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?

Changes in feeding and bowel habits.

Presence of a single palmar crease on the child's hands.

Height and weight measurement below the 50th percentile for their age.

Evaluation of the caregiver's financial resources.

Answer and Explanation

The Correct Answer is A

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.

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Correct Answer is B

Explanation

A. Intrauterine device (IUD). While IUDs are highly effective, they require a pelvic exam for insertion and periodic monitoring, which may be challenging for an adolescent with motor difficulties and decreased memory. Additionally, IUDs do not protect against sexually transmitted infections (STIs).

B. Depot medroxyprogesterone acetate injection. This is the best option because the injection is given every 3 months, making it easier for an adolescent with memory and motor impairments to maintain consistent contraceptive use. It also does not require daily adherence like oral contraceptives.

C. Contraceptive patches. The patch requires weekly changes, which may be difficult for someone with decreased memory and coordination issues, leading to potential gaps in contraceptive coverage.

D. Combined oral contraceptives. Oral contraceptives require daily adherence, which may not be reliable for an adolescent with memory impairments. Missing doses can reduce effectiveness, making them a less suitable option.

A. Pyloric stenosis B. Celiac disease C. Gastroenteritis D. Peritonitis

Correct Answer is D

Explanation

A. Pyloric stenosis. Pyloric stenosis is a condition that affects infants, causing projectile vomiting due to the narrowing of the pyloric sphincter. It is not a complication of appendicitis and is unrelated to this child's condition.

B. Celiac disease. Celiac disease is an autoimmune disorder triggered by gluten consumption, leading to malabsorption and gastrointestinal symptoms. It is a chronic condition and is not associated with appendicitis or its complications.

C. Gastroenteritis. Gastroenteritis involves inflammation of the stomach and intestines, usually due to viral or bacterial infection. While it can cause abdominal pain, it is not a direct complication of appendicitis but rather a separate condition with similar symptoms.

D. Peritonitis. Peritonitis is the most serious complication of appendicitis and occurs when the inflamed appendix ruptures, leading to infection of the peritoneal cavity. It presents with severe abdominal pain, fever, rigidity, and signs of systemic infection, requiring urgent medical intervention.

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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?

Nursing Test Bank

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