A 4-year-old child is hospitalized for an upcoming surgery.
Which play activity would be most appropriate for the nurse to suggest to help the child process this experience?
Holding onto a push-pull toy.
Playing with a medical kit to examine a doll.
Playing a complex card game.
Reading a book alone.
The Correct Answer is B
Choice A rationale
A push-pull toy is a developmentally appropriate tool for a toddler who is perfecting their walking and gross motor skills, typically around 12 to 24 months. For a 4-year-old, this activity is too simplistic and does not provide a mechanism for processing the complex emotions or fears associated with surgery. Preschoolers require activities that engage their imagination and allow them to express specific anxieties about their environment, which a simple mechanical toy does not facilitate.
Choice B rationale
Medical play using a kit and a doll is a highly effective therapeutic technique for hospitalized preschoolers. This activity allows the child to take on a powerful role as the doctor or nurse, reversing the passive role they experience as a patient. By manipulating medical equipment, the child can gain a sense of mastery and control over the situation. This helps reduce anxiety, clarifies misconceptions about procedures, and allows the nurse to observe the child's specific fears.
Choice C rationale
Complex card games require advanced cognitive abilities, such as strategic thinking, memory, and understanding intricate rules, which are generally beyond the developmental stage of a 4-year-old. Preschoolers are in the preoperational stage of development, where they are beginning to use symbols but still struggle with logic and complex rules. Attempting a game that is too difficult can lead to frustration and decreased self-esteem, which is counterproductive when the goal is to provide comfort and emotional processing.
Choice D rationale
Reading a book alone is a passive and solitary activity that may not help a child process the stress of an upcoming surgery. While reading can be a good distraction, 4-year-olds often need interactive and creative outlets to express their feelings. Furthermore, reading alone does not allow for the social interaction or guided play that a nurse or parent can provide to address the child's specific questions or concerns about the hospital experience or the surgical procedure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Macrosomia refers to excessive birth weight, typically defined as greater than 4000 grams or 4500 grams. While this is a very common complication of gestational diabetes due to fetal hyperinsulinemia in response to maternal hyperglycemia, it is not considered a congenital anomaly. It is an overgrowth of otherwise normal tissues occurring later in the pregnancy. Congenital anomalies are structural defects that occur during organogenesis in the first trimester, whereas macrosomia develops during the second and third trimesters.
Choice B rationale
Neural tube defects, such as spina bifida or anencephaly, are significant structural malformations that occur when the neural tube fails to close properly during early embryonic development. Hyperglycemia during the first trimester acts as a teratogen, disrupting the molecular pathways and gene expressions necessary for proper neural development. Mothers with pre-existing or early-onset gestational diabetes are at a significantly higher risk of having offspring with these specific defects if glucose levels are not tightly controlled.
Choice C rationale
Breech presentation occurs when the fetus is positioned buttocks or feet first in the birth canal rather than head first. This is a variation of fetal positioning and is not a congenital anomaly resulting from metabolic or teratogenic influences. While certain maternal factors or uterine shapes can influence fetal position, early first-trimester hyperglycemia does not have a known causal link to the physical orientation of the fetus at the time of delivery or late-term development.
Choice D rationale
A cesarean delivery is an operative procedure used to deliver a baby through incisions in the abdomen and uterus. It is a mode of delivery, not a congenital anomaly. While women with gestational diabetes have a higher rate of cesarean sections due to complications like macrosomia or fetal distress, the surgery itself is a medical intervention. It does not fall under the category of a structural birth defect caused by high glucose levels during the embryonic period.
Correct Answer is A
Explanation
Choice A rationale
Developmental research indicates that infant crying behavior typically follows a predictable curve, peaking at approximately 6 to 8 weeks of age. This peak corresponds with significant neurological maturation and the processing of external stimuli. During this period, infants may experience periods of inconsolable crying, often referred to as the period of PURPLE crying. Understanding this timeline helps parents manage expectations and recognize that this intense phase is a normal, temporary developmental milestone.
Choice B rationale
At 1 week of age, neonates are primarily in a recovery phase following the physiological stress of birth. Their crying is generally limited to basic survival needs such as hunger, discomfort, or the need for sleep. The central nervous system is still highly immature, and the infant has not yet reached the stage of heightened environmental sensitivity that triggers the increased crying duration observed later in the second month of life.
Choice C rationale
By 12 weeks of age, most infants have moved past the peak crying phase and are beginning to develop better self-regulation and social interaction skills. At 3 months, infants often start to show more predictable patterns of behavior and improved circadian rhythms. While they still cry to communicate, the frequency and intensity of crying episodes typically decrease significantly compared to the developmental peak that occurs around the 2-month mark.
Choice D rationale
While crying starts to increase after the first two weeks of life, it has not yet reached its maximum frequency at 4 weeks. The fourth week marks the transition into more alert states, but the physiological and neurological peak of crying is still a few weeks away. Suggesting 4 weeks as the peak would be premature, as data consistently shows the upward trend continues until roughly the middle of the second month.
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