A nurse's note dated 03/01/XX at 1105 indicates the client is a preschool-aged child with a speech delay who is beginning early intervention therapy.
Which nursing action supports the psychosocial development of the client?.
Apply consequences to discourage the client from remaining silent.
Allow the client to remain silent during sessions if they prefer.
Provide frequent verbal praise for attempts to communicate.
Avoid correcting speech errors to prevent client frustration.
The Correct Answer is C
Choice C rationale
According to Erikson, preschool-aged children are in the stage of initiative versus guilt. They are learning to assert power and control over their environment through social interaction and play. Providing verbal praise for communication attempts encourages the child's initiative and builds self-esteem. For a child with a speech delay, positive reinforcement is vital to prevent feelings of failure or guilt. This support fosters a sense of purpose and motivates the child to continue practicing their skills.
Choice A rationale
Applying consequences or punishments to a child for remaining silent is highly counterproductive and can lead to a sense of guilt and inadequacy. In the initiative versus guilt stage, children need a supportive environment to explore their abilities. Negative reinforcement for a physiological or developmental delay like speech impairment can cause the child to shut down emotionally, significantly hindering their psychosocial progress and potentially causing long-term damage to their self-confidence and willingness to interact.
Choice B rationale
While it is important not to pressure a child excessively, simply allowing them to remain silent without providing encouragement does not actively support their development of initiative. In early intervention therapy, the goal is to facilitate growth. If a child remains silent without any structured encouragement or positive feedback for small efforts, they may miss the opportunity to develop the social and communicative skills necessary to successfully navigate this developmental stage and move toward industry in later years.
Choice D rationale
While it is important not to frustrate the child, avoiding all correction is not the best way to support development. Constructive, gentle guidance and modeling correct speech are part of the learning process. The focus should be on praising effort rather than achieving perfection. If a nurse or therapist never provides a model for correct communication, the child may not gain the tools needed to feel competent in their interactions, which is essential for building a healthy ego.
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Related Questions
Correct Answer is C
Explanation
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.
Correct Answer is C
Explanation
Choice A rationale
Vitamin C is a water-soluble antioxidant essential for collagen synthesis and wound healing. While it supports the organic matrix of bone, it is not the primary mineral required for the actual mineralization process or structural density. In adolescents, the focus for skeletal growth is usually on minerals that provide the physical hardness of the bone. Normal adult serum levels of Vitamin C range between 0.4 to 1.5 mg/dL.
Choice B rationale
Zinc is a trace element that plays a critical role in cellular metabolism, protein synthesis, and immune function. It contributes to bone growth by acting as a cofactor for enzymes involved in tissue remodeling. However, it is not the structural foundation of bone tissue itself. During adolescence, while zinc is necessary for overall physical maturation, it is secondary to the primary minerals that build the bone matrix and ensure peak mass.
Choice C rationale
Calcium is the most abundant mineral in the body and is fundamental for the mineralization of the skeletal system. During the adolescent growth spurt, the body requires significantly higher amounts of calcium to achieve peak bone mass and prevent future osteoporosis. It combines with phosphorus to form hydroxyapatite crystals, which give bones their strength and rigidity. The normal serum calcium range for adolescents is typically 8.5 to 10.5 mg/dL for health.
Choice D rationale
Iron is a vital mineral used primarily for the production of hemoglobin, which transports oxygen in the blood. Adolescents need increased iron due to expanding blood volume and muscle mass growth. While it is essential for overall energy and growth, it does not directly participate in the mineralization of bone tissue. Normal hemoglobin levels for adolescent males are 13 to 16 g/dL and for females 12 to 15 g/dL.
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