Peds Chp 20

Which condition is appropriate for the child who has difficulty in reading, performs poorly in school, and complains of frequent headaches? 1 Myopia 2 Hyperopia 3 Cataracts 4 Glaucoma

1 A child with myopia has frequent headaches and has difficulty in reading. The child is able to see objects at a close range but not at a distance. Hyperopia is diagnosed when the ability to see close objects is affected. Cataract is identified when a child is unable to see objects clearly. The perception of halos around objects and eye redness indicate glaucoma.

Which nursing response is appropriate when asked by the parents what toys or presents would provide comfort for their child who is admitted to the health care facility for temporary loss of vision? 1 "Bring old toys from home." 2 "Bring floating toys for water play." 3 "Avoid musical or stuffed toys." 4 "Read from new books to the child."

1 A child with temporary loss of vision will be more comfortable with old toys from home, because the child already knows how to manipulate such toys. Floating toys for water play to promote interactivity are more helpful for children with cognitive impairment. Musical toys and stuffed toys are helpful when a child suffers from temporary loss of vision. Such toys stimulate hearing and touch. The parent would be encouraged to read from familiar books, not new ones, so that the child feels comforted.

Which is a sign of visual impairment in an infant? 1 No reaction to light 2 Excessive rubbing of eyes 3 Rapid lateral movement of the eyes 4 Lack of binocularity before 4 months of age

1 An infant or child who has no reaction to light is likely visually impaired. Excessive rubbing of eyes is a sign of visual impairment in children, not infants. Rapid lateral movement of the eyes is not associated with visual impairment. Lack of binocularity after, not before, 4 months of age is associated with amblyopia and requires further investigation.

Which child is being treated for fragile X syndrome? 1 Child 1 carbamazepine, fluoxetine 2 Child 2 folic acid, gentamicin 3 Child 3 tobramycin, kanamycin 4 Child 4 morphine sulfate, diphehydramine

1 Carbamazepine and fluoxetine are used to control temper outbursts in children with fragile X syndrome. These drugs are used to decrease hyperactivity. Folic acid helps the body produce new cells and prevents changes to DNA. The drug is used to treat anemia and folic acid deficiency. Gentamicin is used to treat severe bacterial infections. Tobramycin is an antibiotic used to treat eye infections. Kanamycin is used to treat bacterial infections in the body. Morphine sulfate is used to treat severe to moderate pain. Diphenhydramine is an antihistamine used to relieve symptoms of allergies and colds.

Which statement is appropriate regarding X-linked dominant patterns with reduced penetrance? 1 Female carriers may exhibit learning disabilities. 2 Male carriers do not exhibit learning disabilities. 3 Sons of all affected males will have fragile X syndrome. 4 Males with full mutation do not exhibit intellectual disabilities.

1 In an X-linked dominant pattern, a female carrier with normal intelligence might exhibit some learning disabilities and psychological disorders. This is called X-linked dominant pattern with reduced penetrance. In an X-linked dominant pattern with reduced penetrance, a male carrier might have learning disabilities and psychological disorders. Sons of the affected male are not affected by the disorder in an X-linked dominant pattern if the father is a carrier of the faulty gene, because sons only inherit the Y chromosome from the father. Males with the full mutation will exhibit intellectual disabilities in an X-linked dominant pattern because they have only one X chromosome.

Which patient has fragile X syndrome? 1 Patient 1 long, wide ears, prominent jaw, macroorchidism 2 Patient 2 small ears, hypoplastic mandible, cryptorchidism 3 Patient 3 mitcrodontia, self-biting, dreamy 4 Patient 4 hyperopia, cracked skin, short foot

1 Long, wide, or protruding ears; a long face with a prominent jaw; and large testes (macroorchidism) are typical characteristics of males with fragile X syndrome. The presence of small ears, a hypoplastic mandible, and cryptorchidism are characteristics of males with Down syndrome. Microdontia is a characteristic feature of patients with Down syndrome. Self-biting is observed in both Down syndrome and fragile X syndrome. Patients with hearing impairments appear to be dreamy and "in their own world." Hyperopia, or farsightedness, is not a clinical manifestation observed in patients with fragile X syndrome. Cracked skin and short feet are clinical manifestations seen in patients with Down syndrome.

Which nursing recommendation is appropriate for the parents of a cognitively impaired child asking for guidance with discipline? 1 Behavior modification is an excellent form of discipline. 2 Discipline is ineffective with cognitively impaired children. 3 Discipline is not necessary for cognitively impaired children. 4 Physical punishment is the most appropriate form of discipline.

1 Positive behaviors and desirable actions should be reinforced with cognitively impaired children. Behavior modification with positive reinforcement is effective in children with cognitive impairment. Discipline is essential in assisting the child in developing boundaries. Most children with cognitive impairment will not be able to understand the reason for the physical punishment, and the behavior will not change. Physical punishment is not an acceptable form of discipline.

Which classification is appropriate for the 6-year-old child who has difficulty hearing faint or distant speech, has normal speech, but is having problems with school performance? 1 Slight 2 Severe 3 Moderate 4 Inattentiveness rather than hearing loss

1 The definition of a slight hearing loss includes normal speech with difficulty hearing faint or distant speech. With severe hearing loss the child may hear a loud voice if it is nearby and may be able to identify loud environmental noises. Moderate hearing loss results in the child's being able to understand conversation at a distance of 3 feet to 5 feet. Children who have difficulty hearing faint or distant speech but have normal speech themselves are by definition experiencing slight hearing loss. The findings in this child are evidence of slight hearing loss, not inattentiveness.

Which activity is appropriate for the parents of a child with a stuttering problem to improve the child's speech? 1 Repeat nursery rhymes 2 Tell the child to go slowly 3 Promise candy for proper speech 4 Tell the child to think before speaking

1 The parents should repeat nursery rhymes or sing songs with the child. This capitalizes on periods of fluent speech with positive reinforcement. Parents would not tell a child with a stuttering problem to "take it easy" or go slowly, because it will only make the child feel more anxious. The parents would refrain from giving gifts or rewards for proper speech; giving gifts indicates the parents' worry. Telling the child to think before the child speaks would be avoided because it will only frustrate the child.

Which clinical symptoms are appropriate with spinal cord compression from atlantoaxial instability? Select all that apply. 1 Loss of motor skills 2 Persistent back pain 3 Persistent neck pain 4 Changes in sensation 5 Loss of bladder control

1,3,4,5 Children with Down syndrome who suffer atlantoaxial instability are at risk for spinal cord compression. Signs of spinal cord compression include persistent neck pain, changes in sensation, loss of motor skills, and loss of bladder or bowel control. Back pain is not a common symptom of spinal cord compression.

Which clinical manifestations are appropriate for myopia in children? Select all that apply. 1 Dizziness 2 Amblyopia 3 Headaches 4 Clumsiness 5 Eye-rubbing

1,3,4,5 Clinical manifestations of myopia in children include headaches, dizziness, clumsiness, and eye-rubbing. Amblyopia, or "lazy eye," is not associated with myopia.

Which clinical manifestations are appropriate for Down syndrome? Select all that apply. 1 Flat nasal bridge 2 Early-onset dementia 3 Hyperplastic mandible 4 Separated sagittal suture 5 High, arched, narrow palate

1,4,5 The most common clinical manifestations of Down syndrome include a separated sagittal suture; small nose; high, arched, narrow palate; wide space between the big and second toes; plantar crease between the big and second toes; hyperflexibility and muscle weakness; neck skin excess and laxity; depressed nasal bridge; and oblique palpebral fissures. Early-onset dementia occurs in one third of those with Down syndrome. Hypoplastic mandible, rather than hyperplastic mandible, is a clinical manifestation of Down syndrome.

Which type of sensory impairment is appropriate for a 4-year-old child who has difficulty processing linguistic information through audition with or without a hearing aid? 1 Slight 2 Profound 3 Moderate 4 Moderately severe

2 A child who has difficulty processing linguistic information through audition with or without a hearing aid has a profound sensory impairment. A slight sensory impairment is defined as difficulty hearing faint or distant speech. A moderate sensory impairment is defined as hearing sufficient to enable successful processing of linguistic information through audition. A moderately severe impairment is defined as hearing sufficient to enable successful processing of linguistic information through audition.

Which primary goal is appropriate when caring for the child with cognitive impairment? 1 Encouraging play 2 Developing vocational skills 3 Promoting optimal development 4 Helping families develop a care plan and having them stay with it

3 A comprehensive approach is desirable in establishing acceptable social behavior and feelings of self-worth and promoting optimal development. Providing parents with guidance for the selection of developmentally appropriate activities is only one component in a comprehensive care plan. Care for the cognitively impaired child is an ongoing process that changes as the child meets developmental milestones. The acquisition of vocational skills will be addressed as the child's capabilities develop and is one component of the comprehensive care plan.

Which nursing action is appropriate before sending the child who suffered a "black eye" after falling while playing to an ophthalmologist? 1 Bandage the eye tightly before getting medical attention. 2 No action is required, because it is a very insignificant injury. 3 Check for hyphema and if results are negative, apply ice. 4 Irrigate the eye with lukewarm water for at least 20 minutes.

3 After hematoma (black eye), the nurse would check the eye for presence of hyphema. If hyphema is absent, the nurse would apply ice to reduce the swelling. Bandaging the eye can worsen the injury. Hyphema is a significant injury and cannot be ignored. A hyphema is a collection of blood in the front part of the eye. Irrigating the eye with water is the intervention required for chemical burns rather than for hematoma.

Which recommendation about discipline is appropriate to give the parents of a cognitively impaired 6-year-old child? 1 Discipline is ineffective with cognitively impaired children. 2 Discipline is not necessary for cognitively impaired children. 3 Behavior modification is an appropriate way to discipline this child. 4 Physical punishment is appropriate discipline for cognitively impaired children.

3 Behavior modification is an appropriate way to discipline a cognitively impaired 6-year-old child. Discipline is essential and can be effective with cognitively impaired children when used appropriately. Physical punishment is not an appropriate way to discipline.

Which symptom is appropriate when confirming hearing loss in a 5-year-old child? 1 Limps while walking 2 Appears malnourished 3 Asks to have questions repeated 4 Is not able to complete a long sentence

3 Children who are suffering from hearing loss are confused when asked some questions. Because they are unable to hear properly, they tend to ask that questions be repeated. This is an important sign of hearing loss. Limping, appearing malnourished, and not being able to complete long sentences are not related to hearing ability.

Which nursing information is appropriate to include in the plan of care for a 6-year-old child with an autism spectrum disorder who is hospitalized for a surgical procedure? 1 Urge the parents to go home and get some rest. 2 Use therapeutic touch when providing care to the child. 3 Encourage the parents to bring in the child's favorite toys. 4 Place the child in a room with another 6-year-old child for company.

3 Children with autism spectrum disorders have special needs and need to be introduced slowly to new situations. Therefore, the nurse would encourage the parents to bring in the child's possessions to help lessen the disruption of hospitalization. It is important for the child with an autism spectrum disorder to have some familiarity when hospitalized. Therefore, it would be beneficial if at least one parent can stay with the child. Children with autism spectrum disorder can become upset with physical touch. Therefore, the nurse would refrain from touching the child except when necessary. The child would also be placed in a private room to decrease stimulation.

Which finding is appropriate when identifying cognitive impairment in children? 1 Fine motor delays 2 Normal eye contact 3 Delayed developmental milestones 4 Increased alertness to voice or movement

3 Delayed achievement of developmental milestones is a major clue to the presence of cognitive impairment in children. Children with Down syndrome or fragile X syndrome have dysmorphic features that make cognitive impairment easier to recognize. Abnormal eye contact, gross motor delay, decreased alertness to voice or movement, language difficulties, and feeding difficulties are all early behavioral signs of cognitive impairment.

Which initial nursing action is appropriate for the child that sprayed deodorant into the eyes? 1 Instill antimicrobial eye drops. 2 Irrigate with copious amounts of hot water. 3 Irrigate with lukewarm water for 20 minutes. 4 Bandage the child's eye tightly and rush to the hospital

3 In the case of chemical burns or injury to the eyes by any chemical, the eye should be irrigated with copious amounts of water. The water used would be lukewarm, and this irrigation should be carried out for at least 20 minutes. This practice significantly reduces the damage to the eye. The next step would be to bandage the eye and take the child to hospital. The eye would not be irrigated with hot water, because it can injure the eye. Antimicrobial drops would not be helpful at this stage, because the eye does not have any infection.

Which nursing action is appropriate for the parents of a child with cognitive impairment finding it difficult to teach self-care skills to their child? 1 Say that it requires patience. 2 Inform about effective coping strategies. 3 Teach developmental sequences of learning. 4 Ask whether proper verbal instructions are given.

3 Parents need to know about the developmental sequences of learning. This helps them assess the child's readiness for learning the skill before teaching it. The parents need to be taught about coping strategies when they are stressed or are unable to cope while providing care for their child. Telling the parent that teaching requires patience is not as effective as teaching them how to solve the problem. The nurse suggests demonstration rather than verbal instructions while teaching, because it is easier to comprehend.

Which clinical manifestations are appropriate for the child with Down syndrome? 1 Small nose, large ears, and hypertonia 2 Large nose, large ears, and short, broad neck 3 Short stature, protruding tongue, and hypotonia 4 Short stature, narrow space between the big and second toes, and hypotonia

3 Short stature, protruding tongue, and hypotonia are common clinical manifestations of Down syndrome that the nurse is likely to observe during an assessment. A small nose, rather than a large one, and small ears, rather than large ones, with a short, broad neck are common clinical manifestations of Down syndrome. A large space, rather than a narrow one, between the big and second toes, along with hypotonia are common clinical manifestations of Down syndrome.

Which skill is appropriate when discussing the importance of a young child to hear sounds? 1 Communication 2 Social development 3 Speech development 4 Behavior modification

3 The ability to hear sounds is essential for the development of speech. The child who cannot hear sounds will have difficulty with communication, social development, and behavior, but the ability to hear sounds is especially important because it is essential for speech development.

Which term is appropriate when describing reduced visual acuity in one eye despite appropriate optical correction? 1 Myopia 2 Hyperopia 3 Amblyopia 4 Astigmatism

3 The definition of amblyopia is the reduction of visual acuity in one eye despite appropriate optical correction. Myopia is nearsightedness, the ability to see objects up close but not clearly at a distance. Hyperopia is farsightedness, the ability to clearly see distant objects but not close ones. Astigmatism is an alteration in vision caused by unequal curvature in the eye's refractive apparatus.

Which nursing instruction is appropriate to include when educating the parents of a child with Down syndrome? 1 "Your child is at the stage of detachment." 2 "The child will cling if you show enough care." 3 "Swaddle your child in a blanket to provide warmth." 4 "Wash your hands once a day when handling secretions."

3 The nurse would encourage the parents of a child with Down syndrome to swaddle the child to provide warmth. The nurse would explain that the child's lack of clinging is a physical characteristic of children with Down syndrome, and not a sign of detachment or rejection or the result of poor parenting. Children with Down syndrome have an underdeveloped nasal bone, which causes chronic drainage of mucus; the nurse would instruct the parents to perform good hand hygiene when handling secretions.

Which nursing action is appropriate when caring for the child who has an eye injury and a freely moving foreign object in the eye over the cornea? 1 Stabilize the object in the eye. 2 Irrigate the eye with cold water. 3 Remove the moving object with gauze. 4 Irrigate the eye with lukewarm water

3 When there is a foreign object moving freely in the eye, the nurse would remove the object using a pointed corner of a gauze pad. Stabilization is not a concern unless an object has penetrated the eye. Irrigation of the eye is not carried out in this situation. Irrigation with lukewarm water is indicated when there is a chemical injury.

Which inheritance pattern is appropriate for full-mutation fragile X syndrome? 1 The cause is unknown. 2 A carrier father passes his mutation to his offspring. 3 A carrier mother passes the mutation to her offspring. 4 A carrier mother or father passes the mutation to the couple's offspring

3 A carrier mother passes the mutation to her offspring. A full-mutation fragile X syndrome occurs when a carrier mother passes the mutation to her offspring, not when a carrier mother or father passes the mutation to the offspring.

Which nursing action is appropriate for the parents of a child with fragile X syndrome wanting to have another baby, but worry that another child might be similarly affected? 1 Assessing for a family history of the syndrome 2 Recommending that they not have another child 3 Reassuring them that the syndrome is not inherited 4 Explaining that prenatal diagnosis of the syndrome is now available

4 Fragile X syndrome can now be detected prenatally. The family would be referred for genetic counseling. Fragile X syndrome is inherited on the X chromosome. Assessment for family history should be done, but it does not address the parents' concern and need for genetic counseling. Nurses do not make recommendations about whether parents would become pregnant and have other children. A referral for genetic counseling is indicated, and, depending on the findings, the geneticist can present family planning options, but the decision is strictly up to the family.

Which nursing interpretation is appropriate for the 2-week-old infant with Down syndrome whose mother comments her infant is difficult to hold and does not cuddle up like her other babies did? 1 Sign of maternal deprivation 2 Sign of detachment and rejection 3 Sign of autism associated with Down syndrome 4 Result of the physical characteristics of Down syndrome

4 Lack of clinging (or molding) between child and mother is a result of the muscle hypotonicity and hyperextensibility of the joints associated with Down syndrome. Mothers may have difficulty with attachment to their child as a result of the lack of clinging or molding behavior that is characteristic of Down syndrome. The nurse would recommend swaddling and wrapping the baby before picking her up. There is no indication of maternal deprivation. A lack of clinging or molding is not symptomatic of detachment and rejection. These physical signs are characteristic of Down syndrome; autism is not associated with Down syndrome.

Which degree of hearing loss is appropriate for the child who is able to hear a loud radio at home, but is not able to understand conversational speech unless it is loud? 1 Slight 2 Severe 3 Profound 4 Moderately severe

4 Patients with moderately severe hearing loss cannot hear sounds less than 40 decibels. These patients might have problems hearing normal conversations, which measure 30 to 45 decibels, but a loud radio at home would measure 80 decibels, which could be heard. Patients with slight hearing loss would not be able to hear sounds that range below 26 decibels. They might not be aware that they have a hearing impairment. Patients with severe hearing loss might not be able to hear sounds that measure less than 60 decibels. Patients with profound hearing loss may hear only loud sounds.

Which finding is appropriate when diagnosing a child with an intellectual disability? 1 An intelligence quotient (IQ) of 70 or less 2 An IQ of 75 or less 3 Subaverage intellectual function, deficits in adaptive skills, and onset at any age 4 Subaverage intellectual function, deficits in adaptive skills, and onset before 18 years of age

4 The diagnosis of intellectual disability is made with the presentation of subaverage intellectual functioning, deficits in adaptive skills, and onset before age 18. IQ is only one component of the diagnosis of intellectual disability. The onset of the deficit in adaptive skills and subaverage intellectual function must occur before age 18 to meet the diagnosis of intellectual disability.

Which condition is appropriate for the child who usually plays alone, does not maintain eye contact, repeatedly twists fingers, has inadequate speech, and does not interact with gestures? 1 Glaucoma 2 Down syndrome 3 Hearing impairment 4 Autism spectrum disorder (ASD)

4 Inadequate speech and no interacting with gestures indicate that the child has ASD. Children with ASD do not maintain eye contact and show repeated motor movements. Hearing impairment is indicated if the child has inadequate speech but responds greatly to gestures or facial expressions. Down syndrome is indicated by physical characteristics such as a rounded and small skull, protruding tongue, and a short, broad neck. Glaucoma is a type of visual impairment in which the child perceives halos around objects.