Chapter 30 Atraumatic Care of Children and Families
The nurse is communicating with a family about their child's illness. Which communication technique would be considered a block to effective communication with the family? using clichés using silence defining the problem clarifying
using clichés A cliché is the first level of communication. It is pleasant chatting and not intended for a relationship to extend beyond a superficial level. Introducing one's self and role allows the communication to progress to a more therapeutic level. The use of silence will allow the parents to sort out their thoughts. The nurse needs to clarify in the communication to illicit the information needed. The parents both will need to collaborate to define the problem so that a plan of care may be developed.
The nurse is consulting with a child life specialist (CLS) to help minimize the stress of hospitalization for a child. Which of the following services would the CLS provide? Select all answers that apply. A) Medical preparation for tests, surgeries, and other medical procedures B) Support before and after, but not during, medical procedures C) Activities to support normal growth and development D) Grief and bereavement support E) Emergency room interventions for children and families F) Only inpatient consultations with families
C) Activities to support normal growth and development D) Grief and bereavement support E) Emergency room interventions for children and families
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 nurse is caring for a 7-year-old child scheduled for a tonsillectomy the next day. The client states, "I really wish I was not having surgery tomorrow. I am not excited about this. Maybe I will be better by tomorrow." Which response by the nurse is most appropriate? "I had my tonsils removed at your age and everything was just fine." "I hope you are better tomorrow, too." "You sound worried. Let's talk about tomorrow." "Would you like to go see an operating room?"
"You sound worried. Let's talk about tomorrow." Therapeutic communication is an interaction between two people that is planned (deliberately intending to determine the true way a child feels), has structure (use specific wording techniques that will encourage the response you expect to elicit), and is helpful and constructive (at the end of the exchange the nurse will know more about the child than at the beginning, and the child, ideally, also knows more about a particular problem or concern). The child seems worried; therefore, the nurse would discuss the child's feelings with the child to determine the best course of action. It is not appropriate for the nurse to state "hope you are better" or "everything was fine" as these are not therapeutic. If possible, it would be appropriate for the child to tour the operating room prior to surgery, after discussion the child's feelings. Seeing the location may help alleviate some fears.
The nurse is caring for a 4-year-old boy with Ewing sarcoma who is scheduled for a computed axial tomography (CAT) scan tomorrow. Which of the following is the best example of therapeutic communication? A) Telling him he will get a shot when he wakes up tomorrow morning B) Telling him how cool he looks in his baseball cap and pajamas C) Using family-familiar words and soft words when possible D) Describing what it is like to get a CAT scan using words he understands
D) Describing what it is like to get a CAT scan using words he understands
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? Discussion Dolls and puppets Pamphlets Video
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 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? Stand several steps away from the parents. Look at the child when the father is talking. Sit straight with feet flat on the floor. Nod head while the mother speaks.
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 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 nurse concludes that the parents are emotionally distraught. The family belongs to a mainline traditional faith community. Discovering that the father is highly health care literate. Finding that the mother relies on American Sign Language.
The family belongs to a mainline traditional faith community. Membership in this traditional faith community impacts learning needs the least. There are no particular values or traditions that would require modification of the care plan for a child with his health problem. Parents experiencing a highly charged emotional state creates a learning barrier for them. A very healthcare-literate person would require less repetition and simplification of the explanations given. A deaf mother may require an interpreter if the nurse does not know American Sign Language.
The nurse is 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 recognizing the parents' desire to use all options presenting options for treatment supporting the child's desires for treatment
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 9-year-old child is newly diagnosed with asthma. The nurse plans to teach the child about triggers related to the diagnosis. What would be the best approach for this child? play an allergy trivia game with the child give the child a list of foods he or she cannot eat have the health care provider teach the child this information show the child a video about planning for allergic-reactions
play an allergy trivia game with the child Learning through play is a valuable tool at this age. School-age children like to participate in their learning. Watching a video is more passive rather than active. It does not give the child the chance to ask questions or get explanations about things in the video that were not understood. Giving the child a list of what he or she cannot have is a negative approach. Using a negative approach generally causes rejection, so the child will not follow through. Educating clients and their families is a large role of nursing.
The nurse contacts a child life specialist (CLS) to work with children on a pediatric ward. What is the primary goal of the CLS? A) Decrease anxiety and fear during hospitalization and painful procedures B) Keep children who are hospitalized distracted from pain C) Perform medical procedures using atraumatic principles D) Act as a liaison between the nurse and the child
A) Decrease anxiety and fear during hospitalization and painful procedures
The nurse is explaining a discharge plan to the parents of an infant being discharged from the hospital. Which of the following characteristics regarding adult learning should the nurse incorporate into her plan? A) Adults are dependent learners. B) Adults are problem focused. C) Adults are future focused. D) Adults do not value past learning.
B) Adults are problem focused.
The nurse is teaching a 6-year-old girl and parent about home care for an eye infection. Which communication techniques would be least effective with this child? Standing beside the child when doing the teaching. Listening attentively to the child while giving time to finish thoughts and ideas. Talking directly to the child even though the parent makes comments. Asking permission to touch the child before doing so.
Standing beside the child when doing the teaching. Standing above a 6-year-old may create the feeling of being dominated. Sitting at her level promotes equality and a more comfortable teaching/learning setting. Listening with patience to the child when she speaks or asks questions allows her time to completely formulate and express her thought or question. It is respectful. Talking to the child as well as the mother during health teaching keeps the child a participant in her care. Asking permission to touch the child reduces threat.
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." "This will only take a few minutes. You should be with your child." "Come, stand by his head. You won't see much up there." "Good. That is what the team doing the procedure would prefer." "Stay. It will be less scary for your child."
"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 nurse is implementing care for a hospitalized toddler. What communication technique would the nurse use with the child to reflect the child's developmental level? A) Allow the child extra time to complete thoughts. B) Communicate solely through play. C) Provide simple but honest and straightforward responses. D) Remain nonjudgmental to avoid alienation.
A) Allow the child extra time to complete thoughts.
The nurse is caring for a 14-year-old boy with an osteosarcoma. Which of the following communication techniques would be least effective for him? A) Letting him choose juice or soda to take pills B) Seeking the teenager's input on all decisions C) Discussing the benefits of chemotherapy with him D) Avoiding undue criticism of noncompliance
A) Letting him choose juice or soda to take pills
The nurse is educating a 15-year-old girl with Graves' disease and her family about the disease and its treatment. Which method of evaluating learning is least effective? Having the child and family demonstrate skills. Requesting the parent to teach the child skills. Asking closed-ended questions for specific facts. Setting up a scenario for them to talk through.
Asking closed-ended questions for specific facts. Asking questions is a valid way to evaluate learning. However, it is far more effective to ask open-ended questions because they will better expose missing or incorrect information. As with teaching, evaluation of learning that involves active participation is more effective. This includes the child and family demonstrating skills, teaching skills to each other, and acting out scenarios.
The nurse is providing tertiary care to a young, uninsured family who has a child with frequent seizures. Which action by the nurse would demonstrate tertiary care? Performing a well-child checkup, noting weight gain Educating the parents regarding appropriate play activities for the child Finding a company to provide a helmet for the child to wear daily. Nutritional guidance for healthy meals for the family.
Finding a company to provide a helmet for the child to wear daily. Tertiary care involves health promotion focused on rehabilitation and prevention of further injury or illness, and it optimizes function. By providing a safety helmet to the child with a history of seizures, the nurse is preventing further injury to the child. Nutritional guidance is an example of primary prevention, focusing on good nutrition to prevent risk factors that may cause impairment. Performing the well-child checkup and educating about appropriate play activities address secondary prevention, which reflects health screening and prompt treatment of problems.
The nurse is providing atraumatic care to children in a hospital setting. Which of the following are principles of this philosophy of care? Select all answers that apply. A) Avoid or reduce painful procedures B) Avoid or reduce physical distress C) Minimize parent-child interactions D) Provide child-centered care E) Minimize child control F) Use core primary nursing
A) Avoid or reduce painful procedures B) Avoid or reduce physical distress F) Use core primary nursing
The child life specialist (CLS) is preparing a 6-year-old child for a magnetic resonance imaging (MRI) scan. Which of the following statements reflects the use of atraumatic principles when explaining the procedure? A) "You will be taken to a magnetic resonance imaging machine for an x-ray of your liver." B) "You may hear some loud noises when you are lying in the machine, but they won't hurt you." C) "You have nothing to worry about; the MRI machine is safe and will not cause you any pain." D) "Let's just get you to the x-ray department for your test and you'll see how simple it is."
B) "You may hear some loud noises when you are lying in the machine, but they won't hurt you."
A nurse is promoting the use of family-centered care in a local community clinic. Which of the following are advantages or disadvantages of this type of care provision? Select all answers that apply. A) Recovery times are longer. B) Anxiety is decreased. C) Communication is improved. D) Health care costs are increased. E) Pain management is enhanced. F) More health care resources are utilized.
B) Anxiety is decreased. C) Communication is improved. E) Pain management is enhanced.
The nurse is educating a 16-year-old girl who has just been diagnosed with acute myelogenous leukemia. Which of the following statements best demonstrates therapeutic communication? A) Discussing the treatment plan in detail for the next few weeks B) Using medical terms when describing the disease C) Assessing the adolescent's emotional status in private D) Talking about clothing and the stores where she shops
C) Assessing the adolescent's emotional status in private
The nurse is preparing a child and his family for a lumbar puncture. Which of the following would be a primary intervention instituted by the CLS to keep the child safe? A) Distraction methods B) Stimulation methods C) Therapeutic hugging D) Therapeutic touch
C) Therapeutic hugging
A family is anxious for information about the status of their ill infant. The parents do not understand the dominant language, but their 14-year-old child is competent in the language, both spoken and written. The health care provider is present, but an interpreter is unavailable. What should the nurse do? Coordinate health care provider and interpreter schedules and arrange an information-sharing session for later in the day. Support the child while the child interprets for the parents and the health care provider at the bedside. Develop a written account of the infant's status with the health care provider that the child can read and explain to the parents. Have the child and health care provider discuss the information thoroughly and help the child share these data with the parents.
Coordinate health care provider and interpreter schedules and arrange an information-sharing session for later in the day. An interpreter is essential. Explanations need to be given and questions relayed and answered. The interpreter needs understanding of the health care environment, not just the language. The parents are anxious for information and "not knowing" is difficult. However, children in the family should not be used as interpreters. This may upset family dynamics by giving a great deal of power to a child.
The nurse is using verbal skills to explain the nursing care plan to parents of a 10-year-old child with cancer. Which of the following describes a guideline the nurse should follow to provide appropriate verbal communication? A) Use closed-ended questions that do not restrict the child's or parent's answers. B) Allow the focus to change without redirecting the conversation. C) Restate the child's and parents comments in your own words. D) Paraphrase the child's or parent's feelings to demonstrate empathy.
D) Paraphrase the child's or parent's feelings to demonstrate empathy.
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? Allow the child to review instructional pamphlets as the nurse is teaching. Suggest the child tell the nurse how he or she wants the range-of-motion exercises to be done. Tell the child different ways to perform the technique so the child can choose. Demonstrate the technique by performing it the same way each time.
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 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? Praise the adolescent often. Provide information and allow the adolescent to process and ask questions. Speak directly to the adolescent and consider the client's input in the decisions about care and education. Offer choices whenever possible.
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 caring for a toddler who is scheduled for an outpatient lumbar puncture. Which action by the nurse would be appropriate? having a child life specialist interact with the toddler before and during the procedure educating the parents to begin preparing the toddler for the procedure about 1 week in advance explaining the procedure with a picture and diagram to ensure cooperation of the toddler reminding the toddler that privacy will be maintained by a gown or blanket during the procedure
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 suspects poor literacy skills in a child's family member when which statement is made? "We communicate with the special education teachers and school daily with a notebook." "I need you to review once more the best way to be sure he swallowed all his medicine." "I forgot my glasses, so I'll read this when I get home and let you know if I have questions." "He gets a suppository every 3 days to prevent constipation."
"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.
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. "They are going to give you some special medicine to help the doctor see what is happening inside your belly." "You will end up in the 'ICU' where you will wake up with some electrodes on your chest." "This little tube will go in your nose and down into your belly." "I am going to give you this shot and it will put you to sleep." "When they come to get you, you will get on a special rolling bed."
"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 uses family-centered care to care for children in a pediatric office. Upon what concept is family-centered care based? A) The family is the constant in the child's life and the primary source of strength. B) The care provider is the constant in the child's life and the primary source of strength. C) The child must be prepared to be his or her own source of strength during times of crisis. D) The wishes of the family should direct the nursing care plan for the child.
A) The family is the constant in the child's life and the primary source of strength.
A nurse manager on a pediatric unit is making assignments for the day. The nurse's goals are atraumatic care for pediatric clients and minimizing parent-child separation. What method of care delivery should the nurse implement? Assign a team of nurses and unlicensed assistive personnel. Assign unlicensed assistive personnel to care for the child to give the parents a break. Assign a core primary nurse. Assign a medication nurse and a primary nurse.
Assign a core primary nurse. Family-centered care is the gold standard for pediatric nursing. It decreases anxiety for both the parent and the child, recovery times are shortened and pain management is enhanced. When a primary nurse is assigned to the child and family, they have an identifiable source to help meet their needs. Oftentimes when more than one person is providing care, effective communication is lost. The family is the primary source for the child and they should not be separated. Having a medication nurse and primary nurses tends to fragment care. The unlicensed assistive personnel can provide basic care for the child, but the parents to be offered to communicate how much involvement they wish in their child's care.
The nurse is teaching the student nurse how to communicate effectively with children. Which one of the following methods would the nurse recommend? A) Position self above the child's level to denote authority. B) If possible, communicate with the child apart from the parent. C) Direct questions and explanations to the child. D) Use the medical terms for body parts and medical care
C) Direct questions and explanations to the child.
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? Maintain complete honesty with the parents. Provide positive feedback to mother and father for care and parenting well done. Expect parents to perform procedures precisely as taught. Consider parents equal partners in care.
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.
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. Inform the child that her biological mom was in prison and would not be able to care for her for a long time. Explain that her biological mom could not care for her so she was given away. Explain to the child that she grew inside another woman, but after the birth she was given to her adoptive mom and dad to raise. Tell the child that her biological mom could not care for her after birth because she was HIV positive. Avoid criticizing the biological parents but reinforce how much the adoptive mom and dad love them.
Explain to the child that she grew inside another woman, but after the birth she was given to her adoptive mom and dad to raise. Avoid criticizing the biological parents but reinforce how much the adoptive mom and dad love them At least by 4 years, children are old enough to fully understand the story of their adoption: they grew inside the body of another woman who, because she could not care for them after they were born, gave them to the adopting parents to raise and love. It is important for parents not to criticize a birth mother as part of the explanation because children need to know, for their own self-esteem, that their birth parents were good people and they were capable of being loved by them, but things just did not work out that way. At age 4, children do not understand HIV status, not being able to provide for the needs of an infant, or prison terms.
A nurse is 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 with the family prior to discharge. Provide information about beta-thalassemia support groups. Make weekly calls to the family to see if their needs are being met. Make sure the family has follow-up appointments for the child's providers.
Have the case manager meet 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 has worked diligently with an adolescent to meet the adolescent's teaching-learning needs and promote the adolescent's use of adaptations for managing the illness that suit preferences and lifestyle. Even so, there is evidence of noncompliance. How does the nurse interpret this situation? More assistance from the family is needed for the adolescent to manage care. The developmental thinking skills of the adolescent prevent the adolescent from seeing the connection between personal actions and the effect on health. Some noncompliance should be expected due to the adolescent's desire for independence, expression of personal values, and peer acceptance. Because the adolescent did not pay attention during the teaching sessions, the adolescent does not know what to do.
Some noncompliance should be expected due to the adolescent's desire for independence, expression of personal values, and peer acceptance. Acceptance of some noncompliance by this adolescent is necessary. Finding compromise to limit noncompliance is important. Developmentally, the adolescent is capable of formal thought. Connecting present actions and future outcomes 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.
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? using a person who is not a professional interpreter allowing too little appointment time for the translation asking the interpreter questions not meant for the family using an older sibling to communicate with the parents
asking the interpreter questions not meant for the family Asking questions or having private conversations with the interpreter may make the family uncomfortable and destroy the child/nurse relationship. Translation takes longer than a same-language appointment and must be considered so that the family is not rushed. Using a nonprofessional runs the risk that he or she won't be able to adequately translate medical terminology. Using an older sibling can upset the family relationships or cause legal problems.
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? video coloring book about diabetes role modeling demonstration
demonstration The purpose of demonstration is to show how the procedure actually is done. Having to imagine steps is little different than reading about them. School-aged children, because of their stage of cognitive development (concrete operations), learn best by demonstration. Watching a video is a good teaching strategy to show the process but it does not have the "real" syringe and vial the child can see and touch. Once the demonstration is complete the child should be allowed to return the demonstration and/or have time to practice with the nurse's assistance.
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? pictures story video dolls
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 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 child developing a chronic illness lack of support people in a crisis limited amount of available resources a parent wishing he or she had more education
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 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? discussing the reasons for the procedure with the child and parents getting paper and markers so that he can draw and color providing Play-Doh for him to manipulate finding an age-appropriate action DVD for him to view
providing Play-Doh for him to manipulate All actions have some merit. The Play-Doh choice is the best means for him to pound, smash, and otherwise vent his feelings in a safe, age-appropriate way. Drawing also is a means to express feelings but is less active. The action DVD may provide venting opportunity through the behaviors of the hero (indirect expression). Discussion is the least helpful immediately, but can be useful later.
The nurse is caring for an 8-year-old client admitted to the hospital for an appendectomy. The client is an immigrant newly arrived in the country. How can the nurse determine the best foods to provide in the postoperative diet? Follow the postoperative dietary prescription. Ensure that a pediatric diet is ordered. Ask the family and child about preferred foods. Request the family members bring foods from home.
Ask the family and child about preferred foods. Clients from different cultures may have different food preferences. The nurse should first ask the client and family about preferred foods and diet. Then the nurse can determine what foods are available that align with both preferences and postoperative orders. Family members may bring foods from home if desired, but this should not be required. The standard pediatric diet or what is prescribed may not align with the family and child's dietary preferences.
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? Genuineness Warmth Attentive listening Empathy
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 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. Giving the child an influenza vaccination. Starting the child's intravenous line. Showing the child where the pediatric playroom is located. Talking to the family about a scheduled diagnostic test. Speaking to the physician as the child's advocate.
Showing the child where the pediatric playroom is located. Speaking to the physician as the child's advocate. Talking to the family about a scheduled diagnostic test. 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.
The nurse notes a 2-year-old toddler with pneumonia is breathing shallow. Which method is best for the nurse to use to teach the toddler how to perform deep breathing exercises? Allow the toddler to blow bubbles in the room Permit the toddler to run around in the playroom Demonstrate to the toddler how to perform deep breathing Tell the toddler he or she can have a treat if he or she breathes deeply
Allow the toddler to blow bubbles in the room Toddlers are learning to be independent. Teaching activities such as deep breathing is more effective when they present as an activity or game. By having the toddler blow bubbles, the toddler will take a deep breathe each time, while having fun. Parents also can help in maintaining the new skill by incorporating it into a daily routine. Permitting the toddler to run would lead to fatigue and increase difficulty in breathing. It is not recommended to bribe a toddler. The nurse can demonstrate the activity; at this age a familiar activity will be easier for the toddler to understand and follow.
The nurse is incorporating nonverbal communication with verbal communication when explaining the treatment plan for a child with juvenile diabetes. Which of the following should the nurse do to communicate effectively with this family? A) Relax; maintain an open posture, with the arms crossed. B) Sit opposite the family and lean forward slightly. C) Use eye contact sparingly to avoid embarrassment. D) Speak a verbal yes or no; do not use head nods.
B) Sit opposite the family and lean forward slightly.
When caring for hospitalized teens, nurses should choose their words and actions carefully since adolescents typically are concerned about: mobility restrictions. separation from peers and family. appearing out of control of the situation and/or themselves. mutilation of their body.
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 parents of a 2-month-old infant have learned that their infant has hemophilia. The parents are visibly upset and ask how this could have happened to them. What is the nurse's best response? "Please do not be upset; it is not your fault. Things like this happen sometimes." "News like this is difficult to hear. Let's talk about what this means for your child." "There is no need to worry. We will teach you how to take care of your child." "I understand how you feel. Let's talk about where you go from here."
"News like this is difficult to hear. Let's talk about what this means for your child." 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.
The nurse is explaining a diagnostic procedure to a 7-year-old girl before the procedure begins. Which statement by the nurse best utilizes the principles of atraumatic care? "You will lie on a special bed that moves in the machine but you can still see out." "The technician needs to take several tubes of blood from you." "I don't think you will be in the X-ray department very long." "The big machine will look inside you to see why you are sick so just hold still."
"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 knows that effective communication with children and their parents is critical to providing atraumatic quality nursing care. Which of the following statements accurately describes the communication patterns of children? A) Communication patterns are similar from one child to the next. B) Children often use more words than adults to describe their fears. C) Children rely more on nonverbal communication and silence. D) Parents more often require affective communication rather than neutral communication.
C) Children rely more on nonverbal communication and silence.
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? Reassure the parents that they have been fully briefed on their child's treatment. Notify the health care provider that the parents still have questions. Answer the parents' questions as completely as possible. Encourage the parents to focus their attention on their child.
Answer the parents' questions as completely as possible. Because the health care provider has discussed the child's care, the nurse should answer the parents' questions as completely as possible. Telling the parents that they have been fully briefed negates their concerns and is inappropriate. Encouraging the parents to focus on their child also negates their concerns. Unless the parents ask specifically for the health care provider, the nurse can answer the parents' questions.
A 10-year-old child with sickle-cell anemia is frequently in the pediatric center of a hospital. What intervention can the nurse provide that will allow the child the sense of control that meets the goals promotes atraumatic care? Advocate for minimal laboratory blood draws. Maintain the child's home routine related to activities of daily living. Promote family-centered care. Provide appropriate pain management.
Maintain the child's home routine related to activities of daily living. To promote a sense of control that meets the goals of atraumatic care, the nurse would attempt to maintain the child's home routine related to activities of daily living. In the hospital, the nurse would use primary nursing. The nurse would encourage the child to have a security item present if desired. Other measures include involving the child and family in planning care from the moment of the first encounter, empowering them by providing knowledge, allowing them choices when available, and making the environment more inviting and less intimidating. The nurse could advocate for minimum blood draws, but with the child's disease this will likely not happen. The nurse can help the child with reassurance and topical pain medication for laboratory draws to prevent the discomfort of multiple needlesticks. These actions, however, do not offer the child a sense of control.
A nurse is assigned to care for a 6-month-old infant hospitalized with diarrhea and dehydration. Because the infant does not have developed speech, what can the nurse do to communicate with the infant? Write on a whiteboard. Use puppets to communicate with the infant. Sing to the infant. Use a stuffed animal to tell a story.
Sing to the infant. Infants primarily communicate through touch, sight, and hearing. Communication can occur through cuddling, holding, rocking, and singing to the infant. The child cannot read, so writing on the whiteboard would be beneficial only for the parents. A 6-month-old infant uses toys as developmental tools, not communication tools. The infant may want to snuggle with the stuffed animal while the nurse tells the story or sings.
The nurse is caring for a 13-year-old client with ulcerative colitis who has a new temporary colostomy. Which nursing intervention is priority? Teach the client how to perform colostomy care. Discuss the process for colostomy reversal with the client. Encourage the parents to care for the child. Set up home health care for the client.
Teach the client how to perform colostomy care. The principles of atraumatic care state to promote sense of control; provide opportunities for control, such as participating in care; attempt to normalize the client's daily schedule; and provide direct suggestions. By teaching the client how to perform colostomy care, the nurse is promoting self-care. The parents need to know how to care for their child; however, it is a priority for the client to receive the education because the client is old enough to perform the care. The nurse will ensure home care is scheduled, but again, this is not a priority. Discussing the reversal process is something the client will be interested in and should be discussed; however, it is not a priority over understanding the current situation.
Which method of communication is appropriate for the nurse to use when caring for a 7-month-old infant? Speak similar to the infant's parents and look in the infant's face when speaking Pronounce words as an infant would, using "baby talk" Use puppets to communicate with the infant Use a soothing and calming tone when speaking to the infant
Use a soothing and calming tone when speaking to the infant To communicate effectively with an infant, the nurse should use a soothing and calming tone when speaking to the infant. A puppet is appropriate when communicating with toddlers and preschool-age children. The nurse should speak clearly when talking to the infant. Talking like the infant's parents is an unreasonable expectation. The nurse should look at the infant when speaking to the infant.
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? "Once surgery is over you'll be back playing baseball in no time." "I understand you are angry, but please don't shout or slam doors." "I am really sorry about your arm, but surgery is needed to correct the problem." "Stop shouting at the nurses. We're only trying to help you."
"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 providing teaching on safety to a group of parents whose children are diagnosed with hemophilia. Which statement made by a parent requires follow-up by the nurse? "We had a trampoline but got rid of it after our child was diagnosed." "Our child always wears a helmet and body padding when playing football." "Our child has a medical alert bracelet that is worn at all times." "We make sure our toddler wears a helmet and knee pads."
"Our child always wears a helmet and body padding when playing football." Contact sports such as football and soccer are safety issues for children diagnosed with hemophilia. There is more chance of sustaining an injury resulting in severe bleeding. Safer sports include swimming and golf. Toddlers who are just learning to walk may have frequent falls, so a soft helmet and knee pads can help prevent injuries. Children diagnosed with hemophilia should wear a medical alert bracelet at all times. Jumping on a trampoline can result in a serious fall resulting in extensive bleeding.
The nurse is preparing a 5-year-old for a radiograph. What would be the best communication to prepare the child for the procedure? "We need to look inside at some of your organs." "We are going to take some x-rays of your body." "X-rays are not painful; you won't feel a thing." "We are going to use a big camera to take pictures inside your body."
"We are going to use a big camera to take pictures inside your body." It is best to use simple terms and phrases that are easily understood. It is important to avoid certain phrases that might confuse or mislead the younger child. Referring to an organ might indicate a musical instrument. Using the term "pain" should be avoided as it may be too explicit and cause undue worry. The term "x-ray" is too technical and is not likely to be understood by a 5-year-old.
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? Understand that the client's culture prefers not to acknowledge pain or medicate for pain. Provide analgesic based on the client's nonverbal pain responses. Explain to the client that pain must be reported to have it treated. Assess the client's pain using a 0 to 10 scale.
Assess the client's pain using a 0 to 10 scale. The nurse should assess the pain using a standardized scale to be as objective as possible. The nurse should not provide analgesic until further discussion and assessment of the pain is completed nor should the nurse make assumptions about the client's cultural responses to pain without further assessment.
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? Assist the child to control emotions. Provide a plan of action. Assess the perception of the problem. Inform the child of priority problems.
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.
The nurse is caring for a parent of a 10-month-old infant. The parent is upset and states, "I have so many questions, but the doctor seems too busy to answer my questions." What is the best action by the nurse? Explain to the parent that the health care provider will be back and will answer questions at that time. Encourage the parent to remain at the infant's bedside so as not to miss any future consultant visits. Assist the parent in preparing a list of questions for the health care provider's next visit. Ask the parent if he or she would like the nurse to ask the health care provider the questions when the provider visits next.
Assist the parent in preparing a list of questions for the health care provider's next visit. Empowering parents so that they can be active partners in their child's care is part of family-centered care. Helping the parent state and write questions will provide information to which the nurse can respond; it will also help the parent interact more effectively with the health care provider and other health team members. Relaying the parent's questions may be helpful on limited occasions but places the nurse between the parent and the health care provider, relaying information in a "third party" manner. Keeping the parent at the bedside watching and waiting causes unnecessary stress. Supporting the busy schedule of the health care provider burdens the parent further.
The nurse is implementing interventions to prevent physical stressors for a 9-year-old child receiving chemotherapy in the hospital. Which of the following is an example of using atraumatic care for this child? A) Use restraint or "holding down" of the child during the procedure to prevent injury. B) Have the parent stand near and/or rub the child's feet during the procedure. C) Insert a saline lock if the child will require multiple doses of parenteral medications. D) Avoid using numbing techniques for multiple blood draws or IV insertion.
C) Insert a saline lock if the child will require multiple doses of parenteral medications.
The nurse is caring for a hospitalized pediatric client. Which intervention will the nurse include to encourage family-centered care? Encourage the caregivers to room-in with the client and siblings to visit when possible. Have a team meeting with the client, family, and involved health care providers. Have the family members meet with a child psychologist to ensure the child's needs are being met. Have the primary health care provider meet with the family to tell them about the child's plan of care.
Have a team meeting with the client, family, and involved health care providers. Family-centered care involves a partnership between the child, family, and health care provider in planning, providing, and evaluating care. It works well with children of any age and in all arenas of health care, from preventive care of the healthy child to long-term care of the chronically ill child. All providers should be involved in the child's plan of care, not just the health care provider or nurses. Encouraging rooming-in and sibling visitation is important for stability and to limit the client's anxiety, not for family-centered care. The child would only need to be assessed by the psychologist if the child were demonstrating emotional difficulties associated with the disease.
The nurse is teaching the parents of a newborn with a metabolic problem about the disorder and its treatment. What is the least effective teaching technique? Discuss how to handle a possible emergency situation. Explain the disorder in common terms. Use the USDAs "MyPlate" diagram to teach necessary nutrition alterations. Provide literature for the parents to read and then have them ask questions.
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.
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? The parents should discuss their stress related to work on a regular basis. The parents should try to avoid unintentional injuries like leaving pills out on the counters where younger children can accidently poison themselves. Keep the stress within the family unit so that the parents do not burden other relatives and friends. 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.
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.
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? The staff is diligent to avoid health care-acquired infections in hospitalized children. The staff works specifically with children who have injuries and accidents. The underlying premise refers to the concept of "do no harm." The concept is best demonstrated by providing a ratio of one nurse to one child.
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 nurse is caring for a 14-year-old boy who has just been diagnosed with a malignant tumor on his liver. Which intervention is most important to this child and family? describing postoperative home care for the child involving the child and family in decision-making discussing treatment options with the child and parents arranging an additional meeting with the nurse practitioner
involving 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.
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? touch silence reassurance supportive statements
touch Touch is the most intimate and meaningful form of nonverbal techniques. When words are inadequate touch rarely is. Touch can be used to accompany reassuring words or in place of words as a strong support signal (e.g. I'm here; I understand; it is all right to be afraid). Staying with the child and touching them while they cry allows the child to be upset with no condemnation, but also says the nurse cares. Silence is used after asking a question and giving the child time to respond. Supportive statements let children know you accept their behavior. Reassurance would only be false in this situation.
The nurse 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? demonstration discussion role-playing videos
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.
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? "Take your child to the emergency department now." "What makes you think your child is in crisis?" "Tell me about the symptoms your child is experiencing" "Call 911 and give the child some water while you wait."
"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 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? "You don't seem concerned about the new treatment regimen." "You haven't said anything about your feelings toward the new treatment plan." "Are you worried about the new treatment plan?" "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.
When teaching an adolescent about home care after hospitalization, what is most important for the nurse to do? Allow opportunity for the adolescent to express feelings. Use the same type of language as the adolescent. Focus the discussion on skill techniques. Provide assurance the nurse will maintain confidentiality.
Allow opportunity for the adolescent to express feelings. Adolescents, struggling for identity, can be responsible for their own self-care if they understand how the new action they are being taught will affect them. Affective learning is important for the adolescent to express his/her feelings about what has happened and their illness. Adolescents have a strong need to be exactly like their friends. This means they will rarely continue with any action that makes them conspicuous in front of their peers. The nurse should not use the same language as the adolescent because there may be pertinent information that would not be shared if the nurse is not translating the adolescent's language correctly. Maintaining confidentiality is always important, and assurance should be given to the adolescent that the nurse will not share information with the adolescent's friends, but that is not the most important task for the nurse at this time.
A 13-year-old adolescent with leukemia expresses concern to the nurse over the numerous recent hospital admissions required. The adolescent states a feeling of powerlessness. Which action by the nurse is most appropriate? Encourage the adolescent to have friends visit while in the hospital. Include the adolescent in discussions about health care decisions. Talk to the adolescent about the diagnosis and current prognosis. Ask the adolescent questions about the previous hospitalizations.
Include the adolescent in discussions about health care decisions. Adolescents feel empowered when health care professionals communicate directly with them. Health care professionals should include the adolescent in discussions and avoid talking about the client in the adolescent's presence. Adolescents are aware of terminology related to diseases and should have a say in treatment decisions. The adolescent should be taught about the disease and treatment to empower the client to make informed decisions. Asking questions about previous hospitalizations does not facilitate in giving the client a sense of empowerment, nor does it provide the nurse with needed information at this time. Due to the client's diagnosis, visitors may not be allowed. Friends are important at this age; however, they will not assist in empowering the client. Discussing the diagnosis and prognosis is important and should be done by the primary health care provider.
The nurse is preparing to reduce a young parent's anxiety about a child needing hospitalization. Which action should the nurse prioritize? Let the parent know you will relay any messages she has for the doctor. Schedule time to address the parent's concerns. Tell the parent about the tests being performed. Include the parent in the medical decision-making.
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 providing discharge teaching for an 8-year-old child after admission with an asthma exacerbation. The child is accompanied by a parent who does not speak the dominant language. How will the nurse complete the discharge teaching? Select all that apply. Request that the family bring a friend who is bilingual to assist with discharge teaching interpretation. Ask the client and family to provide return demonstration of inhaler use to ensure understanding. Speak clearly using short sentences and provide pauses for interpretation and responses. When providing written discharge or follow-up information, ask the interpreter to translate in the family's language. Focus on the interpreter during the conversation and allow them to fully convey any expression or emotion from the child and parent.
Speak clearly using short sentences and provide pauses for interpretation and responses. Ask the client and family to provide return demonstration of inhaler use to ensure understanding. When providing written discharge or follow-up information, ask the interpreter to translate in the family's language. 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 is educating an 8-year-old client newly diagnosed with type 1 diabetes on how to administer insulin. Which finding best indicates the nurse's education was successful? The child demonstrates good technique in self-injection of insulin. The parents of the child demonstrate good technique in administering insulin to their child. The child lists five foods to ingest when determining that blood glucose levels are too low. The child is able to draw the correct amount of insulin up in the syringe.
The child demonstrates good technique in self-injection of insulin. As a final step of communication or teaching, what was communicated or learned must be evaluated. A new plan may need to be developed and teaching continued if communication or learning was less than optimal. An example of an outcome criterion is the child demonstrating good technique in self-injection of insulin, which will include having the child draw up the correct amount of insulin. But that alone does not indicate the client is able to self-administer insulin. The purpose of the education is to have the child, not the parents, develop skills to provide self-care. Learning about foods for hypoglycemia is a separate topic from self-administration of insulin.
During the change of shift report, the nurse reports concerns about the parents of a hospitalized child understanding the written literature provided concerning the child's plan of treatment. Which observations would provide support to this concern? Select all that apply. The child's medical record contains information indicating the family frequently misses appointments. The child's mother asks many questions. The child's mother asks the nurse to complete paperwork for her. The child's mother asks for additional resources to review about the planned treatment. The child's mother provides little responses to information provided.
The child's mother provides little responses to information provided. The child's medical record contains information indicating the family frequently misses appointments. The child's mother asks the nurse to complete paperwork for her. Understanding health-related information can be challenging. It is a role of the nurse to ensure an understanding of information and materials provided. Signs that information is not being understood may include asking few questions about the plan of treatment. Missed appointments may also signal a lack of understanding. Asking the nursing staff to complete paper work may signal a lack of understanding or possibly an inability of the family to do it themselves.
The nurse is assessing the learning needs for a 12-year-old boy with a chronic health condition, as well as his parents. Which aspect would be least pertinent to a learning needs assessment? Finding that the mother relies on American Sign Language. The nurse concludes that the parents are emotionally distraught. The family belongs to a mainline traditional faith community. Discovering that the father is highly health care literate.
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.
Which method of communication is appropriate for the nurse to use when caring for a 7-month-old infant? Speak similar to the infant's parents and look in the infant's face when speaking Use a soothing and calming tone when speaking to the infant Pronounce words as an infant would, using "baby talk" Use puppets to communicate with the infant
Use a soothing and calming tone when speaking to the infant To communicate effectively with an infant, the nurse should use a soothing and calming tone when speaking to the infant. A puppet is appropriate when communicating with toddlers and preschool-age children. The nurse should speak clearly when talking to the infant. Talking like the infant's parents is an unreasonable expectation. The nurse should look at the infant when speaking to the infant.
The nurse is caring for a 14-year-old boy who has just been diagnosed with a malignant tumor on his liver. Which intervention is most important to this child and family? arranging an additional meeting with the nurse practitioner involving the child and family in decision-making describing postoperative home care for the child discussing treatment options with the child and parents
involving 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.
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: ask the child to be less noisy because he is "scaring and bothering other children." review safety measures that could have prevented the injury. have the mother speak firmly to the child to correct the crying and screaming. tell the child, "It's OK to cry, but I need you to hold still." Close the door tightly and reassure the child, "I am being gentle and am almost done."
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.
