RNSG 2201 Care of Children and Families Ch 14 Evolve

Which common plants have toxic parts that could be poisonous to children? Select all that apply.

Apple seeds Holly berries Azalea flowers Buttercup petals (but that sounds delicious tho) (Common plants that have toxic parts that could be poisonous to children include apple seeds, holly berries, azalea flowers, and buttercup petals. Nonpoisonous plants include Boston ferns and roses.)

Which types of maltreatment are considered sexual? Select all that apply.

Incest. Pedophilia. Molestation. Exhibitionism. Child pornography. (Types of sexual maltreatment include incest, pedophilia, molestation, exhibitionism, and child pornography. Neglect is not considered sexual maltreatment, but can be physical or emotional maltreatment or both.)

Which statement by the nurse is appropriate when educating parents about the differences between nightmares and sleep terrors? Select all that apply.

Children do not remember sleep terrors. Nightmares occur in rapid eye movement sleep. Children return to sleep from sleep terrors rapidly. (Nightmares and sleep terrors are common in children. Children do not remember sleep terrors. A child who has sleep terrors usually returns back to sleep quickly. Nightmares occur during rapid eye movement (REM) sleep, which makes it difficult for the child to go back to sleep. Nightmares are usually remembered. Nightmares occur during the latter half of the sleep cycle.)

Which type of maltreatment is appropriate when describing the child that appears to have had plenty of food and has been kept clean but has not been held or given any attention?

Emotional neglect. (Emotional neglect generally refers to failure to meet the child's needs for affection, attention, and emotional nurturance. Emotional abuse refers to the deliberate attempt to destroy or significantly impair a child's self-esteem or competence. Emotional abuse may take the form of rejecting, isolating, terrorizing, ignoring, corrupting, verbally assaulting, or overpressuring the child. Physical neglect involves the deprivation of necessities, such as food, clothing, shelter, supervision, medical care, and education. The deliberate infliction of physical injury on a child, usually by the child's caregiver, is termed physical abuse. Physical abuse can include anything from bruises and fractures to brain damage.)

Which profession is common among mothers with Munchausen syndrome by proxy?

Home health aide (Biologic mothers with some degree of health care knowledge and training are more likely to have Munchausen syndrome by proxy (MSBP) than are biologic mothers with no health care knowledge. Mothers who are teachers, bankers, or accountants are less likely to perpetuate MSBP than a biologic mother who is a home health aide.)

Which heavy metal is appropriate when considering a commonly ingested toxic substance?

Lead (Lead is a heavy metal that is a commonly ingested toxic substance. Mercury toxicity is a rare form of heavy metal poisoning. Iron and silver are not among the commonly ingested toxins.)

Which metal is appropriate to test for in the child that lives in a house built in 1960?

Lead (Lead-based paint in an old home is one of the sources of lead poisoning. Children living in old houses have an increased risk of developing lead poisoning. Old houses are generally not considered to be an important source of iron, copper, or mercury toxicity because these substances are not used in building materials.)

Which nursing action is categorized as a passive measure in terms of preventing the recurrence of poisoning in a child at home?

Limit the number of tablets in one container. (Passive measures are those that do not require the active participation of either the child or the parent. When there are recurrent instances of child poisoning, it is essential to adopt measures that can prevent poisoning. Limiting the number of tablets in one container effectively serves this purpose. Active measures are those that call for active participation by the child or the parents. Advising the parent to keep drugs out of the reach of children will simply eliminate the chance of drug overdose leading to poisoning. Instructing the parents to formulate ways to ensure effective discipline is a method for dealing with the child's behavior of noncompliance. Instructing the parent to discontinue drugs if mild toxicity is observed is suggested while educating the parents on the correct administration of the drug.)

Which syndrome is appropriate when a parent fabricates a child's medical history and symptoms and insists on tests being run on the child?

Munchausen syndrome by proxy (Munchausen syndrome by proxy, also known as medical child abuse or factitious disorder by proxy, is a rare but serious form of child abuse in which caregivers deliberately exaggerate or fabricate histories and symptoms or induce symptoms. Because of the history of symptoms provided by the caregiver, the child endures painful and unnecessary medical testing and procedures. Common symptoms presented are seizures, nausea and vomiting, diarrhea, and altered mental status; usually only the perpetrator witnesses them. Abusive head trauma is a serious form of physical abuse caused by violent shaking of infants and young children. Psychosis is a mental health condition associated with disconnect from reality. This could be connected with this condition but does not best identify this situation.)

Which characteristics differentiate nightmares and sleep terrors?

Nightmares take place during rapid eye movement sleep and are followed by full waking, whereas sleep terrors are a partial arousal from a very deep sleep. (Nightmares take place during rapid eye movement sleep and are followed by full waking, whereas sleep terrors are a partial arousal from very deep sleep (stage IV, or non-REM) sleep. Nightmares tend to result in a memory of the dream, rather than no memory of the dream; sleep terrors do not tend to result in description of the dream. Nightmares do not tend to result in a rapid return to sleep, whereas sleep terrors do. Nightmares tend to occur during the second half of the night, rather than the first half of the night; sleep terrors tend to occur after 1 to 4 hours of sleep rather than 5 to 6 hours.)

Which factors can contribute to the child's risk for lead poisoning? Select all that apply.

Poverty. Younger than 6 years old. Living in older rental homes. Use of Ba-Baw-San for colic. (Risk factors that can contribute to lead poisoning are poverty, age younger than 6 years old, living in older rental homes, and use of Ba-Baw-San for colic. Living in urban areas (not rural) is a risk factor for lead poisoning.)

Which nursing intervention is appropriate when the blood lead level (BLL) is within 5 and 14 mcg/dL in an adolescent client? Select all that apply.

Refer to social services. Conduct followup testing within 1 month and then for every 3 to 4 months. (When the BLL is within 5 and 14 mcg/dL, it is necessary to refer to social services. It is also recommended to conduct follow-up testing within 1 month and for every 3 to 4 months thereafter, apart from providing the family with lead education. It is recommended to provide treatment with appropriate chelation therapy when the BLL is 20 to 44 mcg/dL and above. It is necessary to conduct follow-up testing once every month along with diagnostic testing within 1 to 2 days when the BLL is 45─69 mcg/dL and above.)

Which nursing action is appropriate for the child with acetylsalicylic acid poisoning refusing the activated charcoal treatment because of its black, muddy color?

Serve the slurry in an opaque container with a cover. (The child refuses to take activated charcoal slurry because of its black, muddy color; therefore the nurse should serve the slurry in an opaque container with a cover. This would help the child drink it more easily. Amyl nitrate should not be administered to the child, because it is not an antidote for acetylsalicylic acid poisoning; it is an antidote for cyanide. Activated charcoal forms a complex and prevents the further absorption of acetylsalicylic acid. Therefore it should not be avoided. The child refuses to take activated charcoal slurry due to its black mud color, not because of its taste. Therefore mixing it with cola may not be helpful.)

Which cause is appropriate when describing the preschooler that has daytime tiredness, negative behavior, hyperactivity, difficulty in concentrating, impaired learning ability, and poor control of emotions and impulses?

Sleep disturbance. (The preschooler has symptoms of sleep disturbance, which affects physical and mental health. Due to sleep disturbance, the preschooler may feel tired in the daytime and show behavioral changes. The preschooler may also have difficulty in concentrating, which affects learning ability. Poor emotion control may also be present. Dyslalia is a speech-related problem present in preschoolers with articulation difficulties. Aggression is related to behavior in which the preschooler may attempt to hurt a person or destroy property. Daytime tiredness is not associated with mental illness.)

Which sleep finding is consistent with a child waking up at night, screaming, thrashing, sweating, is not aware of the parents' presence when checked on, and lies back down and sleeps without parental intervention?

Sleep terrors (In sleep terrors the child is only partially aroused; therefore the child does not remember the parents' presence. A nightmare is a frightening dream followed by full awakening; the child would realize that the parents are present. The description of the child's experience does not indicate the presence of seizure activity. Sleep apnea is a cessation of breathing during sleep.)

Which statement is appropriate when young children report sexual abuse by a parent?

They may exhibit various behavioral manifestations. (There is no diagnostic profile of the child who is being sexually abused. Many different behavioral manifestations may be exhibited, from outward sexual behaviors with others to withdrawal and introversion. It is never appropriate to assume that a child has fabricated the story of sexual abuse. Adults are reluctant to believe children, and sexual abuse often goes unreported. Physical examination is normal in approximately 80 percent of abused children. The child will usually try to protect the parents and may accept responsibility for the act.)

Which rationale is appropriate for ensuring an intact and protected airway when using activated charcoal to treat a patient that ingested a poison?

To facilitate gastric lavage (Gastric lavage is performed to empty the stomach of a toxic agent and is likely to lead to aspiration. Therefore it is necessary to ensure that the patient has an intact and protected airway so that complications related to gastrointestinal perforation are better dealt with. Antidotes are administered in cases of toxic ingestion; however, the administration is not related to an intact or protected airway. Syrup of ipecac is an emetic that works by stimulating the vomiting center. Because it delays or inhibits the effectiveness of activated charcoal, it does not improve the patient outcome. It is absolutely necessary for activated charcoal to be administered within 1 hour after the poison has been ingested in order to ensure its effectiveness.)

Which principle method is appropriate when treating a child that has ingested a poison?

Treat the child first, not the poison. (The first and most important principle in dealing with a poisoning is to treat the child first, not the poison. Removing the poison first and then assessing the child is not the method of treating a poisoning. Establishing what contributed to the poisoning is not the most important principle in treating a poisoning. Ipecac is not recommended for routine poison treatment in the home.)

Which toxic agent is an appropriate cause of dermatitis?

Tulip bulb (Tulip bulbs have toxic properties, and topical contact can result in dermatitis. Gasoline is a hydrocarbon that can cause nausea and respiratory distress among several other symptoms. Spider plants are nonpoisonous and therefore will not cause any skin reactions. Mildew remover is likely to cause respiratory obstruction, signs of shock, and severe burning pain in the mouth, throat, and stomach, but not dermatitis.)

Which measure is appropriate to prevent lead poisoning for people living in a community in which most of the houses were built in the year 1960? Select all that apply.

Wash toys and pacifiers frequently. Run the water for 2 minutes before using it. Use cold water for the preparation of formula. (People living in a community in which most of the houses were built in the year 1960 are at high risk of lead poisoning. Toddlers and infants tend to put toys and pacifiers in the mouth and may get poisoned if these have lead on them. Thus all parents should be advised to wash their children's toys and pacifiers frequently. The nurse should inform them that, when using water from pipes, only cold water should be used for drinking, cooking, and reconstituting powder infant formula. In water pipes, lead dissolves quickly into hot water; therefore only cold water is safe for use. Water that sits in the pipes for a time has a relatively high concentration of lead. Therefore the water should be allowed to run for about 2 minutes to flush any residual lead from the pipes prior to drinking. Lead dust can be spread by vacuuming. Hence, vacuuming should not be done on hard surfaces such as floors and windowsills. These floors should be wet mopped. )

Which statement made by the child supports the nurse's suspicion of emotional neglect?

"My father does not praise me even when my teacher praises my drawing." (Emotional neglect involves a disregard for the child's need for emotional nurturance. When the child says that the father didn't praise the child's drawing, it indicates emotional neglect. Not providing a blanket when the child feels cold at night is physical neglect. Not seeking treatment for a broken ankle indicates physical neglect. Not catering to the educational requirements of the child in terms of paying school fees on time also amounts to physical neglect. This is because the lack of payment may interfere with the child's education.)

Which assessment finding is appropriate to consider for an immediate danger in the preschooler with symptoms of a burning throat, choking, and coughing along with nausea and vomiting after ingesting turpentine?

Aspiration and pneumonia (Ingestion of hydrocarbons such as turpentine results in respiratory symptoms that point toward acute pulmonary involvement. Therefore the nurse directs the assessment toward symptoms of aspiration and chemical pneumonia. Allergic reactions can be anticipated in the child when a toxic plant or plant part is ingested. The ingestion of a solid corrosive agent, such as batteries or clinitest tablets, burns tissues, because solid products tend to stick, thereby causing localized damage. The time taken to peak serum salicylate levels may occur with aspirin ingestion, and the time taken can vary with enteric aspirin or the presence of bezoars.)

Which nursing information is appropriate when teaching parents about poison prevention? Select all that apply.

Do not use plants for teas or medicine. Take medications out of sight of children. Post the contact number for the poison control center near the phone. Make babysitters aware of poison control numbers and home address details. (Teaching parents at a community health day regarding poison prevention should include teaching parents to not use plants for teas or medicine, advising parents to take medications out of sight of children, posting the contact number for the poison control center near the phone, and making babysitters aware of the poison control center number and home address details in case an emergency arises. Use of mercury thermometers is no longer recommended due to the risk of inhaled vapors from broken thermometers.)

Which type of maltreatment is appropriate when the child is told that the child is not wanted and belittled?

Emotional abuse (Emotional abuse refers to the deliberate attempt to destroy or significantly impair a child's self-esteem or competence. Emotional abuse may take the form of rejecting, isolating, terrorizing, ignoring, corrupting, verbally assaulting, or overpressuring the child. Physical neglect involves the deprivation of necessities, such as food, clothing, shelter, supervision, medical care, and education. Emotional neglect generally refers to failure to meet the child's needs for affection, attention, and emotional nurturance. The deliberate infliction of physical injury on a child, usually by the child's caregiver, is termed physical abuse. Physical abuse can include anything from bruises and fractures to brain damage.)

Which findings would support the suspicion of emotional abuse and neglect? Select all that apply.

Enuresis. Eating disorder. Suicide attempts. Unusual fearfulness. (Findings that would support the concern and suspicion of emotional abuse and/or neglect include enuresis, eating disorders, suicide attempts, and unusual fearfulness. Bruises on the face, back, and buttock suggest physical abuse.)

Which statements are appropriate regarding the relationship between anemia and lead poisoning? Select all that apply.

Lead can interfere with the binding of iron onto the heme molecule. Blood lead level (BLL) test is currently used for screening and diagnosis. Lead on the heme molecule can make it appear as those a child has anemia. Children who are iron deficient absorb lead more readily than those with sufficient iron stores. (True statements regarding the relationship between anemia and lead poisoning are: (1) Lead can interfere with the binding of iron onto the heme molecule, (2) Blood lead level (BLL) test is currently used for screening and diagnosis, (3) Lead on the heme molecule can make it appear as though a child has anemia, and (4) Children who are iron deficient absorb lead more readily than those with sufficient iron stores. It is true that erythrocyte protoporphyrin (EP) level is a good indicator of toxicity from lead, but it is no longer used as a screening test.)

Which occupations or hobbies involve lead and can contribute to lead poisoning? Select all that apply.

Mining. Radiator repair. Furniture refinishing. Stained-glass making. (Occupations or hobbies that involve lead and can contribute to lead poisoning include mining, radiator repair, furniture refinishing, and stained-glass making. Sewing does not expose a person to lead.)

Which substances contributed to high-lead blood levels in the early 1900s? Select all that apply.

Paint. Gasoline. (Paint and gasoline posed the greatest risk for high-lead blood levels for the public in the early 1900s. Glue, play dough, and paint thinner were not and are not sources of concern for lead poisoning.)

Which sleeping disorder is appropriately described as the child appears awake but not aware of people in the near vicinity, cannot be comforted, and pushes away anyone who tries to hold or restrain the child?

Sleep terrors (The child manifests behavior that defines sleep terrors. Sleep terrors usually occur within non-rapid eye movement (REM) sleep, 1 to 4 hours after falling asleep; the child may sit up, cry, scream, or show apparent anger or fright and thrash more when held or restrained. The child with sleep terrors bears no memory of yelling or thrashing when the child becomes fully awake. Nightmares are defined as scary dreams, and they occur during REM sleep, after which the child is fully awake. Night waking refers to the resistance or refusal to go to bed at night. Delayed sleep onset is associated with excessive or untimely media use that keeps the child awake, thereby causing a delay in falling asleep.)

Which treatments are appropriate for the ingestion of a poisonous substance that requires gastric decontamination? Select all that apply.

Syrup of ipecac. Activated charcoal. (Types of gastric emptying and gastric decontamination include syrup of ipecac and activated charcoal. Gastric lavage may be performed to empty the stomach, but gastric gavage is not. N-acetylcysteine is an antidote but is not used for gastric emptying or gastric decontamination. Chelation therapy is a chemical compound that combines with metal poisons for rapid and safe excretion.)