When assessing a 2.5-year-old, the nurse would expect the toddler to have:

Choice A rationale

A saturated perineal pad within 15 minutes suggests a significant hemorrhage. The most common cause of postpartum hemorrhage is uterine atony, a lack of uterine muscle tone. Assessing the fundus first allows the nurse to determine if the uterus is firm or boggy, a key indicator of atony, and to perform a fundal massage if needed to stimulate contractions and reduce bleeding.

Choice B rationale

While an IV infusion may be necessary to restore blood volume, initiating it is not the first action. The nurse must first determine the cause of the bleeding. The fundus assessment provides critical diagnostic information and an immediate opportunity for intervention (massage) that could resolve the bleeding before initiating a fluid resuscitation.

Choice C rationale

Assessing vital signs is important but should not be the first action. In a situation of heavy bleeding, the priority is to identify and address the source of the hemorrhage. A fundal assessment provides this information immediately. Vital signs will change in response to blood loss, but the fundal assessment provides the most direct and immediate action to stop the bleeding.

Choice D rationale

The health care provider must be notified, but this action is not the first step. The nurse must first gather essential assessment data, such as the condition of the fundus, and initiate immediate interventions like a fundal massage if indicated. Notifying the provider without this information will delay appropriate care.

Choice A rationale

Chronic anemia is not a primary complication of Kawasaki syndrome. The disease process is a vasculitis that primarily affects medium-sized arteries, leading to inflammation and damage. The acute inflammatory state can cause temporary anemia, but it is not a chronic sequela prevented by IVIG and aspirin.

Choice B rationale

Cardiac arrhythmias are not the primary long-term complication targeted by IVIG and aspirin therapy. The main concern is the weakening of the coronary artery walls due to inflammation, which can lead to the formation of aneurysms. Arrhythmias can occur but are not the main focus of this specific treatment.

Choice C rationale

Acute respiratory distress is not a typical complication of Kawasaki syndrome. The syndrome is a systemic vasculitis, not a primary pulmonary disease. Respiratory symptoms like cough or runny nose are part of the initial presentation but are not the serious, life-threatening complication that IVIG and aspirin are given to prevent.

Choice D rationale

Coronary artery aneurysms are the most serious long-term complication of Kawasaki syndrome. The intense inflammation of the blood vessel walls, known as vasculitis, can lead to weakening and bulging of the coronary arteries. High-dose aspirin and IVIG reduce this systemic inflammation, thereby preventing the formation of these aneurysms.