A 3-year-old child is brought to the emergency room by her parents.
They report that she has been coughing and is drooling excessively.
She also seems to be in distress and is refusing to eat.
Based on these symptoms, which of the following is the most likely cause?

Choice A rationale

At 12 months, a child typically says their first single words with meaning, such as "mama" or "dada," and may understand simple commands. Reaching a vocabulary of 50 words is not expected at this early stage of language development.

Choice B rationale

By 24 months, most toddlers have experienced a significant language explosion and are typically able to say at least 50 words and are beginning to combine two words into simple phrases. This is a key milestone in language development.

Choice C rationale

At 36 months, a child's vocabulary has typically expanded significantly, often exceeding several hundred words. They are also using longer and more complex sentences. Saying only 50 words at this age would be considered a developmental delay.

Choice D rationale

At 15 months, children are typically in the stage of building their vocabulary beyond the initial single words. While some may be approaching a larger vocabulary, consistently saying 50 words is more characteristic of older toddlers closer to 24 months.

Choice A rationale

Asking if the child has eaten recently is important for understanding potential causes of elevated blood glucose and to consider the timing of insulin administration relative to meals. However, it does not directly ensure the medication being administered is correct for the right patient.

Choice B rationale

Verifying the child's identity using at least two identifiers and comparing the medication order to the prescription ensures that the right medication, dose, route, and time are being administered to the correct patient. This is a critical step in preventing medication errors and ensuring patient safety, especially with a high-risk medication like insulin.

Choice C rationale

Ensuring the child is comfortable and relaxed is beneficial for the child's overall well-being and can indirectly influence physiological parameters. However, it does not directly address the critical step of verifying the medication and patient identity before administration.

Choice D rationale

Preparing insulin without checking the expiration date is a medication error. Expired medications may have reduced potency or altered chemical properties, potentially leading to ineffective treatment or adverse effects. Checking the expiration date is a fundamental safety check.