A nurse is assessing a preschooler. Which of the following findings should indicate to the nurse a need for speech therapy? (Select all that apply.)

The preschooler speaks in three-word sentences.

The preschooler talks to himself when reading.

The preschooler speaks in a nasally tone.

The preschooler stutters when speaking.

The preschooler mispronounces words.

Answer and Explanation

Correct Answer : C,D,E

Answer: C, D, E

A. The preschooler speaks in three-word sentences.
Speaking in three-word sentences is generally considered developmentally appropriate for a preschooler. By age 3 to 4, children typically use sentences that are more complex, but this is still within a normal range for early language development.

B. The preschooler talks to himself when reading.
Talking to oneself, especially during activities like reading, can be a normal behavior for preschoolers. This self-talk can actually be a part of cognitive development, helping them to process information and reinforce learning, and does not necessarily indicate a need for speech therapy.

C. The preschooler speaks in a nasally tone.
A nasally tone may suggest a speech issue such as a cleft palate or other resonance problems. If the child consistently exhibits this speech pattern, it could indicate a need for further evaluation by a speech therapist to determine the underlying cause and appropriate interventions.

D. The preschooler stutters when speaking.
Stuttering can be a significant speech concern that may require intervention. While some children experience normal disfluencies as they learn to speak, persistent stuttering that interferes with communication is a valid reason to refer the child for speech therapy.

E. The preschooler mispronounces words.
While mispronunciation can occur during language development, consistent or unusual mispronunciations beyond what is typical for the child’s age may indicate a speech sound disorder. If the mispronunciations affect the child's ability to communicate effectively, a referral to a speech therapist would be warranted for assessment and intervention.

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Correct Answer is C

Explanation

A. Before auscultating the chest and abdomen: Examining the tympanic membrane before auscultating the chest and abdomen is not ideal. It's important to follow a systematic approach in physical examination, typically starting with less invasive assessments before progressing to more invasive or uncomfortable ones. Therefore, examining the tympanic membrane before auscultating the chest and abdomen may disrupt this systematic approach.

B. Before examining the head and neck: Similarly, examining the tympanic membrane before examining the head and neck is not appropriate. The head and neck examination typically includes less invasive assessments such as observing the child's appearance, palpating the fontanelles, and inspecting the scalp, face, and neck. The tympanic membrane examination, which involves using an otoscope, is more invasive and should be performed later in the examination.

C. At the end: This is the correct choice. Examining the tympanic membrane at the end of the physical examination allows the nurse to establish rapport with the child and gain their cooperation before performing a potentially uncomfortable or intrusive examination of the ears. Starting with less invasive and more familiar assessments, such as observing the child's general appearance and behavior, auscultating the chest and abdomen, and examining the head and neck, can help build trust and reduce anxiety before proceeding to more specific assessments, such as otoscopy.

D. At the beginning: Examining the tympanic membrane at the beginning of the physical examination may cause the child distress and anxiety, potentially making the rest of the examination more challenging. It's preferable to perform less invasive assessments first to help the child become more comfortable and cooperative before proceeding to more invasive examinations like otoscopy. Therefore, examining the tympanic membrane at the beginning is not recommended.

A. "Why are you feeling so down?" B. "I understand. I've felt like that before, too" C. "I’ll just sit here with you for a few minutes then." D. "It might help you feel better if you talk about it"

Correct Answer is C

Explanation

A. "Why are you feeling so down?": This response may come across as intrusive and may not be well-received by the client. It puts pressure on the client to provide an explanation for their feelings, which they may not be ready or willing to do at that moment.

B. "I understand. I've felt like that before, too": While expressing empathy can be helpful, it's important for the nurse to validate the client's current feelings without making assumptions about their own experiences. This response could inadvertently shift the focus away from the client's feelings and onto the nurse's experiences.

C. "I’ll just sit here with you for a few minutes then.": This is the best response as it acknowledges the client's feelings, respects their desire for solitude, and offers the nurse's presence as a source of support without pressure to talk. Simply being present with the client demonstrates empathy and provides comfort during a difficult time.

D. "It might help you feel better if you talk about it": While encouraging the client to talk about their feelings can be beneficial in some situations, it's essential to respect the client's autonomy and readiness to engage in conversation. In this case, the client has expressed a desire not to talk, so offering unsolicited advice to talk may feel dismissive of their feelings.

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A nurse is assessing a preschooler. Which of the following findings should indicate to the nurse a need for speech therapy? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

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Explanation

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