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

Large ears

Protruding tongue

Transverse palmar creases

Muscular hypertonicity

Low birth weight

Answer and Explanation

Correct Answer : B,C

B. A protruding tongue, often due to a small mouth and poor muscle tone (hypotonia), is a common feature of Down syndrome. This tongue appearance can contribute to difficulties with feeding and speech development.

C. Instead of a single palmar crease (known as a simian crease), individuals with Down syndrome often have transverse palmar creases. This occurs in about 45-50% of cases and is considered a characteristic feature.

A. While large ears are not typically listed as a common feature, individuals with Down's Syndrome may have unusually shaped or small ears.

D. Hypertonicity refers to increased muscle tone or stiffness. In Down syndrome, however, hypotonia (reduced muscle tone) is more common, especially in infancy. Therefore, muscular hypertonicity is not typically associated with Down syndrome.

E While low birth weight can occur in some infants with Down syndrome, it is not a universal characteristic. In fact, some infants with Down syndrome may be born at average or even slightly higher birth weights.

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Correct Answer is B

Explanation

B. Folic acid (also known as folate when naturally occurring in foods) is crucial in preventing neural tube defects (NTDs) such as spina bifida and anencephaly. Adequate folic acid intake before conception and during early pregnancy significantly reduces the risk of these birth defects. The CDC recommends that women of reproductive age consume 400 micrograms (mcg) of folic acid daily, and those planning pregnancy should take a prenatal vitamin with folic acid.

A. Iron is essential for the production of hemoglobin in red blood cells and for oxygen transport in the body. However, it is not specifically known to prevent neural tube defects (NTDs). Iron supplementation

is typically recommended during pregnancy to prevent iron deficiency anemia, which is common among pregnant women.

C. Vitamin C is important for immune function, wound healing, and antioxidant protection. However, it does not have a direct role in preventing neural tube defects. Adequate intake of vitamin C is important for overall health but is not specifically emphasized in preventing NTDs.

D. Calcium is essential for bone health, muscle function, and nerve transmission. While calcium is important during pregnancy for maternal and fetal bone development, it does not have a direct role in preventing neural tube defects.

A. Deep tendon reflexes 4+ B. Fundus at level of umbilicus C. Saturated perineal pad in 30 min D. Approximated edges of episiotomy

Correct Answer is C

Explanation

C. A saturated perineal pad in 30 minutes suggests excessive postpartum bleeding, which is abnormal and could indicate postpartum hemorrhage. This finding requires immediate intervention to assess and manage the cause of bleeding, such as uterine atony, lacerations, or retained placental fragments.

A. Deep tendon reflexes that are 4+ indicate hyperreflexia, which can be a sign of preeclampsia or eclampsia. These conditions require immediate attention due to the risk they pose to both the client and the newborn. However, postpartum hemorrhage is a priority.

B. The fundus should be firm and palpable at or just below the level of the umbilicus 4 hours postpartum. This finding suggests appropriate uterine involution. If the fundus is not well-contracted or if it is higher than expected, it could indicate uterine atony, which can lead to postpartum hemorrhage if not managed promptly. While important, this finding may not require immediate intervention unless there are signs of hemorrhage.

D. Approximated edges of an episiotomy indicate proper healing and would be expected 4 hours postpartum. While it is important to assess episiotomy healing, this finding does not typically require immediate intervention unless there are signs of infection or dehiscence.

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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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