NR 328 Pediatric Nursing; Final Exam Test Bank 3,

Latest 2019/2020.
Chapter 21: The Child with Cognitive, Sensory, or Communication Impairment

MULTIPLE CHOICE

1. 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

ANS: C

The AAIDD has categorized cognitive impairment into adaptive skill domains. The
child must demonstrate functional impairment in at least two of the following adaptive
skill domains: communication, self-care, home living, social skills, use of community
resources, self-direction, health and safety, functional academics, leisure, and work.
Age of onset before 18 years is part of the former criteria. Low intelligence quotient
(IQ) alone is not the sole criterion for cognitive impairment. Etiology is not part of the
classification.

DIF: Cognitive Level: Understanding REF: p. 824

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

2. 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

ANS: D

Secondary prevention involves activities that are designed to identify the condition
early and initiate treatment to avert cerebral damage. Inborn errors of metabolism
such as hypothyroidism, phenylketonuria, and galactosemia can cause cognitive
impairment. Genetic counseling and avoidance of prenatal rubella infections are
examples of primary prevention strategies to preclude the occurrence of disorders that
can cause cognitive impairment. Preschool education and counseling services are
examples of tertiary prevention. These are designed to include early identification of
conditions and provision of appropriate therapies and rehabilitation services.

DIF: Cognitive Level: Understanding REF: p. 826

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

3. 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

ANS: B
The goal for children with cognitive impairment is the promotion of optimum social,
physical, cognitive, and adaptive development as individuals within a family and
community. Vocational skills are only one part of that goal. The focus must also be on
the family and other aspects of development. Out-of-home care is considered part of
the child’s development. Optimum development includes adjustment for both the
family and child.

DIF: Cognitive Level: Understanding REF: p. 828 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

4. 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

ANS: D

Fading is physically taking the child through each sequence of the desired activity and
gradually fading out the physical assistance so the child becomes more independent.
Positive reinforcement when tasks or behaviors are mastered is part of behavior
modification. An essential component is ignoring undesirable behaviors. Verbal
explanations are not as effective as demonstration and physical guidance. Consistent
negative reinforcement is helpful, but positive reinforcement that focuses on skill
attainment should be incorporated.

DIF: Cognitive Level: Analyzing REF: p. 827 TOP: Nursing Process: Evaluation

MSC: Client Needs: Health Promotion and Maintenance

5. 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.

ANS: C

Discipline must begin early. Limit-setting measures must be clear, simple, consistent,
and appropriate for the child’s mental age. Behavior modification, especially
reinforcement of desired behavior and use of time-out procedures, is an appropriate
form of behavior control. Aversive strategies should be avoided in disciplining the
child.

DIF: Cognitive Level: Applying REF: p. 827

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

6. 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.

ANS: C

The acquisition of social skills is a complex task. Initially, an infant stimulation

program should be used. 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. Providing age-appropriate toys and play activities is important, but peer
interactions facilitate social development. Parents should expose the child to
individuals who do not know the child. This enables the child to practice social skills.
Verbal skills are delayed more often than physical skills.

DIF: Cognitive Level: Applying REF: p. 835

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

7. 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.

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 defined for the adolescent. Permanent
contraception by sterilization presents moral and ethical issues and may have
psychologic effects on the adolescent. It may be prohibited in some states. The
adolescent needs to have practical sexual information regarding physical development
and contraception. Cognitively impaired individuals may desire to marry and have
families. The adolescent needs to be protected from individuals who may make
intimate advances.

DIF: Cognitive Level: Applying REF: p. 829

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

8. 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.

ANS: A

Successful teaching begins with a task analysis. The endpoint (self-feeding, toilet
training, and so on) is broken down into the component steps. The child is then guided
to master the individual steps in sequence. Depending on the child’s functional level,
using a spoon for eating should be an achievable goal. The child requires
demonstration and then guided training for each component of the self-feeding.
Feeding finger foods so spoon feeding is unnecessary eliminates some of the
intermediate steps that are necessary to using a fork and spoon. For socialization
purposes, it is desirable that a child use feeding implements.

DIF: Cognitive Level: Understanding REF: p. 827

TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

9. 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

ANS: C

These are characteristics associated with Down syndrome. An infant with

microcephaly has a small head. Cerebral palsy is a diagnosis not usually made at
birth; no characteristic physical signs are present. The infant with fragile X syndrome
has increased head circumference; long, wide, or protruding ears; a long, narrow face
with a prominent jaw; hypotonia; and a high-arched palate.

DIF: Cognitive Level: Understanding REF: p. 834

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

10. 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

ANS: C

Infants with Down syndrome have hypotonicity of muscles and hyperextensibility of

joints, which complicate positioning. The limp, flaccid extremities resemble the
posture of a rag doll. Holding the infant is difficult and cumbersome, and parents may
feel that they are inadequate. A lack of clinging or molding is characteristic of Down
syndrome, not detachment. There is no evidence of maternal deprivation. Autism is
not associated with Down syndrome, and it would not be evident at 2 weeks of age.

DIF: Cognitive Level: Analyzing REF: p. 836

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

11. 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.

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.
Respiratory tract infections combined with cardiac anomalies are the primary cause of
death in the first years. The child has a protruding tongue, which makes feeding
difficult. The parents must persist with feeding while the child continues the
physiologic response of the tongue thrust. The child is predisposed to constipation.
Calories should be appropriate to the child’s weight and growth needs, not mental age.

DIF: Cognitive Level: Applying REF: p. 837 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

12. 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

ANS: B

Fragile X syndrome is the most common inherited cause of cognitive impairment and
the second most common genetic cause of cognitive impairment after Down
syndrome. Fragile X primarily affects males and follows the pattern of X-linked
dominant inheritance with reduced penetrance.

DIF: Cognitive Level: Understanding REF: p. 837

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

13. 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

ANS: A

The absence of babbling or inflections in voice by at least age 7 months is an

indication of hearing difficulties. Lack of eye contact is not indicative of a hearing
loss. An infant with a hearing impairment might react to a loud noise but not respond
to the spoken word. The child with hearing impairment uses gestures rather than
vocalizations to express desires at this age.

DIF: Cognitive Level: Understanding REF: p. 854

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

14. 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.

ANS: B

The whistling sound is acoustic feedback. The nurse should have the child remove the
hearing aid and reinsert it, making sure no hair is caught between the ear mold and the
ear canal. Ignoring the sound or suggesting he raise the volume of the hearing aid
would be annoying to others. The hearing aids are molded specifically for each ear.

DIF: Cognitive Level: Applying REF: p. 842

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