Ch. 16 Health Problems School Age Evolve Quiz

Which components in the diagnostic evaluation are appropriate to differentiate simple childhood obesity from increased fat related to organic causes? Select all that apply.

Family history Body mass index Physical examination Psychologic assessment Screening for comorbidities A careful history is obtained regarding the development of obesity, and a physical examination is performed to differentiate simple obesity from increased fat that results from organic causes. Components of the examination should include a family history of obesity, diabetes, coronary heart disease, and dyslipidemia for all children who are overweight or at risk for being overweight. The physical examination would focus on obtaining a body mass index as well as identifying comorbid conditions and identifiable causes of obesity. For some, psychologic assessment through interviews and standardized personality tests may provide insight into the personality and emotional problems that contribute to obesity and that might interfere with therapy. An ophthalmologic examination does not contribute to the differentiation of simple obesity, as opposed to organic causes such as diabetes, in a child.

Which symptoms are appropriate in a child with depression? Select all that apply.

Focus on violence Somatic complaints Poor school performance Children with depression will complain of nonspecific complaints such as not feeling well and will show a lack of interest in doing homework or achieving in school and getting lower grades than usual. A focus on violence can be associated with depression in the adolescent. A child with depression exhibits a mostly sad facial expression and an absence or diminished range of affective response. Children with depression will exhibit diminished motor activity and complain of being tired.

Which symptoms are associated with conversion reaction in the child? Select all that apply.

Hysteria Pseudoseizures Visual field restriction A child with conversion reaction exhibits exaggerated or uncontrollable emotion or excitement that is sometimes called hysteria. Pseudoseizures and visual field restriction are also manifestations of conversion reaction. Anorexia and aggression are not manifestations of conversion reaction.

Which nursing actions are appropriate to include in the plan of care for a child with enuresis? Select all that apply.

Implement a calendar to record wet and dry nights. Teach positive reinforcement instead of punishment. Teach parents to observe for side effects of any medications used. Encourage the child to maintain a regular bowel evacuation regimen A calendar with wet and dry nights may be helpful to motivate the child to stay dry and maintain a positive perspective on the problem. Parents need to understand that punishment such as scolding, shaming, and threatening is contraindicated. These actions have a negative emotional impact and limited success in reducing the behavior. The nurse would encourage parents to use positive reinforcement, be patient and understanding, and to communicate love and support to the child. Parents would also be taught to observe for side effects of any medications used. Parents would encourage the child to maintain a regular bowel evacuation regimen; constipation can contribute to nocturnal enuresis. It is not appropriate to teach the child that enuresis is only a short-term issue, because the nurse cannot know with certainty when the problem will resolve. Some people may experience enuresis into adulthood.

Which medication is approved for weight loss in children ages 12 years and older?

Orlistat To date, the only drug approved for use in children 12 years of age and older is orlistat, a lipase inhibitor. Insulin is used to treat type 1 diabetes, not obesity. Some drugs have been used to promote weight loss in children with certain conditions such as metformin in obese adolescents with insulin resistance and hyperinsulinemia and octreotide for hypothalamic obesity caused by intracranial tumors. However, these drugs have not been approved for all obese children age 12 and older.

Obesity is classified as an age- and gender-specific body mass index (BMI) at or above which percentile for children?

95th Based on the Center for Disease Control and Prevention Growth Charts for the United States, obesity is classified as an age- and gender-specific BMI at or above the 95th percentile for children of the same age and sex. Age- and gender-specific body mass indexes below the 95th percentile are not consistent with obesity.

Which condition is appropriate for the child with dental caries that has been taking tricyclic antidepressants?

Attention-deficit/hyperactivity disorder (ADHD Tricyclic antidepressants are prescribed for children with ADHD. These drugs increase the incidence of dental caries in children. Primary encopresis is diagnosed when a child has not achieved fecal continence. It is relieved by lubricants such as mineral oil; osmotic laxatives such as lactulose, sorbitol, or polyethylene glycol; and magnesium hydroxide. Conversion reaction, also known as childhood hysteria, is indicated by abdominal pain, fainting, pseudoseizures, paralysis, headaches, and visual field restriction. Achondroplasia is a congenital defect related to growth delay and is not treated with tricyclic antidepressants.

Which components are appropriate in the accurate screening of children and adolescents for obesity? Select all that apply.

BMI Clinical judgement Skinfold thickness measurements The body mass index (BMI) measurement is considered the most accurate method for screening children and adolescents for obesity. Clinical judgment is needed to understand if the youth is at risk for overweight or obesity. BMI measurements are strongly associated with subcutaneous and total body fat as well as skinfold thickness measurements. However, a subset of adolescents (e.g., athletes) may have a high BMI because of increased muscle mass rather than fat mass. Body weight, waist measurement, and hip measurement are not reliable, evidence-based components of accurate screening of children and adolescents for obesity.

For which condition does research suggest overweight children and adolescents are at risk throughout life?

Being overweight throughout life along with health and social consequences Research indicates that overweight children and adolescents are at risk for being overweight throughout life. Being overweight in adulthood is associated with health problems and social consequences. Obesity in childhood and adolescence has been related to elevated blood cholesterol, high blood pressure, respiratory disorders, orthopedic conditions, cholelithiasis, some types of adult-onset cancer, nonalcoholic fatty liver disease (NAFLD), and type 2 diabetes mellitus.

Which statement is appropriate regarding children with posttraumatic stress disorder?

Children often play out the situation over and over again in an attempt to come to terms with their fear Playing out a traumatic situation over and over is an expected response by a child to the traumatic event. Play is often the safest means of communication for children and would be encouraged as a means of expression with a child experiencing posttraumatic stress disorder (PTSD). Denial is a defense mechanism commonly used by children and adolescents. Professional help is indicated if the stages of response are prolonged. Coping strategies and defense mechanisms that have been effective previously may be effective for PTSD.

Which treatment components are recommended for obese children? Select all that apply.

Diet Exercise Behavior modification Pharmacologic agents Treatments most frequently recommended for obese children include diet, exercise, behavior modification, and pharmacologic agents in some situations. Surgical techniques (bariatric surgery) that bypass portions of the intestine or occlude a segment of the stomach to produce a marked diet restriction and weight loss are hazardous and cause many metabolic complications, so these procedures are not frequently recommended for obese children.

Which is the best collaborative approach to the management of childhood obesity?

Prevention The best collaborative approach to the management of obesity is a preventive one. Early recognition and control measures, implemented before the child or adolescent reaches an obese state, are essential. Treatments recommended for obese children include diet, exercise, and behavior modification.

Which nurse actions are appropriate when a child has an avulsed permanent tooth following an accident on the playground? Select all that apply.

Recover tooth If tooth is dirty rinse under water or saline Insert tooth into gingival socket and have child hold it in place A permanent tooth that is avulsed or "knocked out" should be recovered, held by the crown, not by the root, rinsed under water or saline, reimplanted by the child, adult, or nurse, and stabilized as soon as possible. This will allow the blood supply to the tooth to be reestablished and the tooth kept alive. Placing the avulsed tooth in a container of cold milk is not the appropriate treatment, as it does not help to reestablish the tooth's blood supply.

Which social consequences are expected in a school-age child with encopresis? Select all that apply.

Rejected by peers Avoids social situations Poor school attendance The child with encopresis is not well liked by peers and often feels ashamed. The nurse will find that the child may avoid social situations that might lead to embarrassment. School performance and attendance are negatively affected, as the child's offensive odor becomes a target for scorn and derision by classmates. The child is not well accepted by family members and may be severely rejected by the parents as a result of the symptoms. Rejection by peers and parents causes further withdrawal and other behavioral manifestations. The child's school performance is not adequate due to social withdrawal and poor attendance.

Which characteristics would a nurse expect to see in a patient with depression? Select all that apply.

Tiredness Tearfulness Sad facial expression Tiredness, tearfulness or crying, and sad facial expressions are common characteristics of a patient with depression. A patient with depression would not have visual field restriction; it is one manifestation of a patient with conversion reaction who has a tendency to work alone. A depressed patient exhibits solitary actions and does not show interest in working in groups.

Which nursing assessment components are appropriate when determining the causes of enuresis that have occurred several times over the preceding 2 weeks in a 6-year-old child? Select all that apply.

Urinalysis Glucose testing Metabolic panel Physical examination Water deprivation test The nurse expects the health care provider will order a urinalysis to determine if the child has a urinary tract infection. Glucose testing and a water deprivation test can help determine whether the child has diabetes mellitus or diabetes insipidus. A physical examination will help determine whether the child has sustained any physical injuries that could cause enuresis. A metabolic panel can provide valuable information about the health of the child's kidneys and whether they may be the cause of the enuresis. A complete blood count will not provide the information to help determine the cause of enuresis.