A nurse is caring for a child with rheumatic fever. When obtaining the child's medical history from the parent, the nurse should recognize the significance of which of the following data as the possible source of the child's infection?

A. The child has above-normal growth for his age: Congenital hypothyroidism typically results in slowed growth and delayed skeletal maturation due to insufficient thyroid hormone. Above-normal growth is not consistent with this condition and would be unexpected.

B. The child is active and playful: Hypothyroidism in infants usually causes lethargy, hypotonia, and decreased activity. A highly active and playful infant would be atypical and not indicative of untreated congenital hypothyroidism.

C. The skin is pink and healthy looking: Infants with congenital hypothyroidism often have pale, dry, or mottled skin due to decreased metabolism and poor perfusion. Healthy, rosy skin is not a common finding in this condition.

D. It is difficult to keep the child awake: Lethargy and excessive sleepiness are hallmark signs of congenital hypothyroidism in infants. Difficulty keeping the infant awake reflects central nervous system depression caused by thyroid hormone deficiency and is a key clinical indicator.

A. Over the uterine fundus: The tocotransducer measures uterine contractions by detecting changes in abdominal wall tension, which are most prominent at the uterine fundus. Placement over the fundus allows optimal detection of contraction frequency and duration, even though intensity is not directly measured. Proper placement is essential for accurate external monitoring of uterine activity.

B. On the fetal scalp: This placement is associated with internal fetal heart rate monitoring using a fetal scalp electrode, not with the tocotransducer. The tocotransducer is an external device and does not attach to the fetus or assess fetal heart rate directly.

C. Inside uterus: Internal monitoring of uterine contractions requires an intrauterine pressure catheter (IUPC), not a tocotransducer. The tocotransducer is noninvasive and placed externally on the maternal abdomen rather than inside the uterine cavity.

D. Over the mother’s lower abdomen: The lower abdomen does not provide reliable assessment of uterine contractions because contractions originate at the fundus and move downward. Placement here may result in inaccurate or weak contraction tracings.