Question 1
Vignette: A 4-year-old child diagnosed with Autism Spectrum Disorder (ASD) has difficulty engaging in play with peers and often engages in repetitive play alone. The child’s parents are concerned about their child’s social development and ask for strategies to enhance social interaction. Which of the following interventions is most appropriate for the nurse to recommend?
A. Encourage solitary play to strengthen independent skills.
B. Recommend avoiding social interactions to reduce anxiety.
C. Suggest structured play activities with peers to promote social skills.
D. Advise on the use of digital devices for social interaction.
E. Encourage competitive play to stimulate social engagement.
Correct Answer: C. Suggest structured play activities with peers to promote social skills.
Rationale: Structured play activities with peers are beneficial for children with ASD as they provide a predictable and controlled environment that can reduce anxiety associated with unstructured social interactions. These activities help in developing necessary social skills such as turn-taking, sharing, and understanding social cues in a supportive setting. Solitary play, while important for independent skills, does not address the need for social development. Avoiding social interactions and overreliance on digital devices can further isolate the child from necessary social experiences. Competitive play may increase anxiety and frustration due to the unpredictable nature of winning and losing, making structured play the most appropriate recommendation.
Question 2
Vignette: A nurse is conducting an initial assessment on a 6-year-old child with suspected Autism Spectrum Disorder (ASD). Which of the following observations would most strongly support a diagnosis of ASD?
A. Prefers to play alone rather than with other children.
B. Has an exceptional ability in math and puzzle solving.
C. Exhibits delayed language development and lack of eye contact.
D. Frequently engages in imaginative play.
E. Shows extreme fear towards loud noises.
Correct Answer: C. Exhibits delayed language development and lack of eye contact.
Rationale: Delayed language development combined with a lack of eye contact are hallmark signs of ASD, as these symptoms directly relate to the core challenges in communication and social interaction associated with the disorder. While preferring solitary play and showing extreme sensitivities to stimuli like loud noises can be characteristics of ASD, these alone are not as strongly indicative as communication difficulties and social disengagement. Exceptional abilities in specific areas (such as math) and engagement in imaginative play do not directly support an ASD diagnosis and are more related to the child’s interests and strengths.
Question 3
Vignette: A school nurse is preparing a presentation for teachers on strategies to support students with Autism Spectrum Disorder (ASD) in the classroom. Which of the following strategies should the nurse include?
A. Use of clear and consistent routines.
B. Encourage frequent changes in classroom seating.
C. Limit use of visual aids in teaching.
D. Promote group work in unstructured settings.
E. Discourage the use of sensory tools.
Correct Answer: A. Use of clear and consistent routines.
Rationale: Children with ASD often thrive in environments where they can predict the sequence of events, reducing anxiety and making it easier for them to engage and learn. Clear and consistent routines provide a structured environment that minimizes uncertainty. Frequent changes in seating, limiting visual aids, promoting unstructured group work, and discouraging the use of sensory tools are counterproductive for students with ASD, as these strategies can increase anxiety, decrease focus, and hinder learning. Visual aids and sensory tools, along with a predictable environment, are beneficial in supporting the unique learning needs of students with ASD.
Question 4
Vignette: A 10-year-old child with Autism Spectrum Disorder (ASD) is seen in the clinic for a routine check-up. The parents express concern about their child’s recent increase in self-injurious behavior, such as head-banging. Which of the following is the most appropriate initial response by the nurse?
A. Advise the parents to ignore the behavior, as attention might reinforce it.
B. Suggest the immediate start of behavioral therapy.
C. Recommend physical restraints to prevent injury.
D. Encourage the exploration of underlying causes, such as sensory overload or frustration.
E. Prescribe medication to manage the behavior.
Correct Answer: D. Encourage the exploration of underlying causes, such as sensory overload or frustration.
Rationale: Understanding and addressing the underlying causes of self-injurious behavior is crucial in managing and preventing such behaviors in children with ASD. Sensory overload, frustration, communication difficulties, or medical issues can trigger self-injury. Immediate behavioral therapy may be beneficial but should be based on the understanding of these triggers. Ignoring the behavior, using restraints, or resorting to medication as a first response does not address the root cause and may not be effective or could potentially harm the child’s well-being. A thorough assessment to identify and then address these triggers is the most appropriate initial response.
Question 5
Vignette: A nurse is developing a care plan for an adolescent with Autism Spectrum Disorder (ASD) who has difficulty with transitions between activities at school. Which of the following interventions should be included to assist with transitions?
A. Provide sudden transitions to decrease anxiety.
B. Use a visual schedule to outline the day’s activities.
C. Avoid providing warnings before transitions.
D. Encourage the adolescent to determine the schedule independently each day.
E. Limit transitions to no more than one per day.
Correct Answer: B. Use a visual schedule to outline the day’s activities.
Rationale: A visual schedule can greatly assist individuals with ASD in understanding and preparing for upcoming transitions between activities. It provides a clear and concrete representation of what to expect throughout the day, reducing anxiety associated with the unknown and helping to develop independence in transitioning between tasks. Sudden transitions, lack of warnings, and overly restrictive or unpredictable scheduling can increase anxiety and resistance. Allowing the adolescent to independently determine their schedule each day may be empowering but could also lead to confusion and anxiety if not structured properly.
Question 6
Vignette: During a health education session for parents of children with Autism Spectrum Disorder (ASD), a nurse is discussing the importance of dietary management. One parent asks about the role of diet in managing ASD symptoms. Which of the following responses by the nurse is most accurate?
A. “A gluten-free, casein-free diet is a proven and effective treatment for ASD.”
B. “Most children with ASD require a ketogenic diet for symptom management.”
C. “There is no scientific evidence supporting a specific diet for ASD, but individual dietary needs should be considered.”
D. “All children with ASD benefit from high doses of vitamin supplements.”
E. “A sugar-free diet is essential for controlling hyperactivity in children with ASD.”
Correct Answer: C. “There is no scientific evidence supporting a specific diet for ASD, but individual dietary needs should be considered.”
Rationale: While various diets and nutritional strategies are often discussed in the context of ASD, there is no one-size-fits-all dietary approach that is scientifically proven to manage ASD symptoms universally. Individual responses to dietary changes can vary, and some individuals with ASD may have specific food sensitivities or gastrointestinal issues that require attention. It’s important for dietary modifications to be made based on individual needs and under the guidance of healthcare professionals. General claims about the efficacy of gluten-free, casein-free, ketogenic, or sugar-free diets, or high doses of vitamin supplements, lack consistent scientific backing and can mislead parents into pursuing unproven treatments.
Question 7
Vignette: A pediatric nurse is caring for a child with Autism Spectrum Disorder (ASD) who exhibits significant sensory processing difficulties, being extremely sensitive to light and sound. The child is due for a routine vaccination. Which of the following approaches should the nurse take to minimize distress during the vaccination?
A. Conduct the vaccination in a brightly lit room to ensure proper visibility.
B. Use a loud countdown to prepare the child for the injection.
C. Provide a sensory toy or item for the child to focus on during the vaccination.
D. Perform the vaccination without warning to avoid anticipatory anxiety.
E. Encourage the child to listen to loud music through headphones to distract them.
Correct Answer: C. Provide a sensory toy or item for the child to focus on during the vaccination.
Rationale: For children with ASD, especially those with sensory processing difficulties, providing a familiar or comforting sensory object can help reduce anxiety and distract from distressing stimuli, such as the pain or fear associated with vaccinations. This approach respects the child’s sensory sensitivities by offering a positive sensory experience as a form of distraction, rather than introducing potentially overwhelming sensory inputs like bright lights, loud noises, or unexpected actions. It’s a tailored strategy that acknowledges the individual’s specific needs, making the vaccination process less stressful for both the child and the healthcare provider.
Question 8
Vignette: A nurse is working with a teenager with Autism Spectrum Disorder (ASD) who has difficulty understanding non-verbal communication cues. The teenager’s parents are concerned about their child’s ability to form friendships. Which of the following strategies should the nurse suggest to the parents to help their child improve in understanding non-verbal cues?
A. Focus solely on verbal communication as it is more reliable.
B. Use role-playing games to practice recognizing and responding to non-verbal cues.
C. Discourage the teenager from social interactions to avoid confusion.
D. Recommend avoiding eye contact to reduce anxiety.
E. Teach the teenager to ignore non-verbal cues as they are not important.
Correct Answer: B. Use role-playing games to practice recognizing and responding to non-verbal cues.
Rationale: Role-playing games are an effective, interactive method for teaching social skills, including the recognition and interpretation of non-verbal communication cues, to individuals with ASD. Through role-playing, the teenager can safely explore and practice social interactions in a controlled, supportive environment, which can enhance their understanding and responsiveness to non-verbal cues such as facial expressions, body language, and tone of voice. This strategy promotes learning through experience and feedback, which is more engaging and likely to be retained than passive learning. Discouraging social interaction, avoiding eye contact, or ignoring non-verbal cues would not address the developmental needs of the teenager and could further isolate them from potential social learning opportunities.
Question 9
Vignette: A nurse is teaching a group of healthcare professionals about the early signs of Autism Spectrum Disorder (ASD) in toddlers. Which of the following signs would the nurse include as a key indicator of ASD in this age group?
A. Prefers to use gestures over vocalizations to communicate.
B. Exhibits an early interest in numbers and letters.
C. Shows no interest in playing with other children by 24 months.
D. Demonstrates advanced motor skills for age.
E. Frequently engages in parallel play with peers.
Correct Answer: C. Shows no interest in playing with other children by 24 months.
Rationale: A lack of interest in social interactions, such as playing with other children by the age of 24 months, is a significant early sign of ASD. This age is typically when most children start to show a clear interest in social play, making the absence of this interest notable for professionals screening for ASD. While some toddlers may prefer gestures over words initially, or engage in parallel play as part of typical development, a complete disinterest in social engagement is more concerning. An early interest in numbers and letters or advanced motor skills are not direct indicators of ASD and may reflect individual variances in development unrelated to the disorder.
Question 10
Vignette: A 16-year-old with Autism Spectrum Disorder (ASD) is preparing for a transition to adulthood and expresses a desire to live independently. The nurse is discussing with the adolescent and their parents about essential skills for independent living. Which of the following skills would the nurse emphasize as crucial for the adolescent to focus on?
A. Mastering advanced academic subjects.
B. Developing a daily routine for personal hygiene and home maintenance.
C. Learning multiple foreign languages to improve communication skills.
D. Perfecting a specific talent or hobby.
E. Focusing exclusively on online social interactions.
Correct Answer: B. Developing a daily routine for personal hygiene and home maintenance.
Rationale: For adolescents with ASD preparing for independent living, mastering daily living skills such as personal hygiene, meal preparation, home maintenance, and financial management is crucial. These skills are fundamental to living independently and safely, as they cover the basics of self-care and home care. While academic subjects, languages, talents, and hobbies are important for personal development and enrichment, they do not directly equip an individual with the necessary capabilities for day-to-day independent living. Focusing on practical life skills supports the individual’s ability to manage their own needs and contributes to their overall quality of life and independence.