Ch 35: Communication and Teaching with Children and Families

b) Warmth d) Comfort e) Concern Pg. 968 The space between 18 inches to 4 feet (46 cm to 1.2 m) is sensed by most people as personal space. When the nurse sits by the side of the crib or bed or sits next to a person at home, the nurse is within this space. Warmth is an innate quality some people manifest more spontaneously than others. Basic ways that warmth is conveyed are direct eye contact, use of a gentle tone of voice, listening attentively, approaching the child within a comfortable space, and using touch appropriately. Any action that lets the nurse know a person better (e.g., taking a health history, talking about school or family or how a child feels about the present situation) not only lets the nurse plan care but allows the nurse to become increasingly comfortable with the child. Lack of trust or fear are negative experiences and would not be present in an attitude of warmth.

1. What can be perceived by the child when a nurse sits by the bedside to obtain a health history? Select all that apply. a) Fear b) Warmth c) Lack of trust d) Comfort e) Concern

b) Take the child on a tour of the facility and surgical suite and explain what to expect preoperatively and postoperatively Pg. 984-985 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.

10. 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? a) Tell the child about being able to eat popsicles and ice cream after surgery b) Take the child on a tour of the facility and surgical suite and explain what to expect preoperatively and postoperatively c) After interviewing the child, give the child a prize for answering the questions d) Tell the child that the parents will not be able to see him or her until after the child returns to the hospital room

b) Clarifying Pg. 969 Clarifying consists of repeating statements others have made so both people can be certain that the message is understood. This is an example of clarifying. Reflecting is restating the last word or phrase. Open-ended questions invite a variety of responses and allow the client to give all the pertinent information needed to answer the question. Perception checking documents a feeling or emotion that is reported. It is a way of understanding others accurately instead of jumping to conclusions.

11. 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? a) Perception checking b) Clarifying c) Open-ended questions d) Reflecting

a) Get the client to draw a picture Pg. 967 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.

12. 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? a) Get the client to draw a picture b) Tell the client a joke c) Play a happy song for the client d) Leave the client alone

d) Speak directly to the adolescent and consider the client's input in the decisions about care and education Pg. 977 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.

13. 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? a) Provide information and allow the adolescent to process and ask questions b) Offer choices whenever possible c) Praise the adolescent often d) Speak directly to the adolescent and consider the client's input in the decisions about care and education

c) Topping up Pg. 972 "Topping up" is minimizing a child's views by telling a better story. A child tells you, for example, she has a problem; you say, "You want to know what problems really are? Come and work here." Clichéd advice (advice given from a formula, not individualized to the situation) is meaningless because it is too general to be helpful. In the same way 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 comment or disapproving remark rather than a therapeutic one. Parents and children do not come for health care to be criticized; they come to learn more about how to stay well or recover from illness. If you criticize them, they may not reveal any further information to you because they do not want you to react in the same way you did to their preliminary statements.

14. A 16-year-old girl confides in the nurse that her parents are difficult to deal with and that it stresses her out. The nurse responds by saying, "You think that's stressful, you should see some of the clients I have to deal with in here!" Which barrier to communication is this nurse demonstrating? a) Clichéd advice b) Showing disapproval c) Topping up d) Growing defensive

a) Allow opportunity for the adolescent to express feelings Pg. 984 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.

15. When teaching an adolescent about home care after hospitalization, what is most important for the nurse to do? a) Allow opportunity for the adolescent to express feelings b) Focus the discussion on skill techniques c) Use the same type of language as the adolescent d) Provide assurance the nurse will maintain confidentiality

b) "The doctor is going to put a special medicine in your tube so that she will be able to see your stomach better" Pg. 985 When explaining to a child about a procedure that will be performed, the nurse should use terminology that the child will understand. The word "dye" can be misinterpreted as "die" and should be avoided to prevent scaring the child. Using words like inject, contrast, proceed, etc. can cause confusion and misunderstanding. These words can also increase anxiety. One of the roles of the pediatric nurse is to communicate with children on their developmental level. That includes using descriptions of procedures and treatments the child can understand. Making statements like "you will not feel a thing" increases anxiety because the child is waiting for something to happen.

16. 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? a) "The doctor is going to proceed by administering contrast medium into your vein to see what is wrong with you" b) "The doctor is going to put a special medicine in your tube so that she will be able to see your stomach better" c) "The radiologist is going to inject dye into your IV. You will not feel a thing" d) "You are going to have medicine injected into your IV so that the doctor will be able to see your internal organs better"

b) The child may be shy and have some reluctance about communicating Pg. 972 It is difficult to assess how shy children feel when they are reluctant to communicate about such things as the long-term effect a disease will have. If they do not proved much verbal feedback, the tendency is to believe they do not have a concern. The nurse should give the child time to warm up in the conversation. Because this child may not talk much, therapeutic play could help and involve the child in the education process. There is no way to know if the child is just shy, angry, delayed or just does not want to be treated until a way is found to communicate with the child.

17. A nurse is talking with a 10-year-old child and parent about the current treatment plan for the child's asthma. The child stands behind the parent and does not ask questions or look at the nurse. What should the nurse consider the child's behavior could indicate? a) The child may not want to be treated for the asthma b) The child may be shy and have some reluctance about communicating c) The child may be developmentally delayed and not understand the conversation d) The child may be angry about the diagnosis of asthma

d) "Tell me about the symptoms your child is experiencing" Pg. 916 The best response is for the nurse to ask about the symptoms the child has, which will help confirm that the child is in crisis. Once the nurse is sure that the child is in crisis, the parent can be advised to take the child to the emergency department or to call 911. Giving the child water may not be appropriate depending on the child's level of consciousness. Asking the parent what makes him or her think the child is in crisis may not elicit the needed information right away. Asking specifically about the child's symptoms is more to the point.

18. A parent calls the pediatric clinic and tells the nurse "I think my child is having a sickle cell crisis. Should I bring the child to the office?" What is the nurse's best response? a) "What makes you think your child is in crisis?" b) "Take your child to the emergency department now" c) "Call 911 and give the child some water while you wait" d) "Tell me about the symptoms your child is experiencing"

a) "You sound worried. Let's talk about tomorrow" Pg. 965 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.

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

c) "You will need to keep his hands down and his head still" Pg. 984 The nurse needs to provide a specific explanation of the parents' role and what body parts to hold still in a safe manner. Implying that the parents may not be capable or may have to leave the room is inappropriate. Telling the parents that restraints may be required is not helpful, does not teach, and may be perceived as a threat.

2. The nurse is enlisting the parents' assistance for therapeutic hugging prior to an otoscopic examination. What should the nurse emphasize to the parents? a) "If this does not work, we will have to apply restraints" b) "If you are not capable of this, let me know so I can get some assistance" c) "You will need to keep his hands down and his head still" d) "I may need you to leave the room if your son will not remain still"

a) Assess the perception of the problem Pg. 969 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.

20. 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? a) Assess the perception of the problem b) Assist the child to control emotions c) Provide a plan of action d) Inform the child of priority problems

d) Informal teaching Pg. 978 Health teaching may be offered to an individual or to a group and can be both formal or informal. Teaching a group of children about hospitalization would be formal. Assuring this mother about adequate nutrition for her child would be informal teaching. Structured and systematic are two types of formal teaching.

21. A nurse is talking to a mother concerned about her 5-year-old son. She informs the nurse that he eats only cereal and peanut butter every day and fears that he is not getting proper nutrition. The nurse reassures the mother that even though he is eating a limited variety of foods, he is likely getting enough nutrition. Which type of teaching is this nurse practicing? a) Systematic teaching b) Formal teaching c) Structured teaching d) Informal teaching

b) Cognitive Pg. 975 Based on the activities that the nurse prepared to teach the young client about nutrition as it relates to the healing of a wound, there was a change in the level of understanding. Cognitive learning can be gained by any teaching technique as long as it relates to the client's developmental level, intelligence, and attention span. Psychomotor learning involves the ability to perform a skill. Affective learning involves a person's attitude, which is the most difficult to change. Concept-based is an education philosophy of teaching and not a type of learning.

22. A nurse is teaching a young client about the importance of good nutrition for wound healing and incorporates a verbal discussion, a coloring sheet with pictures of foods, and an activity where the client arranges foods that would represent a nutritious meal for the client. Following the activity, the client states, "I will eat more protein from eggs and meats and take my vitamins so my wound will heal faster." The statement demonstrates the child has accomplished which type of learning? a) Psychomotor b) Cognitive c) Affective d) Concept-based

b) First level Pg. 966 The first level of communication is cliché conversation. It is pleasant chatting or comments. When the student tells his or her function and position, it leads the family and client to move the conversation from the cliché level to a more meaningful one.

23. A student nurse walks into a client's room and states, "I am a student nurse who is going to take care of you today." Which level of communication is the student using? a) Second level b) First level c) Fourth level d) Fifth level e) Third level

a) "Our child always wears a helmet and body padding when playing football" Pg. 1252 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.

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

a) Request that the adolescent teach the information to the nurse Pg. 984 The best way for the nurse to determine if teaching has been successful is to ask the client to "teach back" the information taught. Using this method, the nurse can correct any misconceptions. Providing written materials to reinforce teaching, having the client verbalize understanding the instructions, and providing an opportunity to ask questions are all appropriate client education strategies, but they do not evaluate the effectiveness of the teaching.

25. A nurse is providing teaching on the medication regimen for beta-thalassemia to an adolescent. What is the best way for the nurse to determine if the teaching was successful? a) Request that the adolescent teach the information to the nurse b) Provide written materials to reinforce teaching c) Ask the adolescent if the teaching was understood d) Provide an opportunity for the adolescent to ask questions

d) "So do you think the stomach ache is worse after you drink milk?" Pg. 969 Clarifying consists of repeating statements others have made so both of you can be certain you understand them. This is particularly helpful if a child has been describing a set of symptoms or series of actions. The other questions are appropriate, but does not clarify the original statement by the child.

26. A nurse is interviewing a 10-year-old client who is saying "My stomach has been hurting for several days and is worse when I drink milk." To clarify understanding of what the child is saying, which question will the nurse ask? a) "When did you begin to have difficulty with stomach aches after drinking milk?" b) "Can you tell me how much milk you drink at a time?" c) "Is milk a drink that you prefer to have with your meals?" d) "So do you think the stomach ache is worse after you drink milk?"

c) Nurse Pg. 965 The encoder is the person who originates the message, which in this case would be the nurse. The code is the message and the decoder is the client.

27. A nurse is teaching a 7-year-old what to expect during an upcoming tonsillectomy. In this situation related to teaching, which of the following is the encoder? a) Client b) Information about the tonsillectomy c) Nurse d) The hospital

d) Therapeutic Pg. 965 Therapeutic communication is an interaction between two people that is planned, has structure, and is helpful and constructive. In this situation the nurse is using an open-ended question allowing the child to do the talking. The nurse is also sitting by the child conveying care and concern and giving the child a feeling of safety. Nontherapeutic is identified by its lack of structure or planning and lacks a definite purpose (eg, casual communication). Nonverbal defines facial expressions, gestures, and things other than the verbal.

28. An 8-year-old child has just learned that he needs to have surgery. The nurse enters a room and sees the child staring into space with a sad expression. The nurse sits by the child and says, "You look so sad. Would you like to tell me about it?" The nurse is using which type of communication? a) Casual b) Nontherapeutic c) Nonverbal d) Therapeutic

a) The child demonstrates good technique in self-injection of insulin Pg. 964 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.

29. 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? a) The child demonstrates good technique in self-injection of insulin b) The child is able to draw the correct amount of insulin up in the syringe c) The parents of the child demonstrate good technique in administering insulin to their child d) The child lists five foods to ingest when determining that blood glucose levels are too low

a) Learning style Pg. 973 An assessment of the child's learning style needs to be completed prior to conducting the teaching session. Assessing individual learning styles helps to meet each child's best way of learning. The reason for the colostomy is not necessary; care of the colostomy is the focus of the teaching. Manual dexterity may be important for the child to be able to handle equipment safely, but it is not the most important fact to know. The procedure can be adjusted to take into consideration manual dexterity. The parent may or may not be present for the teaching session if the goal is to teach the child self-care skills.

3. The school-age child with a new colostomy will require teaching by the nurse to learn to care for the ostomy. In order for the nurse to teach the child effectively, what is most important for the nurse to know about the child? a) Learning style b) Manual dexterity ability c) Reason for the colostomy d) Presence of parent

a) "These sticky snaps are for your chest" Pg. 982-984 Many health care words can be confusing or scary for children. Avoiding those that are not understood or have double meanings reduces stress. "Sticky snaps" is nonthreatening and understood; "electrode patches" would not be. "Take" implies removing something, which can raise anxiety. "Can I?" and "Is it OK?" are an invitation for the preschooler to refuse.

30. Which statement is most appropriate when initiating a nursing action with a preschool-age child? a) "These sticky snaps are for your chest" b) "Can I put this little clip on your finger?" (oxygen saturation monitor) c) "Is it OK if I listen to your heart?" d) "It is time to take your temperature"

c) Encourage everyone in the family to use good handwashing techniques Pg. 1094, 1119-1122 The child with cystic fibrosis has low resistance, especially to respiratory infections. For this reason, take care to protect the child from any exposure to infectious organisms. Good handwashing techniques should be practiced by the whole family; teach the child and family the importance of this first line of defense. Practice and teach other good hygiene habits.

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

a) "You haven't said anything about your feelings toward the new treatment plan" Pg. 969-970 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.

32. 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? a) "You haven't said anything about your feelings toward the new treatment plan" b) "You don't seem concerned about the new treatment regimen" c) "Are you worried about the new treatment plan?" d) "You must be scared of taking a new chemo"

b) "When special medicine is given, it will cause a very good and different type of sleep" Pg. 985 When providing teaching to a 6-year-old child, the nurse must consider the developmental level and cognitive stage of the child. In this case, the child needs to be able to differentiate the sleep and that there is special medicine used for that purpose. If the child thinks the sleep is the same as every other night, the child may become concerned about people hurting him/her when sleeping at home. "Putting the child to sleep" may indicate to the child that he/she will not wake up, or will go away like a pet. Using the terms "anesthesia" and "appendectomy" is too detailed for a 6-year-old child.

33. Which statement by the nurse is most appropriate when preparing a 6-year-old child for a surgical procedure under general anesthesia? a) "There will be a special health care worker who will put you to sleep" b) "When special medicine is given, it will cause a very good and different type of sleep" c) "When given anesthesia, you will go to sleep just like you do every night" d) "Anesthesia will help you feel no pain during the appendectomy, which will make you feel better"

b) "I can understand that you are concerned about having your blood drawn. I will try and make this as comfortable as possible" Pg. 972 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.

34. 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? a) "I am good at what I do, but even I can miss a vein sometimes" b) "I can understand that you are concerned about having your blood drawn. I will try and make this as comfortable as possible" c) "That is a lot of pressure to place on me. Sometimes, it takes a couple of times to get it right" d) "Why are you so angry?"

a) Dolls Pg. 981 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.

4. 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? a) Dolls b) Story c) Video d) Pictures

d) "It is best to stand when listening to a child to demonstrate knowledge" Pg. 968 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.

5. 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? a) "It is good to sit, not stand when listening" b) "It is good to lean forward when listening" c) "It is best to stoop to a child's level when listening" d) "It is best to stand when listening to a child to demonstrate knowledge"

d) Demonstration Pg. Applying a medicated cream involves psychomotor learning (requires a change in a person's ability to perform a skill). It is best mastered through demonstration and re-demonstration. Cognitive learning involves a change in the individual's level of understanding or knowledge. It can be gained through exposure to any teaching technique but is usually learned through lecture, reading, and audiovisual aids. Affective learning involves a change in a person's attitude. It is best gained through role modeling, role-playing, or shared-experience discussion.

6. A nurse is teaching an 11-year-old client how to apply a topical cream to the skin. Which method of teaching would be most appropriate for the nurse to use? a) Role-play b) Video c) Discussion d) Demonstration

b) 2 years Pg. 966 By age 2 years, children have mastered language well enough to be able to put together two-word sentences (noun and verb).

7. A nursing student learning pediatrics and the development of language correctly identifies the age when children are able to put together two-word (noun-verb) sentences to be: a) 1 year b) 2 years c) 3 years d) 9 months

d) Using clichés Pg. 966 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.

8. 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? a) Defining the problem b) Clarifying c) Using silence d) Using clichés

c) Cognitive learning Pg. 975 Cognitive learning involves a change in the individual's level of understanding or knowledge. Learning the principle behind why a particular medicine must be injected into a muscle, as opposed to subcutaneous tissue, is cognitive learning. It requires adequate development, intelligence, and attention span. It can be gained through exposure to any teaching technique but is usually learned through lecture, reading, and audiovisual aids.

9. A nurse is showing a 9-year-old a video about why insulin is needed. The nurse then plans to discuss a booklet with the child on the same topic after the video. Of what type of learning is this an example? a) Tactile learning b) Psychomotor learning c) Cognitive learning d) Affective learning