Chapter 73- Care of the School-Age Child or Adolescent.rtf

The nurse is examining a 7-year-old girl who presents at the clinic with classic symptoms of diabetes mellitus type 1. Which of the following describes one of these symptoms? A) Decrease in urinary output B) Loss of appetite C) Decrease in desire for fluids D) Weight loss

Ans D Feedback: Children with diabetes mellitus type 1 often have an abrupt onset of the classic symptoms of polyuria (dramatic increase in urinary output, probably with enuresis), polydipsia (abnormal thirst), and polyphagia (increased hunger). These symptoms are usually accompanied by weight loss or failure to gain weight and a lack of energy.

The nurse is caring for a 10-year-old boy diagnosed with chronic ulcerative colitis. Which of the following is a prominent symptom of this disorder? A) Severe diarrhea that may be bloody B) Severe abdominal pain in the right lower quadrant C) Eye damage and decreased vision D) Hip pain or soreness

Ans: A Feedback: Chronic ulcerative colitis (CUC) is a relatively common disorder in adolescents and young adults. It results in inflammation of the colon and rectum.

For many emotional disorders, nurses may set up an appointment with a counselor. Which of the following disorders requires long-term counseling to overcome? A) Bulimia nervosa B) Sleep apnea C) Mittelschmerz D) Retinitis pigmentosa

Ans: A Feedback: Feelings of guilt and depression are common during binges of bulimia nervosa. Long-term counseling is necessary to overcome the disorder. Sleep apnea is a sleep disorder with a physical cause. Mittelschmerz is pain during ovulation. Retinitis pigmentosa is a eye disorder that is an hereditary disease and may require genetic counseling to prevent it.

An 8-year-old client with abnormal posture is diagnosed with functional scoliosis. Which of the following nursing measures is helpful for the nurse to employ when caring for the client and informing his family members? A) The client is provided with counseling to improve posture. B) Encourage the client to stand or sit up straight. C) Restrict the client from activities that require exercise. D) Encourage the family to assist the client with activities of daily living.

Ans: A Feedback: Functional scoliosis occurs because of poor posture and, hence, the client may benefit from counseling in such cases. Frequently encouraging the client to stand or sit up straight usually does not help the client with scoliosis. Clients with scoliosis are usually encouraged to perform routine activities for themselves as much as possible.

A client is diagnosed with juvenile glaucoma. Which of the following accurately describes this disorder? A) Abnormally high intraocular pressure B) Abnormally low intraocular pressure C) Retinal degeneration that causes blindness D) Night blindness

Ans: A Feedback: Glaucoma refers to abnormally high intraocular (within the eyeball) pressure, resulting in eye damage and decreased vision. It may be caused by trauma, hemorrhage into the eye, tumor, inflammatory eye disease, or developmental abnormalities during infancy and early childhood. Retinitis pigmentosa (RP) is characterized by a slowly progressive, bilateral retinal degeneration that often causes blindness.

The nurse is providing patient teaching for an adolescent diagnosed with mononucleosis. Which of the following teaching points should the nurse include? A) Avoid playing contact sports during the acute phase of the illness. B) Be sure to finish the entire course of antibiotics even if symptoms disappear. C) Arrange to have schooling at home for the next 3 to 4 months. D) Wash your towels and clothes separately from the rest of the family.

Ans: A Feedback: Mononucleosis, which typically infects the salivary glands, is transmitted by droplets in saliva, coughs, and sneezes, and by direct contact with mucous membranes (mouth-to-mouth). Treatment for mononucleosis is symptomatic; it includes rest, fluids, and analgesics, not antibiotics. If liver or spleen enlargement is present, the greatest risk of rupture is present during the first 2 to 4 weeks of the illness. Treatment for mononucleosis is symptomatic; acute phase (first 2-4 weeks).

An 8-year-old client is diagnosed with stage II Legg-Calvé-Perthes disease. What are the characteristics of this disease? A) Deposit of new connective tissue because of new blood supply B) Interruption of circulation to hip joint, resulting in necrosis of the femoral head C) Granulation of new bone replaces connective tissue D) Regeneration and completion of bone growth; shape of joint fixed

Ans: A Feedback: Stage II is the depositing of new connective tissue because of new blood supply. Stage I is interruption of circulation to the hip joint, resulting in necrosis of the femoral head. Stage IIIa is granulation of new bone replaces connective tissue, and stage IIIb is regeneration and completion of bone growth; shape of joint fixed.

The nurse is providing teaching for a school athlete who has tinea pedis. Which of the following is a guideline for care of this disorder? A) Expose the feet to air whenever possible. B) Apply antifungal medication between baths. C) Do not expose feet to sunlight. D) Keep wearing the same shoes until the infection subsides.

Ans: A Feedback: The client with tinea pedis (athlete's foot) should expose the feet to air when possible, apply antifungal medication after each bath, expose the feet to sunlight and fresh air, and alternate wearing at least two pairs of shoes.

A nurse is caring for a child with impetigo contagiosa. What are the nursing activities for preventing the spread of infection? A) Keep the child's towels and linens away from others. B) Use only warm water to remove crusts. C) Use antifungal medication, as necessary. D) Avoid exposure to sunlight.

Ans: A Feedback: The nurse caring for the child should ensure that the child's towels and linens are kept away from others to prevent spread of infection. Good handwashing is essential to prevent spread of infection. Crusts should be removed with soap and water. Antibacterial topical or systemic medications are used to treat the infection. The client need not avoid exposure to sunlight.

During a routine medical examination of a 12-year-old client, the nurse notices that the client's fasting sugar level is above 160 mg/dL. After further evaluation, the client is diagnosed with diabetes mellitus type 1. Which of the following teachings should the nurse provide the family when caring for this client? A) Diabetics are at a higher risk for gaining weight. B) Adolescent clients often rebel against treatment. C) Diabetics should avoid frequent physical exertion. D) Self-administration of insulin should be discouraged.

Ans: B Feedback: Adolescents often go through a period of adjustment when diagnosed with diabetes and usually rebel against the treatment. Therefore, the client may require understanding and support during this time. Diabetics do not drastically gain weight; instead, they generally lose weight or fail to gain weight, and lack ene

A parent brings his son to a community clinic with concerns about his posture. On assessment, the nurse notes that there is an abnormal curvature of the thoracic spine that results in a "hunchback" appearance. What disorder would the nurse suspect? A) Lordosis B) Kyphosis C) Scoliosis D) Juvenile rheumatoid arthritis

Ans: B Feedback: Kyphosis is an abnormal curvature of the thoracic spine that results in a "hunchback" appearance. It can result from disease (e.g., tuberculosis), compression fractures, or arthritis. Lordosis is an exaggerated curvature of the lumbar spine in which the pelvis tips forward. It may result from a disease process, or it may be idiopathic. Scoliosis is a lateral curvature, resulting in an S-shaped spinal appearance. Juvenile rheumatoid arthritis (JRA) is a generalized systemic disease of the entire musculoskeletal system. It can lead to deformities, contractures, and impaired movement.

An adolescent is diagnosed with anorexia nervosa. Which of the following is a life-threatening complication of this disorder? A) High blood pressure B) Bradycardia C) Hypercalemia D) Mental illness

Ans: B Feedback: Life-threatening complications of anorexia nervosa include lowered blood pressure, bradycardia, hypokalemia (low potassium), and congestive heart failure. Death may occur.

The nurse is teaching an adolescent with type 1 diabetes how to plan a nutritious menu related to her disease state. Which of the following would the nurse teach this client? A) Children with diabetes need a diet rich in protein. B) Children with diabetes need regular and consistent meals. C) Children with diabetes need extra sugar in their diets. D) Children with diabetes need extra fat in their diets.

Ans: B Feedback: The diabetic child requires the same nutrients as other children, with consistency in quantity of intake and regularity of mealtime

The nurse is teaching an adolescent about medications to treat his acne. Which of the following is a nursing consideration for the use of topical and systemic agents? A) Topical agents, when combined with other agents, may cause excessive oiliness of skin. B) Topical agents may cause bleaching of hair or clothing. C) Tetracycline should be taken 2 hours before, or 1 hour after, any food consumption. D) Retinoic acid, a topical agent, is available in many over-the-counter topical agents.

Ans: B Feedback: Topical agents may cause bleaching of the hair or clothing. Topical agents, when combined with other agents, may cause excessive skin dryness. Tetracycline should be taken 1 hour before, or 2 hours after, any food consumption. Retinoic acid is a prescription drug, whereas salicylic acid and benzoyl peroxide are available in over-the-counter topical agents.

A 14-year-old girl complains of painful menstruation and is diagnosed with primary dysmenorrhea. What is the recommended treatment for this disorder? A) Cold compresses on the abdominal area B) NSAIDs 1 to 2 days before menses begin C) Hot baths D) Antibiotic therapy

Ans: B Feedback: Treatment of primary dysmenorrhea is symptomatic. Administration of NSAIDs 1 to 2 days before the beginning of menses prevents the formation of prostaglandins and helps reduce discomfort and inflammation. Warm baths and relaxation techniques also help reduce pain. In severe cases, oral contraceptives may be used. Antibiotic therapy is not used to treat dysmenorrhea.

A client is undergoing an appendectomy. Which of the following is accurate information regarding appendicitis? A) Abdominal pain localizes to the left upper quadrant. B) Appendicitis is always treated with IV antibiotics. C) Fever, nausea, and vomiting are commonly present. D) Untreated appendicitis leads to pericarditis.

Ans: C Feedback: Appendicitis is an acute infection of the vermiform appendix. Abdominal pain begins in the periumbilical area and localizes in the right lower quadrant. Fever, nausea, and vomiting are commonly present.

A 16-year old client has been diagnosed with anorexia nervosa. The client appears very thin. The client does not have proper dietary intake and is obsessed with losing weight. Which of the following is true for a client with anorexia nervosa? A) There is usually a long-term history of being underweight. B) Weight loss is associated with an underlying physical cause. C) Extreme and persistent hunger is an important sign. D) Even slight weight gain is followed by depression. .

Ans: C Feedback: Extreme and always persistent hunger is an important sign in clients with anorexia nervosa. Predisposing factors often include low self-esteem, perfectionist behavior, and a history of being mildly overweight. Anorexia nervosa is characterized by extreme weight loss with no underlying physical cause. Slight weight gain in clients with anorexia nervosa does not lead to depression, although this can often lead to severe anxiety

The school nurse is teaching adolescents about sexually transmitted infections (STIs). Which of the following accurately describes a characteristic of these disorders? A) In the United States, most STIs occur in people older than 25. B) By law, physicians must report STIs treated in adolescents to their caregivers. C) A history of reproductive or urinary tract disorders may mask STIs. D) The incidence of some STIs is decreasing owing to condom use and public education.

Ans: C Feedback: Sexually active young adults with a history of reproductive and/or urinary tract disorders may have STIs that are not obvious or have not been detected. Most STIs in the United States occur in people younger than age 25. Physicians must, by law, treat an adolescent with an STI without reporting the condition to the adolescent's family caregivers. The incidence of certain STIs is increasing, even with the massive amount of public education about safer sex and condom use.

A mother brings her 9-year-old son to a community health clinic with concerns about his sleep habits. The mother tells the nurse that her son walks in his sleep in the middle of the night and doesn't recall it in the morning. What condition is the mother describing? A) Somniloquism B) Insomnia C) Somnambulism D) Narcolepsy

Ans: C Feedback: Somnambulism (sleep walking) usually occurs during the later stages of non-REM sleep. Children usually do not recall sleep-walking episodes the next morning. Somniloquism (sleep talking) is common in young people. It may or may not be associated with sleep walking. The person can often carry on a logical conversation but will not remember it the next morning. Insomnia is difficulty falling asleep. Narcolepsy is a brief attack of irresistible sleep.

A mother brings her 10-year-old daughter to the pediatrician with concerns about her early sexual development. What is the term for this condition? A) Mittelschmerz B) Dysmenorrhea C) Precocious D) Bulimia nervosa

Ans: C Feedback: The development of secondary sexual characteristics is of particular concern to many adolescents. Precocious (early) and delayed sexual development may occur. These conditions are particularly distressing for adolescents because peer pressure is so significant at this developmental stage. Mittelschmerz is painful ovulation and dysmenorrhea is pain on menstruation. Bulimia nervosa is an eating disorder.

The camp nurse is teaching campers how to prevent Lyme disease. Which of the following is recommended advice? A) Wear dark-colored clothing. B) Wear sandals instead of sneakers. C) Use tweezers to remove a tick. D) Do not use spray repellants on children.

Ans: C Feedback: To avoid Lyme disease, the person should use tweezers to remove a tick by grasping the head and pulling it straight out without crushing the body. Light-colored clothes should be worn in order to see ticks, and sneakers and socks should be worn instead of sandals. Spray repellants should be used outside.

A 15-year-old boy visits the healthcare facility for information on acne. Which of the following should the nurse tell him about acne vulgaris? A) It is slightly more common in girls than in boys. B) It is caused by a lack of sebum secretion. C) It is not influenced significantly by the client's diet. D) It is not influenced by stress and hormonal changes.

Ans: C Feedback: Diet plays no significant role in the development or progression of acne; however, a well-balanced, nutritional diet is essential for the overall good health of the client. Acne vulgaris usually develops during puberty and is slightly more common in boys than in girls. Acne is usually caused by hormonal changes during puberty, along with oversecretions of sebum. Acne vulgaris is generally influenced by stress, because emotional stress seems to cause flare-ups of the condition.

The school nurse teaches a class of adolescents about eating disorders. Which of the following disorder is characterized by loss of control during overeating, followed by purging? A) Anorexia nervosa B) Obesity C) Enuresis D) Bulimia Nervosa

Ans: D Feedback: Bulimia nervosa, known as "gorge-purge syndrome," is an eating disorder characterized by loss of control during overeating, followed by purging. Typically, affected individuals rapidly eat large amounts of food, usually in secret. Following such binges, they attempt to purge their systems of food through self-induced vomiting or laxative and diuretic use. Anorexia nervosa is characterized by extreme weight loss with no underlying physical cause. Obesity is defined as being in excess of 20% of optimum weight, and enuresis is bedwetting.

During a routine medical examination of a 15-year-old boy, the attending nurse notices that the client is overweight for his age group. On further examination, the client is found to be overweight by more than 40% of his optimum weight. Which of the following client teachings must the nurse provide when caring for the client and his family members? A) Obesity is often related to an underlying disease. B) Calorie intake needs to be reduced by at least 5%. C) Obesity is often caused by slow thyroid function. D) Obesity usually increases the risk of developing lordosis.

Ans: D Feedback: Clients who are obese are at a higher risk of developing an exaggerated curvature of the lumbar spine (lordosis) because of the excess abdominal weight that distorts the person's center of gravity. Clients who are obese are usually suggested to decrease their total calorie intake by at least 30%, and not just 5%. Obesity is rarely caused by slow thyroid function. Obesity is rarely related to underlying causes (<5%).

A nurse is planning care for a 15-year-old boy who has acne vulgaris. Which of the following is a long-term goal for this client? A) Client will identify the causes of acne and preventive measures. B) Client will verbalize measures for appropriate skin care and control of acne. C) Client will describe acne and its treatment measures. D) Client will verbalize a decrease in lesions by next visit.

Ans: D Feedback: Determining the client's understanding of acne and its treatments are short- term goals that provide a baseline from which to develop a teaching plan and appropriate strategies. Voicing a decrease in lesions is a long-term goal following treatment.

An adolescent is diagnosed with narcolepsy. Which of the following is a characteristic of this disorder? A) It is an extended attack of irresistible sleep. B) It is caused by an underlying physical condition. C) It interrupts nighttime sleep. D) It is accompanied by an early appearance of REM sleep.

Ans: D Feedback: Narcolepsy is a brief attack of irresistible sleep. An alteration in the young person's emotional state often precipitates this condition. Underlying contributing factors for narcolepsy may be traced to some type of conflict, competition, or unacceptable aggression. Boys are more likely to be affected than girls. Nighttime sleep is basically normal; however, tests usually detect an earlier appearance of REM sleep, which under normal circumstances, occurs toward morning and is marked by dreams.

An 8-year-old client returns from a camping trip with complaints of flu-like symptoms and distinct red ring-shaped rashes over the trunk. The client is diagnosed with Lyme disease. Which of the following information should the nurse provide to the client's mother? A) The bacteria are transmitted to humans through the wood tick. B) All clients with Lyme disease develop the rash over the skin. C) Symptoms appear immediately following the tick bite. D) It can lead to the development of angina and facial palsy.

Ans: D Feedback: Several weeks after a tick bite, if the condition is left untreated, the affected individuals may begin to complain of angina, facial palsy, chronic fatigue, or intellectual impairment. The bacteria causing Lyme disease are transmitted to humans from the deer tick and not the wood tick. the bacteria responsible for causing the condition enter the blood and settle in tissues, where they multiply. Symptoms of Lyme disease usually appear 3-31 days after the bite and not immediately.

A 12-year-old client is diagnosed with sleep apnea. Which of the following are symptoms of this disorder? A) Sleep walking without recall of event B) Uncontrollable urge for prolonged sleep C) Brief attacks of irresistible sleep D) Breathing stops for short periods of time during sleep

Ans: D Feedback: Sleep apnea occurs when a person stops breathing for short periods of time during his or her regular sleeping hours. Physical defects may be the causative factor, and this condition is not uncommon in individuals who are obese. Somnambulism, also referred to as sleep walking, is a common sleep disorder in children, characterized by walking in the sleep, followed by inability to recall the event the following morning. The uncontrollable urge to sleep, characterized by prolonged sleep periods (12-18 hours), is often seen in clients with hypersomnia. Brief attacks of irresistible sleep are characteristic of clients with narcolepsy.

During the routine medical examination of a 5-year-old client, the client's parents ask the nurse for suggestions regarding a nutritious diet for their child. What suggestion should the nurse provide? A) Provide a maximum of 500 mg of cholesterol daily. B) Encourage the child to learn by himself about good food choices. C) Instruct the parents to provide only 10% of calories from fat. D) Instruct the parents to introduce new foods in small servings.

Ans: D Feedback: When introducing new foods at the table, the client's parents are instructed to offer them one at a time in small servings. A maximum of 300 mg of cholesterol is to be provided to prevent the incidence of heart attack. The client's parents are suggested to teach the child how to make good food choices and to avoid completely nonnutritive, high-calorie, high-fat snacks. A minimum of 30%, and not 10%, of the calories should come from fat, with only 10% coming from saturated fats.

A 15-year-old client with complaints of night blindness, nearsightedness, and tunnel vision has been diagnosed with retinitis pigmentosa. Which of the following statements are true in a client with retinitis pigmentosa? A) Cataracts and glaucoma are uncommon in clients with retinitis pigmentosa. B) Retinitis pigmentosa generally occurs owing to a viral infection of the eye. C) Retinitis pigmentosa is often associated with hearing disorders. D) The client is advised to avoid using dark glasses during the day

C Feedback: Clients with retinitis pigmentosa often develop hearing disorders along with macular degeneration. Retinitis pigmentosa is often associated with other ocular disorders, such as cataracts, glaucoma, or blind spots. Retinitis pigmentosa is a hereditary condition and is not caused by viral infections. The client with retinitis pigmentosa is usually advised to wear dark glasses in bright sunlight to avoid further eye irritation and to enhance remaining vision.