HPA III Final Exam- Prep U

D. The child does not make eye contact.

The nurse is collecting data on an 18-month-old child with a diagnosis of autism spectrum disorder (ASD). What clinical manifestation would likely have been noted in the child with this diagnosis? A. The child cries and runs to the door when the caregiver leaves the room. B. The child smiles when the caregiver shows her a stuffed animal. C. The child sits quietly in the caregiver's lap during the interview. D. The child does not make eye contact.

A. attention deficit disorder

The parents of a 9-year-old child tell the nurse, "We are so frustrated with our child. We do not know what to do. Our child makes careless mistakes on tests and homework despite being intelligent, is very disorganized, and never follows through with chores at home." The nurse anticipates this child may have which disorder? A. attention deficit disorder B. bipolar disorder C. obsessive-compulsive disorder D. antisocial personality disorder

A. Severe erosion of teeth

A 17-year-old girl has been diagnosed with bulimia nervosa. Which complication should the nurse carefully assess for in this client? A. Severe erosion of teeth B. Hypertension C. Diabetes mellitus D. Atherosclerosis

C. She refers to the infant as "it" instead of saying the infant's name.

A new mother is holding her infant after a feeding. Which behavior by the mother would be concerning to the nurse related to malattachment? A. She looks into the infant's face. B. She rocks the infant when the infant begins to cry. C. She refers to the infant as "it" instead of saying the infant's name. D. She changes the infant's diaper.

2784 mL

The child has been hospitalized for failure to thrive. The child weighs 23.2 kg. The child is to receive 120 kilocalories per kilogram of weight per day. How many kilocalories should the child eat each day? Record your answer using a whole number. ____mL

B. "He spends hours repeatedly lining up his cars."

The nurse is conducting a well-child assessment of a 3-year-old. Which statement by the parents would warrant further investigation? A. "He spends a lot of time playing with his little cars." B. "He spends hours repeatedly lining up his cars." C. "He is very active and keeps very busy." D. "He would rather run around than sit on my lap and read a book."

D. Vomiting immediately after feeding

A 6-week-old infant is diagnosed with pyloric stenosis. When taking a health history from the parent, which symptom would the nurse expect to hear described? A. Refusal to eat B. Vomiting about 2 hours after feeding C. Chronic diarrhea D. Vomiting immediately after feeding

B. lack of pleasure

A client presents to her postpartum appointment with vague reports. The nurse suspects postpartum depression based on which assessment finding? A. She feels like eating all the time. B. lack of pleasure C. She is over her interest in her baby. D. extreme periods of elation

B. develop rapport for a trusting relationship.

A 14-year-old is admitted to the hospital for the second time for treatment of anorexia nervosa. Her responses to your questions on admission are either yes, no, or no response. Initially, your primary nursing goal in caring for this adolescent would be to: A. encourage her to eat a nutritious diet. B. develop rapport for a trusting relationship. C. decrease her anxiety. D. relieve her anger.

A. "There are no medications available to cure autism spectrum disorder."

A 2-year-old child has been diagnosed with autism spectrum disorder. The parents ask the nurse for a treatment that will cure the disorder. Which is the best response by the nurse? A. "There are no medications available to cure autism spectrum disorder." B. "Your child can be put on a strict diet to guarantee that the medication works." C. "When your child is older, you can try nutrition supplements for a cure." D. "Sometimes hiring a professional to give your child music therapy can cure this."

D. The child constantly stares at a rotating wheel on the crib mobile.

The nurse is caring for a 12-month-old child diagnosed with an autism spectrum disorder. What information from the mother during the health history should the nurse identify as being consistent with the disorder? A. The child speaks in complete sentences. B. The child sleeps at least 12 out of every 24 hours. C. The child responds warmly to the father but not to the mother. D. The child constantly stares at a rotating wheel on the crib mobile.

B. Not responding to the infant crying

The nurse is interacting with a young mother and her 2-week-old infant. Which behavior by the mother should the nurse prioritize and report to the RN or health care provider? A. Talking to the infant and rocking the infant B. Not responding to the infant crying C. Discussing her birth with another new mom D. Breast-feeding the infant in public

C. Validate the client's emotions, allowing her to express them freely.

When caring for a client with postpartum blues, which intervention would be most appropriate? A. Recommend the client to a support group or to a mental health professional. B. Avoid allowing contact between the newborn and the client. C. Validate the client's emotions, allowing her to express them freely. D. Administer antidepressants as prescribed to lessen postpartum blues.

B. Vomiting

Which assessment finding would suggest that a child's postoperative feeding schedule following pyloric stenosis surgery should be slowed? A. Flatulence B. Vomiting C. Semiformed bowel movements D. Falling asleep at each feeding

A. Forgets to turn in homework, does not follow directions, cannot stay in the assigned seat in class and is always talking excessively and inappropriately.

Which observation would demonstrate that the adolescent client suffers from attention deficit hyperactivity disorder (ADHD)? A. Forgets to turn in homework, does not follow directions, cannot stay in the assigned seat in class and is always talking excessively and inappropriately. B. Is withdrawn in social contexts but energetic and engaging with family. C. Is stubborn, resistant to directions, and unwilling to negotiate. D. Shows cruelty to animals, callousness, and lack of guilt and remorse.

C. "These fears are not uncommon."

The nurse is talking with the parents of a dying child. The child's mother confides she is afraid to be with her child at the time of death. Which response by the nurse is appropriate? A. "If you cannot handle being present, your child will understand." B. "You will need to find a way to overcome this obstacle for your child." C. "These fears are not uncommon." D. "If you need to leave your child at the time of death that will be fine."

B. Imbalanced nutrition, less than body requirements

The nurse is admitting a 15-year-old female with severe weight loss from anorexia nervosa. She also has a fluid and electrolyte imbalance. The nurse is preparing the care plan. Which nursing diagnosis will be the highest priority? A. Caregiver role strain B. Imbalanced nutrition, less than body requirements C. Ineffective individual coping D. Impaired social interaction

B. Projectile vomiting

The nurse is caring for a child admitted with pyloric stenosis. Which clinical manifestation would likely have been noted in the child with this diagnosis? A. Explosive diarrhea B. Projectile vomiting C. Severe abdominal pain D. Frequent urination