A 12-year-old adolescent is in the emergency department for a fractured femur and scheduled for surgery. The adolescent appears anxious and asks the nurse, 'Will I be able to ride my bike again?' Which response by the nurse is most therapeutic?
1Acknowledge the child's concern and provide age-appropriate information about recovery and return to activities like bike riding.✓ 정답
2Reassure the child that everything will be fine and not to worry about soccer right now
3Tell the child to ask the surgeon about playing soccer during the pre-operative visit
4Distract the child by suggesting they watch television or play a quiet game instead
해설
Providing honest, age-appropriate information about recovery addresses the adolescent's need for autonomy and reduces anxiety, unlike reassurance, deflection, or distraction.
Core Nursing ExplanationKey Concept Analysis: This question assesses therapeutic communication with an adolescent facing surgery. The core theme is understanding the developmental stage of adolescence and applying appropriate communication techniques. Adolescents are in a stage of developing identity and autonomy. They seek control and information about their bodies and futures. A fractured femur and surgery threaten their independence and ability to engage in valued activities (like bike riding), leading to anxiety. The most therapeutic response respects their cognitive ability to understand information, addresses their specific concern directly, and fosters a sense of partnership in their care.
Answer Rationale: Key Point! Option ① is correct because it uses the principles of therapeutic communication: it first acknowledges the patient's feeling (anxiety/concern), which validates their experience. It then commits to providing honest, age-appropriate information. For a 12-year-old, this means explaining the healing process, rehabilitation timeline, and realistic expectations for returning to activities in terms they can understand. This approach reduces anxiety by replacing fear of the unknown with knowledge, supports their need for autonomy, and builds trust with the nurse.
Distractor Analysis:
Watch out for confusion! Option ② uses false reassurance ("everything will be fine") and dismisses the concern ("not to worry"). This blocks communication, invalidates the adolescent's feelings, and does not provide the concrete information they are seeking. It is a non-therapeutic technique.
Option ③ deflects the responsibility to the surgeon. While the surgeon will provide medical details, the nurse's role is to provide immediate emotional support and preliminary information. Telling the patient to "ask the surgeon" later avoids addressing the current anxiety and misses a key nursing opportunity for patient education and rapport-building.
Option ④ uses distraction, which might be appropriate for a younger child but is generally ineffective and patronizing for an adolescent. It ignores the underlying emotional need for information and control, treating the symptom (the question) rather than addressing the cause (the anxiety).
Related Concepts: This integrates knowledge of Erikson's stages of psychosocial development (Adolescence: Identity vs. Role Confusion), principles of patient education, and perioperative nursing care for pediatric patients. Understanding developmental milestones is crucial for tailoring all nursing interventions, especially communication.
Concept Summary
Concept
Application to This Scenario
Adolescent Development (Erikson)
Stage: Identity vs. Role Confusion. Need for autonomy, control, and information about body/ future.
Abandons nursing role in patient education and support, creates a barrier to communication.
Anatomy, Physiology & Pharmacology Points
While not the focus here, recall that a femur fracture is a major injury involving the largest bone in the body. Healing and rehabilitation take significant time (weeks to months). The adolescent's question about bike riding relates directly to weight-bearing status and physical therapy goals post-surgery (e.g., open reduction internal fixation (ORIF)).
Memory TipsFor Communicating with Adolescents: I-CAN I - Involve them in their care.
C - Provide Clear, honest information.
A - Acknowledge their feelings and concerns.
N - Foster their sense of iNdependence.
High-Frequency NCLEX Topics
Therapeutic communication is a massive category on the NCLEX. You will be tested on choosing the most therapeutic response and identifying non-therapeutic techniques (e.g., giving advice, false reassurance, challenging). Always apply developmental stage considerations. The correct answer often involves reflecting, exploring, or providing factual information.
Watch Out for Question Variations!
* Instead of an adolescent, the patient could be a preschooler (age 4) asking the same question. The correct response might then involve using simple, concrete terms and perhaps therapeutic play with a doll, not detailed long-term information.
* The question could shift to: "The nurse is developing a teaching plan for the adolescent post-femur fracture. Which goal is most important?" Answer: "The adolescent will verbalize understanding of the rehabilitation plan to return to desired activities."
* It could test on non-therapeutic techniques: "Which statement by the nurse requires immediate intervention?" Answer: A statement using false reassurance like "Don't worry, you'll be perfect in no time."
Nursing Clinical Practice GuideClinical Scenario: You are the nurse in a pediatric orthopedics clinic. A 14-year-old patient, an avid skateboarder, is in a cast for a tibia fracture and is worried they'll never be able to skate in a competition next season. They seem withdrawn and irritable.
Nursing Intervention Strategy:
1AssessmentAssess the adolescent's understanding of the injury, their fears, and what the activity means to them (identity, social connection). Use open-ended questions: "Tell me what you're most concerned about with your recovery."
2Planning & Implementation* Acknowledge & Validate: "It makes complete sense that you're worried about skateboarding again. It's a big part of your life."
* Educate Collaboratively: Pull up an X-ray image or a bone model. Explain the healing phases in simple terms. "Your bone needs about 6-8 weeks to form a solid callus. After the cast comes off, we'll start physical therapy (PT) to rebuild strength and flexibility. The PT will work with you on goals for returning to sport."
* Provide Realistic Hope: "Many athletes return to their sport after fractures. The key is following the healing and rehab plan carefully to avoid re-injury."
3EvaluationThe adolescent should be able to state the next steps in their care and verbalize decreased anxiety about the future. Observe for increased engagement in their care plan.
Patient Safety and Precautions: Always ensure the information you provide is within your scope and consistent with the physician's or therapist's plan. Do not make guarantees about outcomes ("You will 100% skate again"), but do provide evidence-based, general prognoses.
Nursing Procedure & Medication Flow
While not a procedure per se, consider communication as a key nursing intervention. Before administering preoperative anxiolytics (e.g., midazolam), therapeutic communication is a non-pharmacological first-line strategy to reduce anxiety. Document your communication: "Adolescent expressed concern about long-term ability to ride bike. Provided age-appropriate education on fracture healing and rehabilitation process. Patient verbalized understanding and appeared less anxious."
A Word from Your Senior Nurse
"Nursing is not just about carrying out physician orders — it's about being the frontline guardian for your patients! In clinical practice, a teenager's 'simple' question about bike riding is never just about the bike. It's about their identity, their freedom, and their future. Taking those 2 extra minutes to give a real, respectful answer can transform their entire hospital experience from one of fear to one of partnership. When studying for your boards, don't just memorize communication techniques — remember the person behind the developmental stage. That mindset will not only earn you a great score on the NCLEX but will make you a truly confident, professional nurse!"
Therapeutic Communication — An interactive process between nurse and patient that focuses on advancing the patient's physical and emotional well-being. Key techniques include active listening, acknowledging feelings, and providing information.
Adolescent (Erikson's Stage) — Erikson's stage of Identity vs. Role Confusion (ages 12-18). The primary task is to develop a sense of self and personal identity. Nursing care should support autonomy and involve the patient in decision-making.
Femur Fracture — A break in the femur (thigh bone), the longest and strongest bone in the body. Often requires surgical intervention (e.g., ORIF) and has a prolonged recovery and rehabilitation period.
Preoperative Anxiety — Fear and apprehension before surgery. Nursing interventions include patient education, therapeutic communication, and sometimes prescribed anxiolytic medications.
Patient Education — A process of assisting people to learn health-related behaviors to achieve optimal health and independence. Must be tailored to the patient's age, developmental level, and readiness to learn.