RNSG 2201 Chapter 37: Impact of Cognitive and Sensory Impairment on the Child and Family NCLEX/EAQs

B (Children with Down syndrome have the same need for socialization as other children.)

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 nurse's 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.

D (Notify parents that adolescent needs to see an ophthalmologist.)

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 (Myopia)

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

C (Risk for Injury.)

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.

B (Cochlear implant.)

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.

C (Atlantoaxial instability)

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 (Brushfield's spots)

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

A (Safety)

The major consideration when selecting toys for a child who is cognitively impaired is: a. Safety. b. Age appropriateness. c. Ability to provide exercise. d. Ability to teach useful skills.

C (White eye reflex.)

The most common clinical manifestation of retinoblastoma is: a. Glaucoma. c. White eye reflex. b. Amblyopia. d. Sunken eye socket.

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

C (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.)

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? A. "Autism is caused by a high intake of proteins during pregnancy." B. "The disorder is caused by vaccines that contain thimerosal." C. "The exact cause of autism spectrum disorders is unknown." D. "Alcohol consumption during pregnancy is linked to autism."

C (Able to independently care for the lenses in a responsible manner.)

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.

D (Infantile glaucoma.)

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

A, C, D (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.)

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: A. Screeches happily when looking at a toy. B. Has difficulty trying to read a book. C. Does not respond when an alarm sounds. D. Points at his tummy to indicate hunger. E. Speaks fast, stutters, and has speech delay.

A (Conductive.)

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.

B (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.)

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: A. To see whether the infant's eyes move toward a flashlight. B. The infant's response to an auditory stimulus. C. The infant's vocal expressions during vocal communication. D. The infant's physical activity toward a large moving object.

C, D, E (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.)

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. A. Loss of pain sensation B. Loss of impulse control C. Loss of established motor skill D. Loss of established bowel control E. Loss of established bladder control

A, B, C (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 for prognostic factors. What findings in the child suggest a better prognosis? Select all that apply. A. Male sex B. Early recognition C. Functional speech D. Lower intelligence E. Behavioral impairment

C (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 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: A. myopia. B. hyperopia. C. amblyopia. D. astigmatism.

C (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.)

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: A. Explains the different departments of the hospital. B. Understands the child's behavior and daily routine. C. Describes the surroundings of the room and the unit. D. Asks the cleaner to move the furnishings around

B (Child's routine habits and preferences are maintained.)

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

A (Maintain a structured routine and keep stimulation to a minimum.)

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 (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.)

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? A. Ask the parents to accompany the child. B. Modify the room according to the child's needs. C. Explain the surroundings of the room. D. Help the child perform daily routine tasks.

C (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 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? A. Aromatherapy and hydrotherapy B. Protein replacement and gene therapy C. Language and occupational therapy D. Hormone and biologic therapy

C (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 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? A. To protect the right eye from dust B. To reduce intraocular pressure in the left eye C. To increase vision in the left eye D. To prevent the child from rubbing the right eye

A (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.)

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? A. Short and broad neck B. Long and thin fingers C. Short and thin lips D. Broad and long nose

C, D (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.)

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. A. All of their sons will have a 50% chance of being affected. B. All of their sons will be carriers for fragile X syndrome. C. The chance of a daughter being affected is 50%. D. All daughters will be carriers for fragile X syndrome. E. All sons will be carriers and will have fragile X syndrome.

C (Irrigate eyes copiously with tap water for 20 minutes)

A father calls the emergency department nurse saying that his daughter's eyes burn after getting some dishwasher detergent in them. The nurse recommends that the child be seen in the emergency department or by an ophthalmologist. What should the nurse recommend before the child is transported? a. Keep the eyes closed. b. Apply cold compresses. c. Irrigate eyes copiously with tap water for 20 minutes. d. Prepare a normal saline solution (salt and water) and irrigate eyes for 20 minutes.

B (Down syndrome)

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.

D (Chronic otitis media.)

A nurse is preparing a teaching session for parents on prevention of childhood hearing loss. The nurse should include that the most common cause of hearing impairment in children is: a. Auditory nerve damage. b. Congenital ear defects. c. Congenital rubella. d. Chronic otitis media.

C (Demonstrate a dressing change on a doll.)

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? a. Verbally explain what will be done. b. Have the child watch a video on dressing changes. c. Demonstrate a dressing change on a doll. d. Explain the importance of keeping the burn area clean.

B ("The onset of autism usually occurs before 3 years of age.")

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."

A (Excessive rubbing of the eyes.)

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.

B (The best method for early detection of cognitive disorders.)

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 (May be caused by a variety of factors.)

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.

A, C (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 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: A. Have vision difficulties." B. Have growth impairment." C. Have difficulty hearing." D. Develop breathing problems." E. Not be able to concentrate."

B (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.)

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: A. Does not keep a stool or small desk near the bed. B. Instructs the cleaner not to move the furniture around. C. Gives the child work to do while the child is in the hospital. D. Does not educate the child about the treatment procedures.

C (Moderately cognitively impaired but trainable.)

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.

D (Cover the "good" eye completely with a patch.)

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

B (Provide peer experiences such as Special Olympics when older.)

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.

A, D, E (Language as used in social communication Symbolic or imaginative play Social interaction)

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

B (Sensorineural)

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 (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.)

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: A. Reading development. B. Speech development. C. Relationships with peers. D. Performance at school

A (Have an extremely developed skill in a particular area.)

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 (Being involved in immunization clinics for children.)

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, B, E (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.)

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. A. Verbal impairment B. Stereotyped behavior patterns C. Hearing and visual impairment D. Nonrepetitive behavioral patterns E. Decreased involvement in play

A (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 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? A. "Children with Down syndrome have lower muscle tone." B. "This happens in some children because of undeveloped bonding." C. "Are you more apprehensive because your child has Down syndrome?" D. "You should see a counselor to help you cope with your child's condition."

A, C, D (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 is assessing a patient with strabismus. Which finding would suggest the cause of strabismus? Select all that apply. A. Poor vision B. Short eyeball C. Congenital defect D. Muscle imbalance E. Unequal curvature in the lens

C (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.)

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

C (Individuals with cognitive impairment need a well-defined, concrete code of sexual conduct.)

The nurse is discussing sexuality with the parents of an adolescent girl with moderate cognitive impairment. Which should the nurse consider when dealing with this issue? a. Sterilization is recommended for any adolescent with cognitive impairment. b. Sexual drive and interest are limited in individuals with cognitive impairment. c. Individuals with cognitive impairment need a well-defined, concrete code of sexual conduct. d. Sexual intercourse rarely occurs unless the individual with cognitive impairment is sexually abused.

D (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.)

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

A ("I am going to request a referral to a hearing specialist.")

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 sister's baby, who is only 9 months old." Which statement by the nurse would be most appropriate to make? a. "I am going to request a referral to a hearing specialist." b. "You should not compare your child to your sister's child." c. "I think your child is fine, but we will check again in 3 months." d. "You should ask other parents what noises their children made at this age."

C (Suggest that he reinsert the hearing aid.)

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.

B (Applying a Fox shield to the affected eye and any type of patch to the other eye.)

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.

C, E (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 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. A. It is caused by a mutation of chromosomes. B. It is more likely to occur if the paternal age is more than 35 years. C. It is more likely to occur if the maternal age is more than 35 years. D. It is caused by acquisition of an extra sex chromosome. E. It is caused by acquisition of an extra autosomal chromosome.

B (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 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: A. Cognitive impairment. B. Difficulty hearing. C. Normal development. D. Chronic mental illness.

D (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 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? A. "The child compensates by increasing listening to your voice and smiling." B. "The child's attention span decreases when a parent is trying to communicate." C. "The child does not make throaty sounds when a parent is trying to communicate." D. "The child's breathing or activity increases when the child is in contact with or near a parent."

D (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 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? A. Examine the eye to look for foreign bodies. B. Irrigate the eye to remove the needle from the eye. C. Evert the upper eyelid to wash the eye thoroughly. D. Observe for hyphema and reaction of the pupil to light.

C (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.)

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: A. Needs hematologic assessment for confirmation of diagnosis." B. May not be able to distinguish between colors." C. May not see clearly for some time after the examination." D. Needs immediate hospitalization after the examination."

C (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.)

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

C (The second most common genetic cause of cognitive impairment.)

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.

D (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.)

What nursing care should be provided to a school-aged child with cognitive impairment? A. Periodic testing of thyroid function B. Education on sexuality C. Education on self-care skills for the child D. Speech therapy referral for the child

C (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.)

What should the nurse do to communicate with a patient who is cognitively impaired and speaks a foreign language? A. Insert the patient's hearing aids. B. Use verbal expressions. C. Use a language translator. D. Use visual aids and drawings.

C (The child may exhibit monotone speech and echolalia.)

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.

B (Achieves a mental age of 8 to 12 years.)

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

C (Congenital heart disease.)

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.

A (As young as possible.)

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 (Speaking at an even rate)

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

C (Encourage parents to leave the child alone for extended periods of time.)

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

A, B, D (High-arched, narrow palate Protruding tongue Transverse palmar crease)

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

B, C, E (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.)

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

C ("When the eye drainage improves, we'll stop giving the antibiotic ointment.")

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

C (Wear eye protection when participating in high-risk sports such as paintball.)

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 (Cataract)

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