An eight-month-old infant with Down syndrome is being seen in the clinic. His mother tells the nurse that he is difficult to hold, that "He's like a rag doll. He does not cuddle up to me like my other babies did." The nurse's best interpretation of this lack of clinging or molding is which of the following?
Sign of detachment and rejection.
Sign of maternal deprivation.
Suggestive of autism associated with Down syndrome
Result of the physical characteristics of Down syndrome.
The Correct Answer is D
A. Detachment and rejection are psychosocial interpretations that require deeper behavioral assessment and are not appropriate assumptions based on physical presentation alone.
B. Maternal deprivation refers to a lack of emotional bonding or nurturing, which is not evidenced here and is not the cause of the floppiness described.
C. While autism can co-occur with Down syndrome, the description given is more characteristic of hypotonia, not autism-specific behavior.
D. Infants with Down syndrome commonly have generalized hypotonia (low muscle tone), which causes them to feel “floppy” or like a rag doll when held. This is a well-known physical trait of the condition and not a sign of emotional or developmental issues at this stage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Kawasaki disease typically presents with fever, conjunctivitis, rash, swollen hands/feet, and lymphadenopathy, not following strep throat or with joint pain as a primary feature.
B. Rheumatic heart disease is a complication of rheumatic fever, which can follow an untreated or inadequately treated streptococcal throat infection. The child’s symptoms—fever, shortness of breath (carditis), abdominal pain, and painful swollen joint (arthritis)—are classic signs of rheumatic fever, which can lead to long-term cardiac damage.
C. Coarctation of the aorta is a congenital condition involving narrowing of the aorta and typically presents with differential blood pressure between extremities, not joint swelling or post-streptococcal symptoms.
D. Dextro-transposition of the great arteries is a cyanotic congenital heart defect that presents in newborns, not older children with post-infectious symptoms.
Correct Answer is D
Explanation
Step 1: Use the Holliday-Segar formula for maintenance fluids:
For the first 10 kg: 100 mL/kg/day
For the next 10 kg: 50 mL/kg/day
For any additional kg over 20 kg: 20 mL/kg/day
Step 2: Calculate for 36 kg
First 10 kg → 10 × 100 = 1,000 mL
Next 10 kg → 10 × 50 = 500 mL
Remaining 16 kg → 16 × 20 = 320 mL
Total = 1000 + 500 + 320 = 1,820 mL/day
Step 3: Convert to hourly rate
1820 mL/day ÷ 24 hr = 75.8 mL/hr
= 76 mL/hr (rounded off to the nearest whole number.
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