A nurse is caring for an 8-month-old infant who screams when the parent leaves the room. The parent begins to cry and says, “I don’t understand why my child is so upset. I’ve never seen my child act this way around others before.” Which of the following statements should the nurse make?
“This is a normal, expected reaction for a child of this age.”
“This is a response to an overstimulating environment.”
“This is a common reaction to an overexposure to caregivers.”
“This is a typical reaction for a child who is sick.”
The Correct Answer is A
A. Separation anxiety is a normal developmental milestone that typically peaks around 8 months of age. It is a sign of healthy attachment and is expected during this stage of infancy.
B. While overstimulation can cause distress in some children, the scenario presented is more indicative of separation anxiety.
C. Overexposure to caregivers is not a recognized cause of the described behavior. Instead, it is a manifestation of the child's attachment to the primary caregiver.
D. The behavior described is more consistent with separation anxiety than illness. Illness-related distress would likely involve other signs and symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Nurses are mandated reporters of child abuse, and informing the parent about the legal obligation to report is appropriate and transparent.
B. Reporting to a supervisor does not relieve the nurse of the responsibility to directly report suspected child abuse to the appropriate authorities.
C. While the nurse should be empathetic, the legal obligation to report takes precedence over discussing details with the parent.
D. In situations of suspected child abuse, it is the responsibility of the nurse, not the provider, to make the initial report.
Correct Answer is A
Explanation
A. Obtaining a detailed history is an appropriate first step in assessing the nature of the bruises. This can help determine if the bruises are due to accidental injuries or if there are concerns for possible abuse.
B. Separating the child from the parents without further assessment may not be justified and could create unnecessary distress for the child and family.
C. Involving a psychiatrist without a clear understanding of the situation may not be the most immediate and necessary action.
D. Reporting suspected abuse to the authorities is a crucial step if abuse is suspected, but obtaining a detailed history is important to gather information for a comprehensive assessment.
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