A parent reports concern that her preschool child is not as coordinated at sports as other children.
Which statement by the nurse is most appropriate to address this concern?
"Children develop differently and practicing will help.”.
"This sounds like a balance problem that needs follow up.”.
"All children should be at the same level by 4 years old.”.
"Your child should be able to throw and catch a ball by now.”
The Correct Answer is A
Choice A rationale
This statement is the most appropriate because it acknowledges the wide range of normal developmental variations in preschoolers. Every child grows and masters motor skills at their own pace. By emphasizing that practice will help, the nurse encourages the parent to provide opportunities for play and physical activity without causing unnecessary alarm. It normalizes the child's current level of coordination while providing a constructive and supportive pathway for improvement through continued physical engagement.
Choice B rationale
Suggesting that a lack of coordination in a preschooler is definitely a balance problem requiring follow-up may be premature and cause unnecessary parental anxiety. Coordination is a complex skill that involves the integration of the nervous system, muscles, and sensory input, all of which are still maturing at age four. Unless there are other significant neurological signs or the child is failing to meet basic developmental milestones, it is better to monitor the child's progress over time.
Choice C rationale
Stating that all children should be at the same level by four years old is scientifically incorrect. Child development is not a uniform process, and there is a broad spectrum of what is considered normal. Expecting all children to possess identical athletic or coordination skills ignores individual differences in temperament, physical build, and environmental exposure. Such a statement can make a parent feel that their child is failing when they may just be on a different developmental trajectory.
Choice D rationale
While many 4-year-olds are learning to throw and catch, this statement is too rigid and may sound critical to a worried parent. Coordination in sports involves complex timing and spatial awareness that some children develop slightly later than others. Setting a definitive standard can be discouraging. It is more helpful to focus on the child's overall progress rather than a single specific skill, as many children catch up to their peers with time and varied play
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Applying the blood pressure cuff directly to a bare arm is the gold standard for achieving an accurate measurement. Placing a cuff over clothing can cause either an overestimation or underestimation of the pressure due to the added thickness or uneven compression of the fabric. Ensuring direct skin contact allows for proper transmission of Korotkoff sounds and ensures that the bladder of the cuff can effectively occlude the brachial artery for a precise reading.
Choice B rationale
Positioning the cuff below the level of the right atrium will result in a falsely elevated blood pressure reading due to the effects of hydrostatic pressure. For every inch the cuff is below heart level, the reading can increase by approximately 2 mmHg. To obtain a clinically valid measurement, the arm must be supported at the level of the fourth intercostal space at the sternum. This ensures that gravity does not artificially inflate the recorded systolic and diastolic values.
Choice C rationale
Allowing the patient to rest for at least five minutes before taking a blood pressure reading is essential to eliminate the influence of recent physical activity or emotional stress. This period of quiescence helps the sympathetic nervous system reach a baseline state, providing a more accurate reflection of the patient's resting hemodynamic status. Failing to wait can result in a transiently elevated reading that does not accurately represent the patient's true cardiovascular health or pregnancy-induced changes.
Choice D rationale
Taking the blood pressure while the woman is seated is a standard and acceptable practice provided her back is supported and her feet are flat on the floor. However, in pregnancy, practitioners must be aware of the potential for uterine compression of the vena cava. While seated is common, some guidelines suggest the left lateral recumbent position to maximize placental perfusion, but a seated position itself does not inherently cause an inaccurate reading if proper technique is used.
Correct Answer is B
Explanation
Choice A rationale
Maternal magnesium levels can influence neonatal health, particularly if the mother was treated with magnesium sulfate for preeclampsia, which can lead to neonatal respiratory depression. However, decreased maternal magnesium is not the primary physiological driver behind respiratory distress syndrome specifically linked to gestational diabetes. The core issue in diabetic pregnancies involves the hormonal interplay between insulin and cortisol rather than electrolyte imbalances involving magnesium, which usually impacts muscle tone and neurological status.
Choice B rationale
Hyperinsulinemia in the fetus, triggered by maternal hyperglycemia, acts as an antagonist to the effects of cortisol. Cortisol is essential for the maturation of Type 2 pneumocytes and the production of surfactant. Surfactant reduces surface tension in the alveoli, preventing collapse during expiration. When fetal insulin levels are high, surfactant synthesis is delayed, leading to an increased risk of respiratory distress syndrome even if the infant is born near full term, as the lungs remain functionally immature.
Choice C rationale
The rooting reflex is a normal primitive reflex found in healthy newborns, where the infant turns their head toward a stimulus touching their cheek to find a food source. This reflex is an indicator of neurological integrity and is unrelated to the pathophysiology of respiratory distress or the effects of gestational diabetes on lung maturation. Its presence does not increase or decrease the risk of breathing difficulties, nor is it affected by the metabolic state of the mother.
Choice D rationale
The startle reflex, also known as the Moro reflex, is another normal primitive reflex in neonates characterized by the spreading of arms and crying in response to a sudden loss of support or a loud noise. Similar to the rooting reflex, it is a marker of central nervous system development. It has no clinical or physiological connection to the production of lung surfactant or the respiratory challenges faced by infants born to mothers with poorly controlled diabetes.
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