341 Ch 28
The drug most commonly abused by children and adolescents is which of the following? a) Ecstasy b) Alcohol c) Marijuana d) Percocet
Alcohol
A child with ADHD is placed on methylphenidate (Ritalin) therapy. Which of the following symptoms may children on Ritalin develop? a) Rapid increase in height b) Hypotension c) Sleepiness d) Anorexia
Anorexia
Which of the following is an example of impaired adaptive functioning in an 8-year-old girl with a developmental disorder? a) The child cannot correctly copy a phone number. b) The child cannot correctly copy a sentence. c) The child's vision is fine but she is a poor reader. d) The child cannot properly dress herself.
The child cannot properly dress herself.
Which of the following signs and symptoms suggest that a 5-year-old boy who does not maintain eye contact or speak may have autism spectrum disorder (ASD)? a) The child constantly opens and closes his hands. b) The child has a slight decrease in head circumference. c) The child has a long face and prominent jaw. d) The child is highly active and inattentive.
The child constantly opens and closes his hands.
A 9-year-old child with attention deficit hyperactivity disorder (ADHD) has been placed on the stimulant methylphenidate. The nurse knows that the teaching has been effective when the parents make which statement? a. "Our child may have some side effects, like insomnia, headache, or stomach ache." b. "Our child knows to take this medication once every 12 hours." c. "We'll bring our child in every week to get blood levels drawn." d. "This drug will have an effect on our child in about 2 weeks."
a. "Our child may have some side effects, like insomnia, headache, or stomach ache."
Which statement is true regarding the use of pharmacologic agents in children with anxiety disorders? a. Anxiolytics and selective serotonin reuptake inhibitors (SSRIs) have been shown to help reduce anxiety. b. Mood-stabilizing medications, including lithium, divalproex, and carbamazepine, are used for their calming and antiaggressive effects. c. The use of pharmacologic agents is discouraged in children because of addictive or suicidal potential. d. Behavioral therapy, including imagery, self-talk, and cognitive techniques, is ineffective without the adjunctive use of pharmacologic agents.
a. Anxiolytics and selective serotonin reuptake inhibitors (SSRIs) have been shown to help reduce anxiety.
The father of a 14-year-old daughter reports she has been rebelling at home. The use of a contract for behaviors has been discussed. Which response from the father indicates the need for further discussion? a. "When my daughter exceeds expectations for her behavior she should be praised." b. "I can relax rules at home if she has had a bad day." c. "The establishment of rules for our home should be held with my daughter as soon as possible." d. "If my daughter becomes angry about established rules at home it is important I remain calm and consistent."
b. "I can relax rules at home if she has had a bad day."
A pediatric client has recently been prescribed methylphenidate. The parent calls the office and insists the medication is not working. How will the nurse respond? a. "Your child's dosage may need to be increased." b. "Tell me why you believe the medication is not working." c. "Tell me how you are administering the medication." d. "Perhaps another medication will be better for your child."
b. "Tell me why you believe the medication is not working."
The nurse suspects that a child is demonstrating signs of attention deficit hyperactivity disorder (ADHD). What behavior did the nurse most likely assess in this child? a. Unrealistic fears b. Persistent disobedience c. A lack of affection for others d. A lack of concentration
d. A lack of concentration
The nurse is caring for a child with ADHD. Which behavior would the nurse not expect the child to display: 1. moody, morose behavior with pouting 2. interruption and inability to take turns 3. forgetfulness and easy distractibility 4. excessive motor activities and fidgeting
moody, morose behavior with pouting
An adolescent girl who has been receiving treatment for anorexia nervosa has failed to gain weight over the past week despite eating all of her meals and snacks. What is the priority nursing intervention? 1. increase the teen's daily caloric tinake by at least 500 calories 2. ensure that the teen's entire fluid intake includes calories 3. supervise the teen for 2h post meals/snacks 4. assess the teen's anxiety level to determine need for medication
supervise the teen for 2h post meals/snacks
The parents of an adolescent are concerned about his mental health and have brought the adolescent into the physician's office for an evaluation. Which statements by the parents indicate that the child may have a mental health disorder? Select all that apply. a) "He has lost 10 pounds over the last 4 months." b) "He has started sleeping for only 3 hours each night." c) "He hangs out with the same kids he always has." d) "He still enjoys playing a lot of baseball." e) "He used to be a straight-A student and now he's bringing home Cs and Ds."
• "He has lost 10 pounds over the last 4 months." • "He has started sleeping for only 3 hours each night." • "He used to be a straight-A student and now he's bringing home Cs and Ds."
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? a) Steve's school nurse b) Steve's homeroom teacher c) Steve's parents d) Steve
Steve
A 9-year-old boy was in a car accident. The child is suffering from posttraumatic stress disorder. Which would be the best approach for treatment? a. Individual psychotherapy sessions b. Psychostimulant medications c. Sensory integration technique d. Antipsychotic medications
a. Individual psychotherapy sessions
A 15y/o girl has been making demands all day, exaggerating her every need. She is now crying, saying she has nothing to live for and threatening to kill herself. What is the priority nursing action? 1. ignore her continured exaggerated and melodramatic behavior 2. consult with the physician or NP to increase her antidepressant dose 3. leave the girl alone for a little whle unitl she compses herself 4. take the girl's suicidal threat seriously and provide close supervision
take the girl's suicidal threat seriously and provide close supervision
A child is suspected of having bipolar disorder. What would the nurse identify if the child was experiencing a manic episode? Select all that apply. a) Flamboyant behavior b) Loss of interest in activity c) Decreased energy d) Decreased sleep e) Pressured speech
• Pressured speech • Decreased sleep • Flamboyant behavior
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. a) Syncope b) Diarrhea c) Warm hands and feet d) Secondary amenorrhea e) Desire for perfectionism
• Syncope • Secondary amenorrhea • Desire for perfectionism
The nurse is caring for a 10-year-old girl with a history of inappropriate behavior. Which statement by the mother would lead the nurse to suspect possible conduct disorder? a) "She argues excessively with her teachers." b) "She blames everyone else for her problems." c) "She recently trampled our neighbor's flower bed." d) "She has frequent temper tantrums."
"She recently trampled our neighbor's flower bed."
The nurse is meeting with a family that has learned that their 11-year-old daughter has some intellectual disabilities. They tell the nurse that she is having trouble coping with different situations at school. What is the best response the nurse could give? a) "Just give her some time, she will learn to adjust." b) "Maybe it would be best if she did not play with those kids at school." c) "Coping and adaptation are often affected by intellectual disabilities." d) "It takes time to learn to cope and adjust, give her some more time."
"Coping and adaptation are often affected by intellectual disabilities."
The nurse is interviewing a depressed 13-year-old girl. During the course of the interview, the girl reveals that her best friend is thinking about committing suicide. How should the nurse respond? a) "Why do you think she wants to kill herself?" b) "Do you know how she is planning to kill herself?" c) "Are you the only person who knows?" d) "Do her parents know she wants to kill herself?"
"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 of the following statements should be the nurse's first response to this adolescent? a) "What is your relationship with your parents like?" b) "Are you and your friends here at school having problems?" c) "You need to be seen immediately by a counselor." d) "Have you made a plan to commit suicide?"
"Have you made a plan to commit suicide?"
The nurse is caring for an adolescent who says, "I'm sick of this. I wish I weren't alive anymore." What is the best response by the nurse? 1. "I often feel sad and sick of things." 2. "Have you thought about hurting yourself." 3. "Are you trying to escape your problems?" 4. "Do your parents know about this feeling?"
"Have you thought about hurting yourself."
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? a) "Tremors and nausea are common side effects." b) "She will probably tell us that she is hungrier than usual." c) "She may notice an increase in urination" d) "If she loses weight, then we know the medication is working."
"If she loses weight, then we know the medication is working."
After teaching the parents of a child with Tourette syndrome about motor and vocal tics, the nurse determines that the teaching was successful when the parents state: a) "Vocal tics are harder to control than the motor tics are." b) "Drugs are the primary method for controlling the symptoms." c) "He can control the tics if he really concentrates on doing so." d) "If we get him focused on an activity, the tics will be less pronounced."
"If we get him focused on an activity, the tics will be less pronounced." Tics become more noticeable or severe during times of stress and less pronounced when the child is focused on an activity such as watching TV, reading, or playing a video game. The tics are not under voluntary control and either type can be difficult to control. Management is highly individualized and involves psychopharmacology and behavioral therapy.
A 10-year-old girl with ADHD has been on Ritalin 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? a) "Let's set up an appointment as soon as possible." b) "Let me talk to the doctor about this." c) "Let's wait a few more weeks before we do anything." d) "What does the teacher say?"
"Let's set up an appointment as soon as possible."
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? a) "Speak to the doctor about atomoxetine." b) "Perhaps the doctor will prescribe long-acting dextroamphetamine." c) "Ask the doctor about long-acting methylphenidate." d) "Talk to the doctor about dextroamphetamine."
"Speak to the doctor about atomoxetine."
A nurse is caring for a 10-year-old intellectually challenged girl hospitalized for a scheduled cholecystectomy. The girl expresses fear related to her hospitalization and unfamiliar surroundings. How should the nurse respond? a) "Don't worry, you will be going home soon." b) "Tell me about a typical day at home." c) "Have you talked to your parents about this?" d) "Do you want some art supplies?"
"Tell me about a typical day at home."
An 11-year-old boy has recently been prescribed Ritalin. The mother calls the pediatrician's office to speak with the advance practice pediatric nurse practitioner (APPNP). This mother has been extremely resistant to medication and insists that the medication is not working. How should the nurse respond? a) "Do you want to increase the dosage?" b) "Tell me why you believe the medication is not working." c) "Are you sure you are administering it properly?" d) "Do you want to try a different medication?"
"Tell me why you believe the medication is not working."
The nurse is working with a group of caregivers of school-age children diagnosed with attention deficit hyperactivity disorder. Which of the following statements would be most appropriate for the nurse to make to this group of caregivers? a) "These children function best if given a set of instructions and then left to do the task." b) "These children study better with quiet background music such as the radio or a CD." c) "The medications your child is on may cause a decreased appetite." d) "A frequent change in routine will be helpful so the child does not get bored."
"The medications your child is on may cause a decreased appetite."
A nurse is providing a routine wellness examination and follow-up for a 3-year-old recently diagnosed with autism spectrum disorder (ASD). Which response indicates a need for additional referral or follow-up? a) "We really like the treatment plan that has been created by his school." b) "We have a couple of baby sitters who know how to handle his needs." c) "We have recently completed his individualized education plan." d) "We try to be flexible and change his routine from day to day."
"We try to be flexible and change his routine from day to day."
The mother of a 13-year-old girl approaches the school nurse. She is concerned because her daughter does not seem happy since the family relocated from another state and started attending a new school. The mother is upset and wants to know what she can do for her daughter. What would be the most helpful information to gather from the mother? a) "What are the specific changes you have seen in your daughter since your move?" b) "How is the rest of the family reacting to the move?" c) "Do you think your daughter is depressed?" d) "Was your daughter happy in her previous school?"
"What are the specific changes you have seen in your daughter since your move?"
An advance practice pediatric nurse practitioner (APPNP) is conducting a mental status examination with a 6-year-old girl. Which of the following questions would be most appropriate? a) "Why does your pink doll hit all the other dolls?" b) "Do you like the doll with pink hair the best or the doll with green hair?" c) "What is the name of the president of the United States?" d) "Isn't it fun to play with dolls?"
"Why does your pink doll hit all the other dolls?"
The mother of a 10-year-old boy with attention deficit hyperactivity disorder (ADHD) contacts the school nurse. She is upset because her son has been made to feel different by his peers because he has to visit the nurse's office for a lunch time dose of medication. The boy is threatening to stop taking his medication. How should the nurse respond? a) "He will need to learn to ignore the children, he needs this medication." b) "You may want to talk to your physician about an extended release medication." c) "I can have the teacher speak with the other children." d) "Remind him that his schoolwork may deteriorate."
"You may want to talk to your physician about an extended release medication."
The nurse is discussing the treatment for a child with attention deficit hyperactivity disorder (ADHD) with a group of school nurses. Which of the following would be an appropriate learning setting for a child with ADHD? a) A classroom with windows facing a playground. b) A classroom with tables and chairs rather than individual desks. c) A classroom with a plan of study that is followed each day. d) A classroom in which children self-select their activities.
A classroom with a plan of study that is followed each day.
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 of the following data would be most important to assess to help evaluate his behavior? a) Whether he was breastfed or bottle-fed as an infant b) Family medical history for circulatory illnesses c) A review of the boy's typical day d) Medical history for communicable diseases
A review of the boy's typical day
Which children would be best characterized as having a separation-anxiety disorder? a) A 10-year-old who says he has a headache if he has a test in school b) A 7-year-old who withdraws from contact with all strangers. c) An 8-year-old who will not stay overnight at a friend's house d) An 8-month-old who cries when he is left with strangers
An 8-year-old who will not stay overnight at a friend's house
The nurse is preparing a presentation for a local health fair on autism spectrum disorders. What statement would the nurse include as part of the presentation? a) Scientific evidence supports the use of complementary therapies. b) Autism cannot be cured. c) Children respond best when the environment is less structured. d) Communication therapies are of little value in treating autism.
Autism cannot be cured.
The nurse is caring for a 12-year-old boy who is profoundly cognitively challenged, with an IQ of 15. Which task is the most challenging that the nurse should expect this client to be able to accomplish as an adult? a) Contribute to his own support by performing unskilled manual labor b) Brush his teeth c) Live independently d) Dress himself
Brush his teeth
A 9-year-old girl with an anxiety disorder is experiencing a panic attack in the waiting room of the pediatrician's office. Which is the first action the nurse should take? a) Calmly move the child to a quiet, comfortable area. b) Quickly find the pediatrician to administer medication. c) Calmly tell the child to relax. d) Quickly enlist the assistance of the child's parent.
Calmly move the child to a quiet, comfortable area.
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? a) Cardiac arrhythmias, confusion, seizures b) Orthostatic hypotension and hypothermia c) Bradycardia with ectopy and seizures d) Hypothermia and irregular pulse
Cardiac arrhythmias, confusion, seizures
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. This behavior indicates a symptom of which of the following? a) Echolalia b) Encopresis c) Enuresis d) Encephalopathy
Encopresis
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? a) Set clear limits on behavior. b) Demonstrate unconditional acceptance of the child as a person. c) Encourage her to discuss her thoughts and feelings. d) Role model appropriate social and conversation 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. Which of the following is the best approach? a) Introduce the concept of accepting differences to reduce conflict. b) Engage the girl in dialogue regarding feelings about self/personal appearance. c) Remind her of the importance of good hygiene for better appearance. d) Explore the girl's feelings about changes in her body with the onset of puberty.
Engage the girl in dialogue regarding feelings about self/personal appearance.
A nurse is conducting a physical examination of an adolescent girl with suspected bulimia. Which assessment finding should the nurse expect? a) Dry sallow skin b) Soft sparse body hair c) Thinning scalp hair d) Eroded dental enamel
Eroded dental enamel
The nurse is preparing a plan to educate the parents of a 10-year-old boy with a learning disorder. Which of the following will be part of this plan? a) Encourage parents to give the child personal space. b) Have parents learn the child's facial expressions. c) Tell parents to check on the child regularly. d) Explain the child's strengths and weaknesses.
Explain the child's strengths and weaknesses.
You have been working with an adolescent with an eating disorder for several days. Which of the following is an indication that she is developing trust in you? a) Her telling you that she is now ready to eat again b) Her saying to you that she trusts you more than anyone else c) Her saying to you that she'll follow your orders but not those of the nurse on the next shift d) Her telling you that she is still inducing vomiting after each meal
Her telling you that she is still inducing vomiting after each meal
Sixteen-year-old Candace 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 six 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 which of the following? a) If the child has been smoking marijuana. b) If the child is excited that she can drive now. c) If the child is planning to commit suicide. d) If the child is experimenting with alcohol.
If the child is planning to commit suicide.
Which behavior typical of children with autism spectrum disorder (ASD) requires you to maintain special care to keep them safe? a) A fascination with bright colors b) A craving for salt c) Insensitivity to pain d) Loss of hearing for high frequencies
Insensitivity to pain
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 of the following behaviors should the nurse recognize as an example of impulsiveness? a) Repeating words or phrases spoken by others b) Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission c) Constantly fidgeting in his chair and shaking his foot d) Inability to answer a question posed by his teacher because he was daydreaming
Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission
The nurse is examining a child with fetal alcohol syndrome (FAS). Which assessment finding should the nurse expect? a) Clubbing of fingers b) Low nasal bridge with short upturned nose c) Short philtrum with thick upper lip d) Macrocephaly
Low nasal bridge with short upturned nose
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? a) Trazodone b) Methylphenidate c) Buspirone d) Fluoxetine
Methylphenidate
The nurse is performing a physical assessment of 16-year-old girl who is cognitively challenged. 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 cognitive challenge as which of the following? a) Moderate b) Severe c) Profound d) Mild
Mild
A child with an intellectual disability is evaluated and found to have an intelligence quotient (IQ) of 65. The nurse interprets this as reflecting which category of intellectual disability? a) Mild b) Severe c) Moderate d) Profound
Mild Mild intellectual disability involves an IQ from 50 to 70. Moderate intellectual disability involves an IQ from 35 to 50. Severe intellectual disability involves an IQ from 20 to 35. A profound intellectual disability involves an IQ less than 20.
When teaching parents of a child with encopresis, which of the following would you stress? a) Need for keeping the child close to bathroom facilities at all times b) Necessity for giving 4 to 6 tablespoons of Kaopectate per day c) Not punishing the child for encopresis d) Importance of cleaning the child immediately after an accident occurs
Not punishing the child for encopresis
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? a) Dilated eyes b) Patches of hair loss c) Watery eyes d) 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
Which of the following signs is consistent with autism spectrum disorder (ASD)in a 2-year-old boy? a) Has below-average intellectual function b) Performs repetitive activity with toys c) Possesses excellent language development d) Shows signs of losing attained skills
Performs repetitive activity with toys
A group of nursing students are reviewing the actions of various drugs used to treat mental health disorders in children. The students demonstrate understanding of the information when they identify which drug as potentiating the activity of serotonin in the brain? a) Lithium b) Sertraline c) Buspirone d) Trazodone
Sertraline Sertraline is a selective serotonin reuptake inhibitor that potentiates serotonin activity in the brain. Trazodone is an atypical antidepressant that inhibits the reuptake of serotonin. Lithium influences the reuptake of serotonin and/or norepinephrine. Buspirone blocks the reuptake of dopamine.
A 17-year-old girl has been diagnosed with bulimia nervosa. Which of the following complications should the nurse carefully assess for in this client? a) Atherosclerosis b) Diabetes mellitus c) Severe erosion of teeth d) Hypertension
Severe erosion of teeth
Contract agreements are often recommended for patients with eating disorders. In forming a contract with a hospitalized adolescent diagnosed with anorexia nervosa, the nurse should make a point to do which of the following? a) Stress to the patient that she is in control of the outcome of her care b) Remind the adolescent about the consequences of misbehavior c) Reward the patient after several days of successful behavior d) Encourage the caregivers to take responsibility for the adolescent
Stress to the patient that she is in control of the outcome of her care
The nurse is conducting an examination of a boy with Tourette syndrome. Which finding should the nurse expect to observe? a) Toe walking b) Spinning and hand flapping c) Lack of eye contact d) Sudden, rapid stereotypical sounds
Sudden, rapid stereotypical sounds
The nurse is preparing an education plan to help the family to learn about their child's developmental disorder and its treatment. Which of the following interventions will be part of the plan? a) Conducting developmental assessments of the child b) Teaching how to plan schedules and routines c) Providing education to build social skills d) Linking the family to support groups
Teaching how to plan schedules and routines
Which of the following signs and symptoms suggest that a 5-year-old boy who does not maintain eye contact or speak may have autism spectrum disorder (ASD)? a) The child has a long face and prominent jaw. b) The child has a slight decrease in head circumference. c) The child constantly pats his legs. d) The child is highly active and inattentive.
The child constantly pats his legs.
The nurse is collecting data on an 18-month-old old child with a diagnosis of autism spectrum disorder (ASD). Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) The child cries and runs to the door when the caregiver leaves the room. b) The child sits quietly in the caregivers lap during interview. c) The child smiles when the caregiver shows her a stuffed animal. d) The child does not make eye contact.
The child does not make eye contact.
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 which of the following applies to this child? a) The child has autism spectrum disorder. b) The child has failure to thrive. c) The child has an addicted caregiver. d) The child has attention deficit hyperactive disorder (ADHD).
The child has attention deficit hyperactive disorder (ADHD).
Which of the following characteristics are commonly noted in the child with anorexia nervosa? a) The child has trouble sitting still and is figety. b) The child is inactive and participates in sedentary activites. c) The child has rigid study skills and ritualistic behavior. d) The child is impulsive and inattentive when spoken to.
The child has rigid study skills and ritualistic behavior.
Which of the following would suggest that a 5-year-old boy might have a developmental disorder? a) The child has trouble with r, l, and y sounds. b) The child is not able to follow directions. c) The child knows what a dog and a cat sound like. d) The child must be supervised when brushing his teeth.
The child is not able to follow directions.
The nurse is collecting data on a 16-year-old adolescent girl with the diagnosis of bulimia. Which of the following would the nurse most likely note in this child? a) The child socializes with friends and shares all her dreams and secrets with them. b) The child is of normal weight for her height according to the growth charts. c) The child has a ritualistic program of exercise that she does every day after school. d) The child is a perfectionist and tries hard to please her parents and teachers.
The child is of normal weight for her height according to the growth charts.
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 that which of the following will be done next? a) The child will be put on a high-calorie, high-protein diet. b) The child will be started on methylphenidate (Ritalin). c) The child will be referred for counseling. d) The child will be placed in a foster home.
The child will be referred for counseling.
The nurse is working with school-age children who are having enuresis or encopresis. Which of the following will most likely be the first step in this child's treatment? a) The child will be taken to a therapist. b) The child will be given a strict daily schedule. c) The child will be given medications. d) The child will have a complete physical exam.
The child will have a complete physical exam.
The nurse is educating the parents of a 6-year-old boy about his learning disorder. Which of the following facts would be included in the discussion? a) The disorder requires comprehensive special education. b) The disorder is caused by a difference in brain architecture. c) Learning disorders indicate lower intelligence. d) Learning disorders are synonymous with learning deficits.
The disorder is caused by a difference in brain architecture.
The nurse is assessing a 6-year-old with attention deficit/hyperactivity disorder (ADHD). The nurse observes the boy making repeated clicking noises and notes he has a slight grimace. The nurse recommends the boy receive further evaluation for: a) Tourette syndrome. b) autism spectrum disorder. c) anxiety disorder. d) Asperger syndrome.
Tourette syndrome Repeated vocal tics such as sniffling, grunting, clicking, or word utterances are associated with Tourette syndrome. The syndrome consists of multiple motor tics and one or more motor tics occurring simultaneously at different times. ADHD and obsessive-compulsive disorder occur in 90% of children with Tourette syndrome. Vocal and motor tics are not typical indicators of Asperger syndrome, anxiety disorder, or autism spectrum disorder.
Many children with autistic spectrum disorder (ASD) are intellectually disabled. a) False b) True
True
To feed lunch to a child with autism spectrum disorder (ASD), which of the following actions would be most important to take? a) Use a repetitive series of movements. b) Use an authoritarian manner to gain control. c) Allow the child to ask questions about the procedure. d) Don't allow him to see the spoon approach his mouth.
Use a repetitive series of movements. Children with ASD typically enjoy repetitive movements or the same action over and over.
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)? a) 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. b) A child flips the light switch off and on until the caregiver asks her to stop and join the other children in playing. c) A child playing in the kitchen area pretends to pour a glass of milk and repeats this over and over. d) After another child takes a toy, the child cries and stomps his feet.
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 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? a) Are you having fun now? b) Do you like playing with trains and blocks? c) Why does that red train keep crashing into all of the other trains? d) What year is it?
Why does that red train keep crashing into all of the other trains?
A child has been diagnosed with medical abuse by his mother. When setting goals, which is of the highest priority? a. Establishing safety of the child b. Therapy for the child c .Obtaining treatment for the mother d. Psychotherapy for the unaffected children in the family
a. Establishing safety of the child
A child is diagnosed with a mental health disorder and is receiving milieu therapy in an inpatient psychiatric setting. Which actions would the nurse likely include to maintain a therapeutic milieu? Select all that apply. a. Making client rounds every 15 minutes b. Deescalating aggressive or anxious behavior c. Role modeling appropriate interactions with others d. Instituting the liberal use of restraints e. Discouraging family involvement in the care
a. Making client rounds every 15 minutes b. Deescalating aggressive or anxious behavior c. Role modeling appropriate interactions with others
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? a. Sexual behavior that correlates with the child's developmental age b. Consistent delays in seeking treatment for the child's injuries c. Injuries that are inconsistent with the reported traumatic event d. Frequent changes in history information with visits
a. Sexual behavior that correlates with the child's developmental age
A mother has presented with her 2 year old child. She states that the child was talking in earlier months but recently has "kind of withdrawn." The child does not interact with other children or adults much but does enjoy throwing a ball, retrieving it and throwing it again. The nurse realizes that the child needs further assessment for which disorder? a. autism spectrum disorder b. attention deficit disorder c. attention deficit hyperactivity disorder d. depression
a. autism spectrum disorder
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. a. erosion of teeth b. menstrual irregularity c. frequent nurse visits d. absence of hunger e. weight fluctuation
a. erosion of teeth b. menstrual irregularity e. weight fluctuation
The nurse is caring for an adolescent diagnosed with anorexia nervosa. Which education will the nurse include in the client's discharge teaching? a. referrals to counseling services b. proper administration of phenelzine c. methods for desensitization d. appropriate exercise routines
a. referrals to counseling services
The nurse is caring for several adolescent clients on the mental health unit. Which clients should the nurse suggest to join a group therapy session? Select all that apply. a. Adolescents with uncontrolled aggressive behavior b. Adolescents who have experienced rape c. Adolescents who have experienced the death of a loved one d. Adolescents with depressive disorder e. Adolescents with a history of substance use disorder
b. Adolescents who have experienced rape c. Adolescents who have experienced the death of a loved one d. Adolescents with depressive disorder e. Adolescents with a history of substance use disorder
A nurse is working at a facility that provides care to children with developmental disabilities. Which role would be the nurse's most important? a. Care provider b. Advocate c. Counselor d. Educator
b. Advocate
A parent brings a preschooler to the behavioral clinic for evaluation. Upon entering the room, the child appears not to notice the nurse's presence. The child screams upon the nurse's touch. What condition should the nurse suspect? a. Findings are normal for a preschooler b. Autism c. Learning disability d. Down syndrome
b. Autism
The child has been diagnosed with attention deficit hyperactivity disorder (ADHD) and has begun taking methylphenidate. Which findings are most likely adverse effects related to this medication? Select all that apply. a. Weight gain b. Occasional headache c. Increased amount of sleep d. Abdominal pain e. Increased irritability
b. Occasional headache d. Abdominal pain e. Increased irritability
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. a. Hyperthermia b. Weak pulse c. Hypertension d. Hypothermia e. Orthostatic hypotension
b. Weak pulse d. Hypothermia e. Orthostatic hypotension
An adolescent has been diagnosed with oppositional defiant disorder. Which symptom does the nurse anticipate? a. frequent arrests and conflict with legal authorities b. angry outbursts directed at authority figures c. typical teenage defiance behavior with parents d. disruptive behavior toward siblings and peers
b. angry outbursts directed at authority figures
The nurse is caring for a child who has been hospitalized repeatedly at multiple hospitals. There is no clear medical diagnosis and the mother is threatening to leave the hospital against medical advice. The nurse suspects what issue? a. anxiety disorder b. caregiver-fabricated illness (formerly Munchausen syndrome by proxy) c. bipolar disorder d. sexual abuse
b. caregiver-fabricated illness (formerly Munchausen syndrome by proxy)
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? a. inappropriate knowledge of sexual terms and actions b. malnourished with frequent absences from school c. isolated from classmates with poor self-esteem d. evidence of bruising on multiple parts of the body
b. malnourished with frequent absences from school
A nurse taking a health history from an adolescent female would become concerned about anorexia if the adolescent made which statement? a. "My monthly cycle is not always regular. Sometimes, I may skip a month or two between my cycles." b. "I exercise every day by running one mile in the late afternoon or mornings on days that are really hot." c. "I've been really tired lately, but I'm afraid that if I rest I will get fatter than I am already." d. "I try to eat three meals each day but don't always have enough time to sit down for each meal."
c. "I've been really tired lately, but I'm afraid that if I rest I will get fatter than I am already."
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? a. "Meal time should be structured but pleasant and relaxed without distractions." b. "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." c. "If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something." d. "We need to allow the client to participate in developing the treatment plan."
c. "If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something."
The nurse is teaching a group of teachers how to recognize symptoms of schizophrenia that may occur in adolescence. Which statement by a teacher indicates that the teaching was effective? a. "Symptoms progress from autism in school age into adolescent psychosis." b. "Schizophrenia is a one-time diagnosis and does not lead to long term illness." c. "Symptoms include hallucinations with a flat affect or paranoia." d. "It presents as multiple personalities after severe incidences of abuse."
c. "Symptoms include hallucinations with a flat affect or paranoia."
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? a. Autism b. Asperger syndrome c. Learning disorder d. Down syndrome
c. Learning disorder
With all the warnings on cigarette packages and media coverage of the side effects of tobacco use, why do school-age children and adolescents continue to smoke or chew tobacco? a. They believe that smokeless tobacco does not have the health concerns of regular tobacco in cigarettes. b. They see their parents or caregivers smoking and do not see the harm it is doing to them. c. School-age and adolescent children view the threats to their health as far in the future, and the child feels that he or she can stop at any time. d. They do not believe the information provided to them through the media.
c. School-age and adolescent children view the threats to their health as far in the future, and the child feels that he or she can stop at any time.
The nurse suspects that a school-age child has Tourette syndrome. What did the nurse mostlikely assess in this client? a. Flat affect b. Running wildly in circles c. Shouting obscenities d. Playing quietly alone
c. Shouting obscenities
A nurse is assessing a little boy who has been diagnosed with Tourette syndrome. Which finding would the nurse expect to see? a. Spinning and hand-flapping b. Toe walking c. Speaks sudden, fast phrases out of context d. Lack of eye contact
c. Speaks sudden, fast phrases out of context
A 15-year-old student has been referred by the homeroom teacher to the school nurse for evaluation. The teacher is concerned that the student may be suffering from major depression. Who should be the primary source of information to investigate the concerns about the student? a. the homeroom teacher b. the school nurse c. the student d. the student's parents
c. the student
The therapy you would expect to see prescribed for an adolescent with anorexia nervosa would be a) a desensitization program. b) counseling her to accept more adult-like behavior. c) administration of an antiemetic drug. d) counseling to improve feelings of control over her body.
counseling to improve feelings of control over her body.
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? a. "I find your language offensive, and you need to stop talking that way." b. "You only have a few minutes to complete your chores." c. "If you calm down right now I will give you a few extra minutes to complete your chores." d. "You appear to be feeling very angry tonight, but you must still complete your chores."
d. "You appear to be feeling very angry tonight, but you must still complete your chores."
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 the child got the bruises. The nurse suspects abuse. Which initial action of the nurse is most appropriate? a. Ask the child to provide a written statement of how he or she got the bruises. b. Interview the child's parents about the origin of the bruises. c. Take photographs of the bruises. d. Document the bruises and any statements made by the child relating to them.
d. Document the bruises and any statements made by the child relating to them.
Which sign or symptom suggests depression in a child? a. Inability to sit still for extended periods of time b. Repetitive behaviors c. Fear of leaving the house d. Somatic complaints and acting-out behavior
d. Somatic complaints and acting-out behavior
A school nurse is developing a plan of care for a child with suspected violence between the child's parents. The nurse monitors for which behaviors in the child? a. compensation by overachieving b. developmental delays c. development of tics or twitches d. aggressive behavior in school
d. aggressive behavior in school
A 14-year-old is admitted to the hospital for the second time for treatment of anorexia nervosa. Her response 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 a) decrease her anxiety. b) develop rapport for a trusting relationship. c) encourage her to eat a nutritious diet. d) relieve her anger.
develop rapport for a trusting relationship.
A 4-year-old has been diagnosed with Tourette syndrome. A unique manifestation of this syndrome is a) obscenity shouting. b) mutism. c) running wildly in circles. d) easily broken bones.
obscenity shouting.
When trying to manage aggressive or impulsive behaviors in children or adolescents, what is the best nursing intervention? 1. train the child to be assertive 2. provide consistency and limit setting 3. allow the child to negotiate the rules 4. encourage the child to express feelings
provide consistency and limit setting
Rumination disorder is a poorly understood condition of young children. This refers to a) a habit of eating nonfood substances. b) excessive worrying about friendships. c) fear of moving objects. d) rechewing undigested food.
rechewing undigested food.
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: a) ask the school psychologist to do psychometric testing. b) call for an appointment with a psychologist. c) schedule an immediate history and physical examination. d) discuss the situation with her teacher.
schedule an immediate history and physical examination.
The child has been diagnosed with a mental health disorder and the child's parents are beginning to incorporate behavior management techniques. Which statements by the child's parent indicate the need for further education? Select all that apply. a) "We're trying to make her accountable and responsible for her own behavior." b) "I use a higher pitched voice when I communicate with her." c) "We have set some boundaries that are nonnegotiable." d) "I am quick to point out the things that she does that make me crazy." e) "We tell her when she is doing something well."
• "I use a higher pitched voice when I communicate with her." • "I am quick to point out the things that she does that make me crazy."
The 18-month-old toddler has been brought into the pediatrician's office by his parents. The nurse interviews the parents regarding the child's abilities. Which findings are warning signs that the toddler may have autism spectrum disorder? Select all that apply. a) Cannot stand on tiptoe b) Has never "babbled" c) Does not use any words d) Does not speak in short sentences e) Does not exhibit attempts to communicate by pointing to objects
• Has never "babbled" • Does not exhibit attempts to communicate by pointing to objects • Does not use any words
The characteristics of the child with autism fall into three categories. Which of the following are the three categories that these characteristics fall in to? a) Inability to respond to verbal stimuli b) Decreased ability to meet developmental milestones c) Inability to communicate with others d) Obviously limited activities and interests. e) Inability to relate to others
• Inability to relate to others • Inability to communicate with others • Obviously limited activities and interests.
