Maternal Child Nursing Chapter 37 Impact of Cognitive and Sensory Impairment on the Child and Family

A week-old newborn is assessed for body weight, birth marks, and height. The birth weight is lower than what it should be for height. Which physical feature of the newborn makes the nurse conclude that the newborn is affected by Down syndrome? 1 Short and broad neck 2 Long and thin fingers 3 Short and thin lips 4 Broad and long nose

1 One of the characteristics of Down syndrome is a short, broad neck. These children have an impaired immune system and are at risk for spinal cord compression. Physical features such as long and thin fingers, short and thin lips, and broad and long nose are all common in a normal child and do not indicate any abnormality.

The nurse is assessing a child with Down syndrome. What findings in the child should alert the nurse to report to the health care provider immediately? Select all that apply. 1 Loss of pain sensation 2 Loss of impulse control 3 Loss of established motor skill 4 Loss of established bowel control 5 Loss of established bladder control

3, 4, 5 Loss of established motor skill and bowel and bladder control indicate spinal cord compression and must be reported immediately. The child with Down syndrome may have persistent neck pain caused by spinal cord compression. These children do not have impaired pain sensation. Children with Down syndrome are not aggressive. Loss of impulse control is not seen in such children.

A child with autism spectrum disorder is hospitalized for a treatment that will last about 1 week. How should the nurse make the child comfortable? 1 Ask the parents to accompany the child. 2 Modify the room according to the child's needs. 3 Explain the surroundings of the room. 4 Help the child perform daily routine tasks.

1 Children with autism spectrum disorders often are uncomfortable in a new environment and may not like to be with strangers. Therefore children with an autism spectrum disorder must be accompanied by their parents during hospitalization. While caring for a visually impaired child, the nurse modify the room according to the needs of the child. This helps prevent accidents. Because the child is not visually impaired, the nurse need not explain the surroundings of the room. Children with autism spectrum disorders often do not like assistance and prefer to perform their daily chores by themselves. Therefore the nurse should not help the child with such activities.

The nurse is assessing a newborn with Down syndrome. The newborn's parent tells the nurse, "We are having a hard time holding our baby. We didn't have this hard of a time with our other children." What would be the nurse's best response? 1 "Children with Down syndrome have lower muscle tone." 2 "This happens in some children because of undeveloped bonding." 3 "Are you more apprehensive because your child has Down syndrome?" 4 "You should see a counselor to help you cope with your child's condition."

1 Newborns with Down syndrome have joint hyperflexibility and low muscle tone. This can make it difficult to hold the newborn because he or she can go limp like a rag doll. This makes it difficult for the parents to embrace and provide warmth to their newborn. This may make parents feel that the newborn is not bonding with them, but difficulty holding the child does not indicate impaired bonding between the child and parents. Inability to understand the child's needs and nonverbal communication indicates undeveloped bonding. Asking the parents whether they are more apprehensive does not answer their question. It is also a closed-ended question, which is not therapeutic communication. Telling the parents they need to see a counselor is not appropriate. They just need support and teaching.

The nurse is assessing a child with autism for prognostic factors. What findings in the child suggest a better prognosis? Select all that apply. 1 Male sex 2 Early recognition 3 Functional speech 4 Lower intelligence 5 Behavioral impairment

1, 2, 3 Male sex carries a more favorable prognosis than female sex. Early recognition allows early intervention to help the child recover. Children with functional speech have a better prognosis than those who do not have functional speech. Children with higher intelligence have a more favorable prognosis than children with lesser intelligence. Children who do not have behavioral impairment have a better prognosis than children with behavioral impairment.

The nurse is assessing a child with autism. What characteristic features of autism does the nurse expect to find in the child? Select all that apply. 1 Verbal impairment 2 Stereotyped behavior patterns 3 Hearing and visual impairment 4 Nonrepetitive behavioral patterns 5 Decreased involvement in play

1, 2, 5 Children with autism usually have verbal impairment caused by poor language development. Autistic children exhibit stereotyped behavioral patterns caused by impaired neuromuscular function. Such children show decreased interest in functional play activities. Autistic children do not usually have hearing and visual impairment. Autistic children exhibit repetitive behavioral patterns.

A pregnant woman is diagnosed with a rubella infection during a prenatal checkup. What does the nurse expect the health care provider will tell the patient? Select all that apply. "The newborn may: 1 Have vision difficulties." 2 Have growth impairment." 3 Have difficulty hearing." 4 Develop breathing problems." 5 Not be able to concentrate."

1, 3 Rubella infections during pregnancy may cause hearing and visual loss in the newborn. However, these impairments may disappear as the child grows. Rubella infections do not cause growth retardation. Growth hormone deficiency or Turner syndrome can lead to growth impairment. Respiratory disorders or allergic reactions can result from hypersensitivities and can cause difficulty breathing in the newborn. A decreased ability to concentrate indicates impaired cognition. It usually results from inadequate intake of omega-3 fatty acids by the mother during pregnancy.

A 4-year-old child is seen in a clinic for a hearing impairment. What action does the nurse observe in the child to confirm hearing impairment? Select all that apply. The child: 1 Screeches happily when looking at a toy. 2 Has difficulty trying to read a book. 3 Does not respond when an alarm sounds. 4 Points at his tummy to indicate hunger. 5 Speaks fast, stutters, and has speech delay.

1, 3, 4 A child with a hearing impairment yells or screeches in pleasure because the child cannot hear how loud these sounds are. The child also does not respond to loud sounds and prefers nonverbal communication such as pointing. A child who has difficulty reading a book may have a visual impairment. Rapid speech with stuttering and speech delay are symptoms of fragile X syndrome.

The nurse is assessing a patient with strabismus. Which finding would suggest the cause of strabismus? Select all that apply. 1 Poor vision 2 Short eyeball 3 Congenital defect 4 Muscle imbalance 5 Unequal curvature in the lens

1, 3, 4 Strabismus may result from poor vision and the resulting straining of eye muscles. Strabismus may result from a congenital defect as a developmental anomaly. Strabismus may also result from muscle imbalance caused by neuromuscular disorders. Short eyeball results in development of hyperopia, not strabismus. Unequal curvature of lens results in astigmatism, not strabismus.

The nurse assesses an infant at birth for height, weight, and other vital signs. What should the nurse include in the assessment to identify a conductive hearing disorder? The nurse assesses: 1 To see whether the infant's eyes move toward a flashlight. 2 The infant's response to an auditory stimulus. 3 The infant's vocal expressions during vocal communication. 4 The infant's physical activity toward a large moving object.

2 Assessment of an infant's response to auditory stimulation is used to detect a conductive hearing impairment in the newborn. Because the nurse suspects hearing impairment, the infant might have failed to respond to auditory stimulus. Eye movement following a flashlight helps in assessing the infant's vision. Vocal expressions or sounds produced in response to communication may indicate whether the infant has a speech or hearing impairment. Assessment of infant's physical activity toward a large moving object is useful to assess the child's muscle coordination. It also tests the infant's visual abilities.

A visually impaired child is hospitalized for eye surgery. What nursing intervention should be included in the plan of care to encourage the child to be independent? The nurse: 1 Does not keep a stool or small desk near the bed. 2 Instructs the cleaner not to move the furniture around. 3 Gives the child work to do while the child is in the hospital. 4 Does not educate the child about the treatment procedures.

2 Changing furniture positions can result in accidents, so this must be avoided. A small stool or a desk should be placed near the bed to support the child so that he or she can climb into bed easily. The child is a patient in the hospital and should not be asked to work while there. Educating the child about the procedures that will be carried out for the treatment will help the child understand and mentally prepare for them.

The parent of a 2-year-old child tell the nurse that the child likes to play alone and asks people to repeat questions several times. The parent also says that the child uses gestures to communicate. What should the nurse infer from this? The child has: 1 Cognitive impairment. 2 Difficulty hearing. 3 Normal development. 4 Chronic mental illness.

2 Children 2 to 3 years old understand the common language used at home, and they try to communicate with family members in the same language. If the child has difficulty understanding and responding after the parent repeats a statement several times, this may indicate the child has a hearing problem. The child does not have lack of orientation, so the nurse should not infer that the child has cognitive impairment. Children stop using gestures and start communicating verbally around the age of 15 months. Therefore the child does not have normal development. The child is not bullying or being aggressive, so the nurse should not infer that the child has a chronic mental illness.

Early detection of a hearing impairment is critical because of its effect on areas of a child's life. The nurse should evaluate further for effects of the hearing impairment on: 1 reading development. 2 speech development. 3 relationships with peers. 4 performance at school

2 The ability to hear sounds is essential for the development of speech. Babies imitate the sounds that they hear. The child will have greater difficulty learning to read, but the primary issue of concern is the effect on speech. Relationships with peers and performance at school will be affected by the child's lack of hearing. The effect will be augmented by difficulties with oral communication.

What should the nurse do to communicate with a patient who is cognitively impaired and speaks a foreign language? 1 Insert the patient's hearing aids. 2 Use verbal expressions. 3 Use a language translator. 4 Use visual aids and drawings.

3 A language translator should be used when any patient speaks a foreign language, no matter what his or her cognitive level is. Inserting the patient's hearing aids will help the patient hear, but it will not break the language barrier. Verbal expressions can be helpful, but they are not as effective as having a translator speaking the patient's language. Visual aids and drawings may be helpful, but not everything is easily communicated with these methods.

The parents of a 3-year-old child report seeing a whitish glow in the child's eyes. The nurse begins to examine the child. What information should the nurse give to the parents before assessment? "The child: 1 Needs hematologic assessment for confirmation of diagnosis." 2 May not be able to distinguish between colors." 3 May not see clearly for some time after the examination." 4 Needs immediate hospitalization after the examination."

3 A strange light in the eyes indicates that the child may have retinoblastoma. It is diagnosed by ophthalmoscopic examination, which involves dilation of the pupil. During this procedure, the eyes become sensitive, and the child may not be able to see clearly for some time. Informing the parents about it will reduce anxiety. Hematologic assessment is not used to diagnose retinoblastoma. A retinoblastoma can be diagnosed by ophthalmoscopic examination under general anesthesia and with imaging studies, including ultrasonography and computed tomography. A child with visual impairment may have difficulty distinguishing between colors, but it is not helpful for the parents to learn about it before the child's illness is diagnosed. The child may need immediate hospitalization after the examination depending on the severity of tumor, but the nurse should not tell the parents about hospitalization because it could make them panic.

A 10-year-old child is diagnosed with an autism spectrum disorder (ASD). The parents ask the nurse about the cause of the disorder. Which answer given by the nurse is most appropriate? 1 "Autism is caused by a high intake of proteins during pregnancy." 2 "The disorder is caused by vaccines that contain thimerosal." 3 "The exact cause of autism spectrum disorders is unknown." 4 "Alcohol consumption during pregnancy is linked to autism."

3 Although the exact cause of ASD is not known, the nurse should always help parents understand that they are not responsible for the child's condition. There are many theories about the cause of ASD, but nothing is definitive. High intake of proteins is necessary during pregnancy because it promotes proper growth and development of the fetus. Vaccines containing thimerosal are not associated with ASD. Thimerosal is a preservative found in some vaccines. Consumption of alcohol during pregnancy leads to fetal alcohol syndrome, not autism.

The parents of a cognitively impaired child ask the nurse for guidance with discipline. The nurse's best response is: 1 "Discipline is ineffective with cognitively impaired children." 2 "Discipline is not necessary for cognitively impaired children." 3 "Behavior modification is an excellent form of discipline." 4 "Physical punishment is the most appropriate form of discipline."

3 Behavior modification with positive reinforcement is effective in children with cognitive impairment. Discipline is essential in assisting the child in developing boundaries. Positive behaviors and desirable actions should be reinforced. Most children with cognitive impairment will not be able to understand the reason for the physical punishment; consequently behavior will not change as a result of the punishment.

A child with fragile X syndrome was prescribed clonidine (Catapres) to improve attention and decrease hyperactivity. What other intervention may improve the child's cognitive ability? 1 Aromatherapy and hydrotherapy 2 Protein replacement and gene therapy 3 Language and occupational therapy 4 Hormone and biologic therapy

3 Children with fragile X syndrome have impaired cognitive development and may be prescribed clonidine (Catapres) to improve attention span and decrease hyperactivity. Other interventions that can improve cognitive ability in these children include speech and language therapies, occupational therapy, and special educational programs. Aromatherapy and hydrotherapy are useful for reducing stress and anxiety. Protein and gene replacement involves replacing the defected gene. It does not improve cognitive ability. Hormone therapy can be given to treat endocrine disorders. Biotherapy is given to strengthen the patient's immunity.

A 10-year-old child has moderate cognitive impairment. With which activity would a teacher expect the child to need help? 1 Copying information from the board 2 Learning safe and healthy habits 3 Performing arithmetic calculations 4 Communicating with classmates

3 Students with moderate cognitive impairment (IQ of 50-55) have difficulty with functional reading and arithmetic calculations. The student can perform simple manual skills, such as copying information from the board, learning safe and healthy habits, and communicating with classmates.

A child with a temporary visual impairment was admitted to the hospital for treatment. What nursing intervention would make the child feel most comfortable in the hospital? The nurse: 1 Explains the different departments of the hospital. 2 Understands the child's behavior and daily routine. 3 Describes the surroundings of the room and the unit. 4 Asks the cleaner to move the furnishings around

3 The nurse helps the child become familiar with the room so that the child knows the layout in order to avoid injury while moving around the room. Explaining to the child about the hospital departments is not necessary to make the child feel comfortable. Understanding the child's daily routine is necessary to plan activities for the child but does not increase comfort. The cleaning personnel are asked to maintain the décor of the room to avoid accidents; therefore changes should be avoided.

The nurse is caring for a child with cognitive impairment. Which statement made by the nurse to the parents is a reason for concern? 1 "I need to know more about cognitive impairment." 2 "I will ask the other staff to help with the child's care." 3 "I do not know what is going on with this child's health." 4 "I'll ask the health care provider to clarify my question."

3 The statement "I do not know what is going on with this child's health" is inappropriate because it indicates that the nurse does not understand the child's needs. The statement "I need to know more about cognitive impairment" shows the nurse's desire to learn about the disorder and help treat the child better. The statement "I will ask the other staff to help with the child's care" shows the nurse's desire to increase his or her skill level. The statement "I will ask the health care provider to clarify my question" is an inappropriate statement made by the nurse. It implies that the nurse is not aware of the care that should be given to a cognitively impaired child.

A child in the clinic exhibits reduced visual acuity in one eye despite appropriate optical correction. The nurse expects the child's health care provider to diagnosis the child with: 1 myopia. 2 hyperopia. 3 amblyopia. 4 astigmatism.

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

A child with strabismus is undergoing treatment for impaired vision of the left eye. The nurse covers the child's right eye with an occlusion patch. Why does the nurse do so? 1 To protect the right eye from dust 2 To reduce intraocular pressure in the left eye 3 To increase vision in the left eye 4 To prevent the child from rubbing the right eye

3 While caring for a child with strabismus, the nurse should cover the unaffected eye with an occlusive patch because it helps stimulate vision and movement in the weaker eye. The main reason for applying an ocular patch is to improve vision in the left eye, not to protect the right eye from dust. Applying an ocular patch on the right eye does not reduce intraocular pressure in the left eye; antiglaucoma medications can be used to reduce intraocular pressure. Applying an occlusion patch will not prevent the child from rubbing his or her eyes. The nurse should explain to the child that rubbing the eyes may cause further damage.

A couple visits the hospital for a prenatal checkup. On reviewing the genetic analysis report, the nurse finds that the male partner has fragile X syndrome. What should the nurse interpret from these findings? Select all that apply. 1 All of their sons will have a 50% chance of being affected. 2 All of their sons will be carriers for fragile X syndrome. 3 The chance of a daughter being affected is 50%. 4 All daughters will be carriers for fragile X syndrome. 5 All sons will be carriers and will have fragile X syndrome.

3, 4 Fragile X syndrome is an X-linked dominant syndrome with reduced penetrance. About 50% of daughters with fathers affected by fragile X syndrome will be affected because the dominant X chromosome can be from the affected father. All daughters with an affected father will be carriers. The sons get Y chromosomes from the father, so they are not necessarily carriers of the syndrome or affected by the syndrome. The sons can be carriers or affected if the syndrome is passed from the mother.

The nursing instructor is explaining the risk factors and pathogenesis of Down syndrome to a group of nursing students. What information should the nurse include in the explanation? Select all that apply. 1 It is caused by a mutation of chromosomes. 2 It is more likely to occur if the paternal age is more than 35 years. 3 It is more likely to occur if the maternal age is more than 35 years. 4 It is caused by acquisition of an extra sex chromosome. 5 It is caused by acquisition of an extra autosomal chromosome.

3, 5 Maternal age more than 35 years increases the risk of having babies with Down syndrome. Down syndrome is caused by the presence of an extra autosomal chromosome. Down syndrome is not caused by a mutation of chromosomes. Advanced paternal age is not a risk factor for Down syndrome. There is no extra sex chromosome in children with Down syndrome.

The parent of a visually impaired infant says to the nurse, "I am afraid that my child may not be able to bond with me because my child cannot maintain eye contact with me." The nurse teaches the parent about other signs that indicate that the child is responding. What should the nurse include in the explanation? 1 "The child compensates by increasing listening to your voice and smiling." 2 "The child's attention span decreases when a parent is trying to communicate." 3 "The child does not make throaty sounds when a parent is trying to communicate." 4 "The child's breathing or activity increases when the child is in contact with or near a parent."

4 Changes in respiratory patterns and increasing activity reflect the child's excitement about being close to the parent. The child is able to hear the parent's voice but is not able to smile when hearing the parent's voice at this age. This happens after about 2 years of age. Decreased attention span could be caused by lack of interest in the communication. When a child makes sounds in response to the parent's communication, it is sign of intimate bonding between the child and parent.

The parents brought their child to the emergency department after a needle penetrated the child's eye. Which action should the nurse perform while caring for the child? 1 Examine the eye to look for foreign bodies. 2 Irrigate the eye to remove the needle from the eye. 3 Evert the upper eyelid to wash the eye thoroughly. 4 Observe for hyphema and reaction of the pupil to light.

4 If a child has a penetrating eye injury of any kind, the nurse should examine the eye to determine whether any aqueous humor has leaked from the penetration site. The nurse should observe the presence of hyphema, or bleeding from the eye. The nurse should also assess for pupillary reaction to light because it helps assess the functioning of the pupil. The nurse does not need to examine the eye for foreign bodies because there is already a foreign body in the eye. If the child is experiencing a penetrating eye injury, the nurse does not irrigate the eye to remove the object because this can further damage the cornea. In the case of chemical burns, the nurse rinses the eye by everting the upper eyelid.

The diagnosis of cognitive impairment is based on the presence of: 1 intelligence quotient (IQ) of 75 or less. 2 IQ of 70 or less. 3 subaverage intellectual functioning, deficits in adaptive skills, and onset at any age. 4 subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age.

4 The diagnosis of cognitive impairment includes subaverage intellectual functioning and deficits in adaptive skills, including an onset before age 18. IQ is only one component of the diagnosis of cognitive impairment. The onset of the deficit must be before age 18 to meet the diagnosis of cognitive impairment.

The nurse is evaluating a child for suspected autism. Which finding in the child suggests autism? 1 Limited functional play 2 Avoidance of body contact 3 Language delay at an early age 4 Inability to maintain eye contact

4 The hallmark of autism is an inability to maintain eye contact with another person. Limited functional play may be seen in children with autism, but it is not a hallmark of autism. Autistic children also avoid body contact, but it is not a hallmark finding. Language delay at an early age is not a hallmark of autism; however, children with autism may exhibit language delay at an early age.

What nursing care should be provided to a school-aged child with cognitive impairment? 1 Periodic testing of thyroid function 2 Education on sexuality 3 Education on self-care skills for the child 4 Speech therapy referral for the child

4 The nurse should refer the child with cognitive impairment for speech therapy. It helps improve communication and promotes social behavior of the child. Periodic testing of the thyroid function is done if the child has Down syndrome. Thyroid function is not altered in all children with cognitive impairment. Sexual information is given to adolescents with cognitive impairment. Younger school-age children with cognitive impairment may not understand information regarding sexuality. Self-care skills should be taught by the parents to children with cognitive impairment.