MCN - Unit 1 - Chapter 30: Atraumatic Care of Children and Families

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 video story pictures

dolls Preschool-age children tend to be frightened of intrusive procedures. Explaining to preschool-age children what the sibling may look like or what the environment may look like is difficult for them to comprehend. Explaining to children why the tubes are necessary, why the sibling cannot talk, and what the sibling will look like is best taught with dolls or puppets. Using dolls or puppets help children visualize details. Pointing to a place on a doll's body is not as intrusive as pointing to the child's own body. Visualizing the tubes coming out of the doll helps the child visualize details. Explaining to children why the tubes and the machines are necessary calls for clear understanding and praise for learning. Pictures, videos, and stories do not allow the child to actively participate in the learning process.

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. 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. 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.

A nurse is attempting to reduce pain that a child is experiencing after an emergency appendectomy. What intervention can the nurse provide to meet this goal? Assess the child frequently and use pharmacologic and nonpharmacologic methods of pain relief as needed. Have the child turn every 2 hours prior to administering pain medication. Encourage oral fluids after surgery. Provide diversional activities postoperatively so the child will not focus on the pain.

Assess the child frequently and use pharmacologic and nonpharmacologic methods of pain relief as needed. Using the principles of atraumatic care, the nurse may attempt to control pain via frequent assessments and use of pharmacologic and nonpharmacologic interventions.

The nurse from a rural area moves to a large city to work in a family clinic where there are families from a variety of different cultures. The nurse should prioritize which goal as she begins working in this new environment? Use each family's culture as a guideline for care Encourage the family to compromise with similarities Examine her own feelings concerning cultures Ask the families about their cultural beliefs

Examine her own feelings concerning cultures The nurse must first understand her own feelings and understanding of her own culture, then try to understand the other cultures. In the process the nurse should develop cultural awareness, engaging in self-exploration beyond one's own culture, seeing children from different cultures, and examining personal biases and prejudices toward other cultures. Once this occurs, the nurse can then learn as much about the culture as possible and become familiar with similarities and differences between his or her own culture and the family's culture. The nurse would adapt nursing care to address the practices of the family's culture to provide culturally competent care.

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. 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? 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. Schedule time to address the parent's concerns.

Include the parent in the medical decision-making. 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.

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. Giving the child an influenza vaccination. Starting the child's intravenous line. Showing the child where the pediatric playroom is located. Speaking to the physician as the child's advocate.

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 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.

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. 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 caring for a young pregnant couple who are members of an extended family. The nurse anticipates the greatest challenge for this family will involve which factor? lack of support people in a crisis a parent wishing he or she had more education limited amount of available resources a child developing a chronic illness

limited amount of available resources Extended families usually consist of the nuclear family of the parents and children and then relatives such as grandparents, aunts, uncles, cousins, etc. living together. This can result in limited resources due to many family members and often few providers. One of the advantages of the extended family is the increased support which is available. The amount of education or a child developing a chronic illness would not be factors to consider nor have any influence in this case.

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. 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. 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.

The parent of a preschool-aged child asks the nurse for ideas on preparing the child for abdominal surgery requiring general anesthesia. What would the nurse recommend for this parent? Select all that apply. Remind the child that parent will be there when the child wakes up. Encourage the child to ask questions and talk about fears. Help the child select a couple of toys appropriate to take to the hospital. Use play to demonstrate procedures on the child's toy dolls. Assure the child that pain medication will take all the 'hurt' away. Schedule a tour, specific for children, of the hospital and surgical area.

Encourage the child to ask questions and talk about fears. Help the child select a couple of toys appropriate to take to the hospital. Use play to demonstrate procedures on the child's toy dolls. Schedule a tour, specific for children, of the hospital and surgical area. The preschooler will benefit by preparations such as play, touring, having familiar toys from home and being able to ask questions. Before promising to "be there when the child wakes up," the parent would need to verify that the hospital allows parents in the postanesthesia care unit (PACU), and if not, the parent would tell the child that he or she will be there when the child gets into the room. Although pain medication will be used to reduce the child's pain postoperatively, the parent would avoid promising the child no pain, as the child will have some postoperative pain.

The nurse is preparing to assess the pain of a postoperative 9-year-old client from a different culture. The charge nurse says, "Those people never admit to pain or take pain medications. You should just mix the medication in with their food." What should the nurse do? Follow the charge nurse's advice and mix the prescribed pain medication with the client's meal. Explain to the charge nurse that this is a stereotype and treatment without consent; then go and assess the client's pain. Tell the family the child needs pain medication and provide education on the different types. Prepare to use a nonverbal pain scale to assess this child's pain level.

Explain to the charge nurse that this is a stereotype and treatment without consent; then go and assess the client's pain. The charge nurse is stereotyping the family based on their culture and making assumptions about their response to pain. The nurse should educate the charge nurse on this behavior and then assess the client before making any determination about the need for pain medication. Additionally, medication should not be administered without consent. The nurse should not routinely mix medications with food. If the client does not consume all the food, the nurse will not know how much medication was taken and the mixture can lead to an unpleasant taste in the food. The nurse should address the charge nurse's behavior. There is no indication a nonverbal pain scale is needed. If language is a barrier, the nurse would use an interpreter.

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.

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. At least by 4 years, children are old enough to fully understand the story of their adoption: they grew inside the body of another woman who, because she could not care for them after they were born, gave them to the adopting parents to raise and love. It is important for parents not to criticize a birth mother as part of the explanation because children need to know, for their own self-esteem, that their birth parents were good people and they were capable of being loved by them, but things just did not work out that way. At age 4, children do not understand HIV status, not being able to provide for the needs of an infant, or prison terms.

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. 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 teaching injection techniques to a school-aged child newly diagnosed with type 1 diabetes. Which observation would be the best evaluation that learning was successful? The child developed a schedule for injection times and sites and has placed it on the refrigerator. The child needs occasional cueing during return demonstration of the injection technique. The child shows an eagerness to learn more about type 1 diabetes. The child explains the importance of performing the injections to keep feeling well.

The child needs occasional cueing during return demonstration of the injection technique. School-age children have a need to cooperate and achieve. Evaluation of learning should measure whether the child actually carries out the procedure or not. For a school-age child to only need occasional cueing, this is considered that learning is achieved. The purpose of the teaching was to ensure the child could properly inject and administer insulin. Understanding the disease process and schedules are not part of learning to inject insulin. Developing a schedule and posting it on the refrigerator would be above the developmental level of a school-ager.

The nurse is planning interventions for a child being evaluated at the health clinic. How will therapeutic communication benefit the child? Therapeutic communication improves the child's ability to cope with the examination. Therapeutic communication will limit the amount of trauma the child experiences. Therapeutic communication assists the nurse in maintaining accurate assessment data. Therapeutic communication enhances the development of trust between the nurse and the child.

Therapeutic communication enhances the development of trust between the nurse and the child. Therapeutic communication involves open-ended questions, therapeutic play, acknowledgment of the client's emotions, and active listening, which all help to enhance the nurse-client relationship by building trust between the client and the nurse. The nurse would implement procedures and interactions specific to the child to provide atraumatic care, which will also assist the child in coping. The nurse would obtain an accurate assessment by encouraging cooperation from the child using play or games.

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

are allowed to practice it. School-age children are in a concrete cognitive stage. They learn best if they can actually practice procedures and demonstrate them on their own. Nurses should explain procedures and the reasons for them in a simple logical way. This age group is not yet where they can think abstractly. They learn best with role playing, games, and show and tell. They need activities that create enthusiasm. Watching someone else do the procedure or seeing it in a book does not allow the child to learn the material and master the procedure. Children should not be criticized for not learning well. The technique of teaching should be changed to meet the child's learning needs.

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

demonstration 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 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 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 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.

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 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.

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 Therapeutic communication is an interaction between two people that is planned, deliberate, has structure, and is helpful and constructive. Using open-ended questions is an example of a therapeutic communication technique. Nurses should demonstrate empathy to clients, not sympathy. Empathy is the ability to put yourself in another person's place and understand and be sensitive to the feelings of another. Direct questioning is a nontherapeutic form of communication and requires only yes or no answers. In instances where there is no cure for the child, if the nurse practices therapeutic communication the nurse still has the ability offer support by the words used or nonverbal communication such as touch. In perspective, these are the most valued, most appreciated, and most helpful aspects of care.

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." "Stay. It will be less scary for your child." "This will only take a few minutes. You should be with your child." "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." Excusing the parent from the procedure is the best response. The parent's needs and abilities need to be respected and supported. Children usually receive the most support from parents. However, others can provide effective support, including nurses and child life personnel. Consider, also, that an anxious parent usually means an anxious child. Assist the parent to comfort the child after the procedure.

A 9-year-old arrives in the clinic for a venipuncture. The child says to the nurse, "You better know what you are doing, because you only get one chance at this!" What is the best response by the nurse? "I can understand that you are concerned about having your blood drawn. I will try and make this as comfortable as possible." "That is a lot of pressure to place on me. Sometimes, it takes a couple of times to get it right." "Why are you so angry?" "I am good at what I do, but even I can miss a vein sometimes."

"I can understand that you are concerned about having your blood drawn. I will try and make this as comfortable as possible." In the same way that children who request health care do not enjoy being criticized, neither does the average health care provider. If a child makes a critical remark, therefore, it is easy to respond with a defensive or protective comment rather than a therapeutic one. The nurse should try to respond instead with a supportive comment. When making this statement the child may not be angry but rather frightened. Telling the child it may take a couple of tries only increases the anxiety and fear.

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? reassurance touch silence supportive statements

touch Touch is the most intimate and meaningful form of nonverbal techniques. When words are inadequate touch rarely is. Touch can be used to accompany reassuring words or in place of words as a strong support signal (e.g. I'm here; I understand; it is all right to be afraid). Staying with the child and touching them while they cry allows the child to be upset with no condemnation, but also says the nurse cares. Silence is used after asking a question and giving the child time to respond. Supportive statements let children know you accept their behavior. Reassurance would only be false in this situation.

The nurse suspects poor literacy skills in a child's family member when which statement is made? "I forgot my glasses, so I'll read this when I get home and let you know if I have questions." "I need you to review once more the best way to be sure he swallowed all his medicine." "He gets a suppository every 3 days to prevent constipation." "We communicate with the special education teachers and school daily with a notebook."

"I forgot my glasses, so I'll read this when I get home and let you know if I have questions." Identifying poor literacy or health literacy skills can be difficult. Many will work to hide this lack. "Forgetting" one's glasses could provide an excuse for not reading or questioning and should raise concerns about literacy. If other indicators such as a history of medication errors, English as a second language, an elderly caretaker (grandparent), or numerous missed appointments are present, the index of suspicion is higher. Needing a review, knowing how the suppository was used, and notebook communication with the school would ordinarily not raise a literacy or health literacy concern, although they do not rule it out.

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? "Stop shouting at the nurses. We're only trying to help you." "I am really sorry about your arm, but surgery is needed to correct the problem." "Once surgery is over you'll be back playing baseball in no time." "I understand you are angry, but please don't shout or slam doors."

"I understand you are angry, but please don't shout or slam doors." All children grow angry at some time, boys generally more than girls. It is difficult to work with angry children because the nurse can get pulled into their anger. The typical response at hearing an angry outburst is to imitate it (e.g., the child shouts at you and you shout back). This is not a therapeutic response and many times escalates the situation. The nurse should acknowledge the child's anger and help the child focus the anger so the child can better identify why there is anger and begin to deal with it. Saying surgery is needed to correct the problem is stating a fact the adolescent already knows and is the cause of the anger. Saying, "You'll be back playing baseball in no time" is offering false reassurance. It also addresses the issue in the future and not in the present.

The parents of a 2-month-old infant have learned that their infant has hemophilia. The parents are visibly upset and ask how this could have happened to them. What is the nurse's best response? "Please do not be upset; it is not your fault. Things like this happen sometimes." "There is no need to worry. We will teach you how to take care of your child." "I understand how you feel. Let's talk about where you go from here." "News like this is difficult to hear. Let's talk about what this means for your child."

"News like this is difficult to hear. Let's talk about what this means for your child." The nurse's best response is to therapeutically acknowledge the parents' concerns and the fact that it is upsetting to them. Next, the nurse should give the parents information about what the diagnosis means for them and their child. While the diagnosis is not the parents' fault, saying that "things like this happen" sometimes is nontherapeutic. Telling the parents that there is no need to worry or that the nurse understands how they feel is untrue and nontherapeutic.

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."

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

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. "This little tube will go in your nose and down into your belly." "I am going to give you this shot and it will put you to sleep." "You will end up in the 'ICU' where you will wake up with some electrodes on your chest." "When they come to get you, you will get on a special rolling bed." "They are going to give you some special medicine to help the doctor see what is happening inside your belly."

"This little tube will go in your nose and down into your belly." "When they come to get you, you will get on a special rolling bed." "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 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." 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.

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 technician needs to take several tubes of blood from you." "The big machine will look inside you to see why you are sick so just hold still." "I don't think you will be in the X-ray department very long."

"You will lie on a special bed that moves in the machine but you can still see out." Introducing strange equipment to the child in age-appropriate words and words that can be understood is atraumatic care. Telling the child the technician is going to take several tubes of blood can be scary as the child may not understand the word technician and the child may worry that all of her blood is being taken. Telling the child that a big machine will look inside her may scare her into thinking that the machine might cut her open to look inside her. Not giving the child an exact time when the procedure will end is not utilizing the principles of atraumatic care. She should be told something like "after lunchtime" or "until dinner time."

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. 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 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. When a child is ill and medication is needed to be administered the child should not have a choice in the timing of medication administration. The medication is administered for the benefit of the child. The preschooler does, however, have choices in the matter. The preschooler can choose how he or she wants to take the medicine, that is, in a medicine cup or through a syringe, if the child wants to squirt the medicine by himself with nursing support or what type of liquid the child would like the medication mixed with. Showing a preschool-age child a video does not accomplish the education, because a child of this age sees the person on the screen separate from himself/herself. The nurse should always speak to the child in words the child can understand.

A group of children with chronic renal disease will be attending a class on nutrition. What are factors the nurse needs to consider to make the class effective for these children? Select all that apply. Have everyone share his or her disease history. Assess for common interests and goals. Limit one person from dominating. Avoid competition in the group. Determine the ability to learn self care.

Assess for common interests and goals. Limit one person from dominating. Avoid competition in the group. Group teaching can add depth to learning. For many children, learning they are not the only person with a particular problem is very important to hear. When a nurse conducts group teaching, there are several guidelines that are important to follow for an effective teaching session. These include: assess for common interests and goals so the information presented will appeal to as many in the group as possible; be certain all the members of the group can see and hear each other; encourage the members of the group to participate; limit one person from dominating; avoid competition in the group; and ask the members of the group to evaluate the experience. The child's ability to learn self care would depend on the age and disease progression and is not considered a guideline for group teaching. Having every child share their disease history might cause anxiety and is not necessary when the topic is nutrition. It may also be construed as an invasion of privacy.

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.

Assess the perception of the problem. Therapeutic communication is an interaction between two people that is planned (e.g., the nurse deliberately intends to determine how a child truly feels), has structure (e.g., the nurse uses specific wording techniques that will encourage a truthful response) and is helpful and constructive (e.g., at the end of the exchange the nurse will know more about the child than in the beginning and ideally the child will know more about a particular problem or concern). The initial goal in working with this child is to determine the child's perception of the problem. Once that is accomplished, the nurse can develop a plan of care to identify priority problems and help the child deal with the fear.

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.

Assign a core primary nurse. Family-centered care is the gold standard for pediatric nursing. It decreases anxiety for both the parent and the child, recovery times are shortened and pain management is enhanced. When a primary nurse is assigned to the child and family, they have an identifiable source to help meet their needs. Oftentimes when more than one person is providing care, effective communication is lost. The family is the primary source for the child and they should not be separated. Having a medication nurse and primary nurses tends to fragment care. The unlicensed assistive personnel can provide basic care for the child, but the parents to be offered to communicate how much involvement they wish in their child's care.

A child is admitted for treatment of a congenital cardiac disorder. The parents are extremely upset and ask, "How could this happen? Will our child die?" What can the nurse do to help the family meet the health care needs of the child? Be honest with the family and allow them to express concerns and ask questions. Inform them that they should wait in the waiting room while the health care provider examines the child. Inform the family that everything will be done to cure the child. Inform the family that to have the best outcome for the child, they must trust everyone involved in the care.

Be honest with the family and allow them to express concerns and ask questions. When communicating with parents, the nurse should be honest. Nurses should allow the parents to express concerns and ask questions, explain equipment and procedures thoroughly, and help the parents to understand the long-term as well as short-term effects of the treatments. When families are frightened they do not know who to trust, so telling them to trust everyone is unrealistic. Not allowing the parents in the room while the health care provider examines the child only increases the parents' anxiety. Informing the parents that everything will be done to "cure" the child is also not being totally honest. Some diseases and defects have no cure.

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? Document that the child's learning is inconsistent with the client's priority problems. Change the plan of care to include the problem that is more consistent with the child's priority problems. Revise the plan of care so that the identified problem is a high-risk problem rather than a priority problem. Plan and implement additional nursing interventions that address the identified problem.

Change the plan of care to include the problem that is more consistent with the child's priority problems. If an assessment is inconsistent with the priority problems identified in the plan of care, the plan of care should be revised. The new plan should include the new relevant problems. The developmental level of the school-age child must be taken into consideration when making or adjusting the plan of care. School-age children enjoy short projects and may learn best if the teaching is broken down into different stages. They become interested in doing things that only their friends are doing. If a problem is a priority that the child must learn to solve or provide self-care, then the teaching plan and plan of care need to be revised to identify how best to achieve the goal. Planning and implementing additional nursing interventions are not necessary if the child refuses to participate. Documenting does not solve the problem.

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. Have the child and health care provider discuss the information thoroughly and help the child share these data with the parents. Support the child while the child interprets for the parents and the health care provider at the bedside. Develop a written account of the infant's status with the health care provider that the child can read and explain to the parents.

Coordinate health care provider and interpreter schedules and arrange an information-sharing session for later in the day. 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 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? Tell the child different ways to perform the technique so the child can choose. Demonstrate the technique by performing it the same way each time. Allow the child to review instructional pamphlets as the nurse is teaching. Suggest the child tell the nurse how he or she wants the range-of-motion exercises to be done.

Demonstrate the technique by performing it the same way each time. For a 9-year-old child, consistent instruction using hands-on techniques is best. All the attention should be focused on the nurse as the nurse is teaching. Achievement and accomplishment are very important to the school-age child. Gaining control over the situation by learning what the nurse is teaching is important to the child's self-esteem. Teaching different ways to perform a technique would be confusing to the child; he or she would likely not learn the skill correctly. The child is not able to dictate how to perform the skills.

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 Genuineness Warmth Attentive listening

Empathy 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.

The nurse is providing tertiary care to a young, uninsured family who has a child with frequent seizures. Which action by the nurse would demonstrate tertiary care? Performing a well-child checkup, noting weight gain Educating the parents regarding appropriate play activities for the child Finding a company to provide a helmet for the child to wear daily. Nutritional guidance for healthy meals for the family.

Finding a company to provide a helmet for the child to wear daily. Tertiary care involves health promotion focused on rehabilitation and prevention of further injury or illness, and it optimizes function. By providing a safety helmet to the child with a history of seizures, the nurse is preventing further injury to the child. Nutritional guidance is an example of primary prevention, focusing on good nutrition to prevent risk factors that may cause impairment. Performing the well-child checkup and educating about appropriate play activities address secondary prevention, which reflects health screening and prompt treatment of problems.

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.

Get the client to draw a picture. A useful nonverbal technique to assess how children feel about a frightening experience is to ask them to draw a picture. Children cannot always verbally express what they are feeling. Being able to convey feelings on paper can open the door for the nurse or child life specialist to help the child deal with the problem. Humor will not fill the void. It is not effective with depression because it is not interpreted as humor. Usually children are looking for a firm support person to be with them, not an amusing one. Using music can be helpful, but the child should pick the type of music that will then convey the mood. The nurse should not leave the child alone. Doing so will only add to further isolation.

The nurse is caring for an adolescent with a newly diagnosed disease process. The adolescent refuses to learn about the disease. Which technique should the nurse use to encourage the adolescent to be actively involved in education about this disease? Help the adolescent understand how new information about the disease will improve health status now. Encourage the adolescent to be educated about the disease to know what to expect concerning treatments. Urge the adolescent to listen attentively to what information the nurse wants to teach. Help the adolescent to realize that he or she is different from peers and needs teaching while they do not.

Help the adolescent understand how new information about the disease will improve health status now. Adolescents are present-oriented, so they generally respond best to information that has direct application. Adolescents do not focus on the future. Urging adolescents to listen and understand that they are different from peers will not encourage learning about the disease process. Adolescents want to be like their peers. Thus, the nurse should provide reasoning why something is important and how it affects the adolescent's current life.

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? Eat lunch with the child. Discuss the situation with the child. Investigate for potential cultural issues. Refer the family to a nutritionist.

Investigate for potential cultural issues. 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 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.

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

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? Inform them that the child has not eaten healthy foods and now it is a necessity. Inform them that someone in the family must have some form of diabetes. Show them how to administer injections so that the child will not have to do it. Provide a comprehensive education program regarding the care of the child with diabetes.

Provide a comprehensive education program regarding the care of the child with diabetes. Principles of atraumatic care include promoting a sense of control and reducing fear of the unknown through education and familiar articles, and decreasing the threat of the environment. Getting a diagnosis of type 1 diabetes can be overwhelming for the family as well as the child. There is a very large amount of information that must be learned to provide care. Developing a comprehensive plan for educating the child and the family is essential. At this point, the family is devastated and is not focused on why the illness has occurred. They need to learn how to deal with the disorder so their child can be treated and safe. Seeking answers will come later. Telling the parents that feeding unhealthy foods to their child caused the disease is inaccurate.

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. Explain the disorder in common terms. Discuss how to handle a possible emergency situation. Use the USDAs "MyPlate" diagram to teach necessary nutrition alterations.

Provide literature for the parents to read and then have them ask questions. 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? Couples today are more concerned about unplanned pregnancies. Reproduction remains an important function of many families. It is primarily the younger members who teach the older members in a family. All adult members share the financial responsibilities.

Reproduction remains an important function of many families. 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 providing discharge teaching for an 8-year-old child after admission with an asthma exacerbation. The child is accompanied by a parent who does not speak the dominant language. How will the nurse complete the discharge teaching? Select all that apply. Request that the family bring a friend who is bilingual to assist with discharge teaching interpretation. Focus on the interpreter during the conversation and allow them to fully convey any expression or emotion from the child and parent. Speak clearly using short sentences and provide pauses for interpretation and responses. Ask the client and family to provide return demonstration of inhaler use to ensure understanding. When providing written discharge or follow-up information, ask the interpreter to translate in the family's language.

Speak clearly using short sentences and provide pauses for interpretation and responses. Ask the client and family to provide return demonstration of inhaler use to ensure understanding. When providing written discharge or follow-up information, ask the interpreter to translate in the family's language. The nurse should use a professional interpreter and not a family friend for all care and procedures. When working with the interpreter, the nurse should focus on the client/family, not the interpreter to see the client's expressions. The interpreter can also translate written materials for the family. Asking the family to provide a return demonstration will assess their understanding.

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.

Speak directly to the adolescent and consider the client's input in the decisions about care and education. 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 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. Listening attentively to the child while giving time to finish thoughts and ideas. Talking directly to the child even though the parent makes comments. Asking permission to touch the child before doing so.

Standing beside the child when doing the teaching.' Standing above a 6-year-old may create the feeling of being dominated. Sitting at her level promotes equality and a more comfortable teaching/learning setting. Listening with patience to the child when she speaks or asks questions allows her time to completely formulate and express her thought or question. It is respectful. Talking to the child as well as the mother during health teaching keeps the child a participant in her care. Asking permission to touch the child reduces threat.

An 8-year-old 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. Nurses can help children cope with the experience by using age-appropriate and child-specific interventions. Preparation can help children and their families to adjust to illness and hospitalization. Preparing the child reduces stress and fear. As much as possible, the nurse or child life specialist can show the child the areas where the child will have surgery, play with age-appropriate dolls to learn such things as IV insertion, and answer all the child's questions. Telling the child the parents will not be able to see him or her increases fear and anxiety. Being able to have a popsicle after surgery is the truth, but it is not the entire truth nor does it prepare the child for unknown places. The purpose of prehospital preparation is not to interview the child but to prepare the child.

The nurse is caring for a 13-year-old client with ulcerative colitis who has a new temporary colostomy. Which nursing intervention is priority? Encourage the parents to care for the child. Teach the client how to perform colostomy care. Set up home health care for the client. Discuss the process for colostomy reversal with the client.

Teach the client how to perform colostomy care. The principles of atraumatic care state to promote sense of control; provide opportunities for control, such as participating in care; attempt to normalize the client's daily schedule; and provide direct suggestions. By teaching the client how to perform colostomy care, the nurse is promoting self-care. The parents need to know how to care for their child; however, it is a priority for the client to receive the education because the client is old enough to perform the care. The nurse will ensure home care is scheduled, but again, this is not a priority. Discussing the reversal process is something the client will be interested in and should be discussed; however, it is not a priority over understanding the current situation.

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.

The child demonstrates good technique in self-injection of insulin. As a final step of communication or teaching, what was communicated or learned must be evaluated. A new plan may need to be developed and teaching continued if communication or learning was less than optimal. An example of an outcome criterion is the child demonstrating good technique in self-injection of insulin, which will include having the child draw up the correct amount of insulin. But that alone does not indicate the client is able to self-administer insulin. The purpose of the education is to have the child, not the parents, develop skills to provide self-care. Learning about foods for hypoglycemia is a separate topic from self-administration of insulin.

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 asks many questions. The child's mother asks for additional resources to review about the planned treatment. 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 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. Understanding health-related information can be challenging. It is a role of the nurse to ensure an understanding of information and materials provided. Signs that information is not being understood may include asking few questions about the plan of treatment. Missed appointments may also signal a lack of understanding. Asking the nursing staff to complete paper work may signal a lack of understanding or possibly an inability of the family to do it themselves.

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. The nurse concludes that the parents are emotionally distraught. Discovering that the father is highly health care literate. Finding that the mother relies on American Sign Language.

The family belongs to a mainline traditional faith community. Membership in this traditional faith community impacts learning needs the least. There are no particular values or traditions that would require modification of the care plan for a child with his health problem. Parents experiencing a highly charged emotional state creates a learning barrier for them. A very healthcare-literate person would require less repetition and simplification of the explanations given. A deaf mother may require an interpreter if the nurse does not know American Sign Language.

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? allowing too little appointment time for the translation using a person who is not a professional interpreter asking the interpreter questions not meant for the family using an older sibling to communicate with the parents

asking the interpreter questions not meant for the family Asking questions or having private conversations with the interpreter may make the family uncomfortable and destroy the child/nurse relationship. Translation takes longer than a same-language appointment and must be considered so that the family is not rushed. Using a nonprofessional runs the risk that he or she won't be able to adequately translate medical terminology. Using an older sibling can upset the family relationships or cause legal problems.

The nurse needs to assess a 4-year-old child's tympanic membrane with an otoscope. What action would make this procedure the safest? asking the parent to use therapeutic hugging during this assessment restraining the child with soft wrist restraints explaining the procedure to the child, emphasizing the importance of not moving during the assessment using the technique of distraction during the assessment of the tympanic membrane

asking the parent to use therapeutic hugging during this assessment Placing the otoscope in the child's ear will require the child to not move in order to prevent damage to the ear or tympanic membrane. Therapeutic hugging (a holding position that promotes close physical contact between the child and a parent or caregiver) would be the best choice for this procedure. Restraints should never be used unless absolutely necessary. The child is too young to rely only on an explanation of the procedure to ensure the child doesn't move. Distraction is very useful in many procedures, but would not be the safest choice for this assessment technique.

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 explaining the procedure with a picture and diagram to ensure cooperation of the toddler reminding the toddler that privacy will be maintained by a gown or blanket during the procedure educating the parents to begin preparing the toddler for the procedure about 1 week in advance

having a child life specialist interact with the toddler before and during the procedure Having a child life specialist play with the toddler would provide the greatest support for the toddler and make the greatest contribution to atraumatic care. Privacy is specifically important to the adolescent age group, rather than the toddler age group. The nurse would educate the parents of the toddler to prepare the child immediately before the procedure. One week of preparation would be more appropriate for the adolescent. Using diagrams and explanations are beneficial to the school-aged child.

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 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.

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 discussing the reasons for the procedure with the child and parents getting paper and markers so that he can draw and color finding an age-appropriate action DVD for him to view

providing Play-Doh for him to manipulate All actions have some merit. The Play-Doh choice is the best means for him to pound, smash, and otherwise vent his feelings in a safe, age-appropriate way. Drawing also is a means to express feelings but is less active. The action DVD may provide venting opportunity through the behaviors of the hero (indirect expression). Discussion is the least helpful immediately, but can be useful later.

A child is 2 days postoperative from abdominal surgery. The nurse needs to begin discharge teaching. When would be the most appropriate time for the nurse to begin the teaching? when the parents are present when the child is ambulatory following a nap when child is pain-free

when child is pain-free Learning occurs best when children are ready to learn. Interference can occur when the child is in pain or if the child is anxious or fearful. Because the child has had surgery, being pain-free would help the child be comfortable and focus on the learning that needs to occur. The parent's presence in the learning process is a supportive measure. The child does not need them to learn. The child needs cognitive, psychomotor, and affective skills. Teaching could occur as the child begins to ambulate or following a nap, but this is not the most important time.