Nokea
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.
Correct Answer: C
Rationale: Orienting the child to his surroundings is critical for safety, as bilateral eye patches impair vision and he is now mobile. Speaking on entry, assisting with feeding, and parental presence are important but secondary to ensuring a safe environment.
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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
Correct Answer: C
Rationale: A hallmark of autism spectrum disorders is the inability to maintain eye contact, reflecting impaired social interaction, with onset before age 3. Parallel play and gross motor development are typically unaffected, and physical growth is not a diagnostic criterion.
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.
Correct Answer: A
Rationale: Task analysis breaks down self-feeding into manageable steps, guiding the child to master each component. Expecting the task to be unlearnable is defeatist, continued spoon-feeding delays independence, and finger foods avoid necessary socialization skills.
The parents of a child with cognitive impairment ask the nurse for guidance with discipline. What should the nurses 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.
Correct Answer: C
Rationale: Behavior modification, using clear, simple, and consistent limits with reinforcement of desired behaviors, is effective for children with cognitive impairment. Discipline is necessary and effective when tailored to mental age, and physical punishment is inappropriate.
Many of the clinical features of Down syndrome present challenges to caregivers. Based on these features, what intervention should the nurse include in the childs care?
- A. Encourage parents to limit feeding attempts because of the tongue thrust.
- B. Modify the diet as necessary to minimize the diarrhea that often occurs.
- C. Provide calories appropriate to the childs mental age.
- D. Use a cool-mist vaporizer to keep the mucous membranes moist and secretions liquefied.
Correct Answer: D
Rationale: A cool-mist vaporizer helps keep mucous membranes moist, reducing the risk of respiratory infections due to mouth breathing from a stuffy nose, a common issue in Down syndrome. Limiting feeding ignores the need to persist through tongue thrust, constipation is more common than diarrhea, and calories should match physical growth needs, not mental age.
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
Correct Answer: D
Rationale: Secondary prevention focuses on early identification and treatment to prevent cerebral damage, such as newborn screening for inborn errors of metabolism like hypothyroidism or phenylketonuria. Genetic counseling and rubella prevention are primary prevention, while preschool education is tertiary prevention.