A nurse is collecting data from a newborn who has fetal alcohol syndrome. Which of the following manifestations should the nurse (Select all that apply.)

A) Tell the client to leave the group if they cannot contribute.
This response is inappropriate as it does not support the client’s participation or create an open, supportive environment. Forcing the client to leave would alienate them and potentially discourage future participation. Group therapy should foster inclusiveness and understanding, not create pressure or exclusion.

B) Allow the client extra time to think of a response.
This is the most appropriate action. Some clients may need additional time to process their thoughts before speaking, especially in a group setting where they may feel anxious or hesitant. Giving the client space and time to formulate a response can encourage participation without forcing them. It allows them to engage at their own pace, promoting comfort and confidence in the group.

C) Appoint the client to lead the discussion.
While giving the client an active role might help them engage, appointing them to lead the discussion could cause undue stress or anxiety, particularly if they are already struggling to contribute. This could overwhelm the client and make them feel more isolated. Instead, a gradual approach to participation is more effective.

D) Ask other group members to limit the number of times they speak.
While this may seem like an effort to allow more time for the silent client, it may not be the best solution. Group therapy is meant to be interactive, and limiting others’ participation may make the group feel less collaborative. It is better to encourage the silent client to speak at their own pace rather than restricting the group’s natural flow of discussion.

A) The child is unable to skate with good balance.
At 4 years old, a child’s balance and coordination are still developing. While skating requires more advanced skills, a child not having good balance at this age is not typically a concern unless other motor skills are delayed. Skating is not an expected milestone for a 4-year-old.

B) The child is unable to jump rope.
Jumping rope is a more complex skill that typically develops later, closer to ages 5 or 6, so the inability to do so at age 4 is not a cause for concern. It is a skill that requires fine motor coordination, balance, and timing, which may not be fully developed at this age.

C) The child is unable to walk downstairs on alternating feet.
At 4 years old, children are expected to be able to walk downstairs using alternating feet (one foot on each step). If a child cannot perform this task, it may indicate a delay in gross motor development, specifically in coordination and balance. This is a developmental milestone that typically emerges by age 4 and should be reported to the physical therapist for further evaluation.

D) The child is unable to walk backwards from heel to toe.
Walking backwards from heel to toe is a more advanced skill that typically develops later in childhood. This skill is not expected at age 4, so the child’s inability to do so is not a red flag for developmental concerns. It is more appropriate for older children.