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Flashcards in Chapter 19 Deck (11):

The diagnosis of intellectual disability 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.

Ans: D
The diagnosis of intellectual disability is made with the presentation of subaverage intellectual functioning, deficits in adaptive skills, and an onset before age 18.
IQ is only one component of the diagnosis of intellectual disability.
IQ is only one component of the diagnosis of intellectual disability.
The onset of the deficit in adaptive skills and subaverage intellectual functioning must occur before age 18 years to meet the diagnosis of intellectual disability.


The primary goal in caring for the child with cognitive impairment is to
a. encourage play.
b. promote optimum development.
c. help families develop a care plan and have them stay with it.
d. develop vocational skills.

Ans: B
A comprehensive approach is desirable to establish acceptable social behavior and feelings of self-worth and promote optimum development. Providing parents guidance for the selection of developmentally appropriate activities is only one component in a comprehensive care plan.
Care for the mentally retarded child is an ongoing process that changes as the child meets developmental milestones.
The development of vocational skills will be addressed as the child's capabilities are developing and is one component of the comprehensive care plan.


The parents of a cognitively impaired child ask the nurse for guidance with discipline. The most appropriate recommendation by the nurse is that
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.

Ans: C
Positive behaviors and desirable actions should be reinforced with cognitively impaired children.
Behavior modification with positive reinforcement is effective in children with cognitive impairment.
Discipline is essential to assist the child in developing boundaries.
Most children with cognitive impairment will not be able to understand the reason for the physical punishment, and the behavior will not change. Physical punishment is not an acceptable form of discipline.


The genetic testing of a child with Down syndrome showed that the disorder was caused by chromosomal translocation. The parents ask about further genetic testing. Based on the nurse’s knowledge of genetics, the most appropriate recommendation is
a. no further genetic testing of the family is indicated.
b. the child should be retested to confirm the diagnosis of Down syndrome.
c. the mother should be tested if she is over age 35.
d. the parents can be tested, since it might be hereditary.

Ans: D
The parents and any siblings should be tested. Down syndrome resulting from a translocation may be inherited. This type of chromosomal abnormality presents issues for future pregnancies.
The child does not require further genetic testing, but the parents and siblings should be further evaluated with genetic testing.
There is no need to retest the child at a later date, because the diagnosis has been validated with chromosomal testing.
This type of chromosomal abnormality occurs in children of parents of all ages.


A 2-week-old infant with Down syndrome is being seen in the clinic. The mother tells the nurse that the infant is difficult to hold. “The baby is like a rag doll and doesn't cuddle up to me like my other babies did." The nurse interprets the infant’s behavior as a
a. sign of maternal deprivation.
b. sign of detachment and rejection.
c. sign of autism associated with Down syndrome.
d. result of the physical characteristics of Down syndrome.

Ans: D
Lack of clinging (or molding) between child and mother is a result of the muscle hypotonicity and hyperextensibility of the joints associated with Down syndrome.
Mothers may have difficulty with attachment to their child due to the lack of clinging or molding behavior characteristic of Down syndrome. The nurse should recommend swaddling and wrapping the baby before picking up. There is no indication of maternal deprivation.
Lack of clinging or molding is not symptomatic of detachment and rejection. These physical signs are characteristic of Down syndrome.
Autism is not associated with Down syndrome.


The parents of a child with fragile X syndrome want to have another baby. They tell the nurse that they worry another child might be similarly affected. What is the most appropriate nursing action?
a. Reassure them that the syndrome is not inherited.
b. Assess for family history of the syndrome.
c. Recommend that they do not have another child.
d. Explain that prenatal diagnosis of the syndrome is now available.

Ans: D
Fragile X syndrome can now be detected prenatally. The family should be referred for genetic counseling.
Fragile X syndrome is inherited on the X chromosome.
This should be done, but it does not address the parents' concern and need for genetic counseling.
Nurses do not make recommendations related to whether parents should become pregnant and have other children. A referral for genetic counseling is indicated, and, based on findings, the geneticist can present family planning options, but the decision is strictly up to the family.


A 6-year-old has difficulty hearing faint or distant speech. The child’s speech is normal, but the child is having problems with school performance. This hearing loss would most likely be classified as
a. slight.
b. severe.
c. moderate.
d. inattentiveness rather than hearing loss.

Ans: A
The definition of a slight hearing loss includes normal speech with difficulty hearing faint and/or distant speech.
With severe hearing loss, the child may hear a loud voice if nearby and may be able to identify loud environmental noises.
Moderate hearing loss results in symptoms of being able to understand conversation at a distance of 3 to 5 feet.
Children with difficulty hearing faint or distant speech, but who have normal speech themselves, are by definition experiencing slight hearing loss.


Early detection of a hearing impairment is critical because of its effect on a variety of areas of a child's life. Which one is of primary importance?
a. Reading development
b. Speech development
c. Relationships with peers
d. Performance at school

Ans: B
The ability to hear sounds is essential for the development of speech. Babies imitate the sounds they hear as they begin to form sounds and eventually words as they grow and develop.
The child will have greater difficulty reading, but the primary issue is the effect of hearing impairment on speech.
Relationships with peers will be affected by the child's lack of hearing. The effect will be compounded by difficulties with oral communication.
Performance at school will be affected by hearing impairment, but some schools are geared to children with hearing loss, and programs in regular schools address the needs of the hearing-impaired child.


What is defined as reduced visual acuity in one eye despite appropriate optical correction?
a. Myopia
b. Hyperopia
c. Amblyopia
d. Astigmatism

Ans: C
The definition of amblyopia is the reduction of visual acuity in one eye despite appropriate optical correction.
Myopia is near-sightedness, which is the ability to see objects up close but not clearly at a distance.
Hyperopia is far-sightedness, which is the ability to clearly see distant objects but not close ones.
Astigmatism is an alteration in vision caused by unequal curvature in the eye's refractive apparatus.


A 5-year-old has bilateral eye patches in place after surgery one day earlier. Today, the child can be out of bed. The most appropriate nursing intervention is to
a. reassure the child and allow the parents to stay
b. allow the child to assist in self-feeding
c. speak to the child when entering the room
d. orient the child to the immediate surroundings

Ans: D
Because the child is out of bed with both eyes patched, the immediate safety concern is for the child to be familiar with his or her immediate surroundings.
Reassurance of the child is essential throughout the hospitalization, as is allowing the parents to stay with their child. Orientation to the room now that the child is out of bed with both of the eyes patched is the priority at this time.
The child should be allowed to self-feed with assistance as needed.
The child should always be referred to by name and spoken to when entering the room.


Autism is a complex developmental disorder. Diagnostic criteria for autism include delayed or abnormal functioning in which area(s) before 3 years of age? (Select all that apply.)
a. Parallel play
b. Social interaction
c. Gross motor development
d. Inability to maintain eye contact
e. Language as used in social communication

Ans: B, D, E