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 D

Explanation

A. Autonomy vs. Shame and Doubt. This stage (ages 1–3 years) is when toddlers begin to assert independence by making simple choices and attempting self-care. However, they lack the cognitive ability and motor skills to manage a suprapubic catheter independently.

B. Trust vs. Mistrust. This stage (birth to 1 year) focuses on developing trust in caregivers. Infants are entirely dependent on others for care and are not developmentally capable of learning catheter care.

C. Initiative vs. Guilt. This stage (ages 3–6 years) involves children exploring their environment and developing a sense of initiative. While they may be curious, they are not developmentally ready to take responsibility for complex self-care tasks like catheter maintenance.

D. Industry vs. Inferiority. This stage (ages 6–12 years) is when children develop a sense of competence and responsibility. They are eager to learn new skills, follow instructions, and take part in their own care, making this the appropriate stage for teaching suprapubic catheter care.

A. “Fragile X syndrome follows an autosomal recessive pattern, so both genetic parents must carry the gene mutation for a child to be affected." B. "Since your child has fragile X syndrome, all of your future sons will also have the condition, but your daughters will not be affected." C. “Fragile X syndrome is inherited in a mitochondrial pattern which means it is passed from the pregnant individual to child through the mitochondrial DNA.” D. “Fragile X syndrome is inherited in an X-linked dominant pattern, which means that if a pregnant client carries the gene mutation, each child has a 50% chance of Inheriting the condition."

Correct Answer is D

Explanation

A. “Fragile X syndrome follows an autosomal recessive pattern, so both genetic parents must carry the gene mutation for a child to be affected.” Fragile X syndrome is not autosomal recessive; it is X-linked dominant, meaning it is associated with mutations in the FMR1 gene on the X chromosome. Only one copy of the mutated gene is needed to express the condition.

B. "Since your child has fragile X syndrome, all of your future sons will also have the condition, but your daughters will not be affected." This is incorrect because not all sons will necessarily inherit the condition, and daughters can also be affected, though they often have milder symptoms due to having two X chromosomes.

C. “Fragile X syndrome is inherited in a mitochondrial pattern which means it is passed from the pregnant individual to the child through mitochondrial DNA.” Mitochondrial inheritance involves genes from the mother’s mitochondria, but fragile X syndrome is not inherited this way—it is an X-linked disorder passed down through the X chromosome.

D. “Fragile X syndrome is inherited in an X-linked dominant pattern, which means that if a pregnant client carries the gene mutation, each child has a 50% chance of inheriting the condition.” This is correct. Fragile X syndrome is X-linked dominant, and a parent who carries the full mutation has a 50% chance of passing it to each child. Males typically have more severe symptoms than females due to having only one X chromosome.

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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

Naxlex Comprehensive Predictor Exams

A nurse is assisting in the care of a client who has a long-term suprapubic catheter in place and is eager to learn how to care for the catheter. The nurse recognizes that a child in which of the following psychosocial developmental stages may be ready for this education?

Correct Answer is D

Explanation

A nurse is reinforcing education about the inheritance patterns of fragile X syndrome to a couple who have a family history of the disorder. Which of the following statements should the nurse make?

Correct Answer is D

Explanation

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