San Jacinto College - RNSG 2201

Chapter 18: Impact of Cognitive or Sensory Impairment on the Child and Family Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition

MULTIPLE CHOICE

1)A young child has an intelligence quotient (IQ) of 45. The nurse should document this finding as:

1. 1. within the lower limits of the range of normal intelligence.
   2. mild cognitive impairment but educable.
   3. moderate cognitive impairment but trainable.
   4. severe cognitive impairment and completely dependent on others for care.

2. When a child with mild cognitive impairment reaches the end of adolescence, which characteristic should be expected?
   1. Achieves a mental age of 5 to 6 years
   2. Achieves a mental age of 8 to 12 years
   3. Unable to progress in functional reading of arthmetic
   4. Acquires practical skills and useful reading and arithmetic to an eighth-grade level

3. When should children with cognitive impairment be referred for stimulation and educational programs?
   1. As young as possible
   2. As soon as they have the ability to communicate in some way
   3. At age 3 years, when schools are required to provide services
   4. At age 5 or 6 years, when schools are required to provide services

4. Which should be the major consideration when selecting toys for a child who is cognitively impaired?
   1. Safety
   2. Age appropriateness
   3. Ability to provide exercise
   4. Ability to teach useful skills

5. What are appropriate intervention facilitate to socialization of the cognitively impaired child?
   1. Provide age-appropriate toys and play activities.
   2. Provide peer experiences, such as scouting, when older.
   3. Avoid exposure to strangers who may not understand cognitive development.
   4. Emphasize mastery of physical skills because they are delayed more often than verbal skills.

6. 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?
   1. Sterilization is recommended for any adolescent with cognitive impairment.
   2. Sexual drive and interest are limited in individuals with cognitive impairment.
   3. Individuals with cognitive impairment need a well-defined, concrete code of

sexual conduct.

1. 4. Sexual intercourse rarely occurs unless the individual with cognitive impairment is sexually abused.

7. When caring for a newborn with Down syndrome, what should the nurse be aware is the most common congenital anomaly associated with Down syndrome?
   1. Hypospadias
   2. Pyloric stenosis
   3. Congenital heart disease
   4. Congenital hip dysplasia

8. Mark, a 9-year-old with Down syndrome, is mainstreamed into a regular third-grade class for part of the school day. His mother asks the school nurse about programs, such as Cub Scouts, that he might join. The nurse’s recommendation should be based on which statement?
   1. Programs like Cub Scouts are inappropriate for children who are cognitively impaired.
   2. Children with Down syndrome have the same need for socialization as other children.
   3. Children with Down syndrome socialize better with children who have similar disabilities.
   4. Parents of children with Down syndrome encourage programs, such as scouting, because they deny that their children have disabilities.

9. What is one of the major physical characteristics of the child with Down syndrome?
   1. Excessive height
   2. Spots on the palms
   3. Inflexibility of the joints
   4. Hypotonic musculature

10. A newborn assessment shows seprated signature, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. Of what are these findings most suggestive?
    1. Microcephaly
    2. Down syndrome
    3. Cerebral palsy
    4. Fragile X syndrome

11. The child with Down syndrome should be evaluated for which condition before participating in some sports?
    1. Hyperflexibility
    2. Cutis marmorata
    3. Atlantoaxial instability

1. 4. Speckling of iris (Brushfield spots)

12. Many of the physical characteristics of Down syndrome present nursing problems. Care of the child should include which intervention?
    1. Delay feeding solid foods until the tongue thrust has stopped.
    2. Modify diet as necessary to minimize the diarrhea that often occurs.
    3. Provide calories appropriate to child’s age.
    4. Use a cool-mist vaporizer to keep mucous membranes moist.

13. A child has just been diagnosed with fragile X syndrome. What is fragile X syndrome?
    1. A chromosomal defect affecting females only
    2. A chromosomal defect that follows the pattern of X-linked recessive disorders
    3. The second most common genetic cause of cognitive impairment
    4. The most common cause of noninherited cognitive impairment

14. A school nurse is performing hearing screening on school children. The nurse recognizes that distortion of sound and problems in discrimination are characteristic of which type of hearing loss?
    1. Conductive

1. 2. Sensorineural
   3. Mixed conductive-sensorineural
   4. Central auditory imperceptive

15. A school nurse is performing hearing screening on school children. The nurse recognizes that the most common type of hearing loss resulting from interference of transmission of sound to the middle ear is characteristic of which type of hearing loss?
    1. Conductive
    2. Sensorineural
    3. Mixed conductive-sensorineural
    4. Central auditory imperceptive

16. Hearing is expressed in decibels (dB), or units of loudness. Which is the softest sound a normal ear can hear?
    1. 0 dB
    2. 10 dB
    3. 40 to 50 dB
    4. 100 dB

17. The nurse should suspect a hearing impairment in an infant who demonstrates which behavior?

1. 1. Absence of the Moro reflex
   2. Absence of babbling by age 7 months
   3. Lack of eye contact when being spoken to
   4. Lack of gesturing to indicate wants after age 15 months

18. 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. Which is the most appropriate nursing action?
    1. Ignore the sound.
    2. Ask him to reverse the hearing aids in his ears.
    3. Suggest he reinsert the hearing aid.
    4. Suggest he raise the volume of the hearing aid.

19. Which is an implanted ear prosthesis for children with sensorineural hearing loss?
    1. Hearing aid
    2. Cochlear implant
    3. Auditory implant
    4. Amplification device

20. A nurse is caring for a hearing-impaired child who lip reads. The nurse should plan which intervention to facilitate lipreading?
    1. Speak at an even rate.

1. 2. Exaggerate pronunciation of words.
   3. Avoid using facial expressions.
   4. Repeat in exactly the same way if the child does not understand.

21. A nurse is preparing a teaching session for parents on prevention of childhood hearing loss. What is the most common cause of hearing impairment in children?
    1. Auditory nerve damage
    2. Congenital ear defects
    3. Congenital rubella
    4. Chronic otitis media

22. Prevention of hearing impairment in children is a major goal for the nurse. This can be achieved through which intervention?
    1. Being involved in immunization clinics for children
    2. Assessing a newborn for hearing loss
    3. Answering parents’ questions about hearing aids
    4. Participating in hearing screening in the community

23. Which term refers to the ability to see objects clearly at close range but not at a distance?
    1. Myopia
    2. Amblyopia

1. 3. Cataract
   4. Glaucoma

24. Which of the following terms refers to opacity of the crystalline lens that prevents light rays from entering the eye and refracting on the retina?
    1. Myopia
    2. Amblyopia
    3. Cataract
    4. Glaucoma

25. A nurse should suspect possible visual impairment in a child who displays which characteristic?
    1. Excessive rubbing of the eyes
    2. Rapid lateral movement of the eyes
    3. Delay in speech development
    4. Lack of interest in casual conversation with peers

26. When assessing the eyes of a neonate, the nurse observes opacity of the lens. This represents which impairment?
    1. Blindness
    2. Glaucoma
    3. Cataracts

1. 4. Retinoblastoma

27. The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes which intervention?
    1. Apply a regular eye patch.
    2. Apply a Fox shield to affected eye and any type of patch to the other eye.
    3. Apply ice until the physician is seen.
    4. Irrigate eye copiously with a sterile saline solution.

28. 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?
    1. Keep eyes closed.
    2. Apply cold compresses.
    3. Irrigate eyes copiously with tap water for 20 minutes.
    4. Prepare a normal saline solution (salt and water) and irrigate eyes for 20 minutes.

29. An adolescent gets hit in the eye during a fight. The school nurse, using a flashlight, notes the presence of gross hyphema (hemorrhage into anterior chamber). What is the priority nursing action?
    1. Apply a Fox shield

1. 2. Instruct the adolescent to apply ice for 24 hours
   3. Have the adolescent rest with eye closed and ice applied
   4. Notify parents that the adolescent needs to see an ophthalmologist

30. Which of the following is the most common clinical manifestation of retinoblastoma?
    1. Glaucoma
    2. Amblyopia
    3. Cat’s eye reflex
    4. Sunken eye socket

31. The nurse is talking to the parent of a 13-month-old child. The mother states, “My child does not make noises like ‘da’ or ‘na’ like my sister’s baby, who is only 9 months old.” Which statement by the nurse would be most appropriate to make?
    1. “I am going to request a referral to a hearing specialist.”
    2. “You should not compare your child to your sister’s child.”
    3. “I think your child is fine, but we will check again in 3 months.”
    4. “You should ask other parents what noises their children made at this age.”

32. 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?

1. 1. Verbally explain what will be done.
   2. Have the child watch a video on dressing changes.
   3. Demonstrate a dressing change on a doll.
   4. Explain the importance of keeping the burn area clean.

33. Parents of a child with Down syndrome ask the nurse about techniques for introducing solid food to their 8-month-old child’s diet. The nurse should give the parents which priority instruction?
    1. It is too early to add solids; the parents should wait for 2 to 3 months.
    2. A small but long, straight-handled spoon should be used to push the food toward the back and side of the mouth.
    3. If the child thrusts the food ouNt,UtRheSIfNeGedTiBn.gCOshMould be stopped.
    4. Solids should be offered only three times a day.

34. 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?
    1. Maintain a structured routine and keep stimulation to a minimum.
    2. Place child in a room with a roommate of the same age.
    3. Maintain frequent touch and eye contact with the child.
    4. Take the child frequently to the playroom to play with other children.

35. Which genetic term refers to the transfer of all or part of a chromosome to a different chromosome after chromosome breakage?
    1. Trisomy
    2. Monosomy
    3. Translocation
    4. Nondisjunction

36. Trisomy 13, trisomy 18, and trisomy 21 have which in common?
    1. Viability is rare.
    2. They are considered deletion syndromes.
    3. Diagnosis is difficult, time-consuming, and expensive.
    4. Diagnosis can be made early, based on physical characteristics.

MULTIPLE RESPONSE

1. Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which areas with onset before age 3 years? (Select all that apply.)
   1. Language as used in social communication
   2. Parallel play
   3. Gross motor development
   4. Growth below the 5th percentile for height and weight
   5. Symbolic or imaginative play
   6. Social interaction

2. Which assessment findings indicate to the nurse a child has Down syndrome? (Select all that apply.)
   1. High arched narrow palate

1. 2. Protruding tongue
   3. Long, slender fingers
   4. Transverse palmar crease
   5. Hypertonic muscle tone

3. A nurse is instructing a nursing assistant on techniques to facilitate lipreading with a

hearing-impaired child who lip reads. Which techniques should the nurse include? (Select all that apply.)

1. 1. Speak at eye level.
   2. Stand at a distance from the child.
   3. Speak words in a loud tone.
   4. Use facial expressions while speaking.
   5. Keep sentences short.