Fundamentals of Nursing Q 325
How should the nurse modify the examination for a 7-year-old child?
A. Ask the parents to leave the room before the examination.
B. Demonstrate equipment before using it.
C. Allow the child to help with the examination.
D. Perform invasive procedures (e.g., otoscopic) last.
Correct Answer: B. Demonstrate equipment before using it.
The nurse should modify his examination by demonstrating equipment before using it to examine a school-age child. The physical examination is often the first direct contact between the nurse and the child. Establishing a trusting relationship between the child and the examiner is important. Throughout the examination the nurse should be sensitive to the cultural needs of and differences among children. Providing a quiet, private environment for the history and physical examination is important. The classic systematic approach to the physical examination is to begin at the head and proceed through the entire body to the toes. When examining a child, however, the examiner tailors the physical assessment to the child’s age and developmental level.
Option A: The nurse should make sure parents are not present during the physical examination of an adolescent, but they usually help younger children feel more secure. To establish trust with the school-age child, the examiner asks the child questions the child can answer. Children in elementary school will talk about school, favorite friends, and activities. Older school-age children may have to be encouraged to talk about their school performance and activities. The examiner encourages the parent to support and reinforce the child’s participation in the examination.
Option C: The nurse should allow a preschooler to help with the examination when possible, but not usually a school-age child. The examination proceeds from head to toe. Children of this age prefer a simple drape over their underpants or a colorful examination gown, and the examiner should be sensitive to the child’s modesty. The examination is a wonderful opportunity to teach the child about the body and personal care. The nurse answers questions openly and in simple terms.
Option D: It is best to perform invasive procedures last for all age groups; therefore, this does not represent a modification. Toddlers are often fearful of invasive procedures, so those should be performed last in this age group.