Chapter 30: Atraumatic Care of Children and Families

A 9-year-old arrives in the clinic for a venipuncture. The child says to the nurse, "You better know what you are doing, because you only get one chance at this!" What is the best response by the nurse?

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

The nurse suspects poor literacy skills in a child's family member when which statement is made?

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

An adolescent who plays catcher on the baseball team begins shouting at the nurses, slams the doors, and refuses to talk to anyone after being given the news that his right arm will require surgery. Which response by the nurse would be the most appropriate in this situation?

"I know 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.

Nursing students are learning about the importance of therapeutic communication in their pediatric course. The nursing instructor identifies a need for further teaching when a student makes which statement?

"It is best to stand when listening to a child to demonstrate knowledge" Good listening is not passive but active. Posture reveals greatly whether one is listening. Sitting, not standing, means the nurse is actively listening and interested in what the child has to say. Leaning forward, not backward, displays interest in the child and conveys an openness. The nurse can convey good listening habits by pulling up a chair to the bedside or to a table when the child is sitting and engaging with the child at the same level.

A parent calls the pediatric clinic and tells the nurse "I think my child is having a sickle cell crisis. Should I bring the child to the office?" What is the nurse's best response?

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

The nurse is educating a 4-year-old child about what to expect during an upcoming procedure. Which statement(s) is appropriate for the nurse to use? Select all that apply.

"This little tube will go in your nose and down into your belly." "When they come to get you, you will get on a special rolling bed." "They are going to give you some special medicine to help the doctor see what is happening inside your belly." It is appropriate to use the word "tube" and not a "catheter." It is appropriate to call a "gurney" a "rolling bed." It is better to call dye "special medicine." Terms used in the other options may be misunderstood by a 4-year-old child.

The nurse is caring for a 7-year-old child scheduled for a tonsillectomy the next day. The client states, "I really wish I was not having surgery tomorrow. I am not excited about this. Maybe I will be better by tomorrow." Which response by the nurse is most appropriate?

"You sound worried. Let's talk about tomorrow" Therapeutic communication is an interaction between two people that is planned (deliberately intending to determine the true way a child feels), has structure (use specific wording techniques that will encourage the response you expect to elicit), and is helpful and constructive (at the end of the exchange the nurse will know more about the child than at the beginning, and the child, ideally, also knows more about a particular problem or concern). The child seems worried; therefore, the nurse would discuss the child's feelings with the child to determine the best course of action. It is not appropriate for the nurse to state "hope you are better" or "everything was fine" as these are not therapeutic. If possible, it would be appropriate for the child to tour the operating room prior to surgery, after discussion the child's feelings. Seeing the location may help alleviate some fears.

The nurse is explaining a diagnostic procedure to a 7-year-old girl before the procedure begins. Which statement by the nurse best utilizes the principles of atraumatic care?

"You will lie on a special bed that moves in the machine but you can still see out." 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."

A school-aged child is hospitalized. The nurse assesses the child to be withdrawn and frowning frequently. Which statement made by the nurse would indicate the nurse is utilizing perception-checking?

"You've said twice you are not worried about missing school. I wonder if you really are worried. Are you?" Perception-checking documents a feeling or emotion reported to the nurse. The correct answer has the nurse verifying a perception in which the child states there is no worry. The nurse responds with a question to ascertain the worry. Asking the child if he or she would like to talk or what bothers him or her are direct questions and not something that has been reported to the nurse. Asking the child is he or she is worried about being able to play baseball is using a technique called focusing, which helps a child center on a subject the nurse suspects is causing the anxiety.

A parent wants to wait outside the room while a procedure is completed on his young child, saying, "I don't think I can stand to see you do this!" The nurse's best response is:

"certainly. I will stay with your child during the procedure" 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.

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?

"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.

An urgent care nurse is cleaning a forehead laceration on a 7-year-old. The mother is present. The child is crying and screaming. The nurse should:

"tell the child 'it is okay 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.

A nurse is attempting to reduce pain that a child is experiencing after an emergency appendectomy. What intervention can the nurse provide to meet this goal?

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

The nurse is assessing the needs of a family with a young child recently diagnosed with muscular dystrophy. The nurse determines case management should be a priority for this family as it will best prioritize which overall goal?

Coordinate the activities to deal with the complex health care system Case management is a means of coordinating various care options such as support groups and counseling, as well as providing ongoing evaluation of care that is used to help the family deal with the complex health care system. Support from groups with similar issues characterizes support groups and self-help groups. Ongoing counseling, such as psychiatric, family, or marital counseling can assist with addressing the family's needs. Family or marital counseling also helps to examine relationships and roles of members and focuses on the interaction of the members.

A 4-year-old adopted child has begun to ask questions about when she was born. Which suggestions by the clinic nurse would be considered the most appropriate answer for this child related to her birth? Select all that apply.

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

A mother of a 9-year-old child newly diagnosed with diabetes is struggling to comes to terms with all the blood monitoring and medications the child will need to maintain a normal quality of life. The mother works full-time and is the primary wage earner for the family. Which interventions suggested by the nurse can possibly help this family? Select all that apply.

Explore how other family members can help with a portion of the responsibility for medication administration. Suggest that a nearby grandparent help with healthy meal preparation while the mother is at work. Provide education for the child in regards to testing blood glucose levels. It would not be helpful, for example, to suggest a mother quit work to better supervise a child's medication regimen if she is the sole wage earner for her family. Helping all family members assume a portion of the responsibility for safe medication administration might be a more workable solution. Asking a close relative to help with meal preparation within the guidelines of a diabetic diet would relieve some of the stress the mother may be feeling. At 9 years of age, the child can be taught to monitor and treat blood glucose levels with supervision. Putting the burden of glucose monitoring and insulin administration on the school nurse is not a good choice since the child has probably eaten prior to getting to school. The school nurse is, however, a valuable resource.

The nurse is caring for an adolescent with a newly diagnosed disease process. The adolescent refuses to learn about the disease. Which technique should the nurse use to encourage the adolescent to be actively involved in education about this disease?

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

A high school nurse has noticed a trend in the reading ability of the freshman class. This high school is located in a poor, urban area where there is a high proportion of single mothers raising their children with minimal financial support. Young children many times do not have adult supervision with homework. The local school nurses discuss issues within the school area. Which suggestion by a high school nurse would be a realistic solution to the problem described in this scenario?

Organize a group of local high school students to begin a reading program in the grade school to increase interest in reading. It is easy to fall into the mindset that a single telephone call or an email about a problem will not make a difference. Organizing adolescents from a local high school to begin a reading program at a grade school so as to increase interest in reading and improve the literacy rate in their neighborhood is a sound example of primary prevention. It is doubtful that the school board will provide reading teachers for each school given financial restraints being placed on public education. Single parents working more than one job to provide necessities for their family will probably not attend a block party since they will be at work. Also, singling the parents out for not supervising homework is unprofessional and not appropriate. Even if the school nurses agree to help after hours with reading, the number of students receiving the private sessions would be very low. The best option is getting high school students involved in the project.

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.

Show the child how to correctly perform the procedure Given time to practice and increase proficiency Have the child perform a return demonstration of the procedure 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.

The nurse has worked diligently with an adolescent to meet his teaching-learning needs and make adaptations for managing his illness to suit his preferences and lifestyle. Even so, there is evidence of noncompliance. The nurse's interpretation is:

Some noncompliance should be expected due to the teen's desire for independence, expression of his personal values, and peer acceptance. Acceptance of some noncompliance by this teen is necessary. Finding compromise to limit noncompliance is important. Developmentally, the adolescent is capable of formal thought. Connecting present and future should not be an issue. There may be some measure of inattentiveness to teaching and some need for more home support, but these do not represent the main reason for noncompliance.

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?

Speak directly to the adolescent and consider the client's input in the decisions about care and education. A teaching tip for adolescents that will allow them control and involvement in the decision-making process is to speak directly to them and consider their input in all decisions about their care and education. Adolescents are particularly sensitive about maintaining body image and the feelings of control and autonomy. Reasons as to why things are important should be conveyed to them. The nurse should collaborate with the teen to develop an acceptable solution to being compliant. The nurse should also expect some noncompliance from adolescents. Even with noncompliance in some areas, there some things the adolescent does well—and the adolescent should be praised for these accomplishments. Choices can be offered whenever possible but for a client with diabetes these choices are often limited.

The nurse is working with an interpreter to meet the health needs of a family with limited skills in the English language. Which action is not recommended?

Talking one-on-one with the interpreter at numerous points throughout the session with the family present. Side conversations with the interpreter can create discomfort for the family and undermine trust. The other actions all enhance the communication.

The child life nurse practitioner has been assigned to assist the hospitalized child and the child's parents. Which interventions are appropriate for the child life specialist to perform? Select all that apply.

Talking to the family about a scheduled diagnostic test Showing the child where the pediatric play room is located Speaking to the physician as the child's advocate The child life specialist commonly assists with nonmedical preparation for diagnostic testing, provides tours, assists in play therapy, and is the child's advocate. The child's nurse gives medication, vaccines, and starts intravenous lines.

During the change of shift report, the nurse reports concerns about the parents of a hospitalized child understanding the written literature provided concerning the child's plan of treatment. Which observations would provide support to this concern? Select all that apply.

The child's mother provides little responses to information provided. The child's medical record contains information indicating the family frequently misses appointments. The child's mother asks the nurse to complete paperwork for her. Understanding health-related information can be challenging. It is a role of the nurse to ensure an understanding of information and materials provided. Signs that information is not being understood may include asking few questions about the plan of treatment. Missed appointments may also signal a lack of understanding. Asking the nursing staff to complete paper work may signal a lack of understanding or possibly an inability of the family to do it themselves.

When teaching an adolescent about home care after hospitalization, what is most important for the nurse to do?

allow opportunity for adolescents to express themselves 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 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?

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.

When caring for hospitalized teens, nurses should choose their words and actions carefully since adolescents typically are concerned about:

appearing out of control of the situation and/or themselves 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 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?

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.

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?

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 they won't be able to adequately translate medical terminology. Using an older sibling can upset the family relationships or cause legal problems.

The nurse is caring for a child who appears fearful and is reluctant to talk. The nurse uses therapeutic communication skills to interact with the child. What initial goal does the nurse accomplish when using these skills to communicate with the child?

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

What should be the first step in developing a teaching plan for a 9-year-old child who needs education about a gluten-free diet for the treatment of celiac disease?

assessing the child current level of understanding Client education occurs when nurses share information, knowledge, and skills with children and their families. For this to be effective, the nurse would first have to assess the child's and family's current level of understanding, the child's cognitive level, the child's physical ability and any psychosocial concerns. The child learns best when the child's input is valued and the child is actively involved in the learning process. Giving the child a video to watch or a pamphlet to read does not allow interaction for learning or the ability to ask questions or voice concerns. If the child is to be on a gluten-free diet, the parents responsible for purchasing the food should also be included in the teaching. Collecting facts about the child's likes and dislikes would be important to know, because gluten-free substitutions may be available. These, however, are not the primary actions. The assessment comes first.

A nurse manager on a pediatric unit is making assignments for the day. The nurse's goals are atraumatic care for pediatric clients and minimizing parent-child separation. What method of care delivery should the nurse implement?

assign a 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 a 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.

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?

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 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?

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 preparing a 4-year-old to go visit his older sibling in the pediatric intensive care unit (PICU). What teaching method would best help in this child's preparation?

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

A preschool child fell off a tricycle and broke an arm that will require surgical repair. The nurse wants to prepare the child for surgery. Which is the best technique the nurse could use to teach the child about what to expect?

dolls Teaching preschool children about what to expect from a hospital experience is often taught using a series of puppets or dolls to represent different hospital personnel such as the surgeon, a nurse, and a nurse's assistant. Preschool children are particularly receptive to puppets and dolls because, with their imagination at its peak, they believe the puppet or doll is actually talking to them. Children can practice giving the doll "shots" or submitting it to procedures they will experience. Coloring, games, and demonstration can be helpful in many situations, but dolls allow the child to have a hands-on learning experience.

The nurse is teaching the caregivers of a child with cystic fibrosis. What is most important for the nurse to teach this family?

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

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?

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 care for a 2-year-old girl with a chronic respiratory disease present since birth. Which of the following would be of least help in working effectively with the parents?

expect parents to perform procedures precisely as taught Parents often modify procedures to better suit the child/family situation and routine. Parents are not new to this child's care—they have been managing it since birth. However, it is essential that safe physical and psychosocial conditions are maintained. Parents often devise creative approaches to the child's care from which nurses can learn. The other strategies are sound and support a good nurse-family-child working relationship.

The community health nurse is assessing a new client who reports he has recently moved to the area and is living with an aunt and her parents. The nurse determines this client resides in which type of family structure?

extended The extended family is a nuclear family with other family members in the same house. The nuclear family is composed of a man, a woman, and their children (either biological or adopted), all of whom share a common household. Members of a communal family share responsibility for homemaking and child rearing; all children are the collective responsibility of adult members. In a blended family, both partners in the marriage bring children from a previous marriage into the household.

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?

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

A 7-year-old child with sickle cell anemia who comes to the hospital frequently appears withdrawn and depressed. The client refuses to talk to anyone or even admit to feeling sad. What would be the best thing for the nurse to do that might help the child deal with his or her feelings?

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

A nurse is providing care for a child diagnosed with beta-thalassemia major, and is preparing the family for discharge. The nurse notes that the family is overwhelmed with the challenges of their child's diagnosis. What is the best way for the nurse to ensure that the family is supported after discharge?

have the case manager meet up with the family prior to discharge The best way for the nurse to ensure the family has the support they need after discharge is to have a case manager meet with the family prior to discharge. The case manager can assess the family for specific needs and coordinate necessary services. Individually, making weekly calls to the family, providing information on support groups, and providing follow-up appointments would be helpful. However, the case manager could coordinate all of those services and provide the family with one person to contact with questions or concerns.

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?

ignoring the adolescents 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 nurse is preparing to reduce a young parent's anxiety about a child needing hospitalization. Which action should the nurse prioritize?

include the parent in the medical decision making The family-centered care approach is a researched-based philosophy that promotes family coping with a child needing medical attention. The nurse should collaborate with the family to address the family's needs, as well as the medical care of the child. Including the parent in the process of medical decision-making would be the priority. The other choices (letting the parents know about the tests to be performed; relaying messages; addressing concerns promptly instead of setting aside to discuss all the concerns simultaneously) would be additional ways to include the parents in the process and relay necessary information to be able to make informed decisions.

The nurse is caring for a 14-year-old girl with terminal cancer and her family. Which intervention provides the best therapeutic communication?

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 family with a 13-year-old child who has cystic fibrosis is having a stressful time since the father is currently unemployed while the mother works full-time. The ill child has been acting out at school. He is "sick of taking medications and doing chest expansion exercises" and "just wants to be like all the other kids." There are two stepbrothers living in the home creating problems of their own. At the moment, the ill child has a respiratory rate of 32 breaths/minute and has a productive cough with bilateral rales in both lung bases. The nurse assessing this family will document which priority NANDA related to the current family dynamics?

interrupted family processes The most appropriate family NANDA would be Interrupted family processes related to the effect of child's illness and situational stressors limiting communication. The other NANDAs may be appropriate given more data, but they are not the priority for this family's current stressors.

The nurse is caring for a 14-year-old boy, and his parents, who has just been diagnosed with a malignant tumor on his liver. Which intervention is most important to this child and family?

involve the child and family in decision making Since the child has just been diagnosed, concerns about postoperative home care would be least important. Arranging an additional meeting with the specialist and discussing treatment options may be necessary at some point, but involving the child and family in decision making is always a goal and is a part of family-centered care.

The school-age child with a new colostomy will require teaching by the nurse to learn to care for the ostomy. In order for the nurse to teach the child effectively, what is most important for the nurse to know about the child?

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

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?

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.

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?

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

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?

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 9-year-old child is newly diagnosed with asthma. The nurse plans to teach the child about triggers related to the diagnosis. What would be the best approach for this child?

plan an allergy trivia game with the child Learning through play is a valuable tool at this age. School-age children like to participate in their learning. Watching a video is more passive rather than active. It does not give the child the chance to ask questions or get explanations about things in the video that were not understood. Giving the child a list of what he or she cannot have is a negative approach. Using a negative approach generally causes rejection, so the child will not follow through. Educating clients and their families is a large role of nursing.

A 5-year-old is obviously relieved yet angry following a procedure he resisted and needed to be restrained to complete. Which nursing action may be most helpful to this kindergartner?

providing play-dough 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 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?

reproduction remains an important function of all 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.), which can result in limited resources available for the family.

A nurse is providing teaching on the medication regimen for beta-thalassemia to an adolescent. What is the best way for the nurse to determine if the teaching was successful?

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

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?

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?

stand beside the bed when the child is 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.

A couple is arguing and bickering all the time. This couple has not told the children yet that they are planning to get a divorce. When the couple discusses this with the school nurse, the nurse shares that at this early phase, children likely experience what type of feelings?

take blame for their parents quarreling and try to behave better The most appropriate answer is taking blame for their parents quarreling. The first phase is apt to be an antagonistic time as parents realize they are no longer compatible, marked by quarreling, hurt feelings, and whispered conversations. This phase can be particularly upsetting for children because they usually have not been told what is happening as yet. They may assume the quarreling is their fault (i.e., if they had behaved better, this would not be happening). They may act out (depending on age of child). Sometimes children share their feelings with the school nurse or teaching and they may use the word "mad" when describing the fighting in the home. Sensitive children may make up imaginary families that are happy.

A nurse is teaching a 6-year-old child and parents about an outpatient surgical procedure the child will have the next day. The child is "shy" and does not maintain eye contact with the nurse. What is the best way for the nurse to approach the child?

talk to the parents first to give the child a chance to "warm up" 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 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?

the LPN holds down the child while another nurse starts the 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 maintain 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 an 8-year-old client newly diagnosed with diabetes mellitus on how to administer insulin. Which finding indicates the nurse's education was successful?

the child demonstrated 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 demonstrates good technique in self-injection of insulin. Having the child draw up the correct amount of insulin is needed, but 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 than self-administration of insulin.

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?

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.

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?

the child may think that 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?

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.

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

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

Based on school-aged cognitive development, which teaching technique would the nurse anticipate as being received the best?

using containers of water to demonstrate how hemorrhage leads to decreased in 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.

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?

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 should be used that the client can easily understand. It is appropriate for the LPN to actively listen, speak to the client, and ask open ended questions.