Chapter 30: Atraumatic Care of Children and Families 1-4

Take the child on a tour of the facility and surgical suite and explain what to expect preoperatively and postoperatively.

An 8-year-old child 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? After interviewing the child, give the child a prize for answering the questions. Tell the child that the parents will not be able to see him or her until after the child returns to the hospital room. Tell the child 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.

are allowed to practice it.

Following a principle of learning, the nurse can anticipate that school-age children will best learn a skill such as bandaging if they: have it demonstrated to them by a teacher. are allowed to practice it. are shown a photo of someone important doing it. are criticized for not learning it well.

Playing a game with coughing and breathing

When planning to teach a toddler about coughing and deep breathing, which would be most effective? Playing a game with coughing and breathing Demonstrating the technique Showing an audio-visual Discussing the importance of coughing

child life specialist

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 psychologist child life specialist occupational therapist play therapist

high level of insecurity

A family that regularly takes in foster children is visiting the junior high school nurse to inform the staff that there will be a new 8th grade foster child beginning school the following week. The school nurse should monitor this new student for which psychosocial response to being moved to the foster care system? aggressive behavior as the child acts out feelings eating disorders like anorexia nervosa high level of insecurity refusal to complete required immunizations

Maintain the child's home routine related to activities of daily living.

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? Advocate for minimal laboratory blood draws. Promote family-centered care. Provide appropriate pain management. Maintain the child's home routine related to activities of daily living.

Speak directly to the adolescent and consider the client's input in the decisions about care and education.

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. Speak directly to the adolescent and consider the client's input in the decisions about care and education. Praise the adolescent often.

Explain to the child that she grew inside another woman, but after the birth she was given to her adoptive mom and dad to raise. Avoid criticizing the biological parents but reinforce how much the adoptive mom and dad love them.

A 4-year-old adopted child has begun to ask questions about when she was born. Which suggestions by the clinic nurse would be considered the most appropriate answer for this child related to her birth? Select all that apply. Explain to the child that she grew inside another woman, but after the birth she was given to her adoptive mom and dad to raise. Tell the child that her biological mom could not care for her after birth because she was HIV positive. Inform the child that her biological mom was in prison and would not be able to care for her for a long time. Explain that her biological mom could not care for her so she was given away. Avoid criticizing the biological parents but reinforce how much the adoptive mom and dad love them.

Clarifying

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 Open-ended questions Reflecting Perception checking

Investigate for potential cultural issues.

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. Discuss the situation with the child. Eat lunch with the child. Refer the family to a nutritionist.

Get the client to draw a picture.

A 7-year-old child with sickle cell anemia who comes to the hospital frequently appears withdrawn and depressed. The client refuses to talk to anyone or even admit to feeling sad. What would be the best thing for the nurse to do that might help the child deal with his or her feelings? Tell the client a joke. Get the client to draw a picture. Play a happy song for the client. Leave the client alone.

play an allergy trivia game 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? show the child a video about planning for allergic-reactions give the child a list of foods he or she cannot eat play an allergy trivia game with the child have the health care provider teach the child this information

Answer the parents' questions as completely as possible.

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? Notify the health care provider that the parents still have questions. Reassure the parents that they have been fully briefed on their child's treatment. Answer the parents' questions as completely as possible. Encourage the parents to focus their attention on their child.

Sing to the infant.

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? Write on a whiteboard. Use puppets to communicate with the infant. Sing to the infant. Use a stuffed animal to tell a story.

Allow the child to choose between juice, water, or soda to take the medication.

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? Show the child a video about medication administration. Use medical terminology when discussing the medication with the child. Allow the child to choose between juice, water, or soda to take the medication. Allow the child to determine if he or she wants to take the medication at that time.

demonstration

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? role modeling video coloring book about diabetes demonstration

Provide opportunities for the parents to participate in the child's care. Encourage the parents to bring personal items to make the child feel more at home. Make the child's room off limits to invasive procedures.

A nurse is providing care for a child hospitalized with a diagnosis of aplastic anemia. In planning the child's care, which intervention(s) will assist the child in adapting to being hospitalized? Select all that apply. Discuss the plan of care out of earshot of the child. Provide opportunities for the parents to participate in the child's care. Encourage the parents to bring personal items to make the child feel more at home. Make the child's room off limits to invasive procedures. Answer any questions the child may have in generalized terms.

"Our child always wears a helmet and body padding when playing football."

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? "We make sure our toddler wears a helmet and knee pads." "Our child has a medical alert bracelet that is worn at all times." "Our child always wears a helmet and body padding when playing football." "We had a trampoline but got rid of it after our child was diagnosed."

Talk to the parents first to give the child a chance to "warm up."

A nurse is teaching a 6-year-old child and parents about an outpatient surgical procedure the child will have the next day. The child is "shy" and does not maintain eye contact with the nurse. What is the best way for the nurse to approach the child? Talk to the parents first to give the child a chance to "warm up." Give information to the parents and let them talk to the child later. Ask the parents to step out of the room and talk with the child privately. Ask the child questions until he or she begins talking freely.

Assign a medication nurse and a primary nurse.

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 team of nurses and unlicensed assistive personnel. Assign unlicensed assistive personnel to care for the child to give the parents a break. Assign a core primary nurse. Assign a medication nurse and a primary nurse.

Approach the toddler while the toddler is being held by the parent.

A parent brings a toddler to the clinic for treatment of a possible ear infection. How will the nurse communicate effectively with this child? Allow the toddler to make independent choices regarding the procedure. Remind the toddler that he or she will have privacy and be covered during the examination. Approach the toddler while the toddler is being held by the parent. Use appropriate medical terminology for the ear, the examination, and the result.

"Tell me about the symptoms your child is experiencing"

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? "Take your child to the emergency department now." "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"

"Certainly. I will stay with your child during the procedure."

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: "Stay. It will be less scary for your child." "This will only take a few minutes. You should be with 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."

dolls

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? coloring games dolls demonstration

The underlying premise refers to the concept of "do no harm."

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 underlying premise refers to the concept of "do no harm." The concept is best demonstrated by providing a ratio of one nurse to one child.

Do not require the child to speak.

A shy child acknowledges the nurse's care by nodding the head. To improve the nurse-client relationship, the nurse should use which intervention? Ask the child open-ended questions. Do not require the child to speak. Respect the child's privacy. Use touch during every interaction.

tell the child, "It's OK to cry, but I need you to hold still."

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: Close the door tightly and reassure the child, "I am being gentle and am almost done." review safety measures that could have prevented the injury. have the mother speak firmly to the child to correct the crying and screaming. tell the child, "It's OK to cry, but I need you to hold still." ask the child to be less noisy because he is "scaring and bothering other children."

Nod head while the mother speaks.

The nurse is assessing the learning needs of the parents of 5-year-old girl who is scheduled for surgery. Which nonverbal cue should the nurse use to show interest in what the family members are saying? Sit straight with feet flat on the floor. Look at the child when the father is talking. Nod head while the mother speaks. Stand several steps away from the parents.

This type of play gives the child an outlet to deal with stress.

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. All children like to play. Playing provides the child with a way to expend some energy during the hospitalization. Therapeutic play lets the nursing staff observe the child's developmental level.

involving the child and family in decision-making

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? arranging an additional meeting with the nurse practitioner discussing treatment options with the child and parents involving the child and family in decision-making describing postoperative home care for the child

Talking to the family about a scheduled diagnostic test. Speaking to the physician as the child's advocate. Showing the child where the pediatric playroom is located.

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. Giving the child an influenza vaccination. Talking to the family about a scheduled diagnostic test. Speaking to the physician as the child's advocate. Showing the child where the pediatric playroom is located. Starting the child's intravenous line.

Assess the client's pain using a 0 to 10 scale.

The nurse is caring for a 15-year-old client following an open reduction and internal fixation (ORIF) of the humerus after an injury and fracture. The client is wincing, diaphoretic, and staying very still in bed to avoid moving the injured arm. The nurse asks if the client has pain, and the client says "it is okay" (above). What should the nurse do for this client? Provide analgesic based on the client's nonverbal pain responses. Assess the client's pain using a 0 to 10 scale. Explain to the client that pain must be reported to have it treated. Understand that the client's culture prefers not to acknowledge pain or medicate for pain.

"You sound worried. Let's talk about tomorrow."

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? "I hope you are better tomorrow, too." "You sound worried. Let's talk about tomorrow." "I had my tonsils removed at your age and everything was just fine." "Would you like to go see an operating room?"

Assess the perception of the problem.

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? Inform the child of priority problems. Assist the child to control emotions. Provide a plan of action. Assess the perception of the problem.

Have a team meeting with the client, family, and involved health care providers.

The nurse is caring for a hospitalized pediatric client. Which intervention will the nurse include to encourage family-centered care? 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. 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.

The child may think the equipment causes the pain.

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? The child is too young to for an explanation of the equipment. Explaining the equipment will only increase the child's fear. The child may think the equipment causes the pain. One explanation will be enough to reduce the child's fear.

Assist the parent in preparing a list of questions for the health care provider's next visit.

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? 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. Ask the parent if he or she would like the nurse to ask the health care provider the questions when the provider visits next. Assist the parent in preparing a list of questions for the health care provider's next visit.

The child demonstrates good technique in self-injection of insulin.

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 lists five foods to ingest when determining that blood glucose levels are too low. The parents of the child demonstrate good technique in administering insulin to their child. The child is able to draw the correct amount of insulin up in the syringe.

drawing pictures

The nurse is having trouble communicating with a hospitalized child. Which communication technique would be the most beneficial for the nurse to offer the child? having the child keep a diary playing video games drawing pictures attending a group discussion

videos

The nurse is planning a teaching session for a group of 12-year-old girls and has determined personal hygiene is a subject that would be of benefit to all. Which method of teaching would be most appropriate for this group? demonstration videos role-playing discussion

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

The nurse is preparing a 5-year-old for a radiograph. What would be the best communication to prepare the child for the procedure? "We are going to take some x-rays of your body." "We need to look inside at some of your organs." "X-rays are not painful; you won't feel a thing." "We are going to use a big camera to take pictures inside your body."

Encourage everyone in the family to use good handwashing techniques.

The nurse is teaching the caregivers of a child with cystic fibrosis. What is most important for the nurse to teach this family? Be sure the child exercises daily. Watch out for signs that family members are overly stressed. Avoid overprotecting the child. Encourage everyone in the family to use good handwashing techniques.

Talking one-on-one with the interpreter at numerous points throughout the session with the family present.

The nurse is working with an interpreter to meet the health needs of a family with limited skills in the dominant language. Which action is not recommended? Talking one-on-one with the interpreter at numerous points throughout the session with the family present. Meeting with the interpreter beforehand, and having the family present, to provide some background information. Pausing after approximately 30 seconds of speaking so the interpreter can translate. Looking at the family while speaking. Having the interpreter review printed information with the family.

The LPN requests minimal laboratory blood draws.

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 holds down the child while another nurse starts an IV. The LPN attempts to follow the child's home schedule as best as possible.

"Your blood pressure reading should be 120/80. Let's talk about some of the things, such as diet and exercise, that can be done to lower the reading and your risk factors for high blood pressure."

nurse is obtaining a blood pressure on an obese 13-year-old adolescent. The blood pressure is 130/86 mm Hg. What statement by the nurse could incorporate an opportunity to educate about obesity? "Your blood pressure reading is too high for someone of your age. You need to start eating better and exercising." "Your blood pressure reading should be 120/80. Let's talk about some of the things, such as diet and exercise, that can be done to lower the reading and your risk factors for high blood pressure." "What are your parents feeding you? You are too overweight for your age group. If you don't lose the weight, you will have a lot of problems." "You must be nervous coming to the office today, because your blood pressure is up."