Question 1

What action is most likely to encourage parents to talk about their feelings related to their child's illness?

Accepted Answer

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.

Question 2

What is the single most important factor to consider when communicating with children?

Accepted Answer

The nurse must be aware of the child's developmental stage to engage in effective 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 behaviors vary in importance based on the child's developmental level.

Question 3

What is an important consideration for the nurse who is communicating with a very young child?

Accepted Answer

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.

Question 4

Which tool measures body fat most accurately?

Accepted Answer

Calipers are used to measure skin-fold thickness,which is an indicator of body fat content. Stadiometers are used to measure height. Cloth tape measures should not be used because they can stretch. Paper or metal tape measures can be used for recumbent lengths and other body measurements that must be made.

Question 5

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to:

Accepted Answer

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 for 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.

Question 6

The nurse is using the NCHS growth chart for an African-American child. The nurse should consider that:

Accepted Answer

The NCHS growth charts can serve as reference guides for all racial or ethnic groups. U.S. African American-children were included in the sample population. The growth chart can be used with the perspective that different groups of children have varying normal distributions on the growth curves. No correction factor exists.

Question 7

An appropriate approach to performing a physical assessment on a toddler is to:

Accepted Answer

Parents can remove clothing,and the child can remain on the parent's lap. The nurse should use minimal physical contact initially to gain the child's 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.

Question 8

When introducing hospital equipment to a preschooler who seems afraid,the nurse's approach should be based on which principle?

Accepted Answer

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 child's fear. The preschooler will need repeated explanations as reassurance.

Question 9

Which age group is most concerned with body integrity?

Accepted Answer

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.

Question 10

With the National Center for Health Statistics (NCHS) criteria,which body mass index (BMI)-for-age percentile indicates a risk for being overweight?

Accepted Answer

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.

Question 11

The nurse is taking a sexual history on an adolescent girl. The best way to determine whether she is sexually active is to:

Accepted Answer

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.

Question 12

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?

Accepted Answer

The birth history refers to 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 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 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. 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.

Question 13

When the nurse interviews an adolescent,it is especially important to:

Accepted Answer

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.

Question 14

The nurse is taking a health history on an adolescent. What best describes how the chief complaint should be determined?

Accepted Answer

The chief complaint is the specific reason for the child's 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 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.

Question 15

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:

Accepted Answer

Information about the attainment of developmental milestones is important to obtain. It provides data about the child's growth and development that should be included in the history. Developmental milestones provide important information about the child's 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 milestones.

Question 16

The nurse is seeing an adolescent boy and his parents in the clinic for the first time. What should the nurse do first?

Accepted Answer

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 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 the confidentiality.

Question 17

Where in the health history should the nurse describe all details related to the chief complaint?

Accepted Answer

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 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.

Question 18

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:

Accepted Answer

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.

Question 19

Which parameter correlates best with measurements of the body's total protein stores?

Accepted Answer

Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body's major protein reserve and is considered an index of the body's protein stores. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skin-fold thickness is a measurement of the body's fat content.

Question 20

The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique might be most helpful?

Accepted Answer

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 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.

Quiz 34: Communication, history, physical and Developmental Assessment