Peds- Chapter 50
Assess for risk factors for abuse in children which include: SATA A) Poverty B) Prematurity C) Cerebral palsy D) Chronic illness E) Intellectual disability F) African American descent
A) Poverty B) Prematurity C) Cerebral palsy D) Chronic illness E) Intellectual disability
A delay in seeking medical treatment, a history that changes over time, and or a history of trauma that is inconsistent with the observed injury all suggest what?
Child abuse
The nurse is caring for a 13-year-old boy with a history of inappropriate behavior. Which statement by the mother would lead the nurse to suspect oppositional defiant disorder rather than conduct disorder? A) "He has frequent temper tantrums." B) "He was pulling the neighbor's dog around by his leash." C) "He is constantly lying to me." D) "He has stolen hundreds of dollars from my purse."
A) "He has frequent temper tantrums." Feedback: Reports of frequent temper tantrums point to oppositional defiant disorder rather than conduct disorder. Reports of cruelty to animals, excessive lying, and stealing point to conduct disorder.
The nurse is caring for a child who takes dextroamphetamine for treatment of ADHD. Which comments by the patient or family would concern the nurse? Select all that apply. A) "I take my sustained released capsule at night before I go to bed." B) "We have noticed that our child shows very little emotion over the last few weeks." C) "I haven't noticed any difference in my appetite." D) "Sometimes my head hurts a little for a short time after I take my medicine." E) "We notice our child gets a little irritable occasionally."
A) "I take my sustained released capsule at night before I go to bed." B) "We have noticed that our child shows very little emotion over the last few weeks." Feedback: Psychostimulants, such as dextroamphetamine, should be taken in the morning in order to avoid difficulty sleeping. A flat affect is a sign of dosages that are too high. Decreased appetite, headache, and irritability are common side effects.
The nurse is caring for a child with bipolar disorder. The child is taking lithium as ordered. The parents inquire about the potential side effects. Which response by the nurse would be most appropriate? A) "You might see excessive urination and thirst, tremor, nausea, weight gain, and diarrhea." B) "He might experience a significant decrease in his appetite and difficulty sleeping." C) "You need to watch for dry mouth, urinary retention, and constipation." D) "This medication can cause seizures, agitation, headache, and nausea."
A) "You might see excessive urination and thirst, tremor, nausea, weight gain, and diarrhea." Feedback: The nurse needs to explain that the potential side effects of lithium include polyuria, polydipsia, tremors, nausea, weight gain, and diarrhea. Decreased appetite and difficulty sleeping are associated with psychostimulants. Anticholinergic effects such as dry mouth, urinary retention, and constipation are often associated with tricyclic antidepressants as well as a-agonist antihypertensive agents such as clonidine. Seizures, agitation, headache, and nausea are associated with atypical antipsychotic agents.
A school nurse is working with the parents of an 8-year-old who has Tourette syndrome on how best to accommodate the child. What advice would be most helpful? Select all that apply. A) Allowing for breaks when tics occur B) Providing for "time-outs" during the day C) Using a tape recorder to take notes D) Ensuring a specified amount of time for test taking E) Implementing a reward system for behavior
A) Allowing for breaks when tics occur C) Using a tape recorder to take notes Feedback: Together the school nurse and parents should arrange for classroom accommodations such as allowing for "tic breaks," taking untimed tests or tests in another room, or using note takers or tape recorders. Time-outs and reward systems are more appropriate for the child with ADHD.
Identify abuse and violence by screening all parents using which questions? SATA A) Are you afraid of anyone at home? B) Does your husband hit you? C) Do you ever feel like you may hit or hurt your child when frustrated?
A) Are you afraid of anyone at home? C) Do you ever feel like you may hit or hurt your child when frustrated?
Injury sites that are common of child abuse include: SATA A) Between the eyes (head) B) Lower/upper back C) Groin/inner thigh area D) Genitals E) Back of thighs/calves F) Buttocks G) Inside of arms H) Hands/Feet
A) Between the eyes (head) B) Lower/upper back C) Groin/inner thigh area D) Genitals E) Back of thighs/calves F) Buttocks G) Inside of arms
Some signs of medical abuse within a child are: SATA A) Child with one or more illnesses that don't respond to treatment or that follow a puzzling course, a similar history in siblings B) Symptoms that do not make sense or that disappear when the perpetrator is removed or not present; the symptoms are witnessed only the caregiver C) Physical and laboratory findings that do not fit with the reported history D) Repeated hospitalizations failing to produce a medical diagnosis, transfers to other hospitals, discharges against medical advice. E) Patient who refuses to accept that the diagnosis is not medical
A) Child with one or more illnesses that don't respond to treatment or that follow a puzzling course, a similar history in siblings B) Symptoms that do not make sense or that disappear when the perpetrator is removed or not present; the symptoms are witnessed only the caregiver C) Physical and laboratory findings that do not fit with the reported history D) Repeated hospitalizations failing to produce a medical diagnosis, transfers to other hospitals, discharges against medical advice. E) Patient who refuses to accept that the diagnosis is not medical
A child is receiving therapy in which he is learning to replace automatic negative thought patterns with alternative ones. The nurse interprets this as which type of therapy? A) Cognitive therapy B) Behavioral therapy C) Milieu therapy D) Individual therapy
A) Cognitive therapy Feedback: Cognitive therapy teaches children to change reactions so that automatic negative thought patterns are replaced with alternative ones. Behavioral therapy uses stimulus and response conditioning to manage or alter behavior, reinforcing desired behaviors and replacing the inappropriate ones. Milieu therapy involves a specially structured setting designed to promote the child's adaptive and social skills. With individual therapy, the child and therapist work together to resolve the conflicts, emotions, or behavior problems.
Screen all infants and toddlers for warning signs of autism which include: SATA A) Delayed language/speech development (usually first sign) B) Eye contact abnormalities C) Does not imitate D) Lack of interest in joint attention E) Failure to develop symbolic-imaginative play F) Losing language or social skills at any age G) Inability to read at age 1
A) Delayed language/speech development (usually first sign) B) Eye contact abnormalities C) Does not imitate D) Lack of interest in joint attention E) Failure to develop symbolic-imaginative play F) Losing language or social skills at any age
A nurse is preparing a program for a parent group about various techniques that can be used to manage behavior. What would the nurse be least likely to include? A) Focus the child's attention on the negative behavior. B) Set limits with the child for responsible behavior. C) Ignore inappropriate behaviors. D) Provide positive Feedback for self-control efforts.
A) Focus the child's attention on the negative behavior. Feedback: Behavior management techniques include redirecting the child's attention when needed, setting limits for responsible behavior, ignoring inappropriate behaviors, and providing praise and positive feedback for the child's self-control efforts.
A nurse is preparing a teaching session for a group of parents with children newly diagnosed with attention deficit/hyperactivity disorder (ADHD). When explaining this disorder to the parents, what would the nurse include as being involved? Select all that apply. A) Impulsivity B) Inattention C) Distractibility D) Hyperactivity E) Defiance F) Anxiety
A) Impulsivity B) Inattention C) Distractibility D) Hyperactivity Feedback: ADHD is characterized by inattention, impulsivity, distractibility, and hyperactivity. Anxiety disorder and oppositional defiant disorder may be comorbidities associated with ADHD.
Signs/symptoms of autism include: SATA A) Infant resist cuddling B) Lack of eye contact C) Indifferent to touch/affection D) Have little change in facial expression E) Large, prominent posteriorly rotated ears F) Hyper pigmented lesions on skin G) Consistent failure to orient to one's name, regard people directly, use gestures, and to develop speech. H) Failure to point at objects and to gaze at an object jointly with another by 18 months
A) Infant resist cuddling B) Lack of eye contact C) Indifferent to touch/affection D) Have little change in facial expression E) Large, prominent posteriorly rotated ears F) Hyper pigmented lesions on skin G) Consistent failure to orient to one's name, regard people directly, use gestures, and to develop speech. H) Failure to point at objects and to gaze at an object jointly with another by 18 months
A school-age child diagnosed with depression is receiving antidepressant therapy. What behavior would the nurse instruct the parents to watch for and to notify the physician immediately if the child demonstrates it? A) Loss of interest B) Gastric upset C) Sedation D) Urinary retention
A) Loss of interest Feedback: Children taking antidepressants are at risk for the development of presuicidal behavior, which may be indicated by a loss of interest or pleasure. Gastric upset, sedation, and urinary retention may or may not occur, but none of these would be as important to report as the potential for self-harm.
The nurse identifies a nursing diagnosis of impaired social interaction related to altered social skills as evidenced by impulsivity and intrusive behavior. The nurse plans to identify factors that aggravate the child's behavior for which reason? A) Minimize stimuli that exacerbate the child's undesired behaviors. B) Improve the child's ability to deal with external stressors. C) Promote increased ability to follow through. D) Encourage the child to adopt expectations into his routine.
A) Minimize stimuli that exacerbate the child's undesired behaviors. Feedback: The nurse identifies aggravating factors to help minimize stimuli that exacerbate the child's undesired behaviors. This must be accomplished first before any other interventions would be effective. Improving the child's ability to deal with external stressors is achieved by modifying the environment to decrease distracting stimuli. Actions such as speaking directly to the child and maintaining eye contact promote engagement and an increased ability to follow through. Providing positive feedback encourages the child to adopt expectations into his routine.
The nurse is preparing an educational program on behavioral management techniques used in children to help alter negative behavior. What information should the nurse include? Select all that apply. A) Set limits and hold the child responsible for their behavior. B) Do not argue, bargain, or negotiate about the limits once established. C) Change caregivers occasionally so the child learns to respond to different people. D) Use a high-pitched voice and remain calm when speaking with the child. E) Ignore inappropriate behaviors.
A) Set limits and hold the child responsible for their behavior. B) Do not argue, bargain, or negotiate about the limits once established. Feedback: Behavior management techniques include setting limits and holding the child responsible for his or her behavior. Not arguing, bargaining or negotiating about the limits once established. Inappropriate behaviors should be ignored. Provide consistent caregivers and establish a daily routine. Use a low-pitched, not high pitched voice and remain calm when speaking with the child.
Signs of child abuse include: SATA A) History of hurting oneself/others B) Running away C) Attempting suicide D) Being involved in high-risk behaviors E) Inappropriate sexual behavior- seductiveness F) Chronic sore throat- forced oral sex or STIS G) Genital burning/itching H) Low self-confidence I) Sleep disturbance J) Hypervigillance K) Headaches L) Stomachaches
ALL OF THE ABOVE A) History of hurting oneself/others B) Running away C) Attempting suicide D) Being involved in high-risk behaviors E) Inappropriate sexual behavior- seductiveness F) Chronic sore throat- forced oral sex or STIS G) Genital burning/itching H) Low self-confidence I) Sleep disturbance J) Hypervigillance K) Headaches L) Stomachaches
The nurse is teaching the mother of a 12-year-old boy about the risk factors associated with drug and alcohol abuse. Which response by the mother indicates a need for further teaching? A) "A family history of alcoholism is a risk factor for substance abuse." B) "Just because his friends are experimenting does not mean that he will." C) "If my husband or I have a substance abuse problem it could increase his risk." D) "Negative life events are a potential risk factor."
B) "Just because his friends are experimenting does not mean that he will." Feedback: The nurse needs to emphasize that a peer group that abuses substances is a risk factor associated with substance abuse and increases the chances of a child experimenting. Other risk factors include a family history of substance abuse, current parental substance abuse, and negative life events.
Identify abuse and violence by screening all children using which questions? SATA A) Does your mother/father ever hurt or hit you? B) Are you afraid of anyone at home? C) Who could you tell if someone hurt you or touched you in a way that made you uncomfortable? D) Has anyone hurt you or touched you in that way?
B) Are you afraid of anyone at home? C) Who could you tell if someone hurt you or touched you in a way that made you uncomfortable? D) Has anyone hurt you or touched you in that way?
What would lead the nurse to suspect that an adolescent has bulimia? A) Body mass index less than 17 B) Calluses on back of knuckles C) Nail pitting D) Bradycardia
B) Calluses on back of knuckles Feedback: The adolescent with bulimia would exhibit calluses on the back of the knuckles and split fingernails and would be of normal weight or slightly overweight. A body mass index of 17, nail pitting, and bradycardia would suggest anorexia.
The nurse is caring for an adolescent girl with anorexia nervosa. What findings would indicate to the nurse that the girl requires hospitalization? A) Weight gain of one-half pound per week B) Food refusal C) Body mass index of 18 D) Soft, sparse body hair and dry, sallow skin
B) Food refusal Feedback: Food refusal, severe weight loss, unstable vital signs, arrested pubertal development, and the need for enteral nutrition warrant hospitalization. Soft, sparse body hair and dry, sallow skin are signs of anorexia, but do not warrant hospitalization. A weight gain of one-half pound per week indicates progress toward therapeutic goals. A body mass index of 18 is on the low end of the normal range of body mass.
A nurse is conducting a screening program for autism in infants and children. What would the nurse identify as a warning sign? A) Lack of babbling by 6 months B) Inability to say a single word by 16 months C) Lack of gestures by 8 months D) Inability to use two words by 18 months
B) Inability to say a single word by 16 months Feedback: Warning signs of autism include no babbling by 12 months, no pointing or using gestures by 12 months, no single words by 16 months, no two-word utterances by 24 months, and loss of language or social skills at any age.
A nurse is reviewing the medical record of an 11-year-old child with a conduct disorder. What would the nurse identify as characteristics of this disorder? Select all answers that apply. A) Easily annoyed B) Initiator of physical fights C) Temper tantrums D) Truancy E) Arrest for arson
B) Initiator of physical fights D) Truancy E) Arrest for arson Feedback: Behaviors associated with conduct disorder include initiation of physical fights, arson, and truancy. Becoming easily annoyed and experiencing temper tantrums are associated with oppositional defiant disorder.
The nurse working in a pediatric mental health clinic is assessing a 4-year-old child who has suffered from physical abuse. Which type of therapy does the nurse anticipate will be most helpful in developing a trusting relationship as well as assisting in determining the patient's current emotional state? A) Behavioral therapy B) Play therapy C) Cognitive behavioral therapy D) Family therapy
B) Play therapy Feedback: Play therapy will be most helpful, especially in the initial phase of assessment, because it encourages the child to act out feelings of sadness, fear, hostility, or anger.
The nurse is caring for a 5-year-old. The child's mother reports that he is extremely sensitive to sounds that most people do not notice and that he prefers complete silence. She explains that the boy is resisting going to school due to the noise and commotion. Additionally, the mother states that he will only wear 100% cotton clothing with all of the tags cut out. The nurse interprets these findings as indicating which disorder or condition? A) Anxiety disorder B) Sensory processing disorder C) Depression D) Obsessive-compulsive disorder
B) Sensory processing disorder Feedback: Sensory processing disorder (sensory integration dysfunction) results in overreaction to different textures and hypersensitivity or hyposensitivity to sensory input. The reported sensitivities to sound and clothing do not point to an anxiety disorder, depression, or obsessive-compulsive disorder.
A nurse is caring for a 5-year-old girl with depression. The girl is having difficulty coping with her feelings of sadness and fear, which stem from her parents' separation and recent divorce. The girl has been prescribed antidepressant medication but the mother thinks the girl would benefit from therapy. The nurse anticipates a referral to a therapist that specializes in: A) individual therapy. B) play therapy. C) behavioral therapy. D) hypnosis.
B) play therapy. Feedback: Play therapy is designed to change emotional status and encourages the child to act out feelings of sadness, fear, hostility, or anger. It is particularly beneficial for the younger child. Play therapy, rather than individual therapy, is recommended for the younger child. Hypnosis promotes deep relaxation, which is not the therapeutic goal for this child. Behavioral therapy is used to encourage appropriate behavior and would not address the girl's sadness.
The nurse is caring for a 3-year-old boy. The parents are concerned that he is exhibiting signs of cognitive delays. Which statement by the parents would lead the nurse to suspect autism spectrum disorder rather than possible learning disability? A) "He is not speaking in complete sentences." B) "We can understand a lot of what he says, but no one else can." C) "He seems to be speaking words less and less frequently." D) "He is unable to sit still for a short story."
C) "He seems to be speaking words less and less frequently." Feedback: Reports of regression or the loss of previously acquired skills points to autism rather than intellectual disability. Not speaking in complete sentences, others not being able to understand what the child is saying, and an inability to sit still for a short story suggest a learning disability.
The nurse is speaking with a parent regarding their child's recent diagnosis of oppositional defiant disorder. Which statement by the parent would cause the nurse to question the diagnosis? A) "I am so tired of arguing with my daughter all the time." B) "My son purposely does exactly the opposite of what his father tells him to do." C) "I feel so bad that my daughter intentionally hurt the neighbor's cat." D) "My daughter gets so annoyed at me when she doesn't get her way."
C) "I feel so bad that my daughter intentionally hurt the neighbor's cat." Feedback: Common behaviors in oppositional defiant disorder include excessive arguing with adults, active defiance, noncompliance with adult requests or limits and easily annoyed. Physical cruelty to animals or people is associated with conduct disorder, not oppositional defiant disorder.
After teaching the parents of a child with attention deficit/hyperactivity disorder about ways to control the child's behavior, the nurse determines a need for additional teaching when the parents state: A) "If he starts to act out, we'll have him do a time-out to help him refocus." B) "We can use a reward system when he behaves appropriately." C) "If he misbehaves, we need to punish him instead of reward him." D) "We need to help him set realistic goals that he can achieve."
C) "If he misbehaves, we need to punish him instead of reward him." Feedback: Punishment for misbehaving would be inappropriate because it would lead to negative feelings and further decrease self-esteem. Appropriate behavior management strategies include time-outs, positive reinforcement, reward or privilege withdrawal, or a token system. Setting realistic goals also is helpful to foster self-esteem and independence.
The nurse is caring for a 7-year-old with Tourette syndrome. The nurse would be alert for which comorbid condition? A) Depression B) Anxiety disorder C) Attention deficit/hyperactivity disorder D) Asperger syndrome
C) Attention deficit/hyperactivity disorder Feedback: Attention deficit/hyperactivity disorder and obsessive-compulsive disorders occur in 50% of children with Tourette syndrome. Depression, anxiety disorder, and Asperger syndrome are not typical comorbid conditions associated with Tourette syndrome.
A nurse is caring for a 10-year-old boy with a nursing diagnosis of ineffective coping related to an inability to deal with stressors secondary to anxiety. What action should the nurse to take first? A) Set clear limits on the child's behavior B) Teach the child problem-solving skills C) Encourage a discussion of the child's thoughts and feelings D) Role model appropriate social and conversation skills
C) Encourage a discussion of the child's thoughts and feelings Feedback: The priority action is to encourage the child to discuss his thoughts and feelings. This is the initial step toward learning to deal with them appropriately. Setting clear limits, teaching problem-solving skills, and role modeling skills would be appropriate as the child begins to learn how to acknowledge and deal with his feelings.
A child with depression is prescribed fluoxetine. The nurse identifies this as belonging to which class of drugs? A) Atypical antidepressant B) Tricyclic antidepressant C) Selective serotonin reuptake inhibitor D) Psychostimulant
C) Selective serotonin reuptake inhibitor Feedback: Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor. Trazodone is an atypical antidepressant; amitriptyline, desipramine, imipramine, and nortriptyline are tricyclic antidepressants. Methylphenidate and the amphetamines are psychostimulants.
The nurse is reviewing the medical record of a child who has dyspraxia. This child will experience difficulty with: A) reading and writing. B) mathematics and computation. C) manual dexterity and coordination. D) composition and spelling.
C) manual dexterity and coordination. Feedback: Dyspraxia refers to problems with manual dexterity and coordination. Dyslexia involves difficulty with reading, writing, and spelling. Dyscalculia involves problems with mathematics and computation. Dysgraphia involves difficulty producing the written word in composition, spelling, and writing.
A child with attention deficit/hyperactivity disorder is prescribed long-acting methylphenidate. What information would the nurse include when teaching the child and his parents about this drug? A) "Give the drug three times a day: morning, midday, and after school." B) "This drug may cause drowsiness, so be careful when doing things." C) "Some increase in appetite may occur, so watch how much you eat." D) "Take this drug every day in the morning when you wake up."
D) "Take this drug every day in the morning when you wake up." Feedback: Long-acting methylphenidate is administered once daily in the morning, whereas the other forms are given three times a day. The drug typically causes difficulty sleeping and decreased appetite.
When reviewing the medical record of a child, what would the nurse interpret as the most sensitive indicator of intellectual disability? A) History of seizures B) Preterm birth C) Vision deficit D) Language delay
D) Language delay Feedback: Due to the extent of cognition required to understand and produce speech, the most sensitive early indicator of intellectual disability is delayed language development. A history of seizures, preterm birth, and vision deficit may be associated with intellectual disability but are not the most sensitive indicators.
A child is prescribed trazodone. What would the nurse be least likely to include in the plan of care related to this drug? A) Monitoring blood pressure for orthostatic hypotension B) Assessing the child for sedation and drowsiness C) Administering the drug with a snack D) Monitoring for tardive dyskinesia
D) Monitoring for tardive dyskinesia Feedback: Trazodone does not cause tardive dyskinesia; antipsychotics do. It can cause orthostatic hypotension, sedation, and drowsiness. It should be given after meals or with snacks to minimize gastrointestinal upset.
The nurse is caring for an adolescent girl with a suspected anxiety disorder. The girl states that she is constantly double-checking that she has unplugged her curling iron and must make sure that everything is in perfect order in her room before she leaves the house. The nurse interprets these findings as indicating which disorder? A) Generalized anxiety disorder B) Posttraumatic stress disorder C) Social phobia D) Obsessive-compulsive disorder
D) Obsessive-compulsive disorder Feedback: Obsessive-compulsive disorder is characterized by compulsions (repetitive behaviors such as cleaning, washing, or checking something) to reduce anxiety about obsessions (unwanted and intrusive thoughts). Posttraumatic stress disorder is an anxiety disorder that occurs after a child is subjected to a traumatic event, later experiencing physiologic arousal when a stimulus triggers memories of the event. Generalized anxiety disorder is characterized by unrealistic concerns over past behavior, future events, and personal competency. Social phobia is characterized by a persistent fear of formal speaking, using public restrooms, or eating in front of others.
When assessing the adolescent with anorexia, what would the nurse expect to find? A) Tachycardia B) Hypertension C) Fever D) Sparse body hair
D) Sparse body hair Feedback: An adolescent with anorexia often exhibits a low body temperature; bradycardia; and hypotension; as well as soft, sparse body hair and thinning scalp hair.
