Nokea
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
Correct Answer: C
Rationale: These physical characteristics, including a separated sagittal suture and protruding tongue, are hallmark signs of Down syndrome. Microcephaly involves a small head, cerebral palsy lacks specific physical signs at birth, and fragile X syndrome presents different features like a long face and large ears.
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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
Correct Answer: C
Rationale: The AAIDD classifies cognitive impairment based on functional impairment in at least two adaptive skill domains, such as communication, self-care, or social skills. Age of onset before 18 is a criterion but not the basis for classification. Subaverage intelligence alone is insufficient, and etiology is not part of the classification system.
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.
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.
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.
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.