FINAL EXAM PEDI 2023/ PrepU CH28

A nurse in a primary care provider's office is performing a comprehensive assessment on a 16-year-old adolescent diagnosed with anorexia. Click to highlight the findings that will require follow up.

abdomen is concave hyperactive bowel sounds. Pulses are weak and thready temperature, 95.9°F (35.5°C); heart rate, 55 beats/min; blood pressure, 88/49 mm Hg body mass index (BMI) of 15.2 sodium, 149 mEq/l (149 mmol/l); potassium, 2.9 mEq/l (2.9 mmol/l); hemoglobin, 9 g/dl (90 g/l); hematocrit, 45% (0.45). Explanation: The abdomen should be flat, not concave. This is a common finding in an adolescent with anorexia.Hyperactive bowel sounds are an abnormal finding and should be assessed further.Weak, thready pulses are an abnormal finding and may indicate dehydration.A temperature of 95.9°F (35.5°C) is subnormal (normal: 97.7°F to 98.6°F; 36.5°C to 37.0°C).A heart rate of 55 beats/min indicates bradycardia, which is often seen in an adolescent with anorexia (normal: 60 to 79 beats/min). A blood pressure of 88/49 mm Hg indicates hypotension (normal: 112-128/66-80 mm Hg).A body mass index (BMI) of 15.2 indicates the adolescent is significantly underweight for their height and weight (normal: 18.5 to 24.9).A serum sodium of 149 mEq/l (149 mmol/l) may indicate dehydration (normal: 135 to 145 mEq/l [135 to 145 mmol/l]).A serum potassium of 2.9 mEq/l (2.9 mmol/l) is an abnormal finding and places the adolescent at high risk for developing a cardiac arrhythmia (normal: 3.5 to 5.2 mEq/l [3.5 to 5.2 mmol/l]).A hemoglobin of 9 g/dl (90 g/l) indicates anemia (normal: 11.1 to 15.7 g/dl [111 to 157 g/l]).

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 constantly opens and closes his hands. The child is highly active and inattentive. The child has a slight decrease in head circumference. The child has a long face and prominent jaw.

The child constantly opens and closes his hands.

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? "I realize I am a quite thin, but I am trying to gain weight." "My stomach really sticks out and looks fat." "Being this skinny really isn't a good idea for my health." "When I see myself in the mirror, I can see my ribs."

"My stomach really sticks out and looks fat." Explanation: A client with anorexia 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 nurse is speaking with an adolescent diagnosed with anorexia. The client states, "I do not get why everyone is so worried about what I eat. I just want to be skinny and my mom wants to control me." What response(s) by the nurse is appropriate? Select all that apply. "We are worried about what you eat because not eating can cause significant health issues including death." "You just need to eat all the food on your trays and we will leave you alone." "We are worried because you are not eating enough food to keep your body functioning like it should." "Your mom just loves you and wants you to be healthy." "I can see you are frustrated with your mom and you feel like she is controlling you. What does she do that makes you feel that way?"

"We are worried about what you eat because not eating can cause significant health issues including death." "We are worried because you are not eating enough food to keep your body functioning like it should." "I can see you are frustrated with your mom and you feel like she is controlling you. What does she do that makes you feel that way?"

The school nurse is assessing a 12-year-old client suspected of having bulimia. Which assessment finding would the nurse expect to see? Eroded dental enamel Thinning scalp hair Sparse body hair Dry skin

Eroded dental enamel Explanation: Bulimia is an eating disorder that causes the child to eat and then vomit purposely. Teens with this disorder may also use laxatives, diuretics, and purgative aids. These habits lead to severe erosion of the teeth because the teeth are constantly exposed to gastrointestinal juices

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 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. A child flips the light switch off and on until the caregiver asks her to stop and join the other children in playing.

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.

A child with attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate hydrochloride. Which adverse effect of this medication should the nurse discuss with the parents? appetite suppression sleepiness garbled speech

appetite suppression Explanation: An adverse effect of methylphenidate hydrochloride is appetite suppression. Sleepiness and garbled speech are not adverse effects of this medication. Children taking this medication can develop growth suppression, not accelerated growth in height.

The nurse is recording vital signs in the client diagnosed with complications of anorexia nervosa. Which finding(s) is consistent with the condition? Select all that apply. hyperthermia hypotension weak pulse hypertension hypothermia

hypotension weak pulse hypothermia Explanation: 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 hypotension, irregular and decreased pulse, or hypothermia.

A school nurse is working with a group of adolescents. Which assessment findings might prompt the nurse to screen for eating disorders? Select all that apply. weight fluctuation erosion of teeth menstrual irregularity absence of hunger frequent nurse visits

weight fluctuation erosion of teeth menstrual irregularity Explanation: Screening for eating disorders may be routine for a particular client population in some clinical settings or may be cued by clinical manifestations, such as weight fluctuation, teeth erosion, disruption of menstruation, chronic constipation, dehydration, gastric reflux, syncope, and others.

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? "Does your child have siblings?" "Does your child come and hug you or seek comfort from you?" "Do you have trouble keeping child care providers for your child?" "Does your child already attend therapies such as speech therapy?"

"Does your child come and hug you or seek comfort from you?" Explanation: Children with autism spectrum disorder lack communication and social skills. These children often will not seek comfort, make eye contact, or develop peer relationships. It is important during the health history for the nurse to focus on the findings the parents are presenting and not on extra information that may or may not be helpful.

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? "We need to allow the client to participate in developing the treatment plan." "Meal time should be structured but pleasant and relaxed without distractions." "If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something." "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 foo

"If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something." Explanation: Withdraw attention if the child refuses to eat: secondary gain is minimized if refusal to eat is ignored rather than with continuous attention

The mother of an 8-year-old boy is concerned that her son has attention deficit hyperactivity disorder. She describes the symptoms he demonstrates. Which behavior should the nurse recognize as an example of impulsiveness? Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission Inability to answer a question posed by his teacher because he was daydreaming Constantly fidgeting in his chair and shaking his foot Repeating words or phrases spoken by others

Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission

The parents of an 18-month-old toddler are concerned that their toddler no longer makes eye contact, does not respond to their smiles or other facial expressions, does not point to toys, and no longer speaks. They said that their toddler used to be able to say "mama" or "dada." The parents started noticing these changes in behavior 3 months ago. Which information can be provided to the parents? "There are many behaviors that can be thought of as signs of autism spectrum disorders, but only a health care provider can confirm the diagnosis." "Autism spectrum disorders are curable, so make sure to let your health care provider know about your concerns as soon as possible." "Once your toddler begins to speak, it will be easier to make a determination." "A toddler who is on the autism spectrum may have difficulty establi

There are many behaviors that can be thought of as signs of autism spectrum disorders, but only a health care provider can confirm the diagnosis." Explanation: The nurse will respond by providing current facts, which in this case is that only a health care provider can confirm a diagnosis of an autism spectrum disorder. Autism spectrum disorders are not diseases that are curable but a spectrum of disorders that affect cognitive, speech, and social interaction. Autism spectrum disorders range from mild to severe as do the behaviors. Autistic behaviors may be first noticed in infancy as developmental delays or between the age of 12 and 36 months when the toddler regresses or loses previously acquired skills. Although infants and toddlers on the autism spectrum may have difficulty establishing or maintaining eye contact, those who are not able to establish eye contact or have difficulties establishing eye contact need to be first tested for vision and hearing to rule out eye or hearing defects. It is inappropriate for the nurse to state, "when your toddler begins to speak, a determination is easier." The toddler was already speaking and stopped speaking 3 months before the visit to the health care provider

To feed lunch to a child with autism spectrum disorder (ASD), which action would be most important for the nurse to take? Allow the child to ask questions about the procedure. Use an authoritarian manner to gain control. Do not allow the child to see the spoon approach the mouth. Use a repetitive series of movements.

Use a repetitive series of movements.

The nurse in the well-child clinic observes that a 5-year-old child in the waiting room is having trouble using a crayon to color. During the visit, the same child climbs off the table several times even after the nurse has asked him to stay on the table. Each time the nurse reminds him he says, "Oh, yeah," and happily climbs back up. The nurse suspects that the child has: attention deficit hyperactive disorder (ADHD). autism spectrum disorder. failure to thrive. an addicted caregiver.

attention deficit hyperactive disorder (ADHD). Explanation: The child with ADHD may have these characteristics: Impulsiveness, easy distractibility, frequent fidgeting or squirming, difficulty sitting still, problems following through on instructions despite being able to understand them, inattentiveness when being spoken to, frequent losing of things, going from one uncompleted activity to another, difficulty taking turns, frequent excessive talking, and engaging in dangerous activities without considering the consequences.

The nurse is caring for a girl with anorexia who has been hospitalized with unstable vital signs and food refusal. The girl requires enteral nutrition. The nurse is alert for which complications that signal refeeding syndrome? cardiac arrhythmias, confusion, seizures orthostatic hypotension and hypothermia hypothermia and irregular pulse bradycardia with ectopy and seizures

cardiac arrhythmias, confusion, seizures Explanation: The nurse should be aware that rapid nutritional replacement in the severely malnourished can lead to refeeding syndrome. Refeeding syndrome is characterized by cardiovascular, hematologic, and neurologic complications such as cardiac arrhythmias, confusion, and seizures

A 17-year-old child has been admitted with complications of anorexia nervosa. What diagnostic tests can be anticipated in the plan of care/treatment? Select all that apply.

complete blood cell count metabolic panel Explanation: Anorexia nervosa is characterized by dramatic weight loss as a result of decreased food intake and sharply increased physical exercise. Complications of anorexia include fluid and electrolyte imbalance, decreased blood volume, cardiac arrhythmia, esophagitis, rupture of the esophagus or stomach, tooth loss, and menstrual problems. A metabolic panel would highlight alterations in electrolyte status. Electrolyte imbalances are also associated with cardiac arrhythmia. Reduced dietary intake may result in anemia. This will be noted in the hemoglobin level. An alteration in blood volume will be reflected in the hematocrit level.

A nurse is assessing a 5-year-old client and suspects that the child may have an autism spectrum disorder. Which assesment(s) supports the nurse's suspicions? Select all that apply. inability to make eye contact hypersensitivity to touch lack of facial expression distinct interest in others around them easily distracted from playing

inability to make eye contact hypersensitivity to touch lack of facial expression Explanation: Symptoms associated with autism spectrum disorder include deficits in nonverbal communicative behaviors (such as abnormalities in eye contact and lack of facial expression) and hyper- or hyposensitivity to sensory input such as touch. In addition, children may demonstrate stereotyped or repetitive motor movement, use of object, or speech.

A parent brings a child to the pediatric clinic, stating that the child was diagnosed with attention deficit hyperactivity disorder (ADHD). Which symptoms does the nurse anticipate finding with this child? inattention, impulsive, and hyperactivity hyperactivity, defiant, and disruptive excess motor activity, learning disability, and depression visual impairment, hyperactivity, oppositional defiant

inattention, impulsive, and hyperactivity Explanation: Attention deficit hyperactivity disorder (ADHD) is characterized by three major behaviors: inattention, impulsiveness, and hyperactivity