Chapter 30: Atraumatic Care of Children and Families

The nurse is preparing a hospitalized child for a lumbar puncture. The health care provider states the procedure will be performed in the child's hospital room. To advocate for the child, what should the nurse inform the health care provider?

"I will have the procedure prepared in the treatment room, so that the child may view the hospital room as safe and secure." Explanation: In the hospital, all invasive procedures should be performed in the treatment room or a room other than the child's room. The child's room should remain a safe and secure area. The lumbar puncture requires special positioning and holding. This should be done by the nurse and not the parents. The decision to have the parents watch the procedure is up to the health care provider and/or hospital policy. If the parents observe the procedure, they need education prior to the procedure about what to expect.

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." Explanation: 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.

The parents of a child admitted for a new diagnosis tell the nurse they have researched the disease on the Internet so they do not have any questions regarding their child's care. Which response(s) by the nurse is therapeutic? Select all that apply.

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

A 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?

"Our child always wears a helmet and body padding when playing football." Explanation: 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 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." Explanation: 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 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 Explanation: 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.

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. Explanation: Because the health care provider has discussed the child's care, the nurse should answer the parents' questions as completely as possible. Telling the parents that they have been fully briefed negates their concerns and is inappropriate. Encouraging the parents to focus on their child also negates their concerns. Unless the parents ask specifically for the health care provider, the nurse can answer the parents' questions.

A nurse is providing some basic hygiene teaching to a preschooler who is continually developing upper respiratory infections from his time spent in day care. What is an example of assessing the child's learning needs?

Asking him what germs are Explanation: Designing a plan begins with assessment of the individual child's needs and how the new knowledge will meld with the child's and family's lifestyle, the child's intellectual and language level, current knowledge level, physical/cognitive capabilities, sociocultural values, and attention span. By asking this boy what germs are, the nurse will elicit his current knowledge level on the subject, along with his intellectual and language levels. The other answers pertain to other aspects of developing and implementing a teaching plan.

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?

Assess the client's pain using a 0 to 10 scale. Explanation: 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?

Assess the perception of the problem. Explanation: 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's current level of understanding Explanation: 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.

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?

Assist the parent in preparing a list of questions for the health care provider's next visit. Explanation: 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.

A family is anxious for information about the status of their infant. The parents do not understand the language used by the health care providers, 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. Explanation: 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 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. Explanation: 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 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. Explanation: 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.

The nurse is caring for a hospitalized pediatric client. Which intervention will the nurse include to encourage family-centered care?

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

A 9-year-old child with rheumatoid arthritis has difficulty moving the hands as well as other joints due to pain. The child refuses to participate in the prescribed physical therapy. What would be the best way for the nurse to make sure the child continues to exercise the joints?

Play a game like "Simon Says" to introduce exercises. Explanation: School-aged children love to play games. By playing "Simon Says" and introducing different exercises to help with movement, the nurse may help stimulate the client to want to be active. Reading about exercises and seeing them demonstrated by a person or in a video will not increase the child's desire, especially since the child is in pain. Exercise for this child should be a pleasant experience and playing a game will help accomplish that goal.

When planning to teach a toddler about coughing and deep breathing, which would be most effective?

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

When developing the plan of care to promote health for a client and family, what would the nurse focus on first?

Reinforcing family strengths Explanation: Identifying family strengths, reinforcing positive behaviors, and providing anticipatory guidance and resources can support the family. Identifying strengths will help the family target resources to draw from for daily functioning as well as when crises develop. From there, support, teaching, and resolving of family conflicts can occur.

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 many families. Explanation: The family serves two functions in relation to society: to reproduce and to socialize offspring. Couples today are less, not more, concerned about unplanned pregnancies. This is because of the development of the various family planning methods. It is the responsibility of the older members to teach the younger ones how to function as adults; however, the younger members also teach the older members about the changing world. There are some families where some adults are not wage earners but may stay at home for a variety of reasons (by choice, disability, etc.). This can result in limited resources available for the family.

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?

Some noncompliance should be expected due to the adolescent's desire for independence, expression of personal values, and peer acceptance. Explanation: 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.

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. Explanation: 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.

An 8-year-old child is scheduled to have a tonsillectomy and adenoidectomy in 2 weeks. What intervention can the nurse provide to help the child and family adjust to the hospitalization?

Take the child on a tour of the facility and surgical suite and explain what to expect preoperatively and postoperatively. Explanation: Nurses can help children cope with the experience by using age-appropriate and child-specific interventions. Preparation can help children and their families to adjust to illness and hospitalization. Preparing the child reduces stress and fear. As much as possible, the nurse or child life specialist can show the child the areas where the child will have surgery, play with age-appropriate dolls to learn such things as IV insertion, and answer all the child's questions. Telling the child the parents will not be able to see him or her increases fear and anxiety. Being able to have a popsicle after surgery is the truth, but it is not the entire truth nor does it prepare the child for unknown places. The purpose of prehospital preparation is not to interview the child but to prepare the child.

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

A child is preparing to undergo a lumbar puncture in the treatment room. What intervention can the nurse provide to minimize stress during the procedure?

Use alternative positioning such as "therapeutic hugging." Explanation: A suggestion for atraumatic care to prevent or minimize physical stressors is to avoid traditional restraint or "holding down" of the child. The nurse should use alternative positioning, such as "therapeutic hugging." This position would also be more effective in the correct positioning of the child for the procedure. For a lumbar puncture the child does not need to be sedated, just be able to be held still. Primary nursing is not warranted in this situation.

After teaching the parents of a toddler how to change the dressing on their child's abdomen, the nurse should use which method to best evaluate the parent's technique?

having parents perform a return demonstration Explanation: Evaluation is the final step in teaching. It is the process of assessing whether teaching has been effective. It is most favorable if evaluation occurs not only after the teaching plan has been implemented but also throughout the entire learning process. Demonstration from the parents is the real proof learning has occurred. Assessing their anxiety should be done prior to and throughout the procedure. Verbalizing the steps only demonstrates cognitive knowledge and not the psychomotor skill of changing the dressing. Using an evaluation tool determines if the parents felt the information was presented adequately or they felt prepared as a result of the teaching, but it does not demonstrate proficiency.

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 Explanation: 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 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 Explanation: 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 preparing to teach a 15-year-old adolescent about recently diagnosed diabetes. What question(s) asked by the nurse will be of assistance in determining the adolescent's needs for learning? Select all that apply.

"How has your diabetes impacted your family?" "Prior to seeing the health care provider for your condition, what did you do to manage it?" "What do you know about the diets recommended for a person with diabetes?" "Who do you think should receive teaching about your diabetes?" A learning needs assessment will provide the nurse with the information needed to provide a beneficial education to the client and family. Determining how the illness has impacted both the client and family is needed. Determining what they know about the condition and what may have been used to manage it will be of help. It is important to assess what information the client and family already have about the condition. This enables the nurse to determine the best "starting point" for teaching. Simply asking the adolescent if the adolescent is ready to take care of oneself will yield no information.

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." Explanation: 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 understand you are angry, but please don't shout or slam doors." Explanation: 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.

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?

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

The nurse is teaching the parents of a newborn with a metabolic problem about the disorder and its treatment. What is the least effective teaching technique?

Provide literature for the parents to read and then have them ask questions. Explanation: The parents may not understand the literature based on their reading level or ability, their understanding of terms, or their own overall literacy. They may not ask questions for all of the former reasons or to avoid appearing "dumb." The other techniques should provide support by using "lay" words, exchanging ideas (discussion) regarding managing an emergency, and using a common visual symbol (USDAs "MyPlate") to teach about nutrition.

The parent of an infant speaks a language the nurse does not speak. The parent's 8-year-old child speaks the same language as the nurse, and the parent wants to communicate with the nurse through the child. How should the nurse best handle teaching the parent?

Obtain an interpreter. Explanation: Many people who speak a language other than the common language for the area bring a support person with them to help interpret at health care appointments. If that support person is a child, it makes it difficult to teach at the child's level so the parent can understand appropriately. Many things are missed in this type of translation. It is preferred that an interpreter be present to explain the teaching to the parent at an adult level. If a nurse who speaks the parent's language could be assigned to this parent, this would be a functional exchange; however, this is not always possible. It is also not always possible to have on duty a nurse who speaks all client languages, given myriad languages clients may speak. An app on a phone is also a great help for phrases and words, but it cannot be utilized for an entire teaching session.

A nurse is providing care for a child hospitalized with a diagnosis of aplastic anemia. In planning the child's care, which intervention(s) will assist the child in adapting to being hospitalized? Select all that apply.

Provide opportunities for the parents to participate in the child's care. Encourage the parents to bring personal items to make the child feel more at home. Make the child's room off limits to invasive procedures. Explanation: Atraumatic care is important to a child's well-being during hospitalization. Examples of this include providing opportunities for the parents and the child to participate in care, encouraging parents to bring personal items, and maintaining the child's room as a safe place, off limits to invasive procedures. It is important to be honest with the child and include the child in all plan of care discussions.

A nurse is 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. Explanation: 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.

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

The nurse is 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. Explanation: As a final step of communication or teaching, what was communicated or learned must be evaluated. A new plan may need to be developed and teaching continued if communication or learning was less than optimal. An example of an outcome criterion is the child demonstrating good technique in self-injection of insulin, which will include having the child draw up the correct amount of insulin. But that alone does not indicate the client is able to self-administer insulin. The purpose of the education is to have the child, not the parents, develop skills to provide self-care. Learning about foods for hypoglycemia is a separate topic from self-administration of insulin.

The nurse is teaching injection techniques to a school-aged child newly diagnosed with type 1 diabetes. Which observation would be the best evaluation that learning was successful?

The child needs occasional cueing during return demonstration of the injection technique. Explanation: School-age children have a need to cooperate and achieve. Evaluation of learning should measure whether the child actually carries out the procedure or not. For a school-age child to only need occasional cueing, this is considered that learning is achieved. The purpose of the teaching was to ensure the child could properly inject and administer insulin. Understanding the disease process and schedules are not part of learning to inject insulin. Developing a schedule and posting it on the refrigerator would be above the developmental level of a school-ager.

The nurse is assessing the teaching needs of the parents of an 8-year-old boy with leukemia. Which assessment should the nurse explore as a potential issue with the parent's health literacy?

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

A recently licensed nurse asked the charge nurse what it means to provide atraumatic care to hospitalized children. Which response by the charge nurse would be accurate?

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

The father of a child hospitalized after a fire questions the use of therapeutic play. He reports he does not understand the purpose. What information can be provided to him?

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

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 Explanation: 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.

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 Explanation: 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 having trouble communicating with a hospitalized child. Which communication technique would be the most beneficial for the nurse to offer the child?

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

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

extended Explanation: The extended family is an immediate family with other family members in the same house. The immediate family is composed of an individual's smallest family unit (commonly parents and their children), 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 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 Explanation: Having a child life specialist play with the toddler would provide the greatest support for the toddler and make the greatest contribution to atraumatic care. Privacy is specifically important to the adolescent age group, rather than the toddler age group. The nurse would educate the parents of the toddler to prepare the child immediately before the procedure. One week of preparation would be more appropriate for the adolescent. Using diagrams and explanations are beneficial to the school-aged child.

The nurse is caring for a 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?

involving the child and family in decision-making Explanation: 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 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 Explanation: 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 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 Explanation: 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.

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's OK to cry, but I need you to hold still." Explanation: 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.

Which is most likely to encourage parents to talk about their feelings related to the poor prognosis their child has been given?

using open-ended questions Explanation: Therapeutic communication is an interaction between two people that is planned, deliberate, has structure, and is helpful and constructive. Using open-ended questions is an example of a therapeutic communication technique. Nurses should demonstrate empathy to clients, not sympathy. Empathy is the ability to put yourself in another person's place and understand and be sensitive to the feelings of another. Direct questioning is a nontherapeutic form of communication and requires only yes or no answers. In instances where there is no cure for the child, if the nurse practices therapeutic communication the nurse still has the ability offer support by the words used or nonverbal communication such as touch. In perspective, these are the most valued, most appreciated, and most helpful aspects of care.