When caring for a preschooler, the nurse understands that this child tends to interpret language in ...

Answer to #1

ANS: C
Throughout the preoperational period, young children tend to interpret language in a literal way. For example, the child who is told that he will be put to sleep during the operation tomorrow may think it means the same as the action recently taken for a pet dog who was too ill to live. Children do not ask for clarification, so messages can be misunderstood quite easily. The concrete operations stage occurs from approximately 7 to 11 years of age. The formal operations stage starts at about age 12+ years. The sensorimotor stage is from birth to about 2 years of age.

Answer to #2

ANS: A
Preschoolers tend to think of their illness, their separation from parents, and any painful treatments as punishment. Play can be used to help children express their feelings about an illness and to role play coping strategies. Allowing the young child to manipulate syringes and give shots to a doll or put a bandage or restraint on a teddy bear's arm gives the child a chance to act out his feelings. The child becomes the aggressor. Play can be a major channel for communication in the nurse-client relationship involving a young child. Preschool children develop communication themes through their play and work through conflict situations in their own good time; the process cannot be rushed. When working with a school-age child, the nurse should search for concrete examples to which the child can relate rather than giving abstract examples. Abstract thinking occurs in the formal operations stage. Children who are 7-11 years of age are in Piaget's concrete operations stage, in which they master the use of numbers and other concrete ideas such as classification and conservation. Children who are 12+ years of age are in Piaget's formal operations stage, in which they tend to think about the future.

Answer to #3

ANS: A
Assessing a child's reaction to illness requires knowing the child's normal patterns of communication. Interactions are observed between parent and child. Variations occur across situations, so that the child under stress or in a different environment may process information at a lower level than he would under normal conditions. Because two children of the same chronological age may have quite different skills as information processors, the nurse needs to assess level of functioning. Some studies show school-age children are more satisfied if their health care provider is the same gender. A severe illness can cause a child to show behaviors that are reminiscent of an earlier stage of development. A certain amount of regression is normal.

Answer to #4

ANS: C
A severe illness can cause a child to show behaviors that are reminiscent of an earlier stage of development. A certain amount of regression is normal. Common behaviors include whining, demanding undue attention, withdrawal, or having toileting accidents. These behaviors might stem from the powerlessness the child feels in attempting to cope with an overwhelming, frightening environment. Reassuring the parents that this is a common response to the stress of illness can be helpful and is the best approach.

Answer to #5

ANS: D
Because children have limited life experience to draw from, they exhibit a narrower range of behaviors in coping with threat. The quiet, overly compliant child who does not complain may be more frightened than the child who screams or cries. The nurse needs to obtain detailed information regarding the usual behavioral responses of the family and child. Some behaviors that look regressive may be a typical behavioral response for the child (e.g., the 2-year-old who wants a bedtime bottle).

Answer to #6

ANS: C
In mastering QSEN competency of patient-centered care, effective tools need be attitudinal, cognitive, and developmentally appropriate.