A nurse in the emergency department is assessing a 5-year-old ...

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A nurse in the emergency department is assessing a 5-year-old child with symptoms of pneumonia and a fever of 102 F. Which intervention can the nurse implement to promote a sense of control for the child?
 
  a. None, this is an emergency and the child should not participate in care.
  b. Allow the child to hold the digital thermometer while taking the child's blood pressure.
  c. Ask the child if it is OK to take a temperature in the ear.
  d. Have parents wait in the waiting room.

Question 2

A child is playing in the playroom. The nurse needs to take a blood pressure on the child. Which is the appropriate procedure for obtaining the blood pressure?
 
  a. Take the blood pressure in the playroom.
  b. Ask the child to come to the exam room to obtain the blood pressure.
  c. Ask the child to return to his or her room for the blood pressure, then escort the child back to the playroom.
  d. Document that the blood pressure was not obtained because the child was in the playroom.

[cuttiesgirl16]

Answer to Question 1

ANS: B
The nurse should allow the child to hold the digital thermometer while taking the child's blood pressure. Unless an emergency is life threatening, children need to participate in their care to maintain a sense of control. Because emergency departments are frequently hectic, there is a tendency to rush through procedures to save time. However, the extra few minutes needed to allow children to participate may save many more minutes of useless resistance and uncooperativeness during subsequent procedures. The child may not give permission, if asked, for a procedure that is necessary to be performed. It is better to give choices such as, Which ear do you want me to do your temperature in? instead of, Can I take your temperature? Parents should remain with their child to help with decreasing the child's anxiety.

Answer to Question 2

ANS: C
The playroom is a safe haven for children, free from medical or nursing procedures. The child can be returned to his or her room for the blood pressure and then escorted back to the playroom. The exam room is reserved for painful procedures that should not be performed in the child's hospital bed. Documenting that the blood pressure was not obtained because the child was in the playroom is inappropriate.