A child is admitted for nonorganic failure to thrive.
The nurse notes poor eye contact, listlessness, and rumination. What is the most appropriate nursing goal?

Choice A rationale

Juvenile Idiopathic Arthritis is a chronic autoimmune inflammatory condition affecting joints in children, often leading to pain, swelling, and stiffness. It does not primarily affect proximal muscle strength or neuromuscular coordination in a way that would manifest as a Gowers sign. The underlying pathology involves synovial inflammation rather than primary muscle weakness.

Choice B rationale

Multiple Sclerosis is a demyelinating disease of the central nervous system, predominantly affecting adults, though rare in children. While it can cause muscle weakness and gait disturbances due to impaired nerve conduction, a positive Gowers sign is not a characteristic or primary indicator of this condition. Its presentation is typically varied and includes sensory deficits, visual disturbances, and ataxia.

Choice C rationale

Osteosarcoma is a malignant bone tumor, primarily affecting long bones, common in adolescents. Its primary manifestations include localized pain, swelling, and sometimes a palpable mass. It causes structural damage to the bone and surrounding tissues but does not directly lead to the proximal muscle weakness and compensatory maneuvers seen with a Gowers sign.

Choice D rationale

Muscular dystrophy, particularly Duchenne muscular dystrophy (DMD), is a genetic disorder characterized by progressive degeneration of muscle fibers, leading to increasing muscle weakness. The Gowers sign is a classic indicator of proximal muscle weakness, where the child uses their hands to "walk up" their legs to stand from a seated position, due to weakness of the gluteal and quadriceps muscles. This sign is highly specific to conditions like DMD where progressive proximal muscle weakness is a hallmark.

Choice A rationale

The Apgar score is a rapid assessment tool utilized at 1 and 5 minutes after birth to evaluate a newborn's physiological adjustment to extrauterine life. It assesses five critical parameters that reflect the newborn's cardiorespiratory and neurological status.

Choice B rationale

While there are five components in the Apgar score (Appearance, Pulse, Grimace, Activity, Respiration), each component can be scored 0, 1, or 2, not just 1 or 2. This scoring system allows for a more nuanced assessment of the newborn's condition.

Choice C rationale

It is not unexpected for a newborn to receive a score of 1 for color, especially at the 1-minute Apgar, as acrocyanosis (bluish discoloration of the hands and feet) is common due to immature peripheral circulation. This finding alone does not typically indicate significant distress.

Choice D rationale

Resuscitation interventions should be initiated based on the newborn's immediate clinical assessment, regardless of the Apgar score. If a newborn exhibits signs of distress, such as apnea or bradycardia, resuscitation should commence promptly without waiting for the 1-minute Apgar score.