A mother brings her male preschooler to the clinic because he has had diarrhea, vomiting, and high fevers for the past three days.
The child begins to cry and cling to his mother when the nurse enters the examination room.
Which action should the nurse implement to get the child to cooperate?
Request extra staff to help with the nursing assessments.
Explain to the child the reasons an examination is needed.
Talk to the mother and gradually focus on the child's toy.
Complete the assessment while allowing the child to cry.
The Correct Answer is C
Choice A rationale
Requesting extra staff to help with the nursing assessments may not be the most effective approach. It could increase the child's anxiety due to the presence of more unfamiliar people in the room. The primary goal is to create a calm environment that helps the child feel safe and more cooperative.
Choice B rationale
Explaining the reasons for the examination to the child may not be effective for a preschooler who may not fully understand or be comforted by such explanations. Young children often require more tangible and immediate means of reassurance and distraction.
Choice C rationale
Talking to the mother and gradually focusing on the child's toy is a practical approach. This strategy helps build rapport with both the mother and the child, and using the toy as a focal point can distract and comfort the child, making the examination process less intimidating and more cooperative.
Choice D rationale
Completing the assessment while allowing the child to cry may not be ideal. It can increase the child's distress and make the assessment more challenging. Addressing the child's emotional needs by providing comfort and distraction can lead to a more successful and less stressful examination.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
While encouraging quiet activities like watching television can provide some distraction and temporary relief, it does not address the underlying need for consistent pain management in juvenile idiopathic arthritis. Distraction techniques should be used as an adjunct to proper pain medication rather than a replacement for it. This condition can cause chronic pain, which may negatively impact the child's quality of life if not managed appropriately.
Choice B rationale
Resting when experiencing pain is a common recommendation, but for juvenile idiopathic arthritis, it's essential to balance rest with physical activity to maintain joint mobility and muscle strength. Only encouraging rest can lead to muscle atrophy and joint stiffness, which can exacerbate the condition in the long term. Regular pain management can help the child stay more active.
Choice C rationale
Hot baths can help to some extent by relaxing muscles and reducing stiffness, but they are not sufficient as a sole method for managing pain in juvenile idiopathic arthritis. The condition often requires consistent medication to control inflammation and pain. Non-pharmacological methods like hot baths should be used in conjunction with prescribed medication rather than as an alternative.
Choice D rationale
Giving pain medication around the clock helps control the pain effectively by maintaining a steady level of medication in the body, preventing breakthrough pain. Consistent pain management allows the child to participate in daily activities and physical therapy, which is essential for maintaining joint function and overall quality of life.
Correct Answer is A
Explanation
Choice A rationale
Checking serum human chorionic gonadotropin (hCG) levels is the appropriate action. hCG levels can help determine the viability of the pregnancy. Decreasing hCG levels may indicate a non-viable pregnancy, while increasing levels suggest a viable pregnancy.
Choice B rationale
Verifying the date of the last menstrual cycle is important but not the priority action in this scenario. While it can provide information on gestational age, it does not directly address the concern of vaginal bleeding.
Choice C rationale
Inquiring about the last occurrence of intercourse is not directly related to assessing the cause of vaginal bleeding. It may provide additional history but does not address the immediate concern.
Choice D rationale
Repeating a urine pregnancy test is not necessary in this context. The client is already known to be pregnant, and a urine test will not provide additional information regarding the cause of the bleeding.
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