NUR 234 Ch 30: Atraumatic Care of Children and Families Exam 2
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." "I hope you are better tomorrow, too." "Would you like to go see an operating room?" "I had my tonsils removed at your age and everything was just fine."
"You sound worried. Let's talk about tomorrow." Explanation: Therapeutic communication is an interaction between two people that is planned (deliberately intending to determine the true way a child feels), has structure (use specific wording techniques that will encourage the response you expect to elicit), and is helpful and constructive (at the end of the exchange the nurse will know more about the child than at the beginning, and the child, ideally, also knows more about a particular problem or concern). The child seems worried; therefore, the nurse would discuss the child's feelings with the child to determine the best course of action.
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. 1. Showing the child where the pediatric playroom is located. 2. Talking to the family about a scheduled diagnostic test. 3. Starting the child's intravenous line. 4. Speaking to the physician as the child's advocate. 5. Giving the child an influenza vaccination.
1. Showing the child where the pediatric playroom is located. 2. Talking to the family about a scheduled diagnostic test. 4. Speaking to the physician as the child's advocate. Explanation: The child life specialist commonly assists with nonmedical preparation for diagnostic testing, provides tours, assists in play therapy, and is the child's advocate. The child's nurse gives medication, vaccines, and starts intravenous lines.
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? Reassure the parents that they have been fully briefed on their child's treatment. Answer the parents' questions as completely as possible. Notify the health care provider that the parents still have questions. Encourage the parents to focus their attention on their child.
Answer the parents' questions as completely as possible. Explanation: Because the health care provider has discussed the child's care, the nurse should answer the parents' questions as completely as possible. Telling the parents that they have been fully briefed negates their concerns and is inappropriate. Encouraging the parents to focus on their child also negates their concerns. Unless the parents ask specifically for the health care provider, the nurse can answer the parents' questions.
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? Ask the parent if he or she would like the nurse to ask the health care provider the questions when the provider visits next. Explain to the parent that the health care provider will be back and will answer questions at that time. Encourage the parent to remain at the infant's bedside so as not to miss any future consultant visits. Assist the parent in preparing a list of questions for the health care provider's next visit.
Assist the parent in preparing a list of questions for the health care provider'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 parent state and write questions will provide information to which the nurse can respond; it will also help the parent interact more effectively with the health care provider and other health team members. Relaying the parent's questions may be helpful on limited occasions but places the nurse between the parent and the health care provider, relaying information in a "third party" manner. Keeping the parent at the bedside watching and waiting causes unnecessary stress. Supporting the busy schedule of the health care provider burdens the parent further.
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? -Support the child while the child interprets for the parents and the health care provider at the bedside. -Coordinate health care provider and interpreter schedules and arrange an information-sharing session for later in the day. -Develop a written account of the infant's status with the health care provider that the child can read and explain to the parents. -Have the child and health care provider discuss the information thoroughly and help the child share these data with the parents.
Coordinate health care provider 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 health care 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 by giving a great deal of power to a child.
The nurse contacts a child life specialist (CLS) to work with children on a pediatric ward. What is the primary goal of the CLS? Act as a liaison between the nurse and the child. Decrease anxiety and fear during hospitalization and painful procedure. Perform medical procedures using atraumatic principles. Keep children who are hospitalized distracted from pain.
Decrease anxiety and fear during hospitalization and painful procedure. The CLS is a specially trained individual who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful (Child Life Council, 2010a, 2010b). The goal of the CLS is to decrease the anxiety and fear while improving and encouraging understanding and cooperation of the child. The CLS may use distraction techniques and act as a liaison, but that is not the primary goal of the CLS role. The CLS does not perform medical procedures.
The nurse is caring for a hospitalized pediatric client. Which intervention will the nurse include to encourage family-centered care? Have the family members meet with a child psychologist to ensure the child's needs are being met. Have the primary health care provider meet with the family to tell them about the child's plan of care. Have a team meeting with the client, family, and involved health care providers. Encourage the caregivers to room-in with the client and siblings to visit when possible.
Have a team meeting with the client, family, and involved health care providers. Explanation: Family-centered care involves a partnership between the child, family, and health care provider in planning, providing, and evaluating care. It works well with children of any age and in all arenas of health care, from preventive care of the healthy child to long-term care of the chronically ill child. All providers should be involved in the child's plan of care, not just the health care provider or nurses. Encouraging rooming-in and sibling visitation is important for stability and to limit the client's anxiety, not for family-centered care. The child would only need to be assessed by the psychologist if the child were demonstrating emotional difficulties associated with the disease.
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. Schedule time to address the parent's concerns. Tell the parent about the tests being performed. Let the parent know you will relay any messages she has for the doctor.
Include the parent in the medical decision-making. Explanation: The family-centered care approach is a researched-based philosophy that promotes family coping with a child needing medical attention. The nurse should collaborate with the family to address the family's needs, as well as the medical care of the child. Including the parent in the process of medical decision-making would be the priority. The other choices (letting the parents know about the tests to be performed; relaying messages; addressing concerns promptly instead of setting aside to discuss all the concerns simultaneously) would be additional ways to include the parents in the process and relay necessary information to be able to make informed 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? Discuss the situation with the child. Investigate for potential cultural issues. Eat lunch with the child. Refer the family to a nutritionist.
Investigate for potential cultural issues. Explanation: Culture influences the family's health beliefs. A newly immigrated family may have attitudes toward food that are culturally founded. The nurse should seek to clarify the cultural food influences of the family and the needs of this child. Discussing the issue with the parents may be an option if the nurse is unable to detect a possible cultural connection by talking with the child. Referring the family to a nutritionist would be inappropriate.
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? Ask the parent to repeat the instructions step-by-step. Make time for questions at the end of the teaching session. Give cues as needed while the parent sets up the infusion. Observe the parent set up and administer the infusion.
Observe the parent set up and administer the infusion. Observing the parent set up and administer the infusion is the best way to evaluate the nurse's teaching. Asking the parent to repeat the instructions, providing an opportunity for asking questions, or providing cues as the parent sets up the infusion does not evaluate the effectiveness of the teaching.
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? Show a video about exercising. Give the client a pamphlet about the importance of exercise. Give the client a coloring book about arthritis. 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 client to want to be active. Reading about exercises and seeing them demonstrated by a person or in a video will not increase the child's desire, especially since the child is in pain. Exercise for this child should be a pleasant experience and playing a game will help accomplish that goal.
The nurse recognizes that which factors contribute to the increase in single-parent families? Increase in the number of gay and lesbian couples Decrease in communal family units Rising divorce rates Increased birth rates in the United States
Rising divorce rates Rising divorce rates, along with wider acceptance of babies born out of wedlock and changes in adoption laws, have caused an increase in single-parent-families. Birth rates in the U.S. have actually declined over the last decade, and thus have not increased the number of single-parent families. Additionally, the increase in gay and lesbian couples has actually decreased the single-parent-family numbers. The decrease in communal family units has not affected single-parent family numbers.
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. Use a stuffed animal to tell a story. Write on a whiteboard. Use puppets to communicate with the infant.
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. The child cannot read, so writing on the whiteboard would be beneficial only for the parents. A 6-month-old infant uses toys as developmental tools, not communication tools. The infant may want to snuggle with the stuffed animal while the nurse tells the story or sings.
The nurse is incorporating nonverbal communication with verbal communication when explaining the treatment plan for a child with type 1 diabetes. What should the nurse do to communicate effectively with this family? Sit opposite the family and lean forward slightly. Speak a verbal yes or no; do not use head nods. Use eye contact sparingly to avoid embarrassment. Relax; maintain an open posture, with the arms crossed.
Sit opposite the family and lean forward slightly. Explanation: Guidelines for appropriate nonverbal communication include the following: sit opposite the family and lean forward slightly; relax: maintain an open posture, with the arms uncrossed; maintain eye contact, and nod your head to demonstrate interest.
The nurse is caring for a hospitalized preschool child and needs to hang IV fluids by the infusion pump. The nurse introduces the infusion pump to the child based on what developmental principle? Explaining the equipment will only increase the child's fear. The child may think the equipment causes the pain. The child is too young to for an explanation of the equipment. One explanation will be enough to reduce the child's fear.
The child may think the equipment causes the pain. Preschool-age children tend to be frightened of intrusive procedures. Teaching about intrusive procedures or medical equipment or explaining to children why it is necessary calls for clear explanations and praise for learning. Preschool-age children are interested in learning because developing a sense of initiative is the main developmental task. The nurse should keep explanations short and words simple. A preschooler's attention span rarely exceeds 5 minutes. Because preschool children notice only one characteristic of an object, the nurse may need to repeat the instructions or explanations later. Children need to have explanations for the needed aspects of care they are to receive.
A recently licensed nurse asked the charge nurse what it means to provide atraumatic care to hospitalized children. Which response by the charge nurse would be accurate? The staff is diligent to avoid health care-acquired infections in hospitalized children. The staff works specifically with children who have injuries and accidents. The concept is best demonstrated by providing a ratio of one nurse to one child. The underlying premise refers to the concept of "do no harm."
The underlying premise refers to the concept of "do no harm." Explanation: Atraumatic care can also be called therapeutic care; it minimizes the child's and family's physical and psychological distress when cared for within the health care system. It is based on the underlying premise of "do no harm." Assigning one nurse to one child is ideal, but may not be practical from a resource and acuity standpoint. Health care-acquired infections are prevented as much as possible, but would be only one aspect of atraumatic care, not the entire concept. Nurses provide atraumatic care to all hospitalized children, regardless of injury or illness.
Which method of communication is appropriate for the nurse to use when caring for a 7-month-old infant? Speak similar to the infant's parents and look in the infant's face when speaking Pronounce words as an infant would, using "baby talk" Use puppets to communicate with the infant 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 use a soothing and calming tone when speaking to the infant. A puppet is appropriate when communicating with toddlers and preschool-age children. The nurse should speak clearly when talking to the infant. Talking like the infant's parents is an unreasonable expectation. The nurse should look at the infant when speaking to the infant.
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? child life specialist occupational therapist child psychologist play therapist
child life specialist 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. The CLS provides therapeutic play, nonmedical preparation for surgeries and procedures, support for siblings, advocacy for the child and family, and grief/bereavement support.
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? coloring book about diabetes role modeling video demonstration
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. Watching a video is a good teaching strategy to show the process but it does not have the "real" syringe and vial the child can see and touch. Once the demonstration is complete the child should be allowed to return the demonstration and/or have time to practice with the nurse's assistance.
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 coloring demonstration games
dolls Explanation: Teaching preschool children about what to expect from a hospital experience is often taught using a series of puppets or dolls to represent different hospital personnel such as the surgeon, a nurse, and a nurse's assistant. Preschool children are particularly receptive to puppets and dolls because, with their imagination at its peak, they believe the puppet or doll is actually talking to them. Children can practice giving the doll "shots" or submitting it to procedures they will experience. Coloring, games, and demonstration can be helpful in many situations, but dolls allow the child to have a hands-on learning experience.
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 arranging an additional meeting with the nurse practitioner describing postoperative home care for the child discussing treatment options with the child and parents
involving the child and family in decision-making Explanation: Since the child has just been diagnosed, concerns about postoperative home care would be least important. Arranging an additional meeting with the specialist and discussing treatment options may be necessary at some point, but involving the child and family in decision-making is always a goal and is a part of family-centered care.
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? show the child a video about planning for allergic-reactions give the child a list of foods he or she cannot eat have the health care provider teach the child this information play an allergy trivia game with the child
play an allergy trivia game with the child Learning through play is a valuable tool at this age. School-age children like to participate in their learning. Watching a video is more passive rather than active. It does not give the child the chance to ask questions or get explanations about things in the video that were not understood. Giving the child a list of what he or she cannot have is a negative approach. Using a negative approach generally causes rejection, so the child will not follow through. Educating clients and their families is a large role of nursing.
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 tell their friends that their parents are always "mad" at them make up false stories, pretending they are "one big happy family" act out their feelings by crying and screaming at their parents to "Stop!"
take blame for their parents quarreling and try to behave better Explanation: The most appropriate answer is taking blame for their parents quarreling. The first phase is apt to be an antagonistic time as parents realize they are no longer compatible, marked by quarreling, hurt feelings, and whispered conversations. This phase can be particularly upsetting for children because they usually have not been told what is happening as yet. They may assume the quarreling is their fault (i.e., if they had behaved better, this would not be happening). They may act out (depending on age of child). Sometimes children share their feelings with the school nurse or teaching and they may use the word "mad" when describing the fighting in the home. Sensitive children may make up imaginary families that are happy.
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: "This will only take a few minutes. You should be with your child." "Stay. It will be less scary for your child." "Certainly. I will stay with your child during the procedure." "Good. That is what the team doing the procedure would prefer." "Come, stand by his head. You won't see much up there."
"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.
When teaching an adolescent about home care after hospitalization, what is most important for the nurse to do? Use the same type of language as the adolescent. Allow opportunity for the adolescent to express feelings. Focus the discussion on skill techniques. Provide assurance the nurse will maintain confidentiality.
Allow opportunity for the adolescent to express feelings. Explanation: Adolescents, struggling for identity, can be responsible for their own self-care if they understand how the new action they are being taught will affect them. Affective learning is important for the adolescent to express his/her feelings about what has happened and their illness. Adolescents have a strong need to be exactly like their friends. This means they will rarely continue with any action that makes them conspicuous in front of their peers. The nurse should not use the same language as the adolescent because there may be pertinent information that would not be shared if the nurse is not translating the adolescent's language correctly. Maintaining confidentiality is always important, and assurance should be given to the adolescent that the nurse will not share information with the adolescent's friends, but that is not the most important task for the nurse at this time.
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? Give cues as needed while the parent sets up the infusion. Ask the parent to repeat the instructions step-by-step. Observe the parent set up and administer the infusion. Make time for questions at the end of the teaching session.
Observe the parent set up and administer the infusion. Observing the parent set up and administer the infusion is the best way to evaluate the nurse's teaching. Asking the parent to repeat the instructions, providing an opportunity for asking questions, or providing cues as the parent sets up the infusion does not evaluate the effectiveness of the teaching.
A child is preparing to undergo a lumbar puncture in the treatment room. What intervention can the nurse provide to minimize stress during the procedure? Administer heavy sedation to the child so that he or she will not move during the procedure. Restrain the child during the procedure. Use alternative positioning such as "therapeutic hugging." Use primary nursing.
Use alternative positioning such as "therapeutic hugging." Explanation: A suggestion for atraumatic care to prevent or minimize physical stressors is to avoid traditional restraint or "holding down" of the child. The nurse should use alternative positioning, such as "therapeutic hugging." This position would also be more effective in the correct positioning of the child for the procedure. For a lumbar puncture the child does not need to be sedated, just be able to be held still. Primary nursing is not warranted in this situation.
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. a. "This little tube will go in your nose and down into your belly." b. "You will end up in the 'ICU' where you will wake up with some electrodes on your chest." c. "I am going to give you this shot and it will put you to sleep." d. "When they come to get you, you will get on a special rolling bed." e. "They are going to give you some special medicine to help the doctor see what is happening inside your belly."
a. "This little tube will go in your nose and down into your belly." d. "When they come to get you, you will get on a special rolling bed." e. "They are going to give you some special medicine to help the doctor see what is happening inside your belly." It is appropriate to use the word "tube" and not a "catheter." It is appropriate to call a "gurney" a "rolling bed." It is better to call dye "special medicine." Terms used in the other options may be misunderstood by a 4-year-old child.
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." "I will prepare the hospital room for the child, because that room is where the child will feel most comfortable." "We will have to have the parents hold the child down because there is not enough assistance on the floor." "The parents want to be present during the procedure, and I informed them that this is not the policy of our facility."
"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 lumbar puncture requires special positioning and holding. This should be done by the nurse and not the parents. The decision to have the parents watch the procedure is up to the health care provider and/or hospital policy. If the parents observe the procedure, they need education prior to the procedure about what to expect.
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 has a medical alert bracelet that is worn at all times." "We had a trampoline but got rid of it after our child was diagnosed." "Our child always wears a helmet and body padding when playing football." "We make sure our toddler wears a helmet and knee pads."
"Our child always wears a helmet and body padding when playing football." Explanation: Contact sports such as football and soccer are safety issues for children diagnosed with hemophilia. There is more chance of sustaining an injury resulting in severe bleeding. Safer sports include swimming and golf. Toddlers who are just learning to walk may have frequent falls, so a soft helmet and knee pads can help prevent injuries. Children diagnosed with hemophilia should wear a medical alert bracelet at all times. Jumping on a trampoline can result in a serious fall resulting in extensive bleeding.
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? "Call 911 and give the child some water while you wait." "Tell me about the symptoms your child is experiencing" "Take your child to the emergency department now." "What makes you think your child is in crisis?"
"Tell me about the symptoms your child is experiencing" The best response is for the nurse to ask about the symptoms the child has, which will help confirm that the child is in crisis. Once the nurse is sure that the child is in crisis, the parent can be advised to take the child to the emergency department or to call 911. Giving the child water may not be appropriate depending on the child's level of consciousness. Asking the parent what makes him or her think the child is in crisis may not elicit the needed information right away. Asking specifically about the child's symptoms is more to the point.
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? "Call 911 and give the child some water while you wait." "What makes you think your child is in crisis?" "Tell me about the symptoms your child is experiencing" "Take your child to the emergency department now."
"Tell me about the symptoms your child is experiencing" The best response is for the nurse to ask about the symptoms the child has, which will help confirm that the child is in crisis. Once the nurse is sure that the child is in crisis, the parent can be advised to take the child to the emergency department or to call 911. Giving the child water may not be appropriate depending on the child's level of consciousness. Asking the parent what makes him or her think the child is in crisis may not elicit the needed information right away. Asking specifically about the child's symptoms is more to the point.
A school-aged child is hospitalized. The nurse assesses the child to be withdrawn and frowning frequently. Which statement made by the nurse would indicate the nurse is utilizing perception-checking? "You've said twice you are not worried about missing school. I wonder if you really are worried. Are you?" "Would you like to talk about what seems to be bothering you?" "You mentioned you play Little League baseball. Are you worried your surgery will keep you from playing again?" "What worries you about being in the hospital?"
"You've said twice you are not worried about missing school. I wonder if you really are worried. Are you?" Explanation: Perception-checking documents a feeling or emotion reported to the nurse. The correct answer has the nurse verifying a perception in which the child states there is no worry. The nurse responds with a question to ascertain the worry. Asking the child if he or she would like to talk or what bothers him or her are direct questions and not something that has been reported to the nurse. Asking the child is he or she is worried about being able to play baseball is using a technique called focusing, which helps a child center on a subject the nurse suspects is causing the anxiety.
The nurse contacts a child life specialist (CLS) to work with children on a pediatric ward. What is the primary goal of the CLS? Decrease anxiety and fear during hospitalization and painful procedure. Keep children who are hospitalized distracted from pain. Act as a liaison between the nurse and the child. Perform medical procedures using atraumatic principles.
Decrease anxiety and fear during hospitalization and painful procedure. The CLS is a specially trained individual who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful (Child Life Council, 2010a, 2010b). The goal of the CLS is to decrease the anxiety and fear while improving and encouraging understanding and cooperation of the child. The CLS may use distraction techniques and act as a liaison, but that is not the primary goal of the CLS role. The CLS does not perform medical procedures.
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? Attentive listening Genuineness Warmth 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.
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? Promote family-centered care. Provide appropriate pain management. Advocate for minimal laboratory blood draws. Maintain the child's home routine related to activities of daily living.
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. The nurse 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. The nurse could advocate for minimum blood draws, but with the child's disease this will likely not happen. The nurse can help the child with reassurance and topical pain medication for laboratory draws to prevent the discomfort of multiple needlesticks. These actions, however, do not offer the child a sense of control.
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? Discuss how to handle a possible emergency situation. Explain the disorder in common terms. Provide literature for the parents to read and then have them ask questions. Use the USDAs "MyPlate" diagram to teach necessary nutrition alterations.
Provide literature for the parents to read and then have them ask questions. Explanation: The parents may not understand the literature 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 (USDAs "MyPlate") to teach about nutrition.
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? It is primarily the younger members who teach the older members in a family. Reproduction remains an important function of many families. Couples today are more concerned about unplanned pregnancies. All adult members share the financial responsibilities.
Reproduction remains an important function of many families. Explanation: The family serves two functions in relation to society: to reproduce and to socialize offspring. Couples today are less, not more, concerned about unplanned pregnancies. This is because of the development of the various family planning methods. It is the responsibility of the older members to teach the younger ones how to function as adults; however, the younger members also teach the older members about the changing world. There are some families where some adults are not wage earners but may stay at home for a variety of reasons (by choice, disability, etc.). This can result in limited resources available for the family.
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? clarifying using silence using clichés defining the problem
Reproduction remains an important function of many families. Explanation: The family serves two functions in relation to society: to reproduce and to socialize offspring. Couples today are less, not more, concerned about unplanned pregnancies. This is because of the development of the various family planning methods. It is the responsibility of the older members to teach the younger ones how to function as adults; however, the younger members also teach the older members about the changing world. There are some families where some adults are not wage earners but may stay at home for a variety of reasons (by choice, disability, etc.). This can result in limited resources available for the family.
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? -Because the adolescent did not pay attention during the teaching sessions, the adolescent does not know what to do. -Some noncompliance should be expected due to the adolescent's desire for independence, expression of personal values, and peer acceptance. -More assistance from the family is needed for the adolescent to manage care. -The developmental thinking skills of the adolescent prevent the adolescent from seeing the connection between personal actions and the effect on health.
Some noncompliance should be expected due to the adolescent's desire for independence, expression of personal values, and peer acceptance. Explanation: Acceptance of some noncompliance by this adolescent is necessary. Finding compromise to limit noncompliance is important. Developmentally, the adolescent is capable of formal thought. Connecting present actions and future outcomes 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 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? Provide information and allow the adolescent to process and ask questions. Offer choices whenever possible. Praise the adolescent often. Speak directly to the adolescent and consider the client's input in the decisions about care and education.
Speak directly to the adolescent and consider the client's input in the decisions about care and education. Explanation: A teaching tip for adolescents that will 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. Adolescents are particularly sensitive about maintaining body image and the feelings of control and autonomy. Reasons as to why things are important should be conveyed to them. The nurse should collaborate with the teen to develop an acceptable solution to being compliant. The nurse should also expect some noncompliance from adolescents. Even with noncompliance in some areas, there some things the adolescent does well—and the adolescent should be praised for these accomplishments. Choices can be offered whenever possible but for a client with diabetes these choices are often limited.
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 lets the child keep her security blanket during a lumbar puncture. The LPN requests minimal laboratory blood draws. The LPN attempts to follow the child's home schedule as best as possible. The LPN holds down the child while another nurse starts an IV.
The LPN holds down the child while another nurse starts an IV. Explanation: The RN would intervene if the LPN held down the child or used traditional restraints unnecessarily. Using alternative positioning such as "therapeutic hugging" is recommended and should be attempted first if at all possible. Minimal sticks should be advocated for with all clients. Following the child's home schedule will help with maintaining a sense of control and help with the child's behavior. The child should be allowed to keep security items when appropriate.
During an office visit to monitor a father's blood pressure, he shares with the nurse that his family is very stressed and experiencing a lot of tension since one or both parents may lose their jobs, their oldest child is applying for colleges (which costs a lot of money), and they recently lost their pet. Which advice should the nurse provide that may prevent an unintentional (accidental) injury? -The parents should discuss finances with their oldest child and try to limit college applications to local, public universities that tend to cost less than private colleges. -Keep the stress within the family unit so that the parents do not burden other relatives and friends. -The parents should try to avoid unintentional injuries like leaving pills out on the counters where younger children can accidently poison themselves. -The parents should discuss their stress related to work on a regular basis.
The parents should try to avoid unintentional injuries like leaving pills out on the counters where younger children can accidently poison themselves. Explanation: The nurse can offer several strategies to reduce family stress. The nurse should encourage parents to reach out for support and explain that under stress, it is easy to become so involved in a problem that one does not realize that other people are around who want to help. Remind family members that unintentional (accidental) injuries increase when people are under stress. Children are more apt to poison themselves when the family is under stress because parents are more apt to leave pills on counters during this time. The nurse should also counsel parents not to rush decisions or make final adaptive outcomes to a stressful situation. As a rule, major decisions should be delayed at least 6 weeks after a stressful event; 6 months is even better. Finally, counsel parents to anticipate life events and plan for them to the extent possible.
A school nurse visiting with a 10-year-old child asks what they do as a family on weekends. The child responds, "Our dad just doesn't want outside people stopping by to visit, so we mainly stay to ourselves." The nurse finds this statement a little odd and makes a mental note to start observing the children in this family for possible signs of what potential problem? abusive or dysfunctional family trying to hide their family abuse from outsiders close-knit family group who prefer their own company doomsday-prepping family who stockpile food supplies and guns fearful of a nuclear attack family of hoarders who do not want people seeing the inside of their home
abusive or dysfunctional family trying to hide their family abuse from outsiders Explanation: A mark of families who are new to a community is they have few community contacts because they have not formed these as yet. This pattern is also the mark of an abusive or dysfunctional family if such a family deliberately keeps outside people separate from them. Families with a hoarding problem or doomsday-prepping families also shield themselves from others but are not very common possibilities. Close-knit families usually have lots of other family members stopping by throughout the week.
During a visit with a new family, the nurse assesses one of their children. The nurse asks about current immunization status and how often the child visits the family health care provider. The nurse also asks the child about experiences with activities outside the home. The nurse reviews the importance of safety like wearing helmets. Given this data, what age group of child would one anticipate this nurse is assessing? adolescent preschool school-age toddler
school-age Explanation: When working with the family of a school-age child, the nurse should focus the assessment on: promoting children's health through immunizations, dental care, and routine health assessments; promoting child safety related to home and automobiles; encouraging socialization experiences outside the home such as sports participation, music lessons, or hobbies; and encouraging a meaningful school experience to make learning a lifetime concern.
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? act out their feelings by crying and screaming at their parents to "Stop!" tell their friends that their parents are always "mad" at them take blame for their parents quarreling and try to behave better make up false stories, pretending they are "one big happy family"
using clichés Explanation: A cliché is the first level of communication. It is pleasant chatting and not intended for a relationship to extend beyond a superficial level. Introducing one's self and role allows the communication to progress to a more therapeutic level. The use of silence will allow the parents to sort out their thoughts. The nurse needs to clarify in the communication to illicit the information needed. The parents both will need to collaborate to define the problem so that a plan of care may be developed.
The registered nurse (RN) and licensed practical nurse (LPN) are caring for a adolescent clients. The RN will intervene if the LPN is seen in which situation while caring for a client? speaking to the client while the caregivers listen and observe asking open-ended questions when talking to the client actively listening to the client while maintaining a relaxed, open body posture using medical terminology to answer the client's questions
using medical terminology to answer the client's questions Explanation: The RN will intervene when the LPN uses medical terminology to answer the client's questions. Terminology that the client can easily understand should be used. It is appropriate for the LPN to actively listen, speak to the client, and ask open-ended questions.
