Question 1

The nurse must suction a child with a tracheostomy. Interventions should include:&#10;A) encouraging child to cough to raise the secretions before suctioning.&#10;B) selecting a catheter with diameter three fourths as large as the diameter of the tracheostomy tube.&#10;C) ensuring each pass of the suction catheter should take no longer than 5 seconds.&#10;D) allowing child to rest after every five times the suction catheter is passed.

Accepted Answer

Suctioning should require no longer than 5 seconds per pass. Otherwise, the airway may be occluded for too long. If the child is able to cough up secretions, suctioning may not be indicated. The catheter should have a diameter one half the size of the tracheostomy tube. If it is too large, it might block the childs airway. The child is allowed to rest for 30 to 60 seconds after each aspiration to allow oxygen tension to return to normal. Then the process is repeated until the trachea is clear.

Question 2

The mother of a 9-year-old child with Down syndrome discusses the childs language abilities. The nurse is not surprised to learn which information about the childs language development?&#10;A) Can take turns during conversation&#10;B) Has good grammar&#10;C) Can speak a foreign language&#10;D) Has difficulty in carrying on a conversation

Accepted Answer

Social language involves maintaining a conversation on a specific topic and taking turns during the conversation. Children with Down syndrome generally have good social language. The language development of children with Down syndrome involves difficulty with grammar but strength in social usage. It would not be expected for children with Down syndrome to be characterized as typically knowing a foreign language. Children with Down syndrome have a general strength in social language such as greeting others and carrying on a conversation in a give-and-take manner and have social skills that exceed expected skills on the basis of intellectual capacity.

Question 3

What is the best intervention when a child with autism is hospitalized?&#10;A) Limit the individuals who enter the childs room.&#10;B) Perform all of the childs activities of daily living for her.&#10;C) Make sure the nurses know this child may be violent.&#10;D) Assign the strongest nurse to control the child.

Accepted Answer

The child with autism is often unable to tolerate the slightest change in routine. Limiting who enters the childs room to those knowledgeable about the childs routine will facilitate the childs adaptation to the hospital environment. The most important nursing consideration when planning care for a child with autism is to assign the child to a nurse who is familiar with the childs routine and to follow that routine. The child should be encouraged to perform toileting and self-care activities as she normally would if she were not in the hospital. There is no indication that the child will be violent. Limiting the number of individuals in contact with the child and maintaining a routine will decrease any chance of violence. Strength should not be a consideration in assignments.

Question 4

Intense stress and isolation as a result of caring for a child with developmental disabilities often lead parents to:&#10;A) heightened parental achievement.&#10;B) overuse of the healthcare system.&#10;C) overindulgence and obesity.&#10;D) child abuse.

Accepted Answer

Child abuse and developmental disabilities are often associated. Stress and isolation may hinder parents from reaching their potential. Parents may feel isolated from support and healthcare services. They report that professionals have limited understanding of their childrens needs. Although overindulgence and obesity may occur, the best answer is child abuse.

Question 5

A child with Asperger syndrome has also been diagnosed with depression. The nurse understands that two or more disorders in an individual is termed:&#10;A) comorbidity.&#10;B) congenital syndrome.&#10;C) mental retardation.&#10;D) developmental impairment.

Accepted Answer

Comorbidity by definition means more than one disorder in an individual. Congenital syndrome means the disorder originated before birth. Mental retardation refers to subaverage intellectual functioning. Developmental impairment refers to functional level.

Question 6

Self-injury, fecal smearing, and severe temper tantrums in a preschool child are symptoms of:&#10;A) mild intellectual impairment.&#10;B) severe intellectual impairment.&#10;C) psychosocial deprivation.&#10;D) separation anxiety.

Accepted Answer

Self-injury, fecal smearing, and severe temper tantrums in a preschool child are symptoms of severe intellectual impairment. Mild intellectual impairment is characterized by social isolation or depression. Psychosocial deprivation may be a cause of intellectual impairment. The symptoms listed are characteristic of severe intellectual impairment. Symptoms of separation anxiety include protest, despair, and detachment.

Question 7

The parents of a child born at 36 weeks of gestation who had respiratory problems requiring 3 days of oxygen therapy are concerned that the infant may have an intellectual impairment. The best nursing statement to the parents is which of the following?

A) A diagnosis of intellectual impairment is not made until the child enters school and experiences academic failure.
B) Routine assessment of development during pediatric visits is the best method of early detection.
C) The baby is not at risk for an intellectual impairment.
D) Tests for intellectual impairments are not reliable for children younger than 3 years.

Accepted Answer

Routine assessment of development from birth is the best method for early detection of problems. Intellectual impairment may be detected before school age. The baby may be at risk for an intellectual impairment as a result of poor oxygenation. The Denver Developmental Screening test may be unreliable for children younger than 3 years, but other assessment tools are available. Several neuropsychological tests are available.

Question 8

Which of the following treatment guidelines would be contraindicated when counseling the family of an infant with fragile X syndrome? Select all that apply.&#10;A) Advise genetic testing for family members.&#10;B) Delay speech therapy until the child is 2 years of age.&#10;C) Educate the family that their child will probably have normal intelligence.&#10;D) Refer the family to an early intervention program.

Accepted Answer

Speech therapy should be started in the first year of life and continued on an ongoing basis. Waiting until the child is 2 years old would not be appropriate. Children with fragile X syndrome have a high incidence of intellectual, language, and social dysfunctions. It is the most common inherited cause of mental retardation. Because fragile X syndrome is an X-linked recessive disorder, genetic testing is appropriate. Early intervention programs assess the child and develop a plan of intervention; this is appropriate.

Deck 1: Pediatric Nursing Interventions and Considerations for Children With Various Developmental Disabilities