nursing care of child with an alteration in behavior, cognition, or development chapter 50

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?

Autism

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 by the nurse?

"Coping and adaptation are often affected by intellectual disabilities."

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

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

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

"He has started sleeping for only 3 hours each night." "He has lost 10 pounds over the last 4 months." "He used to be a straight-A student and now he's bringing home Cs and Ds."

A 14-year-old girl is brought to the emergency department saying she was sexually assaulted. She tells the nurse that she feels guilty for having gone to a party where alcohol was being served. What is the nurse's best response?

"No one deserves to be raped, even going to a party with alcohol."

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

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

A nurse is examining a 4-year-old child with various injuries in multiple places. Which site of injury would introduce suspicion of abuse?

Abdomen

An adolescent has been diagnosed with bulimia, and the parents are asking how to best deal with this problem. What suggestion should the nurse make to the parents to help care for the adolescent?

Develop a contract with the adolescent, setting goals of behavior and her diet, as well as privileges gained by meeting the contracted goals.

The drug most commonly abused by children and adolescents is:

alcohol.

An adolescent has been diagnosed with oppositional defiant disorder. Which symptom does the nurse anticipate?

angry outbursts directed at authority figures

A mother is suspicious that her adolescent has bulimia because the child seems to be dependent upon laxatives and vomits frequently after eating a meal. What physical finding would be most suggestive of this diagnosis?

dental erosions and caries

Candace, age 16, 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 6 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 if the child:

is planning to commit suicide

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

schedule an immediate history and physical examination.

When can autistic behaviors first be noticed?

1 year of age

The nurse is assessing a 7-month-old infant brought to the pediatrician's office by the mother for immunizations. The infant's last immunizations were received at 2 months of age. What physical finding would be suggestive of the diagnosis of nonorganic failure to thrive (NFTT) for this child? Select all that apply.

poor muscle tone listlessness rumination

While interviewing an adolescent client with depression, the client reveals to the nurse that he has considered hurting himself. Which response by the nurse would be most appropriate?

"Tell me exactly how you would hurt yourself."

A nursing student is learning about developmental disorders. The nursing instructor realizes that further instruction is necessary when the student makes which statement?

"A definitive cause can be found for every developmental disorder."

Which treatment modality is especially helpful for adolescents?

Group therapy

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

Insensitivity to pain

The nurse is caring for a 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?

Medical child abuse

A nurse is caring for a 17-year-old female client with bulimia. Which complication of this disease may the nurse see in this child?

Menstrual problems

Which sign or symptom suggests depression in a child?

Somatic complaints and acting-out behavior

The nurse is caring for a 12-month-old child diagnosed with an autism spectrum disorder. What information from the mother during the health history should the nurse identify as being consistent with the disorder?

The child constantly stares at a rotating wheel on the crib mobile.

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

Use a repetitive series of movements.

A nurse in a residential foster home is caring for a 17-year-old client with conduct disorder. The client is using profanity and refusing to complete assigned chores. The nurse reminds theclient that there are only five minutes in which to finish. The client throws a dirty plate at the wall. How should the nurse respond?

"I am sorry you are feeling so angry tonight but you must still complete your chores."

An extremely thin preadolescent is being assessed by the nurse. Which client statement should the nurse identify as being consistent with that of a person with anorexia nervosa?

"I feel chubby no matter what I wear."

What would be the priority goal for the nurse caring for an infant diagnosed with nonorganic failure to thrive?

Provide adequate nutrition for growth.

The nurse is working with school-aged children who are having enuresis or encopresis. What will most likely be the first step in this child's treatment?

The child will have a complete physical exam

A 10-year-old girl with attention-deficit/hyperactivity disorder (ADHD) has been on methylphenidate for 6 months. The girl's mother calls and tells the nurse that the medication is ineffective and requests an immediate increase in the child's dosage. Which response by the nurse would be most appropriate?

"Let's set up an appointment for you to come in 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?

"Speak to the doctor about atomoxetine."

The mother of a 10-year-old boy phones the school nurse. The child has attention deficit/hyperactivity disorder (ADHD) and must go to the office to take medication at lunchtime. The child informed the mother that kids have been making fun that he no longer wants to take the medication. Which is the nurse's best response?

"You can speak with your doctor about extended-release medications for treatment of ADHD."

A 15-year-old Vietnamese-American boy has been referred by his homeroom teacher to the school nurse for evaluation. The teacher is concerned that the adolescent may be suffering from major depression. When investigating these concerns at the family's primary care office, the nurse would use which person as the primary source of information?

The client

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. How would the nurse document this in the medical record?

The client has regressed to encopresis.

Which statement is true regarding the use of pharmacologic agents in children with anxiety disorders?

Anxiolytics and selective serotonin reuptake inhibitors (SSRIs) have been shown to help reduce anxiety.

The nurse is caring for a 13-year-old girl with a nursing diagnosis of Ineffective coping related to inability to deal with life stressors as evidenced by few or no meaningful friendships and low self-esteem. Which intervention would be the priority to promote coping skills?

Encourage her to discuss her thoughts and feelings.

A 6-year-old client has been diagnosed with autism spectrum disorder. Which symptoms would the nurse expect the client to display?

The client spends time alone and shows little interest in making friends

The mother of a school-age child is distraught over the ongoing oppositional behavior demonstrated by the child at home and at school. Which nursing diagnosis should the nurse select as appropriate for the child and family?

Interrupted family processes related to inability of child to follow instructions

A young mother brings her school-aged child to the office for a sports physical examination. During the appointment, the mother informs the nurse that she is worried about her child, who does not like school and does not seem to be reading, writing, or spelling as well as others in the class. The mother adds that the child struggles to get organized and to manage time. What condition does the nurse suspect?

Learning disorder

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

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

A nurse is reviewing the history of a child who was diagnosed with oppositional defiant disorder. Which findings would the nurse note that the child has exhibited for about the last year? Select all that apply.

Refusal to comply with the rules Blaming of others for own mistakes Frequent anger outbursts

A 7-year-old boy being treated for depression will most likely be given which first-line pharmacological treatment?

Selective serotonin reuptake inhibitors

What is an example of impaired adaptive functioning in an 8-year-old girl with a developmental disorder?

The child cannot properly dress herself

Which sign or symptom suggests that a 5-year-old boy who does not maintain eye contact or speak may have autism spectrum disorder (ASD)?

The child constantly opens and closes his hands

What finding would suggest that a 5-year-old boy might have a developmental disorder?

The child is not able to follow directions.

Which approach to drug education would be most effective for a group of school-age children?

providing the children with strategies of how to refuse offers of drugs