.
A nurse is assessing a family and asks, "On whom does the family depend to provide the solution to problems?" What role is the nurse trying to establish? a) Nurturer b) Problem-solver c) Gatekeeper d) Financial manager
Problem-solver Explanation: The problem-solving role is determined based on whom the family relies on to provide the solution to problems. The gatekeeper is the person in the family who determines what information will be released from the family or what new information can be introduced. The financial manager supervises the family finances. The nurturer is the primary caregiver to children or others in the family with challenges.
A nurse is caring for a child with cystic fibrosis who is concerned about being separated from parents. What interventions can the nurse provide that will prevent or minimize child and family separation? a) In the hospital, use primary nursing. b) Promote family-centered care. c) Empower the family and child by providing knowledge. d) Encourage the child to have a security item present.
Promote family-centered care. Explanation: To prevent or minimize child and family separation the nurse would promote family-centered care. Thus, in the hospital, staff members would provide comfortable accommodations for the parent, allow the family the choice about whether to stay for an invasive procedure, and support them in their decisions.
The nurse is teaching the parents of a newborn with a metabolic problem about the disorder and its treatment. Which of the following is the least effective teaching technique? a) Using the food pyramid diagram to teach necessary nutrition alterations b) Providing a print handout for the parent to read and asking for questions c) Discussing how to handle a possible emergency situation d) Explaining the disorder in common terms
Providing a print handout for the parent to read and asking for questions Explanation: The parents may not understand the print handout based on their reading level or ability, their understanding of terms, or their own overall literacy. They may not ask questions for all of the former reasons or to avoid appearing "dumb." The other techniques should provide support by using "lay" words, exchanging ideas (discussion) regarding managing an emergency, and using a common visual symbol (food pyramid) to teach about nutrition.
A nurse is assigned to care for a 6 month old hospitalized with diarrhea and dehydration. Because a child this age does not have developed speech, what can the nurse do to communicate with the child? a) Use puppets to communicate with the child. b) Use a stuffed animal to tell a story. c) Sing to the infant. d) Write on a whiteboard.
Sing to the infant. Explanation: Infants primarily communicate through touch, sight, and hearing. Communication can occur through cuddling, holding, rocking, and singing to the infant.
A nurse is talking with a school-age child with asthma who expresses concerns that peers will not want to be friends because of the disease. What therapeutic communication technique would be beneficial for the nurse to use? a) Sit at the child's level and allow the child time for self-expression. b) Have the child sit down in a chair and the nurse stand next to the child. c) Inform the child that the parents must be present during a personal conversation like this one. d) Give vague responses when the child is asking for advice so the nurse will not be responsible if something happens.
Sit at the child's level and allow the child time for self-expression. Explanation: Sitting at the child's level and allowing the child time for self-expression are steps that improve therapeutic communication.
The nurse has worked diligently with an adolescent to meet his teaching-learning needs and make adaptations for managing his illness to suit his preferences and lifestyle. Even so, there is evidence of noncompliance. The nurse's interpretation is: a) Some noncompliance should be expected due to the teen's desire for independence, expression of his personal values, and peer acceptance. b) Because the adolescent did not pay attention during his teaching sessions, he now does not know what to do. c) More assistance from the family is needed for the teen to manage his care. d) The developmental thinking skills of the adolescent prevent him from seeing the connection between his actions and the effect on his health.
Some noncompliance should be expected due to the teen's desire for independence, expression of his personal values, and peer acceptance. Explanation: Acceptance of some noncompliance by this teen is necessary. Finding compromise to limit noncompliance is important. Developmentally, the adolescent is capable of formal thought. Connecting present and future should not be an issue. There may be some measure of inattentiveness to teaching and some need for more home support, but these do not represent the main reason for noncompliance.
A 15-year-old patient with type 1 diabetes has been noncompliant with his dietary regimen. When educating the teen, what is the most important thing the nurse do to allow the teen to be in control and involved in the decision-making process? a) Praise the patient often. b) Provide information and allow the teen to process and ask questions. c) Speak directly to the teen and consider his input in the decisions about care and education. d) Offer choices whenever possible.
Speak directly to the teen and consider his input in the decisions about care and education. Explanation: A teaching tip for adolescents to allow them control and involvement in the decision-making process is to speak directly to them and consider their input in all decisions about their 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? a) Talking directly to the child even though the mother makes comments b) Listening attentively to the child while giving time to finish thoughts and ideas c) Asking permission to touch the child before doing so d) Standing beside the child when doing the teaching
Standing beside the child when doing the teaching Explanation: Standing above a 6-year-old may create the feeling of being dominated. Sitting at her level promotes equality and a more comfortable teaching-learning setting. Listening with patience to the child when she speaks or questions allows her time to completely formulate and express her thought or question. It is respectful. Talking to the child as well as the mother during health teaching keeps the child a participant in her care. Asking permission to touch the child reduces threat.
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? a) After interviewing the child, give him or her a prize for answering the questions. b) Take the child on a tour of the facility and surgical suite and explain what to expect preoperatively and postoperatively. c) Tell the child that the parents will not be able to see him or her until after the child returns to the hospital room. d) Tell the child all about being able to eat popsicles and ice cream after surgery.
Take the child on a tour of the facility and surgical suite and explain what to expect preoperatively and postoperatively. Explanation: Nurses can help children cope with the experience by using age-appropriate and child-specific interventions. Preparation can help children and their families to adjust to illness and hospitalization.
A nurse is teaching a 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? a) Ask the parents to step out of the room and talk with the child privately. b) Give information to the parents and let them talk to the child later. c) Talk to the parents first to give the child a chance to "warm up." d) Ask the child questions until he or she begins talking freely.
Talk to the parents first to give the child a chance to "warm up." Correct Explanation: If a child is shy, the nurse may start by talking to the parents first to give the child time to "warm up" to the nurse.
The nurse is working with an interpreter to meet the health needs of a family with limited skills in the English language. Which action is not recommended? a) Meeting with the interpreter before, including the family, to provide some background information b) Having the interpreter review printed information with the family c) Talking one-on-one with the interpreter at numerous points throughout the session with the family d) Pausing after approximately 30 seconds of speaking so the interpreter can translate e) Looking at the family while speaking
Talking one-on-one with the interpreter at numerous points throughout the session with the family Explanation: Side conversations with the interpreter can create discomfort for the family and undermine trust. The other actions all enhance the communication.
What type of teaching would be best for a preschooler having an invasive procedure? a) Showing a video b) Letting parents educate the child about the procedure c) Teaching with dolls or toys d) Giving the child a brochure about the procedure and allowing him or her to ask any questions
Teaching with dolls or toys Explanation: Teaching with dolls or toys can help to make an intrusive or invasive procedure seem less frightening for a preschooler.
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: a) Tell the child, "It's OK to cry, but I need you to hold still." b) Review safety measures that could have prevented the injury. c) Have the mother speak firmly to the child to correct the crying and screaming. d) Close the door tightly and reassure the child, "I am being gentle and am almost done." e) Ask the child to be less noisy because he is "scaring and bothering other children."
Tell the child, "It's OK to cry, but I need you to hold still." Explanation: Children should be able to express their feelings openly when they are hurt or frightened. Acknowledging the crying/screaming is developmentally sound. Stating the need to hold still is accurate and respects the child's ability to help. Closing the door is a good idea but "gentle" and "almost done" show little understanding of the child's experience. Expecting the mother to discipline the child or for the child to be able to consider others is unrealistic. Discussing injury prevention at this point is inappropriate, is likely to promote guilt, and appears to place blame, which would interfere with relationship building between nurse, child, and family.
A nurse is examining a 6-year-old boy. The nurse says, "Point to where it hurts the most." The boy points to his stomach. In this scenario, which of the following is the decoder? a) The nurse b) The instruction to point to where it hurts c) The action of pointing to his stomach d) The 6-year-old boy
The 6-year-old boy Explanation: The receiver (decoder) is the person who not only receives the message (hears it, reads it, views it) but interprets or decodes its meaning (cognitive processing); in this case, it is the boy. The encoder is a person who desires to share a thought or feeling with someone else so originates a message; in this case, it is the nurse. The code is the message that is conveyed, as well as the medium or system used to convey it; in this case, it is the instruction to point to where it hurts.
A nurse is caring for a 12 year old who is very demanding. Within 4 hours, the child has pressed a call light 12 times for multiple reasons. What does the nurse understand may be the reason for this child's demanding behavior? a) The child is expecting quality care from the nurse. b) The child is spoiled at home and is continuing this behavior in the hospital. c) The child wants to be sure the nurse is doing what he or she is supposed to be doing. d) The child may be insecure or afraid.
The child may be insecure or afraid. Explanation: Demanding behavior generally stems from insecurity or fear (so afraid that something will happen while the nurse is away that they constantly find more for the nurse to do to keep the nurse available).
A nurse is talking with a 10 year old and her parent about the current treatment plan for the child's asthma. The child stands behind the parent and does not ask questions or look at the nurse. What should the nurse consider the child's behavior could indicate? a) The child may be shy and have some reluctance about communicating. b) The child may be developmentally delayed and not understand the conversation. c) The child may be angry about the diagnosis of asthma. d) The child may not want to be treated for the asthma.
The child may be shy and have some reluctance about communicating. Explanation: It is difficult to assess how shy children feel when they are reluctant to communicate about such things as the long-term effect a disease will have. If they do not give you much verbal feedback, the tendency is to believe they do not have a concern.
The nurse is assessing the learning needs for a 12-year-old boy with a chronic health condition and his parents. Which of the following aspects would be least pertinent to a learning needs assessment? a) The family belongs to a mainline traditional faith community b) Concluding that the parents are emotionally distraught c) Discovering that the father is highly healthcare literate d) Finding that the mother relies on American Sign Language
The family belongs to a mainline traditional faith community Explanation: Membership in this traditional faith community impacts learning needs the least. There are no particular values or traditions that would require modification of the care plan for a child with his health problem. Parents experiencing a highly charged emotional state creates a learning barrier for them. A very healthcare-literate person would require less repetition and simplification of the explanations given. A deaf mother may require an interpreter if the nurse does not know American Sign Language.
A new staff member asks veteran nurses about the meaning of atraumatic care for children. These nurses explain that the concept is based on: a) The child's need to experience no trauma b) Units staffed to provide one nurse for each child c) The underlying premise of "do no harm" d) Peers being helped to develop empathy for the child
The underlying premise of "do no harm" Explanation: Atraumatic care can also be called therapeutic care for children that minimizes the child's and family's physical and psychological distress when cared for within the healthcare system. It is based on the underlying premise of "do no harm." All trauma to children cannot be avoided, but it should be limited to the greatest degree possible. Assigning of one nurse to one child is not practically or economically feasible. Nurses should be assigned to the same child and family as consistently as possible, however. Helping the youngster's peers develop empathy for the child is supportive but not the basic idea that underlies atraumatic care.
The nurse is caring for a 6-year-old girl who will be undergoing a surgical procedure that will result in a temporary ileostomy. Which of the following approaches would be most effective in helping prepare the child for surgery? a) Show the child a teaching DVD about ileostomy care. b) Show the child photographs of another girl with her ileostomy. c) Draw a picture that explains the procedure. d) Use a doll to role-play the events surrounding the surgical experience and the procedure.
Use a doll to role-play the events surrounding the surgical experience and the procedure. Explanation: Using a doll to help the child understand surgery and the procedure will promote understanding in a developmentally appropriate way. Children this age enjoy role-play and regularly use it in everyday life to rehearse events. Drawing a picture may be helpful and age appropriate but less effective than the role-play. Showing the teaching DVD will include information the child is not yet ready for and, unless prepared for young school-agers (unlikely), would not be at her level of understanding. Showing the child photographs of another girl with an ileostomy would be more helpful to an older school-ager. At that time peer modeling can be helpful in teaching as well as in capturing interest.
A nurse is preparing to start an intravenous (IV) line in a child with severe pneumonia. The nervous child asks the nurse to wait until later to do the procedure. What is the best option for the nurse? a) Call the physician to see if the medication can be given in liquid form by mouth. b) Use a firm, positive, confident approach when starting the IV. c) Ask the parents to hold the child down so that the procedure can be completed. d) Inform the child that the procedure will have to be done with or without cooperation.
Use a firm, positive, confident approach when starting the IV. Explanation: The nurse in this scenario should use a firm, positive, and confident approach that provides the child with a sense of security.
A nurse is caring for an infant admitted with diarrhea. The parent tells the nurse that she has to leave to care for another child at home and will be back shortly. What is the most effective way for the nurse to communicate with the infant and meet the child's needs? a) Use creativity. b) Use puppets to communicate with the infant. c) Tell stories. d) Use a soothing and calming tone when speaking to the infant.
Use a soothing and calming tone when speaking to the infant. Explanation: To communicate effectively with an infant the nurse should respond to crying in a timely fashion, allow the infant time to warm up, use a soothing and calming tone when speaking to the infant, and talk to the baby directly.
A nurse manager on a pediatric unit is making assignments for the day. What is the best method of care delivery to meet the goal of atraumatic care for the pediatric patient and to minimize parent-child separation? a) Assign a medication nurse and a primary care nurse. b) Use a team approach. c) Use core primary nursing. d) Have the nursing assistant care for the child because the parent is doing too much work.
Use core primary nursing. Explanation: To meet the goals of atraumatic care and to minimize parent-child separation, the nurse manager should use core primary nursing.
A 5-month-old infant has had a head-to-toe assessment by the nurse, been examined by a teaching team of physicians, and now experienced a blood draw. What behaviors might this infant manifest? a) Assuming a tonic neck reflex posture while looking toward the opposite wall b) Turning toward new sounds and bright toys and making throaty verbalizations c) Yawning, turning away, and making little eye contact d) Opening eyes widely, kicking, and looking intently at a black-and-white mobile
Yawning, turning away, and making little eye contact Explanation: This infant is likely overstimulated, and yawning, turning away, avoiding eye contact, and irritability are signs of this. The infant is attempting to disengage. The tonic neck reflex should have disappeared by 5 months of age. The other behaviors are those of an infant interested in his environment and ready for interaction.
Following a principle of learning, you can anticipate that the children will best learn a skill such as bandaging if they a) have it demonstrated to them by a teacher. b) are criticized for not learning it well. c) are shown a photo of someone important doing it. d) are allowed to practice it.
are allowed to practice it. Explanation: Children in a concrete cognitive stage learn best if they can actually demonstrate procedures.
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? a) open-ended questions b) perception checking c) clarifying d) reflecting
clarifying Explanation: Clarifying consists of repeating statements others have made so both people can be certain that the message is understood. This is an example of clarifying. Reflecting is restating the last word or phrase. Open-ended questions invite a variety of responses. Perception checking documents a feeling or emotion that is reported.
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? a) demonstration b) role modeling c) video d) coloring book about diabetes
demonstration Explanation: The purpose of demonstration is to show how the procedure actually is done. Having to imagine steps is little different than reading about them. School-aged children, because of their stage of cognitive development (concrete operations), learn best by demonstration.
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? a) discussion b) dolls and puppets c) pamphlets d) video
dolls and puppets Explanation: Preschoolers are interested in learning but often frightened by intrusive procedures. Use of dolls or puppets to help children visualize details whenever possible without intruding on their own bodies is an effective teaching strategy.
To teach an adolescent about his or her disease, the best technique would be to a) help him or her understand how new information about the disease will improve health status now. b) help him or her understand how new information about the disease will improve future health. c) help the child to realize that he or she is different from peers and needs teaching while they do not. d) urge him or her to listen attentively to what you want to teach.
help him or her understand how new information about the disease will improve health status now. Explanation: Adolescents are present oriented so they generally respond best to information that has direct application; they want to be like their peers.
A 9-year-old girl is newly diagnosed with asthma. The nurse plans to teach her about triggers related to her diagnosis. The best approach for this child would be to a) show her a video about allergic-reactions planning. b) give her a list of foods she cannot have. c) have the doctor teach her this information. d) play an allergy trivia game with her.
play an allergy trivia game with her Explanation: Learning through play is a valuable tool at this age. She may be bored by a video. Giving her a list of what she cannot have is a negative approach. This teaching is within the scope of the nurse, not the doctor.
Children depend on adults to be knowledgeable. If a 6-year-old asks you a question for which you do not know the answer, your best response would generally be to a) suggest that the child find out the answer independently. b) state that you do not have time to answer questions. c) state that you do not know the answer but you will find out. d) reword the question into one you can answer.
state that you do not know the answer but you will find out. Explanation: Children look to adults to be honest with them.
A nurse is visiting a local first grade class to provide basic teaching on nutrition. She begins by briefly explaining how our bodies need food to be able to perform all of the activities that we do. In the cafeteria at lunch time, she shows the class how to select healthy and diverse foods from the buffet line. She then has the children perform this same task to make sure they understand the principles. Which teaching strategies has this nurse used in this scenario? (Select all that apply.) a) Positive reinforcement b) Lecture c) Behavior modification d) Discussion e) Demonstration f) Redemonstration
• Lecture • Demonstration • Redemonstration Explanation: The nurse uses lecture (explaining how our bodies need food as fuel), demonstration (actually selecting foods from a buffet line), and redemonstration (having the children imitate her by selecting foods from the buffet line) in her teaching. Discussion, positive reinforcement, and behavior modification are not indicated in this scenario.
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.) a) Nodding in response to comments the child makes b) Maintaining eye contact while the child is talking c) Sitting at the level of the child d) Standing up turned toward the door as the child is talking e) Writing notes while the child is expressing his fears
• Nodding in response to comments the child makes • Maintaining eye contact while the child is talking • Sitting at the level of the child Explanation: Posture reveals to a great extent whether you are listening (sitting, not standing, to convey that you are not on the run; leaning forward, not backward; stooping to meet a child's level). Nodding, maintaining eye contact, and stopping all other activities are strong indicators you are attuned to what is being said. Making it clear that you are concentrating on what another is saying by such a motion as nodding indicates you value what the other person is saying.
