PrepU Query Quiz: Development

At the admission interview, the father of a 4-year-old boy with attention deficit hyperactivity disorder (ADHD) says to the nurse, "I know that my wife or I must have caused this disease." What is the nurse's best response? a) "Many parents feel this way, but I doubt there is anything that you did that caused ADHD to develop in your child." b) "ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder." c) "Let us not focus on the cause but rather on what needs to be done to help your son get better. I know that you and your wife are very interested in helping him to improve his behavior." d) "What do you think you might have done that could have led to causing this disorder to develop in your son?"

"ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder." Stating that attention deficit hyperactivity disorder occurs more commonly in families takes the opportunity for teaching while also helping the father realize that he and his wife are not to blame. Parents who are commonly blamed by society for their child's behavior need help with education. Questioning the father on what he thinks he may have done implies that the parents played some role in this disorder, possibly contributing to the father's guilt. Telling the father that many parents feel this way and that the nurse does not think the parents are at fault is premature at this point. Telling the father that he should focus on what needs to be done, rather than what caused the disorder, minimizes the father's concerns and feelings.

During a developmental screening, the nurse finds that a 3-year-old child with cerebral palsy has arrested social and language development. The nurse tells the family: a) "We need to modify your therapy plan." b) "I need to refer you for more developmental testing." c) "This is a sign the cerebral palsy is progressing." d) "Your child has reached his maximum language abilities."

"I need to refer you for more developmental testing." It is important to identify primary developmental delays in children with cerebral palsy and to prevent secondary and tertiary delays. The arrested development is worrisome and requires further investigation. It is possible the lack of development indicates hearing loss or may be a sign of autism. The brain damage caused by cerebral palsy is not progressive. The brain of a young child is quite plastic; assuming the child's development has peaked at age 3 would be a serious mistake. The therapy plan will need to be modified, but a better understanding of the underlying problem will lead to the greatest chance of creating a successful therapy plan.

The parent asks the nurse whether a child with hemiparesis due to spastic cerebral palsy will be able to walk normally because he can pull himself to a standing position. Which response by the nurse would be most appropriate? a) "If he really wants to walk, and works hard, he probably will eventually." b) "Being able to pull to a stand really only tells us his upper-body strength is good." c) "It is difficult to predict, but his ability to bear weight is a positive factor." d) "Ask the health care provider what he thinks at your next appointment."

"It is difficult to predict, but his ability to bear weight is a positive factor." The nurse needs to respond honestly to the mother. Most children with hemiparesis due to spastic cerebral palsy are able to walk because the motor deficit is usually greater in the upper extremity. There is no need to refer the mother to the HCP. Pulling to a stand requires both upper body and lower body strength. The will to walk is important, but without neurologic stability the child may be unable to do so.

A mother brings her child into the clinic for follow up after beginning treatment for Attention Deficit Hyperactivity Disorder (ADHD). One of the outcomes was for the child to complete homework within a one hour time interval. The mother reports that it still takes 1 1/2 hours but that is dramatically reduced from the 3 hours or more before beginning treatment. What is the best response for the nurse to make to the child? a) "You will have to do better next time" b) "Mom, can you sit with him to make sure he meets the outcome?" c) "You have done a great job by focusing on your homework and doing it in much less time. Do you think by your next visit that you can get it down to an hour?" d) "That's okay. I will just change the plan of care"

"You have done a great job by focusing on your homework and doing it in much less time. Do you think by your next visit that you can get it down to an hour?" "You have done a great job by focusing on your homework and doing it in much less time. Do you think by your next visit that you can get it down to an hour?" is a response that acknowledges that the client has not met the set outcomes but encouragement that they have made great improvement. The other responses could discourage the child towards meeting the outcome.

A nurse is caring for children in a children's hospital. Which child would the nurse expect to develop separation anxiety? a) A preschooler who is on an isolation ward b) A school-aged child who has low self- esteem c) An infant who was abandoned by his parents d) A newly hospitalized toddler

A newly hospitalized toddler A newly hospitalized toddler would be most prone to develop separation anxiety.

The parent of a child with spastic cerebral palsy and a communication disorder tells the nurse, "He seems so restless. I think he is in pain." Which action is most indicated? a) Assess the child for pain using the Faces, Legs, Activity, Cry, Consolability (FLACC) scale. b) Assess the child using the pediatric FACES scale. c) Notify the health care provider (HCP) of the change in behavior. d) Administer prescribed pain medication.

Administer prescribed pain medication. The parent is the child's HCP and may be very in tune to subtle changes in the child's behavior. If the parent thinks the child is in pain, it is very likely to be so. The nurse should administer the pain medication and evaluate if the medication affected the child's behavior. The FLACC scale may be difficult to interpret when the child has spasticity. The FACES scale requires self-report which may not be possible in a child with a communication disorder. The HCP should be contacted regarding the change in behavior only if other available interventions are unsuccessful.

A child with spastic cerebral palsy receiving intrathecal baclofen therapy is admitted to the pediatric floor with vomiting and dehydration. The family tells the nurse that they were scheduled to refill the baclofen pump today, but had to cancel the appointment when the child became ill. The nurse should: a) instruct caregivers to call for a refill when the low-volume alarm sounds. b) arrange for the pump to be refilled in the hospital. c) reschedule the pump refill for the day of discharge. d) explain that the medication should be discontinued during illness.

Arrange for the pump to be refilled in the hospital. To prevent a baclofen withdraw, pump refills are scheduled several days before anticipated low-volume alarms. The nurse should make it a high priority to have the pump refilled as soon as possible. Discontinuing baclofen suddenly can result in a high fever, muscle rigidity, change in level of consciousness, and even death. Waiting until the child leaves the hospital for a refill may lead to a low dose or withdraw. Waiting for the low-volume alarm puts the client at risk because medication and team members who can refill the pump may not be readily available under all circumstances.

The parent of a 10-year-old child with attention deficit hyperactivity disorder (ADHD) says her spouse won't allow their child to take more than 5 mg of methylphenidate every morning. The child isn't doing better in school. Which recommendation would the nurse make to the mother? a) Ask the school nurse to give the child the rest of the medication. b) Bring the child's parent to the clinic to discuss the medication. c) Put the child in charge of administering the medication. d) Sneak the medication to the child anyway.

Bring the child's parent to the clinic to discuss the medication. Bringing the parent to the clinic for an educational session about the medication should assist him in understanding why it's necessary for the child to receive the full dose. The parent should be included in the treatment as much as possible. A nurse shouldn't advise dishonesty to a client or family. Putting a 10-year-old in charge of medication is inappropriate. School nurses can only administer medications as per health care provider prescriptions.

Spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy are all examples of which type of disability? a) Age-related b) Acquired c) Developmental d) Acute nontraumatic disorder

Developmental Examples of developmental disabilities are spina bifida, cerebral palsy, and Down syndrome. An example of an acquired disability is a traumatic brain injury. An age-related disability is hearing loss or osteoporosis. An acute nontraumatic disorder is a stroke.

A 5-month-old infant is brought to the clinic by his parents because he "cries too much" and "vomits a lot." The infant's birth weight was 6 lb, 10 oz (3,000 g), and his current weight is 7 lb, 4 oz (3,289 g), falling below the 5th percentile on a standard growth chart. Which data should the nurse identify as the priority? a) feeding pattern b) frequency of regular checkups c) pattern of weight gain d) family dynamics

Feeding pattern Because the infant falls below the 5th percentile on a standard growth chart, the nurse should consider failure to thrive, a term applied to an infant who is not growing at an acceptable rate. Information about feeding patterns, including types and amounts of food, is needed to determine the cause of failure to thrive. If a child does not receive sufficient calories, growth slows. Whether or not the infant has received regular checkups is important but not the priority because that information alone does not provide evidence or substantiation about the infant's growth patterns. The infant's pattern of weight gain is important but not the priority. Rather, the infant's pattern of weight gain provides valuable and useful information over a period of time. Information about family dynamics is important to provide data about family stresses that may affect or help explain the infant's failure to thrive. However, it is not the priority. This information needs to be viewed in conjunction with the infant's feeding patterns to gain a complete picture.

Which information obtained during a health history is most consistent with the diagnosis of failure to thrive in an infant? a) needing to be awakened for feedings b) fear of strangers c) being quiet when held d) fussiness during feedings

Fussiness during feedings Infants who have failure to thrive are typically fussy during feedings. This fussiness may be related to the caretaker not recognizing cues about what the infant needs or wants. Typically infants with failure to thrive are unafraid of strangers. Although they protest being put down, infants with failure to thrive are typically not content while being held because they are not used to it. Infants with failure to thrive typically have difficulty sleeping for any length of time. They often awaken because they are hungry.

A parent of a 7-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) since he was 5 years old is talking to the nurse about her concerns about the son's physical condition. The parent states that his medication, methylphenidate extended release, controls his symptoms well but is causing him to lose weight. It is difficult to get him up and ready for school in the morning unless he is given the medication as soon as he awakens. He does not eat breakfast or very much of his lunch at school; he eats dinner, but only an average amount of food. He has lost 3 lb (1.4 kg) in the last 2 weeks. Which action should the nurse suggest the parent do first? a) Suggest a change of medication to a nonstimulant drug that will treat ADHD without causing the appetite decrease. b) Have the child eat a breakfast bar, banana, and a glass of milk at the same time he takes medication every morning. c) Suggest that the parent supplement the child's dinner with a high-protein drink or other food that will increase his caloric intake. d) Monitor the child's weight closely for 1 month since he is likely to stop losing weight when the school year ends in 2 weeks.

Have the child eat a breakfast bar, banana, and a glass of milk at the same time he takes medication every morning. Because weight loss is a common side effect of methylphenidate and because the child's symptoms are controlled with the stimulant, the first action should be to increase the child's oral intake before the medication's side effects begin. Weight should be monitored, but since the child has already lost weight, a remedy is needed as well as monitoring. The weight loss is directly due to the medication's side effects, so the child will continue to lose weight unless an intervention is made whether or not he is enrolled in school or on summer vacation. A high-protein drink could work, but then the child is taking in all his calories in the evening, which is not best nutritionally. A change of medication should be the last resort since methylphenidate is the most effective medication for ADHD and has been successful with this child.

An elderly male patient was admitted to the geriatric medical unit of the hospital with a diagnosis of failure to thrive and has not walked for several weeks. What exercise routine should the nurse teach the patient in order to prepare him for walking? a) Have the patient lift 2-pound sand bags with his legs while in a supine position. b) Have the patient tighten and relax his thigh muscles several times in succession. c) Place the patient prone and ask him to flex and extend his lower leg repeatedly. d) Teach the patient to perform rapid ankle flexion and extension while he is in a chair.

Have the patient tighten and relax his thigh muscles several times in succession. Quadriceps drills are an isometric exercise in which the patient repeatedly tightens and relaxes his or her thigh muscle in order to strengthen the leg muscles for future walking. Ankle and leg flexion (isotonic exercise) are less useful for restoring leg strength and weights (isokinetic exercise) are not normally used.

The nurse is assessing the muscle tone of a patient with cerebral palsy. Which of the following descriptions does the nurse determine to be an expected assessment of this patient's muscle tone? a) Hypertonic b) Atrophied c) Atonic d) Flaccid

Hypertonic In patients with conditions characterized by upper motor neuron destruction, such as in cerebral palsy, the muscles are often hypertonic. However, in conditions with lower motor neuron destruction, the muscles become atonic and/or atrophied and/or flaccid.

An 8-year-old child with severe cerebral palsy is underweight and undersized for his age. He is being fed a diet of pureed foods and liquids through a syringe. The nurse determine's his biggest nutritional risk factor is: a) inability to metabolize fats. b) increased metabolism. c) impaired oral motor control. d) impaired absorption.

Impaired oral motor control. A child with severe cerebral palsy commonly has a lack of oral motor control that interferes with tongue control, chewing, and swallowing. This is the reason that this child is being fed pureed foods and fluids. Lack of tongue control commonly causes the child to push the food back out of the mouth while trying to chew and swallow. A child with cerebral palsy has a nonprogressive central nervous system insult. Cerebral palsy does not affect the child's metabolism. This child should be able to absorb and metabolize ingested nutrients. Cerebral palsy does not affect the child's metabolism of fats. Cerebral palsy may affect elimination but does not significantly alter absorption.

The nurse assesses the family's ability to cope with the child's cerebral palsy. Which action should alert the nurse to the possibility of their inability to cope with the disease? a) requesting teaching about cerebral palsy in general b) learning measures to meet the child's physical needs c) limiting interaction with extended family and friends d) seeking advice on coping on social media

Limiting interaction with extended family and friends Limited interaction or lack of interaction with friends and family may lead the nurse to suspect a possible problem with the family's ability to cope with others' reactions and responses to a child with cerebral palsy. Learning measures to meet the child's physical needs demonstrates some understanding and acceptance of the disease. Requesting teaching about the disease suggests curiosity or a desire for understanding, thus demonstrating that the family is dealing with the situation. Participating in social media may serve as a form of support and can be a healthy coping mechanism.

An infant is hospitalized for treatment of inorganic failure to thrive. Which nursing action is most appropriate for this child? a) Rotating caregivers to provide more stimulation b) Encouraging the infant to hold a bottle c) Keeping the infant on bed rest to conserve energy d) Maintaining a consistent, structured environment

Maintaining a consistent, structured environment The nurse caring for an infant with inorganic failure to thrive should strive to maintain a consistent, structured environment because it reinforces a caring feeding environment. Encouraging the infant to hold a bottle would reinforce an uncaring feeding environment. The infant should receive social stimulation rather than be confined to bed rest. The number of caregivers should be minimized to promote consistency of care.

A 6-year-old client is diagnosed with attention deficit hyperactivity disorder (ADHD). When asking this client to complete a task, what techniques should the nurse use to communicate most effectively with him? a) Obtain eye contact before speaking, use simple language, and have him repeat what was said. Praise him if he completes the task. b) Explain to the client what he is to do, the consequences if he does not comply, and follow through with praise or consequences as appropriate. c) Fully explain to the client the actions required of him, and offer verbal praise and a food reward for task completion. d) Demonstrate to the client what he is to do, have him imitate the nurse's actions, and give a food reward if he completes the task.

Obtain eye contact before speaking, use simple language, and have him repeat what was said. Praise him if he completes the task. Because the client with ADHD is easily distractible, it is important to obtain eye contact before explaining the task. Simple language and having him repeat what he is told are necessary because of his age. Praise encourages the client to repeat the task in the future as well as building the client's self-esteem. A full explanation with verbal praise and a food reward is inappropriate because a food reward increases the chance that he will expect a physical reward for completing tasks. In addition, a full explanation might be too confusing for someone his age. Explaining consequences focuses on punishment, rather than praise. Although demonstration and imitation is an effective teaching method, rewarding with food fosters dependence on food reward for task completion.

A nurse is caring for a school-age child with cerebral palsy. The child has difficulty eating using regular utensils and requires a lot of assistance. Which referral is most appropriate? a) Registered dietitian b) Physical therapist c) Occupational therapist d) Nursing assistant

Occupational therapist An occupational therapist helps physically disabled clients adapt to physical limitations and is most qualified to help a child with cerebral palsy eat and perform other activities of daily living. A registered dietitian manages and plans for the nutritional needs of children with cerebral palsy but isn't trained in modifying or fitting utensils with assistive devices. A physical therapist is trained to help a child with cerebral palsy gain function and prevent further disability but not to assist the child in performing activities of daily living. A nursing assistant can help a child eat; however, the nursing assistant isn't trained in modifying utensils.

The nurse is caring for a hospitalized toddler who is having a temper tantrum. What is the most realistic approach for the nurse to use to manage the child's temper tantrum? a) Display anger at the child during the tantrum. b) Punish the child after the tantrum. c) Offer material or emotional bribes. d) Offer disapproval and then ignore the tantrum.

Offer disapproval and then ignore the tantrum. Stating one's disapproval and then ignoring the tantrum generally results in a quick resolution of the tantrum. Offering material or emotional bribes may actually increase the frequency of tantrums. Punishing the child does not decrease the frequency of tantrums because the tantrums are generated by an inability to express their feelings. Mirroring the tantrum behavior reinforces that style of communication.

When observing the mother feed her infant diagnosed with failure to thrive, which maternal behavior should cause the nurse to intervene? a) maintaining eye contact with the infant b) sitting on the floor to feed the infant c) talking to the infant during the feeding d) placing the infant in the crib for the feeding

Placing the infant in the crib for the feeding Engagement with an infant is achieved through physical contact, eye contact, and voice contact during feeding. Most important of these is physical contact with the person feeding the infant. Holding the infant in a relaxed manner that provides the most physical contact is important. Thus, placing the infant in the crib for feeding should be a concern because of the lack of physical contact with the infant. Maintaining eye contact with the infant and talking to the infant during feeding promote engagement. The locale of feeding is unimportant as long as the infant's need for contact is met.

An emergency department nurse suspects neglect in a 3-year-old boy admitted for failure to thrive. Signs of neglect in the child would include: a) loud crying and screaming. b) pulling hair and hitting. c) poor hygiene and weight loss. d) slapping, kicking, and punching others.

Poor hygiene and weight loss. Signs of neglect include poor hygiene and weight loss because neglect can involve failure to provide food, bed, shelter, health care, or hygiene. Slapping, kicking, pulling hair, hitting, and punching are examples of forms of physical abuse, not neglect. Loud crying and screaming are normal findings in a 3-year-old boy.

The nurse formulates a plan of care to address negative feeding patterns for a 5-month-old infant diagnosed with failure to thrive. To meet the short-term outcomes of the infant's plan of care, the nurse should expect to implement which intervention? a) Give the infant high-calorie formula. b) Instruct the parents in proper feeding techniques. c) Provide consistent staff to care for the infant. d) Allow the infant to sit in a high chair during feedings.

Provide consistent staff to care for the infant. In the short-term care of this infant, it is important that the same person feed the infant at each meal and that this person be able to assess for negative feeding patterns and replace them with positive patterns. Once the infant is gaining weight and shows progress in the feeding patterns, the parents can be instructed in proper feeding techniques. This is a long-term outcome of nursing care. Because there is no organic reason for the failure to thrive, it should not be necessary to increase the formula calorie content. A 5-month-old infant is too young to be expected to sit in a high chair for feedings and should still be bottle-fed.

When collaborating with the health care provider (HCP) to develop a plan of care for a child diagnosed with attention deficit hyperactivity disorder (ADHD), the treatment plan will likely include which treatments? a) antidepressant medications, such as imipramine, and family therapy b) antianxiety medications, such as buspirone, and home schooling c) anticonvulsant medications, such as carbamazepine, and monthly blood levels d) psychostimulant medications, such as methylphenidate, and behavior modification

Psychostimulant medications, such as methylphenidate, and behavior modification ADHD is typically managed by psychostimulant medications, such as methylphenidate and pemoline, along with behavior modification. Antianxiety medications, such as buspirone, are not appropriate for treating ADHD. Homeschooling commonly is not a possibility because both parents work outside the home. Antidepressants, such as imipramine, are indicated for major depressive disorders and must be used with extreme caution in children because they carry the risk of suicidal thinking. Family therapy may be a part of the treatment. Anticonvulsant medications, such as carbamazepine, are not appropriate for ADHD. Also, carbamazepine levels are obtained weekly early during therapy to avoid toxicity and ascertain therapeutic levels.

When assessing the development of a 15-month-old child with cerebral palsy, whichmilestone should the nurse expect a toddler of this age to have achieved? a) walking up steps b) copying a circle c) putting a block in cup d) using a spoon

Putting a block in cup Delay in achieving developmental milestones is a characteristic of children with cerebral palsy. Ninety percent of typically developing 15-month-old children can put a block in a cup. Walking up steps typically is accomplished at 18 to 24 months. A child usually is able to use a spoon at 18 months. The ability to copy a circle is achieved at approximately 3 to 4 years of age.

A nurse plans a conference to discuss the care plan for an infant admitted to the hospital with a diagnosis of nonorganic failure to thrive. Appropriate participants in the care conference include the: a) registered dietitian, RN, physician, and infant's primary caregiver. b) infant's primary caregiver, RN, physician, and occupational therapist. c) registered nurse (RN), physician, social worker, and infant's parents. d) social worker, RN, occupational therapist, and dietitian.

Registered dietitian, RN, physician, and infant's primary caregiver. The registered dietitian, RN, physician, and infant's primary caregiver are crucial interdisciplinary team members who should participate in this care conference. The dietitian can address nutritional needs. The primary caregiver can provide input. The social worker and occupational therapist may become involved after the infant's condition improves, but they aren't crucial members of the team at this point.

An elementary school nurse is conducting a program for parents on attention deficit hyperactivity disorder (ADHD). Which of the following is the most important information for the nurse to include in the program? a) Girls with ADHD show more aggression than boys with ADHD. b) Diagnosis usually occurs before the child reaches school age. c) The child will have fatigue from the increased activity level. d) Sleep disturbances are common for children with ADHD.

Sleep disturbances are common for children with ADHD. Sleep disturbances are common for children with ADHD. The diagnosis is commonly made after the child starts attending school and is unable to display attentive behavior in class.

Which child should the nurse assess as demonstrating behaviors that need further evaluation? a) Stephen, age 2, who is indifferent to other children and adults and is mute b) Adrienne, age 6, who sucks her thumb when tired and has never spent the night with a friend c) Curt, age 10, who frequently tells his mother that he is going to run away whenever they argue d) Joey, age 2, who refuses to be toilet-trained and talks to himself

Stephen, age 2, who is indifferent to other children and adults and is mute Indifference to other people and mutism may be indicators of autism and would require further investigation. A 2-year-old who talks to himself and refuses to cooperate with toilet training is displaying behaviors typical for this age. Occasional thumb sucking and not having spent the night with a friend would be normal at age 6. Threatening to run away when angry is considered within the range of normal behaviors for a 10-year-old child.

A nurse teaches a mother how to provide adequate nutrition for her toddler, who has cerebral palsy. Which observation indicates that teaching has been effective? a) The child eats finger foods by himself. b) The toddler finishes the meal within a specified period of time. c) The toddler stays neat while eating. d) The child lies down to rest after eating.

The child eats finger foods by himself. The child eating finger foods by himself indicates effective teaching because a child with cerebral palsy should be encouraged to be as independent as possible. Finger foods allow the toddler to feed himself. Because spasticity affects coordinated chewing and swallowing as well as the ability to bring food to the mouth, it's difficult for the child with cerebral palsy to eat neatly. In terms of a specified period of time, the child with cerebral palsy may require more time to bring food to the mouth; thus, chewing and swallowing shouldn't be rushed. A child shouldn't lie down to rest after eating because doing so may cause the child to vomit from a hyperactive gag reflex. Therefore, the child should remain in an upright position after eating to prevent aspiration and choking.

A parent reports that her school-age child has been reprimanded for daydreaming during class. This is a new behavior, and the child's grades are dropping. The nurse should suspect which problem? a) The child may have a hearing problem and needs to have his ears checked b) The child may be having absence seizures and needs to see his primary health care provider for evaluation c) The child may have attention deficit hyperactivity disorder (ADHD) and needs medication d) The child may have a learning disability and needs referral to the special education department

The child may be having absence seizures and needs to see his primary health care provider for evaluation Absence seizures are commonly misinterpreted as daydreaming. The child loses awareness but no alteration in motor activity is exhibited. A mild hearing problem usually is exhibited as leaning forward, talking louder, listening to louder TV and music than usual, and a repetitive "what?" from the child. There isn't enough information in the question scenario to indicate a learning disability. ADHD is characterized by episodes of hyperactivity, not quiet daydreaming.

Which behavior demonstrated by a 6-year-old would help the nurse recognize a learning disability as opposed to attention deficit hyperactivity disorder? a) The child reverses letters and words while reading b) The child has a difficult time reading a chapter book c) The child is easily distracted and reacts impulsively d) The child is always getting into fights during recess

The child reverses letters and words while reading Children who reverse letters and words while reading have dyslexia. Two of the most common characteristics of children with ADHD include inattention and impulsiveness. Although aggressiveness may be common in children with ADHD, it isn't a characteristic that will aid in the diagnosis of this disorder. Six-year-old children aren't usually cognitively ready to read a chapter book.

When providing intermittent nasogastric feedings to an infant with failure to thrive, which method is preferred to confirm tube placement before each feeding? a) Obtain a chest X-ray. b) Compare the tube insertion length to a standardized chart. c) Auscultate the stomach while instilling an air bolus. d) Verify that the gastric PH is less than 5.5.

Verify that the gastric PH is less than 5.5. For children receiving intermittent gavage feedings, the best method to verify the tube placement before each feeding is to aspirate a small amount of gastric contents to verify that the pH is acidic. A pH of 5.5 or less should indicate correct placement in most babies. Depending on the type of feeding tube used, an x-ray may be used to confirm the original tube placement, but use before every feeding would expose the child to unnecessary radiation. Air boluses are misleading because placement in the esophagus or respiratory tract may make the same sound in small infants. Charts might be helpful in determining initial tube insertion length, but do not substitute for nursing assessments.

The health care team determines that the family of an infant with failure to thrive who is to be discharged will need follow-up care. Which approach would be the most effective method of follow-up? a) daily phone calls from the hospital nurse b) twice-weekly clinic appointments c) enrollment in community parenting classes d) weekly visits by a community health nurse

Weekly visits by a community health nurse The most effective follow-up care would occur in the home environment. The community health nurse can be supportive of the parents and will be able to observe parent-infant interactions in a natural environment. The community health nurse can evaluate the infant's progress in gaining weight, offer suggestions to the parents, and help the family solve problems as they arise.

The parents of a preschool child diagnosed with autism must take their child on a plane flight and are concerned about how they can make the experience less stressful for her and their fellow travelers. The nurse suggests a dry run to the airport in which they simulate going through security and boarding a plane. In addition, the nurse suggests taking items to help the child be calm during the flight. In what order of priority from first to last should the parents employ the items listed below? All options must be used. 1. a favorite non-electronic game 2. a favorite stuffed animal or other soft toy 3. medication that can be given as needed to calm the child 4. a DVD player with headphones and favorite games, cartoons, and child films

a DVD player with headphones and favorite games, cartoons, and child films a favorite non-electronic game a favorite stuffed animal or other soft toy medication that can be given as needed to calm the child Electronic games and stories are favorites of most children, but are particularly enjoyed by children on the autism spectrum. The headphones block out some of the noises that might be upsetting to a child on the autism spectrum. If the child cannot be engaged electronically, a favorite non-electronic toy would be the next choice. Stuffed animals or other soft toys can soothe a child who is starting to become upset. Medication should be a last resort as it can have a paradoxical effect if it is an antianxiety medication or may cause too much sedation during the flight.

A young school-age girl whose mother and aunt have been diagnosed as having bipolar disorder and whose father is diagnosed with depression is brought to the clinic because of problems with behavior and attention in school and inability to sleep at night. The child says, "My brain does not turn off at night." The child is diagnosed as experiencing attention deficit hyperactivity disorder (ADHD) with a possibility of bipolar disorder as well. What should the nurse say to the father to explain what the provider said? Select all that apply. a) "Your provider is considering a bipolar diagnosis because of your child's family history of bipolar disorder and her sleep issues." b) "Your provider does not know how to diagnose your child's illness since she has symptoms of both bipolar disorder and ADHD." c) "The child's description of her inability to sleep is irrelevant to diagnosing her condition since she stays up late." d) "ADHD involves difficulty with attention, impulse control, and hyperactivity at school, home, or in both settings." e) "Your child was diagnosed as having ADHD because of her attention and behavior problems at school."

• "ADHD involves difficulty with attention, impulse control, and hyperactivity at school, home, or in both settings." • "Your provider is considering a bipolar diagnosis because of your child's family history of bipolar disorder and her sleep issues." • "Your child was diagnosed as having ADHD because of her attention and behavior problems at school." The client's school problems, the presence of first-degree relatives diagnosed with bipolar disorder and depression, and her inability to sleep at night mirror aspects of both ADHD and bipolar disorder, which are difficult to distinguish from each other in children. Health care providers (HCPs) are reluctant to diagnose young children as bipolar at this age. She may have only one disorder or the other or both. Further monitoring and her response to medication will differentiate whether she is suffering from one of the disorders or both. Any comments indicating that the provider does not know what he or she is doing or that the child's perceptions of her illness are not valid will undermine any trust the father and child might be developing in their caregiver and so should be avoided.

A 10-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) has been switched from a stimulant to atomoxetine 40 mg two times a day. The nurse is instructing the client and her mother about the change in medication. Which statement indicates that the client's mother needs further education about the medication? Select all that apply. a) "If she has mood swings, I should call her psychiatrist." b) "She may have nausea or dizziness for 1 or 2 months." c) "If her ADHD symptoms don't improve in 2 to 3 weeks, I should stop the Strattera." d) "She can't take monoamine oxidase inhibitors while on Strattera." e) "I'll have to make sure she's gaining weight appropriately." f) "I have to give her both doses before lunch."

• "I have to give her both doses before lunch." • "If her ADHD symptoms don't improve in 2 to 3 weeks, I should stop the Strattera." Atomoxetine is a selective norepinephrine reuptake inhibitor antidepressant, not a stimulant. Therefore, a two-times-a-day dosing schedule is appropriate, with a dose given in the morning and late afternoon. It may take more than 2 to 3 weeks to see the full effects of this medication. Nausea and dizziness are transient side effects. Monoamine oxidase inhibitors are contraindicated with atomoxetine.

Which of the following behaviors demonstrated by a 6-year-old child would help the school nurse assess characteristics of attention deficit hyperactivity disorder (ADHD)? a) Is easily distracted in class b) Has speech impediments c) Gets into fights in cafeteria d) Reverses letters and words e) Does not sit still in class

• Gets into fights in cafeteria • Is easily distracted in class • Does not sit still in class Characteristics of ADHD are impulsive behaviors, inattention, and hyperactivity, including getting into fights, being easily distracted, and not sitting still. Reversing letters and words and speech impediments are learning disabilities.

Which nursing interventions are important when caring for a hospitalized toddler? Select all that apply. a) Discourage parents' participation in client care b) Provide thorough explanation to toddler prior to a procedure c) Allow client autonomy by offering select choices d) Maintain the toddler's routine when able e) Encourage use of a security object from home f) Instruct parent that regression commonly occurs

• Instruct parent that regression commonly occurs • Allow client autonomy by offering select choices • Encourage use of a security object from home • Maintain the toddler's routine when able Hospitalization is a stressful time for both the toddler and the parents. Important nursing interventions decrease the stress level. Toddler inventions include allowing security objects from home, maintaining the usual routine and providing autonomy by allowing select, or appropriate choices. Parental interventions include instruction on common regression behavior and allowing participation in the toddler's care. Brief, age appropriate explanations to a toddler immediately prior to a procedure are best.

A 3-year-old is seen in the well child clinic. The mother is concerned that the child may be autistic. Which of the following assessment data would indicate a concern to the nurse? Select all that apply. a) Withdrawing into a private world b) Inability to separate from mother c) Inability to stay on task d) Inability to develop social skills e) Lack of communication abilities

• Lack of communication abilities • Withdrawing into a private world • Inability to develop social skills Children with autism spectrum disorder (ASD) fail to develop interpersonal skills. The child with ASD withdraws into a private world and is not able to develop social skills and communication abilities. Inability to separate is a behavior found in children with separation anxiety. Inattention is associated with children who are diagnosed with Attention Deficit Disorder (ADD).

A nurse assesses the effect of the environment and nutrition on patients visiting a walk-in clinic in a low-income community. Which statements accurately describe these effects? (Select all that apply.) a) Substance abuse by a pregnant woman increases the risk for congenital anomalies in her developing fetus. b) Abuse of alcohol and drugs is more prevalent in teenagers who have poor family relationships. c) Child abuse can lead to deficits in physical development, but psychosocial development is not affected. d) Infants who are malnourished in utero develop the same amount of brain cells as infants who had adequate prenatal nutrition. e) An increased incidence of teenage pregnancy can be linked to substance abuse by adolescents. f) Failure to thrive cannot be linked to emotional deprivation.

• Substance abuse by a pregnant woman increases the risk for congenital anomalies in her developing fetus. • Abuse of alcohol and drugs is more prevalent in teenagers who have poor family relationships. • An increased incidence of teenage pregnancy can be linked to substance abuse by adolescents. Environment and nutrition influence all stages of development. Environmental factors that might alter development include poverty, violence, unsafe living conditions, the presence of lead or mold in the home, and the quality of air and water in the surrounding environment. With this in mind, the following statements accurately describe the effect of the environment and nutrition on clients: substance abuse is a higher risk with this population, abuse of alcohol and drugs in teenagers is a higher risk with this population, and an increased incidence of teen pregnancy can be linked to substance abuse by adolescents. Infants who are malnourished in utero do not develop the same amount of brain cells as infants who have had adequate prenatal nutrition. Failure to thrive can be linked to emotional deprivation. Psychosocial development can be affected by child abuse.

A child with spastic cerebral palsy is to begin botulinum toxin type A injections. Which treatment goals should the health care team set for the child related to botulinum toxin? Select all that apply. a) decreased pain from spasticity b) enhanced self-esteem c) reduced caregiver strain and improved self-care d) improved motor function e) improved nutritional status f) decreased speech impediments

• decreased pain from spasticity • improved motor function • enhanced self-esteem • reduced caregiver strain and improved self-care Botulinum toxin injections can be used to improve many aspects of quality of life for the child with cerebral palsy. The injections can help decrease pain from spasticity. Injections improve motor status by reducing rigidity and allowing for more effective physical therapy to improve range of motion. Decreased spasms enhance self-esteem. Improved motor status facilitates the ability to provide some aspects of care, especially transfers. Botulinum does not significantly affect nutritional status or speech.

In a children's unit team meeting, the staff is working on protocols for dealing with clients with autism spectrum disorder (ASD). Which protocols would be most important? Select all that apply. a) protections from harm to self and others b) reinforcements for appropriate interactions with peers and staff c) limitations on toys allowed d) preparation for any changes in unit routines e) types of verbalizations expected

• protections from harm to self and others • preparation for any changes in unit routines • reinforcements for appropriate interactions with peers and staff Children with autism may have behaviors, such as head banging or pinching, that harm themselves or others. They have a strong need for sameness and need to be prepared for changes. Any client efforts to interact appropriately need to be reinforced because social behaviors are typically limited. What toys these clients have is not as important as what they do with them, such as throwing them at others. Depending on the severity of the autism, the clients' verbalizations vary significantly, so a protocol for this is not possible.