Impact of Cognitive or Sensory Impairment on the Child and Family

Cognitive or Sensory Impairment on the Child and Family

MULTIPLE CHOICE

1. A young child who has an intelligence quotient (IQ) of 45 would be described as which of the following?
a. Within the lower limits of the range of normal intelligence
b. Mildly retarded but educable

c. Moderately retarded but trainable
d. Severely retarded and completely dependent on others for care

ANS: C
Moderately retarded IQs range between 35 and 55.

DIF: Cognitive Level: Comprehension REF: Page 612
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PsychosocialIntegrity:MentalHealthConcepts

2. When a child with mild mental retardation reaches the end of adolescence, which of the following characteristics would be expected?
a. Achieves a mental age of 5 to 6 years
b. Achieves a mental age of 8 to 12 years

c. Unable to progress in functional reading or arithmetic
d. Acquires practical skills and useful reading and arithmetic to an eighth-grade

level

ANS: B
By the end of adolescence, the child with mild mental retardation can acquire practical skills and useful reading and arithmetic to a third- to sixth-grade level. A mental age of 8 to 12 years is obtainable, and the child can be guided toward social conformity.

DIF: Cognitive Level: Comprehension REF: Page 612
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PsychosocialIntegrity:MentalHealthConcepts

3. When should children with cognitive impairment be referred for stimulation and educational programs?
a. As young as possible
b. As soon as they have the ability to communicate in some way

c. At age 3 years, when schools are required to provide services
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 19-2

d. At age 5 or 6 years, when schools are required to provide services

ANS: A
The child’s education should begin as soon as possible. Considerable evidence exists that early intervention programs for children with disabilities are valuable for cognitively impaired children.

DIF: Cognitive Level: Comprehension REF: Page 613
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PsychosocialIntegrity:MentalHealthConcepts

4. Which of the following should be the major consideration when selecting toys for a child who is mentally retarded?
a. Safety
b. Age appropriateness

c. Ability to provide exercise d. Ability to teach useful skills

ANS: A
Safety is the primary concern in selecting recreational and exercise activities for all children. This is especially true for children who are mentally retarded.

DIF: Cognitive Level: Analysis REF: Page 616
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:SafeandEffectiveCareEnvironment:Safetyand Infection Control (Injury Prevention)

5. Appropriate interventions to facilitate socialization of the cognitively impaired child include which of the following?
a. Provide age-appropriate toys and play activities.
b. Provide peer experiences, such as scouting, when older.

c. Avoid exposure to strangers who may not understand cognitive development. d. Emphasize mastery of physical skills because they are delayed more often than

verbal skills.

ANS: B
The acquisition of social skills is a complex task. Children of all ages need peer relationships. Parents should enroll the child in preschool. When older, they should have peer experiences similar to those of other children such as group outings, Boy and Girl Scouts, and Special Olympics.

DIF: Cognitive Level: Comprehension REF: Page 618
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PsychosocialIntegrity:MentalHealthConcepts

6. The nurse is discussing sexuality with the parents of an adolescent girl with moderate cognitive impairment. Which of the following should the nurse consider when dealing with this issue?

Test Bank 19-3

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

sexual conduct.

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 laid out for the adolescent.

DIF: Cognitive Level: Application REF:
TOP: Integrated Process: Teaching/Learning
MSC: AreaofClientNeeds:PsychosocialIntegrity:MentalHealthConcepts

7. When caring for a newborn with Down syndrome, the nurse should be aware that the most common congenital anomaly associated with Down syndrome is which of the following?
a. Hypospadias

b. Pyloric stenosis
c. Congenital heart disease d. Congenital hip dysplasia

ANS: C
Congenital heart malformations, primarily septal defects, are the most common congenital anomaly in Down syndrome.

DIF: Cognitive Level: Comprehension REF: Page 620
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

8. Mark, a 9 year old with Down syndrome, is mainstreamed into a regular third grade 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 of the following?

Programs like Cub Scouts are inappropriate for children who are mentally retarded.
Children with Down syndrome have the same need for socialization as other children.
Children with Down syndrome socialize better with children who have similar disabilities.
Parents of children with Down syndrome encourage programs, such as scouting, because they deny that their children have disabilities.

ANS: B

Page 618

Test Bank 19-4

Children of all ages need peer relationships. Children with Down syndrome should have peer experiences similar to those of other children, such as group outings, Cub Scouts, and Special Olympics.

DIF: Cognitive Level: Analysis REF:
TOP: Integrated Process: Teaching/Learning
MSC: AreaofClientNeeds:PsychosocialIntegrity:MentalHealthConcepts

9. What is one of the major physical characteristics of the child with Down syndrome? a. Excessive height
b. Spots on the palms
c. Inflexibility of the joints

d. Hypotonic musculature

ANS: D
Hypotonic musculature is one of the major characteristics.

DIF: Cognitive Level: Comprehension REF: Page 620
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

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

b. Down syndrome
c. Cerebral palsy
d. Fragile X syndrome

ANS: B
These are characteristics associated with Down syndrome.

DIF: Cognitive Level: Comprehension REF: Page 620
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

11. The child with Down syndrome should be evaluated for which of the following before participating in some sports?
a. Hyperflexibility
b. Cutis marmorata

c. Atlantoaxial instability
d. Speckling of iris (Brushfield spots)

ANS: C
Children with Down syndrome are at risk for atlantoaxial instability. Before participating in sports that put stress on the head and neck, a radiologic examination should be done.

Page 618

Test Bank 19-5

DIF: Cognitive Level: Comprehension REF: Page 620
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

12. Many of the physical characteristics of Down syndrome present nursing problems. Care of the child should include which of the following?
a. Delay feeding solid foods until the tongue thrust has stopped.
b. Modify diet as necessary to minimize the diarrhea that often occurs.

c. Provide calories appropriate to child’s age.
d. Use a cool-mist vaporizer to keep mucous membranes moist.

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.

DIF: Cognitive Level: Analysis REF: Page 622
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

13. Fragile X syndrome is which of the following?
a. Chromosomal defect affecting only females
b. Chromosomal defect that follows the pattern of X-linked recessive disorders c. Second most common genetic cause of mental retardation
d. Most common cause of noninherited mental retardation

ANS: C
Fragile X syndrome is the second most common cause of mental retardation after Down syndrome.

DIF: Cognitive Level: Comprehension REF: Page 622
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

14. Distortion of sound and problems in discrimination are characteristic of what type of hearing loss?

a. Conductive
b. Sensorineural
c. Mixed conductive-sensorineural d. Central auditory imperceptive

ANS: B
Sensorineural hearing loss, also known as perceptive or nerve deafness, involves damage to the inner ear structures or the auditory nerve. It results in distortion of sounds and problems in discrimination.

DIF: Cognitive Level: Comprehension REF: Page 623 TOP: Integrated Process: Nursing Process: Assessment

Test Bank 19-6

MSC: AreaofClientNeeds:PsychosocialIntegrity:Sensory/PerceptualAlterations

15. The most common type of hearing loss, which results from interference of transmission of sound to the middle ear, is called:
a. conductive.
b. sensorineural.

c. mixed conductive-sensorineural. d. central auditory imperceptive.

ANS: A
Conductive or middle-ear hearing loss is the most common type. It results from interference of transmission of sound to the middle ear, most often from recurrent otitis media.

DIF: Cognitive Level: Comprehension REF: Page 623
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PsychosocialIntegrity:Sensory/PerceptualAlterations

16. Hearing is expressed in decibels (dB), or units of loudness. Which of the following is, in decibels, the softest sound a normal ear can hear?
a. 0
b. 10

c. 40 to 50 d. 100

ANS: A
By definition, 0 dB is the softest sound the normal ear can hear.

DIF: Cognitive Level: Comprehension REF: Page 624
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PsychosocialIntegrity:Sensory/PerceptualAlterations

17. The nurse should suspect a hearing impairment in an infant who demonstrates which of the following behaviors?
a. Absence of the Moro reflex
b. Absence of babbling by age 7 months

c. Lack of eye contact when being spoken to
d. Lack of gesturing to indicate wants after age 15 months

ANS: B
The absence of babbling or inflections in voice by age 7 months is an indication of hearing difficulties.

DIF: Cognitive Level: Comprehension REF: Page 624
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PsychosocialIntegrity:Sensory/PerceptualAlterations

Test Bank 19-7

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 of the following is the most appropriate nursing action?
a. Ignore the sound.

b. Ask him to reverse the hearing aids in his ears. c. Suggest he reinsert the hearing aid.
d. Suggest he raise the volume of the hearing aid.

ANS: C
The whistling sound is acoustic feedback. The nurse should have the child remove the hearing aid and reinsert it, making certain no hair is caught between the ear mold and the ear canal.

DIF: Cognitive Level: Analysis REF: Page 624
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PsychosocialIntegrity:Sensory/PerceptualAlterations

19. Which of the following is an implanted ear prosthesis for children with sensorineural hearing loss?

a. Hearing aid
b. Cochlear implant
c. Auditory implant
d. Amplification device

ANS: B
Cochlear implants are surgically implanted, and they provide a sensation of hearing for individuals who have severe or profound hearing loss of sensorineural origin.

DIF: Cognitive Level: Comprehension REF: Page 624
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PsychosocialIntegrity:Sensory/PerceptualAlterations

20. Which of the following facilitates lip reading by the hearing-impaired child? a. Speak at an even rate.
b. Exaggerate pronunciation of words.
c. Avoid using facial expressions.

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

ANS: A
The child should be helped to learn and understand how to read lips by speaking at an even rate.

DIF: Cognitive Level: Comprehension REF: Page 626
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PsychosocialIntegrity:Sensory/PerceptualAlterations

21. The most common cause of hearing impairment in children is which of the following?

Test Bank 19-8

Auditory nerve damage
Congenital ear defects
Congenital rubella
Chronic otitis media

ANS: D
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.

DIF: Cognitive Level: Comprehension REF: Page 623
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PsychosocialIntegrity:Sensory/PerceptualAlterations

22. Prevention of hearing impairment in children is a major goal for the nurse. This can be achieved through which of the following?
a. Being involved in immunization clinics for children
b. Assessing a newborn for hearing loss

c. Answering parents’ questions about hearing aids
d. Participating in hearing screening in the community

ANS: A
Childhood immunizations can eliminate the possibility of acquired sensorineural hearing loss from rubella, mumps, or measles encephalitis.

DIF: Cognitive Level: Comprehension REF: Page 628
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PsychosocialIntegrity:Sensory/PerceptualAlterations

23. Which of the following terms refers to the ability to see objects clearly at close range but not at a distance?
a. Myopia
b. Amblyopia

c. Cataract d. Glaucoma

ANS: A
Myopia, or nearsightedness, refers to the ability to see objects clearly at close range but not a distance.

DIF: Cognitive Level: Comprehension REF: Page 628
TOP: Integrated Process: Nursing Process: Problem Identification
MSC: AreaofClientNeeds:PsychosocialIntegrity:Sensory/PerceptualAlterations

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?
a. Myopia
b. Amblyopia

Test Bank 19-9

c. Cataract d. Glaucoma

ANS: C
This is the definition of a cataract.

DIF: Cognitive Level: Comprehension
TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Prevention and Early Detection of Disease

25. A nurse would suspect possible visual impairment in a child who displays which of the following?

a. Excessive rubbing of the eyes
b. Rapid lateral movement of the eyes
c. Delay in speech development
d. Lack of interest in casual conversation with peers

ANS: A
Excessive rubbing of the eyes is a clinical manifestation of visual impairment.

DIF: Cognitive Level: Comprehension REF: Page 628
TOP: Integrated Process: Nursing Process: Problem Identification
MSC: AreaofClientNeeds:PsychosocialIntegrity:Sensory/PerceptualAlterations

26. When assessing the eyes of a neonate, the nurse observes opacity of the lens. This represents which of the following?
a. Blindness
b. Glaucoma

c. Cataracts
d. Retinoblastoma

ANS: C
A cataract is opacity of the lens of the eye.

DIF: Cognitive Level: Comprehension
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PsychosocialIntegrity:Sensory/PerceptualAlterations

27. The school nurse is caring for a child with a penetrating eye injury. Emergency treatment includes which of the following?
a. Apply a regular eye patch.
b. Apply a Fox shield to affected eye and any type of patch to the other eye. c. Apply ice until the physician is seen.

d. Irrigate eye copiously with a sterile saline solution. ANS: B

REF: Page 629

Test Bank 19-10

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.

DIF: Cognitive Level: Comprehension REF: Page 630
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

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 of the following before the child is transported?

a. Keep eyes closed.
b. Apply cold compresses.
c. Irrigate eyes copiously with tap water for 20 minutes.
d. Prepare a normal saline solution (salt and water) and irrigate 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.

DIF: Cognitive Level: Comprehension REF: Page 630
TOP: Integrated Process: Nursing Process: Intervention
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

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). The nurse should:
a. apply a Fox shield.

b. instruct the adolescent to apply ice for 24 hours.
c. have adolescent rest with eye closed and ice applied.
d. notify parents that adolescent needs to see an ophthalmologist.

ANS: D
The parents should be notified that the adolescent needs to see an ophthalmologist as soon as possible.

DIF: Cognitive Level: Comprehension REF: Page 630
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

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

a. Glaucoma
b. Amblyopia
c. Cat’s eye reflex
d. Sunken eye socket

Test Bank

19-11

ANS: C
When the eye is examined, the light will reflect off of the tumor, giving the eye a whitish appearance. This is called a cat’s eye reflex.

DIF: Cognitive Level: Comprehension REF: Page 633
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

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 of the following statements by the nurse would be most appropriate to make?

a. “I am going to request a referral to a hearing specialist.”
b. “You should not compare your child to your sister’s child.”
c. “I think your child is fine, but we will check again in 3 months.”
d. “You should ask other parents what noises their children made at this age.”

ANS: A
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.

DIF: Cognitive Level: Analysis REF: Page 625
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

MULTIPLE RESPONSE

1. Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which of the following areas with onset before age 3 years? (Select all that apply.)
a. Language as used in social communication

b. Parallel play
c. Gross motor development
d. Growth below the 5th percentile for height and weight e. Symbolic or imaginative play
f. Social interaction

ANS: A, E, F
These are three of the areas in which autistic children may show delayed or abnormal functioning.

DIF: Cognitive Level: Comprehension REF: Page 637
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PsychosocialIntegrity:MentalHealthConcepts