chapter 33: Communication, History, Physical, and Developmental Assessment 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 him- or herself.
b. Make the family comfortable.
c. Explain the purpose of the interview.
d. Give an assurance of privacy.
ANS: A
The first thing that nurses must do is 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 nurse’s 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 confidentiality.
- What approach is most likely to encourage parents to talk about their feelings related to their child’s illness?
a. Being sympathetic
b. Using direct questions
c. Using open-ended questions
d. Avoiding 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 defined as having feelings or emotions in common with another person, rather than understanding those feelings (which is called empathy). Sympathy is not therapeutic in the helping relationship. Direct questions may only obtain limited information. In addition, the parent may consider them threatening. Silence can be an effective interviewing tool. It allows two or more people to share feelings and absorb one another’s emotions 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 child’s physical condition
b. The presence or absence of the child’s parent
c. The child’s developmental level
d. The child’s nonverbal behaviours
ANS: C
The nurse must be aware of the child’s developmental stage to engage in effective communication. An understanding of the typical characteristics of these stages provides the nurse with a framework to facilitate social communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Although the child’s 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 behaviours vary in importance, based on the child’s 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 one’s own feelings, attitudes, and anxiety.
d. Initiate contact with the child when his or her parent is not present.
ANS: B
Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse), facilitating communication. 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, a parent should be present for interactions with young children.
- When introducing hospital equipment to a preschooler who seems afraid, which principle should the nurse keep in mind?
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 child’s fear.
d. One brief explanation is enough to reduce the child’s fear.
ANS: A
Young children attribute human characteristics to inanimate objects. They often fear that an object may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. The nurse should give the child simple, concrete explanations about what the equipment does and how it will feel to help alleviate the child’s fear. Preschoolers will need repeated explanations for reassurance.
- Which age group is most concerned with body integrity?
a. Toddlers
b. Preschoolers
c. School-age children
d. Adolescents
ANS: C
School-age children have heightened concerns about body integrity. They place importance and value on their bodies and are overly sensitive to anything that constitutes a threat or suggests injury. Body integrity is not as important to children in the toddler, preschooler, and adolescent age groups.
- An 8-year-old girl asks the nurse how the blood pressure apparatus works. What is the most appropriate act for the nurse to take?
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 when 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. The 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 about what will be occurring. The nurse must explain how the blood pressure cuff works ahead of time so the child can then quietly observe during the procedure.
- What is the most important thing for a nurse to say when interviewing an adolescent?
a. Focus the discussion on the peer group.
b. Allow for 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 inject feelings into their words. The nurse must be alert to both the words and feelings expressed. Although their peer group is important to those in this age group, the focus of the interview should be on the individual 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 the adolescent. 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 is most helpful in improving communication?
a. Suggest that the child keep a diary.
b. Suggest that the parent read fairytales to the child.
c. Ask the parent if 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. Children’s drawings tell a great deal about them because they are projections of the child’s inner self. It would be difficult for a 6-year-old child to keep a diary, since the child is most likely just learning to read. Reading fairytales to the child is a passive activity involving the parent and child, and would not facilitate communication with the nurse. The child is in a stressful situation and is probably uncomfortable with strangers, not necessarily uncommunicative.
- A nurse is taking the health history of an adolescent. Which statement best describes how to determine the chief complaint?
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 adolescent’s visit to the clinic, office, or hospital. The adolescent is the focus of the history, so this is an appropriate way to determine the chief complaint. A list of symptoms will make it difficult to determine the chief complaint. The nurse should prompt the adolescent to state which symptom caused him 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, not the parent.
- Where in the health history should the nurse describe all the details related to the chief complaint?
a. Past history
b. Chief complaint
c. Present illness
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, at different intervals, and in the present. Past history refers to information that relates to previous aspects of the child’s health, not to the current problem. The chief complaint is the specific reason for the child’s 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
b. Present illness
c. Chief complaint
d. Review of systems
ANS: A
The birth history is information that relates to previous aspects of the child’s health, not to the current problem. The mother’s difficult delivery and prematurity are important parts of an infant’s past history. 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 child’s visit to the clinic, office, or hospital, and would not include birth information. The review of systems is a specific review of each body system and does not include 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 when he started walking without assistance. How should milestones be considered?
a. They are unnecessary because the child is age 3 years.
b. They are an important part of the family history.
c. They are an important part of the child’s past growth and development.
d. They are an important part of the child’s review of systems.
ANS: C
It is important for the nurse to obtain information about the attainment of developmental milestones because they provide data about the child’s growth that should be included in the history. Developmental milestones provide important information about the child’s physical, social, and neurological 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 milestones.
- A nurse is taking the sexual history of an adolescent girl. Which is the best way to determine whether she is sexually active?
a. Ask, “Are you sexually active?”
b. Ask, “Are you having sex with anyone?”
c. Ask, “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 easy to understand. The phrase sexually active is broadly defined and may not give specific enough information for the nurse to provide the necessary care. The word anyone is preferred to using gender-specific terms such as boyfriend or girlfriend, because homosexual experimentation may occur. Questioning about sexual activity should occur when the adolescent is alone.
- Which behaviour indicates to the nurse that the patient is experiencing information overload?
a. Maintains eye contact
b. Plays with hair
c. Has fixed, narrowed eyes
d. Remains focused on the topic of discussion
ANS: B
Nervous habits, such as playing with one’s hair, are a sign that the patient has information overload. Other signs include avoiding eye contact, wide eyes, and attempting to change the topic of discussion.
