A boy aged 4 1/2 years has been having increasingly frequent angry outbursts in preschool. He is aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8-10 weeks. His parents ask the nurse for advice. What is the most appropriate intervention?

Choice A reason: Sodium excess (hypernatremia) is a condition in which the blood sodium level is too high. It can cause symptoms such as thirst, dry mouth, confusion, seizures, and coma. Sodium excess is usually caused by excessive intake of salt or fluids, or by loss of water due to diabetes insipidus, burns, or sweating. Sodium excess does not cause poor skin turgor, weight loss, or irritability.

Choice B reason: Calcium excess (hypercalcemia) is a condition in which the blood calcium level is too high. It can cause symptoms such as nausea, vomiting, constipation, abdominal pain, muscle weakness, bone pain, kidney stones, and cardiac arrhythmias. Calcium excess is usually caused by hyperparathyroidism, malignancy, vitamin D overdose, or prolonged immobilization. Calcium excess does not cause poor skin turgor, weight loss, or tachycardia.

Choice C reason: Overhydration (hypervolemia) is a condition in which the body has too much fluid. It can cause symptoms such as edema, weight gain, shortness of breath, cough, and hypertension. Overhydration is usually caused by excessive intake of fluids, or by retention of fluids due to heart failure, kidney failure, or liver cirrhosis. Overhydration does not cause poor skin turgor, weight loss, or irritability.

Choice D reason: Dehydration is a condition in which the body does not have enough fluid. It can cause symptoms such as poor skin turgor, weight loss, irritability, tachycardia, tachypnea, sunken eyes, dry mouth, and decreased urine output. Dehydration is usually caused by loss of fluids due to vomiting, diarrhea, fever, or excessive sweating. Dehydration is the most likely diagnosis for the infant based on the data.

Choice A reason: This is not an appropriate intervention. Anger and aggression are not normal behaviors in preschoolers, regardless of their gender. They may indicate underlying emotional or developmental issues that need to be addressed.

Choice B reason: This is not an adequate intervention. Talking to the preschool teacher may provide some information about the child's behavior, but it does not address the root cause or offer any solutions. The nurse should collaborate with the teacher and the parents to develop a plan of care for the child.

Choice C reason: This is the most appropriate intervention. A professional psychosocial assessment can help identify the factors that contribute to the child's anger and aggression, such as family stress, trauma, mental health problems, or learning difficulties. The assessment can also provide recommendations for treatment and support for the child and the family.

Choice D reason: This is not a helpful intervention. Consistent and firm discipline is important for any child, but it may not be enough to change the child's behavior if there are other underlying issues. Moreover, harsh or punitive discipline may worsen the child's anger and aggression. The parent should be encouraged to use positive reinforcement, empathy, and problem-solving skills with the child.