Difficulty: Medium
Average Score: 83%
Simulated
Passage / Scenario
A nurse is providing care to a child who has Down syndrome during a well-child checkup.Which of the following assessment findings requires immediate follow-up by the nurse?
Correct answer
A
Rationale
The correct answer is A: Changes in feeding and bowel habits. This assessment finding requires immediate follow-up by the nurse because it could indicate a potential health issue such as gastrointestinal problems, malnutrition, or dehydration. Changes in feeding and bowel habits can be early signs of serious conditions that need prompt intervention.
Choices B, C, and D are not as urgent as A. B: Presence of a single palmar crease is a common variant and not usually a cause for immediate concern. C: Height and weight measurements below the 50th percentile may indicate growth concerns but do not require immediate follow-up unless severe. D: Evaluation of caregiver's financial resources is important for holistic care but does not require immediate attention unless related to the child's immediate health needs.
Choices B, C, and D are not as urgent as A. B: Presence of a single palmar crease is a common variant and not usually a cause for immediate concern. C: Height and weight measurements below the 50th percentile may indicate growth concerns but do not require immediate follow-up unless severe. D: Evaluation of caregiver's financial resources is important for holistic care but does not require immediate attention unless related to the child's immediate health needs.