# 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?

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> subject: Growth & Development

## 문제

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?

## 보기

1. Acknowledge the child's concern and provide age-appropriate information about recovery and return to activities like bike riding. **✔ 정답**
2. Reassure the child that the fracture will heal completely and they will soon resume all sports without any issues.
3. Instruct the child to direct all questions about physical activities to the surgeon during the pre-operative visit.
4. Suggest the child focus on a calming activity like watching television or playing a quiet game to reduce anxiety.

**정답: 1**

## 해설

Providing honest, age-appropriate information about recovery addresses the adolescent's need for autonomy and reduces anxiety, unlike reassurance, deflection, or distraction.

## 심화 해설

Understanding the Therapeutic Communication Context

This question tests your ability to apply therapeutic communication techniques with a pediatric patient experiencing acute anxiety before surgery. The adolescent is not simply asking for a medical prognosis; they are expressing a fear of losing their identity and normalcy. The core of the question lies in recognizing that the patient's verbal question ("Will I be able to ride my bike again?") is a vehicle for the deeper, unspoken concern: "Will my life be the same after this trauma?"

Analysis of the Correct Answer (Option 1)

The correct response is to acknowledge the child's concern and provide age-appropriate information. This approach is the most therapeutic because it validates the patient's emotional state and begins to address the fear of the unknown, which is a primary driver of preoperative anxiety. The systematic review on pain drawings highlights that pain and the associated experience of injury are "highly individual" and can "challenge effective patient-doctor communication" [1]. By acknowledging the specific concern about bike riding, the nurse builds a bridge for effective communication, recognizing the patient's unique perspective. Providing age-appropriate information directly combats the anxiety that stems from uncertainty, a principle that aligns with the rationale behind nurse-led interventions designed to reduce distress, as seen in the context of reducing parental anxiety through targeted communication and support .

Analysis of Incorrect Answers

- Option 2 is non-therapeutic because it offers false reassurance. Stating the fracture "will heal completely" and the child will resume "all sports without any issues" is a promise the nurse cannot make. While the goal is a full return to activity, the path is not always linear. Literature on bone stress injuries in athletes emphasizes that recovery involves a "continuum" and carries a "risk of recurrence if not appropriately managed" [4]. A complete return to sport is a process, not a guarantee, and minimizing this reality invalidates the patient's legitimate fear.

- Option 3 is a communication block. While the surgeon will provide the definitive medical clearance, directing all questions away from the nurse shuts down the therapeutic conversation at a critical moment. The adolescent has chosen to express their anxiety to the nurse at that moment. Deflecting the question fails to address the immediate emotional distress and misses an opportunity for the nurse to provide psychosocial support, a key component of holistic perioperative care.

- Option 4 uses distraction, which can be a helpful non-pharmacological intervention for procedural pain, but it is not the most therapeutic initial response to a direct expression of emotional concern. Suggesting a calming activity without first acknowledging the fear can be perceived as dismissive. The patient’s question is a direct invitation for communication, and moving to distraction bypasses the essential step of validation. The goal is not merely to reduce the visible sign of anxiety but to help the patient process their experience.

Connecting to Perioperative Nursing Practice

For the NCLEX-RN, this scenario underscores the priority of psychosocial integrity within the perioperative setting. The nurse's role extends beyond physical preparation for surgery. The concept of a "nurse-led intervention" to reduce distress, as explored in the randomized trial, is built on a foundation of targeted communication and emotional support . When an adolescent asks about returning to a beloved activity like bike riding, they are communicating their personal definition of a successful recovery. Acknowledging this concern directly and framing the recovery pathway in a realistic, hopeful, and age-appropriate manner is the essence of therapeutic communication. This approach reduces the psychological stress that can negatively impact both the surgical experience and the rehabilitation process. The high incidence of stress fractures in young athletes and the significant "time lost from training" highlight how deeply an injury can affect an adolescent's life, making empathetic, validating communication from the nurse a critical first step in the healing journey .References (research sources)

- [1]A Systematic Review of Pain Drawings for Perioperative Patient Management.Meta-analysis/systematic reviewKnoedler L, Alfertshofer M, Remy K, Hazewinkel MHJ, Austen WG, Weinstein AL, Gfrerer L. (2026) · DOI: 10.1097/gox.0000000000007722

- [4]Stress Fracture in Athletes: A Practical Approach.Research articlePresutti F, Paoletti S, Conte F, Demeco A, Sirico F, Gnasso R, Vecchiato M, Baioccato V, Corsini A, Cerciello S, Guzzini M, Palermi S. (2026) · DOI: 10.3390/jcm15083077

## 임상 시나리오

Pediatric Preoperative CommunicationAddressing the Hidden Fear Behind the Question
When an adolescent asks about returning to a specific activity like bike riding, the question often masks a deeper fear of loss of identity or normalcy. The most therapeutic first step is to validate the emotion by acknowledging the concern directly.

Provide age-appropriate information to combat the anxiety caused by uncertainty. For a 12-year-old, use concrete explanations about bone healing and the typical timeline for returning to activities, avoiding abstract medical jargon.

CautionAvoid false reassurance such as promising a full return to all sports. Outcomes can be unpredictable, and broken promises damage the therapeutic relationship. Do not defer the question to the surgeon, as this dismisses the patient's immediate emotional distress.

## 핵심 개념

- **Therapeutic Communication** — A goal-directed, patient-centered interaction technique used by nurses to build trust, explore feelings, and promote healing, avoiding blocks like false reassurance or changing the subject.
- **False Reassurance** — A non-therapeutic communication block where the nurse offers unfounded guarantees (e.g., 'everything will be fine') that dismiss the patient's valid anxiety and can erode trust.
- **Age-Appropriate Information** — Health teaching tailored to a child's cognitive and developmental level, which reduces fear of the unknown and promotes cooperation by giving a sense of control.
- **Preoperative Anxiety** — A state of distress before surgery often stemming from fear of pain, loss of control, or the unknown, which can be mitigated through validation and clear, honest communication.

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