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A nurse is assessing a newborn who has Trisomy 21 (Down’s Syndrome). Which of the following are common characteristics? (Select all that apply.)

Transverse palmar creases

Muscular hypertonicity

Protruding tongue

Large ears

Low birth weight

Answer and Explanation

Correct Answer : A,C

The correct answers are A. Transverse palmar creases and C. Protruding tongue.

Choice A rationale:

Transverse palmar creases, also known as a single palmar crease, are a common characteristic of Down syndrome. This feature is present in many individuals with the condition.

Choice B rationale:

Muscular hypertonicity (increased muscle tone) is not typical in Down syndrome. Instead, individuals with Down syndrome often have hypotonia (decreased muscle tone).

Choice C rationale:

A protruding tongue is a common characteristic of Down syndrome. This is due to a combination of factors, including a small oral cavity and low muscle tone.

Choice D rationale:

Large ears are not a typical feature of Down syndrome. Individuals with Down syndrome often have small or unusually shaped ears.

Choice E rationale:

Low birth weight is not specifically associated with Down syndrome. While some infants with Down syndrome may have low birth weight, it is not a defining characteristic.

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Correct Answer is C

Explanation

Choice A rationale

Assisting the family to identify prior use of positive coping skills in family crises can be helpful, but it’s not the priority action in this situation.
Choice B rationale
Anticipating a prescription by the provider for an antidepressant might be necessary if the client is diagnosed with postpartum depression. However, the nurse first needs to assess the risk to the client and her newborn.
Choice C rationale
Asking the client if she has considered harming her newborn is the priority action. This question is crucial in assessing for postpartum depression and the safety of the newborn.
Choice D rationale
Reinforcing postpartum and newborn care discharge teaching is important, but it’s not the priority action when the client is expressing feelings of sadness and lack of energy.

A. Position the client on her side. B. Administer oxygen via face mask. C. Elevate the client’s legs. D. Increase the infusion rate of the IV fluid.

Correct Answer is A

Explanation

Choice A rationale
Late decelerations on the fetal monitor are a sign of fetal hypoxia, which means the baby is not getting enough oxygen. The priority nursing action is to position the client on her side, preferably the left side. This position improves blood flow to the uterus and the baby, potentially improving oxygenation.
Choice B rationale

Administering oxygen via face mask can also improve fetal oxygenation, but it is not the first action the nurse should take. Repositioning the client is a quicker intervention and often resolves the issue.
Choice C rationale
Elevating the client’s legs will not improve fetal oxygenation and is not a priority action when late decelerations are noted on the fetal monitor.
Choice D rationale
Increasing the infusion rate of the IV fluid can improve maternal blood volume and cardiac output, potentially improving blood flow to the uterus and the baby. However, it is not the first action the nurse should take when late decelerations are noted.

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A nurse is assessing a newborn who has Trisomy 21 (Down’s Syndrome). Which of the following are common characteristics? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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