The parent of an eight-year-old reports that the child has trouble getting to sleep at night.
Which practices should the nurse recommend to promote sleep? Select all that apply.

Choice C rationale

For a 5-year-old, oral communication supplemented by visual cues is the most developmentally appropriate approach. Facing the child directly allows them to observe the lips, tongue movements, and facial expressions, which are vital for speech-reading. Talking slowly and clearly ensures that the auditory signal is as distinct as possible. This method respects the child's developmental stage while providing the necessary accommodations for their sensory deficit, facilitating a more natural and effective interaction between the nurse and patient.

Choice A rationale

While a quiet environment is helpful for reducing interference, it is not the most comprehensive strategy for active communication. Simply being in a quiet room does not assist the child if the nurse is not also using proper speech techniques like facing the child. Silence removes the barrier of noise but does not provide the positive support of visual speech cues or clarity of articulation. Therefore, it is a supportive measure rather than the primary action for successful dialogue.

Choice B rationale

Writing is generally not an effective or age-appropriate communication tool for a typical 5-year-old. At this age, children are only beginning to develop basic literacy skills and likely cannot read complex sentences or nursing instructions. Relying on written communication would lead to significant gaps in understanding and increase the child's frustration. Communication must be tailored to the child's cognitive and educational level, which at five years old is primarily verbal and visual.

Choice D rationale

Picture boards are useful for non-verbal children or those with profound expressive delays, but for a child with some speech and hearing capabilities, they should be a secondary tool. The goal is to encourage the use of their existing communication skills. Over-reliance on pictures may limit the development of their speech-reading and verbal processing. While helpful in specific situations, facing the child and speaking clearly is the more direct and effective method for standard nursing interactions.

Choice A rationale

Choice A rationale:

Pregestational diabetes is categorized as a maternal medical condition rather than a fetal condition. Although it significantly impacts the fetus, the pathology originates within the mother's endocrine system. Maternal hyperglycemia leads to fetal risks like macrosomia and delayed lung maturity, but the primary diagnosis remains a maternal high-risk factor. Fetal conditions are specific abnormalities or diseases that develop within the fetus itself during the gestation process.

Choice B rationale

Placenta previa is a pregnancy-related complication where the placenta implants in the lower uterine segment, covering the cervical os. This is considered a maternal-fetal unit complication or an obstetric condition. While it causes fetal risks like hemorrhage and preterm birth, it is fundamentally a problem with placental attachment and maternal anatomy rather than a primary condition of the fetus itself. It requires careful management to prevent life-threatening maternal bleeding.

Choice C rationale

Preeclampsia is a multisystem hypertensive disorder of pregnancy characterized by new-onset hypertension and proteinuria after 20 weeks. It is a maternal condition that stems from abnormal placental development and maternal endothelial dysfunction. While it can cause fetal growth restriction due to poor placental perfusion, the diagnosis is based on maternal symptoms and lab values. It is one of the most common high-risk maternal conditions seen in obstetric practice.

Choice D rationale

A neural tube defect is a primary fetal condition resulting from the failure of the neural tube to close during early embryonic development. Examples include spina bifida and anencephaly. These are structural abnormalities inherent to the fetus. Detection is often through maternal serum alpha-fetoprotein screening or ultrasound. Since the defect is a specific developmental anomaly of the fetus, it is correctly classified as a fetal condition in a high-risk pregnancy.

Choice E rationale

Advanced maternal age, defined as 35 years or older at the time of delivery, is a sociodemographic and biophysical risk factor pertaining to the mother. While it increases the risk of fetal chromosomal abnormalities like Down syndrome, the age itself is a characteristic of the mother. It serves as a marker for increased monitoring but is not a fetal condition. Fetal conditions are specific diagnoses or abnormalities found in the unborn baby. .