A young client is admitted to the hospital directly from the clinic.

The physician suspects a problem with the child's immune system.

What test does the nurse anticipate the physician will order for this client?

Choice A rationale

A preference for certain toys is a common, non-pathological finding in toddlers as they develop individual interests and preferences. While extreme rigidity in play or an inability to shift focus may be concerning, simple preference alone does not typically indicate a significant developmental delay in a 30-month-old child, but rather a normal expression of autonomy. Further assessment would involve observing the quality and functional use of play.

Choice B rationale

Food selectivity or "picky eating" is a very frequent and normal developmental phase during toddlerhood, often peaking around age two to five years, and is not usually indicative of a neurological or pervasive developmental disorder. A child's refusal to frequently try new foods, especially in the absence of weight loss or growth failure, is not an immediate alarm for developmental delay.

Choice C rationale

Restlessness in a structured public setting like a restaurant with a waiting period is an expected behavior for a 30-month-old toddler due to their limited attention span and developmental need for gross motor activity and immediate gratification. This is a common age-appropriate reaction to boredom and constraint, not a sign of major developmental pathology.

Choice D rationale

At 30 months old, a child's expressive language milestone should significantly exceed "one or two words" and grunting. The expected milestone for this age is a vocabulary of 50 or more words and the ability to combine two to three words into short phrases or sentences (e.g., "Mommy go"). This finding strongly suggests a language delay warranting immediate comprehensive developmental evaluation.

Choice A rationale

While positioning the child upright can help improve lung expansion and ease breathing, it is not the most immediate priority when a child has significant signs of respiratory distress, including labored breathing and a low oxygen saturation of 90. The immediate need is to increase the partial pressure of oxygen in the blood to prevent hypoxemia and potential organ damage.

Choice B rationale

The child is showing signs of hypoxemia and respiratory compromise (labored breathing, cough, oxygen saturation 90) following a near-drowning incident. Oxygen administration is the priority intervention to increase arterial oxygen saturation and ensure adequate oxygen delivery to tissues. A saturation of 90 is a clinical sign of respiratory insufficiency requiring supplemental oxygenation.

Choice C rationale

Sedation should be avoided in a child with respiratory distress unless agitation is significantly interfering with ventilatory efforts or necessary procedures. Sedatives can further depress respiratory drive, potentially worsening hypoventilation and the existing hypoxemia, which would be detrimental to the child's recovery in this critical scenario.

Choice D rationale

Checking capillary refill time is an assessment of peripheral perfusion, which is important but secondary to immediate oxygenation and ventilation support. While circulatory status is critical, addressing the life-threatening hypoxemia, as indicated by the 90 oxygen saturation, takes precedence in the initial management of a respiratory emergency.