A nurse is developing a care plan for an adolescent who is struggling with role confusion.
Which goal should the nurse include in the plan of care?

Choice A rationale

Building a tower of two blocks is a fine motor milestone typically achieved between 12 and 15 months of age. This task requires the coordination of vertical stacking and precise release of an object, which exceeds the developmental capabilities of a 9 month old infant. At 9 months, infants are more focused on banging objects together or transferring them between hands rather than purposeful vertical construction requiring significant stability.

Choice B rationale

Using a spoon independently is a complex self-feeding skill that usually develops between 15 and 18 months. While a 9 month old may attempt to hold a spoon or play with it, the rotation of the wrist and the coordination required to scoop food and successfully navigate it to the mouth without spilling is a much later developmental achievement. Early infancy focuses more on finger feeding and the beginning of the pincer grasp.

Choice C rationale

The development of the pincer grasp, which involves picking up small objects using the thumb and forefinger, is a hallmark fine motor milestone for a 9 month old. This signifies advanced neurological maturation and coordination of the small muscles in the hand. Normal development at this stage transitions from a crude palmar grasp to this refined movement, allowing the infant to explore small items and begin self-feeding with tiny pieces of food.

Choice D rationale

Holding a crayon with the intent to scribble is a fine motor skill that generally emerges around 12 to 15 months of age. A 9 month old lacks the tripod or even the fisted grip necessary to intentionally manipulate a writing utensil for marking. While they might grasp a crayon using a palmar reflex, they do not possess the cognitive or motor planning to use it as a tool for drawing or scribbling until they are older.

Choice A rationale

Minimizing a child's fear by using terms like silly or dismissing the concern as impossible invalidates the preschooler's perspective. In the preoperational stage of development, children exhibit animism, believing inanimate objects have lifelike qualities and intentions. Telling the child the cuff cannot bite does not address their internal reality. This approach erodes trust and fails to reduce the autonomic nervous system's stress response, making the clinical encounter more difficult and traumatic.

Choice B rationale

Proceeding quickly and using physical restraint increases the child's physiological stress and reinforces the perception that the medical environment is a place of threat. Restraint can lead to a fight or flight response, which elevates heart rate and blood pressure, resulting in inaccurate vital sign measurements. This authoritarian approach can cause long term medical trauma and fear of healthcare providers, hindering future cooperation and the development of a therapeutic relationship with the pediatric client.

Choice C rationale

Allowing the child to practice on a caregiver utilizes therapeutic play, which is a developmentally appropriate intervention for preschoolers. This age group learns through imitation and needs to feel a sense of control over their environment to reduce anxiety. By seeing the cuff inflated on a trusted adult without harm, the child's fear of animism is mitigated through safe observation. This technique fosters cooperation and ensures the recorded blood pressure reflects a calm, resting state.

Choice D rationale

Providing a detailed scientific explanation of how the cuff works is ineffective because preschoolers are in the preoperational stage of cognitive development. They are characterized by egocentrism and literal thinking rather than abstract reasoning. They cannot process complex physiological concepts or the mechanics of pressure transducers. Over-explaining can actually increase anxiety by providing too much information that the child may misinterpret as more evidence of a potential threat or something scary and unknown.