Ricci Chapter 50: Nursing Care of the Child With an Alteration in Behavior, Cognition, Development, or Mental Health/Cognitive or Mental Health Disorder

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

correct fluid and electrolyte imbalances If the child's condition is at a critical stage with fluid and electrolyte deficiencies, parenteral fluids should be administered immediately to hydrate the client before additional treatment can be implemented.

A child with an intellectual disability is evaluated and found to have an intelligence quotient (IQ) of 65. The nurse interprets this as reflecting which category of intellectual disability?

mild Mild intellectual disability involves an IQ from 50 to 70. Moderate intellectual disability involves an IQ from 35 to 50. Severe intellectual disability involves an IQ from 20 to 35. A profound intellectual disability involves an IQ less than 20.

A nurse is examining a 4-year-old child with various injuries in multiple places. Which site of injury would introduce suspicion of abuse?

abdomen The abdomen is the most frequent site of physical injury where abuse is suspected in children 4 years of age and younger. If injuries to the soles and palms are present, the nurse should look into inflicted burns as a possible cause of injury.

The nursing educator has completed an educational program for new nurses on eating disorders in teenagers. Which statement by a participant would indicate a need for further education?

"If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something." Withdraw attention if the child refuses to eat: secondary gain is minimized if refusal to eat is ignored rather than with continuous attention. Mutually establish a contract related to treatment to promote the child's sense of control. Provide mealtime structure, as clear limits let the child know what the expectations are. Provide continuous supervision during the meal and for 30 minutes following it so that the child cannot conceal or dispose of food or induce vomiting.

An adolescent client has been diagnosed with bulimia nervosa. What does the nurse explain as the goal of treatment for this client?

restoring nutritional balance and a healthy self image Treatment focused on restoring nutritional balance and keeping a structured nutritional intake is key for bulimia nervosa. Cognitive behavior therapy concentrates on improving the person's distorted self-image, uncontrollable and excessive eating, and guilt and embarrassment associated with binging and purging.

A nursing student is learning about developmental disorders. The nursing instructor realizes that further instruction is necessary when the student makes which statement?

"A definitive cause can be found in every developmental disorder" For most developmental disorders, causes cannot be identified. Families should not be blamed for causing developmental problems. After a thorough work-up and no identifiable cause is determined, the family should be helped to come to terms with the diagnosis. They should be helped to accept a child's delays and should work to facilitate the child's progress as the child grows and develops at his/her own pace and abilities.

The parents of an adolescent are concerned about his mental health and have brought the adolescent into the physician's office for an evaluation. Which statements by the parents indicate that the child may have a mental health disorder? Select all that apply.

"He has started sleeping for only 3 hours each night." "He has lost 10 pounds over the last 4 months." "He used to be a straight-A student and now he's bringing home Cs and Ds." Altered sleep patterns, weight loss, and problems at school are commonly found in children with mental health disorders. There also may be alterations in friendships and changes in extracurricular activity participation.

The father of a 14-year-old daughter reports she has been rebelling at home. The use of a contract for behaviors has been discussed. Which response from the father indicates the need for further discussion?

"I can relax rules at home if she has had a bad day" When dealing with a child who is having behavioral issues it is important for the parents to be consistent. Once rules and expectations are established the parents need to remain consistent. When a child is angry arguments should be avoided. The parents need to address the child in clear and calm tones.

An adolescent has been diagnosed with bulimia, and the parents are asking how to best deal with this problem. What suggestion should the nurse make to the parents to help care for the adolescent?

Develop a contract with the adolescent, setting goals of behavior and her diet, as well as privileges gained by meeting the contracted goals. Developing a contract with the adolescent, as part of a behavior modification program, lays out clearly defined behaviors and the child's responsibilities related to bulimia and its management. Parents need to be aware and report any verbalizations about being overweight or altered body image. Antiemetics are not appropriate for this disorder since there is not nausea associated with it and it is impossible to monitor the adolescent continually.

With all the warnings on cigarette packages and media coverage of the side effects of tobacco use, why do school-age children and adolescents continue to smoke or chew tobacco?

School-age and adolescent children view the threats to their health as far in the future, and the child feels that he or she can stop at any time. Children who smoke or use tobacco cannot conceive of the future effects that tobacco will have on their bodies. They see others smoking around them and, through example, think smoking is OK for them. They do not understand the effect on their long-term health because they are focused on the here and now.

Parents of a school-age child have begun a program of therapy that includes giving the child a token each time the child follows directions. Which theoretical framework provides the background for such a program?

behavioral theory Reinforcing behaviors with rewards reflects a basic principle of behavioral therapy. This process reinforces the desired behaviors by replacing the inappropriate behaviors with positive behaviors. Psychodynamic theory involves in depth talk theory based on psychoanalysis. Systems theory is looking at all systems to see how they work together to produce as result. This work be the study of the mind, body and spirit. A token economy allows for tokens to be accumulated for good behavior and then exchanged for a meaningful object or privilege.

A 7-year-old child is diagnosed with a learning disability involving reading, writing, and spelling. The nurse identifies this as:

dyslexia Dyslexia is a learning disability that involves reading, writing, and spelling. Dyscalculia is a learning disability that involves mathematics and computation. Dyspraxia is a learning disability that involves problems with manual dexterity and coordination. Dysgraphia is a learning disability that involves problems producing the written word.

The nurse is preparing a plan to educate the parents of a 10-year-old boy with a learning disorder. What will be part of this plan?

explain the child's strengths and weaknesses The nurse will explain the nature of the child's disorder but will also point out the strengths the child possesses as part of the plan. Encouraging parents to provide a personal space for the child is an intervention meant to promote autonomy and responsibility for a child with delayed growth and development. Regularly checking up on the child is a preventive measure to promote safety for a child with a developmental disorder. Learning facial expressions is important when a child has impaired communication skills.

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?

provide clear instructions on what the nurse is going to do When children with an intellectual disability are seen in an emergency department or an ambulatory setting for care, they may need more explanations of what is expected of them than other children. The average 6-year-old child, for example, sees the nurse with a thermometer and thinks, "I'm going to have my temperature taken." When the nurse explains what is going to happen, it is not really news, only a confirmation of what the child had already guessed. A child who is intellectually disabled may not be able to make this association between the thermometer and what the nurse is going to do; the nurse's explanation, therefore, is the first introduction to the event, so it is necessary for it to be thorough and appealing. The nurse would need to talk slowly and enunciate for a child with a hearing defect. It is best to speak to both the child and the parents. A child with intellectual disabilities is not going to be able to read written instructions.

The nurse suspects that a school-age child has Tourette syndrome. What did the nurse most likely assess in this client?

shouting obscenity Tourette syndrome is an inherited syndrome of motor and phonic vocal tics. Complex vocal tics include the repeated use of words or phrases out of context—specifically, coprolalia or the use of socially unacceptable words such as obscenities. Flat affect, playing alone, and running wildly in circles are not manifestations of Tourette syndrome.

The nurse is conducting an examination of a boy with Tourette syndrome. Which finding should the nurse expect to observe?

sudden, rapid stereotypical sounds Sudden, rapid, stereotypical sounds are a hallmark finding with Tourette syndrome. Toe walking and unusual behaviors such as hand-flapping and spinning are indicative of autism spectrum disorder (ASD). Lack of eye contact is associated with ASD but is also noted in children without a mental health disorder.

The nurse is speaking with the parent of a 2-year-old toddler recently diagnosed with autism spectrum disorder. The parent asks about educational programs for the toddler. What is the best response by the nurse?

"Children with autism spectrum disorder enrolled in public schools can have an individualized educational plan to help meet their specific needs." Children with autism spectrum disorder who are enrolled in public schools need to have an individualized educational plan (IEP) in place. Children with autism spectrum disorder can go to public, specialized, or private schools. No matter the school setting, the child will need assistance of some kind.

The nurse is interviewing a 13-year-old girl with depression. During the course of the interview, the girl reveals that her best friend is thinking about committing suicide. Which response by the nurse would be most appropriate?

"Do you know how she is planning to kill herself?" Because the girl is depressed, the nurse suspects that the girl is indirectly talking about herself, not her best friend. When an adolescent raises the issue of suicide, it is important to find out exactly how he or she is envisioning suicide and take measures to prevent an attempted suicide. Therefore, the nurse should ask how the "friend" is contemplating suicide in order gather this information and open a dialogue to encourage the girl to reveal she is talking about herself. Asking why, if the parents know or if the girl is the only one who knows would not elicit the critical information about the method of suicide.

Parents of a 36-month-old child confide in the clinic nurse that their child does not speak and spends hours staring at their ceiling fan. They are worried that their child may have autism spectrum disorder. Which question would be important for the nurse to ask the parents?

"Does your child come and hug you or seek comfort from you?" Children with autism spectrum disorder lack communication and social skills. These children often will not seek comfort, make eye contact, or develop peer relationships. It is important during the health history for the nurse to focus on the findings the parents are presenting and not on extra information that may or may not be helpful.

A nurse is discussing concerns about possible child abuse with the nursing supervisor. Which statement by the nurse requires correction by the supervisor?

"HIPAA prevents nurses from disclosing confidential information from parents." The fact that the information was given in a confidential interview does not free a nurse from this responsibility (it is an exception under the confidentiality rules of the Health Insurance Portability and Accountability Act [HIPAA]) (Fraser, Matthews, Walsh, et al., 2010). Therefore, the nursing supervisor would need to correct this misinformation. The other comments are correct. All health care institutions and agencies have protocols on how the reporting of child maltreatment should be managed. It is important to learn the protocol required by your particular agency, community, and state. Nurses are included in the mandatory category in most states; this means they must report suspected child maltreatment when they identify it. Failure to do so can result in a fine, jail time, or loss of nursing licensure.

An extremely thin preadolescent is being assessed by the nurse. Which client statement will cause the nurse to suspect the client is experiencing anorexia nervosa?

"I feel chubby no matter what I wear" Characteristics of a client with anorexia nervosa include a severely distorted body image with an intense fear of gaining weight or becoming fat. The goal to be a model is not consistent with that of anorexia nervosa. Enjoying fashion is not a characteristic of anorexia nervosa. The fear of food being poisoned is a characteristic of paranoid behavior.

A nurse is teaching the parents of a client with attention deficit/hyperactivity disorder (ADHD) about medications. Which statement by the parents indicates the need for further education?

"If our child takes this medicine, he will no longer have ADHD" ADHD is a lifelong disorder. The medicine prescribed is not a cure, but will help the child focus and will decrease impulsive behaviors.

A 10-year-old girl with attention-deficit/hyperactivity disorder (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. Which response by the nurse would be most appropriate?

"Lets set up an appointment for you to come as soon as possible" The nurse plays a vital role in administering medicines and observing and reporting responses. A face-to-face appointment with the family and the primary health care provider or advanced practice mental health nurse can help uncover patient and parental factors that may be preventing success. Once it is established that the family is using the medication properly as well as instituting structure within the home, it can be determined if an increased dosage or alternate medicine would be appropriate. Deferring to the doctor will not elicit any information from the mother, and waiting will not address the current concerns. The teacher can only reveal partial information about the effectiveness of the medication, which can be reviewed once other factors have been addressed in a face-to-face visit with the family and patient.

The nurse is teaching a group of teachers how to recognize symptoms of schizophrenia that may occur in adolescence. Which statement by a teacher indicates that the teaching was effective?

"Symptoms include hallucinations with a flat affect or paranoia." Children with schizophrenia experience hallucinations (hear or see people or objects that other people cannot) and may display rambling or illogical speech patterns. They may not be responsive (have a flat affect), may withdraw into themselves so completely they are stuporous (catatonia), or be so extremely suspicious that others want to harm them (paranoia) that it is difficult for them to function. Although schizophrenic manifestations may occur suddenly after a major stress in a child's life (such as rejection by a boyfriend or girlfriend), subtle signs of mental illness have usually been present for some time. It is not related to multiple personalities or autism spectrum disorder. Many children who are diagnosed as having schizophrenia in childhood continue to have mental illness as adults, making continuing support and long-term follow-up essential.

A nurse is caring for a 10-year-old intellectually challenged girl hospitalized for a scheduled cholecystectomy. The girl expresses fear related to her hospitalization and unfamiliar surroundings. How should the nurse respond?

"Tell me about a typical day at home" It is important to continue the usual routine of the hospitalized child, particularly of children with intellectual challenge. By asking an open-ended question about a typical day, the nurse can identify the routine activities that can potentially be duplicated in the hospital. Telling the girl she will be going home soon or asking about art supplies does not address her concerns. Asking whether she has talked to her parents is unhelpful at this time.

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?

"We try to be flexible and change our child's routine day to day" The nurse should emphasize the importance of rigid unchanging routines as children with ASD often act out when their routine changes. The other statements would not warrant additional referral or follow-up.

A nurse in a residential foster home is caring for a 17-year-old girl with conduct disorder. The adolescent is using profanity and refusing to complete the assigned chores. The nurse reminds the adolescent that there are only five minutes in which to finish. The adolescent throws a dirty plate at the wall. Which response would be most appropriate?

"You appear to be feeling very angry tonight, but you must still complete your chores" The nurse's goal is to clearly and empathically explain the rules and firmly adhere to them. Telling the adolescent that there are only a few minutes to complete the chores does not exhibit empathy and is not therapeutic. Neither is the statement "I find your language offensive." This statement also does not address the rules. Letting the adolescent have a few extra minutes only reinforces the negative behavior and does not respect the rules of the facility.

While interviewing an adolescent client with depression, the client reveals to the nurse that he has considered hurting himself. Which response by the nurse would be most appropriate?

"tell me exactly how your would hurt yourself" It is important to find out exactly how the adolescent is envisioning harming himself and to take measures to prevent an attempted suicide. Asking the adolescent why, if his parents know, or if he has discussed this with anyone else would elicit little information about the adolescent's thoughts.

The nurse is assessing a 6-year-old with attention deficit/hyperactivity disorder (ADHD). The nurse observes the boy making repeated clicking noises and notes he has a slight grimace. The nurse recommends the boy receive further evaluation for:

Tourette's syndrome Repeated vocal tics such as sniffling, grunting, clicking, or word utterances are associated with Tourette syndrome. The syndrome consists of multiple motor tics and one or more motor tics occurring simultaneously at different times. ADHD and obsessive-compulsive disorder occur in 90% of children with Tourette syndrome. Vocal and motor tics are not typical indicators of Asperger syndrome, anxiety disorder, or autism spectrum disorder.

A 16-year-old client is highly disruptive in class and has been in trouble at home. The parent recently found the adolescent torturing a cat. When questioned, the adolescent laughed. What condition might the client be suffering from?

conduct disorder Adolescents with conduct disorder are often unmanageable at home and disruptive in the community. They have little empathy or concern for others. They may be callous and lack appropriate feelings of guilt, although they may express remorse superficially to avoid punishment. They often blame others for their actions. Risk-taking behaviors such as drinking, smoking, using illegal substances, experimenting with sex, and participating in crime are typical. Cruelty to animals or people, destruction of property, theft, and serious violation of rules are diagnostic criteria. Asperger syndrome is on the autism spectrum, where the child is extremely high in intelligence. Bipolar symptoms consist of wide swings between depression and mania. Tourette syndrome is a condition where motor and vocal tics occur.

A mother is suspicious that her adolescent has bulimia because the child seems to be dependent upon laxatives and vomits frequently after eating a meal. What physical finding would be most suggestive of this diagnosis?

dental erosion and caries A client with bulimia will display dental caries and erosions from the chronic exposure to stomach acids from self-induced vomiting. The normal weight of a client with bulimia will be normal or slightly overweight, not below the 5th percentile. Calluses are noted in the back of the hands of a client with bulimia, not the palms, and recurrent strep throat is not associated with bulimia at all.

The nurse is preparing a teaching plan for the parents of a 9-year-old child with an intellectual disability. Which issue is specific to the child's condition?

difficulty obtaining healthcare services Obtaining adequate health care services for a child with an intellectual disability can be difficult because reimbursement is insufficient and there is a dearth of competent professionals willing to serve this type of client. Changes in living environment and strict adherence to daily routines are problems encountered in children with autism spectrum disorder. Teachers become frustrated with children with learning disorders when they are not aware of the cause of poor performance.

An infant diagnosed with nonorganic failure to thrive (NFTT) is being treated in the hospital. Which intervention would the nurse implement for this child to provide increased nutritional intake?

document all feedings and the infants response to the feeding An NFTT infant requires frequent, scheduled feedings every 2 to 3 hours. The infant also needs to be talked to during the feeding to assist with bonding and development of trust. Always document the volumes the infant took, as well as how the infant fed. The infant is burped several times during the feeding and then placed on the back for sleeping.

The nurse is completing the physical assessment of a 12-year-old child who has a series of bruises in various stages of healing. When asked about the bruises the child appears frightened and offers inconsistent accounts about how the child got the bruises. The nurse suspects abuse. Which initial action of the nurse is most appropriate?

document any bruises and statements made by the child relating to them Nurses in each state have a legal requirement to report suspicions of child abuse or maltreatment. The nurse must document all findings. The medical record will be of importance in establishing the findings. Once the findings are documented, the nurse will need to closely follow the agency policies regarding the reporting process. The nursing supervisor will need to also be involved but that will take place after the documentation has been completed. The child cannot be photographed without appropriate approvals. The child may indeed be asked to provide a more detailed reporting of the bruising, but it is not the role of the nurse to request it. The child's parents will also become a part of the investigation but the interviewing process does not come before the documentation of the findings.

The nurse is talking with the parents of a child who has been identified as having a learning disability. The parents state that their child performs well on oral examinations but otherwise struggles on exams. The nurse is aware that the parents are describing which disorder?

dyslexia Children with dyslexia have difficulty with reading, writing, and spelling. Children with dyscalculia have problems with mathematics and computation. Children with dyspraxia have problems with manual dexterity and coordination. Children with dysgraphia have difficulty producing the written word.

An adolescent male tells the nurse that he has been smoking cigarettes for the last 3 years. The nurse recognizes that this adolescent is at the greatest risk of substance abuse based upon what family history finding?

he has been previously diagnosed with depression Children who are at greatest risk for becoming substance abusers are those who have a low self-esteem, have been diagnosed with depression, and have ADD or have learning disabilities. Lower socioeconomic level, birth order, or being an average student are not contributory factors.

Which factors are possible causes of cognitive disorders? Select all that apply.

head trauma chromosomal disorders anoxia at birth very low birth weight fetal alcohol spectrum disorder Causes of cognitive disorders include chromosomal and metabolic disorders, anoxia at birth, head trauma, very low birth weight, and fetal alcohol spectrum disorder, among other causes. Cystic fibrosis is a hereditary disease, but it does not cause cognitive disorders.

The nurse is assessing a child diagnosed with autism spectrum disorder (ASD). Which finding will the nurse expect to assess?

indifferent attachment to a parent A child with autism spectrum disorder can show a lack of or no attachment to parents. Motor skills are not expected to be slowed or delayed, because a child with ASD tends to spend hours in repetitive play and may display bizarre motor and stereotypic behavior. The child may become completely absorbed in strange repetitive behaviors such as spinning an object, flipping an electrical switch on and off, or walking around the room feeling the walls. Frequently losing things can be associated with attention deficit hyperactivity disorder. Engaging in dangerous activities could be related to a conduct disorder.

Which behavior typical of children with autism spectrum disorder (ASD) requires the nurse to maintain special care to keep them safe?

insensitivity to pain A number of children with autism spectrum disorder may have a hyposensitivity to pain. Thus, if they hurt themselves, they may not feel the associated pain. It is why one can see these children biting themselves or head banging and not feeling any pain. Having cravings, a fascination with colors, and hearing loss may or may not be associated with a child on the autism spectrum but these manifestations would not be associated with safety.

When teaching parents of a child with encopresis, what would the nurse stress?

not punishing the child for encopresis Encopresis (inappropriate soiling of stool) is a symptom of an underlying stress or disease. It can be the manifestation of how the child expresses the trauma or depression that is occurring. The child needs therapy to determine the cause and to treat the problem. If a child is scolded or punished for encopresis or if more than normal attention is paid to the problem, the problem will worsen. Giving medications will not prevent the encopresis. The proximity of the bathroom will not impact the situation, because with encopresis the child soils the underwear and does not go to the bathroom.

The nurse is conducting a community educational program for parents of school-aged children. What would the nurse include in education plan in regards to the potential for drug and alcohol consumption in the school-age population?

parent modeling of drug and alcohol avoidance is vital at this age Parents need to model good behavior (avoidance) of drugs and alcohol when parenting school-aged children. Peer groups are the most influential at this age, so assuring the child's friends are not involved in dangerous use of drugs and alcohol is vital. Anger will not result in a candid conversation with the child and all discussions about the dangers of drug and alcohol consumption should involve factual statements that the child will understand.

The nurse is caring for a 10-year-old girl with an anxiety disorder. During a physical examination, which physical finding would the nurse expect?

patches of hair loss Patches of hair loss that occur with repetitive hair twisting or pulling are associated with anxiety. Watery, dilated eyes and the absence of nasal hair are often signs of substance abuse.

The nurse is caring for an adolescent diagnosed with anorexia nervosa. Which education will the nurse include in the client's discharge teaching?

referrals to counseling service Adolescents with eating disorders need to increase self-esteem or a feeling that they have control over their life. This can be achieved through extensive counseling services, which should be scheduled for this client prior to discharge. The client needs to be nutritionally stable before participating in exercise activities. Desensitization is not a method of treatment used for anorexia. It is used to diminish emotional responsiveness to a stimulus through repeated exposure. Phenelzine, a monoamine oxidase inhibitor (MAOI), is not used to treat anorexia. It is used to treat depression. Selective serotonin reuptake inhibitors (SSRIs) and antipsychotics are typically used to treat clients with anorexia nervosa.

What is an example of impaired adaptive functioning in an 8-year-old girl with a developmental disorder?

the child cannot properly dress herself A child with impaired adaptive functioning would not be able to dress herself properly, if at all. The inability to copy a phone number or sentence, or to read well, reflects learning disorders.

What finding would suggest that a 5-year-old boy might have a developmental disorder?

the child is not able to follow directions A 5-year-old child should be able to follow simple directions. If he is unable to do this, he has not yet achieved a developmental milestone. Brushing his teeth with supervision and knowing cat and dog sounds are normal for this age. Having trouble with R, L, and Y sounds is not unusual and may continue until age 7.

A 15-year-old Vietnamese-American boy has been referred by his homeroom teacher to the school nurse for evaluation. The teacher is concerned that the adolescent may be suffering from major depression. When investigating these concerns at the family's primary care office, the nurse would use which person as the primary source of information?

the client The client is the primary historian, and the nurse should first elicit his perspective on the problem to establish a therapeutic alliance. The school nurse might have some input, but his or her contact with the adolescent may have been minimal. The client's parents can provide insight and assistance, but they may not be willing to do so because of cultural differences. The teacher will provide a valuable timeline and observations as the individual who referred this case; however, the client is still the primary historian.

A nurse is teaching a group of parents about risks for mental health disorders in children. Which factors does the nurse include in this teaching session?

trauma, poverty, and neglect Various factors have been associated with an increased risk for mental health disorders in children, including trauma, poverty or neglect, difficult temperament or attachment problems, medical illness, or major losses to the family such as divorce or death. Stress could be an issue, but prematurity and poor nutrition are not risk factors for mental health disorders. Death in the family or divorce can cause mental health issues as well as illness, but intellectual disability does not. Developmental delay may be a symptom of a problem, but it is not a risk factor. Anoxia at birth is can cause cognitive disability and possible learning problems, but these are not risk factors for mental illness in themselves.

The nurse is meeting with parents who have learned that their 11-year-old child has some cognitive impairments. They tell the nurse that the child is having trouble coping with different situations at school. What is the best response by the nurse?

"Coping and adaptation are often affected by cognitive impairments." A cognitive impairment is a functional state in which there are significant limitations in the cognitive status and adaptive behavior development before the age of 18 years. The child is at increased risk for adjustment disorders because the child's coping strategies are not understood or recognized and his or her range of adaptive strategies may be reduced. Coping, adaptation, and social skills development are greatly dependent on abstract thinking and the ability to generalize from one situation to another. Cognitive impairment includes impairment of abstract thinking. Children who have cognitive impairment are often uncomfortable with unfamiliar surroundings and people. Time is needed to build relationships but the ability to build relationships may be dependent upon the level of the child's impairment.

A pediatric client has recently been prescribed methylphenidate. The parent calls the office and insists the medication is not working. How will the nurse respond?

"Tell me why you believe the medication is not working" Asking the parent to explain why he or she believes the medicine is not working will offer important insights into the parent's definition of effectiveness. It is important for both the parent and health care team to develop a shared definition of effectiveness and improvement. Once this is established, the nurse can suggest the next step in the treatment plan. Stating a different medication or dosage may be needed does not provide any information about the child's response to the current medication. Asking the parent about administering the medication properly could cause the parent to take offense and does not provide the necessary information.

The parents of a 13-year-old tell the nurse that they have done some research and they think their daughter has conduct disorder. The parents report the child excessively argues with them, throws tantrums when not getting her way, and stays mad at them for long periods of time. How should the nurse respond?

"The behavior you are describing sounds more like oppositional defiant disorder than conduct disorder." Oppositional defiant disorder is characterized by excessive arguing with adults, frequent temper tantrums, active defiance, revenge-seeking behaviors, frequent resentment or anger, and touchiness or easily annoyed. Conduct disorder has a host of other behaviors for the criteria of the diagnosis.

The nurse is recording vital signs in the client diagnosed with complications of anorexia nervosa. Which findings are consistent with the condition? Select all that apply.

Orthostatic hypotension Weak pulse Hypothermia Anorexia nervosa is a condition most commonly seen in adolescents. In this condition the individual is obsessed with body weight. There is a noted loss of weight. The vital signs frequently display orthostatic hypotension, irregular and decreased pulse, or hypothermia.

The mother of a school-age child is distraught over the ongoing oppositional behavior demonstrated by the child at home and at school. Which nursing diagnosis should the nurse select as appropriate for the child and family?

Interrupted family processes related to inability of child to follow instructions Oppositional defiant disorders consist of long-term hostile, negativistic, or defiant behaviors that result in disturbed functioning in academic and social domains. Children typically have difficulty controlling their temper; such anger is often directed at an authority figure. The disorder develops most frequently in late preschool or early school age. The diagnosis most appropriate for this child and parent is interrupted family processes. There is no evidence to suggest that the child is at risk for self-directed violence, low self-esteem, or impaired social interaction.

The health care provider has recently informed parents that their child has an intellectual disability. The parents express the need for information and help with the important decisions they need to make concerning care of their child. What is an appropriate nursing diagnosis for this situation?

Parental knowledge deficit related to health care needs for a child with an intellectual disability Parental knowledge deficit related to health care needs for a child with an intellectual disability is the best nursing diagnosis for this situation because it addresses the parental need for information. There may be anxiety, ineffective family coping, and ineffective family process, but there is no data to support that in this situation.

The nurse is discussing the treatment for a child with attention deficit hyperactivity disorder (ADHD) with a group of school nurses. What would be an appropriate learning setting for a child with ADHD?

a classroom with a plan of study that is followed everyday For the child with ADHD, the learning situations should be structured so that the child has minimal distractions and a supportive teacher. Special arrangements can be made to provide an educational atmosphere that is supportive for the child without the need for the child to leave the classroom. Having the child with ADHD face the playground would provide the child with too much distraction. Having the child with ADHD select his or her own activities or placing the child at tables instead of an individual desk means the child would not stay on task. Giving the child too many choices only serves to confuse the child and leads to increasing hyperactivity and loss of control.

The nurse goes in to assess a 13-year-old client on a pediatric floor. Which finding would the nurse expect if the client's admission diagnosis was anorexia?

abdominal pain Anorexia is a disorder that involves refusing to eat to maintain a normal body weight. It is caused by the perception of the person's size or body appearance. It occurs mostly in girls ages 13 to 20. The teen can experience constipation, secondary amenorrhea, and abdominal pain. Signs and symptoms of anorexia include weight loss, low blood pressure, bradycardia, and hypothermia.

A nurse is working at a facility that provides care to children with developmental disabilities. Which role would be the nurse's most important?

advocate Although the nurse would fulfill the roles of educator, care provider, and counselor, the nurse's most important role would be that of an advocate. Children with developmental disabilities often have special health needs. If so, they often interact with many different health care professionals (nurses, pediatricians, occupational therapists, physical therapists, psychologists, and speech and language pathologists) and may require adaptive modifications for school to maximize attendance and learning (e.g., assistance from health aides, nursing care, modifications for regular classes, special education classes, barrier-free facilities). A key nursing role is advocating to obtain services and care that will enable these children to fully participate in and benefit from their educational experiences.

The most common use disorder among children and adolescents is:

alcohol Alcohol misuse occurs when a person ingests a quantity sufficient to cause intoxication. It is also the most common substance use disorder among children and adolescents.

A parent brings a preschooler to the behavioral clinic for evaluation. Upon entering the room, the child appears not to notice the nurse's presence. The child screams upon the nurse's touch. What condition should the nurse suspect?

autism Autistism spectrum disorder is characterized by markedly abnormal or impaired development in social interaction and communication. Social impairment is sustained and includes such things as poor eye contact, not liking to be touched, and preferring solitary activities. The findings are not indicative of Down syndrome or a learning disability. Down syndrome children are usually very friendly and like to be hugged and touched. A child with a learning disability does not have problems with socialization. These symptoms are not normal findings in preschoolers. Preschoolers are very interested in their surroundings and very interactive.

A mother has presented with her 2 year old child. She states that the child was talking in earlier months but recently has "kind of withdrawn." The child does not interact with other children or adults much but does enjoy throwing a ball, retrieving it and throwing it again. The nurse realizes that the child needs further assessment for which disorder?

autism spectrum disorder Playing alone and lack of interaction with others are typical symptoms related to autism. There are not indicators of learning issues with the child at the current time and no tics are being reported. Hyperactivity is not noted in the child, which would indicate a hyperactivity disorder.

A young parent brings the school-aged child to the office for a sports physical examination. During the appointment, the parent informs the nurse about being worried because the child does not like school and does not seem to be reading, writing, or spelling as well as others in the class. The parent adds that the child struggles to get organized and to manage time. What condition does the nurse suspect?

learning disorder The child appears to have a learning disorder based on challenges with reading, spelling, and writing as well as being organized and managing time. Other findings consistent with a learning disorder include delayed language development and difficulty discriminating among sounds. Autism is a spectrum of disorders characterized by markedly abnormal or impaired development in social interaction and communication. Down syndrome is a condition in which extra genetic material causes delays in how a child develops, both physically and cognitively. Asperger syndrome is a type of autism.

The nurse is performing a physical assessment of 16-year-old girl who is intellectually disabled. This client attended her local public elementary school through fifth grade and has since been enrolled at a special education school where she has received social and vocational training. She plans on getting a job in the coming month and on living independently in a few years. The nurse recognizes this client's level of intellectual disability as:

mild About 85% of children who are intellectually disabled have an IQ of 50 to 70 and may be referred to as "educable" by a school system. During early years, these children learn social and communication skills and are often not too distinguishable from average infants or toddlers. They continue to learn academic skills up to about a sixth-grade level. As adults, they can usually achieve social and vocational skills adequate for minimum self-support. They're able to live independently but need guidance and assistance when faced with new situations or unusual stress.

A mother is telling the school nurse about her concerns regarding her 13-year-old daughter, who reports headaches. The child's grades have dropped, and the child is sleeping late and going to bed early every night. Which would the nurse identify as the priority?

scheduling an immediate history and physical examination The first step is to conduct a physical examination to rule out or identify illnesses or physical problems that might cause depression. Once any physical causes have been ruled out, the health care team can determine the most appropriate approach to assess the client's symptoms.

A 7-year-old child being treated for depression will most likely be given which first-line pharmacological treatment?

selective serotonin reuptake inhibitors (SSRIs) The most commonly used antidepressant medications for children and adolescents are SSRIs. Side effects, especially nausea, headache, and stomachache, are minimal, especially when the starting dose is low with a gradual increase to a therapeutic level. Benzodiazepines are prescribed for anxiety, not depression. Tricyclic antidepressants are an older class of antidepression drugs. They have many more side effects and are not widely used. MAOIs are the first class of antidepressants ever made. They had many interactions with food. They are not prescribed for children.

The nurse is conducting an assessment of a 5-year-old client. During the assessment, the nurse notes that the child does not maintain eye contract or speak. The nurse suspects an autism spectrum disorder. Which additional finding would help support the nurse's suspicion?

the child constantly opens and closes the hands Repetitive motor mannerisms such as constantly opening and closing the hands are a typical behavior pattern for autism spectrum disorder. A high level of activity and inattentiveness are typical symptoms of intellectual disability. Decrease in head circumference suggests malnutrition or decelerating brain growth. A long face and prominent jaw are symptoms of fragile X syndrome.

A 6-year-old client has been diagnosed with an autism spectrum disorder. Which symptoms would the nurse expect the client to display?

the client spends time alone and shows little interest in making friends Children with an autism spectrum disorder develop language slowly or not at all. They may use words without attaching meaning to them or communicate with only gestures or noises. They spend time alone and show little interest in making friends. Approximately 80% of people with an autism spectrum disorder also are classified as intellectually impaired. Their most distinctive feature, however, is their seeming isolation from the world around them. This detachment and aloofness help distinguish people with an autism spectrum disorder from those who are solely intellectually impaired. Tourette syndrome is associated with multiple vocal and motor tics. A child with an anxiety disorder may have an irresistible urge to pull out one's hair. A child with separation anxiety would worry constantly about being separated from family.