Review Practice Exercise 2

Health Supervision In Children > Child Health

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Practice Exercise 2

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Total Questions : 5

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Question 1:

A child has been diagnosed with fragile X syndrome. Which of the following health-care referrals should the nurse encourage the parents to make? The nurse should encourage the parents to consult with a(n):

A. Orthopedic surgeon B. Genetic counselor C. Registered dietitian D. Otolaryngologist

Answer and Explanation

Choice A:

Fragile X syndrome does not typically require orthopedic intervention as a priority. While children may have joint laxity or hypotonia, these issues are usually managed through physical/occupational therapy, not surgery.

Choice B:

Families benefit from counseling to learn about the genetic basis of fragile X syndrome, recurrence risks, and implications for siblings and extended family. Genetic counseling also provides emotional support and guidance in navigating available interventions and support services.

Choice C:

Unless feeding issues or obesity develop, dietary management is not a primary concern in fragile X syndrome. This referral may be useful in some cases but is not a priority.

Choice D:

While recurrent ear infections may occur, otolaryngologist referral is not universally required for all children with fragile X. It may be appropriate based on symptoms but not the first or most important referral.

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Question 2:

The nurse notes the following genomic nomenclature and karyotype in the amniocentesis report. Which of the following interpretations of the report is appropriate for the nurse to make?
Nomenclature: 47, XX, +21

A. The fetus has Down syndrome. B. The fetus has fragile X syndrome. C. The fetus will be born with shortened palpebral fissures and hypoplastic upper lip. D. The fetus will be born with hypertonic reflexes and spastic posturing. E. The fetus will be born with hypertonic reflexes and spastic posturing.

Answer and Explanation

Choice A:

The karyotype 47, XX, +21 indicates that the fetus is female (XX) and has an extra chromosome 21, consistent with trisomy 21 (Down syndrome).Rationale for incorrect answers:

Choice B:

Fragile X is due to a trinucleotide (CGG) repeat expansion on the X chromosome, not an extra chromosome. It would not appear as “+21” in karyotype nomenclature.

Choice C:

A fetus born with shortened palpebral fissures and hypoplastic upper lip are features associated with fetal alcohol syndrome, not trisomy 2A.

Choice D:

A fetus born with hypertonic reflexes and spastic posturing suggest cerebral palsy, a neuromotor disorder that develops postnatally, not a chromosomal abnormality identified on karyotype.

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Question 3:

A couple is being discharged from the hospital with their 2-day-old Down syndrome baby. The nurse is

A. providing discharge teaching. The nurse should include in the teaching information regarding which of the following physiological characteristics of the syndrome? B. Small cerebral ventricles C. Weak musculature D. Inability to feel pain E. Low glomerular filtration rate

Answer and Explanation

Choice A:

Small cerebral ventricles is not a typical feature of Down syndrome. Cerebral changes are more related to intellectual disability and increased risk of early-onset Alzheimer’s disease, not ventricular size.

Choice B:

Hypotonia is a hallmark of Down syndrome. It can contribute to poor feeding (difficulty sucking/swallowing), delayed motor milestones (sitting, crawling, walking), and increased joint laxity. Nurses should prepare parents for supportive interventions such as physical therapy and feeding support.

Choice C:

Children with Down syndrome do feel pain; in fact, they may have increased risk of infection or injury due to hypotonia and joint laxity. This is incorrect.

Choice D:

Down syndrome is not associated with impaired renal function as a primary characteristic. Renal issues may occur but are not a defining physiological feature.

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Question 4:

A mother of a child born with Down syndrome is overwhelmed with the future and asks many questions. Which of the following facts should the nurse be aware of? Select all that apply

A. Eighty percent of infants with Down syndrome are born to women younger than 35 years old because younger women have higher fertility rates. B. When feeding infants and young children, use a small, straighthandled spoon to push food to the side and back of the mouth. Feeding difficulties occur due to a protruding tongue and hypotonia. C. Parents generally believe the experience of having this special child makes them stronger and more accepting of others. D. Although some placement in the regular classroom has occurred more recently, this has been found to be detrimental to the child with Down syndrome due to lack of one-on-one teaching. E. The child’s lack of clinging or molding is a physical characteristic, not a sign of detachment or rejection. F. Development may be 3 to 4 years beyond the mental age, especially during early childhood.

Answer and Explanation

Choice A:

Eighty percent of infants with Down syndrome are born to women under 35 because younger women have higher fertility rates, even though the risk increases with maternal age.

Choice B:

Feeding difficulties are common due to hypotonia and a protruding tongue. Using a small, straight-handled spoon placed to the side and back of the mouth helps with effective feeding.

Choice C:

Many parents of children with Down syndrome report that the experience, although challenging, has made them stronger, more compassionate, and accepting of others.

Choice D:

Placement in regular classrooms with support has been found to be beneficial, not detrimental. Inclusion promotes socialization and learning opportunities, although individual support may be needed.

Choice E:

A child’s lack of clinging or molding is due to hypotonia and not emotional detachment or parental rejection. This distinction reassures parents.

Choice F:

Development in Down syndrome is delayed compared to mental age, not accelerated. Milestones are achieved later, often several years behind peers, especially in motor and language areas.

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Question 5:

A 4-year-old with Down syndrome is being seen in the pediatric clinic. The nurse reminds the parents

A. to seek immediate care if the child exhibits which of the following signs/symptoms? B. Upper respiratory illness C. Pendulous abdomen D. Elevated temperature E. Protruding brow

Answer and Explanation

Choice A:

Children with Down syndrome are at high risk for respiratory tract infections due to hypotonia including weak muscle tone and leading to poor cough and difficulty clearing secretions, anatomical airway differences including smaller trachea, enlarged tonsils/adenoids, and macroglossia, and immune system compromise, making them more susceptible to infections. Any upper respiratory illness in these children can rapidly progress to pneumonia or airway obstruction, requiring immediate medical care

Choice B:

Pendulous abdomen is common in Down syndrome due to hypotonia; not an urgent concern.

Choice C:

Elevated temperature alone is not specific or emergent unless linked to respiratory symptoms.

Choice D:

Protruding brow is a facial characteristic of Down syndrome, but not an urgent clinical finding.s.

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Practice Exercise 2

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