4-year-old presented to the ER with the parents with complaints of bowel incontinence, extremity weakness and neck pain. Child has a history of Trisomy 21 with atlantoaxial stability. began having neck pain 24 hours ago after falling off the steps. No injuries reported

The nurse is caring for a client diagnosed with Down Syndrome and a history

of hypotonia and atlantoaxial instability. Which of the following symptoms require priority interventions? (Select All that Apply.)

Pain of the facial bones

Continuous neck pain

Lower extremity pain

Loss of established bladder control

Loss of established motor skills

Answer and Explanation

Correct Answer : C,D,E

A.   Although facial pain could be concerning, it is not the immediate priority when the child has a history of atlantoaxial instability and is presenting with signs that could indicate spinal cord compression. Facial pain does not suggest a direct threat to the spinal cord, which is a more critical concern in this case.
B.   Continuous neck pain in a child with atlantoaxial instability is a significant priority and requires immediate intervention. This could be a sign of spinal cord compression or injury to the cervical spine, which can occur after trauma such as a fall. Since this child has a predisposition for atlantoaxial instability, there is a high risk for neck instability and spinal cord injury, making this a top priority.
C.   While lower extremity pain may be concerning, it is not as high a priority as neck pain in this context. The primary concern here is potential spinal cord compression or neurological injury. If the child is able to move their extremities or does not have severe pain or weakness, this may not require as urgent intervention. However, it should still be monitored closely.
D.   Loss of bladder control is a red flag in children with suspected spinal cord injury. It can indicate nerve involvement in the spinal cord or cauda equina, which can be caused by injury or compression, particularly in a child with atlantoaxial instability. This requires priority intervention to prevent further damage and to initiate appropriate care (e.g., neurological assessment, imaging, and potentially surgical intervention).
E.   The loss of established motor skills is another concerning sign. In this child, it may indicate neurological impairment or spinal cord injury. Since the child has atlantoaxial instability, this is a critical symptom that suggests the possibility of spinal cord compression or injury, requiring immediate evaluation and intervention to prevent permanent neurological damage.

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Correct Answer is B

Explanation

A. Speech and communication abilities are important, but physical safety must come first to prevent accidents or injuries.
B. Safety measures are the highest priority, as children with cognitive impairments may have physical or developmental limitations that increase the risk of falls, accidents, or other harm.
C. Cognitive development and educational needs are important but should be addressed after ensuring
the child’s physical safety.

D. Social and emotional well-being are essential aspects of care, but the immediate focus should be on preventing harm.

A. Distended neck veins B. Red currant jelly stools C. Weight loss D. Occasional vomiting

Correct Answer is C

Explanation

A. Distended neck veins are typically seen in cases of heart failure or other circulatory issues, not pyloric stenosis.
B. Red currant jelly stools are associated with intussusception, not pyloric stenosis.
C. Weight loss is a common manifestation of pyloric stenosis due to vomiting and poor nutrient intake. This occurs as the narrowing of the pylorus obstructs the passage of food.
D. Occasional vomiting could be a sign of pyloric stenosis, but the hallmark feature is projectile vomiting, which occurs more frequently and is often more forceful.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a child with known cognitive impairment. Which of the following is the nurse’s highest priority in the assessment of a child with cognitive impairment?

Correct Answer is B

Explanation

A nurse is caring for a 6-week-old infant diagnosed with pyloric stenosis. Which of the following clinical manifestations should the nurse expect?

Correct Answer is C

Explanation

A nurse is contacted by a parent whose 7-year-old child ingested half a bottle of vitamins with ferrous sulfate. Which of the following instructions should the nurse provide to the parent? Instruct the parent to:

A nurse is caring for a 3-year-old child with Down Syndrome. Which clinical manifestations should the nurse recognize as associated with Down Syndrome? (SELECT ALL THAT APPLY)

A nurse is caring for a child who has cystic fibrosis and receives chest physiotherapy (CPT). Which of the following actions should the nurse plan to take?

A nurse is preparing to perform a dressing change on a 6-year-old client with mild cognitive impairment (CI) from a sport injury. Which strategy should the nurse use to prepare the child for the dressing change?

A nurse is assessing a 15-month-old toddler. Which of the following findings should the nurse report to the provider as a concern?

A nurse is providing teaching to a parent of a 5-year-old client diagnosed with celiac disease. The nurse should include which of the following food choices in the teaching plan?

A nurse is caring for a female newborn with an apparent anorectal malformation. The nurse should assess the infant for which of the following other potential finding?