Question 1

What condition is defined as reduced visual acuity in one eye despite appropriate optical correction?

Accepted Answer

Amblyopia,or lazy eye,is reduced visual acuity in one eye.Amblyopia is usually caused by one eye not receiving sufficient stimulation.The resulting poor vision in the affected eye can be avoided with the treatment of the primary visual defect such as strabismus.Myopia,or nearsightedness,refers to the ability to see objects clearly at close range but not a distance.Hyperopia,or farsightedness,is the ability to see objects at a distance but not at close range.Astigmatism is unequal curvatures in refractive apparatus.

Question 2

A 2-week-old infant with Down syndrome is being seen in the clinic.His mother tells the nurse that he is difficult to hold,that "he's like a rag doll.He doesn't cuddle up to me like my other babies did." What is the nurse's best interpretation of this lack of clinging or molding?

Accepted Answer

Infants with Down syndrome have hypotonicity of muscles and hyperextensibility of joints,which complicate positioning.The limp,flaccid extremities resemble the posture of a rag doll.Holding the infant is difficult and cumbersome,and parents may feel that they are inadequate.A lack of clinging or molding is characteristic of Down syndrome,not detachment.There is no evidence of maternal deprivation.Autism is not associated with Down syndrome,and it would not be evident at 2 weeks of age.

Question 3

What is a primary goal in caring for a child with cognitive impairment?

Accepted Answer

The goal for children with cognitive impairment is the promotion of optimum social,physical,cognitive,and adaptive development as individuals within a family and community.Vocational skills are only one part of that goal.The focus must also be on the family and other aspects of development.Out-of-home care is considered part of the child's development.Optimum development includes adjustment for both the family and child.

Question 4

What intervention is most appropriate to facilitate social development of a child with a cognitive impairment?

Accepted Answer

The acquisition of social skills is a complex task.Initially,an infant stimulation program should be used.Children of all ages need peer relationships.Parents should enroll the child in preschool.When older,they should have peer experiences similar to those of other children such as group outings,Boy and Girl Scouts,and Special Olympics.Providing age-appropriate toys and play activities is important,but peer interactions facilitate social development.Parents should expose the child to individuals who do not know the child.This enables the child to practice social skills.Verbal skills are delayed more often than physical skills.

Question 5

Secondary prevention for cognitive impairment includes what activity?

Accepted Answer

Secondary prevention involves activities that are designed to identify the condition early and initiate treatment to avert cerebral damage.Inborn errors of metabolism such as hypothyroidism,phenylketonuria,and galactosemia can cause cognitive impairment.Genetic counseling and avoidance of prenatal rubella infections are examples of primary prevention strategies to preclude the occurrence of disorders that can cause cognitive impairment.Preschool education and counseling services are examples of tertiary prevention.These are designed to include early identification of conditions and provision of appropriate therapies and rehabilitation services.

Question 6

The mother of a young child with cognitive impairment asks for suggestions about how to teach her child to use a spoon for eating.The nurse should make which recommendation?

Accepted Answer

Successful teaching begins with a task analysis.The endpoint (self-feeding,toilet training,and so on)is broken down into the component steps.The child is then guided to master the individual steps in sequence.Depending on the child's functional level,using a spoon for eating should be an achievable goal.The child requires demonstration and then guided training for each component of the self-feeding.Feeding finger foods so spoon feeding is unnecessary eliminates some of the intermediate steps that are necessary to using a fork and spoon.For socialization purposes,it is desirable that a child use feeding implements.

Question 7

Autism is a complex developmental disorder.The diagnostic criteria for autism include delayed or abnormal functioning in which area with onset before age 3 years?

Accepted Answer

One hallmark of autism spectrum disorders is the child's inability to maintain eye contact with another person.Parallel play is play typical of toddlers and is usually not affected.Social,not gross motor,development is affected by autism.Physical growth and development are not usually affected.

Question 8

The school nurse is caring for a child with a penetrating eye injury.Emergency treatment includes what intervention?

Accepted Answer

The nurse's role in a penetrating eye injury is to prevent further injury to the eye.A Fox shield (if available)should be applied to the injured eye and a regular eye patch to the other eye to prevent bilateral movement.Placing cool compress on the eye during transport to emergency department,irrigating eye copiously with a sterile saline solution,or removing object with a lightly moistened gauze pad may cause more damage to the eye.

Question 9

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.What intervention is the most appropriate nursing action?

Accepted Answer

The whistling sound is acoustic feedback.The nurse should have the child remove the hearing aid and reinsert it,making sure no hair is caught between the ear mold and the ear canal.Ignoring the sound or suggesting he raise the volume of the hearing aid would be annoying to others.The hearing aids are molded specifically for each ear.

Question 10

One of the techniques that has been especially useful for learners having cognitive impairment is called fading.What description best explains this technique?

Accepted Answer

Fading is physically taking the child through each sequence of the desired activity and gradually fading out the physical assistance so the child becomes more independent.Positive reinforcement when tasks or behaviors are mastered is part of behavior modification.An essential component is ignoring undesirable behaviors.Verbal explanations are not as effective as demonstration and physical guidance.Consistent negative reinforcement is helpful,but positive reinforcement that focuses on skill attainment should be incorporated.

Question 11

The nurse should suspect a hearing impairment in an infant who fails to demonstrate which behavior?

Accepted Answer

The absence of babbling or inflections in voice by at least age 7 months is an indication of hearing difficulties.Lack of eye contact is not indicative of a hearing loss.An infant with a hearing impairment might react to a loud noise but not respond to the spoken word.The child with hearing impairment uses gestures rather than vocalizations to express desires at this age.

Question 12

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.The nurse also should recommend which action before the child is transported?

Accepted Answer

The first action is to flush the eyes with clean tap water.This will rinse the detergent from the eyes.Keeping the eyes closed and applying cold compresses may allow the detergent to do further harm to the eyes during transport.Normal saline is not necessary.The delay can allow the detergent to cause continued injury to the eyes.

Question 13

The American Association on Intellectual and Developmental Disabilities (AAIDD),formerly the American Association on Cognitive Impairment,classifies cognitive impairment based on what parameter?

Accepted Answer

The AAIDD has categorized cognitive impairment into adaptive skill domains.The child must demonstrate functional impairment in at least two of the following adaptive skill domains: communication,self-care,home living,social skills,use of community resources,self-direction,health and safety,functional academics,leisure,and work.Age of onset before 18 years is part of the former criteria.Low intelligence quotient (IQ)alone is not the sole criterion for cognitive impairment.Etiology is not part of the classification.

Question 14

The nurse is discussing sexuality with the parents of an adolescent girl who has a moderate cognitive impairment.What factor should the nurse consider when dealing with this issue?

Accepted Answer

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 defined 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.

Question 15

The parents of a child with cognitive impairment ask the nurse for guidance with discipline.What should the nurse's recommendation be based on?

Accepted Answer

Discipline must begin early.Limit-setting measures must be clear,simple,consistent,and appropriate for the child's mental age.Behavior modification,especially reinforcement of desired behavior and use of time-out procedures,is an appropriate form of behavior control.Aversive strategies should be avoided in disciplining the child.

Question 16

A newborn assessment shows a separated sagittal suture,oblique palpebral fissures,a depressed nasal bridge,a protruding tongue,and transverse palmar creases.These findings are most suggestive of which condition?

Accepted Answer

These are characteristics associated with Down syndrome.An 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,or protruding ears; a long,narrow face with a prominent jaw; hypotonia; and a high-arched palate.

Question 17

A 5-year-old child has bilateral eye patches in place after surgery yesterday morning.Today he can be out of bed.What nursing intervention is most important at this time?

Accepted Answer

Safety is the priority concern.Because he can now be out of bed,it is imperative that he knows about his physical surroundings.Speaking to the child is a component of nursing care that is expected with all clients unless contraindicated.Unless additional impairments are present,his meal tray should be set up,and he should be able to feed himself.Reassuring him and allowing his parents to stay with him are essential parts of nursing care for all children.

Question 18

What description applies to fragile X syndrome?

Accepted Answer

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 inheritance with reduced penetrance.

Question 19

Many of the clinical features of Down syndrome present challenges to caregivers.Based on these features,what intervention should be included in the child's care?

Accepted Answer

The constant stuffy nose forces the child to breathe by mouth,drying the mucous membranes and increasing the susceptibility to upper respiratory tract infections.A cool-mist vaporizer will keep the mucous membranes moist and liquefy secretions.Respiratory tract infections combined with cardiac anomalies are the primary cause of death in the first years.The child has a protruding tongue,which makes feeding difficult.The parents must persist with feeding while the child continues the physiologic response of the tongue thrust.The child is predisposed to constipation.Calories should be appropriate to the child's weight and growth needs,not mental age.

Question 20

What technique facilitates lip reading by a hearing-impaired child?

Accepted Answer

Help the child learn and understand how to read lips by speaking at an even rate.Avoiding using facial expressions,exaggerating pronunciation of words,and repeating in exactly the same way if the child does not understand interfere with the child's understanding of the spoken word.

Quiz 21: The Child With Cognitive, sensory, or Communication Impairment