Question 1

What is the single most important factor to consider when communicating with children?
A) The child's physical condition
B) Presence or absence of the child's parent
C) The child's developmental level
D) The child's nonverbal behaviors

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 may be detrimental when speaking with adolescents. Nonverbal behaviors will vary in importance, based on the child's developmental level.

Question 2

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 child when parent is not present.

Accepted Answer

Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This will facilitate communication with a child this age. Speaking in this manner will tend to increase anxiety in very young children. The nurse must be honest with the child. Attempts at deception will lead to a lack of trust. Whenever possible, the parent should be present for interactions with young children.

Question 3

Which is most likely to encourage parents to talk about their feelings related to their child's illness?
A) Be sympathetic.
B) Use direct questions.
C) Use open-ended questions.
D) Avoid periods of silence.

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 helping the 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 4

When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. How should this question be considered?
A) Unnecessary information because child is age 3 years
B) An important part of the family history
C) An important part of the child's past history
D) An important part of the child's review of systems

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 past history. Developmental milestones provide important information about the child's physical, social, and neurologic health and should be included in the history for a 3-year-old 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 5

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

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 that the child can then observe during the procedure.

Question 6

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

Accepted Answer

Asking the adolescent girl whether 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 7

The nurse is having difficulty communicating with a hospitalized 6-year-old child. What technique might 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 if the child is always uncommunicative.
D) Ask the child to draw a picture.

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 who is most likely learning to read to keep a diary. Parents 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.

Question 8

The nurse is taking a health history on an adolescent. Which best describes how the chief complaint should be determined?
A) Ask for detailed listing of symptoms.
B) Ask adolescent, "Why did you come here today?"
C) Use what adolescent says to determine, in correct medical terminology, what the problem is.
D) Interview parent away from adolescent to determine chief complaint.

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 detailed 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 9

Which communication technique should the nurse avoid when interviewing children and their families?
A) Using silence
B) Using clichés
C) Directing the focus
D) Defining the problem

Accepted Answer

Using stereotyped comments or clichés can block effective communication, and this technique should be avoided. After use of such trite phrases, parents will often not respond. Silence can be an effective interviewing tool. Silence permits the interviewee to sort out thoughts and feelings and search for responses to questions. To be effective, the nurse must be able to direct the focus of the interview while allowing maximal freedom of expression. By using open-ended questions, along with guiding questions, the nurse can obtain the necessary information and maintain the relationship with the family. The nurse and parent must collaborate and define the problem that will be the focus of the nursing intervention.

Question 10

The nurse must assess a 10-month-old infant. The infant is sitting on the father's lap and appears to be afraid of the nurse and of what might happen next. Which initial action by the nurse would be most appropriate?
A) Initiate a game of peek-a-boo.
B) Ask father to place the infant on the examination table.
C) Undress the infant while he is still sitting on his father's lap.
D) Talk softly to the infant while taking him from his father.

Accepted Answer

Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done on the father's lap. The nurse should have the father undress the child as needed for the examination.

Question 11

When doing a nutritional assessment on a Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. How should the nurse assess this diet?
A) Indicates they live in poverty
B) Is lacking in protein
C) May provide sufficient amino acids
D) Should be enriched with meat and milk

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 is not indicative of 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 12

Which approach would be best to use to ensure a positive response from a toddler?
A) Assume an eye-level position and talk quietly.
B) Call the toddler's name while picking him or her up.
C) Call the toddler's name and say, "I'm your nurse."
D) Stand by the toddler, addressing him or her by name.

Accepted Answer

It is important that the nurse assume a position at the child's level when communicating with the child. By speaking quietly and focusing on the child, the nurse should be able to obtain a positive response. The nurse should engage the child and inform the toddler what is going to occur. If the nurse picks up the child without explanation, the child is most likely going to become upset. The toddler may not understand the meaning of the phrase, "I'm your nurse." If a positive response is desired, the nurse should assume the child's level when speaking if possible.

Question 13

The nurse is meeting a 5-year-old child for the first time and would like the child to cooperate during a dressing change. The nurse decides to do a simple magic trick using gauze. How should this action be interpreted?
A) Inappropriate, because of child's age
B) A way to establish rapport
C) Too distracting, when cooperation is important
D) Acceptable, if there is adequate time

Accepted Answer

A magic trick or other simple game may help alleviate anxiety for a 5-year-old. It is an excellent method to build rapport and facilitate cooperation during a procedure. Magic tricks appeal to the natural curiosity of young children. The nurse should establish rapport with the child. Failure to do so may cause the procedure to take longer and be more traumatic.

Question 14

A nurse is assigned to four children of different ages. In which age group should the nurse understand that body integrity is a concern?
A) Toddler
B) Preschooler
C) School-age child
D) Adolescent

Accepted Answer

School-age children have a heightened concern about body integrity. They place importance and value on their bodies and are oversensitive to anything that constitutes a threat or suggestion of injury. Body integrity is not as important a concern to toddlers, preschoolers, or adolescents.

Question 15

Which is most important to document about immunizations in the child's health history?
A) Dosage of immunizations received
B) Occurrence of any reaction after an immunization
C) The exact date the immunizations were received
D) Practitioner who administered the immunizations

Accepted Answer

The occurrence of any reaction after an immunization was given is the most important to document in a history because of possible future reactions, especially allergic reactions. Exact dosage of the immunization received may not be recorded on the immunization record. Exact dates are important to obtain but not as important as a history of reaction to an immunization. The practitioner who administered the immunization does not need to be recorded in the health history. A potentially severe physiologic response is the most threatening and most important information to document for safety reasons.

Question 16

When the nurse interviews an adolescent, which is especially important?
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.

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 17

Where in the health history should the nurse describe all details related to the chief complaint?
A) Past history
B) Chief complaint
C) Present illness
D) Review of systems

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

A nurse is preparing to assess a 3-year-old child. What communication technique should the nurse use for this child?
A) Focus communication on child.
B) Explain experiences of others to child.
C) Use easy analogies when possible.
D) Assure child that communication is private.

Accepted Answer

Because children of this age are able to see things only in terms of themselves, the best approach is to focus communication directly on them. Children should be provided with information about what they can do and how they will feel. With children who are egocentric, experiences of others, analogies, and assurances that the communication is private will not be effective because the child is not capable of understanding.

Question 19

The nurse is interviewing the mother of an infant. She reports, "I had a difficult delivery, and my baby was born preterm." This information should be recorded under which of the following headings?
A) Past history
B) Present illness
C) Chief complaint
D) Review of systems

Accepted Answer

The past 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 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. It would not include the birth information. The review of systems is a specific review of each body system. It does not include the preterm birth. Sequelae such as pulmonary dysfunction would be included.

Question 20

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 self.
B) Make family comfortable.
C) Explain purpose of interview.
D) Give assurance of privacy.

Accepted Answer

The first thing that nurses should 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. Clarification of the purpose of the interview and the nurse's role is the next thing that should be done. 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.

Quiz 4: Communication and Physical Assessment of the Child and Family

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

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

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

When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. How should this question be considered?

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

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

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

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

Which communication technique should the nurse avoid when interviewing children and their families?

The nurse must assess a 10-month-old infant. The infant is sitting on the father's lap and appears to be afraid of the nurse and of what might happen next. Which initial action by the nurse would be most appropriate?

When doing a nutritional assessment on a Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. How should the nurse assess this diet?

Which approach would be best to use to ensure a positive response from a toddler?

The nurse is meeting a 5-year-old child for the first time and would like the child to cooperate during a dressing change. The nurse decides to do a simple magic trick using gauze. How should this action be interpreted?

A nurse is assigned to four children of different ages. In which age group should the nurse understand that body integrity is a concern?

Which is most important to document about immunizations in the child's health history?

When the nurse interviews an adolescent, which is especially important?

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

A nurse is preparing to assess a 3-year-old child. What communication technique should the nurse use for this child?

The nurse is interviewing the mother of an infant. She reports, "I had a difficult delivery, and my baby was born preterm." This information should be recorded under which of the following headings?

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