A nurse in a hospital is assisting in the care of a toddler who has a history of congenital brain malformations. The child's family is at the bedside, including the child's 5-year-old sibling who seems distressed. Which of the following nursing interventions would be most appropriate to support the child's sibling?

Ask the parents to escort the child's sibling to the family lounge so they are not in the child's room.

Consult the child life specialist to provide age-appropriate activities and emotional support to the sibling.

Provide the sibling with coloring pages and crayons to keep them occupied in the child's room.

Offer the sibling a tour of the hospital unit to help them become more familiar with the environment.

Answer and Explanation

The Correct Answer is B

A. Ask the parents to escort the child's sibling to the family lounge so they are not in the child's room. Removing the sibling from the room does not address their distress or emotional needs. Siblings of hospitalized children may experience fear, anxiety, or feelings of exclusion, and they need support, not isolation.

B. Consult the child life specialist to provide age-appropriate activities and emotional support to the sibling. Child life specialists are trained to help children understand and cope with hospitalization through play, education, and emotional support. They can help the sibling process their emotions in an age-appropriate way.

C. Provide the sibling with coloring pages and crayons to keep them occupied in the child's room. While coloring can be a helpful distraction, it does not address the sibling’s distress or provide the emotional support they may need to understand their sibling’s condition.

D. Offer the sibling a tour of the hospital unit to help them become more familiar with the environment. A tour may help the child feel more comfortable, but it does not directly address their distress or emotions regarding their sibling’s hospitalization.

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Correct Answer is A

Explanation

A. Changes in feeding and bowel habits. In children with Down syndrome, sudden changes in feeding and bowel habits can indicate serious conditions such as gastrointestinal obstruction (e.g., Hirschsprung’s disease) or hypothyroidism. These conditions require immediate follow-up as they can lead to complications like malnutrition or bowel obstruction.

B. Presence of a single palmar crease on the child's hands. A single transverse palmar crease (simian crease) is a common physical feature in Down syndrome but is not an urgent concern. It does not require immediate medical intervention.

C. Height and weight measurement below the 50th percentile for their age. Children with Down syndrome often have shorter stature and lower weight percentiles due to their genetic condition. While growth monitoring is important, it is not an immediate concern unless severe failure to thrive is present.

D. Evaluation of the caregiver's financial resources. Assessing financial resources is important for long-term care planning, but it does not require urgent medical intervention. Immediate follow-up should prioritize health concerns affecting the child’s well-being.

A. Cough, edema, and increased work of breathing B. Tachypnea and diaphoresis with feeding poor weight gain, and irritability C. Abdominal pain poor appetite and cough D. Bradycardia, rapid weight gain, and irritability

Correct Answer is B

Explanation

A. Cough, edema, and increased work of breathing. While these symptoms can indicate worsening heart failure, cough and edema are less prominent signs in infants compared to respiratory distress and feeding difficulties.

B. Tachypnea and diaphoresis with feeding, poor weight gain, and irritability. This is correct. Infants with worsening heart failure often struggle with feeding due to increased energy demands and difficulty breathing. Tachypnea (rapid breathing) and diaphoresis (excessive sweating) during feeding are classic early signs. Poor weight gain results from inadequate caloric intake, and irritability may be due to fatigue and hypoxia.

C. Abdominal pain, poor appetite, and cough. Abdominal pain is difficult to assess in infants, and poor appetite alone is not a definitive sign of heart failure. Cough may occur but is not a primary indicator of worsening heart failure in infants.

D. Bradycardia, rapid weight gain, and irritability. Bradycardia is not a common sign of worsening heart failure in infants; tachycardia (fast heart rate) is more typical. Rapid weight gain could suggest fluid retention but is not as reliable a sign as feeding difficulties and respiratory distress.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing care to a child who has Down syndrome during a well-child checkup. Which of the following assessment findings requires immediate follow-up by the nurse?

Correct Answer is A

Explanation

A nurse is providing care for an infant who has heart failure and is being discharged from the hospital. When reinforcing discharge education, which of the following clinical manifestations should the nurse ensure caregivers are able to identify as signs of worsening heart failure?

Correct Answer is B

Explanation

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