210 Peds Unit 3

The genetic testing of a child with Down syndrome (DS) showed that it was caused by translocation. The parents ask about further genetic testing. The nurse's BEST response for the parents is: "No further genetic testing is indicated." "The child should be retested to confirm diagnosis of DS." "The mother should be tested if she is over age 35." "The parents can be tested themselves because the child's condition might be hereditary."

"The parents can be tested themselves because the child's condition might be hereditary." (The child does not require further genetic testing, but parents and siblings do. Retesting is not necessary because the diagnosis has been validated with chromosome testing. This type of chromosome abnormality occurs in children of parents of all ages. The parents and any siblings should be tested. Down syndrome resulting from a translocation may be inherited. This type of chromosome abnormality presents issues for future pregnancies.)

After an adolescent diagnosed with attention deficit-hyperactivity disorder (ADHD) begins short-acting methylphenidate (non-amphetamine stimulant) therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. What is the best explanation for this weight loss? 1. The pharmacological action of Ritalin causes a decrease in appetite. 2. Hyperactivity seen in ADHD causes increased caloric expenditure. 3. Side effects of Ritalin cause nausea, and, therefore, caloric intake is decreased. 4. Increased ability to concentrate allows the client to focus on activities rather than food.

1. The pharmacological action of Ritalin causes a decrease in appetite. (Rationale: The pharmacological action of Ritalin causes a decrease in appetite, which often leads to weight loss. Methylphenidate is a central nervous symptom stimulant that serves to increase attention span, control hyperactive behaviors, and improve learning ability.)

A child has been diagnosed with autistic spectrum disorder. The distraught mother cries out, "I'm such a terrible mother. What did I do to cause this?" Which nursing response is most appropriate? 1. "Researchers really don't know what causes autistic spectrum disorder, but the relationship between autistic disorder and fetal alcohol syndrome is being explored." 2. "Poor parenting doesn't cause autistic spectrum disorder. Research has shown that abnormalities in brain structure or function are to blame. This is beyond your control." 3. "Research has shown that the mother appears to play a greater role in the development of autistic spectrum disorder than the father." 4. "Lack of early infant bonding with the mother has shown to be a cause of autistic spectrum disorder. Did you breastfeed or bottle-feed?"

2. "Poor parenting doesn't cause autistic spectrum disorder. Research has shown that abnormalities in brain structure or function are to blame. This is beyond your control." (Rationale: The most appropriate response by the nurse is to explain to the parent that autistic spectrum disorder is believed to be caused by abnormalities in brain structure or function, not poor parenting. Autism occurs in approximately 11.3 per 1,000 children and is about 4.5 times more likely to occur in boys than girls.)

A physician orders short-acting methylphenidate (non-amphetamine stimulant) for a child diagnosed with ADHD. Which information about this medication should the nurse provide to the parents? 1. If one dose of Ritalin is missed, double the next dose. 2. Administer Ritalin to the child after breakfast. 3. Administer Ritalin to the child just prior to bedtime. 4. A side effect of Ritalin is decreased ability to learn.

2. Administer Ritalin to the child after breakfast. (Rationale: The nurse should instruct the parents to administer Ritalin to the child after breakfast. Ritalin is a central nervous system stimulant and can cause decreased appetite. Central nervous system stimulants can also temporarily interrupt growth and development.)

Which of the following findings should a nurse identify that would contribute to a client's development of ADHD? (Select all that apply.) 1. The client's father was a smoker. 2. The client was born 7 weeks premature. 3. The client is lactose intolerant. 4. The client has a sibling diagnosed with ADHD. 5. The client has been diagnosed with dyslexia.

2. The client was born 7 weeks premature. 4. The client has a sibling diagnosed with ADHD. (Rationale: The nurse should identify that premature birth and having a sibling diagnosed with ADHD would predispose a client to the development of ADHD. Research indicates evidence of genetic influences in the etiology of ADHD. Studies also indicate that environmental influences, such as lead exposure and diet, can be linked with the development of ADHD.)

A mother questions the decreased effectiveness of short-acting methylphenidate (non-amphetamine stimulant), prescribed for her child's ADHD. Which nursing response best addresses the mother's concern? 1. "The physician will probably switch from Ritalin to a central nervous system stimulant." 2. "The physician may prescribe an antihistamine with the Ritalin to improve effectiveness." 3. "Your child has probably developed a tolerance to Ritalin and may need a higher dosage." 4. "Your child has developed sensitivity to Ritalin and may be exhibiting an allergy."

3. "Your child has probably developed a tolerance to Ritalin and may need a higher dosage." (Rationale: The nurse should explain to the mother that the child has probably developed a tolerance to Ritalin and may need a higher dosage. Methylphenidate is a central nervous system stimulant, and tolerance can develop rapidly. Physical and psychological dependence can also occur.)

A 19-year-old patient with a diagnosis of Down syndrome is being admitted to your unit for the treatment of community-acquired pneumonia. When planning this patient's care, the nurse recognizes that this patient's disability is categorized as what? A sensory disability A developmental disability An acquired disability An age-associated disability

A developmental disability (Developmental disabilities are those that occur any time from birth to 22 years of age and result in impairment of physical or mental health, cognition, speech, language, or self-care. Examples of developmental disabilities are spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy. Acquired disabilities may occur as a result of an acute and sudden injury, acute nontraumatic disorders, or progression of a chronic disorder. Age-related disabilities are those that occur in the elderly population and are thought to be due to the aging process. A sensory disability is a type of a disability and not a category.)

A nurse is caring for a child with attention deficit-hyperactivity disorder (ADHD). Which medications does the nurse anticipate may be prescribed for this child? (Select all that apply.) A. Adderall (amphetamine salts) B. Haldol (haloperidol) C. Prozac (fluoxetine hydrochloride) D. Ritalin (methylphenidate hydrochloride) E. Strattera (atomoxetine)

A. Adderall (amphetamine salts) D. Ritalin (methylphenidate hydrochloride) E. Strattera (atomoxetine) (Drugs most commonly used for ADHD include stimulants such as Ritalin and Adderall, and Strattera (a nonstimulant). Haldol is an antipsychotic. Prozac is an antidepressant.)

A woman is considering a second pregnancy, but tells the nurse she is not sure she wants to get pregnant again because her first child was born with spina bifida. She is taking folic acid on the advice of her health-care provider. Which information can the nurse provide this woman? A. Alpha-fetoprotein testing can be done in pregnancy. B. Genetic testing is available for this condition. C. It is rare for two children in one family to be affected. D. Usually spina bifida affects only female children.

A. Alpha-fetoprotein testing can be done in pregnancy. (During pregnancy, testing of maternal blood for elevated alpha-fetoprotein is available for an early indication of spina bifida. The other options are incorrect.)

An infant born with spina bifida with a repaired myelomeningocele is brought the emergency department, where the parents report that the infant is very fussy and is feeding poorly. Which nursing action takes priority? A. Assess the baby's fontanels for bulging. B. Attach a cardiac and respiratory monitor. C. Obtain and document the baby's vital signs. D. Try feeding the baby with sucrose water.

A. Assess the baby's fontanels for bulging. (Poor feeding and irritability are signs of increased intracranial pressure (ICP) in infants. A child with spina bifida is at risk for hydrocephalus, which can lead to increased ICP. A corroborating sign would be bulging fontanels. The nurse should quickly palpate the infant's fontanels. Monitoring the child and obtaining vital signs are important actions too, but palpating the fontanels can be done quickly as the nurse handles the child and performs other procedures. The nurse should not attempt to feed this baby now.)

A child with attention deficit-hyperactivity disorder (ADHD) is in the clinic with parents, who complain that even though they are following the treatment plan, the child is not improving. What action can the nurse suggest to improve the effectiveness of the plan? A. Consult with the school nurse to follow through with behavior logs. B. Ensure the entire family is continuing to keep counseling appointments. C. Reassure the parents that it takes a long time to see changes in behavior. D. Teach the parents about herbal and diet therapies they can try at home.

A. Consult with the school nurse to follow through with behavior logs. (The school nurse is in an ideal position to work with teachers and create behavior charts so the child's treatment plan is followed throughout the school day. The parents have already said they are compliant with the treatment plan, so there is no need to assess if they are still going to counseling. Although it may take some children a while to make changes in behavior, simply telling the parents this information does not provide them with information they can use to make positive changes. Diet and herbal therapies are not proven treatments for ADHD.)

An infant is born with spina bifida. She may have Alterations in urinary elimination Increased urine production Renal failure Excessive loss of sodium in the urine

Alterations in urinary elimination (Congenital malformations of the central nervous system may cause serious alterations in urinary elimination.)

A nurse is caring for an infant with developmental dysplasia of the hip (DDH). Based on the nurse's knowledge of DDH, which clinical manifestation should the nurse expect to observe? Select all that apply. Lordosis Positive Babinski sign Asymmetric thigh and gluteal folds Positive Ortolani and Barlow tests Shortening of limb on affected side

Asymmetric thigh and gluteal folds Positive Ortolani and Barlow tests Shortening of limb on affected side (Asymmetric thigh and gluteal folds are a clinical manifestation of DDH and seen from birth to 2 months old. Positive Ortolani and Barlow tests are clinical manifestations of DDH. Ortolani test is the abducting of the thighs to test for hip subluxation or dislocation. Barlow test is the adducting to feel if the femoral head slips out of the socket posterolaterally. Shortening of limb on affected side is another clinical manifestation of DDH. Lordosis is the inward curve of the lumbar spine just above the buttocks and is not a clinical manifestation of DDH. A negative Babinski sign is not a clinical manifestation of DDH. It is a neurologic reflex which should be present in the normal newborn)

The child with Down syndrome should be evaluated for what characteristic before participating in some sports? Hyperflexibility Atlantoaxial instability Cutis marmorata Speckling of iris (Brushfield's spots)

Atlantoaxial instability (Children with Down syndrome are at risk for atlantoaxial instability. Before participating in sports that put stress on the head and neck, a radiologic examination should be done. Although hyperflexibility, cutis marmorata, and Brushfield's spots are characteristics of Down syndrome, they do not affect the child's ability to participate in sports.)

A child is prescribed methylphenidate (Ritalin) to treat attention deficit hyperactivity disorder (ADHD). The parent expresses concern about using a controlled substance to treat ADHD and asks the nurse about using a noncontrolled substance. The nurse knows ADHD can be treated with which noncontrolled substance? Methylphenidate (Concerta) Atomoxetine (Strattera) Amphetamine aspartate (Adderall) Dextroamphetamine sulfate (Dexedrine)

Atomoxetine (Strattera) (Atomoxetine (Strattera) is not a controlled substance because it lacks drug addictive (psychological dependence) properties, unlike amphetamines and phenidates.)

A nurse is preparing to discharge an infant who has developmental dysplasia of the hip (DDH). What discharge instruction would be most important? A. How to correctly perform Ortolani's maneuver B. How to properly use the Pavlik harness C. When to return for corrective surgery D. Where to take the baby to be fit for corrective shoes

B. How to properly use the Pavlik harness (A baby with DDH will be placed in a special splint, most often the Pavlik harness, to keep the legs in a position of abduction. The harness is worn continuously for 3-6 months, during which time bone growth helps create a normal hip joint. Ortolani's maneuver is an assessment for DDH. Surgery may be required, but not until it has been determined that bone growth is not creating a normally shaped hip joint. Corrective shoes are not needed.)

A mother brings a child to the clinic with concerns about attention deficit-hyperactivity disorder (ADHD). Which behavioral assessment findings support this diagnosis? (Select all that apply.) A. Compulsive "collecting" B. Inability to stay in chair for a meal C. Nonstop talking D. Refusal to complete homework E. Sleeping whenever possible

B. Inability to stay in chair for a meal C. Nonstop talking D. Refusal to complete homework (ADHD is characterized by behaviors related to inattention, hyperactivity/impulsivity, or both. The child's inability to sit in a chair for meals, nonstop talking, and refusal to complete homework are all signs of possible ADHD. Compulsive "collecting" could relate to an anxiety disorder such as hoarding. Excessive sleeping could indicate depression.)

A child has the possible diagnosis of autism spectrum. While awaiting the results of further testing, which action by the nurse is the most appropriate? A. Continue to monitor the child for late signs of autism. B. Reassure the parents that concerns are probably not valid. C. Refer the child to audiology to rule out a hearing impairment. D. Wait for results before referring the child to early intervention or a local school program.

C. Refer the child to audiology to rule out a hearing impairment. (Because children on the autism spectrum have difficulties in communication, a hearing test is in order to rule out any physiological cause contributing to this manifestation. Continued monitoring is always appropriate, but that is not the best option. Parents usually do have concerns that are valid regarding their child. Referrals to school-based or early intervention programs should not wait for a definitive diagnosis.)

A patient diagnosed with narcolepsy is prescribed a central nervous system (CNS) stimulant. Which statement best describes the action of CNS stimulants? CNS stimulants activate cyclic adenosine monophosphate. CNS stimulants block or reduce the activity of inhibitory neurons. CNS stimulants increase release of and block reuptake of neurotransmitters. CNS stimulants decrease the production of excitatory neurotransmitters.

CNS stimulants increase release of and block reuptake of neurotransmitters. (CNS stimulation occurs when the amount of neurotransmitters being released and the duration of action of excitatory neurotransmitters are increased.)

A nurse is teaching the family of a child with ADHD about her diet and medications. The child is prescribed short-acting methylphenidate (non-amphetamine stimulant) every day. In teaching about the client's diet, it is most important that the nurse encourage the child to avoid which foods and/or drinks? High-sodium foods High-sugar foods and drinks High-fat foods Caffeinated foods and drinks

Caffeinated foods and drinks (Caffeine is contraindicated with methylphenidate. There is no evidence of the other foods interacting with methylphenidate.)

Mark, a 9-year-old with Down syndrome, is mainstreamed into a regular third-grade class for part of the school day. His mother asks the school nurse about programs such as Cub Scouts that he might join. The nurse's recommendation should be based on knowing that: Programs such as Cub Scouts are inappropriate for children who are cognitively impaired. Children with Down syndrome have the same need for socialization as other children. Children with Down syndrome socialize better with children who have similar disabilities. Parents of children with Down syndrome encourage programs such as scouting because they deny that their children have disabilities.

Children with Down syndrome have the same need for socialization as other children. (Children of all ages need peer relationships. Children with Down syndrome should have peer experiences similar to those of other children, such as group outings, Cub Scouts, and Special Olympics, which can all help children with cognitive impairment to develop socialization skills. Although all children should have an opportunity to form a close relationship with someone of the same developmental level, it is appropriate for children with disabilities to develop relationships with children who do not have disabilities. The parents are acting as advocates for their child.)

When caring for a newborn with Down syndrome, the nurse should be aware that the most common congenital anomaly associated with Down syndrome is: Hypospadias. Congenital heart disease. Pyloric stenosis. Congenital hip dysplasia.

Congenital heart disease. (Congenital heart malformations, primarily septal defects, are very common congenital anomalies in Down syndrome. Hypospadias, pyloric stenosis, and congenital hip dysplasia are not frequent congenital anomalies associated with Down syndrome.)

The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning. Which interventions should the nurse plan for the care of the myelomeningocele sac? Open to air Covered with a sterile, moist, nonadherent dressing Reinforcement of the original dressing if drainage noted A diaper secured over the dressing

Covered with a sterile, moist, nonadherent dressing (Before surgical closure, the myelomeningocele is prevented from drying by the application of a sterile, moist, nonadherent dressing over the defect. The moistening solution is usually sterile normal saline. Dressings are changed frequently (every 2 to 4 hours), and the sac is closely inspected for leaks, abrasions, irritation, and any signs of infection. The sac must be carefully cleansed if it becomes soiled or contaminated. The original dressing would not be reinforced but changed as needed. A diaper is not placed over the dressing because stool contamination can occur.)

A pediatric nurse performs a physical examination on a neonate and notes a spinal lesion with the meninges protruding through the defect that contains spinal cord elements. The nurse documents which condition as being present? A. Hydrocephalus B. Meningitis C. Meningocele D. Myelomeningocele E. Spina bifida occulta

D. Myelomeningocele (A myelomeningocele is the most severe form of spina bifida and is evident on delivery. The meninges protrude through the defect, and they contain spinal cord elements. It appears as a very pronounced skin defect, usually covered by a transparent membrane, and neural tissue may be attached to the inner surface.)

A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of: Microcephaly. Cerebral palsy. Down syndrome. Fragile X syndrome.

Down syndrome. (These are characteristics associated with Down syndrome. The infant with microcephaly has a small head. Cerebral palsy is a diagnosis not usually made at birth. No characteristic physical signs are present. The infant with fragile X syndrome has increased head circumference; long, wide, and/or protruding ears; long, narrow face with prominent jaw; hypotonia; and high, arched palate.)

Which action is contraindicated when a child with Down syndrome is hospitalized? Determine the child's vocabulary for specific body functions. Assess the child's hearing and visual capabilities. Encourage parents to leave the child alone for extended periods of time. Have meals served at the child's usual mealtimes.

Encourage parents to leave the child alone for extended periods of time. (The child with Down syndrome needs routine schedules and consistency. Having familiar people present, especially parents, helps to decrease the child's anxiety. To communicate effectively with the child, it is important to know the child's particular vocabulary for specific body functions. Children with Down syndrome have a high incidence of hearing loss and vision problems and should have hearing and vision assessed whenever they are in a health care facility. Meals should be served at the usual mealtimes because routine schedules and consistency are important to children with Down syndrome.)

A 10-year-old patient will be started on short-acting methylphenidate (non-ampehetamine stimulant) therapy. The nurse will perform which essential baseline assessment before this drug is started? Eye examination Height and weight Liver function studies Hearing test

Height and weight (Assessment of baseline height and weight is important before beginning Ritalin therapy because it may cause a temporary slowing of growth in prepubertal children. The other studies are not as essential at this time.)

Which assessment findings indicate to the nurse a child has Down syndrome (select all that apply)? High-arched, narrow palate Protruding tongue Long, slender fingers Transverse palmar crease Hypertonic muscle tone

High-arched, narrow palate Protruding tongue Transverse palmar crease (The assessment findings of Down syndrome include high-arched, narrow palate; protruding tongue; and transverse palmar creases. The fingers are stubby and the muscle tone is hypotonic, not hypertonic.)

You are the case manager who oversees the multidisciplinary care of several patients living with chronic conditions. Two of your patients are living with spina bifida. You recognize that the center of care for these two patients typically exists where? In the hospital In the physician's office In the home In the rehabilitation facility

In the home (The day-to-day management of illness is largely the responsibility of people with chronic disorders and their families. As a result, the home, rather than the hospital, is the center of care in chronic conditions. Hospitals, rehabilitation facilities, clinics, physician's offices, nursing homes, nursing centers, and community agencies are considered adjuncts or back-up services to daily home management.)

A patient with narcolepsy is prescribed short-acting methylphenidate (non-amphetamine stimulant). Which adverse effects should the nurse include in the teaching of this drug? (Select all that apply.) Select all that apply. Insomnia Headache Weight Loss Decreased blood pressure Increased appetite

Insomnia Headache Weight Loss (The adverse effects of methylphenidate on the cardiovascular system include increased heart rate and blood pressure. Other adverse effects include angina, anxiety, insomnia, headache, tremor, blurred vision, increased metabolic rate, GI distress, dry mouth, and worsening of or new onset of psychiatric disorders (including mania, psychoses, or aggression).)

You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis would be the most essential in caring for the mother of this infant? Disturbed body image Anxiety Interrupted family processes Risk for injury

Interrupted family processes (This mother likely will experience a disruption in the family process related to the birth of a baby with an inherited disorder. Women commonly experience "body image disturbances in the postpartum period"; however, this is unrelated to giving birth to a child with Down syndrome. The mother likely will have a mix of emotions that may include anxiety, guilt, and denial, but this is not the most essential nursing diagnosis for this family. "Risk for injury" is not an applicable nursing diagnosis.)

Autism is a complex developmental disorder. The diagnostic criteria for autism include delayed or abnormal functioning in which area(s) with onset before age 3 years? (select all that apply) Language as used in social communication Gross motor development Growth below the 5th percentile for height and weight Symbolic or imaginative play Social interaction

Language as used in social communication Symbolic or imaginative play Social interaction (Language as used in social communication, symbolic or imaginative play, and social interaction are three of the areas in which autistic children may show delayed or abnormal functioning. Gross motor development and growth below the 5th percentile for height and weight are not areas in which autistic children may show delayed or abnormal functioning.)

A child with autism spectrum disorder (ASD) is admitted to the hospital with pneumonia. The nurse should plan which priority intervention when caring for the child? Maintain a structured routine and keep stimulation to a minimum. Place the child in a room with a roommate of the same age. Maintain frequent touch and eye contact with the child. Take the child frequently to the playroom to play with other children.

Maintain a structured routine and keep stimulation to a minimum. (Providing a structured routine for the child to follow is key in the management of ASD. Decreasing stimulation by using a private room, avoiding extraneous auditory and visual distractions, and encouraging the parents to bring in possessions the child is attached to may lessen the disruptiveness of hospitalization. Because physical contact often upsets these children, minimum holding and eye contact may be necessary to avoid behavioral outbursts. Children with ASD need to be introduced slowly to new situations, with visits with staff caregivers kept short whenever possible. The playroom would be too overwhelming with new people and situations and should not be a priority of care.)

An infant born via cesarean section because of a breech presentation is diagnosed with bilateral congenital hip dysplasia. The primary nursing intervention directed toward this diagnosis is: Assessing the infant frequently to determine abduction of the thighs Maintaining the infant in the position of continuous abduction of both hips Educating the parents about the importance of positioning the infant so that the head of the femurs are in alignment with the hip sockets Providing pain management so that the infant is comfortable in the therapeutic position required

Maintaining the infant in the position of continuous abduction of both hips (Maintenance of continuous abduction of the thigh so that the head of the femur presses into the center of the acetabulum is critical in the care and treatment of this infant. Although the other options are appropriate, they are not primary interventions in this scenario.)

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. What should be included? Apply lotion or powder to minimize skin irritation. Remove the harness several times a day to prevent contractures. Return to the clinic every 1 to 2 weeks. Place a diaper over harness, preferably using a superabsorbent disposable diaper that is relatively thin.

Return to the clinic every 1 to 2 weeks. (Infants have a rapid growth pattern. The child needs to be assessed by the practitioner every 1 to 2 weeks for possible adjustments. Lotions and powders should not be used with the harness. The harness should not be removed, except as directed by the practitioner. A thin disposable diaper can be placed under the harness.)

Autism is a complex developmental disorder. Diagnostic criteria for autism include delayed or abnormal functioning in which area(s) before 3 years of age? Select all that apply. Parallel play Social interaction Gross motor development Inability to maintain eye contact Language as used in social communication

Social interaction Inability to maintain eye contact Language as used in social communication (Children diagnosed with autism show delayed or abnormal functioning in social interactions. A hallmark characteristic of autism is the child's inability to make and maintain eye contact. A characteristic of autism is the child's delay of language at an early age or the sudden deterioration in extant expressive speech. Parallel play is not an area in which autistic children may show delay. When interacting with other children in other forms of play they display functional limitations. Gross motor development is not an area in which autistic children show delayed or abnormal functioning.)

What most accurately describes bowel function in children born with a myelomeningocele? Incontinence cannot be prevented. Enemas and laxatives are contraindicated. Some degree of fecal continence can usually be achieved. Colostomy is usually required by the time the child reaches adolescence.

Some degree of fecal continence can usually be achieved. (Although a lengthy process, continence can be achieved with modification of diet, use of laxatives, and/or enemas. These are part of the strategy to achieve continence. There is no general contraindication. With diet modification and regular toilet habits to prevent constipation and impaction, some degree of fecal continence can be achieved. Colostomy usually is not required.)

The nurse in the neonatal intensive care unit is caring for an infant with myelomeningocele scheduled for surgical repair in the morning. Which early signs of infection should the nurse monitor on this infant? (Select all that apply) Temperature instability Bradycardia Irritability Hypertension Lethargy

Temperature instability Irritability Lethargy (The nurse should observe an infant with unrepaired myelomeningocele for early signs of infection, such as temperature instability (axillary), irritability, and lethargy. Bradycardia and hypertension are not early signs of infection in infants.)

What should the nurse keep in mind when planning to communicate with a child who has autism? The child has normal verbal communication. The child is expected to use sign language. The child may exhibit monotone speech and echolalia. The child is not listening if she is not looking at the nurse.

The child may exhibit monotone speech and echolalia. (Children with autism have abnormalities in the production of speech, such as a monotone voice or echolalia, or inappropriate volume, pitch, rate, rhythm, or intonation. The child has impaired verbal communication and abnormalities in the production of speech. Some autistic children may use sign language, but it is not assumed. Children with autism often are reluctant to initiate direct eye contact.)

A 6-year-old boy has been started on an extended-release form of methylphenidate (non-amphetamine stimulant) for the treatment of attention deficit hyperactivity disorder (ADHD). During a follow-up visit, his mother tells the nurse that she has been giving the medication at bedtime so that it will be "in his system" when he goes to school the next morning. What is the nurse's appropriate evaluation of the mother's actions? She is giving him the medication dosage appropriately. The medication should not be taken until he is at school. The medication should be taken with meals for optimal absorption. The medication should be given 4 to 6 hours before bedtime to diminish insomnia.

The medication should be given 4 to 6 hours before bedtime to diminish insomnia. (Central nervous system stimulants should be taken 4 to 6 hours before bedtime to decrease insomnia. Generally speaking, once-a-day dosing is used with extended-release or long-acting preparations. These formulations eliminate the need to take this medication at school.)

A client with ADHD is prescribed short-acting methylphenidate (non-amphetamine stimulant). Based on the half-life of the drug, how often should the nurse administer the drug? Daily Twice a day Every 8 hours Every 12 hours

Twice a day (Methylphenidate should not be given more than 6 hours before bedtime, because it may cause insomnia.)

The parent of a child who is taking amphetamine (Adderall) to treat attention deficit/hyperactivity disorder (ADHD) asks the provider to recommend an over-the-counter medication to treat a cold. What will the nurse tell the parent? a. "Avoid any products containing pseudoephedrine or caffeine." b. "Never give over-the-counter medications with Adderall." c. "Sudafed is a safe and effective decongestant." d. "Use any over-the-counter medication from the local pharmacy."

a. "Avoid any products containing pseudoephedrine or caffeine." (Adderall is a stimulant, so other stimulants, such as caffeine and pseudoephedrine, should be avoided because a high plasma caffeine level can be fatal.)

The nurse is teaching a parent about short-acting methylphenidate (non-amphetamine stimulant) to treat attention deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching? a. "I should consult a pharmacist when giving my child OTC medications." b. "I will only give my child diet soft drinks while administering this medication." c. "Medication therapy means that behavioral therapy will not be necessary." d. "Weight gain is a common side effect of this medication."

a. "I should consult a pharmacist when giving my child OTC medications." (Since many OTC medications contain stimulants, parents should consult a pharmacist or the provider before giving them with methylphenidate. Diet soft drinks often contain caffeine, a stimulant, and should be avoided with methylphenidate use. Behavioral therapy should still be an essential part of the treatment for ADHD. Weight loss is common.)

The nurse is teaching the parents of a child recently diagnosed with ADHD who has been prescribed short-acting methylphenidate (non-amphetamine stimulant). Which 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. Decreased appetite with subsequent weight loss, insomnia, and increased blood pressure are other common side effects.)

A 3-month-old infant is diagnosed with developmental hip dysplasia. The nurse knows that what is the usual treatment for an infant with this diagnosis? a. A Pavlik harness b. A body spica cast c. Traction d. Triple-diapering

a. A Pavlik harness (In infants who are more than 2 months of age, longer-term immobilization with a Pavlik harness is required.)

The parent of an adolescent who has taken methylphenidate (non-amphetamine stimulant) 20 mg/day for 6 months for attention deficit/hyperactivity disorder (ADHD) brings the child to clinic for evaluation of a recent onset of nausea, vomiting, and headaches. The parent expresses concern that the child seems less focused and more hyperactive than before. What will the nurse do next? a. Ask the child whether the drug is being taken as prescribed. b. Contact the provider to discuss increasing the dose to 30 mg/day. c. Recommend taking the drug with meals to reduce gastrointestinal side effects. d. Report signs of drug toxicity to the patient's provider.

a. Ask the child whether the drug is being taken as prescribed. (Nausea, vomiting, and headaches can occur with drug withdrawal, along with a recurrence of symptoms. The nurse should ask the child about drug compliance. Methylphenidate should be taken 30 to 45 minutes before meals, not with meals.)

What assessment made by the nurse would lead the nurse to suspect hip dysplasia? a. Asymmetrical gluteal folds b. Limited adduction of the affected side c. Foot turned inward d. Deep inguinal creases

a. Asymmetrical gluteal folds (The gluteal folds are asymmetrical because the head of the femur has slipped out of the acetabulum. There is also limited abduction of the affected side, and when the legs are flexed the affected leg seems to be shorter.)

The nurse is obtaining intake information on a new patient being seen for preconception care and notes a family history of neural tube defects. What interventions can the nurse suggest to this woman to help prevent neural tube anomalies in a developing fetus? (Select all that apply.) a. Avoid drug use. b. Follow a low-calorie, low-protein diet. c. Take a folic acid supplement every day. d. Exercise daily. e. Maintain bed rest during the first trimester.

a. Avoid drug use. c. Take a folic acid supplement every day. (The use of drugs during early pregnancy and poor nutrition may contribute to the development of a neural tube defect. The American Academy of Pediatrics (AAP) recommends that all women of childbearing age take a daily multivitamin that contains 0.4 mg of folic acid and continue the intake of folic acid until the twelfth week of pregnancy, when basic neural tube development is completed. Studies have shown that the intake of folic acid before conception dramatically decreases the occurrence of neural tube defects such as spina bifida. Daily exercise and bed rest do not decrease the risk of neural tube anomalies.)

A child diagnosed with attention deficit hyperactivity disorder (ADHD) is going to begin medication therapy. The nurse should plan to teach the family about which classification of medications? a. Central nervous system stimulants b. Monoamine oxidase inhibitors (MAOIs) c. Antipsychotic medications d. Anxiolytic medications

a. Central nervous system stimulants (Central nervous system stimulants increase blood flow to the brain and have proven helpful in reducing hyperactivity in children and adolescents with ADHD. The other medication categories listed would not be appropriate.)

What characteristics are typical in a child diagnosed with Down syndrome? (Select all that apply.) a. Close-set eyes b. Simian creases c. Wide-spaced front teeth d. Protruding tongue e. Curved, small fingers

a. Close-set eyes b. Simian creases d. Protruding tongue e. Curved, small fingers (Children with Down syndrome have close-set upturned eyes, simian creases in palms of hands, protruding tongues, and curved, small fingers. They also have a wide space between their first and second toe and a high incidence of heart defects.)

The parents of a 9-year-old boy have been told by the child's teacher that he exhibits symptoms of attention-deficit/hyperactivity disorder (ADHD). Which specific behaviors may the child exhibit for this diagnosis to be made? (Select all that apply.) a. Frequently interrupts or intrudes on others b. Is easily distracted by outside stimuli c. Has feelings of restlessness or frequently fidgets with hands and/or feet d. Exhibits an excellent short-term memory e. Often leaves tasks incomplete

a. Frequently interrupts or intrudes on others b. Is easily distracted by outside stimuli c. Has feelings of restlessness or frequently fidgets with hands and/or feet e. Often leaves tasks incomplete (These are a few of the behaviors displayed in children with ADHD. Symptoms of ADHD include 14 possible behaviors. For a diagnosis to be made, the client must exhibit at least eight of these behaviors for at least 6 months. An excellent short-term memory is the opposite of what is seen in clients with ADHD.)

Which of the following problems is most often associated with myelomeningocele? a. Hydrocephalus b. Craniosynostosis c. Biliary atresia d. Esophageal atresia

a. Hydrocephalus (Hydrocephalus is a frequently associated anomaly in 80% to 90% of children.)

Which of the following is the most common problem of children born with a myelomeningocele? a. Neurogenic bladder b. Mental retardation c. Respiratory compromise d. Cranioschisis

a. Neurogenic bladder (Myelomeningocele is one of the most common causes of neuropathic (neurogenic) bladder dysfunction among children.)

A nurse is planning to speak with a parent support group about childhood autism. What will the nurse include? a. Significant signs of the disorder manifest by 1 year of age. b. The earliest signs of autism are impulsivity and overactivity. c. Autism is usually diagnosed when the child goes to elementary school. d. Medications can cure childhood autism.

a. Significant signs of the disorder manifest by 1 year of age. (Failure to use eye contact and look at others, poor attention span, and poor orienting to one's name are significant signs of dysfunction by 1 year of age.)

The nurse is teaching a child and a parent about taking short-acting methylphenidate (non-amphetamine stimulant) to treat attention deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching? a. "I should give this drug to my child at bedtime." b. "My child should avoid products containing caffeine." c. "The drug should be stopped immediately if my child develops aggression." d. "We should monitor my child's weight since weight gain is common."

b. "My child should avoid products containing caffeine." (Methylphenidate is a stimulant, so other stimulants such as caffeine should be avoided because a high plasma caffeine level can be fatal. The medication should be taken in the morning. Patients should be taught not to stop the drug abruptly to avoid withdrawal symptoms. Weight loss is common.)

Parents of a child with Down syndrome ask the nurse about techniques for introducing solid food to their 8-month-old child's diet. The nurse should give the parents which priority instruction? a. It is too early to add solids; the parents should wait for 2 to 3 months. b. A small but long, straight-handled spoon should be used to push the food toward the back and side of the mouth. c. If the child thrusts the food out, the feeding should be stopped. d. Solids should be offered only three times a day.

b. A small but long, straight-handled spoon should be used to push the food toward the back and side of the mouth. (Down syndrome children have a protruding tongue which can interfere with feeding, especially of solid foods. Parents need to know that the tongue thrust is not an indication of refusal to feed but a physiologic response. Parents are advised to use a small but long, straight-handled spoon to push the food toward the back and side of the mouth. If food is thrust out, it should be re-fed. Six months is the time to introduce solid foods to a child, so waiting 2 to 3 months is inappropriate. Small frequent feedings should be initiated to prevent the child from tiring. Three times a day is too infrequent.)

Which strategies should the school nurse recommend implementing in the classroom for a child with attention deficit hyperactive disorder (ADHD)? (Select all that apply.) a. Schedule heavier subjects to be taught in the afternoon. b. Accompany verbal instructions by written format. c. Limit number of breaks taken during instructional periods. d. Allow more time for testing. e. Reduce homework and classroom assignments.

b. Accompany verbal instructions by written format. d. Allow more time for testing. e. Reduce homework and classroom assignments. (Children with ADHD need an orderly, predictable, and consistent classroom environment with clear and consistent rules. Homework and classroom assignments may need to be reduced, and more time may need to be allotted for tests to allow the child to complete the task. Verbal instructions should be accompanied by visual references such as written instructions on the blackboard. Schedules may need to be arranged so that academic subjects are taught in the morning when the child is experiencing the effects of the morning dose of medication. Regular and frequent breaks in activity are helpful because sitting in one place for an extended time may be difficult.)

A nurse is doing a newborn assessment on a new admission to the nursery. Which of the following actions should the nurse make when evaluating the baby for developmental dysplasia of the hip? a. Grasp the inner aspects of the baby's calves with thumbs and forefingers. b. Gently abduct the baby's thighs. c. Palpate the baby's patellae to assess for subluxation of the bones. d. Dorsiflex the baby's feet.

b. Gently abduct the baby's thighs. (The nurse would gently abduct the baby's legs.)

The nurse is checking an 8-year-old child who has attention deficit/hyperactivity disorder (ADHD) into a clinic for an annual well-child visit. The child takes short-acting methylphenidate (non-amphetamine stimulant). Which assessments are especially important for this child? a. Heart rate, respiratory rate, and oxygen saturation b. Height, weight, and blood pressure c. Measures of fine- and gross-motor development d. Nausea, vomiting, and gastrointestinal upset

b. Height, weight, and blood pressure (Methylphenidate may cause growth suppression, so the child's height and weight should be assessed. Methylphenidate may also increase blood pressure, so the nurse should pay careful attention to blood pressure.)

A child is diagnosed with attention deficit hyperactivity disorder (ADHD). Which characteristics would the nurse assess in this child? (Select all that apply.) a. Social anxiety b. Impulsivity c. Hyperactivity d. Distractability e. Inattention

b. Impulsivity c. Hyperactivity d. Distractability e. Inattention (ADHD is characterized by inattention, hyperactivity, impulsivity, and distractibility.)

A nurse prepares for an initial interview with a patient with suspected adult attention deficit hyperactivity disorder (ADHD). Questions should be focused to elicit information about which problem? a. Headaches b. Inattention c. Sexual impulses d. Trichotillomania

b. Inattention (Inattention usually persists from childhood into adult ADHD, although hyperactivity, impulsivity, and social impairments may also be present. Headaches would not be expected. Sexual impulses may be affected by adult ADHD, but this area is assessed later. Trichotillomania refers to pulling out one's hair as a tension-relieving behavior.)

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.)

When bathing an infant, what sign does the nurse recognize as a sign of developmental hip dysplasia? a. Hypotonicity of the leg muscles b. One leg is shorter than the other c. Broadening and flattening of the buttocks d. Two skinfolds on the back of each thigh

b. One leg is shorter than the other (When developmental hip dysplasia is present, the leg on the affected side will appear shorter than the leg on the unaffected side.)

The treatment team believes medication will help a patient diagnosed with adult attention deficit hyperactivity disorder (ADHD). Which class of medications does the nurse expect will be prescribed? a. Benzodiazepines b. Psychostimulants c. Antipsychotics d. Anxiolytics

b. Psychostimulants (Psychostimulants, such as methylphenidate and amphetamines, provide the basis for treatment of both adult and childhood ADHD. They are the most commonly used medications; therefore the nurse could expect the health care provider to prescribe a drug in this class. None of the other drugs listed as options have proved useful in the treatment of ADHD.)

Parents of a 2-month-old infant with Down syndrome are attending a well visit at the pediatric clinic. What should they be instructed to provide special attention to in regard to the generalized hypotonicity of the child? a. Preventing hyperthermia b. Respiratory care c. Prevention of diarrhea d. Incontinence care

b. Respiratory care (The child with Down syndrome has generalized hypotonicity, which caused mucus accumulation and respiratory problems.)

When assessing a 2-year-old diagnosed with autism spectrum disorder, a nurse expects: a. hyperactivity and attention deficits. b. failure to develop interpersonal skills. c. history of disobedience and destructive acts. d. high levels of anxiety when separated from a parent.

b. failure to develop interpersonal skills. (Autism spectrum disorder involves distortions in the development of social skills and language that include perception, motor movement, attention, and reality testing. Caretakers frequently mention the child's failure to develop interpersonal skills. The distractors are more relevant to ADHD, separation anxiety, and CD.)

A child diagnosed with attention deficit hyperactivity disorder (ADHD) has hyperactivity, distractibility, and impaired play. The health care provider prescribed long-acting methylphenidate (non-amphetamine stimulant). The desired behavior for which the nurse should monitor is: a. increased expressiveness in communicating with others. b. improved ability to participate in play with other children. c. ability to identify anxiety and implement self-control strategies. d. improved socialization skills with other children and authority figures.

b. improved ability to participate in play with other children. (The goal is improvement in the child's hyperactivity, distractibility, and play. The incorrect options are more relevant for a child with a developmental or anxiety disorder.)

A mother tells the nurse she is afraid to have her infant immunized. Which statement would be the most appropriate response for the nurse? a. "It is normal to be concerned, as some immunizations have been linked to autism." b. "Researching the Internet will provide you more information as to the importance of immunizations." c. "Choosing to not vaccinate your child puts your child and others at risk." d. "Your infant received active immunity at birth, so immunizations are not indicated until 4 months of age."

c. "Choosing to not vaccinate your child puts your child and others at risk." (The child who is not immunized and others around the child are at risk if immunizations do not occur. Scientific studies have not found a relationship between immunizations and autism. Information that is researched on the Internet may not be a reliable source of information as the nurse has no control over the information the client receives. Infants receive natural passive immunity at birth through the placental transfer of maternal antibodies; this protection lasts for about 2 months.)

The nurse is providing care to a child with Down syndrome. What body system has the highest risk of congenital anomaly in a child with Down syndrome? a. Reproductive system b. Genitourinary system c. Cardiovascular system d. Gastrointestinal system

c. Cardiovascular system (Down syndrome children are prone to deformities of the cardiovascular system.)

What is the most appropriate classroom intervention for a child with attention deficit hyperactivity disorder (ADHD) for the school nurse to suggest? a. Seat the child in the back of the room to prevent distractions for other children. b. Pair the child with a student buddy to offer reminders to pay attention. c. Divide work assignments into shorter periods with breaks in between. d. Separate the child from others to increase his focus on schoolwork.

c. Divide work assignments into shorter periods with breaks in between. (The child with ADHD needs breaks between periods of work and study.)

The nurse is caring for a 7-year-old child who has difficulty concentrating and completing tasks and who cannot seem to sit still. Which diagnostic test may be ordered to assist with a diagnosis of attention deficit/hyperactivity disorder (ADHD) in this child? a. Computerized tomography (CT) of the head b. Electrocardiogram (ECG) c. Electroencephalogram (EEG) d. Magnetic resonance imaging (MRI) of the brain

c. Electroencephalogram (EEG) (A child with ADHD may have abnormal EEG findings. CT, MRI, and ECG tests are not diagnostic for ADHD.)

A recommendation to prevent neural tube defects is the supplementation of which of the following? a. Vitamin A throughout pregnancy b. Multivitamin preparations as soon as pregnancy is suspected c. Folic acid for all women of childbearing age d. Folic acid during the first and second trimesters of pregnancy

c. Folic acid for all women of childbearing age (The widespread use of folic acid among women of childbearing age has decreased the incidence of spina bifida significantly.)

The nurse has taken a health history on four multigravida patients at their first prenatal visits. It is high priority that the patient whose first child was diagnosed with which of the following diseases receives nutrition counseling? a. Development dysplasia of the hip b. Achondroplastic dwarfism c. Spina bifida d. Muscular dystrophy

c. Spina bifida (c. The incidence of spina bifida is much higher in women with poor folic acid intakes. It is a priority that this patient receives nutrition counseling.)

The nurse is working with a 15-year-old girl and her parents on a treatment plan for her diagnosis of attention-deficit/hyperactivity disorder (ADHD). The nurse should be sure to: a. Encourage the parents to seek teachers for their daughter who are going to be lenient with assignment schedules because of her diagnosis. b. Remind the parents to determine ahead of time consequences/punishment that they will give their daughter when she is not listening to them and/or teachers. c. Teach the parents how to structure and enforce limits on their daughter's behavior that are appropriate to her condition. d. Inform the client and her parents that medications typically used for ADHD are very safe and have few side effects.

c. Teach the parents how to structure and enforce limits on their daughter's behavior that are appropriate to her condition. (Consistent limit setting is helpful to teens with ADHD because it is difficult for them to set limits for themselves. Encouraging lenient teachers violates this principle. The parents should seek teachers who are understanding of their daughter's condition but remain consistent in setting limits in their course. Positive reinforcement for appropriate behavior is more effective than punishment, and many medications for ADHD react with other medications and sometimes have serious side effects.)

Which behavior indicates that the treatment plan for a child diagnosed with autism spectrum disorder was effective? The child: a. plays with one toy for 30 minutes. b. repeats words spoken by a parent. c. holds the parent's hand while walking. d. spins around and claps hands while walking.

c. holds the parent's hand while walking. (Holding the hand of another person suggests relatedness. Usually, a child with autism would resist holding someone's hand and stand or walk alone, perhaps flapping arms or moving in a stereotypical pattern. The other options reflect behaviors that are consistent with autistic disorder.)

Which of the following vitamins is recommended for all women of childbearing age to reduce the risk of neural tube defects such as spina bifida? a. A b. C c. Niacin d. Folic acid

d. Folic acid (The vitamin supplement that is recommended for all women of childbearing age is a daily dose of 0.4 mg of folic acid. Folic acid taken before conception and during pregnancy can reduce the risk of neural tube defects by 70%.)

A nurse prepares a plan of care for a patient diagnosed with adult attention deficit hyperactivity disorder (ADHD). Which intervention should be included? a. Remind the patient of priorities and deadlines. b. Teach work-related skills such as basic computer literacy. c. Establish penalties for failing to organize and prioritize tasks. d. Give encouragement and strategies for managing and organizing.

d. Give encouragement and strategies for managing and organizing. (The nurse's major responsibilities lie with encouraging the patient to learn and use necessary skills, assisting the patient to stay on task. The nurse is not an ever-present taskmaster or disciplinarian. The nurse does not teach work-related skills; vocational staff members assume those types of tasks.)

What is one of the major physical characteristics of the child with Down syndrome? a. Excessive height b. Spots on the palms c. Inflexibility of the joints d. Hypotonic musculature

d. Hypotonic musculature (Hypotonic musculature is one of the major characteristics.)

Which of the following refers to a hernial protrusion of a saclike cyst of meninges, spinal fluid, and a portion of the spinal cord with its nerves through a defect in the vertebral column? a. Rachischisis b. Encephalocele c. Meningocele d. Myelomeningocele

d. Myelomeningocele (A myelomeningocele has a visible defect with an external saclike protrusion, containing meninges, spinal fluid, and nerves.)

Many of the physical characteristics of Down syndrome present nursing problems. Care of the child should include which of the following? a. Delay feeding solid foods until the tongue thrust has stopped. b. Modify diet as necessary to minimize the diarrhea that often occurs. c. Provide calories appropriate to child's age. d. Use a cool-mist vaporizer to keep mucous membranes moist.

d. Use a cool-mist vaporizer to keep mucous membranes moist. (The constant stuffy nose forces the child to breathe by mouth, drying the mucous membranes and increasing the susceptibility to upper respiratory tract infections. A cool-mist vaporizer will keep the mucous membranes moist and liquefy secretions.)

The parents of a 6-year-old child diagnosed with ADHD will most typically describe their child's behavior as: a learning disorder and muscle paralysis. nervousness and sleeplessness. hyperactivity and decreased attention span. hyperactivity and nervousness.

hyperactivity and decreased attention span. (Hyperactivity and decreased attention span are behaviors consistent with ADHD.)

A pediatric nurse admits a child who has a history of ADHD. The nurse is aware that ADHD may display as: poor coordination and abnormal electroencephalogram (EEG). abnormal EEG and decrease in intelligence. minimal brain dysfunction and marked decrease in intelligence. developmental delay and poor coordination.

poor coordination and abnormal electroencephalogram (EEG). (Diagnostic manifestations of ADHD include poor coordination and an abnormal electroencephalogram.)

A child with spina bifida has developed a latex allergy from numerous bladder catheterizations and surgeries. A PRIORITY nursing intervention is to: recommend allergy testing. provide a latex-free environment. use only powder-free latex gloves. limit use of latex products as much as possible.

provide a latex-free environment. (This is the most important nursing intervention. From birth on, the limitation of exposure to latex is essential in an attempt to minimize sensitization.)

A neural tube defect that is not visible externally in the lumbosacral area would be called: meningocele. myelomeningocele. spina bifida cystica. spina bifida occulta.

spina bifida occulta. (Meningocele contains meninges and spinal fluid but no neural tissue. Unless there are associated cutaneous findings, it is often not identified until later. Myelomeningocele is a neural tube defect that contains meninges, spinal fluid, and nerves. This is a cystic formation with an external saclike protrusion. Spina bifida occulta is completely enclosed. Often this defect will not be noticed.)

A 2-week-old infant with Down syndrome is being seen in the clinic. His mother tells the nurse that he is difficult to hold; that "He is like a rag doll. He does not cuddle up to me like my other babies did." The nurse's best interpretation of this lack of clinging or molding is that it is: a sign of maternal deprivation. a sign of detachment and rejection. suggestive of autism associated with Down syndrome. the result of the physical characteristics of Down syndrome.

the result of the physical characteristics of Down syndrome. (Mothers may have difficulty forming attachment to their children because of these characteristics of Down syndrome. The nurse should recommend swaddling and wrapping the baby before picking him or her up. Mothers may have difficulty forming attachment to their children because of these characteristics of Down syndrome. The nurse should recommend swaddling and wrapping the baby before picking him or her up. Autism is not associated with Down syndrome. This lack of clinging is a result of the muscle hypotonicity and hyperextensibility of the joints associated with Down syndrome.)

The parents of a cognitively impaired child ask the nurse for guidance with discipline. The nurse's BEST response is: "Discipline is ineffective with cognitively impaired children." "Discipline is not necessary for cognitively impaired children." "Behavior modification is an excellent form of discipline." "Physical punishment is the most appropriate form of discipline."

"Behavior modification is an excellent form of discipline." (Behavior modification with positive reinforcement is effective in children with cognitive impairment. Discipline is essential in assisting the child in developing boundaries. Positive behaviors and desirable actions should be reinforced. Most children with cognitive impairment will not be able to understand the reason for the physical punishment; consequently behavior will not change as a result of the punishment.)

How much folic acid is recommended for women of childbearing age? 0.1 mg 0.4 mg 1.5 mg 2 mg

0.4 mg (It has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age will prevent 50% to 70% of cases of neural tube defects. A dose of 0.1 mg is too low, and 1.5 mg and 2 mg are not recommended dosages of folic acid.)

The nurse is talking to a parent with a child who has a latex allergy. Which statement by the parent would indicate a correct understanding of the teaching? "My child will have an allergic reaction if he comes in contact with yeast products." "My child may have an upset stomach if he eats a food made with wheat or barley." "My child will probably develop an allergy to peanuts." "My child should not eat bananas or kiwis."

"My child should not eat bananas or kiwis." (There are cross-reactions between latex allergies and a number of foods such as bananas, avocados, kiwi, and chestnuts. Although yeast products, wheat and barley, and peanuts are potential allergens, they are currently not known to cross-react with latex.)

A woman who is 6 weeks' pregnant tells the nurse that she is worried that the baby might have spina bifida because of a family history. The nurse's BEST response is: "There is no genetic basis for the defect." "Prenatal detection is not possible yet." "Chromosome studies done on amniotic fluid can diagnose the defect prenatally." "The concentration of alpha-fetoprotein in amniotic fluid can indicate the presence of the defect prenatally."

"The concentration of alpha-fetoprotein in amniotic fluid can indicate the presence of the defect prenatally." (The origin of neural tube defects is unknown, but it appears to have a multifactorial inheritance pattern. Prenatal detection is possible through amniotic fluid or chorionic villi sampling. There is no chromosome study at this time. Fetal ultrasound and elevated concentrations of alpha-fetoprotein in amniotic fluid may indicate the presence of anencephaly or myelomeningocele.)

A nurse is providing a parent information regarding autism. Which statement made by the parent indicates understanding of the teaching? "Autism is characterized by periods of remission and exacerbation." "The onset of autism usually occurs before 3 years of age." "Children with autism have imitation and gesturing skills." "Autism can be treated effectively with medication."

"The onset of autism usually occurs before 3 years of age." (The onset of autism usually occurs before 3 years of age. Autism does not have periods of remission and exacerbation. Autistic children lack imitative skills. Medications are of limited use in children with autism.)

A child with autism is hospitalized with asthma. The nurse should plan care so that the: Parents' expectations are met. Child's routine habits and preferences are maintained. Child is supported through the autistic crisis. Parents need not be at the hospital.

Child's routine habits and preferences are maintained. (Children with autism are often unable to tolerate even slight changes in routine. The child's routine habits and preferences are important to maintain. Focus of care is on the child's needs rather than on the parent's desires. Autism is a lifelong condition. The presence of the parents is almost always required when an autistic child is hospitalized.)

Parents have learned that their 6-year-old child has autism. The nurse may help the parents to cope by explaining that the child may: Have an extremely developed skill in a particular area. Outgrow the condition by early adulthood. Have average social skills. Have age-appropriate language skills.

Have an extremely developed skill in a particular area. (Some children with autism have an extremely developed skill in a particular area, such as mathematics or music. No evidence supports that autism is outgrown. Autistic children have abnormal ways of relating to people (social skills). Speech and language skills are usually delayed in autistic children.)

The nurse is caring for an infant with developmental dysplasia of the hip. Which clinical manifestations should the nurse expect to observe? (Select all that apply) Positive Ortolani sign Unequal gluteal folds Negative Babinski's sign Trendelenburg's sign Telescoping of the affected limb Lordosis

Positive Ortolani sign Unequal gluteal folds (A positive Ortolani sign and unequal gluteal folds are clinical manifestations of developmental dysplasia of the hip seen from birth to 2 to 3 months. Negative Babinski's sign, Trendelenburg's sign, telescoping of the affected limb, and lordosis are not clinical manifestations of developmental dysplasia of the hip.)

A nurse working with patients who are diagnosed with ADHD is aware that such patients often take CNS stimulant drugs. These medications are potent with a high potential for abuse and dependence. Based on this potential, how are these medications classified? Schedule IV Schedule II Schedule I Schedule III

Schedule II (CNS stimulants are the first-line drugs of choice for both ADHD and narcolepsy. They are potent drugs with a strong potential for tolerance and psychological dependence and are therefore classified as Schedule II drugs under the Controlled Substances Act.)