If the fetal monitor demonstrates the following pattern, which action would the nurse perform first? (Click on paperclip if image is not showing).

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

Painting a picture requires fine motor skills and a level of artistic expression that may be beyond a typical toddler's developmental stage. While some toddlers may enjoy making marks on paper, the structured activity of painting a picture is more appropriate for preschoolers. Toddlers are still developing hand-eye coordination and may become frustrated with a task that requires precision.

Choice B rationale

Playing peek-a-boo is a game typically enjoyed by infants who are learning about object permanence. While a toddler may still find it amusing, it is not the most developmentally appropriate activity for a hospitalized toddler who is developing gross motor skills, independence, and exploring their environment. The game does not support the toddler's need for autonomy and movement.

Choice C rationale

Listening to music can be a soothing and pleasant activity for a toddler, especially in a hospital setting. However, it is a passive activity. The most appropriate play for a toddler is one that engages their newfound gross motor skills, sense of autonomy, and exploration. A passive activity like listening to music does not fully meet the developmental needs of this age group.

Choice D rationale

Playing with a push-pull toy is the most appropriate activity for a toddler. Toddlers are in the developmental stage of mastering walking and running. These toys support the development of gross motor skills, coordination, and balance. The activity also encourages independent exploration and a sense of mastery, which aligns with the toddler's psychosocial stage of autonomy versus shame and doubt.