Quiz: Chapter 37, Impact of Cognitive or Sensory Impairment on the Child and Family

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?

"Children with Down syndrome have lower muscle tone."

A child is identified as having strabismus. The parents ask the nurse what would be the consequence if they left this condition untreated. What should the nurse tell these parents?

"The child may have amblyopia."

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?

"The child's breathing or activity increases when the child is in contact with or near a parent." Rational 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.

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?

"The exact cause of autism spectrum disorders is unknown."

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 have vision difficulties." "The newborn may have difficulty hearing." Rational: 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.

The genetic testing of a child with Down syndrome (DS) showed that it was caused by translocation. The parents ask about further genetic testing. The nurse's BEST response for the parents is:

"The parents can be tested themselves because the child's condition might be hereditary."

A child in the clinic exhibits reduced visual acuity in one eye despite appropriate optical correction. What does the nurse expect the child's health care provider to diagnosis the child with?

Amblyopia Rational Visual acuity in one eye despite appropriate optical correction is amblyopia. 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.

_______________________ is an alteration in vision caused by unequal curvature in the refractive apparatus of the eye.

Astigmatism

A child with a hearing impairment is prescribed a hearing aid. What is the most important thing the nurse has to tell the parents about the hearing aid?

Batteries should be stored out of reach of children.

A child with Down syndrome presents to the clinic for a sports physical assessment prior to participating in the Special Olympics. What does the nurse anticipate will be integrated into the physical assessment?

Cervical spine X-ray Rational The nurse can anticipate a cervical spin X-ray will be ordered. Children with Down syndrome are at risk for atlantoaxial instability. The Special Olympics requires that all athletes with Down syndrome receive neck X-rays prior to sports participation because it is the only screening available for atlantoaxial instability. Routine lab work, neurological screening, and echocardiogram are not part of a sports physical assessment for children with Down syndrome.

Periodic testing of the thyroid function is done if the child has _______________________

Down syndrome.

The nurse is caring for a child with Down syndrome. What therapeutic management steps should the nurse institute for this child? Select all that apply.

Evaluate vision and hearing. Perform evaluative echocardiography. Rational Children with Down syndrome may have visual defects and conductive hearing loss, so the nurse should evaluate vision and hearing to detect the presence of these defects. Congenital heart malformations are common in children with Down syndrome. Therefore, such children benefit from evaluative echocardiography to detect the presence of septal defects. . These children should undergo radiographic tests to assess atlantoaxial instability, not sacral instability. Children may need surgical correction if they have heart defects.

The parents of a child with fragile X syndrome want to have another baby. They tell the nurse they worry that another child might be similarly affected. What is the most appropriate nursing action?

Explain that prenatal diagnosis of the syndrome is now available. Rational: Fragile X syndrome can now be detected prenatally. The family should be referred for genetic counseling. The syndrome is inherited on the X chromosome. Assessing for family history should be done, but it does not address the parents' concern and need for genetic counseling. The nurse should not offer a recommendation, although a referral for genetic counseling is indicated.

The nurse is caring for an adolescent patient with mild to moderate hearing loss. What is the nurse's plan for communicating with the patient?

Facing the patient when speaking

What difficulties would the nurse face while solely caring for a child with autism spectrum disorder? Select all that apply.

Feeding the child Giving medications Rational Many children with autism spectrum disorders are fussy eaters. They often refuse food because of textures or smells and go without food. The nurse needs to take care while administering medications because the child may not swallow pills or liquids. The nurse asks the parent to accompany the child to help adapt in a new environment. Sometimes children on the autism spectrum have extremely disruptive outbursts when physical contact is needed. Therefore the nurse should not touch the child without the help of the parents. The child is usually accompanied by a parent to other areas in the hospital for necessary treatment procedures.

_______________________ is farsightedness, which is the ability to see distant objects clearly but not those up close.

Hyperopia

A child with fragile X syndrome was prescribed clonidine to improve attention and decrease hyperactivity. What other intervention may improve the child's cognitive ability?

Language and occupational therapy Rational: Children with fragile X syndrome have impaired cognitive development and may be prescribed clonidine 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 defective gene. This treatment is still in the research stage. Hormone therapy can be given to treat endocrine disorders. Biotherapy is given to strengthen the patient's immunity.

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.

Loss of established motor skill Loss of established bowel control Loss of established bladder control Rational 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 a hearing impairment is enrolled in a scout program. The scout leader seeks the nurse's help to teach the rules of different tasks to the child. What should the nurse ask the scout leader to do while educating the child? Select all that apply.

Maintain eye contact when talking. Watch lip movement for lipreading. Speak slowly while explaining the rules.

__________________________ is nearsightedness, which is the ability to see objects up close but not clearly at a distance.

Myopia

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?

Observe for hyphema and reaction of the pupil to light. Rational 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 nurse is assessing a patient with strabismus. Which finding would suggest the cause of strabismus? Select all that apply.

Poor vision Congenital defect Muscle imbalance Rational 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. .

A child has an eye injury caused by accidental penetration of the eye by a small stone. What preliminary measures should the nurse implement before referring to an ophthalmologist? Select all that apply.

Preventing bilateral movements Following strict aseptic precautions Bed rest in 30-degree Fowler position Rational After a penetrating eye injury, the nurse should prevent bilateral movement by applying a patch over the unaffected eye. Movement of the eyes can worsen the injury. Following strict aseptic precautions is a must for handling patients with penetrating injury to the eyes. The nurse should encourage the child to take bed rest in 30-degree Fowler position to prevent increases in intraocular pressure. For the affected eye a Fox shield should be used, not a regular eye patch. The nurse should not attempt to remove the penetrating object.

_____________________ skills should be taught by the parents to children with cognitive impairment.

Self-care

A 6-year-old child has difficulty hearing faint or distant speech. His speech is normal, but he is having problems with his school performance. How would this hearing loss most likely be classified?

Slight Rational This is the definition of a slight hearing loss. With severe loss, the child may hear a loud voice if nearby and may be able to identify loud environmental noises. Moderate hearing loss results in symptoms of being able to understand conversation at a distance of only 3 to 5 feet. With a moderately severe hearing loss, he would be unable to understand a conversation unless it was very loud.

A pregnant patient visits the primary health care provider for a prenatal checkup. The patient reveals that she occasionally smokes and drinks alcoholic beverages. The nurse expects the health care provider will instruct the patient to stop drinking and smoking. What is the rationale for these instructions?

Smoking and alcohol impair the baby's cognitive development.

Autism is a complex developmental disorder. Diagnostic criteria for autism include delayed or abnormal functioning in which area(s) before 3 years of age? (Select all that apply.)

Social interaction Inability to maintain eye contact Language as used in social communication

What nursing care should be provided to a school-aged child with cognitive impairment?

Speech therapy referral for the child Rational The nurse should refer the child with cognitive impairment for speech therapy.

The diagnosis of cognitive impairment is based on the presence of what?

Subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age

A patient reports severe pain in the eye. Further assessment shows that the patient also has photophobia and eye redness. What treatment would the nurse expect the health care provider to prescribe for this patient?

Surgical treatment to open the outflow tract for aqueous humor Rational Severe pain in the eye is caused by elevated intraorbital pressure, caused by the accumulation of aqueous humor in the eye. This is manifested as glaucoma, and the treatment involves surgical intervention to increase the outflow of aqueous humor.

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 difficulty hearing. Rational 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.

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 infant's response to an auditory stimulus Rational The 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

The nurse is caring for a child with chemical eye injuries. Arrange the steps in order to indicate how the nurse should implement treatment.

The nurse first rinses the eye with ample amounts of water thoroughly for 20 minutes and then flushes inside the upper eyelid of the eye. The nurse then holds the head under running lukewarm water and takes the child to the emergency department. After treatment, the child is asked to close his or her eyes and rest. The room is darkened to avoid irritation by light.

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 instructs the cleaner not to move the furniture around.

The nurse is assessing growth and development in an infant and suspects the child has infantile autism. What observations led the nurse to come to this conclusion?

Unresponsiveness to sounds Rational Functional hearing loss is associated with infantile autism. The child has central auditory imperceptions and is unresponsive to sounds as a result of hearing loss. The child may have reduced development and reduced increase in height and weight relative to other children. The presence of bowed legs can be caused by vitamin D deficiency but is not an indication of autism.

Which action performed by the nurse is appropriate during hospitalization of a child with a hearing impairment?

Use books and drawings to communicate with the child.

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.

Verbal impairment Stereotyped behavior patterns Decreased involvement in play Rational 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.

Sexual information is given to ______________________ with cognitive impairment

adolescents

Thyroid function is not__________________ in all children with cognitive impairment

altered

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:

amblyopia.

Unequal curvature of lens results in _________________, not strabismus.

astigmatism

Downs children should undergo radiographic tests to assess ________________ instability, not sacral instability. Children may need surgical correction if they have heart defects.

atlantoaxial

A cloudy lens is replaced with an intraocular lens if the patient has __________________

cataracts

Respiratory disorders or allergic reactions can result from hypersensitivities and can cause____________________ breathing in the newborn.

difficulty

Growth hormone deficiency or Turner syndrome can lead to _________________ impairment

growth

Short eyeball results in development of __________________, not strabismus

hyperopia

Assessment of infant's physical activity toward a large moving object is useful to assess the child's _______________________ It also tests the infant's visual abilities.

muscle coordination.

A decreased ability to concentrate indicates impaired cognition. It usually results from inadequate intake of ___________________ acids by the mother during pregnancy.

omega-3 fatty

A 5-year-old male child has bilateral eye patches that were put in place after surgery yesterday morning. Today he can be allowed to get out of bed. The MOST important nursing intervention is to:

orient him to his immediate surroundings.

Contact lenses are recommended in case of anisometropia, where the two eyes have different _________________ indices.

refractive

Younger school-age children with cognitive impairment may not understand information regarding __________________.

sexuality

Vocal expressions or sounds produced in response to communication may indicate whether the infant has a __________________ or _______________________

speech or hearing impairment.

Surgical interventions to increase visual stimulation to the weaker eye are done in case of ____________________

strabismus

Downs children need periodic_ ----------------, not blood glucose testing

thyroid testing

Eye movement following a flashlight helps in assessing the infant's _______________________

vision