A client who is now a G6 P6006 is 15 minutes postpartum from a normal vaginal delivery. The newborn weighed 10 lbs 13 ounces (4595 grams) at birth.
Which of the following complications should the nurse monitor for in this client?

Choice A rationale

Painting a picture requires fine motor skills and a level of artistic expression that may be beyond a typical toddler's developmental stage. While some toddlers may enjoy making marks on paper, the structured activity of painting a picture is more appropriate for preschoolers. Toddlers are still developing hand-eye coordination and may become frustrated with a task that requires precision.

Choice B rationale

Playing peek-a-boo is a game typically enjoyed by infants who are learning about object permanence. While a toddler may still find it amusing, it is not the most developmentally appropriate activity for a hospitalized toddler who is developing gross motor skills, independence, and exploring their environment. The game does not support the toddler's need for autonomy and movement.

Choice C rationale

Listening to music can be a soothing and pleasant activity for a toddler, especially in a hospital setting. However, it is a passive activity. The most appropriate play for a toddler is one that engages their newfound gross motor skills, sense of autonomy, and exploration. A passive activity like listening to music does not fully meet the developmental needs of this age group.

Choice D rationale

Playing with a push-pull toy is the most appropriate activity for a toddler. Toddlers are in the developmental stage of mastering walking and running. These toys support the development of gross motor skills, coordination, and balance. The activity also encourages independent exploration and a sense of mastery, which aligns with the toddler's psychosocial stage of autonomy versus shame and doubt.

Choice A rationale

Increasing weight loss is an incorrect characteristic. Nephrotic syndrome is marked by massive proteinuria, which leads to a decrease in plasma oncotic pressure. This fluid shift from the intravascular space to the interstitial space results in significant fluid retention, causing weight gain and edema, not weight loss. The body holds onto fluid, masking any potential muscle or fat wasting.

Choice B rationale

Increased urinary output is not a characteristic of nephrotic syndrome. The condition is associated with severe fluid retention and decreased plasma volume, leading to oliguria, or a decreased urinary output. The kidneys are not effectively filtering protein and fluid is being retained in the body, which directly reduces the amount of fluid that can be excreted as urine.

Choice C rationale

Generalized edema is the most common and striking characteristic of nephrotic syndrome. The massive loss of protein, particularly albumin, in the urine leads to a significant decrease in serum albumin levels. Albumin is crucial for maintaining plasma oncotic pressure. The resulting decrease in oncotic pressure causes fluid to shift from the bloodstream into the interstitial spaces, resulting in widespread or anasarca edema.

Choice D rationale

While hypertension can occur, it is not the most common characteristic associated with nephrotic syndrome. The primary physiological change is the massive proteinuria leading to hypoproteinemia and subsequent edema. Hypertension may develop as a result of volume overload, but it is not a hallmark sign. The most prominent and defining symptom is the severe edema.