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. "Your child will have the final say in all decisions regarding palliative care." While the child's preferences and wishes should be considered, decision-making typically involves collaboration between the child, parents, and healthcare team to ensure the best possible care.

B. "The primary goal of palliative care is to improve your child's quality of life." Palliative care focuses on enhancing comfort, relieving symptoms, and providing emotional, social, and spiritual support for the child and their family, regardless of disease prognosis.

C. "Palliative care only addresses your child's physical and mental needs." Palliative care is holistic, addressing not just physical and mental needs but also emotional, spiritual, and social well-being for both the child and their family.

D. "Palliative care will begin once your child has been given 6 months left to live." Palliative care is not limited to end-of-life care. It can be introduced at any stage of a serious illness, alongside curative treatments, to improve the child's overall 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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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?

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