A nurse is assessing a 5-year-old boy and suspects that the child may have an autism spectrum disorder.

Which finding would help support the nurse's suspicions?

Choice A rationale

Digoxin is a cardiac glycoside that slows and strengthens the heart rate and is commonly used in infants with heart failure. For an infant, the normal apical pulse rate typically ranges from 100 to 160 beats per minute. A rate of 80 beats per minute is significantly below the acceptable lower limit, indicating potential digoxin toxicity or an existing underlying bradycardia, requiring the nurse to hold the dose and notify the physician immediately to prevent serious adverse effects.

Choice B rationale

A heart rate of 140 beats per minute is within the normal physiological range for an infant, which is generally 100 to 160 beats per minute. This rate is considered acceptable and does not warrant holding the prescribed dose of digoxin, assuming other parameters and clinical signs of toxicity are absent. Digoxin aims to improve cardiac contractility and may slightly slow the rate but 140 is a safe rate.

Choice C rationale

An apical pulse rate of 100 beats per minute sits at the lower boundary of the normal range for an infant, which spans from 100 to 160 beats per minute. While close to the cutoff, it is still technically acceptable for administering digoxin. The nurse would monitor closely, but the dose would generally not be withheld unless the rate was less than 90 or 100, depending on the facility policy.

Choice D rationale

A heart rate of 120 beats per minute is well within the expected and safe normal range for an infant, which typically extends from 100 to 160 beats per minute. This rate is adequate and does not suggest bradycardia or pose any immediate concern regarding digoxin administration. The dose should be given as scheduled, and continued monitoring should take place.

Choice A rationale

Being easily distracted from playing is a common finding in many children and is a hallmark symptom of Attention-Deficit/Hyperactivity Disorder (ADHD), not a core diagnostic feature of Autism Spectrum Disorder (ASD). Children with ASD often exhibit hyperfocus or intense, restricted interests and may resist interruption of their preferred activities or routines, showing low rather than high distractibility within their focus.

Choice B rationale

Hypersensitivity to touch, along with other sensory input irregularities (hypo- or hypersensitivity to sound, light, taste, or smell), is a common finding in children with Autism Spectrum Disorder (ASD). This sensory processing difference contributes to difficulties with daily functioning, social interaction, and emotional regulation, making it a key supportive characteristic for the suspected diagnosis.

Choice C rationale

Children with typical development show distinct interest in others around them and often seek out social interaction and engagement, which is essential for forming relationships. A key diagnostic criterion for ASD is persistent deficits in social communication and social interaction, which typically manifests as a lack of interest in or difficulty engaging with peers and sharing emotions, supporting the opposite finding.

Choice D rationale

Engaging in conversations with an imaginary friend is considered a normal, healthy part of imaginative, symbolic play development in many preschool-aged children (typically between 3 and 7 years old). In contrast, children with ASD often demonstrate deficits in symbolic or imaginative play and are more likely to engage in repetitive play patterns or use objects in non-functional ways.