NUR 236 PrepU Chapter 50: Nursing Care of the Child With an Alteration in Behavior, Cognition, Development, or Mental Health/Cognitive or Mental Health Disorder

The nurse is 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?

Parental modeling of drug and alcohol avoidance is vital at this age.

A nurse is explaining the difference between anorexia nervosa and bulimia nervosa. The nurse knows the teaching was effective when the parents make which statement?

"Individuals with bulimia have a normal weight or are slightly overweight."

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

"A definitive cause can be found for every developmental disorder."

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?

"I have noticed my child does not look at people when talking to them."

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

"If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something."

After teaching the parents of a child with Tourette syndrome about motor and vocal tics, the nurse determines that the teaching was successful when the parents state:

"If we get him focused on an activity, the tics will be less pronounced."

A child with attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate hydrochloride. What should the nurse instruct the parents regarding an adverse effect of this medication?

Anorexia

An 11-year-old client has come to the school nurse more than 15 times reporting somatic symptoms during the first quarter of the school year. The client has subsequently left school after each visit. Which action by the school nurse would be most appropriate?

Contact the child's parents to discuss the situation.

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

Document the bruises and any statements made by the child relating to them.

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?

Engage the girl in dialogue regarding feelings about self/personal appearance.

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

Interrupted family processes related to inability of child to follow instructions

To feed lunch to a child with autism spectrum disorder (ASD), which action would be most important for the nurse to take?

Use a repetitive series of movements.

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

advocate

The nurse is caring for a girl with anorexia who has been hospitalized with unstable vital signs and food refusal. The girl requires enteral nutrition. The nurse is alert for which complications that signal refeeding syndrome?

cardiac arrhythmias, confusion, seizures

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

restoring nutritional balance and a healthy self-image

The nurse is interviewing a depressed 13-year-old adolescent. During the course of the interview, the adolescent reveals that her best friend is thinking about committing suicide. How should the nurse respond?

"Do you know how your friend is planning to commit suicide?"

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

"Does your child come and hug you or seek comfort from you?"

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

"I can relax rules at home if she has had a bad day."

The nurse is providing teaching about the potential side effects of lithium for the parents of a girl recently diagnosed with bipolar disorder. Which statement by the parents indicates a need for additional teaching?

"If she loses weight, then we know the medication is working."

A 10-year-old girl with attention deficit hyperactivity disorder (ADHD) has been on methylphenidate for 6 months. The girl's mother calls and tells the nurse that the medication is ineffective and requests an immediate increase in the child's dosage. Which response by the nurse would be most appropriate?

"Let's set up an appointment for you to come in as soon as possible.

A 9-year-old child with attention deficit hyperactivity disorder (ADHD) has been placed on the stimulant methylphenidate. The nurse knows that the teaching has been effective when the parents make which statement?

"Our child may have some side effects, like insomnia, headache, or stomach ache."

The nurse is discussing health concerns and issues with a group of caregivers of adolescents. Which statement made by a caregiver would indicate a need for follow-up by the nurse?

"Our daughter has never had any health problems, and now she has developed so many cavities."

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

"Tell me exactly how you would hurt yourself."

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

"Tell me why you believe the medication is not working."

The parents of an 18-month-old toddler are concerned that their toddler no longer makes eye contact, does not respond to their smiles or other facial expressions, does not point to toys, and no longer speaks. They said that their toddler used to be able to say "mama" or "dada." The parents started noticing these changes in behavior 3 months ago. Which information can be provided to the parents?

"There are many behaviors that can be thought of as signs of autism spectrum disorders, but only a health care provider can confirm the diagnosis."

An advance practice pediatric nurse practitioner (APPNP) is conducting a mental status examination with a 6-year-old girl. Which question would be most appropriate?

"Why does your pink doll hit all the other dolls?"

A family includes a 9-year-old child. The nurse suspects that the family has caregiver-fabricated illness (formerly Munchausen syndrome by proxy). Which nursing intervention is best when assessing the child and family in the pediatrician's office?

Ask to speak to the child separate from the family.

A mother is concerned because whenever she takes her 4-year-old son out to play in the yard, he begins eating dirt as soon as her back is turned. The nurse explains that this behavior is known as:

Pica

A school nurse is performing an assessment on a 14-year-old client. Which findings would alert the nurse to a possible mood disorder? Select all that apply.

Psychomotor agitation Changes in sleeping patterns Irritability

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

School-age and adolescent children view the threats to their health as far in the future, and the child feels that he or she can stop at any time.

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

The child constantly opens and closes the hands.

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?

The child may have a fear of being separated from the parent.

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?

The child will have a complete physical exam.

The nurse is observing a group of 2- and 3-year-olds in a play group. Which behavior noted in one of the children indicates to the nurse that the child may have autism spectrum disorder (ASD)?

While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack.

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

a classroom with a plan of study that is followed each day

The nurse is caring for several adolescent clients on the mental health unit. Which clients should the nurse suggest to join a group therapy session? Select all that apply.

adolescents with depressive disorder adolescents with a history of substance use disorder adolescents who have experienced rape adolescents who have experienced the death of a loved one

An adolescent has been diagnosed with oppositional defiant disorder. Which symptom does the nurse anticipate?

angry outbursts directed at authority figures

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

dyslexia.

The football coach notices that one of the players has been more energetic and overly happy lately during practice. The player also got in fight with a teammate last week. The coach contacts the health care provider, concerned that the student is using anabolic steroids. What physical sign would the nurse advise the coach to be on the lookout for that would further validate the illicit drug use?

gynecomastia

An adolescent is being seen in the local clinic for obesity problems. The nurse realizes that which factor would not play a role in this eating disorder?

having positive self-esteem

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

head trauma chromosomal disorders anoxia at birth very low birth weight fetal alcohol spectrum disorder

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

learning disorder

The nurse is examining a child with fetal alcohol spectrum disorder. Which assessment finding should the nurse expect?

low nasal bridge with short upturned nose

A 5-year-old child has frequent visits to the school nurse's office. Which assessment data should alert the nurse that this child may be a victim of physical neglect?

malnourished with frequent absences from school

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

orthostatic hypotension weak pulse hypothermia

Rumination disorder is a poorly understood condition of young children. This refers to:

rechewing undigested food.

A group of nursing students are reviewing the actions of various drugs used to treat mental health disorders in children. The students demonstrate understanding of the information when they identify which drug as potentiating the activity of serotonin in the brain?

sertraline

A nurse is providing an in-service program on child abuse (child mistreatment) for a group of newly hired nurses. When evaluating the effectiveness of the teaching, the nurse determines a need for additional review when the group identifies which as an indicator of possible child abuse (child mistreatment)?

sexual behavior that correlates with the child's developmental age

Which sign or symptom suggests depression in a child?

somatic complaints and acting-out behavior