PEDs: Chapter 50

A nursing student is learning about developmental disorders. The nursing instructor realizes that further instruction is necessary when the student makes which statement? "Families should not be blamed for causing a developmental delay." "Families should work to facilitate the child's progress." "A definitive cause can be found for every developmental disorder." "Families should be helped to accept the child's developmental delay."

"A definitive cause can be found for every developmental disorder." Explanation: For most developmental disorders, causes cannot be identified. Families should not be blamed for causing developmental problems. After a thorough work-up and no identifiable cause is determined, the family should be helped to come to terms with the diagnosis. They should be helped to accept a child's delays and should work to facilitate the child's progress as the child grows and develops at his/her own pace and abilities.

The nurse is providing teaching about medication management of attention deficit hyperactivity disorder (ADHD). Which response indicates a need for further teaching? "This may cause him to have difficulty sleeping." "We should see an improvement in his schoolwork." "If he takes this medicine he will no longer have ADHD." "We should give it to him after he eats breakfast."

"If he takes this medicine he will no longer have ADHD." Explanation: 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.

A 2-year-old child has been diagnosed with autism spectrum disorder. The parents ask the nurse for a treatment that will cure the disorder. Which is the best response by the nurse? "There are no medications available to cure autism spectrum disorder." "When your child is older, you can try nutrition supplements for a cure." "Your child can be put on a strict diet to guarantee that the medication works." "Sometimes hiring a professional to give your child music therapy can cure this."

"There are no medications available to cure autism spectrum disorder." Explanation: Autism spectrum disorder or pervasive developmental disorder is marked by severe language deficits, a deficit in perceptual and motor development, and inabilities to function in social settings and to master reality testing. The basic cause is unknown; therefore, there is no known cure. Interventions such as behavior modification therapy and lots of support are currently being used

The nurse is completing the physical assessment of a 12-year-old child who has a series of bruises in various stages of healing. When asked about the bruises, the child appears frightened and offers inconsistent accounts about how they got the bruises. The nurse suspects abuse. Which initial action by the nurse is appropriate? Ask the child to provide a written statement of how they got the bruises. Take photographs of the bruises. Document the bruises and any statements made by the child relating to them. Interview the child's parents about the origin of the bruises.

Document the bruises and any statements made by the child relating to them. Explanation: Nurses in each state have a legal requirement to report suspicions of child abuse or maltreatment. The nurse must document all findings. The medical record will be of importance in establishing the findings. Once the findings are documented, the nurse will need to closely follow the agency policies regarding the reporting process. The nursing supervisor will need to also be involved but that will take place after the documentation has been completed. The child cannot be photographed without appropriate approvals. The child may be asked to provide a more detailed report of the bruising, but it is not the role of the nurse to request it. The child's parents will also become a part of the investigation, but the interviewing process does not come before the documentation of the findings.

When reviewing the medical record of a child, what would the nurse interpret as the most sensitive indicator of intellectual disability? History of seizures Vision deficit Language delay Preterm birth

Language delay Explanation: Due to the extent of cognition required to understand and produce speech, the most sensitive early indicator of intellectual disability is delayed language development. A history of seizures, preterm birth, and vision deficit may be associated with intellectual disability but are not the most sensitive indicators.

The nurse is collecting data on an 18-month-old child with a diagnosis of autism spectrum disorder (ASD). What clinical manifestation would likely have been noted in the child with this diagnosis? The child smiles when the caregiver shows her a stuffed animal. The child sits quietly in the caregiver's lap during the interview. The child does not make eye contact. The child cries and runs to the door when the caregiver leaves the room.

The child does not make eye contact. Explanation: Children with ASD often display hyperactivity, aggression, temper tantrums, or self-injury behaviors like head banging or hand-biting. They may resist cuddling, lack eye contact, be indifferent to touch or affection, and have little change in facial expression. They do not develop a smiling response to others nor an interest in being touched or cuddled. In fact, they can react violently to attempts to hold them. They do not show the normal fear of separation from parents that most toddlers exhibit. Often they seem not to notice when family caregivers are present.

The parents of a 9-year-old child tell the nurse, "We are so frustrated with our child. We do not know what to do. Our child makes careless mistakes on tests and homework despite being intelligent, is very disorganized, and never follows through with chores at home." The nurse anticipates this child may have which disorder? obsessive-compulsive disorder bipolar disorder antisocial personality disorder attention deficit disorder

attention deficit disorder Explanation: Based on the reported signs and symptoms, attention deficit disorder is likely. Bipolar, obsessive-compulsive, and antisocial personality disorder manifestations are not reported.

A 7-year-old child is diagnosed with a learning disability involving reading, writing, and spelling. The nurse identifies this as: dyspraxia. dyslexia. dysgraphia. dyscalculia.

dyslexia. Explanation: Dyslexia is a learning disability that involves reading, writing, and spelling. Dyscalculia is a learning disability that involves mathematics and computation. Dyspraxia is a learning disability that involves problems with manual dexterity and coordination. Dysgraphia is a learning disability that involves problems producing the written word.

The nurse is caring for a child who has been hospitalized repeatedly at multiple hospitals. There is no clear medical diagnosis and the parent is threatening to leave the hospital against medical advice. The nurse suspects what issue? bipolar disorder sexual abuse medical child abuse (formerly Munchausen syndrome by proxy) anxiety disorder

medical child abuse (formerly Munchausen syndrome by proxy) Explanation: Repeated hospitalizations that fail to produce a medical diagnosis, transfers to other hospitals, and discharges against medical advice are warning signs of medical child abuse (formerly Munchausen syndrome by proxy).

The nurse is performing a physical assessment of 16-year-old girl who is intellectually disabled. This client attended her local public elementary school through fifth grade and has since been enrolled at a special education school where she has received social and vocational training. She plans on getting a job in the coming month and on living independently in a few years. The nurse recognizes this client's level of intellectual disability as: mild. severe. profound. moderate.

mild. Explanation: Children with mild intellectual disability exhibit difficulties in acquisition of academic skills and are typically more concrete in their problem solving. Socially, they are observed as less mature, have a limited understanding of risk, and demonstrate poorer affect regulation than similarly aged peers. As adults, they can usually achieve adequate social and vocational skills for minimum self-support and independent living but need guidance and assistance with complex daily living tasks. During early years, these children learn social and communication skills and are often not too distinguishable from average infants or toddlers. They continue to learn academic skills up to about a sixth-grade level. As adults, they can usually achieve social and vocational skills adequate for minimum self-support. They're able to live independently but need guidance and assistance when faced with new situations or unusual stress.