Step 5 of 6 – Study for the Exam


Preparing to study

Please bear in mind that the exam covers the lifespan, so if you work in pediatrics, you may need to focus your studies on adult and aging issues. Likewise, if you have expertise in adult and aging issues, you need to review pediatrics. Be very familiar with common syndromes and conditions. Know about seizure care. Know about appropriate delegation to caregivers and direct support personnel. Know about medications that are commonly administered to people with IDD. Know about health problems that are associated with different syndromes and conditions, including their signs and symptoms and their treatments. Know about common laws that affect the rights of people with IDD. Know the significance of laboratory values for tests that are commonly ordered for persons with IDD.

Basically, this is a nursing exam that evaluates your overall IDD nursing knowledge. There are no trick questions. You are not asked to do drug calculations, although you may be asked about the appropriateness of a particular medication for a particular client with a particular syndrome or condition in a particular situation. The questions on this exam reflect the day-to-day practice of IDD nurses.


Certification practice questions

These are practice questions only.  They are not actual questions from the certification exams.  Practice questions will range in difficulty.  Some questions will be appropriate for both RNs and LPNs/LVNs, while other questions will not be.

Question 1

A 26-year-old female with Turner Syndrome lives in her own apartment and receives intermittent services from the health support team. She recently has been diagnosed with hypertension. Treatment with Valsartan/hydrochlorothiazide (Diovan HCT) has been initiated. Which statement from the woman illustrates the need for further health education from the nurse?

a) “I should check my blood pressure at least daily, at different times of the day.”

b) “I still have to watch for being hungry and having to go to the bathroom a lot.”

c) “Now my boyfriend and I can get married and I will be able to get pregnant.”

d) “The doctor said I need lab work drawn before I run out of my medicine.”

e) “I will probably have to take the blood pressure medicine for a long time.”

View Week 1 answer

Correct answer: C

Turner Syndrome is specific to females. Cardiovascular and kidney problems are common, with an increased risk for developing hypertension in adulthood. Persons with Turner Syndrome are at a significantly increased risk of developing Type II diabetes. The lack of ovarian development is also characteristic of the syndrome, typically resulting in infertility/sterility. The Turner Syndrome Society notes that “Fertility without assisted reproduction therapy is rare – (less than 1%).” (See references below)

A – At least daily monitoring of blood pressure is indicated. The woman verbalized an understanding of the need to monitor her blood pressure. This does not demonstrate a need for further health education.

B – Persons with Turner Syndrome have twice the risk of the general population of developing diabetes (nih). Polyphagia and polyuria are both signs of diabetes. The woman’s statement indicates that she understands that she must still monitor for signs of diabetes. This does not demonstrate a need for further health education.

C – Lack of ovarian development, typically resulting in infertility/sterility, is characteristic of Turner Syndrome. Her fertility (or lack of) is unrelated to her hypertension or antihypertensive treatment. The woman’s idea that she can marry and will now be able to “get pregnant” indicates that she does not understand the typical characteristics of her syndrome. This lack of understanding indicates a need for further health education about Turner Syndrome.

D – Intermittent monitoring of lab work is indicated, specifically to monitor potassium levels and other electrolytes (because hydrochlorothiazide is a ‘non-potassium sparing’ diuretic). The woman verbalized an understanding of the need to return for lab work. This does not demonstrate a need for further health education.

E – Cardiovascular defects/disease are common in persons with Turner Syndrome, and the woman’s hypertension is probably secondary to her Turner Syndrome. It is likely that her hypertension will continue throughout her lifetime, as will the need for antihypertensive medication. The woman verbalized an understanding of the “long-term” nature of her hypertension. This does not demonstrate a need for further health education.

REFERENCES

  • Ruben, I. Leslie and Allen C. Crocker (2006): Medical Care for Children & Adults with Developmental Disabilities; pp 390 – 391; 419.
  • Brown, Ivan and Maire Percy (2007): A Comprehensive Guide to Intellectual & Developmental Disabilities; pp 257 – 259.
  • Jones, Kenneth Lyons (1997): Smith’s Recognizable Patterns of Human Malformation – 5th Edition; pp 81 – 87.
  • Website Reference: The Turner Syndrome Society:  www.turnersyndrome.org : Turner Syndrome – The Basics; referenced 12/5/08.
  • Website Reference: The National Institutes of Health – Eunice Kennedy-Shriver National Institute of Child Health and Human Development: NIH website – Clinical Features of Turner Syndrome; http//:turners.nichd.nih.gov/ : referenced 12/5/08.

Practice Test Question submitted by Diane Moore.


Question 2

A 12-year-old female with IDD fell after having a seizure and is diagnosed with a fractured left tibia. Last month she fractured her right index finger when she lost her balance while having a seizure. Past medical history includes long-standing cerebral palsy and epilepsy, for which she currently takes carbamazepine (Tegretol). Valproic acid (Epival) was added to her medication regime ten weeks ago and was increased last week. The most recent blood work for CBC, electrolytes, liver function tests and antiepileptic drug levels were within normal limits (WNL) 2 weeks ago.

Which blood work is a priority at this time?

a) Calcium and vitamin D levels

b) Liver function tests

c) Antiepileptic drug levels

d) CBC and electrolytes

View Week 2 answer

Correct answer: C

Long-term use of antiepileptic drugs can increase osteoporosis risk. A long bone fracture in the upper extremity is clinically significant, even though finger and toe fractures are not clinically significant indicators of osteoporosis in children. However, this girl is ambulatory and has no other risk factors. These blood tests could be helpful, but are not the priority at this time.

Liver function needs to be monitored monthly for the first 2 months of treatment in persons taking valproic acid, so liver function tests are not the priority at this time.

Falls caused by seizures are a major safety issue. Antiepileptic drug (AED) levels must be monitored closely, especially with the recent addition of VPA, which can interact with carbamazebine and lower valprioc acid levels. Measure AED levels 5 days after any change in dose.

Monitoring the CBC while on carbamazepine and valproic acid is necessary, and monitoring for hyponatremia is important while on carbamazepine. However, CBC and electrolyte testing is not a priority at this time because results were normal 2 weeks ago.


Question 3

An individual with IDD receives the following medications: phenytoin (Dilantin) and phenobarbital for seizures, loratidine (Claritin) for seasonal allergies, and multivitamin tablets. The loratidine is given in the morning and the phenytoin and phenobarbital are given at bedtime. The physician wants to add ranitidine (Zantac) and sulcrafate (Carafate) for a recent diagnosis of gastroesophageal reflux disorder (GERD). Which is the most correct action nursing action?

  1. Question the physician about the use of both ranitidine and sulcrafate.
  2. Suggest that the individual be tested for H. pylori.
  3. Change the medication schedule so that all doses are given at bedtime.
  4. Schedule ranitidine and sulcrafate to be given in the morning and afternoon.

View Week 3 answer

Correct answer: B

It would be correct to suggest that the individual be tested for H. pylori, because this is a common infection in persons with GERD. Appropriate diagnosis and treatment may avert the need to begin or continue treatment. Some treatments commonly used to treat GI symptoms, such as esophageal reflux, can increase risks for other health problems, e.g., osteoporosis. The GI tract, once rid of the H. pylori, can then heal.

A is Incorrect
Both an H2 blocker (ranitidine), as well as an agent to coat the GI tract (sulcrafate), are sometimes used together to treat GERD.

C is Incorrect
Scheduling all medications to be given separately is unnecessary precautions, because some of these medications can be scheduled to be administered simultaneously.

D is Incorrect
Although this would be an appropriate schedule for these medications, it is more important to definitively diagnose and treat the underlying cause of the reflux.


Question 4

A 30-year-old man with fetal alcohol syndrome has recently transferred from a large facility to a small community-based home. He has a long history of psychotic disorder that is currently being treated with olanzapine (Zyprexa) 30 mg daily at bedtime. Which blood test(s) should be done?

  1. Baseline olanzapine level at 1 month and every 6 months.
  2. Baseline blood glucose and lipid panel and every 3 months.
  3. Baseline serum potassium and every 3 to 6 months.
  4. Baseline thyroid function test and every 6 months.

View Week 4 answer

Correct answer: B
Olazapine can cause hyperglycemia and hyperlipidemia, so routine monitoring of blood glucose and lipid levels is indicated.

A is incorrect.
Blood levels are rarely used to determine the effectiveness of an antipsychotic. Effectiveness is based on clinical judgment and relief of symptoms.

C is incorrect.
Olanzapine does not interfere in any way with blood potassium, neither increasing it nor decreasing it.

D is incorrect.
Olanzapine does not affect thyroid function.


Question 5

A 64-year-old individual with cerebral palsy has been newly diagnosed with osteoporosis. The healthcare provider (HCP) has prescribed alondronate (Fosamax) once daily. Other medications include a multivitamin daily, atorvastin (Lipitor) daily and escitalopram (Lexapro). Which nursing action is of highest priority?

  1. Instruct the individual to continue Fosamax unless HCP instructs otherwise.
  2. Schedule DEXA bone density scan for next annual provider appointment.
  3. Consult with the HCP about the need for calcium and vitamin D supplements.
  4. Encourage the individual to begin a weight-bearing exercise program daily.

View Week 5 answer

Correct answer: C
To be effective Fosamax requires supplementation with calcium and vitamin D.

A is incorrect.
Once prescribed, Fosamax should be continued indefinitely. This instruction is not of highest priority.

B is incorrect.
While it is important that this individual have follow-up DEXA bone scans, it is not of highest priority to make the appointment at this time.

D is incorrect.
Weight-bearing exercise is important to maintain bone density; however, it is not of highest priority.


Question 6

A 20-year-old individual with autism picks at his skin repeatedly, changes his clothes multiple times daily, eats only white foods, and washes his hands four to five times per hour. These behaviors have recently increased. The healthcare provider has prescribed a starting dose of citalopram (Celexa) 40 mg daily. You have contacted the healthcare provider and confirmed the dosage. Which instruction is most important to communicate to support staff?

  1. Observe and report signs of increased anxiety, hyperactivity, irritability, difficulty sleeping, and mood changes.
  2. Ensure that a follow-up medication evaluation appointment is scheduled within three to four weeks.
  3. Work with the client on a self-medication program that includes the need to take medications that are not white in color.
  4. Recognize that medications in this class often require four to six weeks to reach full therapeutic effectiveness.

View Week 6 answer

Correct answer: A
This starting dose of Celexa is high and may cause signs of mania, which need to be reported to the nurse immediately should they occur so that a dose adjustment can be made by the healthcare provider.

B is incorrect.
While it is important to schedule medication review follow-ups, it is more important to communicate instructions to observe the individual’s response to this new medication.

C is incorrect.
Implementing a self-administration of medication program to decrease an individual’s sensitivity to medication and food colors is important; however, it is not a priority at this time.

D is incorrect.
Therapeutic effects of this medication may take four to six weeks to be apparent; however, this instruction is not of highest importance.


Question 7

During the quarterly nursing assessment on a 23-year-old woman with a seizure disorder, pinpoint bruising is noted on her legs, abdomen, and breasts. She also seems lethargic. Her medications are divalproex 250 qid (Depakote), benazepril (Lotensin) 5 mg/day, multivitamin daily, and vitamin D 1000 IU daily. After completing the assessment, which action should the nurse take first?

  1. Ask the woman “Did someone hurt you or did you fall down?”
  2. Complete an incident report and notify the family of the bruises.
  3. Instruct staff to observe for falls and notify the nurse if injury occurs.
  4. Call the healthcare provider to request CBC and Depakote level.

View Week 7 answer

Correct answer: D
Divalproex can cause thrombocytopenia, so the pinpoint bruising and lethargy may indicate divalproex toxicity. This requires immediate healthcare provider notification.

A is incorrect.
Asking the women whether someone has hurt her or if she fell is a leading question and may cause the woman to respond inaccurately. When bruising is present, it is appropriate to interview the person to determine its cause. However, pinpoint (petechial) bruising is unlikely to be caused by abuse or a fall.

B is incorrect.
While those might be appropriate actions for the nurse to take, they would not be the action that the nurse should take first.

C is incorrect.
While those might be appropriate actions for the nurse to take, they would not be the action that the nurse should take first.


Question 8

The mother of a three-year-old child recently diagnosed with autism contacts the nurse and asks, “What do I do with my child? Every time I touch him he cries and arches away.” How should the nurse respond to this mother?

  1. “This behavior is expected in young children with autism. Research shows that nothing can be done.”
  2. “Using a light touch will help to desensitize your son. You may want to brush his skin with just the tips of your fingers.”
  3. “This behavior is not uncommon in children with autism. Using a firm, sustained touch can be helpful.”
  4. “You can call your healthcare provider to see whether there is a medication that can help calm your son.”

View Week 8 answer

Correct answer: C
Although touch aversion is common in persons with autism, research shows that deep touch pressure may be calming.

A is incorrect.
Although touch aversion is common in persons with autism, this response is neither helpful nor therapeutic.

B is incorrect.
Touch aversion is common in persons with autism. Light touch may uncomfortably stimulate the nervous system.

D is incorrect.
Medications may or may not be required in the future. Less intrusive interventions should always be implemented first and their effectiveness evaluated.


Question 9

A 27-year-old man who resides in a group home is deaf and mute due to cytomegalovirus (CMV) infection in utero. He also has a seizure disorder and anxiety, both of which are being effectively treated with medication. He has a long-standing pattern of behavior that involves shaking hands with others in his home. He approaches them, shakes their hands, walks away for 20-30 minutes, and then returns to shake their hands again. A newly hired direct support person (DSP) asks the nurse, “What should I do with this guy who wants to shake hands all the time?” What would be the correct response to the DSP?

  1. “This behavior is a common sign of mental illness and must be documented.”
  2. “Gently push his hands away and shake your head to indicate ‘No.'”
  3. “Shake his hand. This is how he communicates and connects with you.”
  4. “Do not offer your hand and ignore this behavior until he walks away.”

View Week 9 answer

Correct answer: C
Because he is unable to communicate verbally, touch and visual contact provide a way for him to connect with others. This connection is important to him and the constant reassurance that others are present and aware of him decreases his anxiety.

A is incorrect.
This has been a long-standing, socially acceptable behavior and not a common sign of mental illness. His anxiety symptoms have been effectively controlled by medication, and he has no other signs or symptoms of mental illness.

B is incorrect.
Shaking hands is this man’s way of connecting with others, and pushing his hands away may cause him to feel disrespected.

D is incorrect.
Shaking hands is this man’s way of connecting with others, and pushing his hands away may cause him to feel disrespected.


Question 10

A 75-year-old woman with IDD who resides in a group home is approximately 30 pounds overweight. The only medication she takes is a daily multivitamin. The dietician on the woman’s team wants to decrease her food intake to 1000 calories/day. The woman is very upset that she will not be able to eat at McDonald’s on Sunday with her family, and runs out of the interdisciplinary team (IDT) meeting. The nurse finds the woman sitting on her bed crying. Which would be the nurse’s most therapeutic response to the woman?

  1. “You will see. It will be okay. We are just trying to help you live longer.”
  2. “Come with me so you can discuss how you feel with the rest of the team.”
  3. “Sorry. That is the dietician’s decision because you need to lose weight.”
  4. “You are only allowed to be 5% over ideal body weight by state regulation. “

View Week 10 answer

Correct answer: B
This response appropriately advocates for the woman’s rights in this situation.

A is incorrect.
This response is both false reassurance and patronizing. Additionally, the woman is already 75 years old and has no significant health issues. It would be reasonable to question the appropriateness of this health goal.

C is incorrect.
This response does not reflect a person-centered planning approach, nor does accurately describe the proper function of an IDT meeting.

D is incorrect.
Regardless of state regulations, every individual has the right to make personal health decisions, especially in the absence of significant health issues.


Question 11

A direct support person (DSP) reports finding several pairs of urine-soaked pants in the hamper of a 60-year-old man with IDD. This man’s privacy is important to him and he takes pride in his ability to care for himself. There is no history of urinary incontinence and he has verbalized no physical complaints. What instruction should the nurse give to the DSP?

  1. “Thanks for calling me about this. Please let me know if the problem continues.”
  2. “Encourage him to stay well hydrated and remind him to go to the bathroom hourly.”
  3. “It may be a prostate problem. I’ll make an appointment with his healthcare provider.”
  4. “His annual physical is scheduled next month. I’ll be sure to tell the healthcare provider.”

View Week 11 answer

Correct answer: C
It is common for the prostate gland to become enlarged as a man ages. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH. This man needs to be seen by his primary care provider for evaluation.

A is incorrect.
A more aggressive nursing assessment and intervention is indicated.

B is incorrect.
Increasing fluid intake is unlikely to decrease his incontinence.

D is incorrect.
A more aggressive nursing assessment and intervention is indicated.


Question 12

A 72-year-old man had a traumatic brain injury during childhood that resulted in hemiparesis and mild IDD. Until six months ago when his sister passed away, he was living in his own apartment with support from his sister. Since moving into the group home, he seems to have lost interest in activities and his overall self-care skills have significantly declined. Over the past couple of months, he has been complaining that the house is too noisy, and he has been spending more time in his room. When staff tries to engage him, he answers in monosyllables and avoids eye contact. A nursing assessment fails to identify any obvious reasons for the changes in his behavior. What action should the nurse take next?

  1. Refer to his primary healthcare provider to rule out a medical issue.
  2. Encourage staff to be patient during his adjustment to his new home.
  3. Schedule an appointment with an audiologist for a hearing evaluation.
  4. Refer him to a psychiatrist for treatment of his depressive symptoms.

View Week 12 answer

Correct answer: A
All significant changes in behavior, marked decline in function abilities, cognitive decline, or physical complaints first requires a comprehensive medical examination to rule out underlying health issues.

B is incorrect.
While patience is important when individuals are making transitions, medical evaluation is indicated when deterioration in health or decline in function is identified.

C is incorrect.
In this situation, a hearing evaluation is not of primary importance.

D is incorrect.
Referral to a psychiatrist in advance of a thorough medical evaluation by the individual’s primary healthcare provider is premature.


Recommended study material

The DDNA Board of Directors recommends completion of the free online IDD nursing courseware on this website as a useful study tool for the exam. They also recommend the books listed below. You may be able to obtain these books by contacting your local public library to see whether it has the books or whether it can obtain the books for you through an interlibrary loan program. Some recommended books include:

  • Core Curriculum For Specializing In Intellectual and Developmental Disabilities: A Resource for Nurses and Other Health Care Professionals. Edited by Wendy Nehring. ISBN 0-7637-4765-3 Paperback
  • Medical Care for Children and Adults with Developmental Disabilities, Second Edition. Edited by I. Leslie Rubin, M.D., and Allen C. Crocker, M.D. ISBN 1-55766-766-7 Hardcover
  • When Your Child Has a Disability: The Complete Sourcebook of Daily and Medical Care, Revised Edition. Edited by Mark L. Batshaw, M.D. ISBN 1-55766-472-2 Paperback
  • Genetics and Mental Retardation Syndromes: A New Look at Behavior and Interventions. By Elisabeth M. Dykens, Ph.D., Robert M. Hodapp, Ph.D., and Brenda M. Finucane, M.S ISBN 1-55766-471-4 Paperback

Also, the resources section of this site contains more than 1400 links to IDD related materials.