Ch 54: Nursing Care of a Family when a Child has a Cognitive or Mental Health Disorder

a) Appetite suppression Pg. 1544 One of the most common problems associated with taking stimulant medications such as methylphenidate is appetite suppression, leading to failure to gain weight or grow. Any child on these types of medications needs to be seen on a regular basis by a health care professional for weight and height measurements.

10. A school-age boy is on methylphenidate for ADHD. What negative side effect should the mother be advised to monitor for in the child? a) Appetite suppression b) Nausea and vomiting c) Headaches d) Skin rash

d) Hypokalemia Pg. 1550 In the child with bulimia, hypokalemia may occur, especially if the child abuses diuretics to prevent weight gain.

15. The nurse is doing a presentation on the diagnosis of bulimia to a group of pediatric nurses. Which clinical manifestation would the nurse teach this group to observe for in the adolescent with bulimia? a) Soft hair on their backs and arms b) Dry skin and brittle nails c) Constipation d) Hypokalemia

b) Encopresis Pg. 1553 Encopresis is chronic involuntary fecal soiling beyond the age when control is expected (about 3 years of age).

16. During a routine well-child check the caregiver of a 10-year-old tells the nurse that her child has recently starting passing stool into his underwear. This behavior indicates a symptom of which disorder? a) Echolalia b) Encopresis c) Enuresis d) Encephalopathy

c) Language delay Pg. 1534 Due to the extent of cognition required to understand and produce speech, the most sensitive early indicator of intellectual disability is delayed language development. A history of seizures, preterm birth, and vision deficit may be associated with intellectual disability but are not the most sensitive indicators.

18. When reviewing the medical record of a child, what would the nurse interpret as the most sensitive indicator of intellectual disability? a) Vision deficit b) Preterm birth c) Language delay d) History of seizures

b) The child constantly opens and closes his hands Pg. 1538-1539 Repetitive motor mannerisms such as constantly opening and closing the hands are a typical behavior pattern for ASD. A high level of activity and inattentiveness are typical symptoms of intellectual disability. Decrease in head circumference suggests malnutrition or decelerating brain growth. A long face and prominent jaw are symptoms of Fragile X syndrome.

24. Which sign or symptom suggests that a 5-year-old boy who does not maintain eye contact or speak may have autism spectrum disorder (ASD)? a) The child has a slight decrease in head circumference b) The child constantly opens and closes his hands c) The child is highly active and inattentive d) The child has a long face and prominent jaw

a) Parental knowledge deficit related to health care needs for a child with an intellectual disability Pg. 1533 Parental knowledge deficit related to health care needs for a child with an intellectual disability is the best nursing diagnosis for this situation because it addresses the parental need for information. There may be anxiety, ineffective family coping, and ineffective family process, but there is no data to support that in this situation.

4. The health care provider has recently informed parents that their child has an intellectual disability. The parents express the need for information and help with the important decisions they need to make concerning care of their child. What is an appropriate nursing diagnosis for this situation? a) Parental knowledge deficit related to health care needs for a child with an intellectual disability b) Ineffective family process related to having a child with an intellectual disability c) Ineffective family coping related to having a child with an intellectual disability d) Anxiety related to health care needs for a child with an intellectual disability

b) The child will have a complete physical exam Pg. 1553 The child with enuresis or encopresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. A complete physical exam and assessment is done first to rule out any physical cause.

30. The nurse is working with school-aged children who are having enuresis or encopresis. What will most likely be the first step in this child's treatment? a) The child will be taken to a therapist b) The child will have a complete physical exam c) The child will be given a strict daily schedule d) The child will be given medications

a) Schedule an immediate history and physical examination Pg. 1532-1533 The first step is to conduct a physical examination to rule out or identify illnesses or physical problems that might cause depression. Once any physical causes have been ruled out, the health care team can determine the most appropriate approach to assess the girl's symptoms.

7. A mother is telling the school nurse about her concerns regarding her 13-year-old daughter, who is experiencing headaches. Her grades have dropped, and she is sleeping late and going to bed early every night. The nurse advises the mother that the first priority should be to: a) Schedule an immediate history and physical examination b) Call for an appointment with a psychologist c) Ask the school psychologist to do psychometric testing d) Discuss the situation with her teacher

a) Tolerance Pg. The adolescent's statements reflect tolerance, which is the ability of body tissues to endure and adapt to continued or increased use of a substance; this dynamic means the drug user requires larger doses of the drug to produce the desired effect. A substance use disorder is the misuse of an addictive substance that changes the user's mental state. Dependence is a compulsive need to use a substance for its satisfying or pleasurable effects. Withdrawal refers to the physical and psychological symptoms that occur when the drug is no longer being used.

14. The nurse is assessing an adolescent who tells the nurse, "I have been using cocaine for a while now. At first, I would get high after smoking just once. But now I have had to smoke more and more to get the same effect." The nurse interprets the adolescent's statement as reflecting which situation? a) Tolerance b) Use disorder c) Dependence d) Withdrawal

b) The child cannot properly dress herself Pg. 1535 A child with impaired adaptive functioning would not be able to dress herself properly, if at all. The inability to copy a phone number or sentence, or to read well, reflects learning disorders.

19. What is an example of impaired adaptive functioning in an 8-year-old girl with a developmental disorder? a) The child cannot correctly copy a sentence b) The child cannot properly dress herself c) The child's vision is fine but she is a poor reader d) The child cannot correctly copy a phone number

b) Parental modeling of drug and alcohol avoidance is vital at this age Pg. 880 Parents need to model good behavior (avoidance) of drugs and alcohol when parenting school-aged children. Peer groups are the most influential at this age, so assuring the child's friends are not involved in dangerous use of drugs and alcohol is vital. Anger will not result in a candid conversation with the child and all discussions about the dangers of drug and alcohol consumption should involve factual statements that the child will understand.

23. The nurse is conducting a community educational program for parents of school-aged children. What would the nurse include in education plan in regards to the potential for drug and alcohol consumption in the school-age population? a) If the child is experimenting with drugs or alcohol, parental anger is the best approach b) Parental modeling of drug and alcohol avoidance is vital at this age c) Peer groups have little influence on this age group, so allowing freedom of friends is important d) When discussing drugs and alcohol consumption, keep the conversation light and avoid hard facts

a) "You can speak with your doctor about extended-release medications for the treatment of ADHD" Pg. 1543 Extended-release or once-a-day medications would eliminate the need for the boy to come in at lunch. The other responses are not therapeutic.

12. The mother of a 10-year-old boy phones the school nurse. The child has attention deficit/hyperactivity disorder (ADHD) and must go to the office to take medication at lunchtime. The child informed the mother that classmates have been making fun of him because he no longer wants to take the medication. Which is the nurse's best response? a) "You can speak with your doctor about extended-release medications for the treatment of ADHD" b) "He must take his medication; just tell your son to ignore the kids" c) "Tell your son if he doesn't take his medication, his grades may suffer" d) "I will tell his teacher to talk with the kids causing trouble"

b) He has been previously diagnosed with depression Pg. 1552 Children who are at greatest risk for becoming substance abusers are those who have a low self-esteem, have been diagnosed with depression, and have ADD or have learning disabilities. Lower socioeconomic level, birth order, or being an average student are not contributory factors.

3. An adolescent male tells the nurse that he has been smoking cigarettes for the last 3 years. The nurse recognizes that this adolescent is at the greatest risk of substance abuse based upon what family history finding? a) He is a B to C student in school b) He has been previously diagnosed with depression c) He is the oldest child in the family d) He is from a family of higher socioeconomic status

a) "The most important thing for your child to understand is that he or she is not to blame for the bullying" Pg. 879 Bullying is experienced by children during the school-age period. The child being bullied may be picked on due to a perceived difference between the child and peers. These differences include size, religion, manner of dress, or a physical/cognitive delay or impairment. Being bullied is stressful and causes anxiety for the victim. It is most important for the nurse to reinforce to the child and parents that this is not the child's fault. While it is important to determine the presence of injuries and to also report the events to the appropriate personnel, it is most important that the child and family be aware that the child is without blame.

2. During a wellness health check, a 10-year-old child reports not liking school because the child is getting picked on by other children. The child's parents state a desire to know what the child did to cause the bullying. Which statement by the nurse is most therapeutic? a) "The most important thing for your child to understand is that he or she is not to blame for the bullying" b) "This must be reported to the appropriate officials immediately" c) "Please explain any injuries that have resulted" d) "Some children are just more prone to being picked on"

b) Referred for counseling Pg. 1553 Encopresis is the repeated involuntary passage of feces of normal or near-normal stool in places not appropriate for that purpose. If no organic causes (e.g., worms, megacolon) exist, encopresis indicates a serious emotional problem and a need for counseling for the child and the family caregivers. Medications such as methylphenidate are used for hyperactivity. The diet needs to be high fiber. Antidiarrheals are contraindicated because they can cause more constipation. Lubricant laxatives should be used.

27. The nurse is working with a child diagnosed with encopresis. After a complete medical workup has been done, no organic cause has been found for the disorder. What follow-up will the nurse expect? a) Started on methylphenidate b) Referred for counseling c) Put on a high-calorie, high-protein diet d) Administered antidiarrheal medications

a) "Take this drug every day in the morning when you wake up" Pg. 1544 Long-acting methylphenidate is administered once daily in the morning, whereas the other forms are given three times a day. The drug typically causes difficulty sleeping and decreased appetite.

32. A child with attention deficit/hyperactivity disorder is prescribed long-acting methylphenidate. What information would the nurse include when teaching the child and his parents about this drug? a) "Take this drug every day in the morning when you wake up" b) "This drug may cause drowsiness, so be careful when doing things" c) "Some increase in appetite may occur, so watch how much you eat" d) "Give the drug three times a day: morning, midday, and after school"

a) Encourage her to discuss her thoughts and feelings Pg. 1532 The priority intervention is to encourage her to discuss her thoughts and feelings, as this is an initial step toward learning to deal with them appropriately. The other interventions are appropriate, but the priority intervention is to encourage discussion and obtain information from the child. This way the nurse can develop and refine the interventions based on the child's thoughts and feelings.

1. The nurse is caring for a 13-year-old girl with a nursing diagnosis of "Ineffective coping related to inability to deal with life stressors as evidenced by few or no meaningful friendships and low self-esteem." Which intervention would be the priority to promote coping skills? a) Encourage her to discuss her thoughts and feelings b) Role model appropriate social and conversation skills c) Demonstrate unconditional acceptance of the child as a person d) Set clear limits on behavior

b) Tourette syndrome Pg. 1551 Repeated vocal tics such as sniffling, grunting, clicking, or word utterances are associated with Tourette syndrome. The syndrome consists of multiple motor tics and one or more motor tics occurring simultaneously at different times. ADHD and obsessive-compulsive disorder occur in 90% of children with Tourette syndrome. Vocal and motor tics are not typical indicators of Asperger syndrome, anxiety disorder, or autism spectrum disorder.

11. The nurse is assessing a 6-year-old with attention deficit/hyperactivity disorder (ADHD). The nurse observes the boy making repeated clicking noises and notes he has a slight grimace. The nurse recommends the boy receive further evaluation for: a) Anxiety disorder b) Tourette syndrome c) Asperger syndrome d) Autism spectrum disorder

d) Apply lanolin or A+ D ointment to the infant's skin once a shift Pg. 1568 The infant's skin may be very dry due to malnutrition and poor fluid intake, so the nurse needs to apply some type of skin lubricant to prevent irritation. Urinary output should be 0.5 to 1.0 cc per kg per hour. Telling the parents what they are doing wrong will only further harm their self-esteem since many of them feel they are inadequate already. Feeding an infant with 20-calorie formula is not meeting nutritional needs. A minimum 24-calorie formula is needed until the infant begins to gain weight.

13. The nurse is caring for a hospitalized infant who has been diagnosed with nonorganic failure to thrive (NFTT). Which action would the nurse implement for this client? a) Monitor urinary output to ensure that it remains 2 to 3 cc/kg/hr b) Feed the infant 20-calorie formula every 4 hours while in the hospital c) Instruct the parents that they must meet the infant's needs for cuddling and stimulation d) Apply lanolin or A+ D ointment to the infant's skin once a shift

b) The child may have a fear of being separated from the parent Pg. 1547 School-phobic children may have a strong attachment to one parent, usually the mother, and they fear separation from that parent, perhaps because of anxiety about losing her or him while away from home. Being a poor student and worrying about grades would be more common in the later school age and adolescence. A child may be anxious about language but that is generally not enough to cause phobias. If the child is bored at school the parents should ask to meet the teacher and define the child's needs. Many children need extra stimulation but that is not the same as having a phobia.

17. In collecting data on a 7-year-old child with a possible diagnosis of school phobia, the nurse directs questions related to the following topics. Which would most likely be a cause of the child having school phobia? a) The child may be a poor student and be afraid of failing grades b) The child may have a fear of being separated from the parent c) The child may be bored and feels more intellectually stimulated at home d) The child may have a language barrier

d) Mild Pg. 1535 Children with mild intellectual disability exhibit difficulties in acquisition of academic skills and are typically more concrete in their problem solving. Socially, they are observed as less mature, have a limited understanding of risk, and demonstrate poorer affect regulation than similarly aged peers. As adults, they can usually achieve adequate social and vocational skills for minimum self-support and independent living but need guidance and assistance with complex daily living tasks. During early years, these children learn social and communication skills and are often not too distinguishable from average infants or toddlers. They continue to learn academic skills up to about a sixth-grade level. As adults, they can usually achieve social and vocational skills adequate for minimum self-support. They're able to live independently but need guidance and assistance when faced with new situations or unusual stress.

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

a) Work with counselors to develop a child-specific learning plan to achieve highest level possible Pg. 1539-1541 Parents want to have a defined plan in which to follow. Overall, the intent is to improve learning ability and have the child achieve the highest level possible. Professional counselors at schools can assist in the development of a specific plan to meet the needs of the child for the type of learning disorder that has been identified. There are many variants in plan development, because no child is the same. Removing anything harmful is a safety issue. Providing extra learning support or visual reminders may be supportive measures once a learning plan is developed.

21. A child has been diagnosed with a learning disorder. The parents seem very concerned about the child and want to know what they can do. Which nursing instruction would be helpful? a) Work with counselors to develop a child-specific learning plan to achieve highest level possible b) Provide child visual reminders of goals to be met and in what time frame c) Request extra learning support as needed to facilitate accomplishments d) Remove anything harmful from the immediate environment around the child

a) "Does your child come and hug you or seek comfort from you?" Pg. 1539 Children with autism spectrum disorder lack communication and social skills. These children often will not seek comfort, make eye contact, or develop peer relationships. It is important during the health history for the nurse to focus on the findings the parents are presenting and not on extra information that may or may not be helpful.

22. Parents of a 36-month-old child confide in the clinic nurse that their child does not speak and spends hours staring at their ceiling fan. They are worried that their child may have autism spectrum disorder. Which question would be important for the nurse to ask the parents? a) "Does your child come and hug you or seek comfort from you?" b) "Do you have trouble keeping child care providers for your child?" c) "Does your child have siblings?" d) "Does your child already attend therapies such as speech therapy?"

a) "When she watches TV and hears a commercial, she repeats one word from the commercial but doesn't seem to understand what she is saying" Pg. 1539 Echolalia ("parrot speech") is typical of autistic children; they echo words they have heard, such as from a television commercial, but they offer no indication that they understand the words.

25. The nurse is working with a group caregivers of children who are diagnosed with autism. Which statement made by the parents shows an example of echolalia? a) "When she watches TV and hears a commercial, she repeats one word from the commercial but doesn't seem to understand what she is saying" b) "She was at the park and the older kids were playing a game and she was staring at them as if she was wanted to try to copy what they were doing" c) "When reading her a story book about owls, her sister kept telling her that when owls made noises they sounded like an echo. She seemed to understand that animals sounded different from people" d) "When we were in a room with a high ceiling, she was so excited when she said hello and she heard her voice that she said it over and over"

b) "Symptoms include hallucinations with a flat affect or paranoia" Pg. 1553 Children with schizophrenia experience hallucinations (hear or see people or objects that other people cannot) and may display rambling or illogical speech patterns. They may not be responsive (have a flat affect), may withdraw into themselves so completely they are stuporous (catatonia), or be so extremely suspicious that others want to harm them (paranoia) that it is difficult for them to function. Although schizophrenic manifestations may occur suddenly after a major stress in a child's life (such as rejection by a boyfriend or girlfriend), subtle signs of mental illness have usually been present for some time. It is not related to multiple personalities or autism spectrum disorder. Many children who are diagnosed as having schizophrenia in childhood continue to have mental illness as adults, making continuing support and long-term follow-up essential.

26. The nurse is teaching a group of teachers how to recognize symptoms of schizophrenia that may occur in adolescence. Which statement by a teacher indicates that the teaching was effective? a) "Schizophrenia is a one-time diagnosis and does not lead to long term illness" b) "Symptoms include hallucinations with a flat affect or paranoia" c) "Symptoms progress from autism in school age into adolescent psychosis" d) "It presents as multiple personalities after severe incidences of abuse"

b) "Let's set up an appointment as soon as possible" Pg. 1543 The nurse plays a vital role in administering medicines and observing and reporting responses. A face-to-face appointment with the family and the doctor or advance practice mental health nurse can help uncover client and parental factors that may be preventing success. Once it is established that the family is using the medication properly as well as instituting structure within the home, it can be determined if an increased dosage or alternate medicine would be appropriate. Deferring to the doctor will not elicit any information from the mother, and waiting will not address the current concerns. The teacher can only reveal partial information about the effectiveness of the medication, which can be reviewed once other factors have been addressed in a face-to-face visit with the family and client.

28. A 10-year-old girl with ADHD has been on methylphenidate for 6 months. The girl's mother calls and tells the nurse that the medication is ineffective and requests an immediate increase in the child's dosage. What should the nurse say? a) "Let's wait a few more weeks before we do anything" b) "Let's set up an appointment as soon as possible" c) "Let me talk to the doctor about this" d) "What does the teacher say?"

c) "Tell me why you believe the medication is not working" Pg. 1543-1544 Asking the parent to explain why he or she believes the medicine is not working will offer important insights into the parent's definition of effectiveness. It is important for both the parent and health care team to develop a shared definition of effectiveness and improvement. Once this is established, the nurse can suggest the next step in the treatment plan. Stating a different medication or dosage may be needed does not provide any information about the child's response to the current medication. Asking the parent about administering the medication properly could cause the parent to take offense and does not provide the necessary information.

29. A pediatric client has recently been prescribed methylphenidate. The parent calls the office and insists the medication is not working. How will the nurse respond? a) "Perhaps another medication will be better for your child" b) "Tell me how you are administering the medication" c) "Tell me why you believe the medication is not working" d) "Your child's dosage may need to be increased"

a) Arrest for arson c) Truancy e) Initiator of physical fights Pg. 1546 Behaviors associated with conduct disorder include initiation of physical fights, arson, and truancy. Becoming easily annoyed and experiencing temper tantrums are associated with oppositional defiant disorder.

31. A nurse is reviewing the medical record of an 11-year-old child with a conduct disorder. What would the nurse identify as characteristics of this disorder? Select all that apply. a) Arrest for arson b) Temper tantrums c) Truancy d) Easily annoyed e) Initiator of physical fights

d) If there is no organic cause for the problem, the family may need to explore counseling for an emotional problem Pg. 1553 If a child is experiencing encopresis and there is no organic problem found such as constipation, inadequate fiber in the child's diet, or not drinking enough liquids to soften the stool, the child and family may need counseling for an emotional problem. It is thought that either over-controlling or under-controlling the child's life may be a contributory factor, along with emotional stressors in the child's life.

33. Parents of a school-age child experiencing encopresis are discussing the problem with the child's health care team. Their understanding of this problem is indicated when the parents respond in what manner? a) They can help the child by trying to control his stooling pattern with medications b) He needs to be allowed to make his own decisions or choices about his life c) Encopresis always indicates that the child is constipated and needs nutritional counseling d) If there is no organic cause for the problem, the family may need to explore counseling for an emotional problem

d) Engage the girl in dialogue regarding feelings about self/personal appearance Pg. 1533 Engaging the child in dialogue about self and personal appearance may reveal self-perceptions and allow discussion of reality versus perception; this enables discussion of methods to address perceived weaknesses and to focus on strengths. Appearance may reflect self-perception, and a comment regarding hygiene might be poorly received. While pubertal changes can be stressful, a 10-year-old girl may not have entered puberty and the question may not be relevant. The concept of accepting differences is secondary to engaging the child in dialogue about self and appearance.

34. A 10-year-old girl has been referred for evaluation due to difficulties integrating with her peers at her new school. The counselor believes she is at risk for situational low self-esteem due to problematic relationships with both family members and peers. What is the best approach? a) Remind her of the importance of good hygiene for better appearance b) Explore the girl's feelings about changes in her body with the onset of puberty c) Introduce the concept of accepting differences to reduce conflict d) Engage the girl in dialogue regarding feelings about self/personal appearance

a) Chromosomal disorders b) Anoxia at birth c) Head trauma d) Very low birth weight e) Fetal alcohol spectrum disorder Pg. 1534 Causes of cognitive disorders include chromosomal and metabolic disorders, anoxia at birth, head trauma, very low birth weight, and fetal alcohol spectrum disorder, among other causes. Cystic fibrosis is a hereditary disease, but it does not cause cognitive disorders.

35. Which factors are possible causes of cognitive disorders? Select all that apply. a) Chromosomal disorders b) Anoxia at birth c) Head trauma d) Very low birth weight e) Fetal alcohol spectrum disorder f) Cystic fibrosis

a) Angry outbursts directed at authority figures Pg. 1545 Oppositional defiant disorders (ODD) consist of a pattern of irritability, defiant behaviors, and vindictiveness that result in disturbed functioning in academic and social domains. Children and adolescents with ODD typically have difficulty controlling their temper; such anger is often directed at an authority figure. It is important to distinguish behavior that is within normal limits from behavior that is symptomatic. Many teens demonstrate some defiance toward their parents, but it typically does not disrupt their academic and social relationships like ODD. Problems do not typically occur between siblings and peers, rather with authority figures. Children with ODD may have conflict with legal authorities, but this is not something the nurse would anticipate.

36. An adolescent has been diagnosed with oppositional defiant disorder. Which symptom does the nurse anticipate? a) Angry outbursts directed at authority figures b) Frequent arrests and conflict with legal authorities c) Typical teenage defiance behavior with parents d) Disruptive behavior toward siblings and peers

a) The child has rigid study skills and ritualistic behavior Pg. 1549 Anorexic children often are described as successful students who tend to be perfectionists and are always trying to please parents, teachers, and other adults. They may make demands on themselves for cleanliness and order in their environment, or they may engage in rigid schedules for studying and other ritualistic behavior.

37. Which characteristic is commonly noted in the child with anorexia nervosa? a) The child has rigid study skills and ritualistic behavior b) The child is impulsive and inattentive when spoken to c) The child has trouble sitting still and is fidgety d) The child is inactive and participates in sedentary activities

b) Hyperactivity c) Distractibility d) Inattention e) Impulsivity Pg. 1542 ADHD is characterized by inattention, impulsivity, distractibility, and hyperactivity. Anxiety disorder and oppositional defiant disorder may be comorbidities associated with ADHD.

38. A nurse is preparing a teaching session for a group of parents with children newly diagnosed with attention deficit hyperactivity disorder (ADHD). When explaining this disorder to the parents, what would the nurse include as being involved? Select all that apply. a) Defiance b) Hyperactivity c) Distractibility d) Inattention e) Impulsivity d) Anxiety

c) Depression Pg.

39. The nurse observes an adolescent who appears to be persistently sad, has angry outbursts, has a decreased appetite and complains of headache frequently. Additionally, the mother reports that the teen is somewhat defiant and has been missing her curfews. The nurse recognizes that these are all signs of what problem? a) Striving for independence b) Alcohol abuse c) Depression d) Substance abuse

a) Set up a meeting between the parents and school officials to help the child return to school without experiencing her symptoms Pg. 1532 The child should not be kept at home indefinitely for such vague symptoms. Since the symptoms subside when the child is allowed to stay home, school phobia needs to be considered. Setting up a meeting with the principal is not necessary at this point, but the parents need to meet with school officials to determine what is causing the child to be frightened at school. The parents and school officials need to work together to get the child back to school symptom-free. Confronting the child and telling her that no one believes that she is ill will only exacerbate the problem.

5. The school nurse suspects that a girl at her school is experiencing school phobia. She has missed numerous days from school and reports a stomach ache and some vomiting and has a low-grade fever. The symptoms subside when the child is permitted to stay home. What intervention would be appropriate for this child? a) Set up a meeting between the parents and school officials to help the child return to school without experiencing her symptoms b) Continue to allow her to stay home if she appears ill and is complaining of illness c) Explain to the child that everyone knows she is faking her problems and she has to stop because she is going to school d) Meet with her principal to find out why she hates school and doesn't want to go

a) "I have noticed my child does not look at people when talking to them" Pg. 1535-1536 The nurse would highlight that the child does not look at others while talking. This could indicate a developmental delay or autism spectrum disorder. Progression in motor skills is expected in pediatric clients. Sharing is a behavior children learn and may struggle with, especially toddlers and preschoolers; however, this does not indicate a developmental or physical problem. Reading at the same grade level now indicates progress.

6. A 3-year-old child and parent are in the office for a well visit. Which statement by the parent will the nurse highlight for the health care provider? a) "I have noticed my child does not look at people when talking to them" b) "I have seen my child make progress in motor skills over the past several months" c) "My child does not like to share with the neighborhood kids" d) "My child is now able to read at the same level as other classmates"

a) Indifferent attachment to a parent Pg. 1538 A child with autism spectrum disorder can show a lack of or no attachment to parents. Motor skills are not expected to be slowed or delayed, because a child with ASD tends to spend hours in repetitive play and may display bizarre motor and stereotypic behavior. The child may become completely absorbed in strange repetitive behaviors such as spinning an object, flipping an electrical switch on and off, or walking around the room feeling the walls. Frequently losing things can be associated with attention deficit hyperactivity disorder. Engaging in dangerous activities could be related to a conduct disorder.

8. The nurse is assessing a child diagnosed with autism spectrum disorder (ASD). Which finding will the nurse expect to assess? a) Indifferent attachment to a parent b) Slow motor actions c) Frequently losing things d) Engaging in dangerous activities

b) Is planning to commit suicide Pg. 1552 Attempted suicide rarely occurs without warning and usually is preceded by a long history of emotional problems, difficulty forming relationships, feelings of rejection, and low self-esteem. Suicidal adolescents may appear suddenly elated after a long period of acting dejected, and might verbalize their hopelessness with statements such as "I won't be around much longer," or "After Monday, it won't matter anyhow." Some deaths reported as accidents, particularly one-car accidents, are thought to be suicides.

9. A 16-year-old girl is being seen for a long-overdue checkup. Her caregiver has come with her. She is calm, pleasant, and in good spirits. The caregiver reports to the nurse that she is relieved because for the past 6 months the teenager has been lethargic, angry, and sad. The mother reports that since she got her driver's license two days earlier, her child's mood has changed dramatically. Rather than resist this appointment, the girl had simply smiled and said, "It won't matter much, but okay, I'll be ready in a minute." The nurse recognizes that the child's seeming well-being and drastic change in behavior should be further investigated to determine if the child: a) Has been smoking marijuana b) Is planning to commit suicide c) Is excited that she can drive now d) Is experimenting with alcohol