After a tonsillectomy, a 7-year-old girl begins to swallow excessively.
Which intervention is most important for the practical nurse to implement?

Choice A rationale

Using blunt scissors to do cut-outs typically requires fine motor skills and hand-eye coordination that are characteristic of older preschool-aged children, generally around 3 to 4 years old. A two-year-old is still developing these complex manipulative skills, making this behavior not typical for their developmental stage.

Choice B rationale

Riding a tricycle generally emerges as a developmental milestone for children between 3 to 4 years of age. This activity demands advanced gross motor coordination, balance, and bilateral pedaling skills that are usually beyond the capabilities of an average two-year-old, who is still mastering walking and running.

Choice C rationale

Sustained attention to a picture book for 15 minutes is a cognitive ability that develops with age, typically seen in older preschool or school-aged children. A two-year-old's attention span is much shorter, usually limited to a few minutes, reflecting their ongoing neurological maturation and cognitive development.

Choice D rationale

Taking toys away from another child is a common and normal behavior observed in toddlers. This is characteristic of their egocentric stage of development, where they struggle with sharing and understanding others' perspectives, often leading to possessive actions as they explore their environment and assert their will.

Choice A rationale

Administering ibuprofen may alleviate pain temporarily, but it does not address the underlying cause of increased pain and pressure, which could indicate a developing complication such as a perineal hematoma. Providing only symptomatic relief delays investigation and potential intervention for a serious issue.

Choice B rationale

Increased pain and pressure in the vaginal area following a perineal laceration, especially 6 hours postpartum, are classic signs of a developing perineal hematoma. This condition requires prompt medical evaluation by the healthcare provider to assess the extent of bleeding, potential for shock, and determine the need for surgical intervention.

Choice C rationale

Applying an icepack to the perineum is a common comfort measure for swelling and pain associated with lacerations. While it may provide some relief, it will not resolve a developing hematoma or significant internal bleeding that is causing increased pain and pressure. It is an insufficient intervention for the potential severity of the client's symptoms.

Choice D rationale

Providing routine perineal care, such as gentle cleansing and hygiene, is important for comfort and infection prevention. However, it does not address the acute and increasing pain and pressure that suggests a complication beyond typical postpartum discomfort. This intervention would delay necessary medical assessment for a potential hematoma.