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
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
