Chapter 30: Atraumatic Care of Children and Families

A mother voices her concerns to the nurse that her daughter is an "only child" and she is worried that having no siblings may be detrimental to the child. The nurse can reassure the mother that an "only child" tends to excel in what area(s)? Select all that apply. A. Being more relaxed around others B. Advanced language development C. Closer identification with peers instead of parents D. Intellectual achievement E. Less dependence upon the parent

B. Advanced language development D. Intellectual achievement It is shown that "only children" tend to have more advanced language skills and intellectual achievement than children from larger families. This is thought to be from the fact that the parents have more one-on-one time with the only child. "Only children" more closely identify with their parents, are more dependent upon the parents and are not necessarily more relaxed around others.

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? A. Requesting the parent to teach the child skills. B. Asking closed-ended questions for specific facts. C. Having the child and family demonstrate skills. D. Setting up a scenario for them to talk through.

B. 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 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? A. Inform the family that everything will be done to cure the child. B. Be honest with the family and allow them to express concerns and ask questions. C. Inform them that they should wait in the waiting room while the health care provider examines the child. D. Inform the family that to have the best outcome for the child, they must trust everyone involved in the care.

B. 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.

When caring for hospitalized teens, nurses should choose their words and actions carefully since adolescents typically are concerned about: A. mutilation of their body. B. appearing out of control of the situation and/or themselves. C. separation from peers and family. D. mobility restrictions.

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

D. videos 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. Psychomotor learning requires a change in a person's ability to perform a skill. It is best mastered through demonstration and redemonstration. Affective learning involves a change in a person's attitude. It is best gained through role modeling, role-playing, or shared-experience discussion.

The nurse is teaching a child how to self-administer insulin. Place the steps in the order the nurse will complete them when teaching the child. Use each option once. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1. Given time to practice and increase proficiency 2. Have the child perform a return demonstration of the procedure 3. Show the child how to correctly perform the procedure 4. Evaluate the child's performance of the procedure

1. Show the child how to correctly perform the procedure 2. Given time to practice and increase proficiency 3. Have the child perform a return demonstration of the procedure 4. Evaluate the child's performance of the procedure. To educate effectively the nurse utilizes the teaching-learning process. First the nurse would teach or demonstrate what the child needs to know and perform. Then the child would be given time to practice and increase proficiency. The child would return a demonstration of the procedure. After the demonstration from the child, the nurse would evaluate whether it was correct or not. If it was not correctly performed, the nurse would reteach the areas of deficiency.

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: A. "Certainly. I will stay with your child during the procedure." B. "Come, stand by his head. You won't see much up there." C. "Good. That is what the team doing the procedure would prefer." D. "This will only take a few minutes. You should be with your child." E. "Stay. It will be less scary for your child."

A. "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 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? A. providing Play-Doh for him to manipulate B. discussing the reasons for the procedure with the child and parents C. getting paper and markers so that he can draw and color D. finding an age-appropriate action DVD for him to view

A. 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 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. "We had a trampoline but got rid of it after our child was diagnosed." B. "Our child always wears a helmet and body padding when playing football." 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."

B. "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.

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

B. high level of insecurity Theoretically, foster home placement is temporary until children can be returned to their own parents. Unfortunately, if return does not become possible, children may be raised to adulthood in a series of foster care families. Such children can experience a high level of insecurity, concerned that they will have to soon move again. Aggressiveness and eating disorders should be assessed, but these responses are not the priority for most foster children. Immunization completion is not a psychosocial response to being a foster child.

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? A. "Please do not be upset; it is not your fault. Things like this happen sometimes." B. "I understand how you feel. Let's talk about where you go from here." C. "News like this is difficult to hear. Let's talk about what this means for your child." D. "There is no need to worry. We will teach you how to take care of your child."

C. "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 2-year-old child is hospitalized for asthma exacerbation. The parents tell the nurse that they have been treating the wheezing with traditional herbal medicines. How should the nurse respond? A. "Because herbal remedies are mild and natural you may continue giving these to your child while in the hospital if desired." B. "You will need to discontinue these remedies while your child is in the hospital to avoid any drug interactions." C. "Please tell me about how you use the herbal medications so we can assess for herb-drug interactions." D. "If these remedies worked then your child would not have needed hospitalization; there is no reason to continue them."

C. "Please tell me about how you use the herbal medications so we can assess for herb-drug interactions."Herbal medicines can have interactions with prescribed medications; these should be included in the health history and assessed to determine if there are any herb-drug interactions or synergies. Herbal medicines are not always mild and must be properly assessed. Suggesting that the herbal medications are not working or requiring that they be discontinued does not provide for culturally safe and inclusive care.

A home care nurse is teaching a parent how to administer a clotting factor infusion to their child. How can the nurse best evaluate the effectiveness of the teaching? A. Give cues as needed while the parent sets up the infusion. B. Make time for questions at the end of the teaching session. C. Observe the parent set up and administer the infusion. D. Ask the parent to repeat the instructions step-by-step.

C. Observe the parent set up and administer the infusion. Observing the parent set up and administer the infusion is the best way to evaluate the nurse's teaching. Asking the parent to repeat the instructions, providing an opportunity for asking questions, or providing cues as the parent sets up the infusion does not evaluate the effectiveness of the teaching.

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

C. Talk to the parents first to give the child a chance to "warm up." If a child is shy, the nurse may start by talking to the parents first to give the child time to "warm up" to the nurse. The nurse should provide education in specific and clear phrases in an unhurried, quiet, yet confident manner. It is important to communicate with the child at the child's eye level. That means the nurse should sit and not stand. Many times involving the child in play will make the child more comfortable and open up the line of communication. The parents should not have the responsibility of informing the child. Education is the responsibility of the nurse. If the child is shy, asking questions will not produce any communication and may make the situation worse. Talking with the child privately should only be done with older school-age children or adolescents to afford them privacy.

The nurse is 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. video B. story C. pictures D. dolls

D. 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.

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

A. "This little tube will go in your nose and down into your belly." B. "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." D. "When they come to get you, you will get on a special rolling bed." Terms used in the other options may be misunderstood by a 4-year-old child.

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

B. Nod head while the mother speaks. Nodding the head while the other person speaks indicates interest in what he or she is saying. When children and parents feel they are being heard, it builds trust. Sitting straight with feet flat on the floor, looking away from the speaker, and keeping distance from the family may send a message of disinterest.

The nurse is caring for a toddler who is scheduled for an outpatient lumbar puncture. Which action by the nurse would be appropriate? A. explaining the procedure with a picture and diagram to ensure cooperation of the toddler B. having a child life specialist interact with the toddler before and during the procedure C. reminding the toddler that privacy will be maintained by a gown or blanket during the procedure D. educating the parents to begin preparing the toddler for the procedure about 1 week in advance

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

C. 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.

An urgent care nurse is cleaning a forehead laceration on a 7-year-old. The mother is present. The child is crying and screaming. The nurse should: A. Close the door tightly and reassure the child, "I am being gentle and am almost done." B. review safety measures that could have prevented the injury. C. tell the child, "It's OK to cry, but I need you to hold still." D. have the mother speak firmly to the child to correct the crying and screaming. E. ask the child to be less noisy because he is "scaring and bothering other children."

C. tell the child, "It's OK to cry, but I need you to hold still." Children should be able to express their feelings openly when they are hurt or frightened. Acknowledging the crying/screaming is developmentally sound. Stating the need to hold still is accurate and respects the child's ability to help. Closing the door is a good idea but "gentle" and "almost done" show little understanding of the child's experience. Expecting the mother to discipline the child or for the child to be able to consider others is unrealistic. Discussing injury prevention at this point is inappropriate, is likely to promote guilt, and appears to place blame. This would interfere with relationship-building between nurse, child, and family.

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

D. "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.

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

D. "The doctor is going to put a special medicine in your tube so that she will be able to see your stomach better." 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.

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? A. supportive statements B. reassurance C. silence D. touch

D. 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 registered nurse (RN) and licensed practical nurse (LPN) are caring for a adolescent clients. The RN will intervene if the LPN is seen in which situation while caring for a client? A. asking open-ended questions when talking to the client B. speaking to the client while the caregivers listen and observe C. actively listening to the client while maintaining a relaxed, open body posture D. using medical terminology to answer the client's questions

D. using medical terminology to answer the client's questions The RN will intervene when the LPN uses medical terminology to answer the client's questions. Terminology that the client can easily understand should be used. It is appropriate for the LPN to actively listen, speak to the client, and ask open-ended questions.

The nurse is teaching a 15-year-old boy with type 2 diabetes and his parents how to monitor glucose levels. Which communication technique is least effective? A. paraphrasing the parents' comments before responding B. ignoring the adolescent's tirade about his therapy C. using the adolescent's words during the conversation D. using reflection to clarify the parents' understanding

B. ignoring the adolescent's tirade about his therapy The least effective technique is ignoring the adolescent's tirade about his therapy. He is expressing frustration over his lack of control, and his emotions should be acknowledged. Paraphrasing the parents' comments recognizes their feelings. Using the teen's words during the conversation indicates active listening and interest. Reflection clarifies the parents' understanding and point of view.

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

"You haven't said anything about your feelings toward the new treatment plan." Focusing helps children to center on a subject that may be causing them anxiety because they comment on it indirectly or else completely avoid it. It is done by repeating something they said or by mentioning the avoided topic ("You haven't said anything about your feelings toward the new treatment plan"). Once a subject is brought up for discussion, most children respond to it. As long as it can be avoided, however, they do not have to face the problem and will not begin to solve it. The statements that the child does not seem concerned or that the child is scared are assumptions. Asking if the child is worried is a closed ended question that only requires a yes or no answer and will not lead to exploring feelings.

The parents of a child admitted for a new diagnosis tell the nurse they have researched the disease on the Internet so they do not have any questions regarding their child's care. Which response(s) by the nurse is therapeutic? Select all that apply. A. "Please feel free to call me if you have any questions." B. "Educating yourself is always good as long as you are using reliable resources. What sources have you used?" C. "It is great that you have researched the diagnosis, but please be aware that each case can differ somewhat based on the individual." D. "I will let the health care provider know that you feel confident in the information you have researched about the diagnosis." E. "I am surprised you do not have any questions. There are always variances that can make each case a little different."

A. "Please feel free to call me if you have any questions." B. "Educating yourself is always good as long as you are using reliable resources. What sources have you used?" C. "It is great that you have researched the diagnosis, but please be aware that each case can differ somewhat based on the individual." It is important for the nurse to recognize that the parents educating themselves is a positive action while pointing out that each case may still have differences than what they researched. Also, determining if the parents used reliable resources is important in determining if the parents have accurate information about the diagnosis. Providing the parents the opportunity to contact the nurse later if needed will serve to keep communication open. Telling the parents that the nurse will inform the health care provider does not encourage further communication. Telling the parents that the nurse is "surprised" they do not have questions may cause the parents to be defensive.

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

A. 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.

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. Encourage the parents to bring personal items to make the child feel more at home. B. Make the child's room off limits to invasive procedures. C. Discuss the plan of care out of earshot of the child. D. Answer any questions the child may have in generalized terms. E. Provide opportunities for the parents to participate in the child's care.

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

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 be shy and have some reluctance about communicating. B. The child may not want to be treated for the asthma. C. The child may be angry about the diagnosis of asthma. D. The child may be developmentally delayed and not understand the conversation.

A. The child may be shy and have some reluctance about communicating. 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.

During an office visit to monitor a father's blood pressure, he shares with the nurse that his family is very stressed and experiencing a lot of tension since one or both parents may lose their jobs, their oldest child is applying for colleges (which costs a lot of money), and they recently lost their pet. Which advice should the nurse provide that may prevent an unintentional (accidental) injury? A. The parents should try to avoid unintentional injuries like leaving pills out on the counters where younger children can accidently poison themselves. B. Keep the stress within the family unit so that the parents do not burden other relatives and friends. C. The parents should discuss finances with their oldest child and try to limit college applications to local, public universities that tend to cost less than private colleges. D. The parents should discuss their stress related to work on a regular basis.

A. The parents should try to avoid unintentional injuries like leaving pills out on the counters where younger children can accidently poison themselves. The nurse can offer several strategies to reduce family stress. The nurse should encourage parents to reach out for support and explain that under stress, it is easy to become so involved in a problem that one does not realize that other people are around who want to help. Remind family members that unintentional (accidental) injuries increase when people are under stress. Children are more apt to poison themselves when the family is under stress because parents are more apt to leave pills on counters during this time. The nurse should also counsel parents not to rush decisions or make final adaptive outcomes to a stressful situation. As a rule, major decisions should be delayed at least 6 weeks after a stressful event; 6 months is even better. Finally, counsel parents to anticipate life events and plan for them to the extent possible.

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

B. "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? A. "The big machine will look inside you to see why you are sick so just hold still." B. "You will lie on a special bed that moves in the machine but you can still see out." C. "The technician needs to take several tubes of blood from you." D. "I don't think you will be in the X-ray department very long."

B. "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."

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? A. Use each family's culture as a guideline for care B. Examine her own feelings concerning cultures C. Ask the families about their cultural beliefs D. the family to compromise with similarities

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

B. 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.

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? A. Urge the adolescent to listen attentively to what information the nurse wants to teach. B. Help the adolescent understand how new information about the disease will improve health status now. C. Encourage the adolescent to be educated about the disease to know what to expect concerning treatments. D. Help the adolescent to realize that he or she is different from peers and needs teaching while they do not.

B. 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.

The expected outcome of teaching a school-age child about bike safety is that the child will wear a helmet 100% of the time when riding a bike. How best can the nurse assure that this outcome is achieved? A. Refer the family to safety websites. B. Involve the family in the planning. C. Teach the class outside. D. Limit the time for each teaching session.

B. Involve the family in the planning. After formulating a nursing diagnosis, an individualized plan for communication or teaching should be constructed. The plan should detail not only what is to be communicated or learned but also the methods to accomplish this and how it can be evaluated. The most effective way to ensure the expected outcomes are achieved is to ask the child or family to join in the planning. The nurse should make sure the outcomes are concrete and measurable. Teaching the class outside or with the helmet would be appropriate only if this was written in the teaching plan. The family may be referred to safety websites to help them understand bike safety, but it is not a measurable effect of the child wearing the helmet 100% of the time when on the bike.

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

B. 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.

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? A. Explain the disorder in common terms. B. Provide literature for the parents to read and then have them ask questions. C. Discuss how to handle a possible emergency situation. D. Use the USDAs "MyPlate" diagram to teach necessary nutrition alterations.

B. 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.

The nurse is providing discharge instructions to a 12-year-old child and parents after the application of a fiberglass cast placed to manage a fracture of the humerus. What information should be included in the teaching provided? Select all that apply. A. Cover the cast with a fabric wrap when preparing to bathe. B. Report any persistent numbness of the fingers. C. Elevate the casted arm on a pillow today and tomorrow. D. Wiggle the fingers throughout the day and evening. E. f itching occurs around the edges of the cast, use a water-based lubricant to relieve it.

B. Report any persistent numbness of the fingers. C. Elevate the casted arm on a pillow today and tomorrow. D. Wiggle the fingers throughout the day and evening. After the application of a fiberglass cast, it is important to provide education to the client and family prior to discharge. Elevating the cast for the first 48 hours is recommended. This action will reduce edema to the extremity. Movement of the fingers will help with circulation. Checking for movement also provides an assessment for neurovascular status. The cast should not be wrapped in fabric for bathing. Fabric is porous. This will allow the cast to become wet and risk destruction of the device. Persistent numbness and tingling signal neurovascular compromise and must be promptly reported. Itching may be experienced by someone wearing a cast. The use of lubricants would result in damage to the integrity of the cast and should be avoided.

The nurse is admitting a child to the pediatric medical unit. Upon entering the room the nurse realizes that the child and family speak another language than the nurse (the nurse speaks only English). What actions should the nurse take to address this situation? Select all that apply. A. Continue with the admission process since gathering information at this time is vital, then contact an interpreter later. B. Secure the help of the hospital's interpreter immediately before proceeding with the admission process. C. Determine if the child and family are able to read English accurately before giving written directions or information. D. Ask the family if one of their other children speaks English and can act as an interpreter so the admission process can begin. E. When utilizing the interpreter's help keep conversations to a maximum of 20 to 30 minutes.

B. Secure the help of the hospital's interpreter immediately before proceeding with the admission process. C. Determine if the child and family are able to read English accurately before giving written directions or information. E. When utilizing the interpreter's help keep conversations to a maximum of 20 to 30 minutes. The admission process should not continue until the interpreter is present so that correct information is both obtained and given. Sessions of 20 to 30 minutes are the maximum time frame for conversations since attention is lost beyond this time frame. The nurse must determine if the child and family needs written instructions and information in their native language. Children should not be used as an interpreter since they may not be a good translator, and information may be private and should not be shared with the family member.

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

B. Sing a song and have the child sing along. C. Have the child blow bubbles. D. Ask the child to squeeze the nurse's hand. Distraction methods for preschool-age children 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.

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

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

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. A. The child's mother asks many questions. B. The child's mother asks the nurse to complete paperwork for her. C. The child's medical record contains information indicating the family frequently misses appointments. D. The child's mother asks for additional resources to review about the planned treatment. E. The child's mother provides little responses to information provided.

B. The child's mother asks the nurse to complete paperwork for her. C. The child's medical record contains information indicating the family frequently misses appointments. E. The child's mother provides little responses to information provided. 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 planning interventions for a child being evaluated at the health clinic. How will therapeutic communication benefit the child? A. Therapeutic communication improves the child's ability to cope with the examination. B. Therapeutic communication enhances the development of trust between the nurse and the child. C. Therapeutic communication will limit the amount of trauma the child experiences. D. Therapeutic communication assists the nurse in maintaining accurate assessment data.

B. 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.

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. A. Request that the family bring a friend who is bilingual to assist with discharge teaching interpretation. B. When providing written discharge or follow-up information, ask the interpreter to translate in the family's language. C. Ask the client and family to provide return demonstration of inhaler use to ensure understanding. D. Speak clearly using short sentences and provide pauses for interpretation and responses. E. Focus on the interpreter during the conversation and allow them to fully convey any expression or emotion from the child and parent.

B. When providing written discharge or follow-up information, ask the interpreter to translate in the family's language. C. Ask the client and family to provide return demonstration of inhaler use to ensure understanding. D. Speak clearly using short sentences and provide pauses for interpretation and responses. 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.

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

B. 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.

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? A. video B. demonstration C. role modeling D. coloring book about diabetes

B. 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.

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

B. drawing pictures A useful nonverbal technique to learn how children feel about a frightening experience is to ask them to draw a picture of what happened or a picture of themselves. A child's use of color may be a clue as to their mood (happy children will use bright colors; depressed children will use black or dark colors). The child's age would matter if the child were to keep a diary. This would have to be an older school age child or adolescent. If the child is not communicative, attending a group discussion might tend to increase the anxiety because more pressure would be exerted to participate in the group. Playing video games is a single activity and requires the child to focus on the game and not the problem.

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

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

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. A. Explain that her biological mom could not care for her so she was given away. B. Inform the child that her biological mom was in prison and would not be able to care for her for a long time. C. Avoid criticizing the biological parents but reinforce how much the adoptive mom and dad love them. D. 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. E. Tell the child that her biological mom could not care for her after birth because she was HIV positive.

C. Avoid criticizing the biological parents but reinforce how much the adoptive mom and dad love them. D. 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. 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.

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? A. Tell the child different ways to perform the technique so the child can choose. B. Allow the child to review instructional pamphlets as the nurse is teaching. C. Demonstrate the technique by performing it the same way each time. D. Suggest the child tell the nurse how he or she wants the range-of-motion exercises to be done.

C. 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 nurse is working with a 13-year-old girl who continually demands cups of water or juice, specific foods, and constant changes to her bed position. How should the nurse respond to this client? A. Scolding her for her demanding attitude B. Informing the girl's mother of her demanding attitude C. Graciously meeting all of her requests, within reason D. Withdrawing from the room to evade the constant demands

C. Graciously meeting all of her requests, within reason Demanding behavior generally stems from insecurity or fear. Give more of yourself, not less, to counteract this response. When you have proven you are dependably there for them, children do not feel so insecure, and the need to be demanding usually fades. Withdrawing from them has the opposite effect if it increases the child's insecurity and the demanding behavior. Ask, "Is there anything else I can do for you?" not, "Haven't I already done enough?" Scolding the girl or informing her mother will not address the girl's underlying insecurity.

The nurse is caring for a hospitalized pediatric client. Which intervention will the nurse include to encourage family-centered care? A. Have the primary health care provider meet with the family to tell them about the child's plan of care. B. Have the family members meet with a child psychologist to ensure the child's needs are being met. C. Have a team meeting with the client, family, and involved health care providers. D. Encourage the caregivers to room-in with the client and siblings to visit when possible.

C. 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.

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. Praise the adolescent often. C. Speak directly to the adolescent and consider the client's input in the decisions about care and education. D. Offer choices whenever possible.

C. 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.

A school-aged child learns how to do range-of-motion exercises but has been unable to perform them correctly from day to day. Which approach is best for the nurse to take to encourage compliance by the child? A. Encourage the parents to reward the child for performing the exercises correctly. B. Impress upon the child the importance of the exercises to prevent disfiguring complications. C. State "Good job" to the child when performing the range-of-motion exercises correctly. D. Extend the child's visitation hours on days the child performs the exercises correctly.

C. State "Good job" to the child when performing the range-of-motion exercises correctly. Children maintain behaviors better when given praise. This makes learning a positive experience and facilitates the client's industry stage of psychosocial development. Visitation hours are not a priority for the school-age child; this would be more rewarding for the adolescent client. The nurse should encourage the child, not only the parents. Preventing disfigurement is not a concept easily attainable for the school-age child and would be more appropriate for the adolescent.

The registered nurse (RN) and licensed practical nurse (LPN) are caring for a hospitalized child. Which action by the LPN will cause the RN to intervene? A. The LPN requests minimal laboratory blood draws. B. The LPN attempts to follow the child's home schedule as best as possible. C. The LPN holds down the child while another nurse starts an IV. D. The LPN lets the child keep her security blanket during a lumbar puncture.

C. The LPN holds down the child while another nurse starts an IV. The RN would intervene if the LPN held down the child or used traditional restraints unnecessarily. Using alternative positioning such as "therapeutic hugging" is recommended and should be attempted first if at all possible. Minimal sticks should be advocated for with all clients. Following the child's home schedule will help with maintaining a sense of control and help with the child's behavior. The child should be allowed to keep security items when appropriate.

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

D. 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.

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

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

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

D. 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 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. Open-ended questions B. Perception checking C. Reflecting D. Clarifying

D. Clarifying 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.

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

D. Do not require the child to speak. Shy children, as a rule, have much more difficulty talking to people they meet for the first time and establishing peer relationships than others. If they do not give the nurse verbal feedback, it is easy to believe they do not have a concern. That leaves them without support when they most need it. A therapeutic response would be to not leave them alone, but to maintain an active relationship despite the lack of feedback. This does not necessarily involve talking to the child but checking on him or her frequently, remaining in the room during a physical examination, and sitting with the child while the medication takes effect. Respecting the child's privacy is a basic right, but the child should not be left alone just because the child does not talk. Asking open-ended questions requires the child not only to talk but also to give explanations. Using touch at every interaction may make the child anxious when a child-nurse relationship has not developed.

A nurse caring for a preschooler scheduled for abdominal surgery the next day needs to teach about the dressing and drainage tube that the child will have after surgery. Which would be the best technique for the nurse to use? A. Pamphlets B. Video C. Discussion D. Dolls and puppets

D. Dolls and puppets Preschoolers are interested in learning but often frightened by intrusive procedures. Use of dolls or puppets to help children visualize details whenever possible without intruding on their own bodies is an effective teaching strategy.

The nurse is caring for a 14-year-old girl with terminal cancer and her family. Which intervention provides the best therapeutic communication? A. recognizing the parents' desire to use all options B. presenting options for treatment C. supporting the child's desires for treatment D. informing the child in terms she can understand

D. 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 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? A. Genuineness B. Attentive listening C. Warmth D. Empathy

D. 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 preparing to reduce a young parent's anxiety about a child needing hospitalization. Which action should the nurse prioritize? A. Schedule time to address the parent's concerns. B. Tell the parent about the tests being performed. C. Let the parent know you will relay any messages she has for the doctor. D. Include the parent in the medical decision-making.

D. 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.

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

D. 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.

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

D. Playing a game with coughing and breathing Toddlers have vivid imaginations so teaching should be done where the child can take an active role and understand the reality instead of the imaginary. Toddlers respond best to teaching techniques that include games so they feel as if they are playing instead of learning. When the child is active in the learning process it fosters self-confidence and provides them with a sense of control over the situation. The toddler age group does best learning when they can use all their senses in the learning process. Demonstrating, instructing, or showing a video does not provide this opportunity.

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? A. It is primarily the younger members who teach the older members in a family. B. All adult members share the financial responsibilities. C. Couples today are more concerned about unplanned pregnancies. D. Reproduction remains an important function of many families.

D. 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.

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

D. 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 a 6-year-old girl and parent about home care for an eye infection. Which communication techniques would be least effective with this child? A. Asking permission to touch the child before doing so. B. Talking directly to the child even though the parent makes comments. C. Listening attentively to the child while giving time to finish thoughts and ideas. D. Standing beside the child when doing the teaching.

D. 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.

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

D. 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.

The nurse is caring for a hospitalized preschool child and needs to hang IV fluids by the infusion pump. The nurse introduces the infusion pump to the child based on what developmental principle? A. The child is too young to for an explanation of the equipment. B. Explaining the equipment will only increase the child's fear. C. One explanation will be enough to reduce the child's fear. D. The child may think the equipment causes the pain.

D. The child may think the equipment causes the pain. Preschool-age children tend to be frightened of intrusive procedures. Teaching about intrusive procedures or medical equipment or explaining to children why it is necessary calls for clear explanations and praise for learning. Preschool-age children are interested in learning because developing a sense of initiative is the main developmental task. The nurse should keep explanations short and words simple. A preschooler's attention span rarely exceeds 5 minutes. Because preschool children notice only one characteristic of an object, the nurse may need to repeat the instructions or explanations later. Children need to have explanations for the needed aspects of care they are to receive.

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? A. Finding that the mother relies on American Sign Language. B. Discovering that the father is highly health care literate. C. The nurse concludes that the parents are emotionally distraught. D. The family belongs to a mainline traditional faith community.

D. 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 assessing the teaching needs of the parents of an 8-year-old boy with leukemia. Which assessment should the nurse explore as a potential issue with the parent's health literacy? A. The entire family is fluently bilingual. B. The mother seems to ask most of the questions regarding care. C. The parents are taking notes on answers to their questions. D. The parents missed the last scheduled appointment.

D. The parents missed the last scheduled appointment. Missing appointments is one of the red flags to health literacy problems as the parents may not have understood the importance of the appointment or may not have been able to read or understand appointment reminders. Being bilingual does not indicate health literacy issues. Taking notes or one parent being the primary spokesperson for the child's health care are not unusual practices.

A recently licensed nurse asked the charge nurse what it means to provide atraumatic care to hospitalized children. Which response by the charge nurse would be accurate? A. The concept is best demonstrated by providing a ratio of one nurse to one child. B. The staff works specifically with children who have injuries and accidents. C. The staff is diligent to avoid health care-acquired infections in hospitalized children. D. The underlying premise refers to the concept of "do no harm."

D. The underlying premise refers to the concept of "do no harm." Atraumatic care can also be called therapeutic care; it minimizes the child's and family's physical and psychological distress when cared for within the health care system. It is based on the underlying premise of "do no harm." Assigning one nurse to one child is ideal, but may not be practical from a resource and acuity standpoint. Health care-acquired infections are prevented as much as possible, but would be only one aspect of atraumatic care, not the entire concept. Nurses provide atraumatic care to all hospitalized children, regardless of injury or illness.

The father of a child hospitalized after a fire questions the use of therapeutic play. He reports he does not understand the purpose. What information can be provided to him? A. All children like to play. B. Playing provides the child with a way to expend some energy during the hospitalization. C. Therapeutic play lets the nursing staff observe the child's developmental level. D. This type of play gives the child an outlet to deal with stress.

D. This type of play gives the child an outlet to deal with stress. Therapeutic play is a type of play that provides an emotional outlet or improves the child's ability to cope with the stress of illness and hospitalization.

Based on school-aged cognitive development, which teaching technique would the nurse anticipate as being received the best? A. Asking children to think through "what if" situations and blood pressure B. Asking children to conceptualize the effect of falling blood pressure C. Explaining elevated and decreased blood pressure as a concept D. Using containers of water to demonstrate how hemorrhage leads to decreased body fluid

D. Using containers of water to demonstrate how hemorrhage leads to decreased body fluid Children learn best if their input is valued and they are actively involved in the learning process. School-aged children are in the concrete cognitive stage. They understand concepts of space, time and dimension so they learn best by seeing something happen. A child this age likes videos, books, diagrams, and illustrations. Asking children to visualize a concept for which they have no understanding does not help them learn. They need hands-on learning to accurately visualize. Explaining elevated blood pressure, thinking about "what ifs" or conceptualizing falling blood pressure are above the developmental level of school-aged children.

Which is most likely to encourage parents to talk about their feelings related to the poor prognosis their child has been given? A. avoiding periods of silence B. being sympathetic C. using direct questions D. using open-ended questions

D. 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.