Health Promotion and Maintenance
96. A client, who is 44 years old, gravida 3, para 2, has just delivered a newborn suspected of having trisomy 21. Which characteristics should a nurse observe in an infant with this condition? Select all that apply.
. Simian creases.
. Increased muscle tone.
. Flat appearance of the face.
. Small tongue.
. Upward-slanting eye creases.
Test-Taking Tip
Read the answers carefully; in two of the options, the typical characteristics of trisomy 21 are the opposite of the characteristics listed here. If not carefully read, the wrong choice can be made.
Content Area: Child Health, Newborn; Integrated Process: Nursing Process, Assessment; Cognitive Level: Application; Client Need/Subneed: Physiological Integrity/Physiological Adaptation/Pathophysiology
Health Promotion and Maintenance
. . .
Answer 1 is correct because simian creases are a typical finding in a newborn with trisomy 21. Answer 2 is incorrect because decreased, not increased, muscle tone is typical of newborns with trisomy 21. Answer 3 is correct because flat appearance of the face is typical of newborns with trisomy 21. Answer 4 is incorrect because large tongue, not small tongue, is typical of newborns with trisomy 21. Answer 5 is correct because upward-slanting eye creases are typical of newborns with trisomy 21.