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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 shouldthe
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 thefamily. The nurse and
parent must collaborate and define the problem that will be the focus ofthe 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 importantwhen 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 aboutwhat
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 childis 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 equipmentdoes 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 informationabout 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 talesto the child is a
passive activity involving the parent and child; it should not facilitate
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