Chapter 30: Atraumatic Care of Children and Families

7.The nurse uses family-centered care to provide care for children in a pediatric office. Upon what concept is family-centered care based? A) The family is the constant in the child's life and the primary source of strength. B) The care provider is the constant in the child's life and the primary source of strength. C) The child must be prepared to be his or her own source of strength during times of crisis. D) The wishes of the family should direct the nursing care plan for the child.

Ans: A Feedback: Family-centered care involves a partnership between the child, family, and healthcare providers in planning, providing, and evaluating care. Family-centered care enhances parents' and caregivers' confidence in their own skills and also prepares children and young adults for assuming responsibility for their own healthcare needs. It is based on the concept that the family is the constant in the child's life and the primary source of strength and support for the child.

12.The nurse is caring for a 14-year-old boy with an osteosarcoma. Which communication technique would be least effective for him? A) Letting him choose juice or soda to take pills B) Seeking the teenager's input on all decisions C) Discussing the benefits of chemotherapy with him D) Avoiding undue criticism of noncompliance

Ans: A Feedback: Letting the child choose juice or soda to take pills is the least effective communication technique for an adolescent. It may provide some sense of control, but is not as effective as seeking his input on all care decisions, including him during discussions of the benefits of chemotherapy, and avoiding undue criticism of noncompliance.

4.The nurse contacts a child life specialist (CLS) to work with children on a pediatric ward. What is the primary goal of the CLS? A) Decrease anxiety and fear during hospitalization and painful procedure. B) Keep children who are hospitalized distracted from pain. C) Perform medical procedures using atraumatic principles. D) Act as a liaison between the nurse and the child.

Ans: A Feedback: The CLS is a specially trained individual who provides programs that prepare children for hospitalization, surgery, and other procedures that could be painful (Child Life Council, 2010a, 2010b). The goal of the CLS is to decrease the anxiety and fear while improving and encouraging understanding and cooperation of the child. The CLS may use distraction techniques and act as a liaison, but that is not the primary goal of the CLS role. The CLS does not perform medical procedures.

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

Ans: A Feedback: 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.

10.The nurse is implementing care for a hospitalized toddler. What communication technique would the nurse use with the child to reflect the child's developmental level? A) Allow the child extra time to complete thoughts. B) Communicate solely through play. C) Provide simple but honest and straightforward responses. D) Remain nonjudgmental to avoid alienation.

Ans: A Feedback: When working with toddlers and preschoolers, the nurse should allow them time to complete their thoughts. Though language acquisition at this age is exponential, it often takes longer for the young child to find the right words, particularly in response to a query. Infants communicate nonverbally and often through play. School-age children need simple but honest and straightforward responses, and nurses should be nonjudgmental with adolescents to avoid alienating them and to keep lines of communication open.

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

Ans: A, B, C Feedback: Atraumatic care is important to a child's well-being during hospitalization. Examples of this include providing opportunities for the parents and the child to participate in care, encouraging parents to bring personal items, and maintaining the child's room as a safe place, off limits to invasive procedures. It is important to be honest with the child and include the child in all plan of care discussions.

23. A nurse is assisting the health care provider with suturing a laceration on a preschooler's leg. What distraction methods can the nurse perform to promote atraumatic care? Select all that apply. A) Ask the child to squeeze the nurse's hand. B) Sing a song and have the child sing along. C) Have the child blow bubbles. D) Allow the child to play with surgical instruments. E) Let the child suture a doll.

Ans: A, B, C Feedback: Distraction methods for preschoolers include asking the child to squeeze the nurse's hand, encouraging the child to count aloud, singing a song and having the child sing along, pointing out any pictures on the ceiling, having the child blow bubbles, and playing music appealing to the child. Suturing a doll or playing with surgical instruments would be activities better suited for school-age children.

1.The nurse is providing atraumatic care to children in a hospital setting. What are principles of this philosophy of care? Select all that apply. A) Avoid or reduce painful procedures. B) Avoid or reduce physical distress. C) Minimize parent-child interactions. D) Provide child-centered care. E) Minimize child control. F) Use core primary nursing.

Ans: A, B, F Feedback: When using atraumatic care, the nurse would avoid or reduce painful procedures, avoid or reduce physical distress, use core primary nursing, maximize parent-child interactions, provide family-centered care, and provide opportunities for control, such as participating in care, attempting to normalize daily schedule, and providing direct suggestions.

17.The nurse is preparing to perform a dressing change on a 13-year-old client who is being treated for burns he received 2 weeks ago. The client prefers not to take pain medication before the dressing change because it causes drowsiness. What nursing interventions would provide atraumatic care? Select all that apply. A) The nurse asks the client if he would like the television on during the dressing change. B) The nurse asks the client if a small group of nursing students can observe the dressing change. C) The nurse encourages the client to wear headphones to listen to music during the dressing change. D) The nurse encourages the parent to talk to the child about taking pain medication prior to the procedure. E) The nurse tells the client that the dressing change will not be performed unless pain medication is taken.

Ans: A, C Feedback: Minimizing stress prior to and during a procedure helps provide atraumatic care. Since the child chooses to not take pain medication, watching television or using headphones during the procedure provides distraction to the discomfort of the procedure. Students observing does not provide distraction. The child has chosen for the last 2 weeks to not receive pain medication, so having the parent talk to the child again does not provide atraumatic care. The nurse cannot force the child to take pain medication.

19.The nurse is caring for a child who is scheduled to begin chemotherapy. When planning education for the parents, what action by the nurse is most correct? A) Obtain a large classroom to allow the nurse to stand at the front and present information. B) Obtain a small conference room and arrange the chairs in a circle for both the nurse and family members to sit. C) Provide written information to the family and allow them to review it, with instructions to contact the nurse if there are additional questions. D) Provide a video of information to the family, with instructions to contact the nurse if there are additional questions.

Ans: B Feedback: Teaching is an important function of the nurse. When providing education, it is important to offer the information in an environment that is conducive to learning. A circular set of chairs will allow the nurse to face the parents during the exchange. A large class that has the nurse standing and the parents sitting does not provide the ability for a personal interaction needed for this session. Giving the parents information in writing should be done in conjunction with a face-to-face teaching session. Video information may be beneficial but does not replace the face-to-face teaching session.

21. A nurse is preparing to start an intravenous (IV) line in a child with severe pneumonia. The nervous child asks the nurse to wait until later to do the procedure. How should the nurse proceed? A) Inform the child that the procedure will have to happen immediately. B) Explain to the child why the IV is needed and find creative games to utilize while inserting the IV. C) Call the health care provider to see if the medication can be given in liquid form by mouth. D) Ask the parent to hold the child down so that the procedure can be completed.

Ans: B Feedback: When a procedure is necessary the nurse should use a firm, positive, and confident approach that provides the child with a sense of security. The child should be allowed to express feelings of anger, anxiety, fear or frustration but also know the procedure is necessary. In atraumatic care, the nurse should use a topical anesthetic at the IV site prior to the IV insertion to minimize pain. The parents should not be used as a restraint. This causes severe anxiety for the parent and the child. If an IV is prescribed to be placed, then most likely IV medications will be needed. Just because the child does not want the IV, the child should not be allowed to dictate care.

6.The child life specialist (CLS) is preparing a 6-year-old child for a magnetic resonance imaging (MRI) scan. Which statement reflects the use of atraumatic principles when explaining the procedure? A) "You will be taken to a magnetic resonance imaging machine for an x-ray of your liver." B) "You may hear some loud noises when you are lying in the machine, but they won't hurt you." C) "You have nothing to worry about; the MRI machine is safe and will not cause you any pain." D) "Let's just get you to the x-ray department for your test and you'll see how simple it is."

Ans: B Feedback: When using atraumatic principles, the CLS would explain any sensations, such as noises that will be experienced. The language should be simple and at the child's developmental age; using the technical term for the machine might frighten the child. Telling the child there is nothing to worry about does not allay the child's fears. Allowing the child to experience the machine without explaining the sensations does not follow atraumatic principles.

20.The nurse is caring for a teen who will be hospitalized for physical rehabilitation for an extended period of time after an auto accident. When working to promote a good working relationship with the teen, what action by the nurse will be most beneficial? A) Allow the teen to control the daily schedule. B) Keep your word with regard to promises and statements made to the teen. C) Allow the teen to make decisions about the plan of care. D) Include the teen in the weekly interdisciplinary care conferences

Ans: B Feedback: When working with teens, the establishment of trust and rapport is of the highest priority. Establishing trust can best be done by demonstrating consistency and keeping promises made to the teen. Control of the daily schedule may not be feasible. The teen can be allowed to have an impact on some elements of the plan of care but this does not have a greater importance than the establishment of trust. The teen may be able to attend care conferences, but this is not of the highest priority.

18.The nurse is admitting a 7-year-old child to the medical-surgical unit. The child answers questions with very short answers, makes little eye contact with the nurse, and looks to the parent to answer most questions. Which interventions would be appropriate during this admission assessment? Select all that apply. A) Tell the child that you are going to be their nurse so it would be best if they answered your questions. B) When asking questions, look at the child as well as the parent. C) Sit at the child's eye level during the admission questioning process. D) Stop asking questions for the present time and return later when the child feels more comfortable. E) Ask the child if they are always nervous around new people.

Ans: B, C Feedback: The goal is to establish rapport with the client and encourage communication. It is common for young children to be shy, so it is acceptable for the nurse to ask both the child and parent questions until the child feels comfortable talking with the nurse. Sitting at eye level is less intimidating and may help in establishing a trusting relationship. Telling the child that they need to answer the questions appears as condemning the child's behavior. Admission questions are important and can't be delayed until a later time. Asking the child if they are nervous around new people is intimidating and may further block communication.

8.The nurse knows that effective communication with children and their parents is critical to providing atraumatic quality nursing care. Which statement accurately describes the communication patterns of children? A) Communication patterns are similar from one child to the next. B) Children often use more words than adults to describe their fears. C) Children rely more on nonverbal communication and silence. D) Parents more often require affective communication rather than neutral communication.

Ans: C Feedback: Children often use fewer words than adults and may rely more on nonverbal communication and silence. Communication patterns can vary greatly from one child to the next. Some children are very talkative, while others are quiet. Parents more often require neutral communication (i.e., verbal communication that is related to assessing and solving problems), whereas children more often desire affective communication (establishment of rapport and trust, giving comfort).

3.The nurse is implementing interventions to prevent physical stressors for a 9-year-old child receiving chemotherapy in the hospital. How will the nurse provide atraumatic care for this child? A) Use restraint or "holding down" of the child during the procedure to prevent injury. B) Have the parent stand near and/or rub the child's feet during the procedure. C) Insert a saline lock if the child will require multiple doses of parenteral medications. D) Avoid using numbing techniques for multiple blood draws or IV insertion.

Ans: C Feedback: The nurse should insert a saline lock if the child will require multiple doses of parenteral medications. During painful or invasive procedures, the nurse should avoid traditional restraint or "holding down" of the child and use alternative positioning such as "therapeutic hugging." If therapeutic hugging is not an option, the nurse could have the parent stand near the child's head, not his feet to provide visual and verbal comfort. The nurse should also use numbing techniques for blood draws or IV insertion.

13.The nurse is educating a 16-year-old girl who has just been diagnosed with acute myelogenous leukemia. Which statement best demonstrates therapeutic communication? A) Discussing the treatment plan in detail for the next few weeks B) Using medical terms when describing the disease C) Assessing the adolescent's emotional status in private D) Talking about clothing and the stores where she shops

Ans: C Feedback: Therapeutic communication is goal directed and purposeful. Assessing the child's emotional status in private is goal directed and purposeful. Talking about clothing and shopping is not therapeutic communication unless its purpose is to find head coverings or wigs to mask hair loss and that information was not presented. Discussing the treatment plan for the next few weeks in detail is too much information for someone who has just been diagnosed. Using medical terms when describing the disease does not promote understanding.

5.The nurse is preparing a child and his family for a lumbar puncture. Which would be a primary intervention instituted to keep the child safe? A) Distraction methods B) Stimulation methods C) Therapeutic hugging D) Therapeutic touch

Ans: C Feedback: Therapeutic hugging (a holding position that promotes close physical contact between the child and a parent or caregiver) may be used for certain procedures or treatments where the child must remain still. Alternatively, distraction or stimulation (such as with a toy) can help to gain the child's cooperation, but therapeutic hugging would be used to keep the child safe during the procedure. Therapeutic touch is an energy therapy used to promote healing and decrease anxiety and stress and is not related to safety.

9.The nurse is teaching the student nurse how to communicate effectively with children. Which method would the nurse recommend? A) Position self above the child's level to denote authority. B) If possible, communicate with the child apart from the parent. C) Direct questions and explanations to the child. D) Use the medical terms for body parts and medical care.

Ans: C Feedback: To communicate effectively with children, the nurse should direct questions and explanations to the child; position self at the child's level; allow the child to remain near the parent if needed, so the child can remain comfortable and relaxed; and use the child's or family's terms for body parts and medical care when possible.

14.The nurse is performing a cultural assessment of an Asian family that has a child hospitalized for leukemia. What is the best technique for providing culturally competent care for this family? A) Research the culture and base care on findings. B) Ask other Asians to explain their culture. C) Just ask the family about their culture and listen. D) Hire an interpreter to explain the family culture.

Ans: C Feedback: Understanding and respecting the family's culture helps foster good communication and improves child and family education about health care. The best way to assess the family's cultural practices is to ask and then listen. Determine the language spoken at home and observe the use of eye contact and other physical contact. Demonstrate a caring, nonjudgmental attitude and sensitivity to the child's and family's cultural diversity. An interpreter should be hired for a family who does not speak English.

2.The nurse is consulting with a child life specialist (CLS) to help minimize the stress of hospitalization for a child. Which services would the CLS provide? Select all that apply. A) Medical preparation for tests, surgeries, and other medical procedures B) Support before and after, but not during, medical procedures C) Activities to support normal growth and development D) Grief and bereavement support E) Emergency room interventions for children and families F) Only inpatient consultations with families

Ans: C, D, E Feedback: • The CLS would provide activities to support normal growth and development, grief and bereavement support, and emergency room interventions for children and families. The CLS would also provide nonmedical preparation for tests, surgeries, and other medical procedures; support during medical procedures; and outpatient consultation with families (American Academy of Pediatrics, Committee on Hospital Care and Child Life Council, 2014, reaffirmed 2018).

11.The nurse is caring for a 4-year-old boy with Ewing sarcoma who is scheduled for a computed axial tomography (CAT) scan tomorrow. Which is the best example of therapeutic communication? A) Telling him he will get a shot when he wakes up tomorrow morning B) Telling him how cool he looks in his baseball cap and pajamas C) Using family-familiar words and soft words when possible D) Describing what it is like to get a CAT scan using words he understands

Ans: D Feedback: Describing what it is like to get a CAT scan using age-appropriate words is the best example of therapeutic communication. It is goal-directed, focused, and purposeful communication. Using family-familiar words and soft words is a good teaching technique. Telling him how cool he looks in his baseball cap and pajamas is not goal-directed communication. Telling the child he will get a shot when he wakes up could keep him awake all night.

15.The nurse is educating the parents of a 7-year-old girl who has just been diagnosed with epilepsy. Which teaching technique would be most appropriate? A) Assessing the parents' knowledge of the anticonvulsant medications B) Demonstrating proper seizure safety procedures C) Discussing the surgical procedure for epilepsy D) Giving the parents information in small amounts at a time

Ans: D Feedback: Parents, when given a life-altering diagnosis, need time to absorb information and to ask questions. Therefore, giving the parents information in small amounts at a time is best. The child has just been diagnosed with epilepsy, and surgical intervention is not used unless seizures persist in spite of medication therapy. Therefore, discussing surgery would be inappropriate at this time. Assessing the parents' knowledge of the anticonvulsant medications identifies a knowledge gap and need to learn, but it would be unreasonable to think that they would understand the medications when the diagnosis had just been made. Demonstrating proper seizure safety procedures is an effective way to present information to an adult.

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

Ans: D Feedback: 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 needle sticks. These actions, however, do not offer the child a sense of control.