Deck 21: The Child with Cognitive, Sensory, or Communication Impairment

Question 1

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

Answer 1

Babbling by age 12 months

Question 2

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.

Answer 2

Orient him to his immediate surroundings.

Question 3

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

Answer 3

Second most common genetic cause of cognitive impairment

Question 4

What intervention is most appropriate to facilitate social development of a child with a cognitive impairment?

A) Provide age-appropriate toys and play activities.
B) Avoid exposure to strangers who may not understand cognitive development.
C) Provide peer experiences, such as infant stimulation and preschool programs.
D) Emphasize mastery of physical skills because they are delayed more often than verbal skills.

Question 5

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.

Question 6

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.

Question 7

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.

Question 8

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

Question 9

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

Question 10

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. What intervention is the most appropriate nursing action?

A) Ignore the sound.
B) Suggest he reinsert the hearing aid.
C) Ask him to reverse the hearing aids in his ears.
D) Suggest he raise the volume of the hearing aid.

Question 11

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.

Question 12

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.

Question 13

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

Question 14

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.

Question 15

What is a primary goal in caring for a child with cognitive impairment?

A) Developing vocational skills
B) Promoting optimum development
C) Finding appropriate out-of-home care
D) Helping child and family adjust to future care

Question 16

A newborn assessment shows a separated sagittal suture, oblique palpebral fissures, a depressed nasal bridge, a protruding tongue, and transverse palmar creases. These findings are most suggestive of which condition?

A) Microcephaly
B) Cerebral palsy
C) Down syndrome
D) Fragile X syndrome

Question 17

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

Question 18

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

A) Myopia
B) Hyperopia
C) Amblyopia
D) Astigmatism

Question 19

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

Question 20

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.

Question 21

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.

Question 22

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

Question 23

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."

Question 24

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.

Question 25

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

Question 26

A child has a slight (26-40 dB) degree of hearing loss. The nurse recognizes this amount of hearing loss can have what effect? (Select all that apply.)

A) No speech defects
B) Difficulty hearing faint speech
C) Usually is unaware of the hearing difficulty
D) Can distinguish vowels but not consonants
E) Unable to understand conversational speech

Question 27

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

Question 28

The nurse is preparing an education program on hearing impairment for a group of new staff nurses. What concepts should be included? (Select all that apply.)

A) A child with a slight hearing loss is usually unaware of a hearing difficulty.
B) A clinical manifestation of a hearing impairment in children is avoidance of social interaction.
C) A child with a severe hearing loss may hear a loud voice if nearby.
D) Children with sensorineural hearing loss can benefit from the use of a hearing aid.
E) A clinical manifestation of hearing impairment in an infant is lack of the startle reflex.
F) Identification of a hearing loss after the first year is essential to facilitate language development in children.

Question 29

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

Question 30

The camp nurse is choosing a toy for a child with cognitive impairment to play with during swimming time. What toy should the nurse choose to encourage improvement of developmental skills?

A) Dive rings
B) An inner tube
C) Floating ducks
D) A large beach ball

Question 31

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.

Question 32

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.

Question 33

The nurse is performing a physical assessment on a 3-year-old child. The parents state that the child excessively rubs the eyes and often tilts the head to one side. What visual impairment should the nurse suspect?

A) Strabismus
B) Astigmatism
C) Hyperopia, or farsightedness
D) Myopia, or nearsightedness

Question 34

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."

Question 35

The nurse is teaching parents the signs of a hearing impairment in a child. What should the nurse include as signs? (Select all that apply.)

A) Outgoing behavior
B) Yelling to express pleasure
C) Asking to have statements repeated
D) Foot stamping for vibratory sensation
E) Failure to develop intelligible speech by age 24 months

Question 36

The nurse is teaching parents the signs of a hearing impairment in infants. What should the nurse include as signs? (Select all that apply.)

A) Lack of a fencing reflex
B) Lack of a startle reflex to a loud sound
C) Awakened by loud environmental noises
D) Failure to localize a sound by 6 months of age
E) Response to loud noises as opposed to the voice

Question 37

The nurse is teaching a preschool child with a cognitive impairment how to throw a ball overhand. What teaching strategy should the nurse use for this child?

A) Demonstrate how to throw a ball overhand.
B) Explain the reason for throwing a ball overhand.
C) Show pictures of children throwing balls overhand.
D) Explain to the child how to throw the ball overhand.

Question 38

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

Question 39

The community nurse is planning prevention measures designed to avoid conditions that can cause cognitive impairment. Taking folic acid supplements during pregnancy to prevent neural tube defects is which type of prevention strategy?

A) Primary
B) Secondary
C) Tertiary
D) Rehabilitative

Question 40

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

Question 41

The nurse should plan which actions to assist the stuttering child? (Select all that apply.)

A) Ask the child to stop and start over.
B) Promise a reward for proper speech.
C) Set a good example by speaking clearly.
D) Give the child plenty of time to finish sentences.
E) Look directly at the child while he or she is speaking.

Question 42

MATCHING
Match the type of visual impairment to its definition.

Ability to see objects at a distance but not at a close range

A)Myopia
B)Hyperopia
C)Astigmatism
D)Anisometropia
E)Amblyopia

Question 43

MATCHING
Match the type of visual impairment to its definition.

Ability to see objects clearly at close range but not at a distance

A)Myopia
B)Hyperopia
C)Astigmatism
D)Anisometropia
E)Amblyopia

Question 44

MATCHING
Match the type of visual impairment to its definition.

Reduced visual acuity in one eye

A)Myopia
B)Hyperopia
C)Astigmatism
D)Anisometropia
E)Amblyopia

Question 45

MATCHING
Match the type of visual impairment to its definition.

Unequal curvatures in refractive apparatus

A)Myopia
B)Hyperopia
C)Astigmatism
D)Anisometropia
E)Amblyopia

Question 46

MATCHING
Match the type of visual impairment to its definition.

Different refractive strength in each eye

A)Myopia
B)Hyperopia
C)Astigmatism
D)Anisometropia
E)Amblyopia

Question 47

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

Question 48

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.