When visiting a friend, you see an 18-month-old toddler pull a scalding cup of tea off a table onto himself.

 Your first action should be to: 

Choice A rationale

Ignoring temper tantrums can sometimes be effective, but it may also escalate the behavior if the child feels their needs are not being met. From a psychological standpoint, the child is testing boundaries and seeking attention, and ignoring the behavior can be perceived as a lack of engagement, potentially intensifying the tantrum in an attempt to gain a reaction. This approach doesn't address the underlying developmental need for control and independence.

Choice B rationale

Distraction is a highly effective developmental strategy for toddlers. Toddlers have a short attention span and are easily redirected. By introducing a new, engaging activity, the nurse can shift the child's focus away from the source of frustration that triggered the tantrum. This technique prevents the tantrum from escalating and teaches the child to move on from a distressing situation without a power struggle, which is an important step in emotional regulation.

Choice C rationale

A toddler's cognitive development is not yet at a level where they can fully comprehend complex explanations about social norms or acceptable behavior. Their reasoning skills are still very primitive. Attempting to reason with a toddler during a tantrum is often futile and can even prolong the tantrum by giving the child attention for the negative behavior, thereby reinforcing it.

Choice D rationale

Placing a child in their room, or "time-out," is a discipline technique more appropriate for older children who can understand cause and effect. For a toddler, it can be perceived as abandonment or punishment without a clear connection to their behavior. This approach may not be effective and can cause fear or anxiety, failing to teach the child how to manage their emotions constructively.

Choice A rationale

Bright red lochia with large clots suggests uterine atony, which is a failure of the uterine muscles to contract properly. This indicates that the oxytocin is not effective in promoting uterine contraction, which is necessary to control postpartum bleeding. Uterine atony is a leading cause of postpartum hemorrhage, and this finding is a sign of an ongoing bleeding problem, not a sign of effective medication.

Choice B rationale

A firm fundus indicates the uterine muscles are contracting effectively, which compresses blood vessels and prevents excessive bleeding. Oxytocin is a synthetic analog of the naturally occurring hormone oxytocin, and it works by stimulating these smooth muscle contractions in the uterus. Therefore, a firm fundus is the desired therapeutic effect and indicates the medication is working as intended.

Choice C rationale

A boggy fundus signifies a relaxed, poorly contracted uterus. This allows for blood vessels to bleed freely, increasing the risk of postpartum hemorrhage. This is the opposite of the desired effect of oxytocin and indicates that the medication is not effectively promoting uterine contraction to control bleeding.

Choice D rationale

Absent lochia postpartum is not a normal finding and may indicate an issue such as uterine retention of placental fragments or a blood clot, or an abnormal uterine position. The normal progression of lochia (a vaginal discharge after childbirth) is a physiological process that should occur regardless of medication effectiveness. Absent lochia does not demonstrate a normal physiological response to oxytocin.