Cognitive or Sensory Impairment Flashcards Preview

Peds Ex. 3 Practice Questions > Cognitive or Sensory Impairment > Flashcards

Flashcards in Cognitive or Sensory Impairment Deck (43)
Loading flashcards...
1

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?

a.

Keep the eyes closed.

b.

Apply cold compresses.

c.

Irrigate the eyes copiously with tap water for 20 minutes.

d.

Prepare a normal saline solution (salt and water) and irrigate the eyes for 20 minutes.

ANS:  C

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.

1

The nurse is teaching parents of a child with cataracts about the upcoming treatment. The nurse should give the parents what information about the treatment of cataracts?

a.

“The treatment may require more than one surgery.”

b.

“It is corrected with biconcave lenses that focus rays on the retina.”

c.

“Cataracts require surgery to remove the cloudy lens and replace it.”

d.

“Treatment is with a corrective lenses; no surgery is necessary.”

ANS:  C

Treatment for cataracts requires surgery to remove the cloudy lens and replace it (with an intraocular lens implant, removable contact lens, or prescription glasses). Treatment for glaucoma may require more than one surgery. Anisometropia is treated with corrective lenses. Myopia is corrected with biconcave lenses that focus rays on the retina.

2

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

a.

Speak at an even rate.

b.

Avoid using facial expressions.

c.

Exaggerate pronunciation of words.

d.

Repeat in exactly the same way if child does not understand.

ANS:  A

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.

3

The nurse should plan which actions to facilitate lipreading for a child with a hearing impairment? (Select all that apply.)

a.

Face the child directly.

b.

Speak at eye level.

c.

Keep sentences short.

d.

Speak at a fast, even-paced rate.

e.

Establish eye contact and show interest.

ANS:  A, B, C, E

To facilitate lipreading, the nurse should plan to face the child directly, speak at eye level, keep sentences short, and establish eye contact and show interest. The nurse should plan to speak at a slow rate, not a fast one.

4

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

a.

Positive reinforcement when tasks or behaviors are mastered

b.

Repeated verbal explanations until tasks are faded into the child’s development

c.

Negative reinforcement for specific tasks or behaviors that need to be faded out

d.

Gradually reduces the assistance given to the child so the child becomes more independent

ANS:  D

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

5

Secondary prevention for cognitive impairment includes what activity?

a.

Genetic counseling

b.

Avoidance of prenatal rubella infection

c.

Preschool education and counseling services

d.

Newborn screening for treatable inborn errors of metabolism

ANS:  D

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.

5

What intervention should be included in the nursing care of a child with autism spectrum disorder (ASD)?

a.

Assign multiple staff to care for the child.

b.

Communicate with the child at his or her developmental level.

c.

Provide a wide variety of foods for the child to try.

d.

Place the child in a semiprivate room with a roommate of a similar age.

ANS:  B

Children with ASD require individualized care. The nurse needs to communicate with the child at the child’s developmental level. Consistent caregivers are essential for children with ASD. The same staff members should care for the child as much as possible. Children with ASD do not adapt to changing situations. The same foods should be provided to allow the child to adjust. A private room is desirable for children with ASD. Stimulation is minimized.

6

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

a.

Age of onset

b.

Subaverage intelligence

c.

Adaptive skill domains

d.

Causative factors for cognitive impairment

ANS:  C

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

6

The nurse understands that which gestational disorders can cause a cognitive impairment in the newborn? (Select all that apply.)

a.

Prematurity

b.

Postmaturity

c.

Low birth weight

d.

Physiological jaundice

e.

Large for gestational age

ANS:  A, B, C

Prematurity, postmaturity, and low birth weight can be causes of cognitive impairment in newborns. Physiological jaundice and large for gestational age are not associated causes of cognitive impairment in newborns.

7

The nurse is counseling a pregnant 35-year-old woman about estimated risk of Down syndrome. What is the estimated risk for a woman who is 35 years of age?

a.

One in 1200

b.

One in 900

c.

One in 350

d.

One in 100

 

 

ANS:  C

The estimated risk of Down syndrome for a 35-year-old woman is one in 350. One in 1200 is the risk for a 25-year-old woman, one in 900 is the risk for a 30-year–old woman, and one in 100 is the risk for a 40-year-old woman.

8

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?

a.

Sign of detachment and rejection

b.

Indicative of maternal deprivation

c.

A physical characteristic of Down syndrome

d.

Suggestive of autism associated with Down syndrome

ANS:  C

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.

9

What observation in a child should indicate the need for a referral to a specialist regarding a communication impairment?

a.

At 2 years of age, the child fails to respond consistently to sounds.

b.

At 3 years of age, the child fails to use sentences of more than five words.

c.

At 4 years of age, the child has impaired sentence structure.

d.

At 5 years of age, the child has poor voice quality.

ANS:  A

If a 2-year-old child fails to respond consistently to sounds, it is an indication for referral to a specialist regarding communication impairment. At age 3 years, the child failing to use sentences of three words would be an indication for referral; impaired sentence structure would be seen in a 5-year-old child and poor voice quality in an older child who has a communication impairment.

10

The clinic nurse is assessing an infant. What are early signs of cognitive impairment the nurse should discuss with the health care provider? (Select all that apply.)

a.

Head lag at 11 months of age

b.

No pincer grasp at 4 months of age

c.

Colicky incidents at 3 months of age

d.

Unable to speak two to three words at 24 months of age

e.

Unresponsiveness to the environment at 12 months of age

ANS:  A, D, E

Early signs of cognitive impairment include gross motor delay (head lag should be established by 6 months, and head lag still present at 11 months is a delay), language delay (normal language development is speaking two to three words by age 12 months; if unable to speak two to three words at 24 months, that is a delay), and unresponsiveness to the environment at 12 months. No pincer grasp at 4 months of age is normal (palmar grasp is the expected finding), and colicky incidents at 3 months of age is a normal finding.

10

What risk factors can cause a sensorineural hearing impairment in an infant? (Select all that apply.)

a.

Cat scratch disease

b.

Bacterial meningitis

c.

Childhood case of measles

d.

Childhood case of chicken pox

e.

Administration of aminoglycosides for more than 5 days

ANS:  B, C, E

Risk criteria for sensorineural hearing impairment in infants include bacterial meningitis; a case of measles; and administration of ototoxic medications (e.g., gentamicin, tobramycin, kanamycin, streptomycin), including but not limited to the aminoglycosides, for more than 5 days. Cat scratch disease and a childhood case of chicken pox are not risk factors that can cause a sensorineural hearing impairment

12

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?

a.

Parallel play

b.

Gross motor development

c.

Ability to maintain eye contact

d.

Growth below the fifth percentile

ANS:  C

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.

13

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?

a.

Delay feeding solid foods until the tongue thrust has stopped.

b.

Modify the diet as necessary to minimize the diarrhea that often occurs.

c.

Provide calories appropriate to the child’s mental age.

d.

Use a cool-mist vaporizer to keep the mucous membranes moist and secretions liquefied.

ANS:  D

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

15

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

a.

Place a cool compress on eye during transport to the emergency department.

b.

Irrigate the eye copiously with a sterile saline solution.

c.

Remove the object with a lightly moistened gauze pad.

d.

Apply a Fox shield to the affected eye and any type of patch to the other eye.

ANS:  D

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.

16

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?

a.

Do a task analysis first.

b.

Do not expect this task to be learned.

c.

Continue to spoon feed the child until the child tries to do it alone.

d.

Offer only finger foods so spoon feeding is unnecessary.

 

 

ANS:  A

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

17

What action should the school nurse take for a child who has a hematoma (black eye) with no hemorrhage into the anterior chamber?

a.

Apply a warm moist pack.

b.

Have the child keep the eyes open.

c.

Apply ice for the first 24 hours.

d.

Refer to an ophthalmologist immediately.

ANS:  C

The care for a hematoma eye injury with no hemorrhage into the anterior chamber is to apply ice for the first 24 hours. A warm moist pack should not be applied, and the child should keep the eyes closed. Referral to an ophthalmologist is recommended if hyphema (hemorrhage into the anterior chamber) is present.

18

What description applies to fragile X syndrome?

a.

Chromosomal defect affecting only females

b.

Second most common genetic cause of cognitive impairment

c.

Most common cause of uninherited cognitive impairment

d.

Chromosomal defect that follows the pattern of X-linked recessive disorders

ANS:  B

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.

19

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

a.

Babbling by age 12 months

b.

Eye contact when being spoken to

c.

Startle or blink reflex to sound

d.

Gesturing to indicate wants after age 15 months

ANS:  A

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.

20

The nurse is teaching parents of a child with a cognitive impairment signs that indicate the child is developmentally ready for dressing training. What signs should the nurse include that indicate the child is developmentally ready for dressing training? (Select all that apply.)

a.

Can follow verbal commands

b.

Can sit quietly for 1 to 2 minutes

c.

Can master every task of dressing

d.

Can follow physical gestures or cues

e.

Can relate clothing to the appropriate body part

ANS:  A, D, E

Children are considered developmentally ready for dressing training if they can sit quietly for 3 to 5 minutes (not 1 to 2) while working on a task; can follow physical gestures or cues; can follow verbal commands; and can relate clothing to the appropriate body part, such as socks to feet. As with other self-help skills, the child may not be able to master every task but should be evaluated for evidence of willingness to participate at his or her level of readiness.

21

The nurse is teaching feeding strategies to a parent of a 12-month-old infant with Down syndrome. What statement made by the parent indicates a need for further teaching?

a.

“If the food is thrust out, I will reefed it.”

b.

“I will use a small, long, straight-handled spoon.”

c.

“I will place the food on the top of the tongue.”

d.

“I know the tongue thrust doesn’t indicate a refusal of the food.”

ANS:  C

Parents of a child with Down syndrome need to know that the tongue thrust does not indicate refusal to feed but is a physiologic response. Parents are advised to use a small but long, straight-handled spoon to push the food toward the back and side of the mouth. If food is thrust out, it should be refed. If the parent indicates placing the food on the tongue, further teaching is needed.

23

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?

a.

Sterilization is recommended for any adolescent with cognitive impairment.

b.

Sexual drive and interest are very 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 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.

24

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

a.

Discipline is ineffective with cognitively impaired children.

b.

Cognitively impaired children do not require discipline.

c.

Behavior modification is an excellent form of discipline.

d.

Physical punishment is the most appropriate form of discipline.

ANS:  C

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.

24

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

a.

Myopia

b.

Hyperopia

c.

Amblyopia

d.

Astigmatism

ANS:  C

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.

24

What suggestion by the nurse for parents regarding stuttering in children is most helpful?

a.

Offer rewards for proper speech.

b.

Encourage the child to take it easy and go slow when stuttering.

c.

Help the child by supplying words when he or she is experiencing a block.

d.

Give the child plenty of time and the impression that you are not in a hurry.

ANS:  D

Hesitancy and dysfluency should be considered a normal part of speech development. An important approach is to allow the child plenty of time to speak. Promising rewards for proper speech places additional pressure on the child. Encouraging the child to take it easy and go slow when stuttering draws attention to the dysfluency. The child needs to complete a sentence and thought without being interrupted.

25

The nurse is assessing a child with Down syndrome. The nurse recognizes that which are possible comorbidities that can occur with Down syndrome? (Select all that apply.)

a.

Diabetes mellitus

b.

Hodgkin’s disease

c.

Congenital heart defects

d.

Respiratory tract infections

e.

Acute megakaryoblastic leukemia

ANS:  C, D, E

Children with Down syndrome often have multiple comorbidities, contributing to numerous other conditions. Respiratory tract infections are prevalent; when combined with cardiac anomalies, they are the chief cause of death, particularly during the first year. The incidence of leukemia is several times more frequent than expected in the general population, and in about half of the cases, the type is acute megakaryoblastic leukemia.

26

What are indications for a referral regarding a communication impairment in a school-age child? (Select all that apply.)

a.

Barely audible voice quality

b.

Vocal pitch inappropriate for age

c.

Intonation noted during speaking

d.

Maintains a rhythm while speaking

e.

Distortion of sounds after age 7 years

ANS:  A, B, E

Barely audible voice quality, vocal pitch inappropriate for age, and distortion of sounds after age 7 years are indications for a referral regarding a communication impairment. Intonation noted while speaking and maintaining a rhythm while speaking are normal characteristics of speech.

27

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?

a.

Speak to him when entering the room.

b.

Allow him to assist in feeding himself.

c.

Orient him to his immediate surroundings.

d.

Reassure him and allow his parents to stay with him.

ANS:  C

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.