A nurse is performing an annual wellness exam on an 8-year-old child whose last exam was one year ago. Which of the following findings should the nurse report to the provider?

Rationale:

A. Drinks 3 cups of 1% milk per day: This intake is appropriate for an 8-year-old child. It supports bone development by providing sufficient calcium and vitamin D, aligning with dietary guidelines for school-age children.

B. Weight has increased by 5 kg (11 lb): A weight gain of about 2–3 kg (4.4–6.6 lb) per year is typical for children between ages 6 and 12. A 5 kg increase over one year is within normal limits and does not require provider notification unless accompanied by other concerns.

C. Height has increased by 3.8 cm (1.5 in): This is below the expected annual growth rate for an 8-year-old, which is typically 5 to 6.5 cm (2 to 2.5 in) per year. Slowed linear growth can indicate underlying medical or nutritional issues and should be reported for evaluation.

D. Consumes three meals and two snacks per day: This is a healthy and age-appropriate eating pattern for a school-age child, promoting stable energy levels and supporting growth and development.

Rationale:

A. Sudden muscular contractions: Antipsychotics like haloperidol and chlorpromazine can cause extrapyramidal symptoms (EPS), including acute dystonia, which manifests as sudden, involuntary muscle contractions typically affecting the face, neck, or back.

B. Orthostatic hypotension: Chlorpromazine, a low-potency typical antipsychotic, often causes orthostatic hypotension due to its alpha-adrenergic blockade, increasing fall risk, especially in older adults or those new to therapy.

C. Anticholinergic effects: These include dry mouth, blurred vision, constipation, and urinary retention. Chlorpromazine is particularly known for its anticholinergic side effects due to its action on muscarinic receptors.

D. Tremors: Tremors are part of parkinsonian side effects, another form of EPS commonly caused by haloperidol. They result from dopamine blockade in the nigrostriatal pathway.

E. Sedation: Both haloperidol and chlorpromazine can cause sedation. Chlorpromazine is especially sedating due to its histamine (H1) receptor blockade, which depresses the CNS.

F. Increased urination: Not typically associated with these medications. In fact, anticholinergic effects from chlorpromazine more often lead to urinary retention, not increased urination.