What characteristics are typical in a child diagnosed with Down syndrome? (Select the 4 correct answers.)
Simian creases.
Curved, small fingers.
Wide-spaced front teeth.
Protruding tongue.
Lose-set eyes.
Correct Answer : A,B,D
Choice A rationale
A Simian crease, or single palmar transverse crease, is a characteristic dermatoglyphic feature found in approximately 50.
Choice B rationale
Individuals with Down syndrome often exhibit clinodactyly, specifically the inward curvature of the fifth (pinky) finger. This is often accompanied by a single flexion crease instead of the typical two on the small finger, making the fingers appear curved and smaller. These skeletal anomalies are common manifestations of the genetic disorder's effect on bone development.
Choice C rationale
Delayed and irregular eruption of teeth is common in Down syndrome. However, the front teeth (incisors) are often smaller (microdontia) and spaced far apart (diastema), not typically wide-spaced front teeth in the sense of a prominent gap, which is not a primary characteristic. The palate is frequently narrow and high-arched, which contributes to dental irregularities.
Choice D rationale
A protruding tongue (macroglossia) is a frequent physical characteristic in Down syndrome, resulting from a combination of a relatively small oral cavity, hypotonia (low muscle tone) of the facial and tongue muscles, and an objectively large tongue. This feature contributes to feeding difficulties and articulation challenges, and is a notable manifestation of the disorder.
Choice E rationale
The eyes in Down syndrome are typically characterized by upward slanting palpebral fissures, epicanthal folds (skin folds at the inner corner of the eyes), and small white spots on the iris (Brushfield spots). The eyes are usually closely set (hypotelorism) or appear so due to the facial structure, rather than being loose-set (widely spaced), which is characteristic of other syndromes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
The Babinski reflex is assessed by stroking the sole of the foot from the heel up and across the ball, which should cause the toes to curl downward (plantar flexion) in a normal infant. A positive Babinski sign in an adult (toes fanning out) indicates neurological impairment, but in a newborn, a transient fanning and dorsiflexion of the big toe is often a normal finding due to immature central nervous system myelination. This is not the reflex described.
Choice B rationale
The Glabellar reflex (or blink reflex) is elicited by gently tapping the newborn's forehead or glabella (the skin between the eyebrows). A positive response involves the newborn blinking in response to the tap. This is a brainstem-mediated, protective reflex that persists throughout life. It is tested to assess neurological integrity but is unrelated to the described startle reaction with arm and hand movements.
Choice C rationale
The Moro reflex, also known as the startle reflex, is a primitive reflex typically present from birth to about 6 months of age. It is triggered by a sudden loud noise or loss of head support. The characteristic response involves symmetrical abduction and extension of the arms, fanning of the fingers with the thumb and forefinger forming a 'C' shape, followed by adduction of the arms, sometimes accompanied by a tremor, exactly as described.
Choice D rationale
The Tonic neck reflex (or fencing posture) is observed when the infant's head is turned quickly to one side while they are supine. The reflex involves the arm and leg on the side to which the head is turned extending, and the opposite arm and leg flexing. This is a different, posture-regulating reflex, unrelated to the sudden startle response described by the nurse.
Correct Answer is A
Explanation
Choice A rationale
The application of forceps to the fetal head during birth introduces a risk of mechanical trauma to the infant's head, face, and cranial structures. Immediate post-delivery assessment is crucial to detect potential complications such as facial nerve palsy, cephalhematoma, skull fracture, or intracranial hemorrhage, necessitating prompt intervention if damage is identified.
Choice B rationale
Applying a cold pack directly to the infant's scalp is generally not a standard or immediate post-forceps intervention. While cooling might theoretically reduce swelling, the priority is a thorough neurological and physical assessment for trauma, and direct application of cold can potentially induce hypothermia, which is detrimental to a newborn's metabolic stability and thermal regulation.
Choice C rationale
Administering prophylactic antibiotic agents to the infant immediately after a routine forceps-assisted birth is not standard practice. Antibiotics are reserved for cases with clear signs of infection or specific maternal risk factors for sepsis, as unnecessary use contributes to antimicrobial resistance and alters the newborn's developing microbiome.
Choice D rationale
While measuring the circumference of the infant's head is a standard component of the newborn assessment, the immediate priority following a potentially traumatic forceps delivery is a focused assessment for trauma. Head circumference measurement, compared to a detailed trauma check, offers less diagnostic acuity for acute injury. A rapidly increasing circumference may suggest intracranial hemorrhage, but the baseline measurement isn't the first step.
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