Question 1

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?

Accepted Answer

Providing a structured routine for the child to follow is a key in the management of ASD. Decreasing stimulation by using a private room, avoiding extraneous auditory and visual distractions, and encouraging the parents to bring in possessions the child is attached to may lessen the disruptiveness of hospitalization. Because physical contact often upsets these children, minimum holding and eye contact may be necessary to avoid behavioral outbursts. Children with ASD need to be introduced slowly to new situations, with visits with staff caregivers kept short whenever possible. The playroom would be too overwhelming with new people and situations and should not be a priority of care.

Question 2

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?

Accepted Answer

Children with CI have a marked deficit in their ability to discriminate between two or more stimuli because of difficulty in recognizing the relevance of specific cues. However, these children can learn to discriminate if the cues are presented in an exaggerated, concrete form and if all extraneous stimuli are eliminated. Therefore, demonstration is preferable to verbal explanation, and learning should be directed toward mastering a skill rather than understanding the scientific principles underlying a procedure. Watching a video would require the use of both visual and auditory stimulation and might produce overload in the child with mild cognitive impairment. Explaining the importance of keeping the burn area clean would be too abstract for the child.

Question 3

Which term refers to the ability to see objects clearly at close range but not at a distance?

Accepted Answer

Myopia, or nearsightedness, refers to the ability to see objects clearly at close range but not at distance. Amblyopia, or lazy eye, is reduced visual acuity in one eye. A cataract is opacity of the lens of the eye. Glaucoma is a group of eye diseases characterized by increased intraocular pressure.

Question 4

Which of the following is the most common clinical manifestation of retinoblastoma?

Accepted Answer

When the eye is examined, the light will reflect off the tumor, giving the eye a whitish appearance. This is called a cat's eye reflex. A late sign of retinoblastoma is a red, painful eye with glaucoma. Amblyopia, or lazy eye, is reduced visual acuity in one eye. The eye socket is not sunken.

Question 5

The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes which 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. It may cause more damage to the eye to apply a regular eye patch, apply ice until the physician is seen, or irrigate the eye copiously with a sterile saline solution.

Question 6

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.)

Accepted Answer

These are three of the areas in which autistic children may show delayed or abnormal functioning: language as used in social communication, symbolic or imaginative play, and social interaction. Parallel play is typical play of toddlers and is usually not affected. Gross motor development and growth below the 5th percentile for height and weight are usually not characteristic of autism.

Question 7

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.)

Accepted Answer

To facilitate lipreading for a hearing-impaired child who can lip read, the speaker should be at eye level, facing the child directly or at a 45-degree angle. Facial expressions should be used to assist in conveying messages, and the sentences should be kept short. The speaker should stand close to the child, not at a distance, and using a loud tone while speaking will not facilitate lipreading.

Question 8

When assessing the eyes of a neonate, the nurse observes opacity of the lens. This represents which impairment?

Accepted Answer

A cataract is opacity of the lens of the eye. The child may have visual impairment secondary to the cataract, but the opacity is a cataract. Glaucoma is increased intraocular pressure. Retinoblastoma is a tumor of the eye.

Question 9

Which assessment findings indicate to the nurse a child has Down syndrome? (Select all that apply.)

Accepted Answer

The assessment findings of Down syndrome include high arched narrow palate, protruding tongue, and transverse palmar creases. The fingers are stubby and the muscle tone is hypotonic, not hypertonic.

Question 10

Prevention of hearing impairment in children is a major goal for the nurse. This can be achieved through which intervention?

Accepted Answer

Childhood immunizations can eliminate the possibility of acquired sensorineural hearing loss from rubella, mumps, or measles encephalitis. Assessing a newborn for hearing loss, answering parents' questions about hearing aids, and participating in hearing screening in the community are interventions to screen for the presence of hearing loss or deal with an identified loss, not prevention.

Question 11

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?

Accepted Answer

The parents should be notified that the adolescent needs to see an ophthalmologist as soon as possible. Applying a Fox shield, instructing the adolescent to apply ice for 24 hours, and having the adolescent rest with eye closed and ice applied may cause further damage. Referral to an ophthalmologist is indicated.

Question 12

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?

Accepted Answer

Down syndrome children have a protruding tongue which can interfere with feeding, especially of solid foods. Parents need to know that the tongue thrust is not an indication of refusal to feed but 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 re-fed. Six months is the time to introduce solid foods to a child, so waiting 2 to 3 months is inappropriate. Small frequent feedings should be initiated to prevent the child from tiring. Three times a day is too infrequent.

Question 13

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?

Accepted Answer

By 11 months of age a child should be making well-formed syllables such as "da" or "na" and should be referred to a specialist if not. "You should not compare your child to your sister's child," "I think your child is fine, but we will check again in 3 months," and "You should ask other parents what noises their children made at this age," are not appropriate statements to make to the parent.

Question 14

Which genetic term refers to the transfer of all or part of a chromosome to a different chromosome after chromosome breakage?

Accepted Answer

A translocation occurs when a part of a chromosome breaks off and attaches to another chromosome. When this occurs in the germ cells, the translocation can be transmitted to the next generation. Trisomy is the condition in which three of a specific chromosome are found rather than the usual two. Monosomy is the condition in which one of a specific chromosome is noted rather than the usual two. The term is not used for males when the normal complement of sex chromosomes (one X and one Y) is present. Nondisjunction is the failure of a chromosome to separate during cell division. Of the resultant daughter cells, one will be trisomic and one will be monosomic.

Question 15

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 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 16

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?

Accepted Answer

Chronic otitis media is the most common cause of hearing impairment in children. It is essential that appropriate measures be instituted to treat existing infections and prevent recurrences. Auditory nerve damage, congenital ear defects, and congenital rubella are rarer causes of hearing impairment.

Question 17

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?

Accepted Answer

Opacity of the crystalline lens that prevents light rays from entering the eye and refracting on the retina is the definition of a cataract. Myopia, or nearsightedness, refers to the ability to see objects clearly at close range but not at a distance. Amblyopia, or lazy eye, is reduced visual acuity in one eye. Glaucoma is a group of eye diseases characterized by increased intraocular pressure.

Question 18

A nurse should suspect possible visual impairment in a child who displays which characteristic?

Accepted Answer

Excessive rubbing of the eyes is a clinical manifestation of visual impairment. Rapid lateral movement of the eyes, delay in speech development, and lack of interest in casual conversation with peers are not associated with visual impairment.

Question 19

Trisomy 13, trisomy 18, and trisomy 21 have which in common?

Accepted Answer

Each of these disorders, trisomy 13, 18, and 21, has unique physical characteristics. A presumptive diagnosis can often be made soon after birth and later confirmed by chromosomal analysis. Children with trisomy 13 and 18 usually have short life expectancies. Trisomy 21 has a variable life expectancy, with 80% of individuals living to age 30 years. Trisomy 13, trisomy 18, and trisomy 21 are not deletion syndromes.

Quiz 18: Impact of Cognitive or Sensory Impairment on the Child and Family