PN108 PrepU Chapter 42

The nurse is interviewing 13-year-old girl with depression. During the course of the interview, the girl reveals that her best friend is thinking about committing suicide. Which response by the nurse would be most appropriate?

"Do you know how she is planning to kill herself?"

An adolescent comes to the office of the school nurse and after being quiet for several minutes states, "I think the world will be better when I am gone." Which statement should be the nurse's first response to this adolescent?

"Have you made a plan to commit suicide?"

Which statement by an adolescent with anorexia nervosa would be most typical of an adolescent with this disorder?

"I feel chubby no matter what I wear."

The nurse is discussing substance abuse with an adolescent. Which of the following statements made by the adolescent should the nurse follow-up on first?

"I may drink too much on the weekends but I don't drink during the week."

After teaching the parents of a child with attention deficit/hyperactivity disorder about ways to control the child's behavior, the nurse determines a need for additional teaching when the parents state:

"If he misbehaves, we need to punish him instead of reward him."

The nurse is teaching the mother of a 12-year-old boy about the risk factors associated with drug and alcohol abuse. Which response by the mother indicates a need for further teaching?

"Just because his friends are experimenting does not mean that he will."

A 10-year-old girl with ADHD has been on Ritalin (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."

A 15-year-old girl has been evaluated and diagnosed with major depression. The advance practice mental health nurse has prescribed paroxetine (Paxil), a selective serotonin reuptake inhibitor. The mother of the girl refuses to let her take the medicine because she has read about several suicides of teenagers who have been on this medicine. What should the nurse say to address the mother's concerns?

"Let's sit down and talk about your concerns."

The nurse is caring for a child with attention deficit/hyperactivity disorder who is experiencing insomnia related to the prescribed psychostimulant. The parents are considering stopping the medication and want to know if there are other options. Which response by the nurse would be most appropriate?

"Speak to the doctor about atomoxetine."

While interviewing a depressed adolescent boy, he reveals to the nurse that he has considered hurting himself. What should the nurse ask him?

"Tell me exactly how you would hurt yourself."

An 11-year-old boy has recently been prescribed methylphenidate (Ritalin). The mother calls the pediatrician's office to speak with the advanced practice pediatric nurse practitioner. This mother has been extremely resistant to medication and insists that the medication is not working. How should the nurse respond?

"Tell me what makes you think the medication is not working"

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?

0.5 to 1 lb (0.27 to 0.45 kg)

Which behavior demonstrated by a boy with ADHD is most indicative of the syndrome?

A lack of concentration

A 6-year-old is seen in a mental health clinic for possible hyperactivity. His mother reports that he is just "all boy." He has always been active and does not like to sit still for more than a minute. Which data would be most important to assess to help evaluate his behavior?

A review of the boy's typical day

Susan's parents have begun a program of therapy that includes giving Susan a token each time she follows directions. The following theoretical framework provides the background for such a program:

Behavioral theory

A nurse is assessing a child with suspected drug use. Which characteristics are related to an increased risk of substance use? Select all that apply.

Being a member of a family that has had another member who uses drugs Being a member of an abusive family Having behavioral problems Being a slow learner

What would lead the nurse to suspect that an adolescent has bulimia?

Calluses on back of knuckles

An 11-year-old boy 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.

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?

Encourage her to discuss her thoughts and feelings.

A 10-year-old girl has been referred for evaluation due to difficulties integrating with her peers at her new school. The counselor believes she is at risk for situational low self-esteem due to problematic relationships with both family members and peers. What is the best approach?

Engage the girl in dialogue regarding feelings about self/personal appearance.

The nurse is caring for an adolescent girl with anorexia nervosa. What findings would indicate to the nurse that the girl requires hospitalization?

Food refusal

Samuel is a 6-year-old boy who has been diagnosed with autism. Which of the following symptoms would you expect Samuel to display?

He spends time alone and shows little interest in making friends.

The nurse is caring for a 12-month-old with autism spectrum disorder (ASD). What description would you expect to elicit from his mother on history-taking?

He stares at a rotating wheel on his crib mobile.

Which behavior typical of children with autism spectrum disorder (ASD) requires you to maintain special care to keep them safe?

Insensitivity to pain

The nurse is caring for a 10-year-old recently diagnosed with attention deficit/hyperactivity disorder (ADHD). The nurse would expect to provide teaching regarding which medication?

Methylphenidate

A 6-month-old infant presents at the pediatric clinic with his/her mother. The child is very thin, less than 5% on the growth chart, irritable, listless, unresponsive to the nurse, and has poor muscle control. The child has no history of serious illness. When the infant begins to cry, the mother is very slow to respond and the child is not comforted by the mother. The nurse is concerned about the infant, because these are signs of:

Nonorganic failure to thrive

When teaching parents of a child with encopresis, what would you stress?

Not punishing the child for encopresis

The nursing instructor is teaching a group of pediatric nursing students about the stages of substance abuse in children. Which of the following behaviors is associated with Stage 3 - Preoccupation with the mood swing?

Promises to quit or attempts to quit

The nurse is talking with the parents of a child diagnosed with autism. Together, they set specific goals of care for the child. Which goals may be included? Select all that apply.

Promotion of normal development Learning Social interaction Specific language development

The nurse is obtaining the history of an adolescent female who is suspected of having anorexia nervosa. What findings would the nurse expect? Select all that apply.

Syncope Secondary amenorrhea Desire for perfectionism

An advance practice mental health nurse is preparing for an individual therapy session with a 14-year-old boy who has normal cognitive abilities but is suffering from depression. Which of the following approaches is most likely to engage the boy and establish a therapeutic alliance?

Talk therapy with the nurse

To feed lunch to a child with autism spectrum disorder (ASD), which action would it be most important for the nurse to take?

Use a repetitive series of movements.

The nursing instructor is teaching a group of pediatric nursing students about the stages of substance abuse in children. Which of the following behaviors is associated with Stage 2 - Seeking the mood swing?

Uses to get high Takes pride in the amount of the substance consumed Uses to relieve feelings Denies that they have a problem

A nurse is conducting a mental status examination with a 5-year-old boy who is playing with trains and blocks of different colors. He repeats the same actions with the trains over and over again throughout the examination. Which of the following questions would be most appropriate?

Why does that red train keep crashing into all of the other trains?

The therapy you would expect to see prescribed for an adolescent with anorexia nervosa would be:

counseling to improve feelings of control over her body.

The nurse is educating parents of a child recently diagnosed with autism. A description of the characteristics of autism are explained within categories. The nurse becomes concerned when the mother states that the categories of autism are associated with:

inability to properly synthesize glucose.

Rumination disorder is a poorly understood condition of young children. This refers to:

rechewing undigested food.

A nurse is assessing an adolescent female who is suspected of having an eating disorder. When obtaining the history from the adolescent, which of the following would the nurse identify as a possible risk factor? Select all that apply.

Entangled relationships with family members Poor communication with parents Perfectionist personality Satisfaction with appearance Intake of regular meals

An adolescent is being observed for ADHD. Which of the following would demonstrate that she suffers from that disorder?

Forgets to turn in her homework, does not follow directions, cannot stay in her assigned seat in class and is always talking excessively and inappropriately.

The nurse does a weight measurement on an adolescent girl whose ideal weigh is 135 pounds according to the expected weight for her age and height. The adolescent is found to weigh exactly the lowest weight that would indicate to the nurse that this adolescent fits the criteria for obesity. Which of the following amounts does the girl weigh?

162 pounds

The school health nurse is educating a group of teachers regarding anorexia nervosa. The discussion includes which of the following as possible indicators of the illness? Select all that apply.

Tends to be a perfectionist May demonstrate signs of depression Adheres to a rigorous exercise program Has rigid study habits

The nurse is discussing the treatment for a child with attention deficit hyperactivity disorder (ADHD) with a group of school nurses. What would be an appropriate learning setting for a child with ADHD?

A classroom with a plan of study that is followed each day.

A child with ADHD is placed on methylphenidate (Ritalin) therapy. What symptom may children on Ritalin develop?

Anorexia

Steve, a 15-year-old Vietnamese boy, has been referred by his homeroom teacher to the school nurse for evaluation. The teacher is concerned that Steve may be suffering from major depression. Who should be the primary source of information to investigate the concerns about Steve?

Steve

In collecting data on a 7-year-old-child with a possible diagnosis of school phobia, the nurse directs questions related to the following topics. Which of the following would most likely be a cause of the child having school phobia?

The child may have a fear of being separated from her mother.

The nurse is working with a child diagnosed with encopresis. After a complete medical workup has been done, no organic cause has been found for the disorder. The nurse will anticipate the child will next be:

referred for counseling.

A mother is telling the school nurse about her concerns regarding her 13-year-old daughter, who is experiencing headaches. Her grades have dropped, and she is sleeping late and going to bed early every night. The nurse advises the mother that the first priority should be to:

schedule an immediate history and physical examination.

The nurse is discussing teenage substance abuse with a group of caregivers of adolescent children. If the caregivers make the following statements, which statement is the most accurate regarding substance abuse in teens?

"The most common drug used by teenagers is alcohol."

The nurse does a weight measurement on an adolescent girl who should weigh 120 pounds according to the expected weight for her age and height. The adolescent is found to weigh exactly the weight that would indicate to the nurse that this adolescent fits the criteria for anorexia nervosa. Which of the following amounts does the girl weigh?

102 pounds

You have been working with an adolescent with an eating disorder for several days. What is an indication that she is developing trust in you?

Her telling you that she is still inducing vomiting after each meal

A nurse is preparing a teaching session for a group of parents with children newly diagnosed with attention deficit/hyperactivity disorder (ADHD). When explaining this disorder to the parents, what would the nurse include as being involved? Select all that apply.

Impulsivity Inattention Distractibility Hyperactivity

The characteristics of the child with autism fall into three categories. What are these three categories?

Inability to relate to others Inability to communicate with others Obviously limited activities and interests.

A 10-year-old girl has been visiting the school nurse three to four times a week with somatic complaints of a stomachache. She spends a few minutes in the nurse's office and then returns to class. This has been an ongoing complaint for almost two weeks. Which action by the nurse would be most appropriate?

Keep a log of the child's visits and contact the parents if the visits continue

A school-age child diagnosed with depression is receiving antidepressant therapy. What behavior would the nurse instruct the parents to watch for and to notify the physician immediately if the child demonstrates it?

Loss of interest

The child diagnosed with autism spectrum disorder (ASD) will likely display which behavior?

Repetitive actions

The nurse is performing the physical examination of a child with bulimia. What findings would the nurse identify as supporting this disorder? Select all that apply.

Split fingernails Eroded dental enamel

A 14-year-old is admitted to the hospital for the second time for treatment of anorexia nervosa. Her responses to your questions on admission are either yes, no, or no response. Initially, your primary nursing goal in caring for this adolescent would be to:

develop rapport for a trusting relationship.