Sem 3 - Unit 6 - Cognition (Itellectual Disabilities; Chromos Abn; Fetal Alcohol Syndrome)

While playing with a toy car, a toddler accidentally hits the wall and falls down. The toddler then gets angry at the wall for making him fall. Which characteristic of preoperational thought does this behavior indicate? 1 Animism 2 Centration 3 Egocentrism 4 Irreversibility

1 Animism Animism is an act of attributing lifelike qualities to inanimate objects. When a toddler scolds the wall for making him or her fall, it indicates animism. Centration is focusing on one aspect rather than considering all possible alternatives. Egocentrism is the inability to envision situations from perspectives other than one's own. Irreversibility is the inability of toddlers to reverse actions that are physically initiated.

The nurse is providing care to an infant diagnosed with Down syndrome. Which parental statement related to the infant's growth indicates the need for further education? 1 "My baby will have growth deficiencies during infancy." 2 "My child will have accelerated growth during adolescence." 3 "My child will most likely be overweight by 3 years of age." 4 "My baby will have reduced growth in both height and weight."

2 "My child will have accelerated growth during adolescence." Children diagnosed with Down syndrome will often have growth deficiencies. These deficiencies are most pronounced during adolescence and infancy. Because weight gain is more rapid than growth in stature, many children with Down syndrome are overweight by 3 years of age. Overall reduced growth is noted for both height and weight.

The parents of a newborn are told that their neonate may have Down syndrome and that additional diagnostic studies will be done to confirm this diagnosis. What procedure does the nurse expect to be performed? 1 Heel stick 2 Buccal smear 3 Urinary catheterization 4 Venous blood withdrawal

2 Buccal smear The cells in the buccal smear provide a pictorial analysis of chromosomes and show chromosomal abnormalities such as the trisomy found in Down syndrome. Blood from the heel stick is tested for inborn errors of metabolism such as phenylketonuria. Neither urine nor venous blood is not used to assess chromosomal aberrations.

A nurse is performing a physical examination of an infant with Down syndrome. For what anomaly should the nurse assess the child? 1 Bulging fontanels 2 Stiff lower extremities 3 Abnormal heart sounds 4 Unusual pupillary reactions

3 Abnormal heart sounds Cardiac anomalies often accompany genetic problems such as Down syndrome; 30% to 40% of affected infants also have congenital heart defects. Infants with Down syndrome do not have increased intracranial pressure; the fontanels should be flat. The extremities will more likely be relaxed. Children with Down syndrome exhibit the usual pupillary reaction to light.

A nurse is caring for an infant with Down syndrome. What does the nurse recall as the most common serious anomaly associated with this disorder? 1 Renal disease 2 Hepatic defects 3 Congenital heart disease 4 Endocrine gland malfunction

3 Congenital heart disease Many children with Down syndrome have cardiac anomalies, most often ventricular septal defects, which can be life threatening. Renal disease, hepatic defects, and endocrine gland malfunction are not characteristic findings in children with Down syndrome.

While assessing a newborn suspected of having Down syndrome, what does the nurse expect to note as part of the findings? 1 Long, thin fingers 2 Large, protruding ears 3 Hypertonic neck muscles 4 A single line across each palm

4 A single line across each palm A single line across the palm of each hand, a characteristic finding in newborns with Down syndrome, is known as a simian crease. Stubby fingers and small ears, not long, slim fingers and large, protruding ears, are commonly found in newborns with Down syndrome. Newborns with Down syndrome have hypotonic, not hypertonic, muscles.

During which period of pregnancy would functional disabilities in a fetus's brain occur via fetal exposure to a teratogenic agent? 1 Fetal period 2 Presomite period 3 Embryonic period 4 Preimplantation perio

1 Fetal period Teratogenic exposure during the fetal period may cause functional disabilities of the brain in the fetus, such as learning deficits and behavioral abnormalities. Gross malformations due to teratogenic exposure are seen in the embryonic period. Teratogenic exposure during the presomite period or preimplantation period may result in the death of the fetus.

Which teratogens affecting fetal growth and development should the nurse include in a teaching session for pregnant clients? Select all that apply. 1 Rubella 2 Varicella 3 Swordfish 4 Phenytoin 5 Acetaminophen

1 Rubella 2 Varicella 3 Swordfish 4 Phenytoin Teratogens are noxious materials such as viruses, chemicals, and drugs that pass from mother to child during pregnancy that can affect fetal growth and development. Rubella, varicella, swordfish (due to high mercury content), and phenytoin are all teratogens that the nurse should educate pregnancy clients to avoid. Acetaminophen is not a teratogen.

A 12-year-old child with Down syndrome is admitted to the hospital for intravenous antibiotics for pneumonia. Which clinical findings associated with Down syndrome should the nurse expect when performing a physical assessment? Select all that apply. 1 Saddle nose 2 Thin fingers 3 Inner epicanthic folds 4 Hypertonic musculature 5 Transverse palmar crease

1 Saddle nose 3 Inner epicanthic folds 5 Transverse palmar crease Children with Down syndrome have a broad nose with a depressed bridge (saddle nose), as well as inner epicanthic folds and oblique palpebral fissures; they also have speckling of the iris (Brushfield spots). Children with Down syndrome have a transverse palmar crease (simian crease) formed by fusion of the proximal and distal palmar creases. These children also have broad, short, stubby hands and feet. Children with Down syndrome have hypotonic, not hypertonic, musculature.

A client consumes alcohol during pregnancy. Which condition does the nurse anticipate to be seen in the newborn? 1 Stillbirth 2 Heart defects 3 Growth delay 4 Multiple defects

1 Stillbirth A client who is an alcohol abuser may deliver a stillborn baby. Heart defects occur in the newborn when the mother is exposed to antimicrobials during her pregnancy. Newborn growth delays may be caused by antiseizure drug exposure in the mother. Multiple defects may be seen in a child whose mother was exposed to vitamin A derivatives.

A pregnant woman continues consuming alcohol during pregnancy. Which teratogenic effects might be seen in the fetus or neonate? Select all that apply. 1 Stillbirth 2 Ebstein anomaly 3 Neural tube defects 4 Spontaneous abortion 5 Intellectual disabilities

1 Stillbirth 4 Spontaneous abortion 5 Intellectual disabilities Prolonged fetal exposure to alcohol may cause a stillbirth. A spontaneous abortion may occur if the pregnant woman consumes alcohol in excess amounts. Intellectual disabilities may be seen in the neonate if it is exposed to alcohol in the fetal stage. Ebstein anomaly is caused by lithium exposure during pregnancy. Neural tube defects may be due to exposure to antiseizure drugs during pregnancy.

A nurse plans to discuss childhood nutrition with a group of parents whose children have Down syndrome in an attempt to minimize a common nutritional problem. What problem should be addressed? 1 Rickets 2 Obesity 3 Anemia 4 Rumination

2 Obesity Obesity is a common nutritional problem of children with Down syndrome. It is thought to be related to excessive caloric intake and impaired growth. Rickets is a nutritional disorder related to vitamin D deficiency; it is usually not encountered in these children. Anemia is the most common nutritional problem in children with iron deficiency. Rumination is an eating disorder of infancy characterized by repeated regurgitation without a gastrointestinal illness.

The mother of an infant with Down syndrome asks the nurse what causes the disorder. Before responding, the nurse recalls that the genetic factor of Down syndrome results from what? 1 An intrauterine infection 2 An X-linked genetic disorder 3 Extra chromosomal material 4 An autosomal recessive gene

3 Extra chromosomal material Down syndrome (trisomy 21) results from extra chromosomal material on chromosome 21. Down syndrome does not result from a maternal infection. Down syndrome is not related to an X-linked or Y-linked gene. An autosomal recessive gene is not the cause of Down syndrome, although translocation of chromosomes 15 and 21 or 22 is a genetic aberration found in some children with Down syndrome.

An alcoholic mother gave birth to a baby who had alcohol dependency. Which nursing intervention would be helpful in managing alcohol dependency in the baby? 1 Avoid alcohol in the treatment 2 Give treatment to reduce alcohol abuse 3 Give reduced doses of alcohol to overcome drug dependency 4 Administer alcohol to the baby to prevent withdrawal symptoms

3 Give reduced doses of alcohol to overcome drug dependency The baby born to an alcoholic mother should be treated with reduced doses of alcohol to wean the baby from the alcohol dependency. Avoiding alcohol may cause withdrawal syndrome, and the baby may show symptoms of shrill crying and extreme irritability. Treatment to counter the alcohol abuse in the baby may not be effective. Alcohol should not be provided in normal doses to reduce the alcohol dependency or to prevent withdrawal symptoms.

The nurse observes that a child fails to make eye contact and has poor impulse control. Upon further assessment, the nurse finds that the parent is an alcoholic and often neglects the child. What can be said about the child? 1 The child needs to be screened for autism. 2 The child is experiencing separation anxiety. 3 The child feels solitary because of the parent's behavior. 4 The child has developed reactive attachment disorder (RAD).

4 The child has developed reactive attachment disorder (RAD). RAD is a psychological and developmental disorder that occurs in children who are neglected by their primary caregivers. Children with RAD are not cuddly with parents and fail to make eye contact. They also exhibit poor impulse control and may be destructive to themselves and others. Poor eye contact is seen in autistic children as well, but in this case, there is parental neglect that indicates RAD. Separation anxiety is indicated by crying and screaming when the parent leaves the child. Feelings of solitariness do not result in poor impulse control or eye contact.

Which interventions does the nurse implement to empower a family who has a child with Down syndrome? Select all that apply. 1 Ask the family to engage in spiritual activities. 2 Help the family recognize the possible stressors. 3 Encourage the use of problem-solving strategies. 4 Encourage more out-of-home activities for the parents. 5 Refer the family to support groups and Internet resources.

2 Help the family recognize the possible stressors. 3 Encourage the use of problem-solving strategies. 5 Refer the family to support groups and Internet resources. The nurse understands that the family experiences multiple stressors and helps the family recognize those stressors. The nurse encourages the family to use effective problem-solving skills that convey support and care and have a calming influence on the child. The nurse also identifies proper support groups for the family to relieve stress. The use of Internet resources will help the family understand more about the child's disorder. Asking the family to engage in spiritual activities is not appropriate, because spirituality is a personal lifestyle choice. The nurse encourages the parents to spend more time at home to provide care for the child, as opposed to engaging in more out-of-home activities.

During a community health survey, the nurse is conducting a survey about the language development in preschoolers. What behavior is the nurse able to document in preschoolers? Select all that apply. 1 Preschoolers start to understand riddles and jokes. 2 Preschoolers want to know the reason behind an event. 3 Preschoolers have a vocabulary of 8,000 to 14,000 words. 4 Preschoolers know that words may have arbitrary meanings. 5 Preschoolers cannot distinguish between phonetically similar words.

2 Preschoolers want to know the reason behind an event. 3 Preschoolers have a vocabulary of 8,000 to 14,000 words. 5 Preschoolers cannot distinguish between phonetically similar words. Preschoolers start to question "Why?" and "How come?" Their vocabulary increases rapidly and they can define their feelings by using 8,000 to 14,000 words. School-aged children are able to understand riddles and jokes. This is not seen in preschool children. School-aged children clearly understand that words have arbitrary meanings. This is not seen in preschoolers. Preschoolers get confused between phonetically similar sounds. They are not able to understand the difference between die and dye or wood or would. Therefore, the nurse will not document this behavior with preschoolers.

A newborn is found to have Down syndrome. The nurse knows that Down syndrome is usually accompanied by several problems. Which assessment should the nurse perform during the physical examination? 1 Reflex responses for hypotonicity 2 Eye examination for congenital cataracts 3 Sensory stimulation for muscle flaccidity 4 Cardiac irregularities for congenital heart disease

4 Cardiac irregularities for congenital heart disease Children with Down syndrome have a high incidence of congenital heart defects, indicated by altered heart sounds. Without treatment a heart defect may become life threatening. The other options are expected but are not life threatening.

A nurse is caring for a 42-year-old client who is scheduled for an amniocentesis during the fifteenth week of gestation because of concerns regarding Down syndrome. What other fetal problem does an examination of the amniotic fluid reveal at this time? 1 Diabetes 2 Lung maturity 3 Cardiac anomalies 4 Errors of metabolism

4 Errors of metabolism Inherited errors of metabolism may be detected if marker genes for a disease such as Tay-Sachs and thalassemia are present. Fetal diabetes and cardiac disorders cannot be detected with amniocentesis. Fetal lung maturity cannot be determined until after 35 weeks' gestation.

A 15-year-old adolescent with Down syndrome is scheduled for surgery. The parents inform the nurse that their child has a mental age of 8 years. At what age level should the nurse prepare the child's preoperative teaching plan? 1 Adult, for the parents to understand 2 Specific age, as ordered by the healthcare provider 3 Adolescent, because this is the child's chronologic age 4 School-age, because this is the child's developmental age

4 School-age, because this is the child's developmental age A child who is undergoing a procedure needs to be prepared in an easily understood manner; teaching should be directed at the developmenta l, not chronologic, age of this adolescent. The healthcare provider informs the parents about the surgery and its outcomes as a part of informed consent; the nurse may elaborate on this information or correct misinterpretations. It is the nurse's responsibility to prepare the adolescent for the surgery; the healthcare provider may or may not address this need. Information designed for an adolescent will exceed the cognitive ability of a child with the developmental age of 8 years.