The Child with a Developmental Disability

MULTIPLE CHOICE

1. A parent whose child has been diagnosed with a cognitive deficit should be counseled that intellectual impairment:

a.
is usually due to a genetic defect.
b.
may be caused by a variety of factors.
c.
is rarely due to first-trimester events.
d.
is usually caused by parental intellectual impairment.

ANS: B

There is a multitude of causes for intellectual impairment. In nearly half of the cases, a specific cause has not been identified. Only 5% of children with intellectual impairment are affected by a genetic defect. One-third of children with intellectual impairment are affected by first-trimester events. Intellectual impairment can be transmitted to a child only if the parent has a genetic disorder.

DIF: Cognitive Level: Comprehension REF: p. 799

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

2. A parent asks the nurse why a developmental assessment is being conducted for a child during a routine well-child visit. The nurse answers based on the knowledge that routine developmental assessments during well-child visits are:

a.
not necessary unless the parents request them.
b.
the best method for early detection of cognitive disorders.
c.
frightening to parents and children and should be avoided.
d.
valuable in measuring intelligence in children.

ANS: B

Early detection of cognitive disorders can be facilitated through assessment of development at each well-child examination. Developmental assessment is a component of all well-child examinations. Developmental assessments are not frightening when the parent and child are educated about the purpose of the assessment and are not intended to measure intelligence.

DIF: Cognitive Level: Application REF: p. 799|p. 801

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

3. The father of a child recently diagnosed with developmental delay is very rude and hostile toward the nurses. This father was cooperative during the child’s evaluation a month ago. What is the best explanation for this change in parental behavior?

a.
The father is exhibiting symptoms of a psychiatric illness.
b.
The father may be abusing the child.
c.
The father is resentful of the time he is missing from work for this appointment.
d.
The father is in the anger stage of the grief process.

ANS: D

After a child is diagnosed with a developmental delay, the family may feel grief. The grief process begins with a stage of disbelief and denial and then progresses to anger. It is not possible to determine that a parent is exhibiting symptoms of a psychiatric illness on the basis of a single situation. The scenario does not give any information to suggest child abuse. Although the father may have difficulty balancing his work schedule with medical appointments for his child, a more likely explanation for his behavior change is that he is grieving the loss of a normal child.

DIF: Cognitive Level: Comprehension REF: pp. 802-803

OBJ: Nursing Process Step: Evaluation MSC: Psychosocial Integrity

4. An appropriate nursing diagnosis for a child with a cognitive dysfunction who has a limited ability to anticipate danger is:

a.
Impaired social interaction.
b.
Deficient knowledge.
c.
Risk for injury.
d.
Ineffective coping.

ANS: C

The nurse needs to know that limited cognitive abilities to anticipate danger lead to risk for injury. Impaired social interaction is indeed a concern for the child with a cognitive disorder but does not address the limited ability to anticipate danger. Because of the child’s cognitive deficit, knowledge will not be retained and will not decrease the risk for injury. Ineffective individual coping does not address the limited ability to anticipate danger.

DIF: Cognitive Level: Application REF: p. 801

OBJ: Nursing Process Step: Nursing Diagnosis

MSC: Health Promotion and Maintenance

5. Anticipatory guidance for the family of a preadolescent with a cognitive dysfunction should include information about:

a.
institutional placement.
b.
sexual development.
c.
sterilization.
d.
clothing.

ANS: B

Preadolescents who have a cognitive dysfunction may have normal sexual development without the emotional and cognitive abilities to deal with it. It is important to assist the family and child through this developmental stage. Preadolescence does require the child to be institutionalized. Sterilization is not an appropriate intervention when a child has a cognitive dysfunction. By the time a child reaches preadolescence, the family should have received counseling on age-appropriate clothing.

DIF: Cognitive Level: Application REF: p. 802

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

6. The mother of a 9-year-old child with Down syndrome discusses the child’s language abilities. The nurse is not surprised to learn which information about the child’s language development?

a.
Can take turns during conversation
b.
Has good grammar
c.
Can speak a foreign language
d.
Has difficulty in carrying on a conversation

ANS: A

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.

DIF: Cognitive Level: Comprehension REF: pp. 805-806

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

7. The infant with Down syndrome is closely monitored during the first year of life for which condition?

a.
Thyroid complications
b.
Orthopedic malformations
c.
Dental malformation
d.
Cardiac abnormalities

ANS: D

The high incidence of cardiac defects in children with Down syndrome makes assessment for signs and symptoms of these defects important during the first year. Infants with Down syndrome are not known to have thyroid complications. Orthopedic malformations may be present, but special attention is given to assessment for cardiac and gastrointestinal abnormalities. Dental malformations are not a major concern compared with the life-threatening complications of cardiac defects.

DIF: Cognitive Level: Comprehension REF: p. 805

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

8. Which action is contraindicated when a child with Down syndrome is hospitalized?

a.
Determine the child’s vocabulary for specific body functions.
b.
Assess the child’s hearing and visual capabilities.
c.
Encourage parents to leave the child alone.
d.
Have meals served at the child’s usual meal times.

ANS: C

The child with Down syndrome needs routine schedules and consistency. Having familiar people present, especially parents, helps to decrease the child’s anxiety. To communicate effectively with the child, it is important to know the child’s particular vocabulary for specific body functions. Children with Down syndrome have a high incidence of hearing loss and vision problems and should have hearing and vision assessed whenever they are in a healthcare facility. Routine schedules and consistency are important to children.

DIF: Cognitive Level: Application REF: p. 807

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

9. A nurse is giving a parent information about autism. Which statement made by the parent indicates understanding of the teaching?

a.
Autism is characterized by periods of remission and exacerbation.
b.
The onset of autism usually occurs before 2 1/2 years of age.
c.
Children with autism have imitation and gesturing skills.
d.
Autism can be treated effectively with medication.

ANS: B

The onset of autism usually occurs before 30 months of age. Autism does not have periods of remissions and exacerbations. Autistic children lack imitative skills. Medications are of limited use in children with autism.

DIF: Cognitive Level: Application REF: p. 812

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

10. Which should the nurse keep in mind when planning to communicate with a child who is autistic?

a.
The child has normal verbal communication.
b.
Expect the child to use sign language.
c.
The child may exhibit monotone speech and echolalia.
d.
The child is not listening if she is not looking at the nurse.

ANS: C

Children with autism have abnormalities in the production of speech such as a monotone voice or echolalia and inappropriate volume, pitch, rate, rhythm, or intonation. The child has impaired verbal communication and abnormalities in the production of speech. Some autistic children may use sign language, but it is not assumed. Children with autism often are reluctant to initiate direct eye contact.

DIF: Cognitive Level: Comprehension REF: p. 812

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

11. What is the best intervention when a child with autism is hospitalized?

a.
Limit the individuals who enter the child’s room.
b.
Perform all of the child’s activities of daily living for her.
c.
Make sure the nurses know this child may be violent.
d.
Assign the strongest nurse to control the child.

ANS: A

The child with autism is often unable to tolerate the slightest change in routine. Limiting who enters the child’s room to those knowledgeable about the child’s routine will facilitate the child’s 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 child’s 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.

DIF: Cognitive Level: Application REF: p. 814

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

12. Intense stress and isolation as a result of caring for a child with developmental disabilities often lead parents to:

a.
heightened parental achievement.
b.
overuse of the healthcare system.
c.
overindulgence and obesity.
d.
child abuse.

ANS: D

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 children’s needs. Although overindulgence and obesity may occur, the best answer is child abuse.

DIF: Cognitive Level: Comprehension REF: p. 799

OBJ: Nursing Process Step: Assessment MSC: Psychosocial Integrity

13. A child with Asperger syndrome has also been diagnosed with depression. The nurse understands that two or more disorders in an individual is termed:

a.
comorbidity.
b.
congenital syndrome.
c.
mental retardation.
d.
developmental impairment.

ANS: A

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.

DIF: Cognitive Level: Comprehension REF: p. 799

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

14. Self-injury, fecal smearing, and severe temper tantrums in a preschool child are symptoms of:

a.
mild intellectual impairment.
b.
severe intellectual impairment.
c.
psychosocial deprivation.
d.
separation anxiety.

ANS: B

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.

DIF: Cognitive Level: Analysis REF: p. 800

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

15. Throughout their life span, cognitively impaired children are less capable of managing environmental challenges and are at risk for which problem?

a.
Nutritional deficits
b.
Visual impairments
c.
Physical injuries
d.
Psychiatric problems

ANS: C

Safety is a challenge for cognitively impaired children. Decreased capability to manage environmental challenges may lead to physical injuries. Nutritional deficits are related more to dietary habits and the caregivers’ understanding of nutrition. Visual impairments are unrelated to cognitive impairment. Psychiatric problems may coexist with cognitive impairment but are not environmental challenges.

DIF: Cognitive Level: Comprehension REF: p. 804

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

16. 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.”

ANS: B

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.

DIF: Cognitive Level: Application REF: p. 799

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

17. Parents of a child with fragile X syndrome ask the nurse about genetic transmission of this syndrome. In response, the nurse correctly explains that fragile X syndrome is:

a.
most commonly seen in girls.
b.
acquired after birth.
c.
usually transmitted by the male carrier.
d.
usually transmitted by the female carrier.

ANS: D

The gene causing fragile X syndrome is transmitted by the mother. Fragile X syndrome is most common in males, is congenital, and is not transmitted by a male carrier.

DIF: Cognitive Level: Application REF: p. 807

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

18. The best setting for daytime care for a 5-year-old autistic child whose mother works is:

a.
private day care.
b.
public school.
c.
his own home with a sitter.
d.
a specialized program that facilitates interaction by use of behavioral methods.

ANS: D

Autistic children can benefit from specialized educational programs that address their special needs. Day care programs generally do not have resources to meet the needs of severely impaired children. To best meet the needs of an autistic child, the public school may refer the child to a specialized program. A sitter might not have the skills to interact with an autistic child.

DIF: Cognitive Level: Application REF: p. 813

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

19. Parents have learned that their 6-year-old child is autistic. The nurse may help the parents to cope by explaining that the child will:

a.
have abnormal ways of interacting with other children and adults.
b.
outgrow the condition by early adulthood.
c.
have average social skills.
d.
probably have age-appropriate language skills.

ANS: A

Abnormal interaction with people is one of the several characteristics of autism. No evidence supports the belief that autism is outgrown. Autistic children have abnormal ways of relating to people (social skills). Speech and language skills are usually delayed in autistic children.

DIF: Cognitive Level: Application REF: p. 812

OBJ: Nursing Process Step: Implementation MSC: Psychosocial Integrity

20. An autistic child is hospitalized with asthma. The nurse should plan care so that the:

a.
parents’ expectations are met.
b.
child’s routine habits and preferences are maintained.
c.
child is supported through the autistic crisis.
d.
parents need not be at the hospital.

ANS: B

Children with autism are often unable to tolerate even slight changes in routine. Focus of care is on the child’s needs rather than on the parent’s desires. Autism is a life-long condition. The presence of the parents is almost always required when an autistic child is hospitalized.

DIF: Cognitive Level: Application REF: p. 814

OBJ: Nursing Process Step: Planning MSC: Psychosocial Integrity

MULTIPLE RESPONSE

1. Which of the following treatment guidelines would be contraindicated when counseling the family of an infant with fragile X syndrome? Select all that apply.

a.
Advise genetic testing for family members.
b.
Delay speech therapy until the child is 2 years of age.
c.
Educate the family that their child will probably have normal intelligence.
d.
Refer the family to an early intervention program.

ANS: B, C

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.

DIF: Cognitive Level: Application REF: p. 808

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

2. A nurse is assessing a newborn for facial feature characteristics associated with fetal alcohol syndrome. Which characteristics should the nurse expect to assess? Select all that apply.

a.
Short palpebral fissures
b.
Smooth philtrum
c.
Low set ears
d.
Inner epicanthal folds
e.
Thin upper lip

ANS: A, B, E

Infants with fetal alcohol syndrome may have characteristic facial features, including short palpebral fissures, a smooth philtrum (the vertical groove in the median portion of the upper lip), and a thin upper lip. Low set ears and inner epicanthal folds are associated with Down syndrome.

DIF: Cognitive Level: Analysis REF: p. 809

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

3. A nurse should plan to implement which interventions for a child admitted with inorganic failure to thrive? Select all that apply.

a.
Observation of parent–child interactions
b.
Assignment of different nurses to care for the child from day to day
c.
Use of 28 calorie per ounce concentrated formulas
d.
Administration of daily multivitamin supplements
e.
Role-modeling appropriate adult–child interactions

ANS: A, D, E

The nurse should plan to assess parent–child interactions when a child is admitted for nonorganic failure to thrive. The observations should include how the child is held and fed, how eye contact is initiated and maintained, and the facial expressions of both the child and the caregiver during interactions. Role modeling and teaching appropriate adult–child interactions (including holding, touching, and feeding the child) will facilitate appropriate parent–child relationships, enhance parents’ confidence in caring for their child, and facilitate expression by the parents of realistic expectations based on the child’s developmental needs. Daily multivitamin supplements with minerals are often prescribed to ensure that specific nutritional deficiencies do not occur in the course of rapid growth. The nursing staff assigned to care for the child should be consistent. Providing a consistent caregiver from the nursing staff increases trust and provides the child with an adult who anticipates his or her needs and who is able to role model child care to the parent. Caloric enrichment of food is essential, and formula may be concentrated in titrated amounts up to 24 calories per ounce. Greater concentrations can lead to diarrhea and dehydration.

DIF: Cognitive Level: Analysis REF: pp. 810-811

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity