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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.
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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 hes like a rag doll. He doesnt cuddle up to me like my other babies did. What is the nurses 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
Correct Answer: C
Rationale: Hypotonicity and hyperextensibility in Down syndrome cause a rag doll-like posture, making holding difficult. This is a physical characteristic, not detachment, maternal deprivation, or autism, which is not typically associated with Down syndrome at this age.
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 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
Correct Answer: A
Rationale: Absence of babbling by 7 months, and certainly by 12 months, suggests hearing impairment, as it indicates a lack of auditory input for language development. Eye contact and gesturing are not directly tied to hearing, and a startle reflex may occur with loud noises despite hearing issues.
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.
Correct Answer: C
Rationale: A concrete code of sexual conduct helps adolescents with cognitive impairment navigate social situations safely due to their susceptibility to persuasion and limited judgment. Sterilization is ethically complex and not universally recommended, sexual drive is not necessarily limited, and intercourse can occur without abuse, necessitating education.
What condition is defined as reduced visual acuity in one eye despite appropriate optical correction?
- A. Myopia
- B. Hyperopia
- C. Amblyopia
- D. Astigmatism
Correct Answer: C
Rationale: Amblyopia, or lazy eye, is reduced visual acuity in one eye despite correction, often due to insufficient visual stimulation. Myopia is nearsightedness, hyperopia is farsightedness, and astigmatism involves unequal refractive curvatures, none of which define amblyopia.