Peds Final - Cognitive and Mental Health

Schedules and immediate history and physical exam

A 13 year old has been having headaches and is going to bed early and sleeping in late, what does the nurse recommend?

Your child has the same socialization needs as other children who don't have an intellectual disability

8 y/o with developmental delay's parents want him to join a scout club at school. Parents are uncertain, what is the best response from the nurse?

4 high risk factors are noted

The nurse is documenting a history on a newborn arriving for a first check in the pediatrician's office. The nurse is correct to identify how many social stressors in the documentation which could lead to abuse?

Explaining the child's strengths and weaknesses

The nurse is preparing a teaching plan for the parents of a 10-year-old boy with a learning disorder. Which of the following would the nurse most likely include?

The higher socioeconomic families have a greater ability to keep the child abuse from being detected.

The nurse is working in a community setting with families whose children have been abused. The nurse notes that fewer of the families come from higher socioeconomic groups than from lower socioeconomic groups. The nurse recognizes that this is most likely because of which of the following?

Two have an ear infection (in one of which the eardrum is ruptured) and one has scabies.

The public health nurse is providing immunizations to a family that includes three children. Which requires investigation for possible child neglect?

art therapy with the nurse

An advance practice mental health nurse is preparing for an individual therapy session with a 7-year-old girl who has been the victim of sexual abuse. The girl has limited proficiency in the dominant language. Which approach will likely engage the girl?

"Why does your pink doll hit all the other dolls?"

An advanced practice pediatric nurse practitioner is conducting a mental status examination with a six-year-old girl. Which question would be most appropriate for the nurse to ask?

"Learning disorders can be cured if detected early."

An instructor realizes that a student needs clarification about learning disorders when the student states which of the following?

suggesting to the attending physician that the child be admitted for observation

The responsibility of the nurse caring for a victim of child abuse (child maltreatment) in the emergency room would include which of the following?

1. Poor attendance in school 2. Behavioral issues 3. Bedwetting 4.Feelings of guilt

What are manifestations of physical abuse at home?

When one person fabricates or induces illness in another to get attention

What is Munchausen Syndrome by proxy?

Watching a tv commercial and repeating one word and not knowing what it means

What is an example of echolalia?

Ask to speak to the child separately from the family

What is the best way to assess a child with a parent with Munchausen Syndrome by proxy (caregiver-fabricated illness)

Language delay

What is the most sensitive indicator of a learning disability?

Learning disorder

What may a child be suffering from if they don't like school, don't excel like their friends, have poor time management and organizational skills?

The mother was abused as a child

Which factor obtained on history is most apt to be associated with the risk of Munchausen Syndrome by proxy / caregiver-fabricated illness?

"Let's set up an appointment as soon as possible."

A 10-year-old girl with 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. What should the nurse say?

Munchausen Syndrome by proxy / Caregiver-fabricated illness

A child is brought in for nausea and vomiting, the nurse sees she has been seen 12 times in 2 months and the child appears fine, what does the nurse suspect?

whiplash to the neck edema in the brainstem retinal hemorrhage loss of vision intellectual disability

A child who experiences shaken baby syndrome can experience which injuries? Select all that apply.

Anorexia

A child with ADHD is placed on methylphenidate therapy. What symptom may children on methylphenidate develop?

"Take this drug every day in the morning when you wake up."

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?

Safety

A child with intellectual disability engages in self-stimulation, what is a priority for the nurse?

The effects of child abuse (child mistreatment) are manifested in multiple ways. Vulnerability to abuse (mistreatment) depends on the child's age and sex.

A group of nursing students is reviewing information about child abuse (child mistreatment) and neglect and their effect on children. The students demonstrate understanding of the information when they identify which statements as accurate? Select all that apply.

Inability to say a single word by 16 months

A nurse is conducting a screening program for autism spectrum disorder in infants and children. What would the nurse identify as a warning sign?

"Individuals with bulimia have a normal weight or are slightly overweight."

A nurse is explaining the difference between anorexia nervosa and bulimia nervosa. The nurse knows the teaching was effective when the parents make which statement?

social deficits, communication issues, and restricted behaviors

A nurse is presenting a workshop to parents about autism spectrum disorder (ASD). What does the nurse describe as the difficulties seen with ASD that impair everyday functioning?

"If he misbehaves, we need to punish him instead of reward him."

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:

He is speaking words less and less frequently

In a 3 y/o what is a symptoms that would be indicative of autism and not a learning disability?

"This must be difficult for you. Let's talk with the social worker to see what programs are available for your child."

Parents of a child with physical and developmental special needs state they wish their child could attend school. How should the nurse respond?

Indifferent attachment to a parent

What will the nurse find in a child with autism?

complete blood cell count metabolic panel

A 17-year-old child has been admitted with complications of anorexia nervosa. What diagnostic tests can be anticipated in the plan of care/treatment? Select all that apply.

Does your child come and hug you or seek comfort from you?

A 36 month old does not speak and spends hours staring at a ceiling fan. What questions would be important for the nurse to ask the parents?

Playing with a boy and girl doll in a sexually graphic manner Using inappropriate adult language Arranging dolls in unnatural positions for play

A 6-year-old child is playing. Which play scenarios witnessed by the nurse are indicative that the child is sexually abused? Select all that apply.

Provide clear instructions on what the nurse is going to do.

A 6-year-old child with cognitive disabilities presents to the emergency department with the parents, having fallen and hit the head. How will the nurse need to modify care, based on the disabilities?

The child is unable to properly bathe himself.

A 9-year-old boy with a developmental disorder demonstrates an impairment in adaptive functioning. Which finding would the nurse document to support this?

Leave the treatment area and call the social services department in the hospital.

A caregiver who works in the hospital brings his 9-year-old son to the emergency room with a spiral fracture of the tibia. The caregiver reports that the injury occurred when the boy's 5-year-old sister hit him with wooden bat. The injury is inconsistent with an impact and with the sister's strength. Which of the following would be appropriate for the nurse to do in this situation?

Stress the need for adequate nutrition.

A child has been prescribed methylphenidate to take daily. Which nursing instructions are important to provide to the family?

Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission

A mother is concerned her 8 y/o has ADHD, what does the mother describe that is an example of impulsiveness

eroded dental enamel

A nurse is conducting a physical examination of an adolescent girl with suspected bulimia. Which assessment finding should the nurse expect?

sexual behavior that correlates with the child's developmental age

A nurse is providing an in-service program on child abuse (child mistreatment) 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 (child mistreatment)?

The mother was maltreated as a child; the child was born prematurely; the father recently lost his job.

A nurse is working with a child she suspects may be a victim of maltreatment in her home. Which combination of characteristics related to the parent, the child, and the circumstances would most strongly indicate the risk for maltreatment of this child?

"The child with a developmental delay will catch up to peers eventually."

A nursing student is learning about the concept of "developmental delay" during a pediatrics rotation. The instructor realizes that the student needs further instruction in this area after stating:

Autism spectrum disorder

A parent brings a preschooler to the behavioral clinic for evaluation. The child does not notice the nurses presence and screams when the nurse touches him. What condition should the nurse suspect?

"Does your child interact with you when playing?"

A parent expresses concern that the child has an autism spectrum disorder. The nurse obtains a health history of the symptoms to understand the parent's concern. Which question would the nurse ask first?

"My stomach really sticks out and looks fat."

According to the American Psychiatric Association (DSM-5, 2013), a client with anorexia nervosa has a body image disturbance in which one's body weight or shape is not experienced realistically. Which statement by a client would best validate this criterion?

Play therapy

In a 4 y/o with a history of abuse, what therapy would be most helpful in developing a trusting relationship as well as determining the child's current emotional state?

Possesses excellent language development

In a 5 y/o what is a symptom of Asperger Syndrome

Insensitivity to pain

In a child with autism, what is one quality that a nurse would need to maintain special care to keep them safe?

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

In an adolescent diagnosed with bulimia, parents ask how to best deal with the problem, what suggestion should the nurse make?

Methylphenidate

Med to treat ADHD

Easily distracted Failure to complete tasks before going on to another one Impulsiveness

Parents are reluctant to accept that their preschooler has attention deficit hyperactivity disorder (ADHD), so the nurse is explaining the commonly seen characteristics of this syndrome. Which characteristics would the nurse include in her explanation? Select all that apply.

1. We are worries about what you eat because not eating can lead to significant health issues including death 2. We are worried because you are not eating enough food to keep your body functioning like it should 3. I can see you are frustrated with your mom and you feel like she is controlling you. What does she do that makes you feel that way?

Speaking with an adolescent diagnosed with anorexia she states, "I do not get why everyone is so worries about what I eat. I just want to be skinny and my mom wants to control me". What responses by the nurse are appropriate?

"Screening is recommended between 18 and 24 months or when concerns are identified."

The mother of a 6-month-old child reports she has been hearing so much about autism spectrum disorder. She questions if this is something that can be tested for. What response by the nurse is appropriate?

linear abrasions on ankles and wrists

The nurse has documented the following on the medical record of four children. When caring for the client assignment, for which child would the nurse initiate additional abuse (child maltreatment) screening?

attention deficit hyperactive disorder (ADHD).

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 the child has:

Long-term unemployment without supplemental income

The nurse is caring for a child who has unusual bruises and marks that do not match the child's developmental age. When completing an admission assessment, which other information does the nurse identify as a potential factor in child abuse?

cardiac arrhythmias, confusion, seizures

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?

"It is more important for our child to get sleep than eat breakfast."

The nurse is discussing healthy eating with the parents of a school-age client. Which statement by the parents indicates additional teaching is needed?

inability to properly synthesize glucose.

The nurse is educating parents of a child recently diagnosed with autism spectrum disorder. A description of the characteristics of autism spectrun disorder are explained within categories. The nurse becomes concerned when the mother states that the categories of autism spectrum disorder are associated with:

"His brother just plays too rough with him."

The nurse is interviewing the caregiver of a 5-year-old child who has been admitted with bruises on the abdomen and thighs as well as additional bruises in various stages of healing. Which statement made by the caregiver might alert the health care team to the possibility of child abuse (child maltreatment)?

"Your child needs time to adjust comfortably to school routines and build a trusting relationship with other children."

The nurse is meeting with parents of a child who have learned that their 11-year-old child has mild cognitive impairments that make it more difficult for their child to adapt to the new environment and make friends with other children. What is the best response by the nurse?

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.

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)?

"We try to be flexible and change our child's routine from day to day."

The nurse is providing a routine wellness examination for a 5-year-old child diagnosed with autism spectrum disorder (ASD). Which response by the client's parent will cause the nurse to intervene?

"The medications your child is on may cause a decreased appetite."

The nurse is working with a group of caregivers of school-aged children diagnosed with attention deficit hyperactivity disorder (ADHD). Which statement would be most appropriate for the nurse to make to this group of caregivers?

physical abuse abusive head trauma (shaken baby syndrome) caregiver-fabricated illness (formerly Munchausen syndrome by proxy) emotional/psychological abuse neglect sexual abuse

The nursing student learning about child abuse (child maltreatment) correctly identifies which of the following as types of abuse in children? Select all that apply.

"Rocking can be seen as a form of self-stimulation."

The parent of an 11-month-old infant is concerned that the infant is developing an autism spectrum disorder, because the infant likes to rock on the hands and knees in the crib before going to sleep. What should the nurse respond to this parent's concern?

"There are many behaviors that can be thought of as signs of autism spectrum disorders, but only a health care provider can confirm the diagnosis."

The parents of an 18-month-old toddler are concerned that their toddler no longer makes eye contact, does not respond to their smiles or other facial expressions, does not point to toys, and no longer speaks. They said that their toddler used to be able to say "mama" or "dada." The parents started noticing these changes in behavior 3 months ago. Which information can be provided to the parents?

"I've been really tired lately, but I'm afraid that if I rest I will get fatter than I am already"

What statement from a female adolescent would concern the nurse about anorexia?

A caregiver is intentionally demeaning to a child. A caregiver neglects a child's physical needs. A caregiver punches the child's arm when the child does not follow instructions.

When interacting with a pediatric client and family, which would prompt further investigation for potential child abuse (child maltreatment)? Select all that apply.

Multiple emergency room visits with lengthy history Difficult to find symptoms on physical examination History of apnea only seen by parent Multiple diagnostic tests without symptom validation

When reviewing the history of an 8-year-old client, which data lead the nurse to recognize Munchausen syndrome by proxy? Select all that apply.

A definitive cause can be found for every developmental disorder

When talking to students about developmental disorders, what statement warrants further teaching?

Children with learning disabilities have a corresponding low IQ

When teaching a group of students, which of the following statements would warrant further teaching?

Examine the child's history of school achievement. Examine the child's current school placement. Examine needs for special education support

When working with a school-aged child to help determine current cognitive functioning, which of the following should the nurse do? (Select all that apply.)

Using play to reduce stress

Which action is most helpful in encouraging the expression of feelings in a pediatric client who is abused?

Ensuring client care and safety

Which action is the nursing priority when suspecting that a pediatric client is abused?

Inconsistent caregiver stories regarding injuries Injuries with patterns related to common objects Bruises in the inner aspects of the arms Bruises assessed on soft tissue areas

Which assessment findings have made the pediatric nurse suspicious of child abuse? Select all that apply.

The child has rigid study skills and ritualistic behavior.

Which characteristic is commonly noted in the child with anorexia nervosa?

psychological, physical, and sexual maltreatment and neglect

Which elements are included in child abuse (child maltreatment )? Select the best answer.

1. Fractures in various stages of healing 2. CT scan that shows unexplained cerebral hemorrhage 3.spiral fracture of the femur

Which of the following that is evaluated would most likely be due to child abuse?

Performs repetitive activity with toys

Which sign is consistent with autism spectrum disorder (ASD) in a 2-year-old boy?

Repetitive movements like patting legs or opening and closing hands

Which signs or symptoms of a 5 y/o who does not maintain eye contact or speak may indicate autism spectrum disorder?