A nurse needs to obtain a blood sample from a preschooler prior to treatment. The nurse uses which strategy when completing this procedure on a preschooler?

Choice A rationale Using the most restrictive restraints should be avoided as it can increase the preschooler's anxiety, fear, and resistance, making the procedure more traumatic and difficult. Less restrictive, therapeutic holding by a parent or staff member is preferred, combined with distraction and preparation, to minimize psychological distress while maintaining safety. Choice B rationale Asking a preschooler (typically aged three to five) to count to 100 is generally beyond their attention span and cognitive ability for distraction, which should be brief and concrete. Effective distraction for this age group involves methods like blowing bubbles, watching a video, or looking at a book to divert their attention for the short duration of the procedure. Choice C rationale Applying a topical anesthetic cream, such as lidocaine (e.g., EMLA or LMX4), 30 to 60 minutes prior to a venipuncture or injection is an evidence-based strategy. This effectively numbs the skin, significantly reducing the pain sensation and anxiety associated with the needle stick, which is critical for minimizing trauma in young children. Choice D rationale Asking the parents or caregiver to leave the room is not recommended, as their presence typically provides comfort, security, and a sense of control for the preschooler. Parental presence and involvement in comforting the child have been shown to reduce distress and non-cooperation during painful procedures.