TEST BANK FOR

PEDIATRIC PRIMARY CARE

4

TH EDITION RICHARDSON

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Pediatric Primary Care 4th Edition Richardson

Testbank/StudyGuide

Chapter 1 Obtaining an Initial History

MULTIPLE CHOICE

1. The nurse is seeing an adolescent and the parents in the clinic for the first time. Which should

the nurse do first?

a. Introduce him- or herself.

b. Make the family comfortable.

c. Give assurance of privacy.

d. Explain the purpose of the interview.

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.

Clarification of the purpose of the interview and the nurses role is the second thing that should be

done. During the initial part of the interview, the nurse should include general conversation to

help make the family feel at ease. The interview also 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.

2. Which is considered a block to effective communication?

a. Using silence

b. Using clichs

c. Directing the focus

d. Defining the problem

ANS: B

Using stereotyped comments or clichs can block effective communication. After the nurse uses

such trite phrases, parents often do 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 maximum freedom of expression. By using open-ended questions and guiding

questions, the nurse can obtain the necessary information and maintain a relationship with the

family. The nurse and parent must collaborate and define the problem that will be the focus of

the nursing intervention.

3. Which is the single most important factor to consider when communicating with children?

a. Presence of the childs parent

b. Childs physical condition

c. Childs developmental level

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d. 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. Nonverbal behaviors vary in importance based on the childs

developmental level and physical condition. Although the childs physical condition is a

consideration, developmental level is much more important. The presence of parents is important

when communicating with young children but may be detrimental when speaking with

adolescents.

4. Because children younger than 5 years are egocentric, the nurse should do which when

communicating with them?

a. Focus communication on the child.

b. Use easy analogies when possible.

c. Explain experiences of others to the child.

d. Assure the child that communication is private.

ANS: A

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, analogies,

experiences, and assurances that communication is private will not be effective because the child

is not capable of understanding.

5. The nurses approach when introducing hospital equipment to a preschooler who seems afraid

should be based on which principle?

a. The child may think the equipment is alive.

b. Explaining the equipment will only increase the childs fear.

c. One brief explanation will be enough to reduce the childs fear.

d. The child is too young to understand what the equipment does.

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. Simple, concrete explanations about what the equipment

does and how it will feel will help alleviate the childs fear. Preschoolers need repeated

explanations as reassurance.

6. 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. Use the same type of language as the adolescent.

d. Emphasize that confidentiality will always be maintained.

ANS: B

Adolescents, like all children, need opportunities to express their feelings. Often they interject

feelings into their words. The nurse must be alert to the words and feelings expressed. The nurse

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should maintain a professional relationship with adolescents. To avoid misunderstanding or

misinterpretation of words and phrases used, the nurse should clarify the terms used, what

information will be shared with other members of the health care team, and any limits to

confidentiality. Although the peer group is important to this age group, the interview should

focus on the adolescent.

7. The nurse is preparing to assess a 10-month-old infant. He is sitting on his fathers lap and

appears to be afraid of the nurse and of what might happen next. Which initial actions by the

nurse should be most appropriate?

a. Initiate a game of peek-a-boo.

b. Ask the infants father to place the infant on the examination table.

c. Talk softly to the infant while taking him from his father.

d. Undress the infant while he is still sitting on his fathers lap.

ANS: A

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 with the child on the fathers lap.

The nurse should have the father undress the child as needed during the examination.

8. An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most

appropriate nursing action is which?

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 so that the child can then

observe during the procedure. The 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 in asking how the blood

pressure apparatus works, just requesting clarification of what will occur.

9. The nurse is having difficulty communicating with a hospitalized 6-year-old child. Which

technique should be most helpful?

a. Recommend that the child keep a diary.

b. Provide supplies for the child to draw a picture.

c. Suggest that the parent read fairy tales to the child.

d. Ask the parent if the child is always uncommunicative.

ANS: B

Drawing is one of the most valuable forms of communication. Childrens drawings tell a great

deal about them because they are projections of the childrens inner self. A diary should be

difficult for a 6-year-old child, who is most likely learning to read. The parent reading fairy tales

to the child is a passive activity involving the parent and child; it should not facilitate

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