What action is contraindicated when a child with Down syndrome is hospitalized?

Choice A rationale

Time-outs are an effective behavioral strategy for children with attention deficit/hyperactivity disorder (ADHD) because they remove the child from an overstimulating or reinforcing environment, allowing them to calm down and regain self-control. This technique supports the management of impulsive or disruptive behaviors by providing a structured pause.

Choice B rationale

A positive reward system is a highly recommended intervention for managing ADHD behavior, as these children respond well to immediate and consistent reinforcement for desirable actions. Rewards motivate them to practice and internalize appropriate behaviors, focusing on positive achievements rather out of negative consequences.

Choice C rationale

Punishing misbehavior instead of using positive reinforcement or logical consequences is generally ineffective and detrimental for children with ADHD. Effective management focuses on structure, positive feedback for desired behavior, and clear, immediate, non-physical consequences, not purely on punitive measures, which can worsen self-esteem and compliance.

Choice D rationale

Helping the child with ADHD set realistic, achievable goals is essential for building self-efficacy and confidence. Breaking down tasks into smaller, manageable steps reduces feelings of overwhelm and allows the child to experience success, which is a powerful motivator for continued effort and behavioral control.

Choice A rationale

Neonatal jaundice, or hyperbilirubinemia, is common and frequently results from a higher-than-normal red blood cell mass in the newborn and a shorter lifespan of these cells. This rapid breakdown releases excess unconjugated bilirubin, which the newborn's immature liver cannot process and excrete quickly enough, leading to its accumulation in the skin and sclera.

Choice B rationale

Although severe or prolonged jaundice can indicate a serious underlying disorder, such as liver failure or biliary atresia, most physiologic jaundice is a transient, normal occurrence due to liver immaturity, not a sign of immediate organ failure. Pathological jaundice requires a thorough investigation to rule out metabolic or liver pathology.

Choice C rationale

Adequate intake of breast milk or formula is crucial because it promotes gastrointestinal motility and the passage of meconium, which contains bilirubin. Delayed feeding can lead to increased enterohepatic recirculation of bilirubin, worsening jaundice, but the underlying cause is usually the rapid red blood cell breakdown, not solely a lack of feeding.

Choice D rationale

Jaundice caused by the newborn's immune system attacking red blood cells, known as hemolytic disease of the newborn (e.g., ABO or Rh incompatibility), is a type of pathological jaundice. While this does cause elevated bilirubin, it is not the explanation for the typical, common physiologic jaundice seen in most healthy newborns.