Chapter 33: Alterations in Cognition and Mental Health
According to the American Psychiatric Association (DSM-5, 2013), a client with anorexia nervosa has a body image disturbance in which one's body weight or shape is not experienced realistically. Which statement by a client would best validate this criterion? "When I see myself in the mirror, I can see my ribs." "My stomach really sticks out and looks fat." "I realize I am a quite thin, but I am trying to gain weight." "Being this skinny really isn't a good idea for my health."
"My stomach really sticks out and looks fat." Rationale:A client with anorexic nervosa does not accurately view body weight or shape. Verbalizing that the stomach "sticks out" and viewing it as fat validates the disturbance in body image associated with anorexia nervosa. The other statements acknowledge that the client is underweight and that being extremely underweight is not healthy.
The parents of a child with physical and developmental special needs state, "We wish our child could get some kind of educational experience." How should the nurse respond? "I am sure it must be difficult to know that your child will never be able to go to school like other children." "It would be very difficult for your child to attend school with all of their disabilities. It's unfortunate, but it is reality." "Since all children can attend school regardless of their special need, I suggest you talk with your local school about enrolling your child." "This must be difficult for you. Let's talk with the social worker to see what programs are available for your child."
"This must be difficult for you. Let's talk with the social worker to see what programs are available for your child." Rationale:Education is federally mandated. Contacting the social worker gives the parents the support they need to find and choose the appropriate school. Telling them to contact their local school is not supportive of the parent's needs.
A nurse is providing a routine wellness examination and follow-up for a 3-year-old recently diagnosed with autism spectrum disorder (ASD). Which response indicates a need for additional referral or follow-up? "We really like the treatment plan that has been created by his school." "We have a couple of babysitters who know how to handle his needs." "We have recently completed his individualized education plan." "We try to be flexible and change his routine from day to day."
"We try to be flexible and change his routine from day to day." Rationale:The nurse should emphasize the importance of rigid unchanging routines as children with ASD often act out when their routine changes. The other statements would not warrant additional referral or follow-up.
The mother of a 10-year-old boy with attention deficit hyperactivity disorder (ADHD) contacts the school nurse. She is upset because her son has been made to feel different by his peers because he has to visit the nurse's office for a lunch-time dose of medication. The boy is threatening to stop taking his medication. How should the nurse respond? "Remind him that his schoolwork may deteriorate." "I can have the teacher speak with the other children." "He will need to learn to ignore the children, he needs this medication." "You may want to talk to your physician about an extended-release medication."
"You may want to talk to your physician about an extended-release medication." Rationale:The nurse should encourage the family to explore with their physician the option of one of the newer extended-release or once-daily ADHD medications. The other statements are not helpful and do not address the mother's or boy's concerns.
The nurse is reviewing the medical records for a group of children who have been seen in the clinic. Which children would be considered candidates for an evaluation of a learning disability? Select all that apply. A 3-year-old child who has speech that is difficult to decipher by anyone other than the parents. The 33-month-old child who is unable to converse using complete short sentences. A 3-year-old child who is unable to hop. A 4-year-old who is unable to button their sweater without assistance. The mother of a 24-month-old child reports her child is rarely able to sit still and listen to a short story.
A 3-year-old child who has speech that is difficult to decipher by anyone other than the parents. The 33-month-old child who is unable to converse using complete short sentences. Rationale:Developmental milestones required assessment. Children who are not meeting the milestones should be considered for possible learning disabilities. If a child cannot speak in sentences by 30 months of age, does not have understandable speech 50% of the time by age 3 years, cannot sit still for a short story by 3 to 5 years of age, or cannot tie shoes, cut, button, or hop by 5 to 6 years of age, refer the child to be evaluated for a learning disability.
While teaching the family of a young patient with a developmental delay, the nurse informs them they should do which of the following to maximize the child's potential? (Select all that apply.) Consider the child's abilities Consider the siblings' interests Consider the child's interests Consider special needs when planning activities Consider the parent's interests
Consider the child's abilities Consider the child's interests Consider special needs when planning activities Rationale:To maximize the child's potential, the family must consider the child's interests, abilities, and special needs when planning activities. Taking the parents and siblings' interests into account does not maximize the child's potential when working with a child with special needs.
An adolescent has been diagnosed with bulimia, and the parents are asking how to best deal with this problem. What suggestion should the nurse make to the parents to help care for the adolescent? Minimize or ignore any comments made by the adolescent about body image distortion or being overweight and dieting. Administer antiemetics on a regular basis to reduce the urge to vomit after eating. Monitor the adolescent constantly to ensure that she is not binge eating. Develop a contract with the adolescent, setting goals of behavior and her diet, as well as privileges gained by meeting the contracted goals.
Develop a contract with the adolescent, setting goals of behavior and her diet, as well as privileges gained by meeting the contracted goals. Rationale:Developing a contract with the adolescent, as part of a behavior modification program, lays out clearly defined behaviors and the child's responsibilities related to bulimia and its management. Parents need to be aware and report any verbalizations about being overweight or altered body image. Antiemetics are not appropriate for this disorder since there is not nausea associated with it and it is impossible to monitor the adolescent continually.
A nurse is conducting a physical examination of an adolescent girl with suspected bulimia. Which assessment finding should the nurse expect? Soft sparse body hair Thinning scalp hair Dry sallow skin Eroded dental enamel
Eroded dental enamel Rationale:The nurse should be sure to carefully assess the mouth and oropharynx for eroded dental enamel, red gums, and inflamed throat from self-induced vomiting. The other findings are typically noted with anorexia nervosa.
A parent brings a child to the clinic because the parent suspects a cognitive impairment. What tests should the nurse anticipate the health care provider will order for the child? Select all that apply. Neuroendocrine tests Blood lead levels Hearing and vision screening Tests to rule out infections Genetic and chromosome tests
Neuroendocrine tests Blood lead levels Hearing and vision screening Tests to rule out infections Genetic and chromosome tests Rationale:The child with a suspected cognitiv impairment should have thorough physical and neurological examinations. Also determining whether deficits in hearing, vision, or motor skills are causing or contributing to the problem is important. The child should be tested for infection, lead, genetic or chromosomal problems, and neuroendocrine problems--all of which can cause or contribute to a cognitive impairment.
A 6-year-old child with cognitive disabilities presents to the emergency department with the parents, having fallen and hit the head. How will the nurse need to modify care, based on the disabilities? Speak to the parents because the child will not be able to understand. Provide clear instructions on what the nurse is going to do. Provide written instructions as well as oral instructions for the child. Talk slowly and enunciate clearly.
Provide clear instructions on what the nurse is going to do. Rationale:When children with an intellectual disability are seen in an emergency department or an ambulatory setting for care, they may need more explanations of what is expected of them than other children. The average 6-year-old child, for example, sees the nurse with a thermometer and thinks, "I'm going to have my temperature taken." When the nurse explains what is going to happen, it is not really news, only a confirmation of what the child had already guessed. A child who is intellectually disabled may not be able to make this association between the thermometer and what the nurse is going to do; the nurse's explanation, therefore, is the first introduction to the event, so it is necessary for it to be thorough and appealing. The nurse would need to talk slowly and enunciate for a child with a hearing defect. It is best to speak to both the child and the parents. A child with intellectual disabilities is not going to be able to read written instructions.
A parent brings a child to the pediatric clinic, stating that the child was diagnosed with attention deficit hyperactivity disorder (ADHD). Which symptom does the nurse anticipate finding with this child? excess motor activity, learning disability, and depression hyperactivity, defiant, and disruptive inattention, impulsive, and hyperactivity visual impairment, hyperactivity, oppositional defiant
inattention, impulsive, and hyperactivity Rationale:Attention deficit hyperactivity disorder (ADHD) is characterized by three major behaviors: inattention, impulsiveness, and hyperactivity. Defiance may be present in some children, but not all, and many times ADHD causes disruption in multiple environments. Excess motor activity is present with hyperactivity, but learning disability and depression may occur as a result of having ADHD. Visual impairment must be ruled out with ADHD as sometimes children with visual impairment appear inattentive due to being unable to read the board. Hyperactivity is a part of ADHD, but not visual impairment. Oppositional defiant disorder may also present in children with ADHD, but it is not considered part of ADHD.
An adolescent client has been diagnosed with bulimia nervosa. What does the nurse explain as the goal of treatment for this client? restoring nutritional balance and a healthy self-image family therapy as this is linked to family disturbances removing the stressors from life that caused this helping the client return to a healthy weight for height
restoring nutritional balance and a healthy self-image Rationale:Treatment focused on restoring nutritional balance and keeping a structured nutritional intake is key for bulimia nervosa. Cognitive-behavior therapy concentrates on improving the person's distorted self-image, uncontrollable and excessive eating, and guilt and embarrassment associated with binging and purging.