FINAL PED CHAPTER 8
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?"
"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. It is not appropriate for the nurse to state "hope you are better" or "everything was fine" as these are not therapeutic. If possible, it would be appropriate for the child to tour the operating room prior to surgery, after discussion the child's feelings. Seeing the location may help alleviate some fears.
When teaching an adolescent about home care after hospitalization, what is most important for the nurse to do? Focus the discussion on skill techniques. Use the same type of language as the adolescent. Allow opportunity for the adolescent to express feelings. Provide assurance the nurse will maintain confidentiality.
Allow opportunity for the adolescent to express feelings.
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.
Allow the child to choose between juice, water, or soda to take the medication.
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.
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 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? Having the child and family demonstrate skills. Asking closed-ended questions for specific facts. Requesting the parent to teach the child skills. Setting up a scenario for them to talk through.
Asking closed-ended questions for specific facts. Explanation: Asking questions is a valid way to evaluate learning. However, it is far more effective to ask open-ended questions because they will better expose missing or incorrect information. As with teaching, evaluation of learning that involves active participation is more effective. This includes the child and family demonstrating skills, teaching skills to each other, and acting out scenarios
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. Encourage the child to sit quietly.
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.
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.
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 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? Playing provides the child with a way to expend some energy during the hospitalization. All children like to play. This type of play gives the child an outlet to deal with stress. Therapeutic play lets the nursing staff observe the child's developmental level.
This type of play gives the child an outlet to deal with stress. Explanation: Therapeutic play is a type of play that provides an emotional outlet or improves the child's ability to cope with the stress of illness and hospitalization.
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. mobility restrictions. mutilation of their body. separation from peers and family.
appearing out of control of the situation and/or themselves. Explanation: Adolescents are concerned about how others view them. They wish not to do or say "dumb" things or appear babyish. This concern may cause them to worry about postanesthesia behavior or about how they might react to a procedure. Independence is desired yet a concern. Mobility restrictions, mutilation, and separation are more common fears/anxieties in preschool-age children and school-age children.
The nurse is providing atraumatic care to a child hospitalized forcardiac surgery. Which of the following is a recommended guidelinewhen communicating with the child's parents? a. Do not cause undue stress by providing details of the surgery b. Direct the focus of the parent from providing routine care of the childto preparing for the surgery c. Direct the parents to the physician if they have questions about thesurgery d. Treat the parents as equal partners in the care of their child byallowing them to perform as much care as possible
d. Treat the parents as equal partners in the care of their child byallowing them to perform as much care as possible. Rationale: The nurse should allow the parent to express concerns andask questions, as well as explain equipment and proceduresthoroughly. The nurse should also teach and encourage the parent toperform as much of the child's care as is reasonable and permitted.This helps to give the parents a sense of value and control.
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 silence using clichés defining the problem clarifying
using clichés
Nursing students are learning about the importance of therapeutic communication in their pediatric course. The nursing instructor identifies a need for further teaching when a student makes which statement? "It is good to sit, not stand when listening." "It is good to lean forward when listening." "It is best to stoop to a child's level when listening." "It is best to stand when listening to a child to demonstrate knowledge."
"It is best to stand when listening to a child to demonstrate knowledge." Explanation: Good listening is not passive but active. Posture reveals greatly whether one is listening. Sitting, not standing, means the nurse is actively listening and interested in what the child has to say. Leaning forward, not backward, displays interest in the child and conveys an openness. The nurse can convey good listening habits by pulling up a chair to the bedside or to a table when the child is sitting and engaging with the child at the same level.
A nurse is preparing a 7-year-old child for abdominal computed tomography (CT) scanning with intravenous contrast. What statement would be most appropriate to explain the injection of the contrast dye to the child? "The radiologist is going to inject dye into your IV. You will not feel a thing." "The doctor is going to put a special medicine in your tube so that she will be able to see your stomach better." "You are going to have medicine injected into your IV so that the doctor will be able to see your internal organs better." "The doctor is going to proceed by administering contrast medium into your vein to see what is wrong with you."
"The doctor is going to put a special medicine in your tube so that she will be able to see your stomach better."
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 don't seem concerned about the new treatment regimen." "Are you worried about the new treatment plan?" "You haven't said anything about your feelings toward the new treatment plan." "You must be scared of taking a new chemo."
"You haven't said anything about your feelings toward the new treatment plan." Explanation: Focusing helps children to center on a subject that may be causing them anxiety because they comment on it indirectly or else completely avoid it. It is done by repeating something they said or by mentioning the avoided topic ("You haven't said anything about your feelings toward the new treatment plan"). Once a subject is brought up for discussion, most children respond to it. As long as it can be avoided, however, they do not have to face the problem and will not begin to solve it. The statements that the child does not seem concerned or that the child is scared are assumptions. Asking if the child is worried is a closed ended question that only requires a yes or no answer and will not lead to exploring feelings.
The nurse is incorporating nonverbal communication with verbal communication when explaining the treatment plan for a child with juvenile diabetes. What should the nurse do to communicate effectively with this family? a. Relax; maintain an open posture, with the arms crossed. b. Sit opposite the family and lean forward slightly. c. Use eye contact sparingly to avoid embarrassment. d. Speak a verbal yes or no; do not use head nods.
ANS: B Feedback: 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.
An adolescent is being cared for on the inpatient unit. When planning care using atraumatic care principles, what is of the highest priority for the nurse? Minimize parent-child separation. Allow the teenager to participate in the planning of care. Providing books and music that are appealing to the teenager. Assigning the child to a private room.
Allow the teenager to participate in the planning of care. Explanation: Teenagers need to have feelings of control over their environment. This can be best achieved by allowing the teen to actively participate in developing the plan of care. While separation from the parents may be of concern for any child, this is less important for the teenager than maintaining control. Providing age-appropriate activities of interest is important but this does not have a greater impact than allowing control to be maintained. Privacy is important to an adolescent but it's not as important as allowing the teenager to participate in the planning of his or her care. Reference:
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? Open-ended questions Reflecting Clarifying Perception checking
Clarifying
A nurse is providing care for a child diagnosed with beta-thalassemia who is receiving a blood transfusion. The child reports being bored and asks to go to the playroom. What is the best action for the nurse to take? Accompany the child to the playroom if the child is stable. Explain that the child cannot go to the playroom during the transfusion. Have a child-life specialist find an appropriate activity to occupy the child during the transfusion. Explain the need for quiet rest during a blood transfusion.
Have a child-life specialist find an appropriate activity to occupy the child during the transfusion. Explanation: The best action the nurse can take is to have the child-life specialist work with child to find something interesting the child can do while in the room. There is a safety issue involved if the nurse tries to administer the transfusion in the playroom. The nurse can deny the request or explain the need for rest but if the child is feeling well it will likely not be enough to satisfy the child. Finding an appropriate activity for the child to engage in is the best option.
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.
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.
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? 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. 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.
Take the child on a tour of the facility and surgical suite and explain what to expect preoperatively and postoperatively.
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.
Talk to the parents first to give the child a chance to "warm up." Explanation: If a child is shy, the nurse may start by talking to the parents first to give the child time to "warm up" to the nurse. The nurse should provide education in specific and clear phrases in an unhurried, quiet, yet confident manner. It is important to communicate with the child at the child's eye level. That means the nurse should sit and not stand. Many times involving the child in play will make the child more comfortable and open up the line of communication. The parents should not have the responsibility of informing the child. Education is the responsibility of the nurse. If the child is shy, asking questions will not produce any communication and may make the situation worse. Talking with the child privately should only be done with older school-age children or adolescents to afford them privacy.
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.
Talking one-on-one with the interpreter at numerous points throughout the session with the family present.
The nurse is preparing a child and his family for a lumbar puncture. Which would be a primary intervention instituted to keep the child safe? a. Distraction methods b. Stimulation methods c. Therapeutic hugging d. Therapeutic touch
c. Therapeutic hugging Feedback: Therapeutic hugging (a holding position that promotes close physical contact between the child and a parent or caregiver) may be used for certain procedures or treatments where the child must remain still. Alternatively, distraction or stimulation (such as with a toy) can help to gain the child's cooperation, but therapeutic hugging would be used to keep the child safe during the procedure. Therapeutic touch is an energy therapy used to promote healing and decrease anxiety and stress and is not related to safety.
The nurse is caring for a 14-year-old girl with terminal cancer and her family. Which intervention provides the best therapeutic communication? recognizing the parents' desire to use all options supporting the child's desires for treatment presenting options for treatment informing the child in terms she can understand
informing the child in terms she can understand Explanation: Informing the child in terms that she can understand is the best example of therapeutic communication, which is goal-focused, purposeful communication. Recognizing the parents' and child's desire regarding treatment options is part of family-entered care. Presenting options for treatment is vague.
The nurse is caring for a 14-year-old girl with terminal cancer and her family. Which intervention provides the best therapeutic communication? recognizing the parents' desire to use all options supporting the child's desires for treatment presenting options for treatment informing the child in terms she can understand
informing the child in terms she can understand Explanation: Informing the child in terms that she can understand is the best example of therapeutic communication, which is goal-focused, purposeful communication. Recognizing the parents' and child's desire regarding treatment options is part of family-entered care. Presenting options for treatment is vague.
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
involving the child and family in decision-making
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: 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." have the mother speak firmly to the child to correct the crying and screaming. review safety measures that could have prevented the injury. Close the door tightly and reassure the child, "I am being gentle and am almost done."
tell the child, "It's OK to cry, but I need you to hold still." Explanation: Children should be able to express their feelings openly when they are hurt or frightened. Acknowledging the crying/screaming is developmentally sound. Stating the need to hold still is accurate and respects the child's ability to help. Closing the door is a good idea but "gentle" and "almost done" show little understanding of the child's experience. Expecting the mother to discipline the child or for the child to be able to consider others is unrealistic. Discussing injury prevention at this point is inappropriate, is likely to promote guilt, and appears to place blame. This would interfere with relationship-building between nurse, child, and family.
Which is most likely to encourage parents to talk about their feelings related to the poor prognosis their child has been given? being sympathetic using direct questions using open-ended questions avoiding periods of silence
using open-ended questions
