Pediatric Exam IV

A high school student calls to ask the nurse for advice on how to care for a new navel piercing. How should the nurse respond? 1. "Avoid contact with another person's bodily fluids until the area is well healed." 2. "Do not move or turn the jewelry for the first three days." 3. "Apply lotion to the area, rubbing gently, to prevent skin from becoming dry and irritated." 4. "Apply warm soaks to the area for the first two days to minimize swelling."

1

A mother of two children, an 8-year-old and a 10-year-old, tells you that her husband has recently been deployed to the Middle East. The mother is concerned about the children's constant interest in watching TV news coverage of activities in the Middle East. The most appropriate suggestion for the nurse to make to this mother would be: 1. "Spend time with your children, and take cues from them about how much they want to discuss." 2. "Allow the children to watch as much television as they want. This is how they are coping with their father's absence." 3. "The less that you discuss this, the quicker the children will adjust to their father's absence. Try to keep them busy and use distractions to keep their mind off of it." 4. "It will just take some time to adjust to their father's absence and then everything will return to normal."

1

A parent is concerned about her eight-year-old child's recent behavior and calls the nurse for advice. According to the parent, her child is constantly crying, is not sleeping well, and has withdrawn from activities. The nurse should recognize that this behavior could be a response to: 1. Bullying. 2. Normal behavior for the age. 3. Lead poisoning. 4. Drug abuse.

1

The nurse is working with the mother of a child with autism. The goal of the session is to plan strategies to increase the child's socialization. The nurse is explaining behavior modification as a treatment process. The nurse will encourage the mother to: 1. Create a reward system when the child interacts with a person. 2. Punish the child when the child's social behaviors are inappropriate. 3. Use dolls to demonstrate appropriate social interactions to the child. 4. Enroll the child in a day care to encourage interaction with other children.

1

The school nurse in the high school recognizes that teenage pregnancy is a major problem in the school. The nurse recognizes that many high school girls hide their pregnancy to prevent adults from knowing they are pregnant. Therefore, it is important that the nurse insure that all pregnant teenagers are aware of: 1. Safe haven laws. 2. Birth control available to all teenagers. 3. Domestic abuse protection. 4. The father's financial responsibility for the infant.

1

The waiting room of the mental health clinic is full of children with various mental health issues. The nurse watches the children and notes that which child is displaying symptoms of autism? 1. Four-year-old girl who doesn't make eye contact with mother and resists the mother's touch 2. Three-year-old boy who joins one group of children then moves to another group of children without joining their activities 3. 18-month-old child who walks around the area using the furniture to provide balance 4. Six-year-old boy who chatters constantly to anyone who will listen

1

A child is brought to the emergency department in a coma. The mother thinks the child may have ingested a poison. The nurse will assess: Standard Text: Select all that apply. 1. For burns around the mouth. 2. The child's breath. 3. The child's vomitus. 4. Hair samples. 5. Blood and urine toxicology screens.

1,2,3,5

A seven-year-old girl has been clinging to her mother and refusing to go to school. The child is diagnosed with separation anxiety disorder, and the treatment plan will include cognitive-behavioral therapy (CBT). The nurse would explain to the parents that CBT will include: Standard Text: Select all that apply. 1. Self-talking. 2. Relaxation. 3. Hypnosis. 4. Anti-depressant medications. 5. Recognition of feelings.

1,2,5

The pediatric public health nurse visits a facility for the homeless. The nurse would evaluate the children staying at the facility for what type of medical/health issues? Standard Text: Select all that apply. 1. Dental caries 2. Infections secondary to tattoos 3. Lack of immunizations 4. Nutritional deficits 5. Munchausen syndrome by proxy

1,3,4

Regular TV use should be discouraged in children in ages ________ because the child needs constant human reactions in which the child can respond and see you react to those responses

1-3 years old

Mental retardation must be diagnosed before_________ otherwise considered trauma or injury

18 years if age

A child is admitted for scald burns to his buttocks and thighs. According to the mother, she was preparing the child's bath and before she could test the water, the child fell in and was scalded. The nurse would suspect child abuse because: 1. The burns are uneven, with some burns deeper than others. 2. The child's hands and feet are free of burns. 3. In addition to the main burn site, there are splash burns surrounding the area. 4. The mother was home alone with the child.

2

A young infant is admitted to the hospital unit with physical injuries. The nurse is taking the child's history. The statement by the parent that would be most suspicious for abuse is: 1. "I was walking up the steps and slipped on the ice, falling while carrying my baby." 2. "The baby's 18-month-old brother was trying to pull the baby out of the crib and dropped the baby on the floor." 3. "I placed the baby in the infant swing. His six-year-old brother was running through the house and tripped over the swing, causing it to fall." 4. "I did not realize that my baby was able to roll over yet, and I was just gone a minute to check on dinner when the baby rolled off of the couch and onto our tile floor."

2

The school nurse is planning a smoking prevention program for middle school students. All of the following activities will be utilized. Which is likely to be the most effective in preventing middle school children from smoking? 1. A demonstration of the pathophysiology of the effects of smoking tobacco on the body given by the school's biology teacher 2. A talk on the importance of not smoking given by a local high school basketball star 3. Colorful posters with catchy slogans displayed throughout the school 4. A pledge campaign during which students sign contracts saying that they will not use tobacco products

2

While working at a weekend "free clinic," the nurse is assessing a three-year-old when the mother of the child confides that it has been very difficult providing for her family of four children on her limited budget. She is not sure that she has enough money to buy both food for the rest of the month and the antibiotic that is needed for the child's ear infection. Which intervention by the nurse would be most beneficial for the child and this family? 1. Talking with the mother about keeping the child's ear clean by using a Q-tip 2. Putting the mother in contact with a local agency that provides food on a regular basis to needy families and helps them access other resources in the community 3. Providing the mother with samples of food and food stamps for the child 4. Giving the mother free samples of an antibiotic.

2

A child is admitted to the hospital with a diagnosis of lead poisoning. The health department nurse is investigating the child's home to locate the source of the lead that the child has ingested. Which possibilities will the nurse investigate? Standard Text: Select all that apply. 1. The home's foundation for a possible radon leak 2. The home's water pipes 3. The dirt surrounding the house 4. The presence of imported toys or antique baby furniture 5. Gas stored in cans

2,3,4

The nurse recognizes that the person guilty of child abuse may have which symptoms? 1. Physical illness 2. Alcoholism 3. Many friends and families nearby 4. Unrealistic expectations for their child 5. The abuser has no relationship to the child.

2,4

The mother tells the nurse that her maternity leave is almost over and she will be returning to work soon. She will need to place her infant in a day care, and she asks the nurse how to know which day care is best. The nurse will tell the mother to investigate day care programs that: Standard Text: Select all that apply. 1. Are close to her work in the event of an emergency 2. Require all staff have criminal background checks 3. Are attractive in appearance, with bright colors and interesting visual stimulation 4. Provide regular training of the staff and administration 5. Have policies regarding child health and emergencies, such as immunization requirements and emergency medical forms

2,4,5

A child with autism is being admitted to the hospital with dehydration. Upon admission, the nurse should: 1. Encourage the parents to avoid bringing favorite toys from home that might be lost. 2. Take the child on a tour of the pediatric unit. 3. Assign the child to his single-bed hospital room. 4. Take the child to the playroom for arts and crafts.

3

A concerned parent calls the school nurse because of changes in his 15-year-old's behavior. Which behaviors would the nurse identify as most likely to be abnormal and indicate possible substance abuse in an adolescent? 1. Becoming very involved with friends and in activities related to the basketball team that she is on, never seeming to be home, and, when she is home, preferring to be in her room with the door shut 2. Becoming moody, crying, and weeping one minute and then cheerful and excited the next 3. Receiving numerous detentions lately from teachers for sleeping in class 4. Buying baggy, oversized clothing at thrift shops and dyeing her hair black

3

A mother brings her 11-year-old son to the pediatric clinic for investigation of stomach complaints. The mother says that for the last two months, the child has complained of abdominal pain three to four mornings per week. The mother states the child usually complains on school days and always seems to be better by afternoon. The child was able to attend a weekend Boy Scout camp without difficulty but has missed several days of school due to complaints. The nurse would suspect which mental health disorder? 1. Separation anxiety 2. Depression 3. School phobia 4. Bipolar disorder

3

A mother brings her 22-month-old child to the well-child clinic for an evaluation. The mother states that this child does not seem to be developing like her sister's child of the same age. The nurse will perform which screening test that may provide information about the child's development? 1. MRI of the head 2. An EEG 3. A Denver II 4. Chromosomal study

3

A nine-year-old has been diagnosed with a learning disorder that is characterized by problems with manual dexterity and coordination. The nurse teaches parents that this disorder is called: 1. Dysgraphia. 2. Dyscalculia. 3. Dyspraxia. 4. Dyslexia.

3

The mother of a six-year-old brings her son to the physician because his teacher thinks he might have attention deficit/hyperactivity disorder (ADHD). The nurse is interviewing the mother about the child's history. The nurse knows that which factors could be associated with ADHD? 1. Measles, mumps, and rubella vaccine 2. Advanced parental age 3. Prenatal exposure to smoke 4. Immune response

3

The nurse is assessing a child with Down syndrome. The child is at greater risk of developing which illness than children who do not have Down syndrome? 1. Rheumatic heart disease 2. Glomerulonephritis 3. Leukemia 4. Hepatitis

3

The nurse knows that the mother of a six-year-old needs more teaching about her son's diagnosis of ADHD when she states: 1. "I will develop a reward system for desired behaviors." 2. "I will take my child to the physician every three months for a weight and height check." 3. "I will let him do his homework while he is watching his favorite television show." 4. "I will stick to the same routine each day after school."

3

The nurse works in a pediatric unit. In working with a parent who is suspected of Munchausen syndrome by proxy, it is very important for the nurse to: 1. Try to keep the parent separated from the child as much as possible. 2. Explain to the child that the parent is causing the illness and that the health care team will prevent the child from being harmed 3. Carefully document parent-child interactions. 4. Confront the parent with concerns of possible abuse.

3

The nurse at a high school is screening students for mental health issues. The nurse would want to refer the adolescent for depression if the child shows which symptoms of depression? Standard Text: Select all that apply. 1. Agoraphobia 2. Somatic complaints 3. Focus on violence 4. Poor self-care 5. Poor school performance

3,4,5

The school nurse and teacher are working on a plan to improve the behavior and learning of a child recently diagnosed with attention deficit/hyperactivity disorder (ADHD). Which activities will the nurse suggest be included in the plan? Standard Text: Select all that apply. 1. Asking the mother to seek a prescription for methylphenidate (Ritalin) for the child 2. Placing the child's desk at the back of the room to reduce distractions 3. Developing a consistent routine for the classroom 4. Limiting the decorations in the classroom 5. Determining areas where the child performs well and using these areas to promote self-esteem

3,4,5

A seven-year-old child has been seen in the pediatric clinic three times in the last two months for complaints of abdominal pain. On each occasion, the physical exam and all ordered lab work have been normal. The most important information to assess at this time would be: 1. The child's normal eating habits. 2. Recent viral illnesses or other infectious symptoms. 3. Review of the child's immunization history. 4. Changes in school or home life.

4

During a well-child exam, the parents of a four-year-old child inform the nurse that they are thinking of buying a television for their child's bedroom and ask for advice as to whether this is appropriate. The best response from the nurse would be: 1. "It is okay for children to have a television in their room as long as you limit the amount of time they watch it to less than two hours per day." 2. "Research has shown that watching educational television shows improves a child's performance in school." 3. "Don't buy a television for your child's room; he is much too young for that." 4. "Research has shown that children with a television in their bedroom spend significantly less time playing outside than other children."

4

The child is admitted to the hospital unit for injuries. The mother's boyfriend is suspected of child abuse. The nurse's primary role, in addition to reporting to the proper authorities, is: 1. Gathering information about how the injuries occurred. 2. Collecting evidence against the suspected abuser. 3. Encouraging the child to talk about his experience. 4. Protecting the child from further injury.

4

The nurse is providing care to homeless teens at an outreach clinic. Which of the following is most important for the nurse to understand? 1. Teens who are homeless will get a job and somewhere to live. 2. Teens who are homeless will seek help when needed. 3. Teens who are homeless will not be fearful of authority figures. 4. Teens who are homeless are most likely to have unprotected sex.

4

The school nurse notices a sixth-grade girl with bald patches in her hair. The hair itself is clean and shiny. Prior to referring the girl to her healthcare provider for alopecia, the nurse would want to watch the child for signs of: 1. Lice. 2. Dietary imbalances. 3. Schizophrenia. 4. Trichotillomania.

4

While the nurse is taking the history of a 10-year-old child, the parents admit to owning firearms. An appropriate safety measure for the nurse to suggest would be which of the following? 1. Keeping all the guns put away and out of the child's reach 2. Taking the child to a shooting range for lessons on how to use a gun properly 3. Storing the guns and ammunition in the same place 4. Using a gun lock on all firearms in the house

4

A nurse is performing a developmental assessment on several children in a clinic setting. Which children exhibit a delay in meeting developmental milestones? Standard Text: Select all that apply. 1. An 18-month-old toddler who is unable to speak in sentences 2. A two-year-old who is unable to cut with scissors 3. A two-year-old who cannot recite her phone number 4. A six-year-old who is unable to sit still for a short story 5. A five-year-old who is unable to button his shirt

4,5

Brain develops from fetal neural tube during first ____ to _____ weeks of gestation

4-6

Denver Developmental Screening Tool can be used up to ___ years of age and covers what 3 areas

6 Fine and gross motor Language development Personal-Social Skills

Mental Retardation is defined as having and IQ of less than ___-___ and ___________ behavior in at least 2 areas

70-75, adaptive

Peak age to try tobacco?

9-14 years

Children with delays in self-regulation, difficulty finishing tasks, and fidgeting behavior most likely have

ADD or ADHD

When caring for children with ASD, the nurse should take particular care in the hospital because the children have difficulty

Adapting to new situations

At what age are you capable of advanced thinking processes

Adolescence

At what age does the brain mature

Around 5 years of age

What type of therapy can be used with all ages?

Art therapy

Children with this type of autistic disorder are high functioning individuals with impaired social interactions and low language comprehension

Asperger's Syndrome

Therapy that is planned on the basis that learned behavior can be unlearned

Behavioral therapy

Common issue that leads to school phobia

Bullying

Therapy used for children with school phobia

CBT

Hypnosis is easier on adults or children?

Children

Therapy that is used to recognize the automatic negative thinking that individuals feel that can become problematic

Cognitive Therapy

Adaptive behavior areas for mental retardation

Communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, safety

Conditions associated with Down Syndrome

Congenital heart defects, hearing loss with frequent otitis media, strabismus, gastrointestinal problems, orthodontic problems, hypothyroid disease, leukemia, diabetes

The nurse is assessing a four-year-old child with a possible alteration in mental health. Which findings indicate a need for further investigation? Standard Text: Select all that apply. 1. Fails to make eye contact 2. Flinches when touched on the arm 3. History of limited prenatal care and precipitant delivery 4. Head circumference has not changed in over one year 5. Flat facial expressions

Correct Answer: 1,2,3,5

difficulty with math and computations

Discalculia

difficulty writing, spelling and composition

Dysgraphia

difficulty with writing, reading and spelling

Dyslexia

difficulty with manual dexterity & coordination

Dyspraxia

Children taking stimulants should have ______ prior to prescribing

EKG

True or False Children usually present with one mental illness

False-usually more than one

True or False You should question family members separately if abuse is suspected and question the eldest child first because they are most likely to tell the truth

False-you should question the youngest first because they are most likely to forget a fabricated story or remember what should be said.

Type of therapy that considers the influence of the family and how the individual reflects the family's influence—also focuses on the relationships among family members

Family Therapy

Characteristics of FAS

Flat mid-face, low nasal bridge, narrow upper lip, short up-turned nose, poor coordination, failure to thrive, hearing loss, and skeletal and joint abnormalities

Physical characteristics of Down Syndrome

Flattened nose and face, upward slanting eyes, low set ears, single palmer crease, short 5th finger, widely separated 1st and 2nd toes and increased skin creases

If a child with Asperger Syndrome is hospitalized, the nurse should

Follow rituals and routines that are used at home and ask about a special toy or activity that reduces the child's stress

Education for All Handicapped Children Act

Free appropriate education to all children with handicaps from 2-21 years of age

Therapy that is helpful with adolescents who are peer-oriented—group members act as therapists so there can be multiple therapists in a group as they talk and discuss and help each other.

Group Therapy

Common somatic complaints associated with school phobia

Headaches, nausea, stomachache

Important to remember with piercings and tattoos to teach them that some places do not properly sterilize needles putting them at risk for

Hepatitus and HIV

When is it most obvious that children have and attention deficit disorder?

In the classroom

Classic Symptoms of ADD and ADHD

Inattention Hyperactivity Impulsivity

Type of therapy in which child and therapist establish long and short goals and work together to reach those goals

Individual therapy

Common side effects of stimulant drugs (3)

Insomnia, anorexia, tachycardia

Conditions that may affect ADD and ADHD

Lead and Mercury Exposure Prenatal Alcohol and Drug exposure Genetic predisposition with environmental influences

Common causes of learning disabilities

Low birth weight, prenatal difficulties, genetic predisposition

Red Flags for Autism

No babbling or communicating with gestures by 12 months No Single words by 16 months No spontaneous 2 word phrases by 24 months Loss of language or Social skills previously achieved

Type of therapy often used for younger children who have been sexually abused

Play therapy

What type of therapy is best for preschoolers and toddlers

Play therapy

Americans with Disabilities act

Public accommodations, transportation, commercial facilities, and local state, & federal government services must be accessible to handicapped individuals

Autism Spectrum Disorder can lead to impairments in (4)

Social Interactions Communication Adapting to new situations Attention Span & Organizing responses to situations

Persistent, irrational or excessive fear of negative evaluation or embarrassment in social situations

Social Phobia

Nursing Care for ASD

Stabilize the environment Provide Supportive Care Enhance Communication Safe Environment Anticipatory Guidance Not to Cure but to manage

Red flags for learning disabilities

Unable to phrase sentences by 2 ½ yrs Understandable speech less than 50% of time by 3 yrs Unable to tie shoes, button, hop, or cut with scissors by kindergarten Unable to sit for a short story by 3-5 yrs

Therapy that uses progressive relaxation and depending upon the ability of the child may or may not be effective. Has been used depending on the child to help with anxiety issues and chronic pain

Visualization & Guided Imagery

4 main risks with tattoos

allergic reaction to the ink development of scar tissue-keloids risk for infection formation of granulomas near a tattoo

Oppositional Defiance Disorder is a conduct disorder that is chronic in which the child may harm ________ and is seen in 2-16% of children. There are no ____________ and treatment is __________

animals, medications, psychotherapy

Nurses are mandated reporters of ______&______ abuse

child and elder

Children with ODD

do not follow the acceptable rules of society including running away from home, lying, truancy, sexually active at a young age, drug use, and burglary with little or no guilt or remore.

PUBLIC LAW 99-457

early intervention services for infants & toddlers with developmental delays using federal funds

Children do not usually make ___ _______ and should believe the child until proven wrong

false allegations

Slow achievement of developmental milestones are a red flag for

further evaluations and screenings

Children who bully have a tendency to be involved in

intimate domestic violance

Developmental influences active on

mental health

Medications used for ADD and ADHD

methylphenidate(Ritalin/Concerta) Dextroamphetamine (Adderall) Atomoxetine (Strattera)-non-stimulant

When speaking to children about tobacco use, it is important to keep a ______________ attitude

nonjudgemental

Most common abusers

parent/guardian or male friend of child's mother and associated with substance abuse

Tattoos teach patients to

powders, lotions to reduce irritation. Do no rub

Peircings teach patient to

rotate device, keep clean and dry, mouth piercings increases risk for infective edocarditis

Problems that may occur along with mental retardation

sensory impairment Speech problems Motor disability Seizure disorders

Bullying is considered any of the following

verbal abuse, name calling, social exclusion, spreading rumors, threats, and physical abuse