Peds Ch. 27 & 42

CRAFFT

6-item screen for alcohol or drugs in adolescents, 14-18 (C=car, R=relax, A=alone, F=forget, F= family or friends, T= trouble)

Refeeding syndrome

potentially fatal complication that can occur with aggressive nutritional rehabilitation and weight gain in severe malnutrition. Monitor calorie intake and weight gain and electrolytes.

The child plays and sleeps quietly for long periods of time without fussing.

The nurse is caring for a 6-month-old infant diagnosed with nonorganic failure to thrive. Which of the following would the nurse most likely have noted with this child?

The beginning of puberty

The nursing instructor is leading a class discussion on the various aspects of adolescents. The instructors determines the class is successful after the students correctly choose which milestone as the beginning of adolescence?

"Wet dreams are not the result of anything you are doing but are simply the body's way of ridding itself of excess semen."

A 15-year-old client tells the nurse he has been having wet dreams and is ashamed and afraid he will get into trouble because he believes his parents think he is too young to understand or know about sex. To which statement would be the most appropriate for the nurse to respond?

Red meat, poultry, and fish

A group of nursing students are preparing sample menus for the lacto-ovo-vegetarian diet. The instructor determines the presentation is successful after noting the students avoided the use of which foods in planning the menus?

True

Depressive disorder-findings must be present for 1 year to diagnose in children and adolescents

126 pounds

When weighing and measuring an adolescent whose ideal body weight is 105 pounds, the nurse would identify the child as obese if the child weighs which of the following?

"Have you explored with your child if something is causing her to be afraid to go to school?"

A 10 year-old girl has a pattern of school success, solid peer relationships, and a healthy family life. The girl's caregiver reports for the past 3 weeks the child has reported abdominal pain with vomiting and diarrhea, and tells the caregiver lets her stay home, she is fine by mid-morning. She is also fine on weekends. which question should the nurse prioritize to this caregiver?

Failure to Thrive (FTT)

Inadequate growth resulting from inability to obtain or use calories required for growth. •Infant or child who falls below the fifth percentile for weight (and possibly height) or persistent weight loss •Inadequate caloric intake •Inadequate absorption •Increased metabolism •Defective utilization RISK FACTORS: •premature birth •low birth weight •IUGR •Neglect •Lack of parental knowledge •Disturbed maternal-child attachment •Poverty •Family Stress •Feeding resistance Clinical manifestations and diagnosis: •less than fifth percentile on growth chart for weight •malnourished appearance •poor muscle tone •no fear of strangers •minimal smiling •decreased activity level •developmental delay •withdrawal behavior

Alcohol

The drug most commonly abused by children and adolescents is:

Rumination

The nurse is collecting data for a child diagnosed with nonorganic failure to thrive, and notes that the child voluntarily vomits after eating. This is referred to as:

Anorexia Nervosa (AN)

•most common in female adolescents •result of psychological and physiologic factors •family hx commonly noted Sx: •visibly emaciated (skeleton like) •dry skin •brittle nails •lanugo on backs and extremities •amenorrhea •constipation •intolerance to cold •bradycardia •arrhythmias •low blood pressure •anemia •malnutrition •dehydration •electrolyte imbalance Characteristics: •successful students •perfectionistic •always trying to please others •depression and anxiety •deny weight loss •adhere to rigid program of exercise •may show obsessive compulsive traits •rigid schedules •ritualistic behavior •deny hunger •fatigue •preoccupation with fear of gaining weight

Encourage the client and the client's family to participate in family therapy.

. The nurse is caring for an adolescent with anorexia nervosa. What intervention should the nurse include in the care of this client?

4 stages of substance abuse

1. experimental- learning the mood swing 2. more regular use with noticeable changes in schoolwork, friendships, and dress. Seeking the mood swing. 3. Preoccupation with the mood swing, dramatic behavior changes, truancy, lost job. 4. Using to feel normal. Dependency with deterioration in health

A sense of trust and identity

A 17-year-old female is meeting with the nurse for an annual well-visit and is asking the nurse questions about how to know when one is in love. The nurse should point out which factor to help decide if both individuals have reached a mutual agreement and are ready for an intimate relationship?

"Having wet dreams indicates that your body is going through a process of maturing."

A male nurse is meeting with a group of 12-year-old boys to discuss expected bodily changes. After one of the boy's says, "My older brother told me my bed might be wet and that means I had a wet dream. Is that true?" What is the best response from the nurse?

"I am almost 15 now, so that means I could possibly get this disease."

A male nurse is meeting with a group of high school boys to discuss various health topics. After the session on testicular self-exam, the nurse determines the session is successful when one of the students responds with which comment?

"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?

Anabolic Steroids

Adolescent athletes sometimes take megadoses of which of the following substances because they believe it will increase their athletic abilities?

ASD (autism spectrum disorder)

COMPLEX NEURODEVELOPMENTAL DISORDER WITH SPECTRUM OF BEHAVIORS AFFECTING ABILITY TO COMMUNICATE, LEARN AND INTERACT IN SOCIAL SETTINGS. BEGINS IN EARLY CHILDHOOD AND CONTINUES THROUGHOUT LIFE. Sx- delays in at least one: social interaction, social communication, imaginative play prior to age 3 •distress when routine changed •unusual attachment to objects •impaired verbal/nonverbal communication-lng delays •repetitive movements/behaviors-rocking, twirling, flapping arms and hands, walking on tiptoe, twisting and turning fingers, head banging, face/body slapping, self biting •Echolalia in severe ASD •atypical sensory perception-overresponsive or underresponsive •may test cognitively impaired (IQ less than 70) but have unusual memory in math, artistic, musical ability

Is planning to commit suicide

Candace, age 16, is being seen for a long overdue checkup. Her caregiver has come with her. Candace is calm, pleasant, and in good spirits. The caregiver reports to the nurse that she is relieved because for the past 6 months Candace has been lethargic, angry, and sad. The mother reports that since she got her driver's license two days earlier, her child's mood has changed dramatically. Rather than resist this appointment, Candace has simply smiled and said " It won't matter much, but okay, I'll be ready in a minute." The nurse recognizes that the child's seeming well-being and drastic change in behavior should be further investigated to determine if the child:

Bulimia Nervosa (BN)

Clinical manifestations and diagnosis: •eats large amounts of food in distinct time period •dental caries and erosion •throat irritation •endocrine and electrolyte imbalance •cardiac irregularities •menstrual problems •calluses on back of hand •foul smelling breath TX: varies Many aspects of tx similar to anorexia nervosa Food diaries to evaluate eating patterns SSRI's Support group

Stress to the client that she is in control of the outcome of her care

Contract agreements are often recommended for clients with eating disorders. Informing a contract with a hospitalized adolescent diagnosed with anorexia nervosa, the nurse should make a point to:

encopresis

During a routine well-child check the caregiver of a 10-year-old tells the nurse that her child has recently starting passing stool into his underwear. This behavior indicates a symptom of which disorder?

Anxiety disorders

SX include: sleep disturbances, restlessness, fatigue, irratibility, muscle tension, difficulty concentrating

Tolerance

The ability of body tissues to endure and adapt to continued or increased use of substance, so that the drug user requires larger doses of the drug to produce the desired effect is called:

Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates.

The father of a 15-year-old daughter is concerned she is not getting adequate nutrition to play high school basketball. Her games are on Friday nights. Which suggestion should the nurse point out will best suit the needs of this adolescent?

gynecomastia

The football coach notices that one of the players has been more energetic and overly happy lately during practice. The player also got in fight with a teammate last week. The coach contacts the health care provider, concerned that the student is using anabolic steroids. What physical sign would the nurse advise the coach to be on the lookout for that would further validate the illicit drug use?

Vegetarian diets can be healthy; ensure she includes whole-grain products, legumes, nuts, seeds, and soy dairy substitutes.

The mother of an adolescent has called to talk to the pediatric nurse over concern that her daughter is not getting proper nutrition now that she has started following a vegetarian diet. Which response should the nurse prioritize for this mother?

A 14-month old whose reaction to his caregiver leaving him is to calmly repeat the statement, "Bye bye, Will. Bye bye, Will.

The nurse has gathered the following data on four different children. Which child will likely be further assessed and tested for autism?

Complete a rape kit to rule out possible sexual abuse while the client was blacked out.

The nurse in an emergency department is assessing an 18-year-old who is reporting a gap in memory for the previous night. The client reports feeling dizzy and disoriented after drinking only one drink. The client woke up in a friend's bed but has no recollection of getting there. What action should the nurse prioritize for this client?

Attention deficit hyperactive disorder (ADHD)

The nurse in the well-child clinic observes 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:

"You're following expected patterns of growth."

The nurse is assessing a 16-year-old girl at an annual well-clinic visit and notes the girl started menses at 13 years of age and grew 1 inch (2.5 cm) over the past year. When questioned by the young lady if this is normal, which answer should the nurse prioritize?

Even slight malocclusions make chewing and jaw function less efficient.

The nurse is assessing a teenage client and notes his lower front teeth are slightly crossed over. The nurse points out to his caregiver that he should see an orthodontist about this to prevent which potential situation?

"Do you have oral, anal, or vaginal sex?"

The nurse is assessing an adolescent in the clinic at a routine well-visit. Which question should the nurse prioritize to encourage the adolescent to share detailed information?

Correct fluid and electrolyte imbalances

The nurse is caring for a child with an eating disorder. Which is the priority treatment for the disorder?

The child is of normal weight for her height according to the growth charts.

The nurse is collecting data on a 16-year-old girl with the diagnosis of bulimia. What would the nurse most likely note in this child?

The child does not make eye contact.

The nurse is collecting data on an 18-month-old child with a diagnosis of autism spectrum disorder (ASD). What clinical manifestations would likely have been noted in the child with this diagnosis?

Ecstasy

The nurse is collecting data on an adolescent who is brought to the emergency center by her caregivers, who suspect that she has been using substances. The adolescent states that she has not had anything to eat nor any sleep in several days, but that she is nauseated. The nurse observes that she is diaphoretic, clenching her teeth and complaining of blurred vision. Which substance would this adolescent most likely have been using?

The nurse should teach and support the caregiver

The nurse is developing a plan of care for the child hospitalized with nonorganic failure to thrive. The following nursing interventions would be included in this plan. Which nursing intervention would be the highest priority for this child

" Our daughter has never had any health problems, and now she has developed so many cavities."

The nurse is discussing health concerns and issues with a group of caregivers of adolescents. Which statement made by a caregiver would indicate a need for follow-up by the nurse?

0.08%

The nurse is discussing the use of alcohol with a group of adolescents. One of the teens says that she heard your fine motor control could be affected at low levels of alcohol. Another teen was correct in saying that most states consider a person under the influence of alcohol if the blood alcohol level is which of the following?

Hypokalemia

The nurse is doing a presentation on the diagnosis of bulimia to a group of pediatric nurses. Which clinical manifestation would the nurse teach this group to observe for in the adolescent with bulimia?

Withdrawal Symptoms

The nurse is doing an in-service training with nurses who will be working with children who have concerns with drugs and alcohol. In discussing this topic, one of the nurses says she has heard that there may be physical and psychological signs that occur when a drug is no long being used. Which term best describes what the nurse is referring to?

Dependance

The nurse is doing an in-service training with nurses who will be working with children who have concerns with drugs and alcohol. In discussing this topic, one of the nurses says that sometimes a person has a compulsive need to use a substance for its satisfying or pleasurable effects. Which term best describes what the nurse is referring to?

A heterosexual relationship

The nurse is leading a discussion in a health class at the high school on adolescent relationships. The nurse determines the session is successful when the students correctly choose which type of relationship as involving a member of the opposite sex?

68 in (172.72 cm)

The nurse is measuring the height of a 13-year-old girl who was 56 in (142.24 cm) tall at age 9. The nurse predicts the girl will be approximately how tall if following the normal pattern of growth?

-Dried fruits -Peanuts -Hard boiled eggs

The nurse is meeting with a group of adolescent athletes to discuss their nutritional needs. The nurse should encourage the adolescents to include which foods in their diet to increase iron intake?

Being honest and straightforward with teenagers will encourage them to ask about subjects like sexuality.

The nurse is meeting with a group of caregivers of adolescents and discussing sex and sexuality, including how to discuss these issues with their children. Which comment should the nurse prioritize with this group of caregivers?

Let them choose their hairstyle, even though it may not look the best for them.

The nurse is meeting with a group of caregivers of adolescents. Which example should the nurse point out is most effective for the caregiver to support the adolescent?

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)?

Boys grow at a slower, steadier rate than do girls.

The nurse is preparing a presentation for a local health fair depicting the differences in maturity between preadolescents. Which differing factor should the nurse prioritize in the presentation?

Teens are busy developing their own personal identity.

The nurse is preparing to participate in a community discussion on the needs of the adolescents in the local school. The nurse should point out which goal is the primary concern for these young individuals as the committee makes plans?

Soybean curd

The nurse is teaching a nutritional class to a group of Asian adolescents who are lactose-intolerant. Which food should the nurse point out will help these adolescents consume the calcium they need for proper nutrition?

Stress to the client that he or she is in control of the outcome of the care.

The nurse is working on forming a contract with a hospitalized adolescent diagnosed with anorexia nervosa. Which information should the nurse prioritize with the client when making the contract?

referred for counseling

The nurse is working with a child diagnosed with encopresis. After a complete medical workup has been done, no organic cause has been found for the disorder. What follow-up will the nurse expect?

"When she watches TV and hears a commercial, she repeats one word from the commercial but doesn't seem to understand what she is saying."

The nurse is working with a group caregivers of children who are diagnosed with autism. Which statement made by the parents shows an example of echolalia

Marijuana

The nurse is working with a group of caregiver's of adolescents who have abused substances. One of the caregivers states, " My son used to do great in school. However, since he started using drugs he has no motivation, he is never on time, and he makes the worst decisions, especially when is is driving." These behaviors indicate that this adolescent was likely using which substance?

Cocaine

The nurse is working with a group of caregivers of adolescents who have abused substances. one of the caregivers states, " i have heard that some drugs have the effect of causing an excited feeling and it makes the person more social." Which drug would most likely have the effect this caregiver is describing?

"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

The child will have a complete physical exam.

The nurse is working with school-aged children who are having enuresis or encopresis. What will most likely be the first step in this child's treatment?

Compulsive overeating

The nurse recognizes in working with children that the child who has polyphagia will likely exhibit which of the following?

A 12-year-old girl whose parents have just gotten a divorce

The nurse recognizes that which client has the greatest risk for suicidal behavior?

"The diet excludes red meat and possibly poultry."

The nutritionist is presenting information about vegetarian diets with a group of nursing students. The nutritionist determines the session is successful when the students correctly choose which factor concerning the semi-vegetarian diet?

He has developed his own identity by now; being able to establish close relationships with girls is important preparation for all of his adult relationships. They should honor his need to be with, or talk to, his girlfriend as long as he has completed his schoolwork for the day.

The parents of a 16-year-old male are worried about recent changes in his behavior, ignoring his schoolwork and sports, and spending almost all of his free time interacting with his girlfriend. Which suggestion should the nurse point out would best address this situation?

"Adolescents need to know how to use condoms correctly to avoid sexually transmitted infections."

The school nurse is conducting a health class with a group of high school students on the topic of sex and sexuality issues. The nurse determines the session is successful when the students correctly choose which aspect as most important?

"You have lots of hormone changes going on right now."

The school nurse is meeting with a group of 11-year-old girls to discuss expected puberty changes in their bodies. When one of the girls states, 'I just feel like my whole body is changing and I don't know why' what should the nurse point out to this group?

The individual's sex no longer decides which career options are available.

The school nurse is preparing for a career fair at the local high school. Which factor should the nurse point out when presenting various medical career options to the students?

Dairy products, meat, poultry, fish, and eggs

The school nurse is presenting information to a group of high school students who are asking about vegetarian diets? Which foods will the nurse point out are not eaten when following the vegan diet?

"I am feeling so fat. I think I need to exercise a few extra hours today."

The school nurse is teaching a health class on nutrition with some adolescents. Which comment by a student should the nurse prioritize and provide more teaching?

The child has rigid study skills and ritualistic behaviors

Which characteristic is commonly noted in the child with anorexia nervosa

Diabetes Mellitus

Which disorder is a concern in adulthood as well as in childhood for the person who is overweight or obese during childhood?

ADHD (Attention-Deficit Hyperactivity Disorder)

•DX-Vanderbilt form •Manifestations present between 4- 18 y/o •Dx often made in school age children •Manifestations present in more than one setting •Evidence of social or academic impairment •Six or more findings from a category are present •Genetic, environmental, dietary factors play a role -Generally revealed prior to 7 y/o Common in childhood-can prevail into adulthood •Sx- impulsiveness, easily distracted, excessive fidgeting or squirming, difficulty playing quietly, problems with following instructions (can understand them), lack of organization, forgetfulness, losing things, going from one uncomplicated activity to another. •Multidisciplinary approach-pediatric and education specialists, psychologist, teacher, caregivers •Thorough physical and neurological exam and hx.

NURSING CARE FOR ADHD

•Maintain a calm, patient attitude •Give simple instructions •Limit distractions •Use consistency and praise •Support families •Educate on medication side effects-anorexia, weight loss, nervousness, sleep disturbances