A nurse is caring for a client who is pregnant and is at the end of their first trimester.
The nurse places the Doppler ultrasound in which of the following locations to begin assessing for the fetal heart tones (FHTs)?

Choice A rationale

Lateral curvature of the spine, known as scoliosis, can occur in Duchenne muscular dystrophy (DMD) as a secondary complication due to progressive muscle weakness affecting the spinal support. However, it is not the primary or initial characteristic manifestation of the disease. The fundamental pathology of DMD is direct muscle fiber degeneration leading to weakness.

Choice B rationale

Joint inflammation is characteristic of inflammatory arthropathies, such as juvenile idiopathic arthritis. Duchenne muscular dystrophy is a primary myopathy, a disorder of muscle tissue itself, not a condition primarily involving inflammation of the joints. While secondary musculoskeletal issues can arise, joint inflammation is not a hallmark feature of the disease.

Choice C rationale

Duchenne muscular dystrophy is an X-linked recessive disorder characterized by the absence of dystrophin, a crucial protein for maintaining muscle fiber integrity. This leads to progressive degeneration of skeletal muscle fibers, resulting in escalating muscle weakness. This weakness typically manifests in early childhood, starting in the proximal muscles and gradually spreading, leading to loss of ambulation.

Choice D rationale

While severe muscle weakness in Duchenne muscular dystrophy can indirectly lead to some skeletal deformities over time, such as contractures and kyphoscoliosis, these are typically secondary consequences rather than primary manifestations. The direct and defining characteristic of the disease is the progressive degeneration and weakness of the muscles themselves.

Choice A rationale

Restraining a child with autism can exacerbate distress and lead to further agitation due to sensory overload and a feeling of loss of control. Physical restraint can activate the sympathetic nervous system, increasing heart rate and cortisol levels, which can traumatize the child and hinder therapeutic rapport, contravening principles of trauma-informed care.

Choice B rationale

Hand flapping and rocking are common self-stimulatory behaviors, or "stimming," in children with autism, serving to regulate sensory input and manage anxiety. Allowing these behaviors in a low-stimulus environment supports emotional regulation by reducing external stressors and promoting a sense of security, which is crucial for individuals with sensory processing differences.

Choice C rationale

Immediately redirecting or attempting to stop self-stimulatory behaviors can be counterproductive for a child with autism. These behaviors often serve a vital self-regulatory function; interrupting them without providing an alternative coping mechanism can increase anxiety, frustration, and escalate behavioral challenges, disrupting their internal equilibrium.

Choice D rationale

Engaging in verbal interaction to distract a child with autism during self-soothing can disrupt their regulatory process. Children with ASD often have difficulties with social communication and may find unexpected verbal input overwhelming, potentially increasing sensory overload and agitation, rather than providing effective distraction or comfort.