A nurse is caring for a toddler who is scheduled to have a lumbar puncture. Which of the following actions should the nurse take?

Choice A rationale Swaddling is a comforting technique used for infants to provide security and warmth, but it is not appropriate for a toddler undergoing a lumbar puncture. A toddler requires specific positioning to widen the intervertebral spaces, and a swaddle would restrict the ability to achieve the necessary spinal flexion. Furthermore, a warm blanket does not provide the physical immobilization required to ensure the safety of the needle insertion into the subarachnoid space during the diagnostic procedure. Choice B rationale The prone position, where the client lies flat on their stomach, is contraindicated for a lumbar puncture because it flattens the spinal column and closes the intervertebral spaces. This would make it nearly impossible for the provider to safely insert the needle between the vertebrae to reach the cerebrospinal fluid. Proper assistance is needed to hold a toddler, but the child must be in a position that flexes the spine rather than extending it in a prone manner. Choice C rationale The side-lying, knee-chest position is the standard and preferred position for a lumbar puncture. By arching the back and pulling the knees toward the chest, the intervertebral spaces are opened and widened, allowing easier access for the needle. For a toddler, this position must be maintained firmly by an assistant to prevent sudden movement, which could lead to nerve damage or a traumatic tap. This position optimizes the safety and success of the spinal fluid collection. Choice D rationale While some protocols suggest lying flat for a period after a lumbar puncture to prevent post-dural puncture headaches, physically restraining a toddler for one hour is unnecessary and can cause extreme distress. Monitoring the child and encouraging quiet play is preferred. Restraints are a last resort and are not a standard post-procedural requirement for this age group. The primary focus after the procedure is observing the puncture site for drainage and assessing the child's neurological status and comfort.