Essentials of Pediatric Nursing - Chapter 28
Parents of a 36-month-old child confide in the clinic nurse that their child does not speak and spends hours staring at their ceiling fan. They are worried that their child may have autism spectrum disorder. Which question would be important for the nurse to ask the parents? "Do you have trouble keeping child care providers for your child?" "Does your child have siblings?" "Does your child come and hug you or seek comfort from you?" "Does your child already attend therapies such as speech?"
"Does your child come and hug you or seek comfort from you?" Children with autism spectrum disorder lack communication and social skills. These children often will not seek comfort, make eye contact, or develop peer relationships
A nurse is providing care to an adolescent being treated for anorexia as an outpatient. The nurse is evaluating the adolescent's weight gain over the past week. The nurse determines that the adolescent is achieving the expected outcome when the adolescent shows a gain of how much for the week? 2 to 3 lb (0.91 to 1.37 kg) 3 to 4 lb (1.37 to 1.81 kg) 0.5 to 1 lb (0.27 to 0.45 kg) 1 to 2 lb (0.45 to 0.91 kg)
0.5 to 1 lb (0.27 to 0.45 kg) A weight gain of 2 to 3 lb/week (0.91 to 1.37 kg/week) while hospitalized, and 0.5 to 1 lb/week (0.27 to 0.45 kg/week) in outpatient programs, is targeted for clients undergoing treatment for anorexia.
When can autistic behaviors first be noticed? 16 years of age 13 years of age 1 year of age 5 years of age
1 year of age Autistic behaviors may be first noticed in infancy as developmental delays, or subsequently between the age of 12 and 36 months when the child regresses or loses previously acquired skills.
The nurse is caring for a 13-year-old girl with a nursing diagnosis of Ineffective coping related to inability to deal with life stressors as evidenced by few or no meaningful friendships and low self-esteem. Which intervention would be the priority to promote coping skills? Set clear limits on behavior. Encourage her to discuss her thoughts and feelings. Role model appropriate social and conversation skills. Demonstrate unconditional acceptance of the child as a person.
Encourage her to discuss her thoughts and feelings. The priority intervention is to encourage her to discuss her thoughts and feelings, as this is an initial step toward learning to deal with them appropriately. The other interventions are appropriate, but the priority intervention is to encourage discussion and obtain information from the child. This way the nurse can develop and refine the interventions based on the child's thoughts and feelings.
An adolescent male tells the nurse that he has been smoking cigarettes for the last 3 years. The nurse recognizes that this adolescent is at the greatest risk of substance abuse based upon what family history finding? He is the oldest child in the family. He has been previously diagnosed with depression. He is a B to C student in school. He is from a family of higher socioeconomic status.
He has been previously diagnosed with depression. Children who are at greatest risk for becoming substance abusers are those who have a low self-esteem, have been diagnosed with depression, and have ADD or have learning disabilities. Lower socioeconomic level, birth order, or being an average student are not contributory factors.
A nurse on the pediatric floor is taking care of a child who has an intellectual disability. The child's chart lists the IQ as a score of 36. Into which classification area would this score fall? Moderate Severe Mild Profound
Moderate An IQ of 35-50 is classified as moderate. An IQ of 50-70 is classified as mild. An IQ of 20-35 is classified as severe. An IQ that is less than 20 is considered profound.
The nurse is collecting data from the caregiver of an 8-year-old child who recently started soiling his underwear each day rather than using the toilet to defecate. How would the nurse document this in the medical record? The client has symptoms of encephalopathy. The client is demonstrating echolalia. The client is displaying enuresis. The client has regressed to encopresis.
The client has regressed to encopresis. Encopresis is chronic involuntary fecal soiling beyond the age when control is expected (about 3 years of age). When the client reverts back to this behavior, it is noted as a regression in development.
The most common use disorder among children and adolescents is: alcohol. oxycodone. ecstasy. marijuana.
alcohol Alcohol misuse occurs when a person ingests a quantity sufficient to cause intoxication. It is also the most common substance use disorder among children and adolescents.
During adolescence, alcohol is connected to what problem frequently seen in this age group? drug usage teen suicide automobile accidents violence
automobile accidents Adolescents who drink and drive do not realize the impact of the alcohol in their reflexes and judgment. Fine motor control and judgment are affected even at lower levels of alcohol consumption. Driving is considered another adult behavior. There are no prying adult eyes on the adolescent drivers, so they think they are invincible and can drink and drive.
Candace, age 16, is being seen for a long overdue checkup. Her caregiver has come with her. Candace is calm, pleasant, and in good spirits. The caregiver reports to the nurse that she is relieved because for the past 6 months Candace has been lethargic, angry, and sad. The mother reports that since she got her driver's license two days earlier, her child's mood has changed dramatically. Rather than resist this appointment, Candace had simply smiled and said, "It won't matter much, but okay, I'll be ready in a minute." The nurse recognizes that the child's seeming well-being and drastic change in behavior should be further investigated to determine if the child: is planning to commit suicide. is excited that she can drive now. has been smoking marijuana. is experimenting with alcohol.
is planning to commit suicide. Attempted suicide rarely occurs without warning and usually is preceded by a long history of emotional problems, difficulty forming relationships, feelings of rejection, and low self-esteem. Suicidal adolescents may appear suddenly elated after a long period of acting dejected, and might verbalize their hopelessness with statements such as "I won't be around much longer," or "After Monday, it won't matter anyhow." Some deaths reported as accidents, particularly one-car accidents, are thought to be suicides.
What is an example of impaired adaptive functioning in an 8-year-old girl with a developmental disorder? The child's vision is fine but she is a poor reader. The child cannot correctly copy a phone number. The child cannot properly dress herself. The child cannot correctly copy a sentence.
The child cannot properly dress herself. A child with impaired adaptive functioning would not be able to dress herself properly, if at all. The inability to copy a phone number or sentence, or to read well reflects learning disorders.
A 6-year-old client has been diagnosed with an autism spectrum disorder. Which symptoms would the nurse expect the client to display? The client has a irresistible urge to pull out one's hair. The client has multiple motor tics and several vocal tics. The client spends time alone and shows little interest in making friends. The client becomes overly attached to those around him or her.
The client spends time alone and shows little interest in making friends. Children with an autism spectrum disorder develop language slowly or not at all. They may use words without attaching meaning to them or communicate with only gestures or noises. They spend time alone and show little interest in making friends. Approximately 80% of people with an autism spectrum disorder also are classified as intellectually impaired. Their most distinctive feature, however, is their seeming isolation from the world around them. This detachment and aloofness help distinguish people with an autism spectrum disorder from those who are solely intellectually impaired. Tourette syndrome is associated with multiple vocal and motor tics. A child with an anxiety disorder may have an irreistible urge to pull out one's hair. A child with separation anxiety would worry constantly about being separated from family.
A nurse in a residential foster home is caring for a 17-year-old client with oppositional defiant disorder. The client is using profanity and refusing to complete assigned chores. The nurse reminds the client that there are only 5 minutes in which to finish the chores. The client throws a dirty plate at the wall. How should the nurse respond? "I am sorry you are feeling so angry tonight but you must still complete your chores." "You only have a few minutes to complete your chores." "If you calm down right now I will give you a few extra minutes to complete your chores." "I find your language offensive and you need to stop talking that way."
"I am sorry you are feeling so angry tonight but you must still complete your chores." An adolescent with an oppositional defiant disorder can frequently demonstrate active defiance, has frequent anger and is noncompliant with adult requests or limits. In this situation the nurse's goal is to clearly but empathetically explain the rules and firmly adhere to them. Telling the adolescent there are only a few minutes to complete the chores does not exhibit empathy. Nor does the statement "I find your language offensive." It also does not address the rules. Letting the adolescent have a few extra minutes only reinforces the negative behavior and does not respect the rules of the facility.
A nurse is examining a 4-year-old child with various injuries in multiple places. Which site of injury would introduce suspicion of abuse? Ears Abdomen Soles of feet Palms of hands
Abdomen The abdomen is the most frequent site of physical injury where abuse is suspected in children 4 years of age and younger. If injuries to the soles and palms are present, the nurse should look into inflicted burns as a possible cause of injury.
A nurse is working at a facility that provides care to children with developmental disabilities. Which role would be the nurse's most important? Educator Counselor Advocate Care provider
Advocate Although the nurse would fulfill the roles of educator, care provider, and counselor, the nurse's most important role would be that of an advocate. Children with developmental disabilities often have special health needs. If so, they often interact with many different health care professionals (nurses, pediatricians, occupational therapists, physical therapists, psychologists, and speech and language pathologists) and may require adaptive modifications for school to maximize attendance and learning (e.g., assistance from health aides, nursing care, modifications for regular classes, special education classes, barrier-free facilities). A key nursing role is advocating to obtain services and care that will enable these children to fully participate in and benefit from their educational experiences.
A family includes a 9-year-old child. The nurse suspects that the family has Munchausen syndrome by proxy. Which nursing intervention is best when assessing the child and family in the pediatrician's office? Turn off the video surveillance in the room Keep both parents in the room at all times Ask to speak to the child separate from the family Ask the parents together how the child is doing
Ask to speak to the child separate from the family In Munchhausen syndrome by proxy, parents report prolonged, unexplained illnesses for the child. Even though the child has been seen for medical treatment, the health issues are never resolved. The parent shows lack of concern about the symptoms and the illnesses. Symptoms usually occur when no one else is present. The nurse should speak to the child alone, video and document interactions, contact the medical team, and contact protection services for the child if needed.
An 11-year-old client has come to the school nurse more than 15 times for somatic complaints during the first quarter of school and has subsequently left school after each visit. What should the school nurse do? Contact the child's parents to discuss the situation. Keep a log of the child's attendance and continue to monitor the situation. Make an unannounced home visit on a day the child is not in school. Talk to the student's teacher.
Contact the child's parents to discuss the situation. The best approach is to involve the child and the parent. Contact with the parents can elicit additional information and provide family details that may be contributing to the child's school refusal. A home visit might make the family take a defensive stance. The teacher's information will supplement the details provided by the parents. The nurse should quickly address the signs of school refusal; waiting would not benefit the child.
An infant diagnosed with nonorganic failure to thrive (NFTT) is being treated in the hospital. Which intervention would the nurse implement for this child to provide increased nutritional intake? Recommend that the parents rock the infant quietly and not talk to the infant. Burp at the end of every feeding and place the infant on the stomach. Feed the infant on demand so the infant will be hungry. Document all feedings and the infant's response to the feeding.
Document all feedings and the infant's response to the feeding. An NFTT infant requires frequent, scheduled feedings every 2 to 3 hours. The infant also needs to be talked to during the feeding to assist with bonding and development of trust. Always document the volumes the infant took, as well as how the infant fed. The infant is burped several times during the feeding and then placed on the back for sleeping.
A nursing student learning about autism spectrum disorders correctly identifies which mannerisms as common in affected clients? Select all that apply. Overeating Head banging Running in circles Rocking Hand wringing
Hand wringing Head banging Rocking Running in circles Children with an autism spectrum disorder may not interact with others in conversation. They may insist on certain routines and have very narrow ranges of interest. They also may have repetitive mannerisms, such as hand wringing, head banging, rocking, and running in circles. Children with an autism spectrum disorder generally have little interest in eating. Overeating is more associated with depression.
The nurse is assessing a child diagnosed with autism spectrum disorder (ASD). Which finding will the nurse expect to assess? Slow motor actions Frequently losing things Indifferent attachment to a parent Engaging in dangerous activities
Indifferent attachment to a parent A child on the autism spectrum disorder can show a lack of or no attachment to parents. Motor skills are not expected to be slowed or delayed, because a child with ASD tends to spend hours in repetetive play and may display bizarre motor and stereotypic behavior. The child may become completely absorbed in strange repetitive behaviors such as spinning an object, flipping an electrical switch on and off, or walking around the room feeling the walls. Frequently losing things can be associated with attention deficit hyperactivity disorder. Engaging in dangerous activities could be related to a conduct disorder.
The mother of a school-age child is distraught over the ongoing oppositional behavior demonstrated by the child at home and at school. Which nursing diagnosis should the nurse select as appropriate for the child and family? Situational low self-esteem related to lack of successful coping strategies Impaired social interaction related to short attention span and distractibility Interrupted family processes related to inability of child to follow instructions Risk for self-directed violence related to impulsivity
Interrupted family processes related to inability of child to follow instructions Oppositional defiant disorders consist of long-term hostile, negativistic, or defiant behaviors that result in disturbed functioning in academic and social domains. Children typically have difficulty controlling their temper; such anger is often directed at an authority figure. The disorder develops most frequently in late preschool or early school age. The diagnosis most appropriate for this child and parent is interrupted family processes. There is no evidence to suggest that the child is at risk for self-directed violence, low self-esteem, or impaired social interaction.
A young parent brings the school-aged child to the office for a sports physical examination. During the appointment, the parent informs the nurse about being worried because the child does not like school and does not seem to be reading, writing, or spelling as well as others in the class. The parent adds that the child struggles to get organized and to manage time. What condition does the nurse suspect? Learning disorder Autism Asperger syndrome Down syndrome
Learning disorder The child appears to have a learning disorder based on challenges with reading, spelling, and writing as well as being organized and managing time. Other findings consistent with a learning disorder include delayed language development and difficulty discriminating among sounds. Autism is a spectrum of disorders characterized by markedly abnormal or impaired development in social interaction and communication. Down syndrome is a condition in which extra genetic material cuases delays in how a child develops, both physically and cogntively. Asperger syndrome is a type of autism.
The nurse is recording vital signs in the client diagnosed with complications of anorexia nervosa. Which findings are consistent with the condition? Select all that apply. Hypertension Orthostatic hypotension Weak pulse Hypothermia Hyperthermia
Orthostatic hypotension Weak pulse Hypothermia Anorexia nervosa is a condition most commonly seen in adolescents. In this condition the individual is obsessed with body weight. There is a noted loss of weight. The vital signs frequently display orthostatic hypotension, irregular and decreased pulse, or hypothermia.
The nurse is caring for a 10-year-old girl with an anxiety disorder. During a physical examination, which physical finding would the nurse expect? Patches of hair loss Watery eyes Dilated eyes Absence of nasal hair
Patches of hair loss Patches of hair loss that occur with repetitive hair twisting or pulling are associated with anxiety. Watery, dilated eyes and the absence of nasal hair are often signs of substance abuse
What would be the priority goal for the nurse caring for an infant diagnosed with nonorganic failure to thrive? Praise positive parenting. Keep the skin dry and intact. Provide adequate nutrition for growth. Teach the parent not to spoil the infant.
Provide adequate nutrition for growth. A nonorganic failure to thrive (NFTT) infant has been receiving inadequate nutrition for some time prior to being diagnosed, so the priority goal is correcting this problem and making sure the infant is receiving adequate nutrition for growth. It is usually a "catch up" time initially to ensure that the infant is getting enough calories to grow and make up for lost time. Praising the parent when they do something right is a good idea, but nutrition comes first.
A nurse is providing an in-service program on child abuse for a group of newly hired nurses. When evaluating the effectiveness of the teaching, the nurse determines a need for additional review when the group identifies which as an indicator of possible child abuse? Injuries that are inconsistent with the reported traumatic event Frequent changes in history information with visits Sexual behavior that correlates with the child's developmental age Consistent delays in seeking treatment for the child's injuries
Sexual behavior that correlates with the child's developmental age Sexual behavior that correlates with the child's developmental age would be appropriate and not an indicator of child abuse. A delay in seeking medical treatment, a history that changes over time, or a history of trauma that is inconsistent with the observed injury all suggest child abuse.
Which sign or symptom suggests that a 5-year-old boy who does not maintain eye contact or speak may have autism spectrum disorder (ASD)? The child has a long face and prominent jaw. The child is highly active and inattentive. The child has a slight decrease in head circumference. The child constantly opens and closes his hands.
The child constantly opens and closes his hands. Repetitive motor mannerisms such as constantly opening and closing the hands are a typical behavior pattern for ASD. A high level of activity and inattentiveness are typical symptoms of intellectual disability. Decrease in head circumference suggests malnutrition or decelerating brain growth. A long face and prominent jaw are symptoms of fragile X syndrome.
The nurse is conducting an assessment of a 5-year-old client. During the assessment, the nurse notes that the child does not maintain eye contract or speak. The nurse suspects an autism spectrum disorder. Which additional finding would help support the nurse's suspicion? The child constantly opens and closes the hands. The child has a long face and prominent jaw. The child has a slight decrease in head circumference. The child is highly active and inattentive.
The child constantly opens and closes the hands. Repetitive motor mannerisms such as constantly opening and closing the hands are a typical behavior pattern for autism spectrum disorder. A high level of activity and inattentiveness are typical symptoms of intellectual disability. Decrease in head circumference suggests malnutrition or decelerating brain growth. A long face and prominent jaw are symptoms of fragile X syndrome.
Which sign or symptom suggests that a 5-year-old child who does not maintain eye contact or speak may have autism spectrum disorder (ASD)? The child has a long face and prominent jaw. The child is highly active and inattentive. The child has a slight decrease in head circumference. The child constantly pats his or her legs.
The child constantly pats his or her legs. Repetitive motor mannerisms such as the child constantly patting his or her legs are a typical behavior pattern for autism spectrum disorder. Typical behavior for these children is repetitive activity. They demonstrate bizzare motor and stereotypic behaviors. A high level of activity and inattentiveness are typical symptoms of cognitive impairment. A decrease in head circumference suggests malnutrition or decelerating brain growth. A long face and prominent jaw are symptoms of fragile X syndrome.
The nurse is caring for a 12-month-old child diagnosed with an autism spectrum disorder. What information from the mother during the health history should the nurse identify as being consistent with the disorder? The child sleeps at least 12 out of every 24 hours. The child responds warmly to the father but not to the mother. The child speaks in complete sentences. The child constantly stares at a rotating wheel on the crib mobile.
The child constantly stares at a rotating wheel on the crib mobile. A manifestation of an autism spectrum disorder is an abnormal response to sensory stimuli such as staring at a rotating wheel on the crib mobile. A child with an autism spectrum disorder will demonstrate repetitive words and failure to develop social relationships. The number of hours of sleep is not used to help identify an autism spectrum disorder.
The nurse is observing a group of 2- and 3-year-olds in a play group. Which behavior noted in one of the children indicates to the nurse that the child may have autism spectrum disorder (ASD)? After another child takes a toy, the child cries and stomps his feet. A child flips the light switch off and on until the caregiver asks her to stop and join the other children in playing. A child playing in the kitchen area pretends to pour a glass of milk and repeats this over and over. While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack.
While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack. Children with ASD become completely absorbed in strange repetitive behaviors such as spinning an object, flipping an electrical switch on and off, or walking around the room feeling the walls. If these movements are interrupted or if objects in the environment are moved, a violent temper tantrum may result. These tantrums may include self-destructive acts such as hand biting and head banging. Although infants and toddlers normally are self-centered, ritualistic, and prone to displays of temper, autistic children show these characteristics to an extreme degree coupled with an almost total lack of response to other people.
The football coach notices that one of the players has been more energetic and overly happy lately during practice. The player also got in fight with a teammate last week. The coach contacts the health care provider, concerned that the student is using anabolic steroids. What physical sign would the nurse advise the coach to be on the lookout for that would further validate the illicit drug use? extended periods of fatigue headaches fainting gynecomastia
gynecomastia Anabolic steroid use can cause periods of euphoria and decreased fatigue, not more fatigue. Gynecomastia is a common side effect of prolonged steroid use, as well as liver damage, hypertension, psychotic episodes, and aggression. Headaches and fainting are not side effects of steroid use.
A 5-year-old child has frequent visits to the school nurse's office. Which assessment data should alert the nurse that this child may be a victim of physical neglect? evidence of bruising on multiple parts of the body isolated from classmates with poor self-esteem malnourished with frequent absences from school inappropriate knowledge of sexual terms and actions
malnourished with frequent absences from school A neglected child may appear unwashed, thin, and malnourished or be dressed inappropriately, such as without mittens, a coat, or shoes in cold weather. Not requiring a child to attend school, deliberately keeping a child out of school without setting up a home school program, or allowing a child to go unsupervised after school may also be interpreted as neglect. Isolated from classmates with poor self-esteem may be a child who is emotionally neglected. Evidence of bruising on multiple parts of the body might indicate child abuse. Inappropriate knowledge of sexual terms and actions is more likely when a child is sexually abused.
Which approach to drug education would be most effective for a group of school-age children? telling the children how expensive drugs can be to buy recommending the students tell the police when they see someone using drugs reporting the statistics of HIV exposure when sharing needles for drug injections providing the children with strategies of how to refuse offers of drugs
providing the children with strategies of how to refuse offers of drugs By fostering self-esteem and empowering children to stand up against drugs and providing them with strategies to avoid drugs when offered to them, parents and health care providers can make an impact on children's behavior and positively influence them to resist drugs when offered to them.
The nurse is meeting with a family that has learned that their 11-year-old child has some cognitive impairments. They tell the nurse that the child is having trouble coping with different situations at school. What is the best response by the nurse? "Just give your child some time; your child will learn to adjust." "Maybe it would be best if your child did not play with those kids at school." "Coping and adaptation are often affected by cognitive impairments." "Your child's impairment means it takes more time to learn to cope, you will need to give your child more time."
"Coping and adaptation are often affected by intellectual disabilities." The child is at increased risk for adjustment disorders because the child's coping strategies are not understood or recognized and his or her range of adaptive strategies may be reduced. Coping, adaptation, and social skills development are greatly dependent on abstract thinking and the ability to generalize from one situation to another. Abstract thinking is impaired in intellectual disability. Children who have intellectual disability are often uncomfortable with unfamiliar surroundings and people. Time is needed to build relationships.
The nurse is providing teaching about medication management of attention deficit hyperactivity disorder (ADHD). Which response indicates a need for further teaching? "We should give it to him after he eats breakfast." "If he takes this medicine he will no longer have ADHD." "We should see an improvement in his schoolwork." "This may cause him to have difficulty sleeping."
"If he takes this medicine he will no longer have ADHD." It is important to remind the parents that medications for the management of ADHD are not a cure but help to increase the child's ability to pay attention and decrease the level of impulsive behavior. The other statements are correct.
The nurse is providing teaching about the potential side effects of lithium for the parents of a girl recently diagnosed with bipolar disorder. Which statement by the parents indicates a need for additional teaching? "She may notice an increase in urination" "If she loses weight, then we know the medication is working." "She will probably tell us that she is hungrier than usual." "Tremors and nausea are common side effects."
"If she loses weight, then we know the medication is working." Weight gain, not weight loss, is a side effect of the drug. An increased appetite occurs with lithium. Lithium is associated with tremors and nausea. Polyuria occurs with lithium
The nursing educator has completed an educational program for new nurses on eating disorders in teenagers. Which statement by a participant would indicate a need for further education? "If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something." "Meal time should be structured but pleasant and relaxed without distractions." "We need to stay with them for at least 30 minutes after they eat so they don't try to vomit or dispose of the food." "We need to allow the client to participate in developing the treatment plan."
"If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something." Withdraw attention if the child refuses to eat: secondary gain is minimized if refusal to eat is ignored rather than with continuous attention. Mutually establish a contract related to treatment to promote the child's sense of control. Provide mealtime structure, as clear limits let the child know what the expectations are. Provide continuous supervision during the meal and for 30 minutes following it so that the child cannot conceal or dispose of food or induce vomiting.
A 10-year-old girl with ADHD has been on methylphenidate for 6 months. The girl's mother calls and tells the nurse that the medication is ineffective and requests an immediate increase in the child's dosage. What should the nurse say? "Let's set up an appointment as soon as possible." "Let me talk to the doctor about this." "What does the teacher say?" "Let's wait a few more weeks before we do anything."
"Let's set up an appointment as soon as possible." The nurse plays a vital role in administering medicines and observing and reporting responses. A face-to-face appointment with the family and the doctor or advance practice mental health nurse can help uncover client and parental factors that may be preventing success. Once it is established that the family is using the medication properly as well as instituting structure within the home, it can be determined if an increased dosage or alternate medicine would be appropriate. Deferring to the doctor will not elicit any information from the mother, and waiting will not address the current concerns. The teacher can only reveal partial information about the effectiveness of the medication, which can be reviewed once other factors have been addressed in a face-to-face visit with the family and client.
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." "Being this skinny really isn't a good idea for my health." "I realize I am a quite thin, but I am trying to gain weight."
"My stomach really sticks out and looks fat." 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.
During a wellness health check, a 10-year-old child reports not liking school because the child is getting picked on. The child's parents state wishing they knew what the child did to cause these children to bully the child. Which statement by the nurse is most therapeutic? "Some children are just more prone to being picked on." "The most important thing for your child to understand is that he or she is not to blame for the bullying." "Please explain any injuries that have resulted." "Please explain any injuries that have resulted." "This must be reported to the appropriate officials immediately."
"The most important thing for your child to understand is that he or she is not to blame for the bullying." Bullying is experienced by children during the school age periods of life. The child being bullied may have been picked due to a perceived difference between the and peers. These differences include size, religion, manner of dress, or a physical/cognitive delay or impairment. Being bullied is stressful and causes anxiety for the victim. It is most important that the nurse reinforce to the child and parents that this is not the child's fault and that the child is a victim. While it is important to determine the presence of injuries and to also report the events to the appropriate personnel, it is most important that the child and family be aware that the child is without blame.
A nurse in a residential foster home is caring for a 17-year-old girl with conduct disorder. The adolescent is using profanity and refusing to complete the assigned chores. The nurse reminds the adolescent that there are only five minutes in which to finish. The adolescent throws a dirty plate at the wall. Which response would be most appropriate? "You only have a few minutes to complete your chores." "You appear to be feeling very angry tonight, but you must still complete your chores." "If you calm down right now I will give you a few extra minutes to complete your chores." "I find your language offensive, and you need to stop talking that way."
"You appear to be feeling very angry tonight, but you must still complete your chores." The nurse's goal is to clearly and empathically explain the rules and firmly adhere to them. Telling the adolescent that there are only a few minutes to complete the chores does not exhibit empathy and is not therapeutic. Neither is the statement "I find your language offensive." This statement also does not address the rules. Letting the adolescent have a few extra minutes only reinforces the negative behavior and does not respect the rules of the facility.
