PREPU PEDS Chapter 8
The nurse is preparing to do an altered family function risk assessment on a client. Which question should the nurse ask first?
"How would each member describe this family?"
An adolescent who plays catcher on the baseball team begins shouting at the nurses, slams the doors, and refuses to talk to anyone after being given the news that his right arm will require surgery. Which response by the nurse would be the most appropriate in this situation?
"I understand you are angry, but please don't shout or slam doors."
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:
"It's OK to cry, but I need you to hold still."
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.
"They are going to give you some special medicine to help the doctor see what is happening inside your belly." "When they come to get you, you will get on a special rolling bed." "This little tube will go in your nose and down into your belly."
The child with cancer spends time watching TV and talking very little about a new chemotherapy regimen that is to start next week. What is the best statement the nurse could use to help the child discuss feelings about the new treatment?
"You haven't said anything about your feelings toward the new treatment plan."
The nurse is caring for a 7-year-old child scheduled for a tonsillectomy the next day. The client states, "I really wish I was not having surgery tomorrow. I am not excited about this. Maybe I will be better by tomorrow." Which response by the nurse is most appropriate?
"You sound worried. Let's talk about tomorrow."
The nurse is explaining a diagnostic procedure to a 7-year-old girl before the procedure begins. Which statement by the nurse best utilizes the principles of atraumatic care?
"You will lie on a special bed that moves in the machine but you can still see out."
The nurse is preparing a 4-year-old to go visit an older sibling in the pediatric intensive care unit (PICU). What teaching method would best help in this child's preparation?
dolls
A nurse is preparing to administer medication to a preschool-age child. What can the nurse do to ensure communication with the child is effective?
Allow the child to choose a drink to have with it
The nurse is caring for a hospitalized child who is from another country who is well spoken in the dominant language. What is the best means for the nurse to determine any unique cultural needs of the family during the child's hospitalization?
Ask the child and family about preferences.
The nurse is educating a 15-year-old girl with Graves' disease and her family about the disease and its treatment. Which method of evaluating learning is least effective?
Asking closed-ended questions for specific facts.
The nurse is caring for a child who appears fearful and is reluctant to talk. The nurse uses therapeutic communication skills to interact with the child. What initial goal does the nurse accomplish when using these skills to communicate with the child?
Assess the perception of the problem.
What should be the first step in developing a teaching plan for a 9-year-old child who needs education about a gluten-free diet for the treatment of celiac disease?
Assessing the child's current level of understanding
A nurse manager on a pediatric unit is making assignments for the day. The nurse's goals are atraumatic care for pediatric clients and minimizing parent-child separation. What method of care delivery should the nurse implement?
Assign a core primary nurse.
The nurse notes that a school-age child does not participate in any teaching or demonstrate any learning identified in the plan of care as priority problems. What action should the nurse implement?
Change the plan of care to include the problem that is more consistent with the child's priority problems.
A 6-year-old reports pain in the stomach upon eating. The nurse replies, "Let me see if I have this right. Every time you eat anything, you get a pain in your tummy?" The nurse is using which technique of therapeutic communication?
Clarifying
A 5-year-old girl tenses up when the nurse approaches to examine her. "Are you afraid?" the nurse asks her. The girl shakes her head in denial. As the nurse lifts the stethoscope to auscultate the girl's chest, however, the nurse notices that the girl tenses up again and grips the edge of the examination table tightly. "Oh—you are afraid of the stethoscope, aren't you?" the nurse replies. "It's okay—it doesn't hurt; see—reach out and touch it." Which communication technique is the nurse demonstrating here?
Empathy
An adolescent remark rather sarcastically that she feels like a "lab rat." What is the priority nursing action?
Ensure information is shared and decisions about care are made with the teen and not for the teen.
An adolescent remarks rather sarcastically that she feels like a "lab rat." What is the priority nursing action?
Ensure information is shared and decisions about care are made with the teen and not for the teen.
The nurse is caring for a child who appears fearful and is reluctant to talk. The nurse uses therapeutic communication skills to interact with the child. What initial goal does the nurse accomplish when using these skills to communicate with the child?
Ensure information is shared and decisions about care are made with the teen and not for the teen.
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. How should the nurse proceed?
Explain to the child why the IV is needed and find creative games to utilize while inserting the IV.
A 13-year-old adolescent with leukemia expresses concern to the nurse over the numerous recent hospital admissions required. The adolescent states a feeling of powerlessness. Which action by the nurse is most appropriate?
Include them in discussions about their health care decisions.
A 7-year-old child who has recently immigrated with the family is brought to the school nurse because the child refuses to eat lunch. Which response should the nurse prioritize?
Investigate for potential cultural issues.
A 10-year-old child with sickle-cell anemia is frequently in the pediatric center of a hospital. What intervention can the nurse provide that will allow the child the sense of control that meets the goals promotes atraumatic care?
Maintain the child's home routine related to activities of daily living.
A home care nurse is teaching a parent how to administer a clotting factor infusion to their child. How can the nurse best evaluate the effectiveness of the teaching?
Observe the parent set up and administer the infusion.
A 9-year-old child with rheumatoid arthritis has difficulty moving the hands as well as other joints due to pain. The child refuses to participate in the prescribed physical therapy. What would be the best way for the nurse to make sure the child continues to exercise the joints?
Play a game like "Simon Says" to introduce exercises.
A child is diagnosed with type 1 diabetes. The parents are devastated. They state, "No one in our family has ever had any problems like this." What interventions can the nurse provide to promote a sense of control and reduce fear of the unknown for the child and family?
Provide a comprehensive education program regarding the care of the child with diabetes.
The nurse is teaching the parents of a newborn with a metabolic problem about the disorder and its treatment. What is the least effective teaching technique?
Provide literature for the parents to read and then have them ask questions.
A nurse is providing teaching on the medication regimen for beta-thalassemia to an adolescent. What is the best way for the nurse to determine if the teaching was successful?
Request that the adolescent teach the information to the nurse.
The nurse is admitting a child to the pediatric medical unit. Upon entering the room the nurse realizes that the child and family speak another language than the nurse (the nurse speaks only English). What actions should the nurse take to address this situation? Select all that apply.
Secure the help of the hospital's interpreter immediately before proceeding with the admission process. When utilizing the interpreter's help keep conversations to a maximum of 20 to 30 minutes. Determine if the child and family are able to read English accurately before giving written directions or information.
A nurse is assigned to care for a 6-month-old infant hospitalized with diarrhea and dehydration. Because the infant does not have developed speech, what can the nurse do to communicate with the infant?
Singing
The nurse has worked diligently with an adolescent to meet the adolescent's teaching-learning needs and promote the adolescent's use of adaptations for managing the illness that suit preferences and lifestyle. Even so, there is evidence of noncompliance. How does the nurse interpret this situation?
Some noncompliance should be expected due to the adolescent's desire for independence, expression of personal values, and peer acceptance.
The nurse is teaching a 6-year-old girl and parent about home care for an eye infection. Which communication techniques would be least effective with this child?
Standing beside the child when doing the teaching.
The nurse is caring for a 8-year-old client scheduled for a computed tomography (CT) scan. The client is anxious about the procedure. Which action by the nurse is appropriate?
Take the child to see the CT equipment and answer any questions.
The child life nurse practitioner has been assigned to assist the hospitalized child and the child's parents. Which interventions are appropriate for the child life specialist to perform? Select all that apply.
Talking to the family about a scheduled diagnostic test. Showing the child where the pediatric playroom is located. Speaking to the physician as the child's advocate.
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 approach would be most effective in helping prepare the child for surgery?
Use a doll to role-play the events surrounding the surgical experience and the procedure.
Based on school-aged cognitive development, which teaching technique would the nurse anticipate as being received the best?
Using containers of water to demonstrate how hemorrhage leads to decreased body fluid
When caring for hospitalized teens, nurses should choose their words and actions carefully since adolescents typically are concerned about:
appearing out of control of the situation and/or themselves.
The nurse is educating the family of a 2-year-old boy with bronchiolitis about the disorder and its treatment. The family parents speak only Chinese. Which action, involving an interpreter, can jeopardize the family's trust?
asking the interpreter questions not meant for the family
A nurse is preparing to teach an 8-year-old child recently diagnosed with diabetes how to give an insulin injection. Which is the best technique for the nurse to use?
demonstration
A preschool child fell off a tricycle and broke an arm that will require surgical repair. The nurse wants to prepare the child for surgery. Which is the best technique the nurse could use to teach the child about what to expect?
dolls
The nurse is caring for a toddler who is scheduled for an outpatient lumbar puncture. Which action by the nurse would be appropriate?
having a child life specialist interact with the toddler before and during the procedure
The nurse is caring for a 14-year-old girl with terminal cancer and her family. Which intervention provides the best therapeutic communication?
informing the child in terms she can understand
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
A 5-year-old is obviously relieved yet angry following a procedure he resisted and needed to be restrained to complete. Which nursing action may be most helpful to this kindergartner?
providing Play-Doh for him to manipulate
The nurse is communicating with a family about their child's illness. Which communication technique would be considered a block to effective communication with the family?
using clichés
A parent wants to wait outside the room while a procedure is completed on his young child, saying, "I don't think I can stand to see you do this!" The nurse's best response is:
"Certainly. I will stay with your child during the procedure."
A nurse is preparing discharge instructions to the parent of a child diagnosed with beta thalassemia. The child will need to take subcutaneous deferoxamine. As the nurse begins the instruction, the parent says "This is all so overwhelming. Can we do this another time?" How should the nurse respond?
Agree to come back later and discuss the parent's concerns.
The nurse is caring for a parent of a 10-month-old infant. The parent is upset and states, "I have so many questions, but the doctor seems too busy to answer my questions." What is the best action by the nurse?
Assist the parent in preparing a list of questions for the health care provider's next visit. SUBMIT ANSWER
The nurse is preparing to teach a 9-year-old child how to do active range-of-motion exercises. Which technique would be most appropriate to use?
Demonstrate the technique by performing it the same way each time.
15-year-old client with type 1 diabetes has been noncompliant with the dietary regimen. When educating the adolescent, what is the most important thing the nurse can do to allow the adolescent to be in control and involved in the decision-making process?
Speak directly to the adolescent and consider the client's input in the decisions about care and education.
The registered nurse (RN) and licensed practical nurse (LPN) are caring for a hospitalized child. Which action by the LPN will cause the RN to intervene?
The LPN holds down the child while another nurse starts an IV.
The nurse is educating an 8-year-old client newly diagnosed with type 1 diabetes on how to administer insulin. Which finding best indicates the nurse's education was successful?
The child demonstrates good technique in self-injection of insulin.
The child has been admitted to a pediatric unit in a hospital. Which nursing interventions use atraumatic care principles? Select all that apply.
applying a numbing cream prior to starting the child's intravenous line asking the child if he would like to take a bath before or after he takes his medication encouraging the family to bring in the child's favorite stuffed animal from home showing the parent how to unfold the chair in the child's room into a bed
The nurse is caring for a 3-year-old child who must have a lumbar puncture. Which action provides the greatest contribution toward atraumatic care?
having a child life specialist play with the child
A 9-year-old child is newly diagnosed with asthma. The nurse plans to teach the child about triggers related to the diagnosis. What would be the best approach for this child?
play an allergy trivia game with the child
A child is hospitalized with complications related to hemophilia. The health care provider has discussed the child's plan of care with the parents, but they continue to ask questions. What action will the nurse take?
Answer the parents' questions as completely as possible.
A family is anxious for information about the status of their ill infant. The parents do not understand the dominant language, but their 14-year-old child is competent in the language, both spoken and written. The health care provider is present, but an interpreter is unavailable. What should the nurse do?
Coordinate health care provider and interpreter schedules and arrange an information-sharing session for later in the day.
A nurse is working with a 13-year-old girl who continually demands cups of water or juice, specific foods, and constant changes to her bed position. How should the nurse respond to this client?
Graciously meeting her requests, within reason
The nurse is caring for a hospitalized pediatric client. Which intervention will the nurse include to encourage family-centered care?
Have a team meeting with the client, family, and involved health care providers.
The nurse is caring for a child undergoing a painful procedure. When using distraction, which methods would be appropriate? Select all that apply.
Sing to the child. Ask the child to squeeze the nurse's hand. Play music the child likes. Ask the child to tell a story about a happy memory.
The nurse suggests to the parent of a preschooler who had unexpected surgery that the child be given a doctor/nurse kit to play with at home. Select all reasons that this would be an effective strategy.
The child can use the kit with dolls or stuffed animals to work through feelings about the healthcare experience. The parent can observe the child's play to identify any misperceptions about the unprepared-for experience and correct them. Role-play is an age-appropriate, common form of play for preschoolers through which experimentation and learning occur. The preschooler can pretend to be a physician or nurse practitioner who has the power to control events that the child lacked as a recipient of care.
During the change of shift report, the nurse reports concerns about the parents of a hospitalized child understanding the written literature provided concerning the child's plan of treatment. Which observations would provide support to this concern? Select all that apply.
The child's mother provides little responses to information provided. The child's medical record contains information indicating the family frequently misses appointments. The child's mother asks the nurse to complete paperwork for her.
The nurse is assessing the learning needs for a 12-year-old boy with a chronic health condition, as well as his parents. Which aspect would be least pertinent to a learning needs assessment?
The family belongs to a mainline traditional faith community.
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 underlying premise refers to the concept of "do no harm."
The nurse is planning interventions for a child being evaluated at the health clinic. How will therapeutic communication benefit the child?
Therapeutic communication enhances the development of trust between the nurse and the child.
After teaching the parents of a toddler how to change the dressing on their child's abdomen, the nurse should use which method to best evaluate the parent's technique?
having parents perform a return demonstration
A child who has had several surgeries to correct a congenital defect is found crying after receiving the news another surgery will be needed. The nurse could best assist this child through what form of communication?
touch
The inpatient pediatric care unit has recently added a child life specialist (CLS) to the care team. When reviewing needs of the children on the unit, which would be appropriate for referral to the CLS? Select all that apply.
A child and family who are facing a recent terminal diagnosis for the child. The family consisting of an infant and her teenage mother. The child whose parents cannot visit as a result of suspicions of child abuse.
A nurse is talking with a 10-year-old child and 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?
The child may be shy and have some reluctance about communicating.
The father of a child hospitalized after a fire questions the use of therapeutic play. He reports he does not understand the purpose. What information can be provided to him?
This type of play gives the child an outlet to deal with stress.
