A nurse is assisting with care for an 11-year-old child who has appendicitis. For which of the following complications should the nurse anticipate assisting with collecting data for the RN assessment of the client?

Language Delay: "No attempt to communicate verbally. Makes repetitive noises that change pitch but do not seem to be associated with trying to communicate." By 12–13 months, toddlers typically say 1–2 words, attempt to mimic sounds, and use gestures (e.g., pointing, waving) to communicate. The lack of verbal communication and repetitive vocalizations without meaning raise concerns about delayed expressive language development, which is an early sign of ASD or speech delay

Lack of Social Reciprocity: "Parent picks up toddler and gives them a hug and a kiss on the cheek. Toddler does not respond or cuddle them back." By this age, toddlers typically enjoy physical affection, seek comfort, and show attachment to caregivers. A lack of reciprocal affection or engagement may indicate social communication deficits, which are hallmark features of ASD.

Nutrition: Likes fruit like blueberries and peaches, but spits out vegetables." Food preferences at this age are common, and rejecting vegetables alone is not necessarily concerning. However, extreme food selectivity (avoiding entire food groups, refusing textures) can be a sign of sensory processing issues, which are more common in ASD.

Fine Motor: "Drinks from a cup when parent holds it but does not pick up the cup or try to hold it." By 12–13 months, toddlers typically attempt to hold and drink from a cup independently.Delayed self-feeding skills may indicate fine motor delays or lack of interest in independent eating, which can be seen in neurodevelopmental disorders like ASD.

Lack of Joint Attention: "Does not respond when asked to point to a body part or show the nurse the toy they are playing with." At 12–13 months, toddlers should be able to follow simple commands and engage in joint attention (e.g., pointing to objects, responding to names). Failure to follow basic commands or lack of engagement with others is a red flag for delayed receptive language development or social communication deficits.Lack of joint attention is one of the earliest indicators of ASD and warrants immediate follow-up.

"Uses one finger to repetitively spin a wheel on a toy truck". This behavior is another important red flag for autism spectrum disorder (ASD) and requires immediate follow-up. This child’s repetitive spinning of a wheel using one finger suggests fixated, repetitive behaviors, which are hallmark features of ASD.

A. "Most vaccines require only one dose." Many vaccines require multiple doses or booster shots to ensure long-term immunity. For example, the influenza vaccine is given annually, and the pneumococcal vaccine may require boosters in high-risk children.

B. "Children who have underlying respiratory diseases should not receive vaccines." Children with underlying respiratory conditions (e.g., asthma, cystic fibrosis) are often at higher risk for complications from respiratory infections. Vaccination is especially important for these children to protect them from severe illness.

C. "Early immunization is key to the prevention of illnesses." Vaccinating children at the recommended ages helps build early immunity against preventable respiratory infections like influenza, pneumococcal disease, and pertussis. Early immunization reduces disease severity and complications.

D. "The rhinovirus can be prevented with a vaccine." The rhinovirus (which causes the common cold) does not have a vaccine because it has many different strains and mutates frequently. Vaccines are available for other respiratory illnesses, such as influenza, pneumonia, and pertussis.