A nurse is caring for an 18-month-old toddler who has been hospitalized for 10 days. After the toddler's mother leaves the room, the nurse observes the toddler sitting quietly in the cornerof the crib, sucking her thumb. When the nurse approaches the crib, the toddler turns away from the nurse. The nurse should understand that these behaviors indicate which of the following developmental reactions?

A. Increased intracranial pressurE. Pulsation and bulging of the fontanel may be signs of

increased intracranial pressure in infants. However, it is important to differentiate between normal fontanel characteristics and abnormal signs of elevated intracranial pressure. In this case, the pulsation and bulging are likely normal responses to crying and changes in intracranial pressure during the newborn period.

B. Dehydration: Dehydration typically presents with sunken fontanels rather than pulsation and bulging. Dehydration is a serious condition that requires prompt assessment and intervention, but it is not indicated by the findings described in the scenario.

C. Overhydration: Overhydration is not typically associated with pulsation and bulging of the fontanel. Overhydration may lead to fluid overload and edema but does not directly affect fontanel characteristics.

D. These are normal findings: Pulsation and brief bulging of the fontanel in response to crying are considered normal findings in newborns. Fontanels allow for the flexibility of the skull bones during childbirth and provide space for brain growth during infancy. Pulsation and bulging may occur temporarily during crying or changes in intracranial pressure and are not necessarily

indicative of pathology.

A. Vary the child's schedule each day: While some variation in activities may be beneficial, providing a stable and predictable routine can also promote a sense of security and stability for the child during hospitalization.

B. According to Erikson's psychosocial development theory, the psychosocial stage for a 10- year-old child is industry versus inferiority. During this stage, children are developing a sense of competence by mastering new skills and tasks. Encouraging the child to complete school work supports this developmental stage by fostering a sense of accomplishment and competence. It

also helps maintain a sense of normalcy and continuity with academic activities despite the hospitalization.

C. Discourage visits from the client's friends: Social interaction with peers is important for the child's emotional well-being and development. Discouraging visits from friends would likely have a negative impact on the child's psychosocial needs during hospitalization.

D. Provide a daily session with a play therapist: While play therapy may be beneficial for addressing emotional needs, it may not directly address the child's psychosocial development according to Erikson's theory. Encouraging completion of school work aligns more closely with the developmental tasks of this stage.