# Situation: In the treatment room of a district hospital, the nurse prepares a 4-year-old girl for blood extraction. It is her first time to have blood taken. Each of the following is an appropriate action during the extraction. Which one BEST supports the central task of her psychosocial stage?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629421  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: In the treatment room of a district hospital, the nurse prepares a 4-year-old girl for blood extraction. It is her first time to have blood taken.

Each of the following is an appropriate action during the extraction. Which one BEST supports the central task of her psychosocial stage?

## 보기

1. Let her sit upright on her mother's lap, held in a comforting hug
2. Let her hold the cotton ball and choose which bandage to use **✔ 정답**
3. Tell her simply what she will feel just before the needle goes in
4. Cover the puncture site with a bandage as soon as the needle is out

**정답: 2**

## 해설

All four actions are sound, but each serves a different need. A 4-year-old is in Erikson's stage of initiative vs. guilt (3 to 6 years), whose task is to plan, start, and take part in activities, so giving her a helping role and a choice builds initiative. Sitting on her mother's lap draws on attachment, brief honest sensory preparation suits preoperational thinking, and a bandage answers the preschool fear of bodily injury; none of these gives her an active role.

## 심화 해설

Matching the action to Erikson's stage
All four actions in this item are good nursing practice, but the question asks which one best supports the central task of her psychosocial stage. A 4-year-old is in Erikson's stage of initiative vs. guilt, which spans about 3 to 6 years. Her developmental task is to plan, start, and take part in activities and to feel that her own efforts matter. Letting her hold the cotton ball and choose the bandage gives her an active role and a real choice, which directly builds initiative.

Why an active role matters in a procedure
Blood extraction is something done to the child, and preschoolers can feel helpless and fearful during it. When the nurse turns part of the procedure into a job she can do, such as holding the cotton or picking a bandage, the child shifts from a passive recipient to a participant. Success at a small task reinforces a sense of purpose; being shamed or restrained without any role can foster guilt. Choices should be real and limited, such as two bandages to pick from, and never about whether the procedure will happen.

What the other actions address
Each distractor meets a different need, which is why it is tempting.

| Action | Need it meets | Why it is not the best answer |
| --- | --- | --- |
| Sitting upright on mother's lap in a hug | Attachment and security; comfort positioning | Comforting, but it gives the child no active role |
| Simple sensory preparation just before the needle | Preoperational thinking; reduces fear of the unknown | Supports understanding, not the psychosocial task |
| Bandage right after the needle is out | Preschool fear of bodily injury and leaking | Eases fear, but she still has no role |

Watch out! When an item says that each option is appropriate and asks which one BEST fits a specific framework, the answer is the option that matches that framework most directly. Do not pick the option that seems kindest overall; pick the one that fits the named theory.

Exam takeaway
Pair the age with the stage first: toddler, autonomy vs. shame and doubt; preschooler, initiative vs. guilt; school age, industry vs. inferiority. For a preschooler, any action that lets the child help, plan, or choose supports initiative. Comfort positioning, honest preparation, and bandages remain part of good care, but they serve attachment, cognition, and body-image fears rather than the psychosocial task.

## 임상 시나리오

Initiative in a Preschooler's ProcedureBlood extraction in a 4-year-old
A 4-year-old is in Erikson's stage of initiative vs. guilt (3 to 6 years). Her task is to plan, start, and take part in activities.

Give her a small helping job and a real, limited choice, such as holding the cotton ball and picking a bandage. This turns her from a passive recipient into a participant.

Comfort positioning on the parent's lap, brief honest sensory preparation, and a bandage are still used; they meet attachment, cognitive, and body-image needs.

CautionOffer choices only where a choice truly exists. Never ask whether she wants the procedure if it must be done.

## 핵심 개념

- **Initiative vs. guilt** — Erikson's preschool stage, about 3 to 6 years, in which the child learns to plan and start activities with purpose.
- **Erikson's psychosocial theory** — A theory of eight life stages, each with a central conflict that shapes personality and social development.
- **Preoperational thought** — Piaget's stage, about 2 to 7 years, marked by concrete, egocentric, and magical thinking.
- **Therapeutic play** — Planned activities that let a child take part in or rehearse care to reduce fear and build mastery.

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