Wong Ch 16:Health Problems of School-Age Children and Adolescents

Turner syndrome is suspected in an adolescent girl with short stature. This is caused by which of the following? a. Absence of one of the X chromosomes b. Presence of an incomplete Y chromosome c. Precocious puberty in an otherwise healthy child d. Excess production of both androgens and estrogens

A. Absence of one of the X chromosomes Turner syndrome is caused by an absence of one of the X chromosomes. Most girls who have this disorder have one X chromosome missing from all cells.

Which of the following is descriptive of central nervous system stimulants? a. They produce strong physical dependence. b. They can result in strong psychologic dependence. c. Withdrawal symptoms are life threatening. d. Acute intoxication can lead to coma.

b. They can result in strong psychologic dependence. Central nervous system stimulants such as amphetamines and cocaine produce a strong psychologic dependence.

An occlusive dressing is applied to a large abrasion. This is advantageous because the dressing will accomplish what? a. Deliver vitamin C to the wound. b. Provide an antiseptic for the wound. c. Maintain a moist environment for healing. d. Promote mechanical friction for healing.

ANS: C Occlusive dressings, such as Acuderm, are not adherent to the wound site. They provide a moist wound surface and insulate the wound. The dressing does not have vitamin C or antiseptic capabilities. Acuderm protects against friction.

Which of the following is the usual presenting symptom for testicular cancer? a. Hard, painful mass b. Hard, painless mass c. Epididymis easily palpated d. Scrotal swelling and pain

B. Hard, painless mass The usual presenting symptom for testicular cancer is a heavy, hard, painless mass that is either smooth or nodular and palpated on the testes.

The nurse is teaching the parents of a child recently diagnosed with ADHD who has been prescribed methylphenidate (Ritalin). Which of the following should the nurse include in teaching about the side effects of methylphenidate? a. "Your child may experience a sense of nervousness." b. "You may see an increase in your child's appetite." c. "Your child may experience daytime sleepiness." d. "You may see a decrease in your child's blood pressure."

a. "Your child may experience a sense of nervousness." Nervousness is one of the common side effects of Ritalin.

An adolescent girl tells the nurse that she is very suicidal. The nurse asks her if she has a specific plan. Asking this should be considered which of the following? a. An appropriate part of the assessment b. Not a critical part of the assessment c. Suggesting that the adolescent needs a plan d. Encouraging the adolescent to devise a plan

a. An appropriate part of the assessment Routine health assessments of adolescents should include questions that assess the presence of suicidal ideation or intent. Questions such as "Have you ever developed a plan to hurt yourself or kill yourself" should be part of that assessment.

Which of the following is the most commonly used method in completed suicides? a. Firearms b. Drug overdose c. Self-inflected laceration d. Carbon monoxide poisoning

a. Firearms Firearms are the most commonly used instruments in completed suicides among both males and females. For adolescent boys, firearms are followed by hanging and overdose. For adolescent females, overdose and strangulation are the next most common means of completed suicide.

Which of the following statements is correct about childhood obesity? a. Heredity is an important factor in the development of obesity. b. Childhood obesity in the United States is decreasing. c. Childhood obesity is the result of inactivity. d. Childhood obesity can be attributed to an underlying disease in most cases.

a. Heredity is an important factor in the development of obesity. Heredity is an important fact that contributes to obesity. Identical twins reared apart tend to resemble their biologic parents to a greater extent than their adoptive parents. It is difficult to distinguish between hereditary and environmental factors.

A mother calls the school nurse saying that her daughter has developed a school phobia. She has been out of school 3 days. The nurse's recommendations should include which of the following? a. Immediately return child to school. b. Explain to child that this is the last day she can stay home. c. Determine cause of phobia before returning child to school. d. Seek professional counseling before forcing child to return to school.

a. Immediately return child to school. The primary goal is to return the child to school. Parents must be convinced gently, but firmly, that immediate return is essential and that it is their responsibility to insist on school attendance.

The nurse is caring for an adolescent brought to the hospital with acute drug toxicity. Cocaine is believed to be the drug involved. Data collection should include which of the following? a. Mode of administration b. Drug's actual content c. Function the drug plays in the adolescent's life d. Adolescent's level of interest in rehabilitation

a. Mode of administration When the drug is questionable or unknown, every effort must be made to determine the type, amount of drug taken, the mode and time of administration, and factors relating to the onset of presenting symptoms.

What is the most significant factor in distinguishing those who commit suicide from those who make suicidal attempts or threats? a. Social isolation b. Level of stress c. Degree of depression d. Desire to punish others

a. Social isolation Social isolation is a significant factor in distinguishing adolescents who will kill themselves from those who will not. It is also more characteristic of those who complete suicide than of those who make attempts or threats.

A sexually active female adolescent asks the nurse about the contraceptive Depo-Provera. The nurse should explain that it: a. requires injections every 3 months. b. requires daily administration of medication by mouth. c. provides long-term continuous protection, up to 5 years. d. prevents pregnancy if given within 72 hours of unprotected sex.

a. requires injections every 3 months The contraceptive Depo-Provera is administered by injection every 3 months.

Which of the following statements is true concerning adolescent suicide? a. A sense of hopelessness and despair are a normal part of adolescence. b. Gay and lesbian adolescents are at a particularly high risk for suicide. c. Problem-solving skills are of limited value to the suicidal adolescent. d. Previous suicide attempts are not an indication of risk for completed suicides.

b. Gay and lesbian adolescents are at a particularly high risk for suicide. A significant number of teenage suicides occur among homosexual youths. Gay and lesbian adolescents who live in families or communities that do not accept homosexuality are likely to suffer low self-esteem, self-loathing, depression, and hopelessness as a result of a lack of acceptance from their family or community.

Which of the following is descriptive of attention deficit hyperactivity disorder (ADHD)? a. Manifestations exhibited are so bizarre that the diagnosis is fairly easy. b. Manifestations affect every aspect of the child's life but are most obvious in the classroom. c. Learning disabilities associated with ADHD eventually disappear when adulthood is reached. d. Diagnosis of ADHD requires that all manifestations of the disorder be present.

b. Manifestations affect every aspect of the child's life but are most obvious in the classroom. ADHD affects every aspect of the child's life, but the disruption is most obvious in the classroom.

Brian, age 12 years, has short stature because of a constitutional growth delay. The nurse should be the most concerned about which of the following? a. Proper administration of thyroid hormone b. Proper administration of human growth hormones c. Child's self-esteem and sense of competence d. Helping child understand that his height is most likely caused by chronic illness and is not his fault

c. Child's self-esteem and sense of competence Most cases of constitutional growth delay are caused by simple constitutional delay of puberty, and the child can be assured that normal development will eventually take place. Listening to distressed adolescents and conveying interest and concern are important interventions for these children and adolescents. They should be encouraged to focus on the positives aspects of their bodies and personalities.

Which of the following statements regarding chlamydial infections is correct? a. Treatment of choice is oral penicillin. b. Treatment of choice is nystatin or miconazole. c. Clinical manifestations include dysuria and urethral itching in males. d. Clinical manifestations include small, painful vesicles on genital areas.

c. Clinical manifestations include dysuria and urethral itching in males. Symptoms of chlamydial infection in males include meatal erythema, tenderness, itching, dysuria, and urethral discharge. Some infected males have no symptoms.

Young people with anorexia nervosa are often described as being which of the following? a. Independent b. Disruptive c. Conforming d. Low achieving

c. Conforming Individuals with anorexia nervosa are described as perfectionist, academically high achievers, conforming, and conscientious.

Which of the following is an important consideration when the nurse is discussing enuresis with the parents of a young child? a. Enuresis is more common in girls than in boys. b. Enuresis is neither inherited nor has a familial tendency. c. Organic causes that may be related to enuresis should be considered first. d. Psychogenic factors that cause enuresis persist into adulthood.

c. Organic causes that may be related to enuresis should be considered first. Organic causes that may be related to enuresis should be ruled out before psychogenic factors are considered.

The school nurse is discussing testicular self-examination with adolescent boys. Why is this important? a. Epididymitis is common during adolescence. b. Asymptomatic sexually transmitted diseases may be present. c. Testicular tumors during adolescence are generally malignant. d. Testicular tumors, although usually benign, are common during adolescence.

c. Testicular tumors during adolescence are generally malignant. Tumors of the testes are not common, but when manifested in adolescence, they are generally malignant and demand immediate evaluation.

Adolescents with bulimia may experience which of the following complications as a result of the frequent vomiting? a. Diarrhea b. Amenorrhea c. Cold intolerance d. Erosion of tooth enamel

d. Erosion of tooth enamel Some of the signs of bulimia include erosion of tooth enamel, increased dental caries from vomited gastric acid, throat complaints, fluid and electrolyte disturbances, and abdominal complaints from laxative abuse.

Which of the following symptoms would the nurse expect to observe during the physical assessment of an adolescent girl with severe weight loss and disrupted metabolism associated with anorexia nervosa? a. Dysmenorrhea and oliguria b. Tachycardia and tachypnea c. Heat intolerance and increased blood pressure d. Lowered body temperature and brittle nails

d. Lowered body temperature and brittle nails Symptoms of anorexia nervosa include lower body temperature, severe weight loss, decreased blood pressure, dry skin, brittle nails, altered metabolic activity, and presence of lanugo hair.

An adolescent girl asks the school nurse for advice because she has dysmenorrhea. She says that a friend recommended she try an over-the-counter nonsteroidal antiinflammatory drug (NSAID). The nurse's response should be based on which of the following? a. Aspirin is the drug of choice for the treatment of dysmenorrhea. b. Over-the-counter NSAIDs are rarely strong enough to provide adequate pain relief. c. NSAIDs are effective because of their analgesic effect. d. NSAIDs are effective because they inhibit prostaglandins, leading to reduction in uterine activity.

d. NSAIDs are effective because they inhibit prostaglandins, leading to reduction in uterine activity. First-line therapy for adolescents with dysmenorrhea is NSAIDs. This group of drugs blocks the formation of prostaglandins.

The weight loss of anorexia nervosa is usually triggered by which of the following? a. Sexual abuse b. School failure c. Independence from family d. Traumatic interpersonal conflict

d. Traumatic interpersonal conflict Weight loss may be triggered by a typical adolescent crisis such as the onset of menstruation or a traumatic interpersonal incident; situations of severe family stress, such as parental separation or divorce; or circumstances in which the young person lacks personal control, such as being teased, changing schools, or entering college.

Which of the following statements is true about gonorrhea? a. It is caused by Treponema pallidum. b. Treatment is by multidose administration of penicillin. c. Treatment is by topical applications to lesions. d. Treatment of all sexual contacts is an essential part of treatment.

d. Treatment of all sexual contacts is an essential part of treatment. The treatment plan should include finding and treating all sexual partners.

Which of the following is descriptive of bulimia during adolescence? a. Strong sense of control over eating behavior b. Feelings of elation after the binge-purge cycle c. Profound lack of awareness that the eating pattern is abnormal d. Weight that can be normal, slightly above normal, or below normal

d. Weight that can be normal, slightly above normal, or below normal Individuals with bulimia are of normal or more commonly slightly above normal weight. Those who also restrict their intake can become severely underweight.

An adolescent girl calls the nurse at the clinic because she had unprotected sex the night before and does not want to be pregnant. The nurse should explain that: a. it is too late to prevent an unwanted pregnancy. b. an abortion may be the best option if she is pregnant. c. Norplant can be administered to prevent pregnancy for up to 5 years. d. postcoital contraception is available to prevent implantation and therefore pregnancy.

d. postcoital contraception is available to prevent implantation and therefore pregnancy. Several emergency methods of contraception are available.

A child is becoming increasingly anxious over attending school with increasing frequency as the school year has gone on. Now the child is also presenting with physical symptoms which subside when the child remains at home. Based on this finding, the nurse would suspect that the child has A. school phobia. B. passive aggressive disorder. C. psychosomatic complaints. D. general anxiety disorder.

ANS: A School phobia (school refusal and school avoidance) refers to expression of fear or increasing anxiety related to the attendance of school. Physical symptoms may accompany this presentation and resolve when the child is not in attendance at school. The described behavior does not indicate passive aggressive disorder or general anxiety disorder. And while the child manifests psychosomatic complaints, these are correlated directly with the school environment as a trigger.

The nurse is teaching an adolescent female with primary dysmenorrhea foods that are natural diuretics. What foods should the nurse include in the teaching plan? (Select all that apply.) a. Peaches b. Asparagus c. Watermelon d. Wheat bread e. Dairy products

ANS: A, B, C Natural diuretics such as asparagus, cranberry juice, peaches, parsley, or watermelon may help reduce edema and related discomforts of primary dysmenorrhea. Wheat bread and dairy products are not natural diuretics.

The nurse is teaching a school-age child about factors that can delay wound healing. What factors should the nurse include in the teaching session? (Select all that apply.) a. Deficient vitamin C b. Deficient vitamin D c. Increased circulation d. Dry wound environment e. Increase in white blood cells

ANS: A, B, D Factors that delay wound healing are a dry wound environment (allows epithelial cells to dry), deficient vitamin C (inhibits formation of collagen fibers), and deficient vitamin D (regulates growth and differentiation of cell types). Decreased, not increased, circulation delays healing. An increase in the white blood cell count may occur but does not delay healing.

The clinic nurse is assessing an adolescent on a topical antibacterial agent. The nurse should assess for which side effects that can be seen with topical antibacterial agents? (Select all that apply.) a. Burning b. Dryness c. Dry eyes d. Erythema e. Nasal irritation

ANS: A, B, D Side effects of topical antibacterial medications include erythema, dryness, and burning; using the medications every other day will decrease the adverse effects. Dry eyes and nasal irritation are seen with use of isotretinoin, 13-cis-retinoic acid (Accutane).

The nurse is teaching an adolescent female about the symptoms of premenstrual syndrome (PMS). What symptoms should the nurse include in the teaching session? (Select all that apply.) a. Headaches b. Fluid retention c. Increased energy d. Emotional changes e. Premenstrual cravings

ANS: A, B, D, E Symptoms of PMS include fluid retention (abdominal bloating, pelvic fullness, edema of the lower extremities, breast tenderness, and weight gain), behavioral or emotional changes (depression, crying spells, irritability, panic attacks, and impaired ability to concentrate), premenstrual cravings (sweets, salt, increased appetite, and food binges), headache, and backache. Fatigue rather than increased energy occurs.

The school nurse is teaching a group of adolescent females which measures to take to prevent genital tract infections. What should the nurse include in the teaching session? (Select all that apply.) a. Use condoms. b. Douche once a week. c. Avoid tight-fitting clothing. d. Limit exposure to bubble baths. e. Avoid colored and scented toilet tissue.

ANS: A, C, D, E Measure to take to prevent genital tract infections include using condoms, avoiding tight-fitting clothing, limiting exposure to bubble baths, and avoiding colored and scented toilet tissue. Douching should be avoided.

The nurse is teaching parents of a school-age child how to cleanse small wounds. What should the nurse advise the parents to avoid using to cleanse a wound? (Select all that apply.) a. Alcohol b. Normal saline c. Tepid water d. Povidoneiodine e. Hydrogen peroxide

ANS: A, D, E Caution caregivers to avoid cleansing the wound with povidoneiodine, alcohol, and hydrogen peroxide because these products disrupt wound healing. Normal saline and tepid water are safe to use when cleansing wounds.

The nurse is teaching an adolescent with premenstrual syndrome (PMS) dietary measures to relieve the symptoms of PMS. What should the nurse include in the teaching session? (Select all that apply.) a. Limit salt in the diet. b. Limit legumes in the diet. c. Include red meat in the diet. d. Include whole grains in the diet. e. Limit consumption of refined sugar.

ANS: A, D, E Dietary treatment for PMS includes limiting consumption of refined sugar, salt, red meat, alcohol, and caffeinated beverages. Women can be encouraged to include whole grains, legumes, seeds, nuts, vegetables, fruits, and vegetable oils in their diet.

The nurse is teaching an adolescent girl strategies to relieve dysmenorrhea. What should the nurse include in the teaching session? (Select all that apply.) a. Effleurage b. Diet high in fat c. Limiting exercise d. Use of a heating pad e. Massaging the lower back

ANS: A, D, E Dysmenorrhea can be relieved by heat (heating pad or hot bath), which minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Also, massaging the lower back can reduce pain by relaxing paravertebral muscles and increasing the pelvic blood supply. Soft, rhythmic rubbing of the abdomen (effleurage) is useful because it provides a distraction and an alternative focal point. A low-fat, not a high-fat, diet can help with dysmenorrhea, and exercise should not be limited because exercise can be beneficial.

What menstrual disorders are indications for a pelvic examination? (Select all that apply.) a. Amenorrhea b. Dyspareunia c. Impaired fertility d. Irregular uterine or vaginal bleeding e. Dysmenorrhea unresponsive to therapy

ANS: A, D, E Indications for a pelvic examination include amenorrhea, irregular uterine or vaginal bleeding, and dysmenorrhea unresponsive to therapy. Impaired fertility is not an indication for a pelvic examination; it can be a result of endometriosis. Dyspareunia (painful intercourse) is not an indication for a pelvic examination but may be a sign of endometriosis.

A 15-year-old girl tells the school nurse that she has not started to menstruate yet. Onset of secondary sexual characteristics was about 2 1/2 years ago. The nurse should take which action? a. Explain that this is not unusual. b. Refer the adolescent for an evaluation. c. Make an assumption that the adolescent is pregnant. d. Suggest that the adolescent stop exercising until menarche occurs.

ANS: B A referral is indicated. Menarche should follow the onset of secondary sexual development within 2 1/2 years. A careful examination is done to reveal any physical abnormalities, signs of androgen excess, and congenital defects of the genital tract. The lack of the onset of menstruation at this age is a potential indication of a physical problem. Assuming that the adolescent is pregnant is inappropriate. The nurse does not have any indication that the adolescent is sexually active. The amount of exercise should be assessed before suggesting that the adolescent stop exercising until menarche occurs.

A 6-year-old boy with very fair skin will be joining his family during a beach vacation. What should the nurse recommend? a. Keep him off the beach during the daytime hours. b. Use sunscreen with an SPF of at least 15 and reapply it every 2 to 3 hours. c. Apply a topical sunscreen product with an SPF of 30 in the morning. d. Dress him in long pants and long-sleeved shirt and keep him under a beach umbrella.

ANS: B A sunscreen with an SPF (sun protection factor) of at least 15 is recommended. The sunscreen should be reapplied every 2 to 3 hours and after the child is in the water or sweating excessively. During a beach vacation, avoiding the beach during daytime hours is impractical. The highest risk of sun exposure is from 10 AM to 3 PM. Sunlight exposure should be limited during this time. An SPF of 30 is good, but reapplying it is necessary every 2 to 3 hours and when the child gets wet. Long pants and a shirt are impractical. The beach umbrella can be used with the sunscreen to limit exposure to the sun.

The nurse is discussing health behaviors with a 14-year-old who recently began smoking cigarettes. An appropriate tactic for the nurse to use when discussing this lifestyle choice is A. cigarette smoking is only "cool" in high school and is not accepted in college. B. cigarette smoking can cause permanent damage to the lungs and can cause cancer as an adult. C. cigarettes are expensive, and a 14-year-old will not be able to afford them, so he should stop smoking. D. cigarettes contain nicotine, and this will cause addiction to other drugs.

ANS: B Cigarette smoking can cause permanent damage to the lungs and can cause cancer as an adult. At 14, the child only thinks of the present. The nurse would need to include and explain, and even use pictures to illustrate, what might happen to the body if the child continues to smoke. Saying cigarette smoking is only cool in high school and is not accepted in college is not a useful tactic the nurse should use when discussing smoking cigarettes. Suggesting that cigarettes are not affordable and the 14-year-old should therefore stop smoking is not a healthy approach to teaching adolescents to stop smoking. Cigarettes contain nicotine, and this will cause addiction to other drugs. Adolescents are not often concerned with whether cigarette smoking will lead to other addictions.

It is important that women with anogenital warts caused by the human papillomavirus (HPV) receive adequate treatment because this sexually transmitted infection increases the risk of what? a. Gonorrhea b. Cervical cancer c. Chlamydial infection d. Urinary tract infection

ANS: B Infection with HPV is associated with cervical dysplasia and cervical cancer. A vaccine has been developed and is recommended for young women.

3. A toddler has a deep laceration contaminated with dirt and sand. Before closing the wound, the nurse should irrigate with what solution? a. Alcohol b. Normal saline c. Povidoneiodine d. Hydrogen peroxide

ANS: B Normal saline is the only acceptable fluid for irrigation listed. The nurse should cleanse the wound with a forced stream of normal saline or water. Alcohol is not used for wound irrigation. Povidoneiodine is contraindicated for cleansing fresh, open wounds. Hydrogen peroxide can cause formation of subcutaneous gas when applied under pressure.

The clinic nurse is evaluating a patient with a vaginal infection. The nurse knows that the normal vaginal pH is in which range? a. 3.0 to 4.0 b. 4.0 to 5.0 c. 5.0 to 6.0 d. 6.0 to 7.0

ANS: B Normal vaginal secretions are acidic, with a pH range of 4.0 to 5.0.

The nurse is teaching a class on obesity prevention to parents in the community. What is a contributing factor to childhood obesity? a. Birth weight b. Parental overweight c. Age at the onset of puberty d. Asian ethnic background

ANS: B There is a high correlation between parental adiposity and childhood adiposity. Obese children do not have higher birth weights than nonobese children. Early menarche is associated with obesity, but the age of puberty is not a contributing factor. African Americans and Hispanics have disproportionately high percentages of overweight individuals, but Asians do not.

An adolescent patient is being treated for a Trichomonas infection with the appropriate antibiotic. Which instruction should be included in the plan of care? A. Only the person needs to be treated and not any sexual partners. B. Patient should refrain from drinking beer during treatment. C. Antibiotic must be administered via parenteral route. D. Topical medication in the form of an antifungal is also included in the treatment plan.

ANS: B Treatment of Trichomonas is accomplished through use of Flagyl which is an ant infective agent. Alcohol should be avoided during the treatment phase and for a 48-hour period following treatment. Sexual partners should be treated as this is considered to be a sexually transmitted disease. Medication can be administered orally as well parenterally. Topical medication is not prescribed for treatment.

The nurse is caring for a child with erythema multiforme (Stevens-Johnson syndrome). What local manifestations does the nurse expect to assess in this child? (Select all that apply.) a. Papular urticaria b. Erythematous papular rash c. Lesions absent in the scalp d. Lesions enlarge by peripheral expansion e. Firm papules that may be capped by vesicles

ANS: B, C, D Local manifestations of erythema multiforme include an erythematous popular rash, lesions involving most skin surfaces except the scalp and lesions that enlarge by peripheral expansion. Papular urticaria and firm papules capped by vesicles are characteristics of an insect bite.

The nurse is caring for an adolescent male with gynecomastia. What groups of drugs can induce gynecomastia in male adolescents? (Select all that apply.) a. Oral antibiotics b. Oral ketoconazoles c. Calcium channel blockers d. Histamine-2 receptor blockers e. Cancer chemotherapeutic agents

ANS: B, C, D, E Gynecomastia may be drug induced; calcium channel blockers, cancer chemotherapeutic agents, histamine-2 receptor blockers, and oral ketoconazoles have all been shown to cause the disorder. Oral antibiotics have not been shown to cause gynecomastia.

The nurse is caring for a child with psoriasis. What local manifestations does the nurse expect to assess in this child? (Select all that apply.) a. Development of wheals b. First lesions appear in the scalp c. Round, thick, dry reddish patches d. Lesions appear in intergluteal folds e. Patches are covered with coarse, silvery scales

ANS: B, C, E Local manifestations of psoriasis include lesions that appear in the scalp initially and round, thick dry patches covered with coarse, silvery scales. Development of wheals is seen in urticaria. Lesions in intergluteal folds are characteristic of intertrigo.

What are risk factors of testicular cancer? (Select all that apply.) a. Hispanic b. Infertility c. Alcohol use d. Tobacco use e. Family history

ANS: B, D, E Risk factors of testicular cancer include infertility, tobacco use, and a family history. White, not Hispanic, ethnicity is a high risk, and alcohol use is not a risk.

The nurse has determined that an adolescents body mass index (BMI) is in the 90th percentile. What information should the nurse convey to the adolescent? a. The adolescent is overweight. b. The adolescent has maintained weight within the normal range. c. The adolescent is at risk for becoming overweight. d. Nutritional supplementation should occur at least three times per week

ANS: C Adolescents with BMIs between the 85th and 94th percentile for age and gender are at risk for becoming overweight. Adolescents with BMIs greater than the 95th percentile are classified as overweight. Nutritional guidance, not supplementation, is needed.

A nurse is working with teenagers and their parents in a school drug prevention program. Several of the parents ask how they can determine if their child has a problem with drugs. The most appropriate response by the nurse is: A. There is no way to know until they tell you. B. At some point, the child will develop depression and attempt suicide; then you can put them in rehab. C. It is common for them to withdraw and not achieve normal developmental tasks. You should then consult a professional. D. You should make your child take a home test for drugs. You can buy those at the drug store.

ANS: C Children and teenagers who begin using drugs may often stop participating in routine activities and not continue to achieve the normal milestones of the adolescent period. If the parent ever has a question, they should seek information from a health care provider. Waiting for the child to tell the parent is not a way to determine if the child has a problem with drugs. It is a very passive approach to parenting. Waiting for the child to develop depression and attempt suicide is not a preventive approach to handling drug use. Taking a home test for drugs is not a measure that should be taken unless the child has been caught engaging in drug use.

What goal is most important when caring for a child with anorexia nervosa (AN)? a. Limit fluid intake. b. Prevent depression. c. Correct malnutrition. d. Encourage weight gain.

ANS: C In children diagnosed with AN or bulimia nervosa, the priority consideration is to correct the malnutrition. Severe malnutrition, electrolyte disturbances, vital sign abnormalities, and psychiatric disorders may be present. Careful monitoring is necessary to avoid complications. Often fluid intake is restricted by individuals with AN. Fluid balance must be restored. Preventing depression is important, but the correction of potentially life-threatening malnutrition takes precedence. After the initial malnutrition is corrected, then a plan is established for nutritional therapy.

After a treatment plan for acne has been initiated, which time period should the nurse explain to an adolescent before improvement will be seen? a. 2 to 4 weeks b. 4 to 6 weeks c. 6 to 8 weeks d. 8 to 10 weeks

ANS: C Inform patients that after a treatment plan for acne has been initiated, it will take 6 to 8 weeks to appreciate improvement in their skin.

Which action should be included in a plan of care for an adolescent who is being treated for depression with tricyclic antidepressants? A. Restriction of fluids is needed to prevent fluid overload. B. Recording of daily weight. C. Make sure that dental hygiene is being performed on a routine basis. E. Increase in caloric intake to maintain weight.

ANS: C The use of tricyclic antidepressants exerts a significant effect on dentition ranging to increased incidence of dental caries and decreased amount of saliva. Therefore, a dental hygiene program should be included as part of therapeutic management in order to avoid potential complications. Fluid intake should be encouraged and there is no need for documented daily weights or increase in caloric intake to maintain weight.

The nurse is facilitating a conference between the teachers and parents of a 7-year-old child newly diagnosed with attention deficit hyperactivity disorder (ADHD). What does the nurse stress? a. Academic subjects should be taught in the afternoon. b. Low-interest activities in the classroom should be minimized. c. Visual references should accompany verbal instruction. d. The childs environment should be visually stimulating.

ANS: C Verbal instructions should always be accompanied by visual or written instructions. This provides the child with reinforcement and a reference to expectations. Academic subjects should be taught in the morning when the child is experiencing the effects of the morning dose of medication. Low-interest activities should be mixed with high-interest activities to maintain the childs attention. Environmental stimulation should be minimized to help eliminate distractions that can overexcite the child.

Which symptoms are commonly seen in a child with depression? Select all that apply. A. Focus on violence B. Excessive laughing C. Somatic complaints D. Increased motor activity E. Poor school performance

ANS: C, E Children with depression will complain of nonspecific complaints such as not feeling well. Children with depression will show a lack of interest in doing homework or achieving in school and getting lower grades than usual. Focus on violence can be associated with depression in the adolescent. A child with depression exhibits predominantly sad facial expression with absence or diminished range of affective response. Children with depression will have diminished motor activity and complain of being too tired.

The clinic nurse is evaluating an adolescent with menses that have stopped occurring. The nurse understands that which minimum amount of time should the menses be absent after a period of menstruation to be diagnosed as secondary amenorrhea? a. 3 months b. 4 months c. 5 months d. 6 months

ANS: D A 6-month or more cessation of menses after a period of menstruation is secondary amenorrhea.

The nurse is teaching an adolescent about acne care. What statement by the adolescent indicates a need for further teaching? a. I will cleanse my face twice a day. b. I will frequently shampoo my hair. c. I will brush my hair away from my forehead. d. I will use my antibacterial soap to cleanse my face.

ANS: D Antibacterial soaps are ineffective and may be drying when used in combination with topical acne medications. Further teaching is needed if the adolescent indicates using antibacterial soap. Gentle cleansing with a mild cleanser once or twice daily is usually sufficient. For some adolescents, hygiene of the hair and scalp appears to be related to the clinical activity of acne. Acne on the forehead may improve with brushing the hair away from the forehead and more frequent shampooing.

What best describes central nervous system (CNS) stimulants? a. Acute intoxication can lead to coma. b. They produce strong physical dependence. c. Withdrawal symptoms are life threatening. d. They can result in strong psychologic dependence.

ANS: D CNS stimulants such as amphetamines and cocaine produce a strong psychologic dependence. Acute intoxication leads to violent aggressive behavior or psychotic episodes characterized by paranoia, uncontrollable agitation, and restlessness. This class of drugs does not produce strong physical dependence and can be withdrawn without much danger.

The nurse is teaching a class on the dangers of "huffing." What information is included as a major side effect of "huffing?" A. Cardiac arrest B. Loss of vision C. Delay of growth D. Loss of consciousness

ANS: D Skin discoloration is not a side effect of huffing. Cardiac arrest is not typically a major side effect of huffing. Loss of consciousness and respiratory arrest are major side effects of huffing. Delay of growth is not a side effect of huffing.

An older school-age child asks the nurse, What is the reason for this topical corticosteroid cream? What rationale should the nurse give? a. The cream is used for an antifungal effect. b. The cream is used for an analgesic effect. c. The cream is used for an antibacterial effect. d. The cream is used for an anti-inflammatory effect.

ANS: D The glucocorticoids are the therapeutic agents used most widely for skin disorders. Their local anti-inflammatory effects are merely palliative, so the medication must be applied until the disease state undergoes a remission or the causative agent is eliminated. It does not have an antifungal, analgesic, or antibacterial effect.

Which of the following statements is correct regarding sports injuries during adolescence? a. The increase in strength and vigor during adolescence helps prevent injuries related to fatigue. b. Conditioning does not help prevent many sports injuries. c. More injuries occur during organized athletic competition than during recreational sports participation. d. Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities.

D-Adolescents may not possess insight and judgment to recognize when a sports activity is beyond their capabilities. Injuries occur when the adolescent's body is not suited to the sport and/or when they lack the insight and judgment to recognize that an activity exceeds their physical abilities.

Which of the following statements is true about smoking in adolescence? a. Smoking is related to other high-risk behaviors. b. Smoking will not continue unless peer pressure continues. c. Smoking is less common when the adolescent's parent(s) smokes. d. Smoking among adolescents is becoming more prevalent.

A. Smoking is related to other high-risk behaviors. Cigarettes are considered a gateway drug. Teenagers who smoke are 11.4 times more likely to use an illicit drug.

Deficiency of which vitamin or mineral results in an inadequate inflammatory response? a. A b. B1 c. C d. Zinc

ANS: A A deficiency of vitamin A results in an inadequate inflammatory response. Deficiencies of vitamins B1 and C result in decreased collagen formation. A deficiency of zinc leads to impaired epithelialization.

The nurse is admitting a child with frostbite. What health care prescription should the nurse question and verify? a. Massage the injured tissue. b. Apply a loose dressing after rewarming. c. Avoid any application of dry heat to the area. d. Administer acetaminophen (Tylenol) for discomfort.

ANS: A A frostbite victim should not have injured tissue rubbed. It is contraindicated because it can cause damage by rupture of crystallized cells. After rewarming, a loose dressing is applied to the affected skin, and analgesia is administered if indicated. Dry heat is not applied.

A 9-year-old child has just been diagnosed with recurrent abdominal pain (RAP). In preparing for discharge, the nurse should include what in the home care instructions to the parents? a. Following a high-fiber diet b. Using stimulant laxatives c. Using ice packs on the abdomen when pain occurs d. Sitting on the toilet for 30 minutes after each meal

ANS: A A high-fiber diet with possible addition of bulk laxatives is beneficial for children with RAP. Bulk-forming laxatives such as psyllium are recommended. Stimulant laxatives may produce painful cramping for the child. Warm packs, such as a heating pad, may help ease the discomfort. Bowel training is recommended to assist the child in establishing regular bowel habits. Thirty minutes is too long for the child to sit on the toilet. The time should be limited to 15 minutes.

A 13-year-old boy comes to the school nurse complaining of sudden and severe scrotal pain. He denies any trauma to the scrotum. What is the most appropriate nursing action? a. Refer him for immediate medical evaluation. b. Administer analgesics and recommend scrotal support. c. Apply an ice bag and observe for increasing pain. d. Reassure the adolescent that occasional pain is common with the changes of puberty.

ANS: A Any adolescent boy with redness, swelling, or pain in the scrotum is referred for immediate evaluation. These are signs of testicular torsion, which is a medical emergency. If the possibility of testicular torsion is eliminated, appropriate interventions include administering analgesics and recommending scrotal support. applying an ice bag and observing for increasing pain. and reassuring the adolescent that occasional pain is common with the changes of puberty.

The management of a child who has just been stung by a bee or wasp should include applying what? a. Cool compresses b. Antibiotic cream c. Warm compresses d. Corticosteroid cream

ANS: A Bee or wasp stings are initially treated by carefully removing the stinger, cleansing with soap and water, applying cool compresses, and using common household agents such as lemon juice or a paste made with aspirin and baking soda. Antibiotic cream is unnecessary unless a secondary infection occurs. Warm compresses are avoided. Corticosteroid cream is not part of the initial therapy. If a severe reaction occurs, systemic corticosteroids may be indicated.

An important distinction in understanding substance abuse is that drug misuse, abuse, and addiction are considered what? a. Voluntary behaviors based on psychosocial needs b. Problems that occur in conjunction with addiction c. Involuntary physiologic responses to the pharmacologic characteristics of drugs d. Legal use of substances for purposes other than medicinal.

ANS: A Drug misuse, abuse, and addiction are considered voluntary behaviors. Cultural norms define what is abuse and misuse. Addiction is a psychologic dependence on a substance with or without physical dependence. Physical dependence is an involuntary response to the pharmacologic characteristics of the drug such as an opiate or alcohol. Legality is not always a factor in substance abuse. Legal substances such as alcohol and tobacco can also be misused or abused and can cause addiction.

What is a priority goal in the postpartum care of an adolescent mother? a. Prevention of subsequent pregnancies b. Ensuring that the father of the baby cares for the child c. Returning the mother to a prepregnancy lifestyle d. Facilitating formula feeding to minimize interruptions

ANS: A Postpartum care of the adolescent is directed at preventing subsequent pregnancies and enhancing life outcomes for the teen parents and child. Health care programs should provide comprehensive contraceptive services at the same time the child is seen for appointments. Ensuring the father of the baby cares for the child is not part of the postpartum care of the mother. The adolescent mother cannot return to a prepregnancy lifestyle. She now has an infant to care for. Breastfeeding is recommended for the infant. The nurse and mother should explore the best nutrition for both the mothers needs and those of the infant.

A pregnant 15-year-old adolescent tells the nurse that she did not use any form of contraception because she was afraid her parents would find out. The nurse should recognize what? a. This is a frequent reason given by adolescents. b. This suggests a poor parentchild relationship. c. This is not a good reason to not get contraception. d. This indicates that the adolescent is unaware of her legal rights.

ANS: A This is one of the most common reasons given by teenagers for not using contraception. Although it is optimum for the parents to be involved in the health care of adolescents, some adolescents require confidential care. Privacy is important as they develop their personal identity and establish relationships. The adolescent may be concerned about parental judgment. The adolescent should discuss with the health care provider contraception that meets her needs; some of the longer acting birth control methods may be preferable. The adolescent did not tell the nurse that she was unaware that she could legally obtain contraceptive materials; she was concerned about her parents.

During a well-child visit, the nurse practitioner provides guidance about promoting healthy eating in a child who is overweight. What does the nurse advise? a. Slow down eating meals. b. Avoid between-meal snacks. c. Include low-fat foods in meals. d. Use foods that child likes as special treats.

ANS: A When a child slows down the eating process, it is easier to recognize signs of fullness. If food is consumed rapidly, this feedback is lost. Regular meals and snacks are encouraged to prevent the child from becoming too hungry and overeating. Low-fat foods are usually higher in calories than the regular versions. Nutritional labels should be checked and foods high in sugar and calories avoided. Food should not be used as a special treat or reward; this encourages the child to use food as comfort measures in response to boredom and stress.

A sexually active adolescent asks the school nurse about prevention of sexually transmitted infections (STIs). What should the nurse recommend? a. Use of condoms b. Prophylactic antibiotics c. Any type of contraception method d. Withdrawal method of contraception

ANS: A When used appropriately, condoms provide a barrier to the organisms that cause STIs. Prophylactic antibiotics are not recommended; they are effective only against bacteria, not viruses. Only condoms create a physical barrier that prevents contact with the organisms.

The school nurse is assessing a childs severely scraped knee for infection. What are signs of a wound infection? (Select all that apply.) a. Odor b. Edema c. Dry scab d. Purulent exudate e. Decreased temperature

ANS: A, B, D Signs of wound infection are odor, edema, and purulent exudate. Increased, not decreased, temperature indicates infection. A dry scab over the wound is part of the healing process.

A 9-year-old child has just been diagnosed with recurrent abdominal pain (RAP). Which of the following should the nurse include in preparing the family for discharge? (Select all that apply.) a. "Your child should be on a high-fiber diet." b. "You may give your child a stimulant laxative once a week." c. "You should help your child with bowel training to establish regular bowel habits." d. "Your child may place ice packs on the abdomen when pain occurs."

ANS: A, C A high-fiber diet with possible addition of bulk laxatives is beneficial in children with RAP. Bowel training is recommended to assist the child in establishing regular bowel habits.

The nurse is teaching an adolescent about the use of tretinoin (Retin-A). What should the nurse include in the teaching session? (Select all that apply.) a. Begin with a pea-sized dot of medication. b. Apply additional medication to the throat. c. Use sunscreen daily and avoid the sun when possible. d. Divide the medication into the three main areas of the face. e. Apply the medication immediately after washing the face.

ANS: A, C, D Tretinoin is available as a cream, gel, or liquid. This drug can be extremely irritating to the skin and requires careful patient education for optimal usage. The patient should be instructed to begin with a pea-sized dot of medication, which is divided into the three main areas of the face and then gently rubbed into each area. The avoidance of the sun and the daily use of sunscreen must be emphasized because sun exposure can result in severe sunburn. The medication should not be applied for at least 20 to 30 minutes after washing to decrease the burning sensation. The medication should not be applied to the throat.

What conditions are physical complications of obesity? (Select all that apply.) a. Type 2 diabetes mellitus b. QT interval prolongation c. Fatty liver disease d. Gastrointestinal dysfunction e. Abnormal growth acceleration f. Dental erosion

ANS: A, C, E Physical complications of obesity include type 2 diabetes mellitus, which is reaching epidemic proportions in children and adolescents; fatty liver disease not related to alcohol consumption; and abnormal growth acceleration in which overweight children tend to be taller and mature earlier than children who are not overweight. Prolonged QT intervals, gastrointestinal dysfunction, and dental erosion are physical complications observed in children or adolescents who have eating disorders such as anorexia nervosa or bulimia.

The nurse is explaining the purpose of using a vacuum-assisted closure (VAC) device to assist in the healing of a wound. What should the nurse explain as the purpose of using a VAC device? a. The device will decrease capillary flow. b. The device applies gentle continuous suction. c. The device will allow the wound to remain open. d. The device will prevent the formation of granulation tissue.

ANS: B A VAC device uses a technique that involves placing a foam dressing into the wound, covering it with an occlusive dressing, and applying gentle continuous suction. The negative pressure of the suction is applied from the foam dressing to the wound surfaces. The mechanical force removes excess fluids from the wound, stimulates formation of granulation tissue, restores capillary flow, and fosters closure of the wound.

Parents are concerned that their 6-year-old son continues to occasionally wet the bed. What does the nurse explain? a. This is likely because of increased stress at home. b. Enuresis usually ceases between 6 and 8 years of age. c. Drug therapy will be prescribed to treat the enuresis. d. Testing will be necessary to determine what type of kidney problem exists.

ANS: B Further data must be gathered before the diagnosis of enuresis is made. Enuresis is the inappropriate voiding of urine at least twice a week. This child does meet the age criterion, but the parents need to be questioned about and keep a diary on the frequency of events. If the bedwetting is infrequent, parents can be encouraged that the child may grow out of this behavior. Drug therapy will not be prescribed until a more complete evaluation is done. Additional assessment information must be gathered, but at this time, there is no indication of renal disease.

Parents phone the nurse and say that their child just knocked out a permanent tooth. What should the nurses instructions to the parents include? a. Place the tooth in dry container for transport. b. Hold the tooth by the crown and not by the root area. c. Transport the child and tooth to a dentist within 18 hours. d. Take the child to hospital emergency department if his or her mouth is bleeding.

ANS: B It is important to avoid touching the root area of the tooth. The tooth should be held by the crown area; rinsed in milk, saline, or running water; and reimplanted as soon as possible. The tooth is kept moist during transport to maintain viability. Cold milk is the most desirable medium for transport. The child needs to be seen by a dentist as soon as possible. Tooth evulsion causes a large amount of bleeding. The child will need to be seen by a dentist because of the loss of a tooth, not the bleeding.

An adolescent girl is brought to the hospital emergency department by her parents after being raped. The girl is calm and controlled throughout the interview and examination. The nurse should recognize this behavior is what? a. A sign that a rape has not actually occurred b. One of a variety of behaviors normally seen in rape victims c. Indicative of a higher than usual level of maturity in the adolescent d. Suggestive that the adolescent had severe emotional problems before the rape occurred

ANS: B Rape victims display a wide range of behaviors. A controlled manner may be an attempt to maintain composure while hiding the inner turmoil. Because the observed behavior is within the range of expected behavior, there are no data to indicate that a rape has not actually occurred, that the adolescent is unusually mature, or that she had severe emotional problems before the rape occurred.

What is a major physical risk for young adolescents during pregnancy? a. Osteoporosis frequently develops. b. Fetopelvic disproportion is a common problem. c. Delivery is usually precipitous in this age group. d. Pregnancy will adversely affect the adolescents development.

ANS: B Teenagers younger than 15 years of age have increased obstetric risks. Fetopelvic disproportion is one of the most common complications. Osteoporosis occurs later in life and is not related to adolescent pregnancy. Prolonged, not precipitous, labor is common in this age group. Teenage mothers are socially, educationally, psychologically, and economically disadvantaged. Support is necessary because the tasks of motherhood are superimposed on adolescent development tasks.

A child has had contact with some poison ivy. The school nurse understands that the full-blown reaction should be evident after how many days? a. 1 day b. 2 days c. 3 days d. 4 days

ANS: B The full-blown reaction to poison ivy is evident after about 2 days, with linear patches or streaks of erythemic, raised, fluid-filled vesicles; swelling; and persistent itching at the site of contact.

A school-age child has been bitten on the leg by a large snake that may be poisonous. During transport to an emergency facility, what should the care include? a. Apply ice to the snakebite. b. Immobilize the leg with a splint. c. Place a loose tourniquet distal to the bite. d. Apply warm compresses to the snakebite.

ANS: B The leg should be immobilized. Ice decreases blood flow to the area, which allows the venom to work more destruction and decreases the effect of antivenin on the natural immune mechanisms. A loose tourniquet is placed proximal, not distal, to the area of the bite to delay the flow of lymph. This can delay movement of the venom into the peripheral circulation. The tourniquet should be applied so that a pulse can be felt distal to the bite. Warmth increases circulation to the area and helps the toxin into the peripheral circulation.

What do nursing responsibilities regarding weight gain for an adolescent with anorexia nervosa include? a. Administer tube feedings until target weight is achieved. b. Restore body weight to within 10% of the adolescents ideal weight. c. Encourage continuation of strenuous exercise as long as adolescent is not losing weight. d. Facilitate as rapid a weight gain as possible with a high-calorie diet.

ANS: B The restoration of body weight to a target weight or endpoint within 10% of ideal body weight is one of the main goals of therapy. Strenuous exercise is avoided as part of the need to modify behaviors. Tube feedings are intrusive and are avoided. They should only be used when other measures have failed. Weight restoration is accomplished slowly. The goal is 1 kg/wk to avoid the risk of metabolic and cardiac problems. Slow weight gain can minimize anxiety and depression.

The emergency department nurse is admitting a child with a temperature of 35 C (95 F). What physical effects of hypothermia should the nurse expect to observe in this child? (Select all that apply.) a. Bradycardia b. Vigorous shivering c. Decreased respiratory rate d. Decreased intestinal motility e. Task performance is impaired

ANS: B, D, E Hypothermia has varying physical effects depending on the childs core temperature. At 35 C (95 F), a child would experience vigorous shivering, decreased intestinal motility, and task performance impairment. Bradycardia and decreased respiratory rate are physical effects observed as the body temperature continues to decrease.

An adolescent patient has been diagnosed with a vulvovaginal candidiasis (yeast infection). The nurse expects the health care provider to recommend which vaginal cream? a. Premarin b. Estradiol (Estrace) c. Miconazole (Monistat) d. Clindamycin phosphate (Cleocin)

ANS: C A number of antifungal preparations are available for the treatment of vulvovaginal candidiasis infections. Many of these medications (e.g., miconazole [Monistat] and clotrimazole [Gyne-Lotrimin]) are available as over-the-counter (OTC) agents. Premarin and Estrace are estrogen vaginal creams and are used to treat vaginal dryness. Cleocin is an antibacterial vaginal cream used to treat bacterial vaginal infections.

The nurses role in facilitating successful childrearing in unmarried teenage mothers includes what? a. Facilitating marriage between the mother and father of the baby b. Teaching the adolescent the long-term needs of the growing child c. Providing information and feedback about positive parenting skills d. Encouraging the infants grandmother to take responsibility for care

ANS: C Competence in a teenage mother is increased when feedback is provided about positive parenting skills and use of community resources. The nurse can identify and refer the mother to programs such as support groups for adolescent mothers, infant stimulation programs, and parenting programs. Facilitating marriage between the mother and the father of the baby may produce additional stress and detract from their ability to care for the infant. Encouraging the infants grandmother to take responsibility for care would decrease the mothers ability to develop successful childrearing behaviors. Supportive families can provide assistance to enable the teenage mother to complete school. Many adolescents do not have a future perspective for themselves. The nurse includes information on normal infant development to aid the mother in having reasonable expectations.

The nurse is caring for a child with a decubiti on the buttocks. The nurse notes that the dressing covering the decubiti is loose. What action should the nurse implement? a. Retape the dressing. b. Remove the dressing. c. Change the dressing. d. Reinforce the dressing.

ANS: C Dressings should always be changed when they are loose or soiled. They should be changed more frequently in areas where contamination is likely (e.g., sacral area, buttocks, tracheal area). The dressing should not be retaped, removed, or reinforced.

The nurse understands that medications delivered by which route are more likely to cause a drug reaction? a. Oral b. Topical c. Intravenous d. Intramuscular

ANS: C Drugs administered by the intravenous route are more likely to cause a reaction than the oral, topical, or intramuscular route.

Descriptions of young people with anorexia nervosa (AN) often include which criteria? a. Impulsive b. Extroverted c. Perfectionist d. Low achieving

ANS: C Individuals with AN are described as striving for perfection, which may manifest in other compulsive disorders. They are also academically high achievers. Impulsive and extroverted personalities are more characteristic of bulimia nervosa.

What behavior is the nurse most likely to assess in an adolescent with anorexia nervosa (AN)? a. Eats in secrecy b. Uses food as a coping mechanism c. Has a marked preoccupation with food d. Lacks awareness of how eating affects weight loss

ANS: C Individuals with AN display great interest in food. They prepare meals for others, talk about food, and hoard food. During meals, food play may occur to appear as if the person is eating. Persons with AN consume a small amount of food, so they have no need to eat in secrecy. Individuals with bulimia nervosa (BN) usually binge privately. Food is not used as a coping mechanism in AN, as is common in BN. Individuals with AN know about the relationship between calorie intake and calorie expenditure. They can regulate intake and then exercise to not gain or to lose weight.

The nurse should know what about Lyme disease? a. Very difficult to prevent b. Easily treated with oral antibiotics in stages 1, 2, and 3 c. Caused by a spirochete that enters the skin through a tick bite d. Common in geographic areas where the soil contains the mycotic spores that cause the disease

ANS: C Lyme disease is caused by Borrelia burgdorferi, a spirochete spread by ticks. The early characteristic rash is erythema migrans. Tick bites should be avoided by entering tick-infested areas with caution. Light-colored clothing should be worn to identify ticks easily. Long-sleeve shirts and long pants tucked into socks should be worn. Early treatment of the erythema migrans (stage 1) can prevent the development of Lyme disease. Lyme disease is caused by a spirochete, not mycotic spores.

What is a characteristic of children with depression? a. Increased range of affective response b. Tendency to prefer play instead of schoolwork c. Change in appetite resulting in weight loss or gain d. Preoccupation with need to perform well in school

ANS: C Physiologic characteristics of children with depression include changes in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping patterns, insomnia or hypersomnia, and constipation. Children who are depressed have sad facial expressions with absent or diminished range of affective response. These children withdraw from previously enjoyed activities and engage in solitary play or work with a lack of interest in play. They are uninterested in doing homework or achieving in school, resulting in lower grades.

The middle school nurse is planning a behavior modification program for overweight children. What is the most important goal for participants of the program? a. Learn how to cook low-fat meals. b. Improve relationships with peers. c. Identify and eliminate inappropriate eating habits. d. Achieve normal weight during the program.

ANS: C The goal of behavior modification in weight control is to help the participant identify abnormal eating processes. After the abnormal patterns are identified, then techniques, including problem solving, are taught to eliminate inappropriate eating. Learning how to cook low-fat meals can be a component of the program, but the focus of behavior modification is identifying target behaviors that need to be changed. Improving relationships is not the focus of weight management behavior management programs. Achieving normal weight during the program is an inappropriate goal. As the child incorporates the techniques, weight gain will slow. In childhood obesity, the goal is to stop the increase of weight gain.

Tretinoin (Retin-A) is a commonly used topical agent for the treatment of acne. What do nursing considerations with this drug include? a. Sun exposure increases effectiveness. b. Cosmetics with lanolin and petrolatum are preferred in acne. c. Applying of the medication occurs at least 20 to 30 minutes after washing. d. Erythema and peeling are indications of toxicity and need to be reported.

ANS: C The medication should not be applied for at least 20 to 30 minutes after washing to decrease the burning sensation. The avoidance of sun and the use of sunscreen agents must be emphasized because sun exposure can result in severe sunburn. Cosmetics with lanolin, petrolatum, vegetable oil, lauryl alcohol, butyl stearate, and oleic acid can increase comedone production. Erythema and peeling are common local manifestations.

A parent calls the clinic nurse because his 7-year-old child was bitten by a black widow spider. What action should the nurse advise the parent to take? a. Apply warm compresses. b. Carefully scrape off the stinger. c. Take the child to the emergency department. d. Apply a thin layer of corticosteroid cream.

ANS: C The venom of the black widow spider has a neurotoxic effect. The parent should take the child to the emergency department for treatment with antivenin and muscle relaxants as needed. Warm compresses increase the circulation to the area and facilitate the spread of the venom. The black widow spider does not have a stinger. Corticosteroid cream has no effect on the venom.

The nurse is caring for a child who has a temperature of 30 C (86 F). What physical effects of hypothermia should the nurse expect to observe in this child? (Select all that apply.) a. Reduced urinary output b. Injury to peripheral tissue c. Increased blood pressure d. Tachycardia e. Irritability with loss of consciousness f. Rigid extremities

ANS: C, D, E Hypothermia has varying physical effects depending on the childs core temperature. At 30 C (86 F), a child would experience an increase in blood pressure, tachycardia, and irritability followed by a loss of consciousness. Reduced urinary output from a decrease of blood flow to the kidneys, injury to peripheral tissue, and rigid extremities are physical effects observed as the body temperature continues to decrease.

The nurse is presenting an educational program to a group of parents about differences between anorexia nervosa (AN) and bulimia nervosa (BN) at a community outreach program. What statement by a parent would indicate a need for additional teaching? a. A child with AN will turn away from food to cope, but a child with BN turns to food to cope. b. A child with AN maintains rigid control and is introverted, but a child with BN is an extrovert and frequently loses control. c. A child with AN denies the illness, but a child with BN recognizes the illness. d. A child with AN is usually sexually active and seeks intimacy, but a child with BN avoids intimacy and is usually not sexually active.

ANS: D A child with AN is usually the one who avoids intimacy and is not sexually active, but a child BN often seeks intimacy and is sexually active. A child with AN turns away from food to cope with life, maintains rigid control, is introverted, and denies the illness. A child with BN turns to food to cope, is an extrovert who loses control, and recognizes that he or she has an illness.

During a well-child visit, the nurse plots the childs BMI on the health record. What is the purpose of the BMI? a. To determine medication dosages b. To predict adult height and weight c. To identify coping strategies used by the child d. To provide a consistent measure of obesity

ANS: D A consistent measure of the degree of obesity is important to determine whether modification of the body fat component is indicated. Body surface area (BSA), not BMI, is used for medication dosage calculation. The BMI is not a predictor of adult height. A child with a high BMI may use food as a coping mechanism, but the BMI is not correlated with coping strategy use.

The nurse is assisting the family of a child with a history of encopresis. What should be included in the nurses discussion with the family? a. Instruct the parents to sit the child on the toilet at twice-daily routine intervals. b. Instruct the parents that the child will probably need to have daily enemas. c. Suggest the use of stimulant cathartics weekly. d. Reassure the family that most problems are resolved successfully, with some relapses during periods of stress.

ANS: D Children may be unaware of a prior sensation and be unable to control the urge after it begins. They may be so accustomed to bowel accidents that they may be unable to smell or feel them. Family counseling is directed toward reassurance that most problems resolve successfully, although relapses during periods of stress are possible. Sitting the child on the toilet is not recommended because it may intensify the parentchild conflict. Enemas may be needed for impactions, but long-term use prevents the child from assuming responsibility for defecation. Stimulant cathartics may cause cramping that can frighten children.

What strategy is considered one of the best for preventing smoking in teenagers? a. Large-scale printed information campaigns b. Emphasis on the long-term effects of smoking on health c. Threatening the social norms of groups most likely to smoke d. Peer-led programs emphasizing the social consequences of smoking

ANS: D Peer-led programs emphasizing the social consequences of smoking have proved most successful. Short-term effects such as an unpleasant odor and stains on the teeth and hands are stressed. If a significant number of peers convince their classmates that smoking is not popular, others will follow. Large-scale printed information campaigns are not effective. A specified curriculum and teaching can increase benefit. Long-term effects do not dissuade adolescents because they do not have a future perspective. Threatening the norms of the social group is one of the least effective means of prevention.

What is an important consideration in the diagnosis of attention deficit hyperactivity disorder (ADHD)? a. Learning disabilities are apparent at an early age. b. The child will always be distracted by external stimuli. c. Parental observations of the childs behavior are most relevant. d. It must be determined whether the childs behavior is age appropriate or problematic.

ANS: D The diagnosis of ADHD is complex. A multidisciplinary evaluation should be done to determine whether the childs behavior is appropriate for the developmental age or whether it is problematic. Learning disabilities are usually not evident until the child enters school. Each child with ADHD responds differently to stimuli. Some children are distracted by internal stimuli and others by external stimuli. Parents can only provide one viewpoint of the childs behavior. Many observers should be asked to provide input with structured tools to facilitate the diagnosis.

The school nurse is reviewing the process of wound healing. What is the initial response at the site of injury? a. Contraction b. Maturation c. Fibroplasia d. Inflammation

ANS: D The initial response at the site of injury is inflammation, a vascular and cellular response that prepares the tissues for the subsequent repair process. Fibroplasia (granulation or proliferation), the second phase of healing, lasts from 5 days to 4 weeks. During contraction and maturation, the third and fourth phases of wound healing, collagen continues to be deposited and organized into layers, compressing the new blood vessels and gradually stopping blood flow across the wound.

What is characteristic of children with posttraumatic stress disorder (PTSD)? a. Denial as a defense mechanism is unusual. b. Traumatic effects cannot remain indefinitely. c. Previous coping strategies and defense mechanisms are not useful. d. Children often play out the situation over and over again.

ANS: D The third phase of adjustment to PTSD involves the children playing out the situation over and over to come to terms with their fears. Denial is frequently used as a defense mechanism during the second phase. For some children, traumatic effects can remain indefinitely. Coping is a learned response. During the third stage, the children can be helped to use their coping strategies to deal with their fears.

Smokeless tobacco is: a. not addicting. b. proven to be carcinogenic. c. easy to stop using. d. a safe alternative to cigarette smoking.

B. Proven to be carcinogenic Smokeless tobacco is a popular substitute for cigarettes and poses serious health hazards to children and adolescents. Smokeless tobacco is associated with cancer of the mouth and jaw.

An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago. She has not received any medical care. She smokes but denies any other substance use. The priority nursing action is which of the following? a. Notify her parents. b. Refer for prenatal care. c. Explain the importance of not smoking. d. Discuss dietary needs for adequate fetal growth.

B. Refer for prenatal care Teenage girls and their unborn children are at greater risk for complications during pregnancy and delivery. With improved therapies, the mortality for teenage pregnancy is decreasing, but the morbidity is high.

Which of the following abnormalities is a common sex chromosome defect? a. Down b. Turner c. Marfan d. Hemophilia

B. Turner Turner syndrome is caused by an absence of one of the X chromosomes.

A 14-year-old boy and his parents are concerned about bilateral breast enlargement. The nurse's discussion of this should be based on which of the following? a. This is usually benign and temporary. b. This is usually caused by Klinefelter syndrome. c. Administration of estrogen effectively reduces gynecomastia. d. Administration of testosterone effectively reduces gynecomastia.

a. This is usually benign and temporary. The male breast responds to hormonal changes. Some degree of bilateral or unilateral breast enlargement occurs frequently in boys during puberty.

Correct terminology is necessary in understanding substance abuse. Physical dependence is which of the following? a. Problem that occurs in conjunction with addiction b. Involuntary physiologic response to drug c. Culturally defined use of drugs for purposes other than accepted medical purposes d. Voluntary behavior based on psychosocial needs

b. Involuntary physiologic response to drug Physical dependence is an involuntary response to the pharmacologic characteristics of drugs such as opioids or alcohol.

The psychologic effects of being obese during adolescence include which of the following? a. Sexual promiscuity b. Poor body image c. Feelings of contempt for thin peers d. Accurate body image but self-deprecating attitude

b. Poor body image Common emotional consequences of obesity include poor body image, low self-esteem, social isolation, and feelings of depression and isolation.

Which of the following is a characteristic of children with depression? a. Increased range of affective response b. Preoccupation with need to perform well in school c. Change in appetite, resulting in weight loss or gain d. Tendency to prefer play instead of schoolwork

c. Change in appetite, resulting in weight loss or gain Physiologic characteristics of children with depression include change in appetite resulting in weight loss or gain, nonspecific complaints of not feeling well, alterations in sleeping pattern, insomnia or hypersomnia, and constipation.

Prevention of pelvic inflammatory disease (PID) in adolescents is important because it: a. is easily prevented by proper personal hygiene. b. is easily prevented by compliance with any form of contraception. c. can have devastating effects on the reproductive tract of affected adolescents. d. can cause life-threatening and serious defects in the future children of affected adolescents.

c. can have devastating effects on the reproductive tract of affected adolescents. PID is a major concern because of its devastating effects on the reproductive tract. Short-term complications include abscess formation in the fallopian tubes, whereas long-term complications include ectopic pregnancy, infertility, and dyspareunia.

The nurse is assisting the family of a child with a history of encopresis. Which one of the following should be included in the nurse's discussion with this family? a. Instruct the parents to sit the child on the toilet at twice-daily routine intervals. b. Instruct the parents that the child will probably need to have daily enemas. c. Suggest the use of stimulant cathartics weekly. d. Reassure the family that most problems are resolved successfully, with some relapses during periods of stress.

d. Reassure the family that most problems are resolved successfully, with some relapses during periods of stress. Children may be unaware of a prior sensation and unable to control the urge once it begins. They may be so accustomed to bowel accidents that they are unable to smell or feel it. Family counseling is directed toward reassurance that most problems resolve successfully, although relapses during periods of stress are possible.

Anorexia nervosa may best be described as which of the following? a. Occurs most frequently in adolescent males b. Occurs most frequently in adolescents from lower socioeconomic groups c. Results from a posterior pituitary disorder d. Results in severe weight loss in the absence of obvious physical causes

d. Results in severe weight loss in the absence of obvious physical causes The etiology of anorexia remains unclear, but a distinct psychologic component is present. The diagnosis is based primarily on psychologic and behavioral criteria.

An adolescent asks the nurse what causes primary dysmenorrhea. The nurse's response should be based on which of the following? a. It is an inherited problem. b. Excessive estrogen production causes uterine pain. c. There is no physiologic cause; it is a psychologic reaction. d. There is a relation between prostaglandins and uterine contractility.

d. There is a relation between prostaglandins and uterine contractility. The exact etiology of primary dysmenorrhea is debated. Overproduction of uterine prostaglandins has been implicated, as has overproduction of vasopressin.