A nurse is caring for a 4-year-old male client with a history of prematurity and organ transplants in the pediatric unit.

Exhibits
Which interventions should the nurse implement to address the client’s emotional distress? (Select all that apply.)

Encourage the mother to visit more frequently if possible.

Engage the child life specialist for daily therapeutic play sessions.

Administer a sedative to calm the client during outbursts.

Facilitate communication with the mother via video calls.

Restrict interactions with staff to minimize overstimulation.

Provide consistent staff assignments to build trust.

Answer and Explanation

Correct Answer : A,B,D,F

Choice A rationale: Increased maternal presence supports the emotional attachment critical in early childhood development. Children aged 3–5 thrive on stability in primary caregiver interactions, which promotes a secure base for psychosocial growth as described by Bowlby’s attachment theory. Prolonged hospital stays disrupt normal social development and increase vulnerability to stress-related behaviors including withdrawal, hyperactivity, or regression. Encouraging maternal visitation can regulate cortisol levels and reduce sympathetic nervous system activation, easing elevated heart rate and blood pressure responses.

Choice B rationale: Daily engagement with a child life specialist introduces structured therapeutic play, which activates dopamine pathways involved in reward and coping, alleviating anxiety and fostering resilience. Through play, children process emotions and gain mastery over their environment. In hospitalized children, routine play reduces hospitalization stress, enhances emotional regulation, and supports neurological development. Play therapy can modulate cortisol secretion and stabilize autonomic responses, improving adaptive behavior and maintaining cognitive milestones even amid medical stressors.

Choice C rationale: Sedatives suppress the central nervous system and may temporarily reduce behavioral outbursts, but they do not address emotional root causes. Their use in young children must be cautiously considered due to immature hepatic and renal systems impacting drug metabolism and clearance. Behavioral symptoms stemming from emotional distress require psychosocial intervention. Additionally, sedatives may blunt coping mechanisms, increase risk of dependency, and interfere with neurodevelopment by affecting GABAergic transmission in critical developmental windows.

Choice D rationale: Video call communication preserves attachment continuity by maintaining the child’s connection with the primary caregiver despite physical absence. This interaction stimulates emotional pathways involving oxytocin release, which counters cortisol-mediated stress reactions. Visual and auditory reassurance promotes emotional security and can regulate sleep, appetite, and behavior. Studies in pediatric populations show virtual interactions reduce anxiety scores, support social-emotional stability, and reinforce familiarity in environments with prolonged caregiver separation.

Choice E rationale: Limiting staff interactions may reduce sensory input but risks worsening emotional isolation and decreasing opportunities for positive human engagement. Hospitalized children benefit from social contact that can scaffold emotional support, model coping, and promote developmental stimulation. Overstimulation is better addressed through individualized care plans with environmental modifications rather than social restriction. Neurobiologically, human engagement activates mirror neurons and oxytocin pathways essential for trust and emotional growth.

Choice F rationale: Consistent staffing fosters relational stability, trust formation, and psychological safety. It supports secure attachment dynamics in substitute caregiver contexts, particularly when primary attachment figures are intermittently present. Familiar caregiver interactions reduce anxiety, support routine predictability, and facilitate therapeutic rapport. Neurodevelopmental models show that repeated positive interpersonal contact in early childhood promotes limbic system regulation and reduces behavioral dysregulation often triggered by caregiver inconsistency.

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Correct Answer is C

Explanation

Choice A rationale

This rationale describes a Freudian psychoanalytic theory of development, which focuses on psychosexual stages and the unconscious mind. This theory is not the basis for explaining individual differences in the timing of physical milestones such as walking. Motor development is a biologically driven process, not a result of psychosexual energies.

Choice B rationale

This rationale describes Erikson's theory of psychosocial development, which posits that individuals progress through a series of stages based on social interactions. While this theory is important for understanding social and emotional development, it does not explain variations in the timing of physical milestones like walking.

Choice C rationale

Motor development follows a predictable sequence, but the exact timing of milestones is influenced by a combination of genetic factors and environmental influences. Each child has a unique biological timetable for maturation, and the range for achieving milestones like walking is broad. The nurse should reassure the parent that a 14-month-old not walking is within the normal developmental range.

Choice D rationale

This rationale describes Piaget's theory of cognitive development, which focuses on how children construct knowledge through adaptation and assimilation. This theory is centered on intellectual and cognitive processes and does not provide an explanation for variations in the timing of gross motor skills such as walking.

A. Initiate formula feeding. B. Assist the mother to breastfeed the infant. C. Give intravenous 10% dextrose in water. D. Provide 1.125 oz (34 mL) of oral glucose.

Correct Answer is B

Explanation

Choice A rationale

The newborn's heelstick glucose level is 36 mg/dL (2.0 mmol/L), which is below the normal range (40-60 mg/dL). While this indicates a need for intervention, formula feeding is not the first step because the newborn is asymptomatic and has successfully breastfed, suggesting that breastfeeding may still be an option to raise the glucose level.

Choice B rationale

The initial intervention for an asymptomatic newborn with a heelstick glucose level of 36 mg/dL is to encourage breastfeeding. Breast milk contains lactose, which is a sugar that can help raise the newborn's blood glucose levels naturally. Breastfeeding also promotes bonding and is a less invasive intervention than formula or IV dextrose.

Choice C rationale

Intravenous 10% dextrose is a more invasive intervention reserved for symptomatic newborns with hypoglycemia or those who do not respond to oral feedings. Since this newborn is asymptomatic and has already breastfed, a less aggressive approach is warranted as the first step.

Choice D rationale

Administering oral glucose is an appropriate intervention for hypoglycemia. However, since the newborn has already demonstrated an ability to breastfeed, assisting the mother to breastfeed again is the preferred initial approach because it is a natural and effective way to raise blood glucose levels.

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A nurse is caring for a 4-year-old male client with a history of prematurity and organ transplants in the pediatric unit. Exhibits Which interventions should the nurse implement to address the client’s emotional distress? (Select all that apply.)

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Correct Answer is C

Explanation

A three-hour-old newborn, of a gestational diabetic mother, is asymptomatic and successfully breastfed shortly after birth. The newborn's heelstick glucose level is 36 mg/dL (2.0 mmol/L). Which intervention should the nurse do first?

Correct Answer is B

Explanation

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A nurse is caring for a 4-year-old male client with a history of prematurity and organ transplants in the pediatric unit.

Exhibits
Which interventions should the nurse implement to address the client’s emotional distress? (Select all that apply.)