A nurse is taking care of a post-operative cesarean section patient who underwent an emergency cesarean section due to a category II fetal heart tracing 12 hours ago.
The patient is upset as a cesarean section was not part of their birth plan and wants to know if they will be able to have a vaginal delivery with their next pregnancy.The best response by the nurse would be:

Choice A rationale

Coronary thrombosis is a life-threatening complication where a blood clot forms in a coronary artery, leading to a myocardial infarction. Kawasaki disease causes inflammation of the blood vessels (vasculitis), which can damage the endothelium of the coronary arteries. This damage creates a site for clot formation, which can occlude blood flow and cause severe myocardial ischemia or death.

Choice B rationale

Coronary stenosis is a narrowing of the coronary arteries. While it can be a long-term complication of Kawasaki disease, leading to restricted blood flow, it is generally considered a less immediate and life-threatening complication than an acute thrombosis or aneurysm. The stenosis itself is not the most serious acute event, although it does increase the risk of later cardiac events.

Choice C rationale

A decreased sedimentation rate, or ESR, would not be a complication. In fact, an elevated ESR is a hallmark of the acute inflammatory process in Kawasaki disease. The ESR measures the rate at which red blood cells settle, which is increased during inflammation due to the presence of acute-phase proteins. A decreased ESR would indicate a reduction in inflammation, not a complication.

Choice D rationale

Coronary artery aneurysm is a primary serious complication of Kawasaki disease. The vasculitis can weaken the arterial walls, leading to the formation of aneurysms. These aneurysms can rupture, causing a hemorrhage, or they can be the site of a thrombosis. Aneurysms are a significant source of long-term morbidity and mortality in children with the disease.

Choice E rationale

Hypocoagulability, or a reduced ability to form blood clots, is not a complication of Kawasaki disease. In the acute phase, patients are more likely to be in a hypercoagulable state due to the systemic inflammatory response. This increased risk of clotting is what makes coronary thrombosis a significant concern, not hypocoagulability

Choice A rationale

Ignoring temper tantrums can sometimes be effective, but it may also escalate the behavior if the child feels their needs are not being met. From a psychological standpoint, the child is testing boundaries and seeking attention, and ignoring the behavior can be perceived as a lack of engagement, potentially intensifying the tantrum in an attempt to gain a reaction. This approach doesn't address the underlying developmental need for control and independence.

Choice B rationale

Distraction is a highly effective developmental strategy for toddlers. Toddlers have a short attention span and are easily redirected. By introducing a new, engaging activity, the nurse can shift the child's focus away from the source of frustration that triggered the tantrum. This technique prevents the tantrum from escalating and teaches the child to move on from a distressing situation without a power struggle, which is an important step in emotional regulation.

Choice C rationale

A toddler's cognitive development is not yet at a level where they can fully comprehend complex explanations about social norms or acceptable behavior. Their reasoning skills are still very primitive. Attempting to reason with a toddler during a tantrum is often futile and can even prolong the tantrum by giving the child attention for the negative behavior, thereby reinforcing it.

Choice D rationale

Placing a child in their room, or "time-out," is a discipline technique more appropriate for older children who can understand cause and effect. For a toddler, it can be perceived as abandonment or punishment without a clear connection to their behavior. This approach may not be effective and can cause fear or anxiety, failing to teach the child how to manage their emotions constructively.