chapter 29 Flashcards
The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the nurse do first?
a.Introduce himself or herself.
c. Explain the purpose of the interview.
b. Make the family comfortable.
d. Give an assurance of privacy.
ANS: A
The first thing that nurses must do is to introduce themselves to the patient and family. Parents and other adults should be addressed with appropriate titles unless they specify a preferred name. During the initial part of the interview the nurse should include general conversation to help make the family feel at ease. Next, the purpose of the interview and the nurses role should be clarified. The interview should take place in an environment as free of distraction as possible. In addition, the nurse should clarify which information will be shared with other members of the health care team and any limits to the confidentiality.
Which action is most likely to encourage parents to talk about their feelings related to their childs illness?
a.
Be sympathetic.
c.
Use open-ended questions.
b.
Use direct questions.
d.
Avoid periods of silence.
ANS: C
Closed-ended questions should be avoided when attempting to elicit parents feelings. Open-ended questions require the parent to respond with more than a brief answer. Sympathy is having feelings or emotions in common with another person rather than understanding those feelings (empathy). Sympathy is not therapeutic in the helping relationship. Direct questions may obtain limited information. In addition, the parent may consider them threatening. Silence can be an effective interviewing tool. It allows sharing of feelings in which two or more people absorb the emotion in depth. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions.
What is the single most important factor to consider when communicating with children?
a.
The childs physical condition
b.
The presence or absence of the childs parent
c.
The childs developmental level
d.
The childs nonverbal behaviors
ANS: C
The nurse must be aware of the childs developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Although the childs physical condition is a consideration, developmental level is much more important. The parents presence is important when communicating with young children, but it may be detrimental when speaking with adolescents. Nonverbal behaviors vary in importance based on the childs developmental level.
What is an important consideration for the nurse who is communicating with a very young child?
a.
Speak loudly, clearly, and directly.
b.
Use transition objects such as a doll.
c.
Disguise own feelings, attitudes, and anxiety.
d.
Initiate contact with the child when the parent is not present.
ANS: B
Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This facilitates communication with this age child.
Speaking loudly, clearly, and directly tends to increase anxiety in very young children. The nurse must be honest with the child. Attempts at deception lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children.
When introducing hospital equipment to a preschooler who seems afraid, the nurses approach should be based on which principle?
a.
The child may think the equipment is alive.
b.
The child is too young to understand what the equipment does.
c.
Explaining the equipment will only increase the childs fear.
d.
One brief explanation is enough to reduce the childs fear.
ANS: A
Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. The child should be given simple concrete explanations about what the equipment does and how it will feel to the child. Simple, concrete explanations help alleviate the childs fear. The preschooler will need repeated explanations as reassurance.
Which age group is most concerned with body integrity?
a.
Toddler
c.
School-age child
b.
Preschooler
d.
Adolescent
ANS: C
School-age children have a heightened concern about body integrity. They place importance and value on their bodies and are overly sensitive to anything that constitutes a threat or suggestion of injury. Body integrity is not as important a concern to children in the toddler, preschooler, and adolescent age groups.
An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to:
a.
Ask her why she wants to know.
b.
Determine why she is so anxious.
c.
Explain in simple terms how it works.
d.
Tell her she will see how it works as it is used.
ANS: C
School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child. A nurse should respond positively to requests for information about procedures and health information. By not responding, the nurse may be limiting communication with the child. The child is not exhibiting anxiety, just requesting clarification of what will be occurring. The nurse must explain how the blood pressure cuff works so the child can then observe during the procedure.
When the nurse interviews an adolescent, it is especially important to:
a.
Focus the discussion on the peer group.
b.
Allow an opportunity to express feelings.
c.
Emphasize that confidentiality will always be maintained.
d.
Use the same type of language as the adolescent.
ANS: B
Adolescents, like all children, need an opportunity to express their feelings. Often they will interject feelings into their words. The nurse must be alert to the words and feelings expressed. Although the peer group is important to this age group, the focus of the interview should be on the adolescent. The nurse should clarify which information will be shared with other members of the health care team and any limits to confidentiality. The nurse should maintain a professional relationship with adolescents. To avoid misinterpretation of words and phrases that the adolescent may use, the nurse should clarify terms frequently.
The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique may be most helpful?
a.
Suggest that the child keep a diary.
b.
Suggest that the parent read fairy tales to the child.
c.
Ask the parent whether the child is always uncommunicative.
d.
Ask the child to draw a picture.
ANS: D
Drawing is one of the most valuable forms of communication. Childrens drawings tell a great deal about them because they are projections of the childs inner self. It would be difficult for a 6-year-old child to keep a diary because the child is most likely learning to read. Reading fairy tales to the child is a passive activity involving the parent and child. It would not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not necessarily uncommunicative.
The nurse is taking a health history on an adolescent. What best describes how the chief complaint should be determined?
a.
Ask for a detailed listing of symptoms.
b.
Ask the adolescent, Why did you come here today?
c.
Use what the adolescent says to determine, in correct medical terminology, what the problem is.
d.
Interview the parent away from the adolescent to determine the chief complaint.
ANS: B
The chief complaint is the specific reason for the childs visit to the clinic, office, or hospital. Because the adolescent is the focus of the history, this is an appropriate way to determine the chief complaint. A listing of symptoms will make it difficult to determine the chief complaint. The adolescent should be prompted to tell which symptom caused him or her to seek help at this time. The chief complaint is usually written in the words that the parent or adolescent uses to describe the reason for seeking help. The parent and adolescent may be interviewed separately, but the nurse should determine the reason the adolescent is seeking attention at this time.
Where in the health history should the nurse describe all details related to the chief complaint?
a.
Past history
c.
Present illness
b.
Chief complaint
d.
Review of systems
ANS: C
The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. The focus of the present illness is on all factors relevant to the main problem, even if they have disappeared or changed during the onset, interval, and present. Past history refers to information that relates to previous aspects of the childs health, not to the current problem. The chief complaint is the specific reason for the childs visit to the clinic, office, or hospital. It does not contain the narrative portion describing the onset and progression. The review of systems is a specific review of each body system.
The nurse is interviewing the mother of an infant. She reports, I had a difficult delivery, and my baby was born prematurely. This information should be recorded under which heading?
a.
Birth history
c.
Chief complaint
b.
Present illness
d.
Review of systems
ANS: A
The birth history refers to information that relates to previous aspects of the childs health, not to the current problem. The mothers difficult delivery and prematurity are important parts of the past history of an infant. The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present. Unless the chief complaint is directly related to the prematurity, this information is not included in the history of present illness. The chief complaint is the specific reason for the childs visit to the clinic, office, or hospital. It would not include the birth information. The review of systems is a specific review of each body system. It does not include the premature birth. Sequelae such as pulmonary dysfunction would be included.
When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. This should be considered because these milestones are:
a.
Unnecessary information because the child is age 3 years.
b.
An important part of the family history.
c.
An important part of the childs past growth and development.
d.
An important part of the childs review of systems.
ANS: C
Information about the attainment of developmental milestones is important to obtain. It provides data about the childs growth and development that should be included in the history. Developmental milestones provide important information about the childs physical, social, and neurologic health. The developmental milestones are specific to this child. If pertinent, attainment of milestones by siblings would be included in the family history. The review of systems does not include the developmental
The nurse is taking a sexual history on an adolescent girl. The best way to determine whether she is sexually active is to:
a.
Ask her, Are you sexually active?
b.
Ask her, Are you having sex with anyone?
c.
Ask her, Are you having sex with a boyfriend?
d.
Ask both the girl and her parent if she is sexually active.
ANS: B
Asking the adolescent girl if she is having sex with anyone is a direct question that is well understood. The phrase sexually active is broadly defined and may not provide specific information to the nurse to provide necessary care. The word anyone is preferred to using gender-specific terms such as boyfriend or girlfriend. Because homosexual experimentation may occur, it is preferable to use gender-neutral terms. Questioning about sexual activity should occur when the adolescent is alone.
When doing a nutritional assessment on an Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. The nurse should recognize that this diet:
a.
Indicates that they live in poverty.
b.
Is lacking in protein.
c.
May provide sufficient amino acids.
d.
Should be enriched with meat and milk.
ANS: C
The diet that contains vegetable, legumes, and starches may provide sufficient essential amino acids, even though the actual amount of meat or dairy protein is low. Many cultures use diets that contain this combination of foods. It does not indicate poverty. Combinations of foods contain the essential amino acids necessary for growth. A dietary assessment should be done, but many vegetarian diets are sufficient for growth.
Which parameter correlates best with measurements of the bodys total protein stores?
a.
Height
c.
Skin-fold thickness
b.
Weight
d.
Upper arm circumference
ANS: D
Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves as the bodys major protein reserve and is considered an index of the bodys protein stores. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skin-fold thickness is a measurement of the bodys fat content.
An appropriate approach to performing a physical assessment on a toddler is to:
a.
Always proceed in a head-to-toe direction.
b.
Perform traumatic procedures first.
c.
Use minimal physical contact initially.
d.
Demonstrate use of equipment.
ANS: C
Parents can remove the childs clothing, and the child can remain on the parents lap. The nurse should use minimal physical contact initially to gain the childs cooperation. The head-to-toe assessment can be done in older children but usually must be adapted in younger children. Traumatic procedures should always be performed last. These will most likely upset the child and inhibit cooperation. The nurse should introduce the equipment slowly. The child can inspect the equipment, but demonstrations are usually too complex for this age group.
With the National Center for Health Statistics (NCHS) criteria, which body mass index (BMI)for-age percentile indicates a risk for being overweight?
a.
10th percentile
c.
85th percentile
b.
9th percentile
d.
95th percentile
ANS: C
Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children in the 9th and 10th percentiles are within normal limits. Children who are greater than or equal to the 95th percentile are considered overweight.
