The practical nurse (PN) is observing a two-year-old child at play.
Which should the PN consider normal behavior for a toddler?

Choice A rationale

Monitoring serum electrolytes is the top priority for an infant with congenital adrenal hyperplasia (CAH). This condition involves an enzymatic defect that impairs cortisol and aldosterone synthesis, leading to salt wasting due to insufficient aldosterone. This can cause life-threatening hyponatremia and hyperkalemia, requiring urgent intervention. Normal ranges are typically sodium 135-145 mEq/L and potassium 3.5-5.0 mEq/L.

Choice B rationale

Checking for hypothermia is important for any neonate or infant, as they have immature thermoregulation. While a general nursing intervention, it is not the most specific or life-threatening concern directly related to the pathophysiology of congenital adrenal hyperplasia, which primarily involves electrolyte imbalances.

Choice C rationale

Assessing for urinary tract infection is a relevant general health assessment, especially in infants with ambiguous genitalia, due to potential anatomical variations. However, while important for overall health, it does not address the immediate, life-threatening metabolic derangements associated with congenital adrenal hyperplasia.

Choice D rationale

Recording daily weights is crucial for assessing fluid balance in infants, particularly those at risk for dehydration or fluid retention. While important for monitoring overall health and fluid status, it is secondary to the critical need to monitor and correct acute electrolyte imbalances that can rapidly become life-threatening in CAH.

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.