A nurse is caring for a client on postpartum day 2 who is preparing to go home with their newborn.
The nurse notes that the client's blood type is O- and the newborn's blood type is A+. Which of the following actions by the nurse is appropriate?

Choice A rationale

This is a significant underestimation of a 2-3 year old's language skills. While a toddler can follow commands, their expressive language is also developing rapidly. They typically transition from single words to multi-word sentences and have a vocabulary of several hundred words. The lack of speech would be a cause for concern and would require further developmental evaluation.

Choice B rationale

This is the expected language skill level for a 2-3 year old toddler. At this stage, a toddler's vocabulary expands significantly, and they begin to combine words into simple sentences. This two-word stage, often called "telegraphic speech," is a key milestone and indicates the child is beginning to understand and apply grammatical rules.

Choice C rationale

This is an overestimation of a 2-3 year old's language skills. While their vocabulary is growing, their speech is not typically fully clear or understandable to all listeners. They may still mispronounce words or omit certain sounds. Full clarity of speech is usually not achieved until 4 or 5 years of age.

Choice D rationale

This is an overestimation of a 2-3 year old's vocabulary. The typical vocabulary for a 2-year-old is around 50 words, and by age 3, it may increase to around 200-300 words. A vocabulary of 800-900 words is more characteristic of a 4 to 5 year old and is not the expected norm for this age group.

Choice A rationale

Social isolation is a significant stressor for toddlers, whose developing sense of security is highly dependent on familiar caregivers. Separation from parents and limited interaction with other children can disrupt this attachment, leading to anxiety and a sense of abandonment. This emotional distress is a direct result of their cognitive stage, where they lack the capacity for abstract thought to understand temporary separation. This can cause significant emotional and developmental regression, including withdrawal and behavioral changes.

Choice B rationale

Toddlers thrive on predictable routines for their sense of safety and control. Hospitalization disrupts these established patterns, including meal times, sleep schedules, and play activities. The unpredictable nature of hospital care, such as frequent assessments and procedures, creates a feeling of chaos and loss of control. This interruption can lead to increased stress, anxiety, and behavioral issues as the child struggles to adapt to the new, unstructured environment.

Choice C rationale

Toddlers have a limited understanding of bodily integrity and medical procedures. They may perceive painful or invasive procedures as a threat or punishment. The fear of being hurt is a primary stressor, as they lack the cognitive ability to rationalize the necessity of medical interventions. This fear is exacerbated by the presence of unfamiliar people in scrubs and the use of medical equipment, which can seem frightening and overwhelming.

Choice D rationale

Sleep is critical for a toddler’s growth and development. Hospitalization often leads to significant sleep disturbances due to the noisy and brightly lit environment, frequent interruptions for assessments, and the underlying stress and anxiety of being in an unfamiliar place. This disruption to their normal sleep-wake cycle can result in irritability, fatigue, and difficulty coping with other stressors, hindering their physical and psychological recovery.

Choice E rationale

Self-concept disturbances are not typically a primary stressor for toddlers. Self-concept, which involves an individual's perception of their own identity and worth, is a more abstract concept that develops later in childhood. Toddlers are in a stage of developing autonomy and a sense of self separate from their parents, but their stressors are more immediate and concrete, such as separation anxiety, fear, and disruption of routines, rather than complex self-perceptions.