NCLEX · General

A 3-year-old patient refuses to cooperate with a physical examination. Which play strategy is most developmentally appropriate?

Correct answer

Allow the child to handle the stethoscope before using it, listen to a stuffed animal first, and narrate each step in simple terms before doing it — preschoolers aged 3-5 understand and respond well to play-based preparation and simple explanation

  1. A Restrain the child and proceed quickly
  2. B Allow the child to handle the stethoscope before using it, listen to a stuffed animal first, and narrate each step in simple terms before doing it — preschoolers aged 3-5 understand and respond well to play-based preparation and simple explanation
  3. C Tell the parent to force the child to cooperate
  4. D Skip non-essential parts of the exam

Why this is the answer

PRESCHOOLER (3-5 years) DEVELOPMENTAL CHARACTERISTICS: Significant fear of bodily harm and intrusive procedures; concrete thinking (only understand what they can directly experience); animistic thinking (toys can 'feel' things — listening to a stuffed animal first removes the fear that it hurts); beginning of magical thinking; can cooperate when given some control and preparation. THERAPEUTIC PLAY STRATEGIES: Familiarize with equipment before use; use simple, concrete language ('I'm going to listen to your heart'); allow handling of non-sharp instruments; maintain predictability (tell before you do); allow limited choices to give sense of control ('Do you want me to listen to your tummy or your back first?'); use distraction (bubbles, music, pictures). VERSUS INFANT (0-1): No verbal preparation possible; fast, efficient is better; parents as comfort; VERSUS SCHOOL-AGE (6-12): Can receive detailed explanation; curious and cooperative; education and rationale work well.
Source: NCLEX-RN Test Plan: Health Promotion — Growth and Development, Preschooler Exam Preparation

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