Unit 5 Development and Cognition NUR 2261

Which behavior would be typical for a child with autism? A. Lack of eye contact B. Crying for attention C. Catatonia-like rigidity D. Engaging in parallel play

ANS: A Lack of eye contact

Which clinical findings associated with Down syndrome should the nurse expect when performing a physical assessment? Select all that apply. A. Saddle nose B. Thin fingers C. Inner epicanthic folds D. Transverse palmar crease

ANS: A, C, D A: Saddle nose C: Inner epicanthic folds D: Transverse palmar crease

Which nutrition-related problem would the nurse address when teaching childhood nutrition to a group of parents whose children have Down syndrome? A. Rickets B. Obesity C. Anemia D. Rumination

ANS: B Obesity

At which age are the signs of autism initially evident? A. 1 to 3 months B. 6 months C. 2 years D. 6 years

ANS: C 2 years

List the interventions in order, from the least invasive to the most invasive, for a child with attention-deficit hyperactivity disorder (ADHD) who often becomes frustrated and loses control. A. Place the child in a time-out. B. Use a signal to remind the child to use self-control. C. Monitor behavior for cues of rising anxiety. D. Avoid situations that usually precipitate frustration. F. Refocus the child's behavior with a specific directive.

ANS: D,C,B,F,A

A child who has attention-deficit/hyperactivity disorder (ADHD) is prescribed methylphenidate hydrochloride. Which behavior indicates the child needs further treatment? A. The child follows instructions given by teachers on a regular basis. B. The child remains attentive during long classes while seated at a desk. C. The child experiences difficulty keeping school assignments organized. D. When instructed to wait, the child sits in one place without complaint.

ANS: C The child experiences difficulty keeping school assignments organized.

Which nursing objective would the nurse add to the plan of care for a child with attention-deficit/hyperactivity disorder (ADHD) who engages in self-destructive behavior? A. Keeping the child from inflicting any self-injury B. Assisting the child to improve communication skills C. Helping the child formulate realistic ego boundaries D. Providing the child with opportunities to discharge energy

ANS: A Keeping the child from inflicting any self-injury

When a 5-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) bounces out of a chair and runs over and slaps another child, what is the nurses best action? a. Instruct the parents to take the aggressive child home. b. Direct the aggressive child to stop immediately. c. Call for emergency assistance from other staff. d. Take the aggressive child to another room.

ANS: D The nurse should manage the milieu with structure and limit setting. Removing the aggressive child to another room is an appropriate consequence for the aggressiveness. Directing the child to stop will not be effective. This is not an emergency. Intervention is needed rather than sending the child home.

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.

Fragile X syndrome is the most common inherited cause of cognitive impairment and the second most common genetic cause of cognitive impairment after Down syndrome. Fragile X primarily affects males and follows the pattern of X-linked dominant disorders with reduced penetrance.

Which assessment finding would cause the nurse to consider a child to be most at risk for the development of mental illness? a. The child has been raised by a parent with recurring major depressive disorder. b. The child's best friend was absent from the child's birthday party. c. The child was not promoted to the next grade one year. d. The child moved to three new homes over a 2-year period.

ANS: A Children raised by a depressed parent have an increased risk of developing an emotional disorder. Familial risk factors correlate with child psychiatric disorders, including severe marital discord, low socioeconomic status, large families and overcrowding, parental criminality, maternal psychiatric disorders, and foster-care placement. The chronicity of the parent's depression means it has been a consistent stressor. The other factors are not as risk-enhancing.

Which nursing diagnosis is universally applicable for children diagnosed with autism spectrum disorders? a. Impaired social interaction related to difficulty relating to others b. Chronic low self-esteem related to excessive negative feedback c. Deficient fluid volume related to abnormal eating habits d. Anxiety related to nightmares and repetitive activities

ANS: A Children diagnosed with autism spectrum disorders display profoundly disturbed social relatedness. They seem aloof and indifferent to others, often preferring inanimate objects to human interaction. Language is often delayed and deviant, further complicating relationship issues. The other nursing diagnoses might not be appropriate in all cases.

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.

ANS: A Providing a structured routine for the child to follow is key in the management of ASD. Decreasing stimulation by using a private room, avoiding extraneous auditory and visual distractions, and encouraging the parents to bring in possessions the child is attached to may lessen the disruptiveness of hospitalization. Because physical contact often upsets these children, minimum holding and eye contact may be necessary to avoid behavioral outbursts. Children with ASD need to be introduced slowly to new situations, with visits with staff caregivers kept short whenever possible. The playroom would be too overwhelming with new people and situations and should not be a priority of care.

Methylphenidate has been prescribed with meals for a child with attention-deficit/hyperactivity disorder (ADHD). Which rationale would the nurse provide for the parents about the timing of the medication administration? A. Ritalin depresses the appetite. B. This will ensure proper absorption. C. It is an oral mucous membrane irritant. D. Children tend to forget to take it before meals.

ANS: A Ritalin depresses the appetite. A side effect of methylphenidate is anorexia; it should be given during or immediately after breakfast. The absorption rate is not affected by the timing of when it is given. Oral mucous membrane irritation is not a side effect of methylphenidate. In a child of this age the parents are responsible for administering medications.

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

ANS: A The childs education should begin as soon as possible. Considerable evidence exists that early intervention programs for children with disabilities are valuable for cognitively impaired children. The early intervention may facilitate the childs development of communication skills. States are encouraged to provide early intervention programs from birth under Public Law 101-476, the Individuals with Disabilities Act.

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

ANS: A, B, D The assessment findings of Down syndrome include high-arched, narrow palate; protruding tongue; and transverse palmar creases. The fingers are stubby and the muscle tone is hypotonic, not hypertonic.

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

ANS: A, D, E Language as used in social communication, symbolic or imaginative play, and social interaction are three of the areas in which autistic children may show delayed or abnormal functioning. Gross motor development and growth below the 5th percentile for height and weight are not areas in which autistic children may show delayed or abnormal functioning.

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? A. "My baby will have growth deficiencies during infancy." B. "My child will have accelerated growth during adolescence." C. "My child will most likely be overweight by 3 years of age." D. "My baby will have reduced growth in both height and weight."

ANS: B "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.

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

ANS: B By the end of adolescence, the child with mild cognitive impairment can usually acquire social and vocational skills, may need occasional guidance and support when under unusual social or economic stress, and may be able to adjust to marriage but not childrearing. Achieving a mental age of 5 to 6 years is considered a level of skill development associated with severe cognitive impairment. Being unable to progress in functional reading or math would indicate a level of skill development associated with profound cognitive impairment. Acquiring practical skills and useful reading and math to an eighth-grade level represents a level of skill development

Which assessment findings would the nurse report to the health care provider as a possible sign of autism in an 18-month-old child? a. Child clings to mother or father during times of stress and fatigue b. Child avoids eye contact and does not respond to facial expressions c. Child cries when the nurse approaches to do the physical examination d. Child verbalizes using single words with gestures and hand motions

ANS: B Child avoids eye contact and does not respond to facial expressions

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.

ANS: B Early detection of cognitive disorders can be facilitated through assessment of development at each well-child examination. Developmental assessment is a component of all well-child examinations; however, they are not intended to measure intelligence. Developmental assessments are not frightening when the parent and child are educated about the purpose of the assessment.

Which action would the nurse take for a 6-year-old child with autism spectrum disorder who is nonverbal and makes limited eye contact? A. Encourage the child to sing songs with the nurse. B. Engage in parallel play while sitting next to the child. C. Provide opportunities for the child to play with other children. D. Use therapeutic holding when the child does not respond to verbal interactions

ANS: B Engage in parallel play while sitting next to the child.

A nurse working in a pediatric clinic recognizes that which child is most at risk for cognitive impairment? a. An infant who is being fed reconstituted powdered formula b. A toddler living in an older home that is being remodeled c. A preschooler who attends a play group 3 days a week d. A school-age child who rides a school bus 5 days a week

ANS: B Older homes frequently have lead-based paint; paint chips generated by remodeling put toddlers, who often put foreign objects in their mouths, at risk for exposure to lead which is a known toxic substance that can affect cognitive function. Powdered formulas, attendance at play groups, or riding on a school bus are not known to impair cognitive development

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.

ANS: B The acquisition of social skills is a complex task. Children of all ages need peer relationships. Parents should enroll the child in preschool. When older, the child should have peer experiences similar to other children, such as group outings, Boy or Girl Scouts, and Special Olympics. Providing age-appropriate toys and play activities is important, but peer interactions will facilitate social development. Parents should expose the child to strangers so the child can practice social skills. Verbal skills are delayed more than physical skills.

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.

ANS: B There are a multitude of causes for intellectual impairment. In most cases, a specific cause has not been identified. Only a small percentage of children with intellectual impairment are affected by a genetic defect. One third of children with intellectual impairment are affected by first-trimester events. Intellectual impairment can be transmitted to a child only if the parent has a genetic disorder.

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.

ANS: B These are characteristics associated with Down syndrome. The infant with microcephaly has a small head. Cerebral palsy is a diagnosis not usually made at birth. No characteristic physical signs are present. The infant with fragile X syndrome has increased head circumference; long, wide, and/or protruding ears; long, narrow face with prominent jaw; hypotonia; and high, arched palate.

Which strategy would the nurse employ to be effective when using play therapy with a 6-year-old child with autism? a. Play music and dance with the child. b. Use mechanical and inanimate objects for play. c. Employing positive reinforcements such as hugging. d. Provide brightly colored toys and blocks that can be held

ANS: B Use mechanical and inanimate objects for play. Self-isolation and disinterest in interpersonal relationships lead the autistic child to find security in nonthreatening, impersonal objects. Dancing with the child is too threatening for a child with autism because of the close personal contact it requires. Close interaction, such as hugging, with others is too threatening for a child with autism. These children do not respond to brightly colored toys and blocks as other children do unless movement is involved

A nurse prepares to lead a discussion at a community health center regarding childrens health problems. The nurse wants to use current terminology when discussing these issues. Which terms are appropriate for the nurse to use? Select all that apply. a. Autism b. Bullying c. Mental retardation d. Autism spectrum disorder e. Intellectual development disorder

ANS: B, D, E Some dated terminology contributes to the stigma of mental illness and misconceptions about mental illness. Its important for the nurse to use current terminology.

A pregnant client whose first child has Down syndrome is about to undergo amniocentesis. The client tells the nurse that she does not know what she will do if this fetus has the same diagnosis and asks if the nurse thinks that abortion is the same as killing. Which response would the nurse give? A. "Some people think that that's what an abortion is." B. "No, I don't think so, but it's your decision to make." C. "I really can't answer that question. Are you ambivalent about abortion?" D. "I don't want to answer that question at this time. How do you feel about it?"

ANS: C "I really can't answer that question. Are you ambivalent about abortion?"

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.

ANS: C Adolescents with moderate cognitive impairment may be easily persuaded and lack judgment. A well-defined, concrete code of conduct with specific instructions for handling certain situations should be laid out for the adolescent. Permanent contraception by sterilization presents moral and ethical issues and may have psychologic effects on the adolescent. It may be prohibited in some states. The adolescent needs to have practical sexual information regarding physical development and contraception. Cognitively impaired individuals may desire to marry and have families. The adolescent needs to be protected from individuals who may make intimate advances.

A kindergartener is disruptive in class. This child is unable to sit for expected lengths of time, inattentive to the teacher, screams while the teacher is talking, and is aggressive toward other children. The nurse plans interventions designed to: a. promote integration of self-concept. b. provide inpatient treatment for the child. c. reduce loneliness and increase self-esteem. d. improve language and communication skills.

ANS: C Because of their disruptive behaviors, children with ADHD often receive negative feedback from parents, teachers, and peers, leading to self-esteem disturbance. These behaviors also cause peers to avoid the child with ADHD, leaving the child with ADHD vulnerable to loneliness. The child does not need inpatient treatment at this time. The incorrect options might or might not be relevant.

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.

ANS: C Children with CI have a marked deficit in their ability to discriminate between two or more stimuli because of difficulty in recognizing the relevance of specific cues. However, these children can learn to discriminate if the cues are presented in an exaggerated, concrete form and if all extraneous stimuli are eliminated. Therefore, demonstration is preferable to verbal explanation, and learning should be directed toward mastering a skill rather than understanding the scientific principles underlying a procedure. Watching a video would require the use of both visual and auditory stimulation and might produce overload in the child with mild CI. Explaining the importance of keeping the burn area clean would be too abstract for the child.

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 (Brushfields spots)

ANS: C Children with Down syndrome are at risk for atlantoaxial instability. Before participating in sports that put stress on the head and neck, a radiologic examination should be done. Although hyperflexibility, cutis marmorata, and Brushfields spots are characteristics of Down syndrome, they do not affect the childs ability to participate in sports.

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.

ANS: C Children with autism have abnormalities in the production of speech, such as a monotone voice or echolalia, or inappropriate volume, pitch, rate, rhythm, or intonation. The child has impaired verbal communication and abnormalities in the production of speech. Some autistic children may use sign language, but it is not assumed.

Which comorbidity is associated Down syndrome? A. Renal disease B. Hepatic defects C. Congenital heart disease D. Endocrine gland malfunction

ANS: C Congenital heart disease

Which behavior indicates that the treatment plan for a child diagnosed with an autism spectrum disorder was effective? The child: a. plays with one toy for 30 minutes. b. repeats words spoken by a parent. c. holds the parents hand while walking. d. spins around and claps hands while walking.

ANS: C Holding the hand of another person suggests relatedness. Usually, a child with an autism spectrum disorder would resist holding someones hand and stand or walk alone, perhaps flapping arms or moving in a stereotyped pattern. The incorrect options reflect behaviors that are consistent with autism spectrum disorders.

Which characteristic is commonly seen in children who have autism? A. Excessive response to any stimulus B. Normal response to physical contact C. Lacks response to the environment D. Limited response due to low intelligence

ANS: C Lacks response to the environment poor interpersonal relationships, inappropriate behavior, and learning disabilities prevent autistic children from emotionally adapting or responding to the environment even when the intelligence level is high. It is the lack of response to stimuli that is the clue that the child may have autism. Children with autism have an aversion to physical contact. Low level of intelligence is not a defining characteristic for autistic children.

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.

ANS: C Moderately cognitively impaired IQs range from 35 to 55. The lower limit of normal intelligence is approximately 70 to 75. Individuals with IQs of 50 to 70 are considered mildly cognitively impaired but educable. An IQ of 20 to 40 results in severe cognitive impairment.

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

ANS: C The child with Down syndrome needs routine schedules and consistency. Having familiar people present, especially parents, helps to decrease the childs anxiety. To communicate effectively with the child, it is important to know the childs particular vocabulary for specific body functions. Children with Down syndrome have a high incidence of hearing loss and vision problems and should have hearing and vision assessed whenever they are in a health care facility. Meals should be served at the usual mealtimes because routine schedules and consistency are important to children with Down syndrome.

A child diagnosed with attention deficit hyperactivity disorder (ADHD) shows hyperactivity, aggression, and impaired play. The health care provider prescribed amphetamine salts (Adderall). The nurse should monitor for which desired behavior? a. Increased expressiveness in communication with others b. Abilities to identify anxiety and implement self-control strategies c. Improved abilities to participate in cooperative play with other children d. Tolerates social interactions for short periods without disruption or frustration

ANS: C The goal is improvement in the childs hyperactivity, aggression, and play. The remaining options are more relevant for a child with intellectual development disorder or an anxiety disorder.

What is the nurses priority focused assessment for side effects in a child taking methylphenidate (Ritalin) for attention deficit hyperactivity disorder (ADHD)? a. Dystonia, akinesia, and extrapyramidal symptoms b. Bradycardia and hypotensive episodes c. Sleep disturbances and weight loss d. Neuroleptic malignant syndrome

ANS: C The most common side effects are gastrointestinal disturbances, reduced appetite, weight loss, urinary retention, dizziness, fatigue, and insomnia. Weight loss has the potential to interfere with the childs growth and development. The distracters relate to side effects of conventional antipsychotic medications.

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.

ANS: C The nurse needs to know that limited cognitive abilities to anticipate danger lead to risk for injury. Impaired social interaction is indeed a concern for the child with a cognitive disorder but does not address the limitedability to anticipate danger. Because of the childs cognitive deficit, knowledge will not be retained and will not decrease the risk for injury. Ineffective individual coping does not address the limited ability to anticipate danger.

Assessment data for a 7-year-old reveals an inability to take turns, blurting out answers to questions beforea question is complete, and frequently interrupting others conversations. How should the nurse document these behaviors? a. Disobedience b. Hyperactivity c. Impulsivity d. Anxiety

ANS: C These behaviors are most directly related to impulsivity. Hyperactive behaviors are more physical in nature, such as running, pushing, and the inability to sit. Inattention is demonstrated by failure to listen. Defiance is demonstrated by willfully doing what an authority figure has said not to do.

A 7-year-old, who is described as impulsive and hyperactive, tells the nurse, "I am a dummy, because I don't pay attention, and I can't read like the other kids." The nurse notes that these behaviors are most consistent with which diagnosis? A. Attention deficit disorder B. Conduct disorder C. Autism D. Attention deficit hyperactivity disorder

ANS: D The data are most consistent with attention deficit hyperactivity disorder (ADHD) as described in the DSM-5. The other options present with characteristics and behaviors that differ from those in the scenario.

A child with attention-deficit/hyperactivity disorder (ADHD) is prescribed methylphenidate. The mother asks about its action and side effects. Which response by the nurse is most appropriate? A. "This medicine increases the appetite." B. "This medicine must be continued until adulthood." C. "It is a short-acting medicine that must be given with each meal." D. "It is a stimulant that has a calming effect on children with ADHD."

ANS: D "It is a stimulant that has a calming effect on children with ADHD." Although the exact mechanism is unknown, clinical improvements have been reported with sympathomimetic amines such as methylphenidate. After the purpose and action of the drug are explained, the nurse should review side effects with the parent. The appetite of a child taking methylphenidate usually diminishes. The child should be medicated for as short a period as possible. Each child is evaluated individually. The duration of methylphenidate is 3 to 6 hours, or 8 hours with the extended-release form.

A pregnant woman presents in labor at term, having had no prenatal care. After birth her infant is noted to be small for gestational age with small eyes and a thin upper lip. The infant also is microcephalic. On the basis of her infants physical findings, this woman should be questioned about her use of which substance during pregnancy? a. Alcohol b. Cocaine c. Heroin d. Marijuana

ANS: A The description of the infant suggests fetal alcohol syndrome, which is consistent with maternal alcohol consumption during pregnancy. Fetal brain, kidney, and urogenital system malformations have been associated with maternal cocaine ingestions. Heroin use in pregnancy frequently results in intrauterine growth restriction. The infant may have a shrill cry and sleep cycle disturbances and present with poor feeding, tachypnea, vomiting, diarrhea, hypothermia or hyperthermia, and sweating. Studies have found a higher incidence of meconium staining in infants born of mothers who used marijuana during pregnancy.

A client has just given birth to an infant with Down syndrome. The mother is crying and asks the nurse what she is supposed to do now. Which response would the nurse give? A. "Tell me what you know about Down syndrome." B. "I would just continue to rest and recover from your delivery." C. "You really need to pull yourself together for your baby." D. "Should I call in a chaplain or social worker for you?"

ANS: A "Tell me what you know about Down syndrome."

The child prescribed an antipsychotic medication to manage violent behavior is one most likely diagnosed with: a. attention deficit hyperactivity disorder. b. posttraumatic stress disorder. c. communication disorder. d. an anxiety disorder.

ANS: A Antipsychotic medication is useful for managing aggressive or violent behavior in some children diagnosed with attention deficit hyperactivity disorder. If medication were prescribed for a child with an anxiety disorder, it would be a benzodiazepine. Medications are generally not needed for children with communication disorder. Treatment of PTSD is more often associated with SSRI medications.

A child diagnosed with attention deficit hyperactivity disorder will begin medication therapy. The nurse should prepare a plan to teach the family about which classification of medications? a. Central nervous system stimulants b. Tricyclic antidepressants c. Antipsychotics d. Anxiolytics

ANS: A Central nervous system stimulants, such as methylphenidate and pemoline (Cylert), increase blood flow to the brain and have proved helpful in reducing hyperactivity in children and adolescents with attention deficit hyperactivity disorder. The other medication categories listed would not be appropriate.

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.

ANS: A Safety is the primary concern in selecting recreational and exercise activities for all children. This is especially true for children who are cognitively impaired. Age appropriateness, the ability to provide exercise, and the ability to teach useful skills are all factors to consider in the selection of toys, but safety is of paramount importance.

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.

ANS: A Some children with autism have an extremely developed skill in a particular area, such as mathematics or music. No evidence supports that autism is outgrown. Autistic children have abnormal ways

The nurse is caring for a child who has attention-deficit/hyperactivity disorder (ADHD). Which changes in the child's classroom will be beneficial? Select all that apply. One, some, or all responses may be correct. A. Providing breaks frequently at regular intervals B. Writing instructions on the blackboard after verbalization C. Increasing the number of classroom assignments and homework D. Improving the writing skills of the child compared with computer skills E. Scheduling academic subjects for times when the child is under the effect of medication

ANS: A, B, E A: Providing breaks frequently at regular intervals B: Writing instructions on the blackboard after verbalization E: Scheduling academic subjects for times when the child is under the effect of medication

For a child with attention-deficit/hyperactivity disorder (ADHD), which behaviors are expected? Select all that apply. One, some, or all responses may be correct. A. Impulsiveness B. Excessive talking C. Spitefulness and vindictiveness D. Deliberate annoyance of others E. Playing video games for hours on end F. Failure to follow through or finish tasks

ANS: A, B, E, F A. Impulsiveness B. Excessive talking E. Playing video games for hours on end F. Failure to follow through or finish tasks Impulsivity, the inability to limit or control words or actions, results in spontaneous, irresponsible verbalizations or behaviors. Hyperactivity occurs with both words and actions. Games that are fun, engaging, and interactive often maintain the focus of a child with ADHD. Inattention and distractibility result in inability to focus long enough to complete tasks. Being spiteful and vindictive toward others is characteristic of oppositional defiant disorder. Annoying others deliberately is associated with oppositional defiant disorder; children with ADHD may be annoying, but their behavior is not deliberate.

Which craniofacial characteristics indicate to the nurse that the newborn has fetal alcohol syndrome (FAS)? Select all that apply. One, some, or all responses may be correct. A. Thin upper lip B. Wide-open eyes C. Small upturned nose D. Larger-than-average head E. Smooth vertical ridge in the upper lip

ANS: A, C, E A: Thin upper lip C: Small upturned nose E: Smooth vertical ridge in the upper lip The abnormal facial characteristics associated with FAS include: - vermilion (a thin upper lip) - philtrum (a small upturned nose, and a smooth vertical ridge) in the upper lip all of which are distinctive in these infants. Infants with FAS have: - small eyes with epicanthic folds - rather than wide-open eyes - microcephaly (head circumference less than the tenth percentile)

A nurse working in a pediatric clinic recognizes that which child is most at risk for cognitive impairment? a. An infant who is being fed reconstituted powdered formula b. A toddler living in an older home that is being remodeled c. A preschooler who attends a play group 3 days a week d. A school-age child who rides a school bus 5 days a week

ANS: B Older homes frequently have lead-based paint; paint chips generated by remodeling put toddlers, who often put foreign objects in their mouths, at risk for exposure to lead which is a known toxic substance that can affect cognitive function. Powdered formulas, attendance at play groups, or riding on a school bus are not known to impair cognitive development

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 nurses 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.

ANS: B Children of all ages need peer relationships. Children with Down syndrome should have peer experiences similar to those of other children, such as group outings, Cub Scouts, and Special Olympics, which can all help children with cognitive impairment to develop socialization skills. Although all children should have an opportunity to form a close relationship with someone of the same developmental level, it is appropriate for children with disabilities to develop relationships with children who do not have disabilities. The parents are acting as advocates for their child.

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

ANS: B Children with autism are often unable to tolerate even slight changes in routine. The childs routine habits and preferences are important to maintain. Focus of care is on the childs needs rather than on the parents desires. Autism is a lifelong condition. The presence of the parents is almost always required when an autistic child is hospitalized.

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.

ANS: B The onset of autism usually occurs before 3 years of age. Autism does not have periods of remission and exacerbation. Autistic children lack imitative skills. Medications are of limited use in children with autism.

At the time of a home visit, the nurse notices that each parent and child in a family has his or her own personal online communication device. Each member of the family is in a different area of the home. Which nursing actions are appropriate? Select all that apply. a. Report the finding to the official child protection social services agency. b. Educate all members of the family about risks associated with cyberbullying. c. Talk with the parents about parental controls on the childrens communication devices. d. Encourage the family to schedule daily time together without communication devices. e. Obtain the familys network password and examine online sites family members have visited.

ANS: B, C, D Education and awareness-based approaches have a chance of effectively reducing harmful online behavior, including risks associated with cyberbullying. Parental controls on the childrens devices will support safe internet use. Family time together will promote healthy bonding and a sense of security among members. There is no evidence of danger to the children, so a report to child protective agency is unnecessary. It would be inappropriate to seek the familys network password and an invasion of privacy to inspect sites family members have visited.

Which actions would the nurse implement to empower a family who has a child with Down syndrome? Select all that apply. One, some, or all responses may be correct. A. Ask the family to engage in spiritual activities. B. Help the family recognize the possible stressors. C. Encourage the use of problem-solving strategies. D. Encourage more out-of-home activities for the parents. E. Refer the family to support groups and Internet resources.

ANS: B, C, E B: Help the family recognize the possible stressors. C: Encourage the use of problem-solving strategies. E: Refer the family to support groups and Internet resources.

A nurse will prepare teaching materials for the parents of a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which medication will the information focus on? a. Paroxetine (Paxil) b. Imipramine (Tofranil) c. Methyphenidate (Ritalin) d. Carbamazepine (Tegretol)

ANS: C CNS stimulants are the drugs of choice for treating children with ADHD: Ritalin and dexedrine are commonly used. None of the other drugs are psychostimulants used to treat ADHD.

Which clinical finding would prompt the nurse to perform further assessment of an infant with Down syndrome? A. Flat occiput B. Small, low-set ears C. Circumoral cyanosis D. Protruding furrowed tongue

ANS: C Circumoral cyanosis

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.

ANS: C Congenital heart malformations, primarily septal defects, are very common congenital anomalies in Down syndrome. Hypospadias, pyloric stenosis, and congenital hip dysplasia are not frequent congenital anomalies associated with Down syndrome.

The parent of an infant with Down syndrome asks the cause. Before responding, the nurse recalls that the genetic factor of Down syndrome results from which? A. An intrauterine infection B. An X-linked genetic disorder C. Extra chromosomal material D. An autosomal recessive gene

ANS: C 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.

When group therapy is prescribed as a treatment modality, the nurse would suggest placement of a 9-year- old in a group that uses: a. guided imagery. b. talk focused on a specific issue. c. play and talk about a play activity. d. group discussion about selected topics.

ANS: C Group therapy for young children takes the form of play. For elementary school children, therapy combines play and talk about the activity. For adolescents, group therapy involves more talking.

A desired outcome for a 12-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care? a. Reality therapy b. Simple restitution c. Social skills group d. Insight-oriented group therapy

ANS: C Social skills training teaches the child to recognize the impact of his or her behavior on others. It uses instruction, role-playing, and positive reinforcement to enhance social outcomes. The other therapies would have lesser or no impact on peer relationships.

When a 5-year-old is disruptive, the nurse says, You must take a time-out. The expectation is that the child will: a. go to a quiet room until called for the next activity. b. slowly count to 20 before returning to the group activity. c. sit on the edge of the activity until able to regain self-control. d. sit quietly on the lap of a staff member until able to apologize for the behavior.

ANS: C Time-out is designed so that staff can be consistent in their interventions. Time-out may require going to a designated room or sitting on the periphery of an activity until the child gains self-control and reviews the episode with a staff member. Time-out may not require going to a designated room and does not involve special attention such as holding. Counting to 10 or 20 is not sufficient.

Which instructions would the nurse include in parent teaching for their 6-year-old child with autism spectrum disorder who exhibits frequent spinning and hand-flapping behaviors? A. Hold the child. B. Place the child in time-out. C. Use another activity to distract the child. D. Determine the reason for the child's behavior.

ANS: C Use another activity to distract the child. Providing a constructive distraction will help redirect the autistic child's behavior. Physical contact provokes anxiety for the autistic child. A time-out is punitive and is not constructive. The reason for this repetitive behavior is unknown.

A nurse prepares the plan of care for a 15-year-old diagnosed with moderate intellectual developmental disorder. What are the highest outcomes that are realistic for this patient? Within 5 years, the patient will: (select all that apply) a. graduate from high school. b. live independently in an apartment. c. independently perform own personal hygiene. d. obtain employment in a local sheltered workshop. e. correctly use public buses to travel in the community.

ANS: C, D, E Individuals with moderate intellectual developmental disorder progress academically to about the second grade. These people can learn to travel in familiar areas and perform unskilled or semiskilled work. With supervision, the person can function in the community, but independent living is not likely.

Which behaviors indicate that the interventions used to help a 6-year-old boy with attention-deficit/hyperactivity disorder (ADHD) have been effective? Select all that apply. One, some, or all responses may be correct. A. Is not inhibited by rules or routines B. Has fun playing with toys by himself C. Waits for others to finish speaking D. Has an increased attention span in school E. Takes a turn during games with others

ANS: C, D, E, C. Waits for others to finish speaking D. Has an increased attention span in school E. Takes a turn during games with others One characteristic of children with ADHD is the inability to remain focused on any activity; an increased attention span in school indicates that the child has improved. Other characteristics of children with ADHD are impulsivity, impatience, and the inability to delay gratification; the ability to wait for one's turn in line indicates that the child has improved. A lack of inhibition by rules or routines indicates that the child has not made sufficient progress and his behavior is still impulsive. Having fun playing with toys by himself indicates that the child has not made progress because children should enjoy playing with peers at this age. A 6-year-old child usually does not experience nocturnal enuresis; there are no data to indicate that the child had enuresis.

Which behaviors are observed in children with autism? Select all that apply. One, some, or all responses may be correct. A. Imitates others B. Engages in cooperative play C. Avoids eye-to-eye contact D. Seeks physical contact E. Performs repetitive activities F. Prefers children rather than adults

ANS: C, E C. Avoids eye-to-eye contact Impairments in social interaction are manifested by a lack of eye contact, a lack of facial responses, and a lack of responsiveness to and interest in others. E. Performs repetitive activities Children with autism display obsessive ritualistic behaviors, such as rocking, spinning, dipping, swaying, walking on toes, head banging, or hand biting, because of their self-absorption and need to stimulate themselves.

A nurse assesses a 3-year-old diagnosed with an autism spectrum disorder. Which finding is most associated with the childs disorder? The child: a. has occasional toileting accidents. b. is unable to read childrens books. c. cries when separated from a parent. d. continuously rocks in place for 30 minutes.

ANS: D Autism spectrum disorder involves distortions in development of social skills and language that include perception, motor movement, attention, and reality testing. Body rocking for extended periods suggests autism spectrum disorder. The distracters are expected findings for a 3-year-old.

Which assessment would the nurse prioritize for a newborn with Down syndrome? a. Reflex responses for hypotonicity b. Eye examination for congenital cataracts c. Sensory examination for muscle flaccidity d. Cardiac irregularities for congenital heart disease

ANS: D 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.

The parent of a 6-year-old says, My child is in constant motion and talks all the time. My child isn't interested in toys but is out of bed every morning before me. The childs behavior is most consistent with diagnostic criteria for: a. communication disorder. b. stereotypic movement disorder. c. intellectual development disorder. d. attention deficit hyperactivity disorder.

ANS: D Excessive motion, distractibility, and excessive talkativeness are seen in attention deficit hyperactivity disorder (ADHD). The behaviors presented in the scenario do not suggest intellectual development, stereotypic, or communication disorder.

Which prognosis for a normal, productive life would be appropriate for a child with autism spectrum disorder? A. Dependent on an accurate diagnosis B. Often related to the child's overall temperament C. Ensured as long as the child attends a school tailored to meet needs D. Guarded because of interference with so many parameters of function

ANS: D Guarded because of interference with so many parameters of function Research studies have shown that the prognosis for normal productive function in autistic people is guarded, particularly if there are delays in language development. Accurate diagnosis and early interventions have not been shown to promote a normal, productive life; however, early intervention may help individuals maximize their abilities. Although temperament may affect the child's response to treatment, it does not affect prognosis to any extent. Stating that success is ensured as long as the child attends a school tailored to meet needs is false reassurance and is not helpful.

Which play activity is the best choice to suggest to the parents of a school-aged child with autism? a. Holding a cuddly toy b. Climbing a jungle gym c. Building with small blocks d. Riding on a playground merry-go-round

ANS: D Riding on a playground merry-go-round The rhythmic movement of the merry-go-round provides an opportunity for the child to practice spatial and sensory orientation. This is important in helping the child increase interaction with the environment. The autistic child rejects cuddling and anything that feels cuddly. Jungle gyms and blocks do not provide rhythmic movements that will engage the child.

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 which age level would the nurse prepare the child's preoperative teaching plan? A. Adult, for the parents to understand B. Specific age, as ordered by the health care provider (HCP) C. Adolescent, because this is the child's chronological age D. School-age, because this is the child's developmental age

ANS: D School-age, because this is the child's developmental age

Which child demonstrates behaviors indicative of a neurodevelopmental disorder? a. A 4-year-old who stuttered for 3 weeks after the birth of a sibling b. A 9-month-old who does not eat vegetables and likes to be rocked c. A 3-month-old who cries after feeding until burped and sucks a thumb d. A 3-year-old who is mute, passive toward adults, and twirls while walking

ANS: D Symptoms consistent with autistic spectrum disorders (ASD) are evident in the correct answer. Autistic spectrum disorder is one type of neurodevelopmental disorder. The behaviors of the other children are within normal ranges.

A child diagnosed with attention deficit hyperactivity disorder had this nursing diagnosis: impaired social interaction related to excessive neuronal activity as evidenced by aggression and demanding behavior with others. Which finding indicates the plan of care was effective? The child: a. has an improved ability to identify anxiety and use self-control strategies. b. has increased expressiveness in communication with others. c. shows increased responsiveness to authority figures. d. engages in cooperative play with other children.

ANS: D The goal should be directly related to the defining characteristics of the nursing diagnosis, in this case, improvement in the childs aggressiveness and play. The distracters are more relevant for a child with autism spectrum or anxiety disorder.

The multiple marker test is used to assess the fetus for which condition? a. Down syndrome b. Diaphragmatic hernia c. Congenital cardiac abnormality d. Anencephaly

ANS: A The maternal serum level of alpha-fetoprotein is used to screen for Down syndrome, neural tube defects, and other chromosome anomalies. The multiple marker test would not detect diaphragmatic hernia, congenital cardiac abnormality, or anencephaly. Additional testing, such as ultrasonography and amniocentesis, would be required to diagnose these conditions

While assessing a newborn suspected of having Down syndrome, which would the nurse expect to note as part of the findings? A. Long, thin fingers B. Large, protruding ears C. Hypertonic neck muscles D. A single crease across each palm

ANS: D A single crease across each palm