The parents of a four-year-old patient are concerned because the child has lost several teeth.
What response by the nurse is most appropriate?
"Your child should be checked for malnutrition.”.
"It is normal at this age for your child to begin losing deciduous teeth.”.
"You should focus on flossing your child's teeth more often so they will not fall out.”.
"Your child should drink milk often.”.
The Correct Answer is A
Choice A rationale
A four-year-old child losing several teeth is an abnormal clinical finding that necessitates a thorough investigation into their nutritional status. While the shedding of primary teeth is a biological certainty, it typically commences around age six. Premature tooth loss can be a clinical manifestation of severe malnutrition, specifically deficiencies in calcium, phosphorus, or vitamin D, or potentially underlying systemic diseases or localized periodontal infections that require immediate medical and dental evaluation for the patient.
Choice B rationale
Stating that it is normal for a four-year-old to lose deciduous teeth is scientifically inaccurate and provides false reassurance to the parents. The physiological process of resorption of the roots of primary teeth, driven by the eruption of permanent successors, generally begins between the ages of five and seven. Losing multiple teeth at age four is premature and suggests a pathological process, such as dental caries, trauma, or metabolic bone disturbances, rather than a normal developmental milestone.
Choice C rationale
Recommending increased flossing assumes that the tooth loss is strictly due to poor oral hygiene and periodontal disease. While hygiene is important, flossing alone will not prevent teeth from falling out if the underlying cause is systemic, such as a primary immune deficiency or a metabolic disorder. Furthermore, this response ignores the diagnostic priority of determining why the teeth are being lost prematurely, potentially delaying necessary medical intervention for the child's underlying health condition.
Choice D rationale
Suggesting that the child should drink milk often is a limited intervention that addresses calcium intake but fails to investigate the etiology of the premature tooth loss. While calcium is essential for dental hydroxyapatite stability, simply increasing milk consumption does not account for other factors like protein-energy malnutrition or endocrine disorders. The nurse must first ensure a comprehensive physical and nutritional assessment is performed rather than offering a simplistic dietary suggestion that may not solve the problem.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Removing the child from the room to a playroom may cause the child to feel excluded or anxious, especially in a new and unfamiliar hospital environment. At age eight, children are still very attached to their primary caregivers during stressful events. Separation during the interview could lead to distress for both the mother and the child, potentially hindering the collection of accurate and thorough health history data. It is better to keep the family unit together.
Choice B rationale
Providing age appropriate distractions like art supplies or paper is an effective strategy to engage an eight year old while allowing the adult to focus on the interview. This technique utilizes the child's natural need for industry and activity. By giving the child a task, the nurse acknowledges their presence and developmental needs without requiring them to remain unnaturally still or silent. This approach facilitates a smoother data collection process while minimizing interruptions in a positive way.
Choice C rationale
While television can be a distraction, it is often a passive and loud one that may interfere with the audio clarity of the interview. It does not engage the child's fine motor skills or creativity as effectively as art supplies might. Additionally, the nurse has less control over the content being shown, which may not be appropriate or calming. Using active engagement tools is generally preferred over passive screen time in a clinical developmental setting for a school age child.
Choice D rationale
Asking a parent to force a child to remain quiet is often ineffective and can create tension during the interview. An eight year old child has a limited capacity for prolonged silence when they feel they have something to contribute or when they are bored. This request places an unnecessary burden on the mother and may make her feel defensive or embarrassed, which can negatively impact the rapport and the quality of information she provides. .
Correct Answer is A
Explanation
Choice A rationale
Dressing oneself is a significant social and personal milestone that is typically achieved by the age of 4 years. At this stage, children have developed the fine motor skills and the desire for independence required to put on their clothes, manage large buttons, and sometimes even zip up jackets. Achieving this milestone reflects the child's growing autonomy and their ability to perform self-care tasks, which are essential components of personal and social development in the preschool years.
Choice B rationale
Identifying the color blue is considered a cognitive milestone rather than a social or personal skill. While it is an important developmental marker, it relates to the child's ability to categorize, name, and recognize visual stimuli. The question asks specifically for a social or personal skill, which involves behaviors related to self-care, social interaction, and emotional regulation. Cognitive skills like color recognition are usually assessed separately from the personal-social domain in developmental screening tools like the Denver II.
Choice C rationale
Naming family members in pictures is a cognitive and language milestone that is often achieved earlier than age four. While it involves a social component, it is primarily a task of memory and language labeling. By age four, social milestones are more complex, involving interactions with peers and the performance of independent tasks. While naming family is a healthy sign of recognition, it does not represent the advanced self-sufficiency and social maturity expected of a typical 4-year-old child.
Choice D rationale
Recognizing letters of the alphabet is a pre-literacy cognitive skill. This milestone involves visual discrimination and memory. While some 4-year-olds can recognize letters, this is not a personal or social skill. Social and personal milestones focus on how a child manages their own needs and relates to others. Academic or pre-academic skills like letter recognition are part of the cognitive domain and can vary widely based on the child's exposure to educational materials and environment.
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