NUR 243 PrepU Ch 8 Atraumatic Care of Children and Families
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."
An adolescent remarks rather sarcastically that she feels like a "lab rat." What is the priority nursing action?
Ensure information is shared and decisions about care are made with the teen and not for the teen
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
A nurse is preparing to teach an 8-year-old child recently diagnosed with diabetes how to give an insulin injection. Which is the best technique for the nurse to use?
demonstration
The 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
A 5-month-old infant has had a head-to-toe assessment by the nurse, been examined by a teaching team of physicians, and now experienced a blood draw. What behaviors might this infant manifest?
yawning, turning away, and making little eye contact
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."
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."
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."
A 2-year-old child is hospitalized for asthma exacerbation. The parents tell the nurse that they have been treating the wheezing with traditional herbal medicines. How should the nurse respond?
"Please tell me about how you use the herbal medications so we can assess for herb-drug interactions."
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 haven't said anything about your feelings toward the new treatment plan."
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."
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."
A 16-year-old transgender male client who was assigned female at birth presents to the primary care clinic for an annual health assessment. The client wears a breast binder and has been taking testosterone for the past 8 months. The client is sexually active. What will the nurse include in the care plan for this client? Select all that apply.
-Discuss the need for contraception use. -Offer testing for sexually transmitted infecions. -Assess the client's menstrual cycle history. -Review human papillomavirus vaccination status
The child life nurse practitioner has been assigned to assist the hospitalized child and the child's parents. Which interventions are appropriate for the child life specialist to perform? Select all that apply.
-Talking to the family about a scheduled diagnostic test. -Showing the child where the pediatric playroom is located. -Speaking to the physician as the child's advocate
During the change of shift report, the nurse reports concerns about the parents of a hospitalized child understanding the written literature provided concerning the child's plan of treatment. Which observations would provide support to this concern? Select all that apply.
-The child's mother provides little responses to information provided. -The child's medical record contains information indicating the family frequently misses appointments. -The child's mother asks the nurse to complete paperwork for her.
The nurse is teaching a 7-year-old girl about her upcoming tonsillectomy. Which techniques would be appropriate for this child? Select all that apply.
-allowing the child to do as much self care as possible -offering choices of drinks and gelatin after the procedure -explaining that anesthesia is a lot like falling asleep
The child has been admitted to a pediatric unit in a hospital. Which nursing interventions use atraumatic care principles? Select all that apply.
-applying a numbing cream prior to starting the child's intravenous line a-sking the child if he would like to take a bath before or after he takes his medication -encouraging the family to bring in the child's favorite stuffed animal from home -showing the parent how to unfold the chair in the child's room into a bed
The nurse is teaching a child how to self-administer insulin. Place the steps in the order the nurse will complete them when teaching the child. Use each option once.
1. Show the child how to correctly perform the procedure 2. Given time to practice and increase proficiency 3. Have the child perform a return demonstration of the procedure 4. Evaluate the child's performance of the procedure
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
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
A parent brings a toddler to the clinic for treatment of a possible ear infection. How will the nurse communicate effectively with this child?
Approach the toddler while the toddler is being held by the parent.
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.
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
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.
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
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
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
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.
A shy child acknowledges the nurse's care by nodding the head. To improve the nurse-client relationship, the nurse should use which intervention?
Do not require the child to speak.
The nurse is providing care for a 2-year-old girl with a chronic respiratory disease present since birth. Which of the following would be of least help in working effectively with the parents?
Expect parents to perform procedures precisely as taught.
A 7-year-old child with sickle cell anemia who comes to the hospital frequently appears withdrawn and depressed. The client refuses to talk to anyone or even admit to feeling sad. What would be the best thing for the nurse to do that might help the child deal with his or her feelings?
Get the client to draw a picture
A 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.
The nurse is caring for an adolescent with a newly diagnosed disease process. The adolescent refuses to learn about the disease. Which technique should the nurse use to encourage the adolescent to be actively involved in education about this disease?
Help the adolescent understand how new information about the disease will improve health status now
A 7-year-old child who has recently immigrated with the family is brought to the school nurse because the child refuses to eat lunch. Which response should the nurse prioritize?
Investigate for potential cultural issues.
A 10-year-old child with sickle-cell anemia is frequently in the pediatric center of a hospital. What intervention can the nurse provide that will allow the child the sense of control that meets the goals promotes atraumatic care?
Maintain the child's home routine related to activities of daily living
A home care nurse is teaching a parent how to administer a clotting factor infusion to their child. How can the nurse best evaluate the effectiveness of the teaching?
Observe the parent set up and administer the infusion.
When planning to teach a toddler about coughing and deep breathing, which would be most effective?
Playing a game with coughing and breathing
Prior to discharge, the nurse teaches a school-age child how to change the wafer on the new colostomy. The nurse observes the child making the hole too big to fit over the stoma. What action should the nurse implement following this child's return demonstration? Select all that apply.
Repeat the demonstration to show the child the proper technique. Offer positive reinforcement regarding the child's ability to follow through with obtaining the necessary supplies. Discharge the child with written instructions and illustrations to reinforce the correct procedure. Remind the child of the reason not to make the hole too large
A nurse is providing teaching on the medication regimen for beta-thalassemia to an adolescent. What is the best way for the nurse to determine if the teaching was successful?
Request that the adolescent teach the information to the nurse.
The nurse is caring for a child undergoing a painful procedure. When using distraction, which methods would be appropriate? Select all that apply.
Sing to the child. Ask the child to squeeze the nurse's hand. Play music the child likes. Ask the child to tell a story about a happy memory
The nurse is meeting an 8-year-old girl with cancer and her family for the first time. What will best help to establish a relationship with the child and family? Select all that apply.
Sitting at eye level with the child and parents. Keeping both a relaxed posture and word flow. Redirecting the conversation to maintain focus.
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.
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
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."
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
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 nurse is caring for a hospitalized preschool child and needs to hang IV fluids by the infusion pump. The nurse introduces the infusion pump to the child based on what developmental principle?
The child may think the equipment causes the pain
The nurse is assessing the learning needs for a 12-year-old boy with a chronic health condition, as well as his parents. Which aspect would be least pertinent to a learning needs assessment?
The family belongs to a mainline traditional faith community
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."
The nurse is planning interventions for a child being evaluated at the health clinic. How will therapeutic communication benefit the child?
Therapeutic communication enhances the development of trust between the nurse and the child.
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.
A nurse is teaching an 11-year-old client how to apply a topical cream to t
demonstration Explanation: Applying a medicated cream involves psychomotor learning (requires a change in a person's ability to perform a skill). It is best mastered through demonstration and re-demonstration. 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. Affective learning involves a change in a person's attitude. It is best gained through role modeling, role-playing, or shared-experience discussion
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
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
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
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."
A parent calls the pediatric clinic and tells the nurse "I think my child is having a sickle cell crisis. Should I bring the child to the office?" What is the nurse's best response?
"Tell me about the symptoms your child is experiencing"
A nurse is assisting the health care provider with suturing a laceration on a preschool-age child's leg. What distraction methods can the nurse perform to promote atraumatic care? Select all that apply.
Ask the child to squeeze the nurse's hand. Sing a song and have the child sing along. Have the child blow bubbles
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?
Include the adolescent in discussions about health care decisions
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.
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