(Ch. 37 PERRY) Cognitive or Sensory Impairment on the Child

A nurse is preparing to perform a dressing change on a 6-year-old child with mild cognitive impairment (CI) who sustained a minor burn. Which strategy should the nurse use to prepare the child for this procedure? Verbally explain what will be done. Have the child watch a video on dressing changes. Demonstrate a dressing change on a doll. Explain the importance of keeping the burn area clean.

Demonstrate a dressing change on a doll.

The nurse is talking to the parent of a 13-month-old child. The mother states, My child does not make noises like da or na like my sisters baby, who is only 9 months old. Which statement by the nurse would be most appropriate to make? I am going to request a referral to a hearing specialist. You should not compare your child to your sisters child. I think your child is fine, but we will check again in 3 months. You should ask other parents what noises their children made at this age.

I am going to request a referral to a hearing specialist.

A 2-year-old girl has excessive tearing and corneal haziness. The nurse knows that these symptoms may indicate: Viral conjunctivitis. Paralytic strabismus. Congenital cataract. Infantile glaucoma.

Infantile glaucoma.

Which interventions should the nurse plan when caring for a child with a visual impairment (select all that apply)? Touch the child upon entering the room before speaking. Keep items in the room in the same location. Describe the placement of the eating utensils on the meal tray. Use color examples to describe something to a child who has been blind since birth. Identify noises for the child.

Keep items in the room in the same location. Describe the placement of the eating utensils on the meal tray. Identify noises for the child.

A nurse is instructing a nursing assistant on techniques to facilitate lipreading with a hearing-impaired child who lip-reads. Which techniques should the nurse include (select all that apply)? Speak at eye level. Stand at a distance from the child. Speak words in a loud tone. Use facial expressions while speaking. Keep sentences short.

Speak at eye level. Use facial expressions while speaking. Keep sentences short.

Appropriate interventions to facilitate socialization of the cognitively impaired child include to: a. Provide age-appropriate toys and play activities. b. Provide peer experiences such as Special Olympics when older. c. Avoid exposure to strangers who may not understand cognitive development. d. Emphasize mastery of physical skills because they are delayed more often than verbal skills.

b. Provide peer experiences such as Special Olympics when older.

A 10-year-old patient is talking to the nurse about wanting to try contact lenses instead of wearing glasses. She states that the other children at her school call her four-eyes. Contact lenses should be prescribed for a child who is: a. At least 12 years of age. b. Able to read all the written information and instructions. c. Able to independently care for the lenses in a responsible manner. d. Confident that she really wants contact lenses.

c. Able to independently care for the lenses in a responsible manner.

A child with autism spectrum disorder (ASD) is admitted to the hospital with pneumonia. The nurse should plan which priority intervention when caring for the child? a. Maintain a structured routine and keep stimulation to a minimum. b. Place the child in a room with a roommate of the same age. c. Maintain frequent touch and eye contact with the child. d. Take the child frequently to the playroom to play with other children.

A Providing a structured routine for the child to follow is key in the management of ASD. Decreasing stimulation by using a private room, avoiding extraneous auditory and visual distractions, and encouraging the parents to bring in possessions the child is attached to may lessen the disruptiveness of hospitalization. Because physical contact often upsets these children, minimum holding and eye contact may be necessary to avoid behavioral outbursts. Children with ASD need to be introduced slowly to new situations, with visits with staff caregivers kept short whenever possible. The playroom would be too overwhelming with new people and situations and should not be a priority of care.

Parents have learned that their 6-year-old child has autism. The nurse may help the parents to cope by explaining that the child may: a. Have an extremely developed skill in a particular area. b. Outgrow the condition by early adulthood. c. Have average social skills. d. Have age-appropriate language skills.

A Some children with autism have an extremely developed skill in a particular area, such as mathematics or music. No evidence supports that autism is outgrown. Autistic children have abnormal ways of relating to people (social skills). Speech and language skills are usually delayed in autistic children.

Which assessment findings indicate to the nurse a child has Down syndrome (select all that apply)? a. High-arched, narrow palate b. Protruding tongue c. Long, slender fingers d. Transverse palmar crease e. Hypertonic muscle tone

A, B, D The assessment findings of Down syndrome include high-arched, narrow palate; protruding tongue; and transverse palmar creases. The fingers are stubby and the muscle tone is hypotonic, not hypertonic.

Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which area(s) with onset before age 3 years (select all that apply)? a. Language as used in social communication b. Gross motor development c. Growth below the 5th percentile for height and weight d. Symbolic or imaginative play e. Social interaction

A, D, E Language as used in social communication, symbolic or imaginative play, and social interaction are three of the areas in which autistic children may show delayed or abnormal functioning. Gross motor development and growth below the 5th percentile for height and weight are not areas in which autistic children may show delayed or abnormal functioning.

The teaching plan for the parents of a 3-year-old child with amblyopia (lazy eye) should include what instruction? Apply a patch to the childs eyeglass lenses. Apply a patch only during waking hours. Apply a patch over the bad eye to strengthen it. Cover the good eye completely with a patch.

Cover the good eye completely with a patch.

Mark, a 9-year-old with Down syndrome, is mainstreamed into a regular third-grade class for part of the school day. His mother asks the school nurse about programs such as Cub Scouts that he might join. The nurses recommendation should be based on knowing that: a. Programs such as Cub Scouts are inappropriate for children who are cognitively impaired. b. Children with Down syndrome have the same need for socialization as other children. c. Children with Down syndrome socialize better with children who have similar disabilities. d. Parents of children with Down syndrome encourage programs such as scouting because they deny that their children have disabilities.

B Children of all ages need peer relationships. Children with Down syndrome should have peer experiences similar to those of other children, such as group outings, Cub Scouts, and Special Olympics, which can all help children with cognitive impairment to develop socialization skills. Although all children should have an opportunity to form a close relationship with someone of the same developmental level, it is appropriate for children with disabilities to develop relationships with children who do not have disabilities. The parents are acting as advocates for their child.

A child with autism is hospitalized with asthma. The nurse should plan care so that the: a. Parents expectations are met. b. Childs routine habits and preferences are maintained. c. Child is supported through the autistic crisis. d. Parents need not be at the hospital.

B Children with autism are often unable to tolerate even slight changes in routine. The childs routine habits and preferences are important to maintain. Focus of care is on the childs needs rather than on the parents desires. Autism is a lifelong condition. The presence of the parents is almost always required when an autistic child is hospitalized.

A nurse is providing a parent information regarding autism. Which statement made by the parent indicates understanding of the teaching? a. Autism is characterized by periods of remission and exacerbation. b. The onset of autism usually occurs before 3 years of age. c. Children with autism have imitation and gesturing skills. d. Autism can be treated effectively with medication.

B The onset of autism usually occurs before 3 years of age. Autism does not have periods of remission and exacerbation. Autistic children lack imitative skills. Medications are of limited use in children with autism.

A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of: a. Microcephaly. b. Down syndrome. c. Cerebral palsy. d. Fragile X syndrome.

B These are characteristics associated with Down syndrome. The infant with microcephaly has a small head. Cerebral palsy is a diagnosis not usually made at birth. No characteristic physical signs are present. The infant with fragile X syndrome has increased head circumference; long, wide, and/or protruding ears; long, narrow face with prominent jaw; hypotonia; and high, arched palate.

The child with Down syndrome should be evaluated for what characteristic before participating in some sports? a. Hyperflexibility b. Cutis marmorata c. Atlantoaxial instability d. Speckling of iris (Brushfields spots)

C Children with Down syndrome are at risk for atlantoaxial instability. Before participating in sports that put stress on the head and neck, a radiologic examination should be done. Although hyperflexibility, cutis marmorata, and Brushfields spots are characteristics of Down syndrome, they do not affect the childs ability to participate in sports.

What should the nurse keep in mind when planning to communicate with a child who has autism? a. The child has normal verbal communication. b. The child is expected to use sign language. c. The child may exhibit monotone speech and echolalia. d. The child is not listening if she is not looking at the nurse.

C Children with autism have abnormalities in the production of speech, such as a monotone voice or echolalia, or inappropriate volume, pitch, rate, rhythm, or intonation. The child has impaired verbal communication and abnormalities in the production of speech. Some autistic children may use sign language, but it is not assumed. Children with autism often are reluctant to initiate direct eye contact.

When caring for a newborn with Down syndrome, the nurse should be aware that the most common congenital anomaly associated with Down syndrome is: a. Hypospadias. b. Pyloric stenosis. c. Congenital heart disease. d. Congenital hip dysplasia.

C Congenital heart malformations, primarily septal defects, are very common congenital anomalies in Down syndrome. Hypospadias, pyloric stenosis, and congenital hip dysplasia are not frequent congenital anomalies associated with Down syndrome.

The pediatric nurse understands that fragile X syndrome is: a. A chromosome defect affecting only females. b. A chromosome defect that follows the pattern of X-linked recessive disorders. c. The second most common genetic cause of cognitive impairment. d. The most common cause of noninherited cognitive impairment.

C Fragile X syndrome is the most common inherited cause of cognitive impairment and the second most common genetic cause of cognitive impairment after Down syndrome. Fragile X primarily affects males and follows the pattern of X-linked dominant disorders with reduced penetrance.

Which action is contraindicated when a child with Down syndrome is hospitalized? a. Determine the childs vocabulary for specific body functions. b. Assess the childs hearing and visual capabilities. c. Encourage parents to leave the child alone for extended periods of time. d. Have meals served at the childs usual mealtimes.

C The child with Down syndrome needs routine schedules and consistency. Having familiar people present, especially parents, helps to decrease the childs anxiety. To communicate effectively with the child, it is important to know the childs particular vocabulary for specific body functions. Children with Down syndrome have a high incidence of hearing loss and vision problems and should have hearing and vision assessed whenever they are in a health care facility. Meals should be served at the usual mealtimes because routine schedules and consistency are important to children with Down syndrome.

When should children with cognitive impairment be referred for stimulation and educational programs? a. As young as possible b. As soon as they have the ability to communicate in some way c. At age 3 years, when schools are required to provide services d. At age 5 or 6 years, when schools are required to provide services

a. As young as possible

Prevention of hearing impairment in children is a major goal for the nurse. This can be achieved through: a. Being involved in immunization clinics for children. b. Assessing a newborn for hearing loss. c. Answering parents questions about hearing aids. d. Participating in hearing screening in the community.

a. Being involved in immunization clinics for children.

A nurse would suspect possible visual impairment in a child who displays: a. Excessive rubbing of the eyes. b. Rapid lateral movement of the eyes. c. Delay in speech development. d. Lack of interest in casual conversation with peers.

a. Excessive rubbing of the eyes.

Which action best facilitates lipreading by the hearing-impaired child? a. Speaking at an even rate b. Exaggerating pronunciation of words c. Avoiding using facial expressions d. Repeating in exactly the same way if child does not understand

a. Speaking at an even rate

The most common type of hearing loss, which results from interference of transmission of sound to the middle ear, is called: a. conductive b. sensorineural c. mixed conductive-sensorineural d. central auditory imperceptive

a. conductive

The major consideration when selecting toys for a child who is cognitively impaired is: a. safety b. age appropriate c. ability to provide exercise d. ability to teach useful skills

a. safety

When a child with mild cognitive impairment reaches the end of adolescence, what characteristic would be expected? a. Achieves a mental age of 5 to 6 years b. Achieves a mental age of 8 to 12 years c. Is unable to progress in functional reading or arithmetic d. Acquires practical skills and useful reading and arithmetic to an eighth-grade level

b. Achieves a mental age of 8 to 12 years

The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes: a. Applying a regular eye patch. b. Applying a Fox shield to the affected eye and any type of patch to the other eye. c. Applying ice until the physician is seen. d. Irrigating the eye copiously with a sterile saline solution.

b. Applying a Fox shield to the affected eye and any type of patch to the other eye.

A parent whose child has been diagnosed with a cognitive deficit should be counseled that intellectual impairment: a. Is usually due to a genetic defect. b. May be caused by a variety of factors. c. Is rarely due to first-trimester events. d. Is usually caused by parental intellectual impairment.

b. May be caused by a variety of factors.

A parent asks the nurse why a developmental assessment is being conducted for a child during a routine well-child visit. The nurse answers based on the knowledge that routine developmental assessments during well-child visits are: a. Not necessary unless the parents request them. b. The best method for early detection of cognitive disorders. c. Frightening to parents and children and should be avoided. d. Valuable in measuring intelligence in children.

b. The best method for early detection of cognitive disorders.

An implanted ear prosthesis for children with sensorineural hearing loss is a(n): a. hearing aid b. cochlear implant c. auditory implant d. amplification device

b. cochlear implant

Distortion of sound and problems in discrimination are characteristic of which type of hearing loss? a. conductive b. sensorineural c. mixed conductive-sensorineural d. central auditory imperceptive

b. sensorineural

A young child who has an intelligence quotient (IQ) of 45 would be described as: a. Within the lower limits of the range of normal intelligence. b. Mildly cognitively impaired but educable. c. Moderately cognitively impaired but trainable. d. Severely cognitively impaired and completely dependent on others for care.

c. Moderately cognitively impaired but trainable.

An appropriate nursing diagnosis for a child with a cognitive dysfunction who has a limited ability to anticipate danger is: a. Impaired Social Interaction. b. Deficient knowledge c. Risk for Injury. d. ineffective coping

c. Risk for Injury.

The nurse is talking with a 10-year-old boy who wears bilateral hearing aids. The left hearing aid is making an annoying whistling sound that the child cannot hear. The most appropriate nursing action is to: a. Ignore the sound. b. Ask him to reverse the hearing aids in his ears. c. Suggest that he reinsert the hearing aid. d. Suggest that he raise the volume of the hearing aid

c. Suggest that he reinsert the hearing aid.

Which teaching guideline helps prevent eye injuries during sports and play activities? a. Restrict helmet use to those who wear eyeglasses or contact lenses. b. Discourage the use of goggles with helmets. c. Wear eye protection when participating in high-risk sports such as paintball. d. Wear a face mask when playing any sport or playing roughly.

c. Wear eye protection when participating in high-risk sports such as paintball.

Which statement by a parent about a childs conjunctivitis indicates that further teaching is needed? a. Ill have separate towels and washcloths for each family member. b. Ill notify my doctor if the eye gets redder or the drainage increases. c. When the eye drainage improves, well stop giving the antibiotic ointment. d. After taking the antibiotic for 24 hours, my child can return to school.

c. When the eye drainage improves, well stop giving the antibiotic ointment.

Which term refers to opacity of the crystalline lens that prevents light rays from entering the eye and refracting on the retina? a. myopia b. amblyopia c. cataract d. glaucoma

c. cataract

24. The most common clinical manifestation of retinoblastoma is: a. glaucoma b. amblyopia c. white eye reflex d. sunken eye socket

c. white eye reflex

An adolescent gets hit in the eye during a fight. The school nurse, using a flashlight, notes the presence of gross hyphema (hemorrhage into anterior chamber). The nurse should: a. Apply a Fox shield. b. Instruct the adolescent to apply ice for 24 hours. c. Have adolescent rest with eye closed and ice applied. d. Notify parents that adolescent needs to see an ophthalmologist.

d. Notify parents that adolescent needs to see an ophthalmologist.

An adolescent male visits his primary care provider complaining of difficulty with his vision. When the nurse asks the adolescent to explain what visual deficits he is experiencing, the adolescent states, I am having difficulty seeing distant objects; they are less clear than things that are close. What disorder does the nurse suspect the adolescent has? a. Hyphema b. Astigmatism c. Amblyopia d. myopia

d. myopia