Correct answer: 3

In the United States, internationally adopted children are those who have been adopted by U.S. citizens from countries outside the U.S. This process is known as intercountry adoption, and it involves both adoption and immigration procedures.

Rationale for correct answer:
C. Incomplete immunization records and potential infectious diseases is the most urgent concern because it poses immediate public health and personal health risks. The nurse should initiate serologic testing for vaccine-preventable diseases, perform screenings for tuberculosis, hepatitis, HIV, and parasites, and plan catch-up immunizations according to CDC guidelines. Early detection prevents complications and protects others.

Rationale for incorrect answers:

A. Social and behavioral problems may occur, especially with attachment and adjustment, but they are not immediately life-threatening and can be addressed after urgent infectious disease concerns are managed.

B. While language barriers may impact communication and school readiness, they do not pose an urgent health risk; interpreters and language support can be arranged as part of long-term care.

D. Nutritional deficiencies such as iron and vitamin D are common in international adoptions and should be addressed, but they are typically less urgent than communicable disease control.

Take home points

• Newly adopted international children require comprehensive medical screening, including infectious disease testing and immunization verification.
• Catch-up vaccination should be started promptly if records are missing or unreliable.
• Nutritional, developmental, and behavioral assessments are important but follow after urgent public health safety measures.
• Early coordination with specialists such as infectious disease and developmental pediatrics can improve outcomes for internationally adopted children.

A medical home is not a physical building but a model of care in which a primary care provider offers accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care. It is the central place where all of a child’s healthcare needs are managed, including preventive care, acute care, chronic illness management, and coordination with specialists.

Rationale for correct answer:
B. A primary care pediatric practice provides continuity of care, maintains complete health records, and coordinates referrals to specialists. It fosters an ongoing relationship between the family and healthcare providers, which is central to the medical home concept.

Rationale for incorrect answers:

A. An urgent care center provides episodic, short-term treatment for acute illnesses or injuries, not ongoing comprehensive care.

C. A mobile outreach immunization program delivers a specific preventive service but does not coordinate or manage overall healthcare needs.

D. A dermatology practice focuses on a single specialty; does not provide comprehensive primary care or coordinate all aspects of a patient’s health.

Take home points

• A medical home is characterized by continuous, coordinated, and comprehensive care, not just a location.
• Primary care providers, especially in pediatrics, serve as the central point for managing a child’s preventive, acute, and chronic care needs.
• Specialty or urgent services can support the medical home but cannot replace it.

Screening tests in children are essential components of preventive health care, designed to detect potential health issues before symptoms arise. These tests help identify children at risk for certain conditions so that early interventions can be made.

Rationale for correct answer:
C. Iron deficiency anemia screening based on risk factors: At 9 months, this is the most relevant screening. Infants in high-risk groups should have hemoglobin or hematocrit checked earlier than the universal 12-month screening. Early detection ensures timely dietary counseling and supplementation if needed.

Rationale for incorrect answers:

A. Blood pressure screening: Routine BP measurement typically starts at age 3 years unless there are risk factors such as congenital heart disease or kidney problems.

B. Lead screening for all children: Universal screening is not done at 9 months for all children; instead, lead testing is typically recommended at 12 and 24 months or earlier if specific risk factors are present.

D. Hyperlipidemia screening: Routine lipid screening is generally recommended between ages 9–11 years and again at 17–21 years, unless there is a strong family history of early cardiovascular disease.

Take home points

• At 9 months, iron deficiency anemia screening is risk-based, with universal testing at 12 months.
• Blood pressure, lead, and lipid screenings have different recommended ages and are not routine at this visit for healthy infants.
• Early detection of anemia supports optimal cognitive and motor development.

Oral health is tightly connected to nutrition. Poor oral hygiene can lead to early childhood caries, which may affect an infant’s ability to eat comfortably and get adequate nutrients. Starting oral hygiene early promotes healthy feeding and supports lifelong dental habits.

Rationale for correct answer:

C. The best practice is to begin oral hygiene before teeth erupt by cleaning the gums with a soft, damp washcloth. Once teeth emerge (typically around 6 months), continue cleaning with a washcloth or soft infant toothbrush without toothpaste. This practice reduces bacterial growth and helps the infant get used to oral care routines.

Rationale for incorrect answers:

A. Oral care should begin before tooth eruption, not after full dentition. Delaying increases risk of early childhood caries.

B. Infants should not use toothpaste until at least age 12–18 months, and even then, only a rice-grain amount of fluoride toothpaste under supervision. Toothpaste is not needed for early oral cleaning.

D. Rinsing is not necessary and may pose a choking hazard in young infants. Instead, cleaning with a washcloth is safer and more effective for removing milk residue and bacteria.

Take home points

• Begin oral care before teeth erupt using a damp washcloth to clean gums.
• Continue daily cleaning as new teeth come in to promote healthy oral development.
• Avoid toothpaste in infants under 12 months unless directed by a dentist.
• Early oral hygiene helps prevent nutritional disruptions due to dental discomfort or caries and builds lifelong habits.

• Polio vaccine is part of the first-year immunization schedule, typically at 2, 4, and 6 months.
• MMR (measles, mumps, rubella) is not given until after the first year (12–15 months).
• Nurses should use calm, supportive language to explain vaccine timing and importance.
• Accurate vaccine education helps reduce hesitancy and strengthens caregiver confidence in health decisions.

Sun exposure refers to the amount of time a child’s skin is exposed to ultraviolet (UV) rays from the sun. While some sunlight is beneficial by helping the body produce vitamin D, it also carries risks, especially for children, whose skin is more delicate and sensitive than adults.

Rationale for correct answers:

B. Broad-spectrum sunscreen offers protection from both types of harmful ultraviolet radiation. UVA contributes to skin aging, while UVB causes sunburn. For infants over 6 months, using a broad-spectrum, SPF 30 or higher sunscreen on exposed skin is recommended.

C. UV rays can damage the eyes. Sunglasses that block 100% of UVA and UVB rays help protect the infant’s developing eyes from long-term harm like cataracts or retinal damage.

E. Lightweight, long-sleeved shirts and pants offer effective physical protection from the sun. A wide-brimmed hat also helps shield the face and neck.

Rationale for incorrect answers:

A. Sunscreen should be reapplied every 2 hours or more frequently if the child is sweating or in water, even if the sunscreen is labeled as “water-resistant.” Waiting 4–6 hours between applications is insufficient.

D. The most intense sun exposure occurs between 10 a.m. and 4 p.m., not just 12–2 p.m. During these hours, children should be kept in the shade, wear protective clothing, and have sunscreen applied to exposed areas.

Take home points

• Infants over 6 months should use broad-spectrum sunscreen and wear protective clothing and sunglasses.
• Reapply sunscreen every 2 hours or after swimming/sweating.
• Avoid sun exposure between 10 a.m. and 4 p.m., not just midday.
• Therapeutic teaching should empower caregivers to enjoy outdoor activities safely, using clear, supportive communication.

At 2 years of age, children are especially vulnerable to environmental toxins due to increased hand-to-mouth activity, crawling, and developing neurological systems. During well-child visits, nurses and providers screen for exposures that can impact long-term growth and development.

Rationale for correct answer:

C. Lead screening is routinely recommended for children at 12 and 24 months, particularly for those at increased risk such as living in older homes, exposed to peeling paint, or residing in areas with known environmental risks. Lead is a neurotoxin that can cause cognitive delays, attention problems, and behavioral issues, even at low blood levels.

Rationale for incorrect answers:

A. Routine calcium level screening is not indicated during a standard well-child visit unless there is a specific medical concern, such as rickets or a metabolic disorder.

B. Mercury testing is only done if there is known exposure, such as from contaminated fish or environmental sources. It is not part of routine screening in toddlers.

D. Fluoride is important for dental health, but its levels are not typically measured in blood. Instead, fluoride exposure is assessed through water source and dental hygiene practices.

Take home points

• Lead screening is standard at the 1- and 2-year well-child visits, especially for children in high-risk environments.
• Lead exposure can be asymptomatic but harmful, making early detection critical.
• Nurses should educate parents on lead prevention, such as avoiding peeling paint, using cold tap water for cooking, and maintaining good hygiene practices.
• Routine testing for mercury, calcium, or fluoride is not part of standard 2-year-old care unless clinically indicated.

Health promotion for school-age children includes education on nutrition, physical activity, dental hygiene, injury prevention, and immunizations. At this stage, children begin to take more personal responsibility for their health behaviors, and nurses play a crucial role in reinforcing developmentally appropriate preventive practices during routine visits.

Rationale for correct answer:

A. Dental hygiene is a key area of health promotion for 10-year-olds. Brushing twice daily with fluoride toothpaste helps prevent cavities and gum disease, which are common issues in this age group. This goal is age-appropriate, promotes daily self-care, and aligns with recommended guidelines from dental associations.

Rationale for incorrect answers:

B. The first dose of meningococcal conjugate vaccine (MenACWY) is recommended at age 11–12, not at age 10. Therefore, this is premature for a 10-year-old child during a routine visit.

C. While swimming lessons are encouraged earlier in childhood, this statement is not a measurable or time-specific goal for a 10-year-old. It’s too vague and lacks the clarity needed for an actionable teaching objective during a clinic visit.

D. Bicyclists should ride on the right-hand side of the road, going with the flow of traffic, not against it. Teaching otherwise increases the risk of injury.

Take home points

• Daily dental hygiene using fluoride toothpaste is essential and age-appropriate for school-age children.
• Meningococcal vaccination begins at age 11–12, not 10.
• Safety education should include correct bicycle riding practices, including riding with traffic.
• Health goals for children should be specific, measurable, realistic, and developmentally appropriate.

When a parent expresses worry about their child’s development, the nurse’s role is to use therapeutic communication to explore the concern. This approach builds trust, encourages information sharing, and provides a clearer understanding of the child’s developmental progress.

Rationale for correct answer:
C. “Tell me more about your concerns.” This is an open-ended, supportive, and nonjudgmental response that invites the mother to elaborate on her observations. It validates her feelings and gives the nurse important context to guide further assessment and screening.

Rationale for incorrect answers:

A. “I’ll be able to tell you more after I do his physical.” This delays addressing her concern and shuts down immediate dialogue. It also misses the opportunity to gather parental insight.

B. “Fill out this developmental screening questionnaire and then I can let you know.” While screening tools are important, jumping to paperwork before discussion can feel impersonal and may overlook key details.

D. “All mothers worry about their babies. I’m sure he’s doing well.” This dismisses the mother’s concern, risks invalidating her feelings, and could prevent disclosure of important developmental issues.

Take home points

• Use open-ended questions to explore caregiver concerns in detail.
• Parents are often the first to notice subtle developmental delays.
• Therapeutic communication strengthens the nurse–family relationship and guides appropriate screening or referral.
• Avoid responses that dismiss or minimize parental concerns.

Universal newborn hearing screening is recommended for all infants before 1 month of age to detect congenital hearing loss early. Even if an infant appears to respond to sound, this does not rule out mild, unilateral, or frequency-specific hearing loss that could affect speech and language development.

Rationale for Correct Answer:
B. Schedule the infant immediately for newborn hearing screening: The absence of documented screening means the infant’s hearing status is unknown. Formal screening (e.g., otoacoustic emissions [OAE] or auditory brainstem response [ABR]) is necessary, as informal bedside tests with bells or voices are not accurate diagnostic tools.

Rationale for incorrect answers:

A. Do nothing; responding to the bell proves the infant does not have a hearing deficit: This is incorrect because informal sound-response checks can miss partial or frequency-specific hearing loss.

C. Ask the mother to observe for signs that the infant is not hearing well: Observation alone is unreliable for early detection; delays in diagnosis can harm speech and language development.

D. Screen again with the bell at the infant’s 2-month visit: Waiting risks missing the early intervention window and using an inaccurate method.

Take home points

• All infants should have a documented newborn hearing screening before 1 month of age.
• Informal sound checks are not a substitute for standardized screening methods like OAE or ABR.
• Early identification and intervention for hearing loss significantly improve language and developmental outcomes.
• If screening was missed, it should be scheduled immediately, even if the infant appears to respond to sound.

Accurate immunization documentation is essential to ensure children are up to date and to avoid unnecessary repeat vaccinations. Verbal reports from caregivers are not reliable evidence of vaccination status.

Rationale for correct answer:
D. Calling the local health department and verifying the child’s immunization status allows the nurse to confirm exactly which vaccines were given and when, ensuring the child’s immunization schedule remains accurate and avoiding unnecessary repeats or missed doses. This is the safest and most efficient action.

Rationale for incorrect answers:

A. Asking the mother to bring the records to the 18-month health supervision visit delays verification and could result in a missed opportunity to update needed immunizations promptly.

B. Starting the “catch-up” schedule because there are no immunization records could lead to unnecessary repeat vaccinations, discomfort, and expense if the child is actually up to date.

C. Keeping the child at the facility while the mother returns home for the records is inconvenient for the family and unnecessary when verification can be done quickly through a phone call to the local health department.

Take home points

• Always verify immunization status using written, official records or direct confirmation from the provider who administered the vaccines.
• Verbal caregiver reports are not sufficient for documentation.
• Prompt verification prevents unnecessary repeat doses and ensures the child is adequately protected.
• Health departments and immunization registries are valuable resources for confirming vaccination history.

Vision screening in preschool-aged children requires tools that match their developmental level. Many 4-year-olds cannot consistently recognize letters, so charts that use symbols or simple pictures are preferred.

Rationale for correct answer:
D. The Cardiff Visual Acuity Test for Matching or Estimation (CVTME) is specifically designed for young children, this chart uses simple, recognizable images arranged to measure acuity reliably in preschoolers. It’s ideal for children around 3–5 years old who may not know their letters but can identify or match pictures.

Rationale for incorrect answers:

A. Snellen uses letters and requires literacy or letter recognition; generally more suitable for children ≥6 years old.

B. Ishihara is used to assess color vision, not visual acuity; inappropriate for standard acuity screening.

C. Allen figures uses familiar pictures (e.g., animals, objects) and is also suitable for young children, but CVTME is considered more accurate and developmentally appropriate for a 4-year-old’s formal acuity testing.

Take home points

• Vision screening should be adapted to the child’s developmental and cognitive level.
• For preschoolers who cannot read letters, picture-based charts like CVTME or Allen figures are preferred.
• Snellen charts are for older children and adults, while Ishihara is for color vision testing only.
• Early detection of vision problems prevents long-term learning and developmental difficulties.

The American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) recommend that a child’s first dental visit occur within 6 months of the first tooth eruption and no later than 12 months of age.

Rationale for correct answer:
A. By the first birthday: This allows early detection of oral health problems, parent education on brushing, fluoride use, and diet, and establishes a dental home for the child. Early visits also help the child become comfortable with dental care.

Rationale for incorrect answers:
B. By the second birthday: This delays preventive education and may allow dental decay to progress before intervention.
C. By entry into kindergarten: Far too late for prevention; caries and other oral health issues can already be advanced by this age.
D. By entry into first grade: This is well beyond the ideal window for establishing preventive oral health practices and may lead to missed opportunities for early intervention.

Take home points

• First dental visit: by 12 months or within 6 months of first tooth eruption.
• Early visits focus on prevention, education, and risk assessment.
• Establishing a dental home early supports lifelong oral health habits.
• Parents should be taught to clean the infant’s gums and teeth with a soft cloth or brush and avoid prolonged bottle use, especially at night.

Vaccinations in children are a cornerstone of preventive health care, protecting them from serious and potentially life-threatening diseases. They work by stimulating the immune system to recognize and fight specific pathogens before a child is exposed to them naturally. Between the ages of 1 and 5 years, children receive routine booster doses of key vaccines to maintain immunity against serious diseases.

Rationale for correct answers:

A. Inactivated poliovirus (IPV) booster doses are given between ages 4–6 years after the primary series in infancy.

B. The 5th dose of Diphtheria, tetanus, pertussis (DTaP) is given at 4–6 years to maintain protection.

C. The second dose of Measles, mumps, rubella (MMR) is given between 4–6 years for long-term immunity.

Rationale for incorrect answers:

D. The Hepatitis B (HepB) series is typically completed by 6–18 months of age, so it is not routinely given to healthy children aged 1–5 unless they are catching up.

E. The first routine dose of meningococcal vaccine is recommended at 11–12 years for healthy children, unless earlier vaccination is indicated for high-risk groups.

Take home points

• Ages 4–6 years are key for booster doses before school entry (DTaP, IPV, MMR, Varicella).
• HepB and meningococcal vaccines are not routine in healthy 1–5-year-olds unless catch-up or high-risk.
• Following the national immunization schedule ensures timely, lasting protection.

Good oral hygiene during adolescence is critical for preventing cavities, gingivitis, periodontal disease, and bad breath. This age group often experiences increased sugar intake, orthodontic appliances, and sometimes lapses in hygiene habits. Professional dental visits twice a year allow for preventive care, early detection of issues, and reinforcement of healthy habits.

Rationale for correct answer:
A. Floss daily, brush teeth twice a day, and see the dentist two times per year: This follows the American Dental Association (ADA) recommendations for maintaining optimal oral health. Brushing removes plaque from tooth surfaces, flossing cleans between teeth where a brush can’t reach, and regular dental visits provide professional cleaning and monitoring.

Rationale for incorrect answers:
B. Brushing only once daily is insufficient to remove plaque and food debris effectively.
C. Annual dental visits may delay diagnosis and treatment of problems; twice-yearly visits are preferred.
D. Flossing and brushing habits are good here, but annual visits alone may not provide the best preventive care.

Take home points

• Adolescents should brush twice daily with fluoride toothpaste and floss once daily.
• Professional dental visits twice yearly help maintain oral health and prevent disease.
• Teaching should emphasize the link between oral health and overall health, including heart health, nutrition, and self-esteem.

Normalization is the process of supporting children with chronic illness to live as normal a life as possible. Disability normalization involves encouraging inclusive environments where children with disabilities are treated as full participants in school and community life.

Rationale for correct answer:

B. Allowing the child to attend school and participate in age-appropriate activities promotes independence and self-esteem, encourages peer interaction and social development, helps maintain a sense of routine and normalcy despite medical challenges.

Rationale for incorrect answers:

A. Restricting the child's social interactions to prevent infection is overly restrictive and isolates the child. It may cause social and emotional harm, unless specifically required during immune suppression.

C. Encouraging the child to focus solely on their illness and treatment reinforces the “sick role” and limits opportunities for growth, play, and socialization.

D. Keeping the child isolated at home to reduce stress increases loneliness and delays normal developmental experiences. Stress is better managed through coping strategies and supportive environments, not isolation.

Take home points:

• Normalization is integration of illness into daily life, not making the illness the focus of life.
• Encourage participation in school, play, and family activities whenever possible.
• Provide anticipatory guidance to parents: reasonable limits and expectations foster independence.

Coping refers to the thoughts, behaviors, and emotional strategies people use to manage stress, adversity, or challenging situations. It’s how we adapt, whether consciously or unconsciously, to internal pressures (like anxiety or grief) or external demands like illness, conflict, or change.

Rationale for correct answer:

C. Families of children with chronic illness often experience stress, grief, guilt, and helplessness. The most effective initial nursing intervention is to provide emotional support through therapeutic communication. Actively listening and validating feelings builds trust between the nurse and family, helps the family feel heard and understood, and opens the door for further teaching, coping strategies, and resource referral.

Rationale for incorrect answers:

A. Telling them to be strong for their child minimizes the family’s emotions. It is not therapeutic and may make them feel guilty for expressing distress.

B. Referring them to a psychologist without discussion is premature. The family may feel dismissed or abandoned. Referral can be helpful later, but not as an initial step.

D. Providing them with a list of all available resources without explanation may overwhelm the family. Resources should be explained after establishing rapport and understanding needs.

Take home points

• Therapeutic communication comes first in family-centered nursing care.
• Listening and validation build a foundation for later education, resources, and referrals.
• Families coping with chronic illness benefit most when nurses provide emotional support + practical guidance.

Normalization is a key principle in pediatric nursing care for children with disabilities. It encourages families to treat their child as normally as possible while providing the necessary support.

Rationale for correct answer:
B. Explaining to parents that establishing reasonable limits fosters independence and age-appropriate responsibility is the best anticipatory guidance. This approach allows the child to grow within their abilities, preventing over-dependence while encouraging self-esteem and confidence.

Rationale for incorrect answers:

A. Telling parents that “giving in” is not a detriment is inaccurate. Constantly giving in may foster dependency, behavioral problems, and hinder independence.

C. Advising parents to wait until just before procedures to explain them is not developmentally appropriate. Children should be prepared according to their level of understanding, which reduces anxiety and builds trust.

D. Suggesting that siblings should not have similar rules undermines family consistency. While accommodations may be necessary, children with disabilities should still be part of the family unit with expectations tailored but not completely exempt.

Take home points

• Normalization means integrating children with disabilities into everyday routines with appropriate expectations.
• Setting consistent and reasonable limits helps children develop independence and self-confidence.
• Parents should prepare children for procedures at their developmental level, not delay explanations until the last minute.
• Consistency in family rules and expectations promotes fairness and stability for all siblings.

Families of children with chronic illness or disabilities often develop resilience through positive coping strategies that foster hope, independence, and acceptance. These methods help both the child and family adapt to ongoing challenges while maintaining a sense of normalcy.

Rationale for correct answers:
B. Developing relationships with other families in similar circumstances provides social support, reduces isolation, and fosters shared understanding.
C. Parents who set long-term goals instill a sense of hope and direction, helping the child and family look beyond daily struggles.
D. Focusing on the child’s strengths and encouraging independence promotes self-esteem and helps the child achieve developmental milestones within their abilities.
E. Accepting that chronic illness is part of living allows families to move forward, adapt routines, and maintain quality of life instead of remaining stuck in denial or grief.

Rationale for incorrect answer:

A. Protecting the child from learning about their illness is not adaptive. Age-appropriate education about the illness fosters coping, trust, and empowerment. Shielding the child may increase anxiety and hinder self-management skills.

Take home points

• Resilience in families of children with chronic illness is built on support networks, hope, independence, and acceptance.
• Open communication and age-appropriate education about illness empower children rather than protect them.
• Families thrive when they balance realistic limitations with a focus on strengths and possibilities.

Effective pain management in terminally ill children focuses on comfort, dignity, and quality of life. The nurse’s role is to ensure that the child’s pain is adequately controlled using both pharmacologic and non-pharmacologic methods, while addressing misconceptions parents or providers may have about opioid use.

Rationale for correct answers:
A. Breakthrough pain is common in terminal illness, and timely administration of additional doses is essential for relief.

B. Opioid drugs such as morphine are the mainstay for severe pain in terminal illness. Doses are titrated upward as needed to maintain optimal comfort, without a ceiling limit in palliative care.
D. Nurses may fear that high opioid doses hasten death, but according to the principle of double effect, the intent is comfort, not hastening death. When administered appropriately, opioids relieve suffering without intentionally causing death.
E. Non-pharmacologic interventions (music therapy, distraction, guided imagery, relaxation techniques) complement medications and give the child and family a sense of control, improving quality of life.

Rationale for incorrect answers:

C. Addiction is not a concern in terminal pediatric pain management. The focus is on comfort, not long-term dependence. Educating parents about this distinction is essential to reduce fear and ensure the child receives appropriate relief.

Take home points

• Scheduled opioid dosing with breakthrough coverage ensures consistent comfort in terminally ill children.
• Addiction is not a concern at end-of-life care, comfort and dignity are the priority.
• The principle of double effect supports opioid use even at higher doses if the intent is pain relief, not hastening death.
• Combining pharmacologic and non-pharmacologic strategies provides holistic care for both child and family.

Preschool children (ages 3–5) are in the preoperational stage of cognitive development. They use magical thinking and egocentrism, often believing their thoughts or behaviors are powerful enough to cause events, including death. This belief can lead them to feel responsible or guilty when someone dies.

Rationale for correct answer:

A. Preschoolers believe their thoughts are sufficient to cause death due to magical thinking and egocentrism. They may think, “If I was mad at Mommy and she got sick, I made it happen.” This belief is developmentally normal but can cause distress and guilt if not addressed with reassurance.

Rationale for incorrect answers:
B. While preschoolers do have magical thinking, the key distinction is their specific belief that their own thoughts or actions can directly cause death, making option 1 the more precise answer.
C. A concrete understanding of death develops later, in school-age children, who begin to grasp death’s permanence and universality.
D. Viewing events only in their own frame of reference (living) describes toddlers, who do not comprehend death but react to separation and changes in routine.

Take home points

• Preschoolers (3–5 years): Believe their thoughts or actions can cause death (magical thinking, guilt).
• School-age children (6–12 years): Understand death as final, universal, and irreversible.
• Toddlers: Have no real concept of death, only separation anxiety.
• Adolescents: Grasp the finality of death but may feel invulnerable themselves, leading to risk-taking behaviors.

Fragile X Syndrome (FXS) is caused by a mutation in the FMR1 gene on the X chromosome, which normally produces a protein (FMRP) essential for brain development. In FXS, this gene is either silenced or doesn’t produce enough of the protein, leading to developmental challenges.

Rationale for correct answer:
B. Families benefit from counseling to learn about the genetic basis of fragile X syndrome, recurrence risks, and implications for siblings and extended family. Genetic counseling also provides emotional support and guidance in navigating available interventions and support services.

Rationale for incorrect answers:

A. Fragile X syndrome does not typically require orthopedic intervention as a priority. While children may have joint laxity or hypotonia, these issues are usually managed through physical/occupational therapy, not surgery.

C. Unless feeding issues or obesity develop, dietary management is not a primary concern in fragile X syndrome. This referral may be useful in some cases but is not a priority.

D. While recurrent ear infections may occur, otolaryngologist referral is not universally required for all children with fragile X. It may be appropriate based on symptoms but not the first or most important referral.

Take home points

• Fragile X syndrome is a hereditary condition, and genetic counseling is crucial for families to understand risks, recurrence, and support options.
• Early interventions (speech therapy, occupational therapy, behavioral therapy) are key to improving outcomes.
• Nurses should ensure families receive appropriate referrals to support services and education tailored to developmental needs.

Down syndrome is a genetic condition caused by the presence of an extra copy of chromosome 2A. This additional genetic material affects how the body and brain develop, leading to a range of physical, cognitive, and developmental differences.

Rationale for correct answer:

A. The karyotype 47, XX, +21 indicates that the fetus is female (XX) and has an extra chromosome 21, consistent with trisomy 21 (Down syndrome).

Rationale for incorrect answers:
B. Fragile X is due to a trinucleotide (CGG) repeat expansion on the X chromosome, not an extra chromosome. It would not appear as “+21” in karyotype nomenclature.

C. A fetus born with shortened palpebral fissures and hypoplastic upper lip are features associated with fetal alcohol syndrome, not trisomy 2A.

D. A fetus born with hypertonic reflexes and spastic posturing suggest cerebral palsy, a neuromotor disorder that develops postnatally, not a chromosomal abnormality identified on karyotype.

Take home points

• 47, XX, +21 = Female with trisomy 21 (Down syndrome).
• Down syndrome features include intellectual disability, characteristic facial features, and increased risk for cardiac and other health issues.
• Other syndromes (fragile X, fetal alcohol syndrome, cerebral palsy) have different etiologies and would not appear as +21 on karyotype.

Down syndrome is a genetic condition caused by the presence of an extra copy of chromosome 21, which is why it's also called trisomy 2A. This additional genetic material affects how the body and brain develop, leading to a range of physical, cognitive, and developmental differences.

Rationale for correct answer:
B. Hypotonia is a hallmark of Down syndrome. It can contribute to poor feeding (difficulty sucking/swallowing), delayed motor milestones (sitting, crawling, walking), and increased joint laxity. Nurses should prepare parents for supportive interventions such as physical therapy and feeding support.

Rationale for incorrect answers:

A. Small cerebral ventricles is not a typical feature of Down syndrome. Cerebral changes are more related to intellectual disability and increased risk of early-onset Alzheimer’s disease, not ventricular size.

C. Children with Down syndrome do feel pain; in fact, they may have increased risk of infection or injury due to hypotonia and joint laxity. This is incorrect.

D. Down syndrome is not associated with impaired renal function as a primary characteristic. Renal issues may occur but are not a defining physiological feature.

Take home points

• Hypotonia is a key physiologic characteristic of Down syndrome and has implications for feeding, motor skills, and development.
• Parents should be educated on the importance of early interventions such as physical therapy, occupational therapy, and feeding support.
• Discharge teaching should always emphasize supporting development and recognizing health concerns such as feeding problems, infection, and congenital heart disease risk.

When counseling families of children with Down syndrome, it is essential that nurses provide accurate, supportive, and evidence-based information. This helps parents cope, plan for the future, and provide the best care for their child.

Rationale for correct answers:

A. Eighty percent of infants with Down syndrome are born to women under 35 because younger women have higher fertility rates, even though the risk increases with maternal age.

B. Feeding difficulties are common due to hypotonia and a protruding tongue. Using a small, straight-handled spoon placed to the side and back of the mouth helps with effective feeding.

C. Many parents of children with Down syndrome report that the experience, although challenging, has made them stronger, more compassionate, and accepting of others.

E. A child’s lack of clinging or molding is due to hypotonia and not emotional detachment or parental rejection. This distinction reassures parents.

Rationale for incorrect answers:
D. Placement in regular classrooms with support has been found to be beneficial, not detrimental. Inclusion promotes socialization and learning opportunities, although individual support may be needed.
F. Development in Down syndrome is delayed compared to mental age, not accelerated. Milestones are achieved later, often several years behind peers, especially in motor and language areas.

Take home points

• Most children with Down syndrome are born to younger mothers, despite increased risk in older women.
• Feeding support and special techniques are often needed in infancy due to hypotonia and tongue protrusion.
• Many parents find resilience and strength in raising a child with Down syndrome.
• Inclusion in regular classrooms can support development when tailored assistance is provided.

Down syndrome is a genetic condition caused by the presence of an extra copy of chromosome 2A. This additional genetic material affects how the body and brain develop, leading to a range of physical, cognitive, and developmental differences.

Rationale for correct answer:

A. Children with Down syndrome are at high risk for respiratory tract infections due to hypotonia including weak muscle tone and leading to poor cough and difficulty clearing secretions, anatomical airway differences including smaller trachea, enlarged tonsils/adenoids, and macroglossia, and immune system compromise, making them more susceptible to infections. Any upper respiratory illness in these children can rapidly progress to pneumonia or airway obstruction, requiring immediate medical care.

Rationale for incorrect answers:

B. Pendulous abdomen is common in Down syndrome due to hypotonia; not an urgent concern.

C. Elevated temperature alone is not specific or emergent unless linked to respiratory symptoms.

D. Protruding brow is a facial characteristic of Down syndrome, but not an urgent clinical finding.

Take-Home Points:

• Children with Down syndrome require close monitoring for respiratory complications.
• Parents should seek medical care promptly if their child has:
  • Cough, congestion, or difficulty breathing.
  • Signs of infection such as lethargy, decreased feeding, or fever with respiratory symptoms.
• Preventive measures: routine vaccinations, RSV prophylaxis in infancy, and regular ENT evaluations.

Hearing impairment, also known as hearing loss is a condition where a person experiences partial or complete inability to hear sounds. It can affect one or both ears and vary in severity from mild to profound.

Rationale for correct answer:

C. Hearing impairment in infants can delay the development of speech, language, and social interaction skills. Early detection through newborn hearing screening and timely interventions (hearing aids, cochlear implants, or speech therapy) help the child achieve normal communication and social milestones.

Rationale for incorrect answers:

A. Early detection doesn’t eliminate the need for surgical correction if structural issues exist.

B. Hearing impairment itself doesn’t cause other disabilities; it mainly affects language and psychosocial development.

D. Early detection does not prevent hearing aids. It actually ensures they are provided as early as needed.

Take home points

• Universal newborn hearing screening should be done within the first month of life.
• Intervention should start before 6 months to optimize outcomes.
• The goal is to promote language, communication, cognitive, and social development.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects how a person communicates, interacts socially, and processes sensory information. The term “spectrum” reflects the wide range of symptoms, abilities, and challenges that individuals with autism may experience.

Rationale for correct answer:

C. Children with Autism Spectrum Disorder (ASD) often become agitated due to sensory overload such as too much noise, light, or activity. The best intervention is to remove the child from the overstimulating environment and place them in a calm, quiet space to help them self-regulate. This approach prevents escalation and respects the child’s need for a structured, low-stimulation setting.

Rationale for incorrect answers:

A. Physically restraining the child should only be a last resort when there is risk of harm. It may increase distress and agitation in ASD.

B. Introducing new toys to distract them may actually increase agitation due to unfamiliarity or overstimulation. Children with ASD prefer routine and familiar objects.

D. Telling them to stop their behavior is a verbal commands and are often ineffective, as the child may not process them in moments of agitation and may feel more frustrated.

Take home points

• First-line nursing action: reduce environmental stimuli.
• Maintain structured routines and provide predictable, calm settings.
• Use familiar comfort objects or coping strategies if needed.
• Restraints and verbal scolding should be avoided unless safety is compromised.

Hospitalization can be especially stressful for children with visual impairment. Nurses can reduce anxiety and foster trust by ensuring consistency, orientation, reassurance, and clear communication.

Rationale for correct answers:

A. Reassurance throughout treatment is essential since the child cannot rely on visual cues. Explaining each step helps reduce fear and uncertainty.

B. Ensuring parents are comfortable with room organization provides safety and consistency for the child. Parents can help the child learn where objects are placed, preventing accidents.

C. Assigning the same nurse whenever possible offers consistency, familiarity, and trust, which are especially important for visually impaired children.

E. Health care providers should always identify themselves upon entering the room so the child feels secure and included in interactions.

Rationale for incorrect answer:
D. Taking over most of the child’s care is not appropriate. Children with visual impairments benefit from independence and normalization of daily routines. Encouraging self-care and parent involvement fosters autonomy, not dependence.

Take home points

• Provide clear explanations and reassurance since visual cues are absent.
• Maintain consistency in caregivers and environment for security.
• Always announce your presence and actions to avoid startling or confusing the child.
• Encourage independence and participation, rather than overprotecting, to support normal development.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects how a person communicates, interacts socially, and processes sensory information. The term “spectrum” reflects the wide range of symptoms, abilities, and challenges that individuals with autism may experience.

Rationale for correct answer:
C. Providing a structured routine is a cornerstone of ASD management. Predictability helps reduce anxiety, improves cooperation, and allows children to function more effectively.

Rationale for incorrect answers:

A. Placement in a long-term care setting is not the goal. Most children with ASD remain at home with their families and benefit from community-based support and interventions.

B. Sharing a hospital room with another child may actually increase stress and overstimulation. Children with ASD often do better in quieter, less stimulating environments.

D. Comforting children with ASD does not always involve holding or cuddling. Many children with ASD dislike physical touch or find it overstimulating. Comfort should be based on the child’s individual needs and preferences.

Take home points

• Structured routines are essential for children with ASD.
• Family and community support are prioritized over long-term institutional placement.
• Minimize overstimulation in hospital and home environments.
• Comfort measures
• should be individualized, as many children with ASD may not tolerate physical affection.

Support from other parents of children with special health care needs is a powerful coping mechanism. Shared experiences foster understanding, reduce isolation, and help families adapt to challenges more effectively than professional advice alone at times.

Rationale for correct answer:
C. Support between parents of special children is extremely valuable. Parents often find strength, comfort, and practical advice from those who have experienced similar challenges. These peer connections promote resilience, normalize feelings, and provide ongoing emotional support.

Rationale for incorrect answers:

A. Assuming the nurse has not provided enough support is inaccurate. While professional support is important, peer support adds a unique dimension that nurses cannot replace.

B. Viewing the relationship as potentially unhealthy is incorrect. Unless it becomes exclusive or fosters dependency, peer support is beneficial, not harmful.

D. Confidentiality is not a concern here as long as families willingly share their own experiences. The nurse must only safeguard protected health information.

Take home points

• Parent-to-parent support is highly effective in managing stress and promoting coping for families of children with special needs.
• Nurses should encourage peer connections through support groups or networking opportunities.
• Professional support and peer support complement each other, ensuring holistic family care.
• Confidentiality concerns arise only if health professionals disclose private information, not when parents voluntarily share.

Safe and compassionate care during the transition from curative to palliative treatment in pediatric oncology emphasizes supporting both the child and family. Nurses play a key role in ensuring that families remain central to decision-making, honoring their values, preferences, and cultural beliefs.

Rationale for correct answer:
C. Families are the primary caregivers and advocates for the child. Including them ensures respect for their values, promotes understanding of the goals of care, and helps them adjust emotionally to the transition. This approach enhances shared decision-making, maintains dignity, and strengthens coping mechanisms.

Rationale for incorrect answers:

A. The health care professionals should make the decision about the child’s care excludes the family, undermines trust, and disregards their role as the child’s advocate. Ethical pediatric care requires family participation in all major decisions.

B. Continuing aggressive treatment without benefit may increase suffering, prolong distress, and is not consistent with palliative principles. Hope can be reframed toward comfort, quality of life, and meaningful moments.

C. Palliative care is available across settings, including hospitals, hospices, and home. The choice depends on family preference, resources, and the child’s needs.

Take home points

• In pediatric palliative care, family-centered decision-making is essential.
• Nurses should support the family by providing honest information, emotional support, and guidance.
• Hope is not lost, rather, it is redirected toward comfort, dignity, and quality of life.
• Palliative care can occur in hospitals, hospices, or at home depending on the child and family’s wishes.

Safe and effective pediatric nursing care requires collaboration with caregivers, especially when caring for children with complex medical needs like a gastrostomy tube, tracheostomy, and multiple medications.

Rationale for correct answer:
B. Parents of medically complex children develop extensive expertise in daily care. The nurse should acknowledge this knowledge, involve the mother as a partner in care, and integrate her input into the plan. This approach promotes safety, minimizes errors, and supports family-centered care.

Rationale for incorrect answers:

A. Incorporating the mother’s assistance in care when convenient minimizes her role and implies she is only helpful occasionally. Her involvement should be central, not optional.

C. While caregiver rest is important, dismissing her may cause anxiety and reduce continuity of care. Instead, the nurse should support her presence and encourage breaks as appropriate.

D. While providing family-centered care since the mother is there is correct in principle, it is too general. True family-centered care requires specifically acknowledging the mother’s expertise and integrating her knowledge, making option 2 the best choice.

Take home points

• Parents of chronically ill children are vital partners in care and should be recognized as experts.
• Family-centered care means active, equal collaboration, not just presence or occasional involvement.
• Nurses should validate and respect parental input while ensuring safety and professional oversight.
• Empowering parents improves trust, adherence, and outcomes in children with complex health needs.

Supporting families of children with developmental disabilities requires empathy, validation, and encouragement. Starting school can be an emotional milestone for any parent, and even more so when additional needs are involved. The nurse’s best response is one that normalizes the mother’s feelings, showing understanding and compassion without judgment.

Rationale for correct answer:
D. “It is normal to feel stressed or sad at this time.” This statement validates the mother’s emotions, reassures her that her reaction is expected, and opens the door for further supportive discussion. It reflects therapeutic communication, which acknowledges feelings without dismissing or minimizing them.

Rationale for incorrect answers:

A. “Do you need some time alone to collect yourself?” This may come across as dismissive and does not directly validate her emotions. It could shut down communication instead of fostering support.

B. “You’ve known for a while this time would come.” This response is non-therapeutic, potentially judgmental, and invalidates her feelings by suggesting she should be prepared.

C. “Can I call your husband or a friend for you?” While offering support is helpful, this bypasses the opportunity for the nurse to provide direct emotional support and validation. It shifts responsibility away instead of first acknowledging her feelings.

Take home points

• Therapeutic communication involves validating emotions, showing empathy, and encouraging expression.
• Parents of children with disabilities often experience added stress during developmental milestones, nurses should provide reassurance and support.
• Avoid dismissive, judgmental, or minimizing statements; instead, acknowledge feelings as normal and offer continued guidance.
• Validation builds trust and strengthens the nurse-family relationship.

Discipline in children with developmental disabilities should be consistent, developmentally appropriate, and aligned with family values. Nurses should guide parents toward strategies that foster independence, promote acceptable behavior, and respect the child’s unique needs.

Rationale for correct answer:

A. “You should choose methods that are most congruent with your values about discipline.” This response emphasizes the importance of aligning discipline strategies with the family’s beliefs, which promotes consistency and follow-through. It avoids a one-size-fits-all approach and instead empowers parents to apply discipline in a way that supports both the child’s development and the family’s framework.

Rationale for incorrect answers:
B. “Children like this really can’t follow directions, so they may be very hard to discipline.” This is discouraging, non-therapeutic, and untrue. Children with developmental disabilities can follow directions with structure, patience, and consistency.

C. “Punish your child only for socially unacceptable or offending behaviors.” Discipline should focus on teaching, guiding, and reinforcing positive behavior, not solely punishment. Limiting discipline to punishment misses the opportunity for positive reinforcement and skill development.

D. “Spanking works well for this type of child, as they really don’t like pain.” Corporal punishment is inappropriate and harmful. It does not teach desired behaviors, may cause fear or aggression, and is not recommended in pediatric nursing practice.

Take home points

• Discipline for children with developmental disabilities should be consistent, individualized, and value-based.
• Positive reinforcement, clear expectations, and patience are more effective than punishment.
• Nurses should empower and support parents with strategies that respect both the child’s abilities and the family’s beliefs.
• Corporal punishment is never an appropriate recommendation in pediatric nursing.

A chronically ill child demonstrating detachment behaviors may appear indifferent to the parents, show minimal distress upon separation, or redirect attachment to caregivers such as nurses. This behavior reflects ineffective coping, often seen when the child has experienced prolonged hospitalizations or repeated separations from parents.

Rationale for correct answer:
C. Hugging the nurse and ignoring the parents indicates detachment. Instead of showing distress or seeking comfort from parents, the child transfers attachment to the nurse and minimizes interaction with the parents. This is a maladaptive coping response to prolonged separation and hospitalization.

Rationale for incorrect answers:

A. Crying and begging the parents to stay represents separation anxiety, not detachment. It reflects active emotional attachment and protest.

B. Waving good bye and asking the parents when they would return is a healthy coping behavior, showing trust and security in the parents’ return. It is not detachment.

D. Grabbing the legs of the parents and refusing to let them go reflects protest behavior, not detachment. The child is still strongly attached and resists separation.

Take home points

• Detachment behaviors occur when a child adapts to repeated separation by withdrawing emotional connection from parents and attaching to others.
• This indicates ineffective coping and requires interventions to support parent-child bonding.
• Nurses should encourage frequent parental involvement and provide opportunities for positive interactions.
• Distinguishing between protest, despair, and detachment phases of separation anxiety is key in pediatric nursing.

When a parent expresses concern that their child is not acting like or responding the same as a sibling, the nurse should perform a thorough developmental assessment while also supporting the parent emotionally. The focus is on assessing possible developmental issues while reassuring the parent appropriately.

Rationale for correct answers:

A. Assessment for dysmorphic syndromes is important if developmental differences are noted. Conditions such as congenital anomalies or microcephaly may underlie developmental delays.

B. Inquiring about temperament such as irritability and lethargy helps identify possible neurological, metabolic, or developmental issues influencing the child’s behavior.

C. Explaining that all children are different is key for parental reassurance. Comparison with siblings can create unnecessary anxiety or pressure; each child develops uniquely.

D. Noting language development appropriate for the child’s age is a standard part of developmental assessment and can reveal early indicators of delays or disorders.

Rationale for incorrect answer:
E. Meeting siblings to assess similarities is not necessary for evaluating developmental differences. Assessment should be focused on the individual child’s growth and milestones, not comparisons to family traits.

Take home points

• Parental concerns about differences between siblings should always be taken seriously.
• A thorough developmental assessment such as growth, language, behavior, and neurological signs is essential.
• Normalize differences while carefully evaluating for potential disorders.
• Avoid direct sibling comparisons, each child has unique developmental patterns.

Speech and language milestones are critical indicators of a child’s development. Certain delays or persistent speech difficulties are red flags that warrant referral for a speech and language evaluation.

Rationale for correct answers:

A. Failure to speak any meaningful words at 2 years old is a developmental red flag. By this age, children should be using several single words spontaneously. Lack of expressive language warrants referral.

C. Failure to use sentences of three or more words by 3 years old indicates a possible expressive language delay. Most 3-year-olds should be able to form short, understandable sentences.

D. Stuttering or dysfluency can be normal in preschoolers (ages 2–5), especially during language bursts. However, persistent or significant dysfluency (such as repeating sounds, words, or phrases) can indicate a need for evaluation.

E. Frequent omission of final consonants in a 3-year-old is concerning. While some articulation errors are normal, consistent omission of final consonants after age 3 is not developmentally appropriate.

Rationale for incorrect answers:
B. Using different words or nicknames for people is typical of normal language development and shows creativity in communication.
E. Omission of word endings such as plurals or verb tenses may still be developmentally normal at 3 years old. Many children master these grammatical rules closer to age D.

Take home points

• By age 2: Child should use at least 50 words and begin combining words.
• By age 3: Child should form 3–4 word sentences and be mostly understandable to familiar listeners.
• Speech referral red flags: no meaningful words at 2, no short sentences at 3, and persistent articulation errors (e.g., omitting final consonants).
• Some errors (stuttering, word endings) are developmentally normal at 3 years.

Down syndrome is a genetic condition caused by the presence of an extra copy of chromosome 21, which is why it's also called trisomy 2A. This additional genetic material affects how the body and brain develop, leading to a range of physical, cognitive, and developmental differences.

Rationale for correct answer:

A. A single transverse palmar crease is a common finding in infants with Down syndrome. While it can also appear in healthy infants, its presence along with other physical characteristics supports the diagnosis of trisomy 2A.

Rationale for incorrect answers:
B. The presence of extra digits is associated more with trisomy 13 (Patau syndrome), not trisomy 2A.

C. A transient skin color change (half red, half pale) due to immature blood vessel regulation in newborns. It is a benign and temporary finding, not specific to Down syndrome.

D. Benign bluish pigmentation commonly found on the sacral area of infants with darker skin tones. These are unrelated to chromosomal abnormalities.

Take home points

• Simian crease is a key physical finding in Down syndrome, though not diagnostic on its own.
• Other common Down syndrome features: hypotonia, upslanting palpebral fissures, epicanthal folds, flat nasal bridge, and small ears.
• Distinguish Down syndrome features from findings related to other syndromes (e.g., polydactyly in trisomy 13).
• Early recognition allows prompt evaluation for associated conditions (e.g., congenital heart disease, GI anomalies).

Down syndrome is a genetic condition caused by the presence of an extra copy of chromosome 21, which is why it's also called trisomy 2A. This additional genetic material affects how the body and brain develop, leading to a range of physical, cognitive, and developmental differences.

Rationale for correct answers:
B. Protruding tongue is common in infants with Down syndrome, often due to hypotonia and a relatively small oral cavity.

D. Wide, flat nasal bridge is a typical facial characteristic of Down syndrome, helping distinguish craniofacial appearance in affected infants.

Rationale for incorrect answers:

A. Elongated face is not characteristic of Down syndrome. It is more commonly seen in conditions like Marfan syndrome.

C. Infants with Down syndrome typically have small, low-set ears, not large or high-set.

E. Asymmetric Moro reflex usually suggests birth injury such as brachial plexus injury or clavicle fracture rather than Down syndrome.

Take home points

• Classic Down syndrome features in newborns include: hypotonia, protruding tongue, wide flat nasal bridge, small ears, simian crease, and upslanting palpebral fissures.
• Differentiating features are important because other syndromes (e.g., trisomy 13 or 18, Marfan syndrome) have distinct facial/physical characteristics.
• Early recognition allows timely screening for associated conditions such as congenital heart disease, GI anomalies, and thyroid dysfunction.

Fragile X Syndrome (FXS) is caused by a mutation in the FMR1 gene on the X chromosome, which normally produces a protein (FMRP) essential for brain development. In FXS, this gene is either silenced or doesn’t produce enough of the protein, leading to developmental challenges.

Rationale for correct answer:
B. Aggressive behavior is common in fragile X syndrome. Children may exhibit aggression toward themselves or others, often triggered by stress, overstimulation, or difficulty with communication. This is a key behavioral manifestation educators and nurses should anticipate.

Rationale for incorrect answers:

A. Lordotic posturing is not a typical finding. Lordosis is more associated with musculoskeletal or spinal conditions.

C. Two different eye colors is called heterochromia, which is unrelated to fragile X syndrome.

D. Asynchronous breathing is not associated with fragile X. Breathing irregularities are not part of the syndrome’s typical manifestations.

Take home points

• Fragile X syndrome is the most common inherited cause of intellectual disability.
• Key features include: intellectual disability, speech and developmental delays, social anxiety, hyperactivity, and behavioral issues including aggression.
• Physical features may include a long face, large ears, and macroorchidism (after puberty).
• Nurses and teachers should be prepared to implement behavioral support strategies and foster structured, low-stress environments.

Fragile X Syndrome (FXS) is caused by a mutation in the FMR1 gene on the X chromosome, which normally produces a protein (FMRP) essential for brain development. In FXS, this gene is either silenced or doesn’t produce enough of the protein, leading to developmental challenges.

Rationale for correct answer:
B. Arm flapping is a common behavioral feature of fragile X syndrome, often triggered by excitement, stress, or overstimulation. It reflects the syndrome’s link to autistic-like behaviors and sensory processing challenges.

Rationale for incorrect answers:

A. Strabismus may occur in many children but is not a defining or common feature of fragile X syndrome.

C. Vision deficit is not a hallmark feature of fragile X. Visual problems can occur in any child but are not specifically linked to this condition.

D. Nevus flammeus, also known as a “port-wine stain,” this is a vascular birthmark unrelated to fragile X syndrome.

Take home points

• Fragile X syndrome features include: intellectual disability, speech/language delay, autistic-like behaviors (hand flapping, poor eye contact), hyperactivity, anxiety, and sometimes aggression.
• Physical features may include long face, large protruding ears, and (post-puberty) macroorchidism.
• Behavioral manifestations (such as arm flapping) are often the most noticeable signs in childhood and affect learning and social integration.
• Early intervention with speech therapy, occupational therapy, and behavioral support is critical.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects how a person communicates, interacts socially, and processes sensory information. The term “spectrum” reflects the wide range of symptoms, abilities, and challenges that individuals with autism may experience.

Rationale for correct answers:

A. Has yet to learn his colors or the names of animals: Language and developmental delays are common in children with autism spectrum disorder (ASD). Difficulty with basic learning tasks is often an early sign.

B. Becomes upset each time the teacher asks the child to stop what he is doing: Children with ASD often show resistance to change or transitions, and may have difficulty stopping repetitive or preferred activities.

E. Covers his ears whenever the school principal makes an announcement on the loud speaker: Many children with ASD have sensory sensitivities such as hypersensitivity to sounds, lights, or textures.

Rationale for incorrect answers:

C. Is the first in line when it is time to go out to play in the playground: This behavior is normal enthusiasm for play, not an indicator of autism.

D. Runs to the teacher to get a kiss whenever he gets hurt while playing: Children with ASD often have difficulty with social reciprocity and seeking comfort from others. Running for a kiss when hurt indicates appropriate social/emotional response, not autism.

Take home points

• Key features of autism spectrum disorder include:
  • Communication difficulties (speech delay, trouble naming objects, poor eye contact).
  • Repetitive or restrictive behaviors (rigid routines, upset with change).
  • Sensory sensitivities (covering ears, avoiding textures).
  • Impairment in social reciprocity (not usually seeking comfort, trouble forming peer relationships).

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects how a person communicates, interacts socially, and processes sensory information. The term “spectrum” reflects the wide range of symptoms, abilities, and challenges that individuals with autism may experience.

Rationale for correct answer:

A. Children with autism spectrum disorder (ASD) thrive on structure, predictability, and routine. A strict, consistent schedule for treatments, meals, and daily care reduces anxiety and behavioral outbursts. Sudden changes can be very distressing for children with ASD.

Rationale for Incorrect Answers:

B. Children with ASD may have difficulty with social interactions and overstimulation in busy playrooms. Play therapy can be helpful, but it should be individualized and not forced.

C. Keeping all of the room lights on throughout the night is not appropriate; it may worsen sleep disturbances is already common in autism and cause sensory overload.

D. Providing the child with sugar-free juice at snack time is not specific to autism management. Unless the child has diabetes or dental concerns, this intervention is not related to autism care.

Take home points

• Nursing care for children with autism should prioritize:
  • Consistency and routine in care.
  • Minimizing sensory overload (noise, light, crowds).
  • Respecting communication styles (use of pictures, simple words, or devices).
  • Creating a safe, structured environment to reduce anxiety.

When caring for culturally diverse families, the nurse’s priority is to understand the parents’ perception of the illness or disability. This approach acknowledges their beliefs, values, and concerns, allowing the nurse to provide culturally sensitive care while building trust.

Rationale for correct answer:
C. By exploring the parents’ perceptions, concerns, and worries, the nurse gains insight into how the family views the illness, its seriousness, and how they believe it should be managed. This facilitates individualized, culturally competent care and promotes collaboration.

Rationale for incorrect answers:

A. Asking about the extended family’s views may provide some information, but it does not directly address the parents’ own beliefs and perceptions, which are essential for guiding care.

B. Exploring alternative therapies is important but comes after understanding the family’s overall view of the illness. It is one aspect of cultural care, not the starting point.

D. Acknowledging language barriers is necessary, but it does not justify health care professionals making decisions without family input. Professional interpreters should be used to ensure communication and respect for family values.

Take home points

• The first step is to understand the family’s own perception of the illness/disability.
• Cultural competence means listening, respecting, and integrating beliefs into care when safe and possible.
• Extended family input and alternative therapies can be explored after building understanding.
• Use interpreters, not assumptions, to overcome language barriers and support shared decision-making.