Peds_Exam 3_VU

A pregnant client has heard about Down syndrome and wants to know about the risk factors associated with it. What would the nurse include as a risk factor?

Advanced maternal age Advanced maternal age is one the most important factors that increases the risk of an infant being born with Down syndrome. Down syndrome is not associated with advanced paternal age, recurrent miscarriages, or family history of Down syndrome.

The nurse is reviewing patterns of inheritance regarding genetic disorders. Which disorders are considered monogenic? Select all that apply. a.Autosomal dominant b.Autosomal recessive c.X-linked dominant d.Mitochondrial inheritance e.Genomic imprinting

Answer: a, b, c Monogenic disorders (caused by a single gene that is defective) include autosomal dominant, autosomal recessive, X-linked dominant, and X-linked recessive disorders. Mitochondrial inheritance and genomic imprinting are considered multifactorial disorders (caused by multiple gene and environmental factors).

The nurse is performing an assessment of a 6-year-old girl with Turner syndrome. What finding would the nurse most likely assess? a) short stature & slow growth b) enlarged thyroid gland c) pectus carinatum d) short, stubby trident hands

Short stature. Girls with Turner syndrome usually have a single X chromosome, causing them to have short stature and infertility. Persons with sickle cell anemia have painful joints. Color blindness occurs in persons diagnosed with Huntington disease, and they may exhibit chorealike movements. Progressive dementia occurs in early-onset familial Alzheimer disease.

Which statement about multifactorial inheritance is true? a) A sex bias is usually present. b) No environmental factors contribute to the disorder. c) Second-generation offspring of the affected individual will express the disorder more frequently than immediate offspring. d) It is predictable.

a) A sex bias is usually present.

A nurse is caring for a 17-year-old female client with bulimia. Which complication of this disease may the nurse see in this child? a) Menstrual problems b) Hernia c) Partial paralysis d) Severe acne

a) Menstrual problems Paralysis, hernia, and acne are not distinguishing features of bulimia. Bulimia is an eating disorder that has assessment findings of menstrual problems, esophagitis, cardiac arrhythmias, and fluid and electrolyte imbalance.

The student nurse is studying the genetics of clients who are seeking assistance from a genetic counseling center. The student nurse notes monogenic disorders have which characteristic? a) The disorders are considered single-gene b) The disorders are considered multifactorial Inheritance c) The disorders are considered mitochondrial inheritance patterns d) The disorders are considered nontraditional inheritance patterns

a) The disorders are considered single-gene Mono = 1

The nurse is working with a family as they make decisions regarding their newborn's care following the diagnosis of a serious genetic disorder. What response by the nurse would be appropriate? a) "Are you sure your doctor has enough experience to help you care for your child?" b) "What are some advantages and disadvantages of the decisions you are making for the baby?" c) "My niece has the same disorder so I can tell you what I think you should do about it." d) "Requestng input from your extended family will likely complicate your ability to make decisions."

b) "What are some advantages and disadvantages of the decisions you are making for the baby?"

A nurse is teaching about autosomal dominant and recessive genetics. Which statement by the nurse is accurate? a "An autosomal dominant disorder is classified as X-linked." b) "An autosomal dominant disorder has a lower risk of phenotyping than an autosomal recessive disorder." c) "Two abnormal genes, one from each parent, are required to produce the phenotype in an autosomal recessive disorder." d) "One abnormal autosomal recessive gene is needed for outward presentation of the disorder."

c "Two abnormal genes, one from each parent, are required to produce the phenotype in an autosomal recessive disorder." Explanation: An autosomal recessive disorder requires two abnormal genes to outwardly express the disorder. Recessive disorders have a lower risk of phenotyping than dominant disorders. X-linked and autosomal disorders are two different classifications.

A 15-year-old Vietnamese-American boy has been referred by his homeroom teacher to the school nurse for evaluation. The teacher is concerned that the adolescent may be suffering from major depression. When investigating these concerns at the family's primary care office, the nurse would use which person as the primary source of information? a) The client's parents b) The client's homeroom teacher c) The client d) The client's school nurse

c) the client The client is the primary historian, and the nurse should first elicit his perspective on the problem to establish a therapeutic alliance. The school nurse might have some input, but his or her contact with the adolescent may have been minimal. The client's parents can provide insight and assistance, but they may not be willing to do so because of cultural differences. The teacher will provide a valuable timeline and observations as the individual who referred this case; however, the client is still the primary historian.

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? a) gynecomastia b) extended periods of fatigue c) fainting d) headaches

a) gynecomastia Anabolic steroid use can cause periods of euphoria and decreased fatigue, not more fatigue. Gynecomastia is a common side effect of prolonged steroid use, as well as liver damage, hypertension, psychotic episodes, and aggression

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) schedule an immediate history and physical examination. 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.

The nurse is caring for several pregnant women. Which woman would the nurse identify as being at highest risk for having a child born with Down syndrome? a) A woman at 24 weeks' gestation having an amniocentesis b) A women at 28 weeks' gestation who will be 37 years old at the time of delivery c) A woman with a 2-year-old child diagnosed with Turner syndrome at birth d) A women whose husband's family has a history of genetic disorders

b) A women at 28 weeks' gestation who will be 37 years old at the time of delivery

The nurse is examining a child with fetal alcohol syndrome (FAS). Which assessment finding should the nurse expect? a) Short philtrum with thick upper lip b) Low nasal bridge with short upturned nose c) Clubbing of fingers d Macrocephaly

b) Low nasal bridge with short upturned nose Typical facial features of a child w/FAS from alcohol use by mother while pregnant: a low nasal bridge with short upturned nose, flattened midface, and a long philtrum with narrow upper lip.

The parents of a child diagnosed with Tay-Sachs inquire about progression of the disorder. Which statement by the nurse is accurate? a) "Lifetime steroid therapy will reverse the blindness." b) "The child will experince decreased muscular and neurologic functioning until death occurs." c) "Anticonvulstants will be given to prolong life and prevent further brain damage." d) "Symptoms can be controlled by eliminating dairy products."

b) "The child will experince decreased muscular and neurologic functioning until death occurs." Explanation: This is an irreversible progressive disorder that affects the functioning of muscles and the neurologic system. Symptoms cannot be controlled by changes in the diet, and medication therapy will not reverse symptoms nor prolong life. Medication will be used to treat symptoms and provide comfort measures.

The most common use disorder among children and adolescents is: a) oxycodone. b) alcohol. c) ecstasy. d) marijuana.

b) alcohol Alcohol misuse occurs when a person ingests a quantity sufficient to cause intoxication. It is also the most common substance use disorder among children and adolescents.

The nurse is reviewing the health records for several children at a health clinic. Which child would the nurse expect to be newly diagnosed with an inborn error of metabolism? a) An adolescent male b) A preschool male c) A newborn female d) A female toddler

c) A newborn female When a previously healthy newborn presents with a history of deterioration, suspect an inborn error of metabolism.

A mother has presented with her 2 year old child. She states that the child was talking in earlier months but recently has "kind of withdrawn." The child does not interact with other children or adults much but does enjoy throwing a ball, retrieving it and throwing it again. The nurse realizes that the child needs further assessment for which disorder? a) Attention Deficit Hyperactivity Disorder b) Attention Deficit Disorder c) Autism d) Depression

c) Autism Playing alone and lack of interaction with others are typical symptoms related to autism. There are not indicators of learning issues with the child at the current time and no tics are being reported. Hyperactivity is not noted in the child which would indicate a hyperactivity disorder.

The nurse is assessing a 3-year-old boy with Sturge-Weber syndrome. Which finding is most indicative of the disorder? a) Record shows the boy has seizures b) Observation indicates mild retardation c) Inspection reveals a port wine stain d) Observation shows behavior problems

c) Inspection reveals a port wine stain Explanation: Children with Sturge-Weber syndrome will have a facial nevus, or port wine stain, most often seen on the forehead and one eye. While the child may experience seizures, retardation, and behavior problems, they are not definitive findings.

When assessing newborns for chromosomal disorders, which assessment would be most suggestive of a problem? a) Slanting of the palpebral fissure b) Bowed legs c) Low-set ears d) Short neck

c) Low-set ears A number of common chromosomal disorders, such as trisomies, include low-set ears

The nurse is caring for a 10-year-old recently diagnosed with attention deficit hyperactivity disorder (ADHD). The nurse would expect to provide teaching regarding which medication? a) Fluoxetine b) Trazodone c) Methylphenidate d) Buspirone

c) Methylphenidate Methylphenidate is a psychostimulant commonly prescribed for ADHD. Trazodone is used to treat depression. Buspirone is used for anxiety. Fluoxetine is used for depression.

The nurse is caring for an 8-year-old girl who has just been diagnosed with fragile X syndrome. Which interventions is priority? a.Explain care required due to the disorder b.Assess family's ability to learn about the disorder c.Educate the family about available resources d.Screen to determine current level of functioning

Answer: b The priority intervention is to assess the family's ability to learn about the disorder. The family needs time to adjust to the diagnosis and be ready to learn for teaching to be effective. Screening to determine current level of functioning, explaining the care required due to the disorder, and educating the family about available resources are interventions that can be taken once the family is ready.

The nurse is assessing a 2-week-old boy who was born at home and has not had metabolic screening. Which sign or symptom indicates phenylketonuria? a.Increased reflex action on palpation b.Signs of jaundice c.Musty or mousy odor to the urine d.Report of seizures

Answer: c Children with phenylketonuria will have a musty or mousy odor to their urine, as well as an eczema-like rash, irritability, and vomiting. Increased reflex action and seizures are typical of maple sugar urine disease. Signs of jaundice, diarrhea, and vomiting are typical of galactosemia. Seizures are a sign of biotinidase deficiency or maple sugar urine disease.

A nurse is assessing a child diagnosed with Sturge-Weber syndrome. What finding would the nurse expect to find when assessing the skin? a) Pigmented nevi b) Tumors c) Café-au-lait spots d) Port wine stain

Inspection reveals a port wine stain Explanation: Children with Sturge-Weber syndrome will have a facial nevus, or port wine stain, most often seen on the forehead and one eye. While the child may experience seizures, retardation, and behavior problems, they are not definitive findings.

The nurse is interviewing a 13-year-old girl with depression. During the course of the interview, the girl reveals that her best friend is thinking about committing suicide. Which response by the nurse would be most appropriate? a) "Do you know how she is planning to kill herself?" b) "Why do you think she wants to kill herself?" c) "Are you the only person who knows?" d) "Do her parents know she wants to kill herself?"

a) "Do you know how she is planning to kill herself?" Because the girl is depressed, the nurse suspects that the girl is indirectly talking about herself, not her best friend. When an adolescent raises the issue of suicide, it is important to find out exactly how he or she is envisioning suicide and take measures to prevent an attempted suicide. Therefore, the nurse should ask how the "friend" is contemplating suicide in order gather this information and open a dialogue to encourage the girl to reveal she is talking about herself. Asking why, if the parents know or if the girl is the only one who knows would not elicit the critical information about the method of suicide.

The nurse is caring for a newborn girl with galactosemia. Which intervention will be necessary for her health? a) Adhering to a low phenylalanine diet b) Eliminating dairy products from the diet c) Supplementing with thiamine throughout the lifespan d) Eating frequent meals and never fasting

b) Eliminating dairy products from the diet Explanation: Galactosemia is a deficiency in the liver enzyme needed to convert galactose into glucose. This means the child will have to eliminate milk and dairy products from her diet for life. Adhering to a low phenylalanine diet is an intervention for phenylketonuria. Eating frequent meals and never fasting is an intervention for medium-chain acyl-CoA dehydrogenase deficiency. Maple sugar urine disease requires a low-protein diet and supplementation with thiamine.

The nurse is educating an 18-year-old female client with Turner syndrome. What information will the nurse include in the teaching plan? a) The need to eliminate amino acids from the diet b) Resources regarding infertility and family planning c) Requirements for post secondary educational needs d) The options for a cure as the client enters adulthood

b) Resources regarding infertility and family planning

A school nurse is developing a plan of care for a child with suspected violence between the child's parents. The nurse monitors for which behaviors in the child? a) compensation by overachieving b) aggressive behavior in school c) development of tics or twitches d) developmental delays

b) aggressive behavior in school. Children who have a parent who is violent may be identified because of behavior problems, noncompliance, and aggression in school. Developmental delays occur in children with other disorders. Development of tics or twitches occurs with Tourette's syndrome. Compensating by overachieving is not typically related to violence in the home.

The nurse is conducting an examination of a boy with Tourette syndrome. Which finding should the nurse expect to observe? a) Toe walking b) Lack of eye contact c) Sudden, rapid stereotypical sounds d) Spinning and hand flapping

c) Sudden, rapid stereotypical sounds 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.

A nurse assesses that a 15-year-old female client has not developed secondary sexual characteristics, is short in stature, and has a webbed neck. The nurse identifies this as being most likely related to which diagnosis? a) Patau syndrome b) Edwards syndrome c) Turner syndrome d) Klinefelter syndrome

c) Turner syndrome

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? a) "The establishment of rules for our home should be held with my daughter as soon as possible." b) "If my daughter becomes angry about established rules at home it is important I remain calm and consistent." c) "When my daughter exceeds expectations for her behavior she should be praised." d) "I can relax rules at home if she has had a bad day."

d) "I can relax rules at home if she has had a bad day." When dealing with a child who is having behavioral issues it is important for the parents to be consistent. Once rules and expectations are established the parents need to remain consistent. When a child is angry arguments should be avoided. The parents need to address the child in clear and calm tones.

Which sign is consistent with autism spectrum disorder (ASD) in a 2-year-old boy? a) Shows signs of losing attained skills b) Has below-average intellectual function c) Possesses excellent language development d) Performs repetitive activity with toys

d) Performs repetitive activity with toys The repetitive behavior pattern with the toys, along with observation of communication and social impairment, would suggest ASD. Below-average intellectual function is a sign of intellectual disability. Loss of attained skills is a sign of Rett syndrome, which occurs only in girls. The presence of excellent language skills suggests Asperger syndrome.

What would be the priority goal for the nurse caring for an infant diagnosed with nonorganic failure to thrive? a) Keep the skin dry and intact. b) Provide adequate nutrition for growth. c) Teach the parent not to spoil the infant. d) Praise positive parenting.

b) Provide adequate nutrition for growth. A nonorganic failure to thrive (NFTT) infant has been receiving inadequate nutrition for some time prior to being diagnosed, so the priority goal is correcting this problem and making sure the infant is receiving adequate nutrition for growth. It is usually a "catch up" time initially to ensure that the infant is getting enough calories to grow and make up for lost time. Praising the parent when they do something right is a good idea, but nutrition comes first.

The nurse is educating the parents of a newborn diagnosed with Tay-Sachs disease. Which parent statement would indicate additional teaching is needed? a) "Even though he looks healthy, this is a serious genetic disorder." b) "We are very sad there is no cure for this disease at this time." c) "We are happy he will eventually grow out of these symptoms." d) "Our baby may need medication to control seizures if they occur."

c) "We are happy he will eventually grow out of these symptoms." Tay-Sachs: caused by insufficient activity of an enzyme called hexosaminidase A, which is necessary for the breakdown of certain fatty substances in brain and nerve cells. No treatment or cure. Medical management will focus on managing symptoms and maintaining comfort. Anticonvulsants may be given to control seizures. Death usually occurs in early childhood, by age 4 or 5. Carriers can be identified by a blood test and prenatal testing is available.

Which is an inborn error of metabolism that affects growth and development? a) Cystic fibrosis b) Achondroplasia c) Turner syndrome d) Hunter syndrome

d) Hunter Syndrome Hunter syndrome is an inborn error of metabolism that hinders development and results in altered physical appearance and impaired mental development. Cystic fibrosis is a genetic disorder that results in accumulation of mucus in the lungs and pancreas. Achondroplasia is a congenital disorder that is a common cause for the structural defect called dwarfism. Turner syndrome is a chromosomal abnormality associated with webbed neck and low-set ears.

A pregnant woman of Jewish descent comes to the clinic for counseling and tells the nurse that she is worried her baby may be born with a genetic disorder. Which disease does the nurse identify to be a risk for this client's baby based on the family's ancestry? a) Down syndrome b) sickle cell anemia c) b-thalassemia d) Tay-Sachs

d) Tay-Sachs Explanation: Sickle cell anemia occurs most often in African Americans, Tay-Sachs disease occurs most often in people of Jewish ancestry. B-thalassemia is a blood dyscrasia that occurs frequently in families of Greek or Italian heritage. Down syndrome is not attributed to Jewish ancestry.

The nurse is caring for a 6-year-old girl who has been diagnosed with neurofibromatosis. What is the priority intervention? a) Referring the parents to a neurofibromatosis support group b) Pointing out the child's positive attributes to her c) Providing postoperative care when tumors are removed d) Urging the parents to schedule yearly physical examinations

d) Urging the parents to schedule yearly physical examinations

What finding would suggest that a 5-year-old boy might have a developmental disorder? a) The child must be supervised when brushing his teeth. b) The child is not able to follow directions. c) The child has trouble with r, l, and y sounds. d) The child knows what a dog and a cat sound like.

b) The child is not able to follow directions. A 5-year-old child should be able to follow simple directions. If he is unable to do this, he has not yet achieved a developmental milestone. Brushing his teeth with supervision and knowing cat and dog sounds are normal for this age. Having trouble with r, l, and y sounds is not unusual and may continue until age 7

The nurse is assessing an 8-week-old infant in the clinic. The parent states the infant was feeding well and gaining weight until a few weeks ago and now is noted to have lost weight and "isn't doing well" per the parent. What action would the nurse take next? a) Suggest the child be fed in a supine position, using a car seat or carrier b) Advise the parent to decrease the feedings daily to every 6 hours c) Assess the infant further for an inborn error of metabolism d) Refer the parents to a dietitian for education on increasing the child's appetite

c) Assess the infant further for an inborn error of metabolism

The mother of an 8-year-old boy is concerned that her son has attention-deficit/hyperactivity disorder. She describes the symptoms he demonstrates. Which behavior should the nurse recognize as an example of impulsiveness? a) Repeating words or phrases spoken by others b) Constantly fidgeting in his chair and shaking his foot c) Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission d) Inability to answer a question posed by his teacher because he was daydreaming

c) Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission The disorder is characterized by three major behaviors: inattention, impulsiveness, and hyperactivity. Inattention makes children become easily distracted and often may not seem to listen or complete tasks effectively. Impulsiveness causes them to act before they think and therefore to have difficulty with such tasks as awaiting turns. With hyperactivity, children may shift excessively from one activity to another, exhibit excessive or exaggerated muscular activity, such as excessive climbing onto objects, constant fidgeting, or aimless or haphazard running. Repeating words or phrases spoken by others is echolalia and is associated with autistic spectrum disorder.

An infant diagnosed with nonorganic failure to thrive (NFTT) is being treated in the hospital. Which intervention would the nurse implement for this child to provide increased nutritional intake? a) Feed the infant on demand so the infant will be hungry. b) Recommend that the parents rock the infant quietly and not talk to the infant. c) Burp at the end of every feeding and place the infant on the stomach. d) Document all feedings and the infant's response to the feeding.

d) Document all feedings and the infant's response to the feeding. An NFTT infant requires frequent, scheduled feedings every 2 to 3 hours. The infant also needs to be talked to during the feeding to assist with bonding and development of trust. Always document the volumes the infant took, as well as how the infant fed. The infant is burped several times during the feeding and then placed on the back for sleeping.

The nurse is working closely with the parent of a 6-year-old client who was just diagnosed with attention deficit/hyperactivity disorder (ADHD). Which methods used in behavior modification would be appropriate for this child? Select all that apply. a) Be fair but firm, and stick to rules b) Provide a structured environment c) Give short and clear explanations d) Wait a few days to punish e) Give medication only when needed

a) Be fair but firm, and stick to rules b) Provide a structured environment c) Give short and clear explanations A variety of treatments are used in the therapeutic management of ADHD. Behavior modification may help treat the varying causes, because the cause of the disorder is unknown. A quiet, structured environment decreases stimulation for this child. Medication should be followed as prescribed to avoid behavior changes and side effects. These children have trouble paying attention and focusing. Therefore, short goals and being firm add to the structured environment.

An adolescent has been diagnosed with bulimia, and the parents are asking how to best deal with this problem. What suggestion should the nurse make to the parents to help care for the adolescent? a) Develop a contract with the adolescent, setting goals of behavior and her diet, as well as privileges gained by meeting the contracted goals. b) Minimize or ignore any comments made by the adolescent about body image distortion or being overweight and dieting. c) Administer antiemetics on a regular basis to reduce the urge to vomit after eating. d) Monitor the adolescent constantly to ensure that she is not binge eating.

a) Develop a contract with the adolescent, setting goals of behavior and her diet, as well as privileges gained by meeting the contracted goals. Developing a contract with the adolescent, as part of a behavior modification program, lays out clearly defined behaviors and the child's responsibilities related to bulimia and its management. Parents need to be aware and report any verbalizations about being overweight or altered body image. Antiemetics are not appropriate for this disorder since there is not nausea associated with it and it is impossible to monitor the adolescent continually.

The nurse is caring for a child who has been hospitalized for maltreatment. When reviewing the child's records which findings may have placed the child at an increased risk for abuse? Select all that apply. a) The child's mother has a history of substance use disorder. b) Both parents work outside of the home. c) The child has cerebral palsy. d) The child was born prematurely. e) The child's father is the primary care taker.

a) The child's mother has a history of substance use disorder. c) The child has cerebral palsy. d) The child was born prematurely. Although not every chilld abused or child abuser will fit a profile of characteristics, many will. Child abuse occurs across all socioeconomic levels, but the findings are more prevalant in those experiencing poverty. Additional risk factors include prematurity, chronic illnesses, parental substance use disorder, cerebral palsy and cognitive impairment. Parents working outside the home and paternal caregivers are not families facing increased risk for abuse.

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) mild. b) profound. c) moderate. d) severe.

a) mild About 85% of children who are intellectually disabled have an IQ of 50 to 70 and may be referred to as "educable" by a school system. 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.

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 contract or speak. The nurse suspects an autism spectrum disorder. Which additional finding would help support the nurse's suspicion? a) The child has a slight decrease in head circumference. b) The child constantly opens and closes the hands. c) The child is highly active and inattentive. d) The child has a long face and prominent jaw.

b) The child constantly opens and closes the hands. Repetitive motor mannerisms such as constantly opening and closing the hands are a typical behavior pattern for autism spectrum disorder. 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.

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) autism spectrum disorder. b) Tourette syndrome. c) anxiety disorder. d) Asperger syndrome.

b) Tourette syndrome. 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.

A parent brings a preschooler to the behavioral clinic for evaluation. Upon entering the room, the child appears not to notice the nurse's presence. The child screams upon the nurse's touch. What condition should the nurse suspect? a) Findings are normal for a preschooler b) Autism c) Down syndrome d) Learning disability

b) autism Autistism spectrum disorder is characterized by markedly abnormal or impaired development in social interaction and communication. Social impairment is sustained and includes such things as poor eye contact, not liking to be touched, and preferring solitary activities. The findings are not indicative of Down syndrome or a learning disability. Down syndrome children are usually very friendly and like to be hugged and touched. A child with a learning disability does not have problems with socialization. These symptoms are not normal findings in preschoolers. Preschoolers are very interested in their surroundings and very interactive.

A parent brings a child to the pediatric clinic, stating that the child was diagnosed with attention deficit hyperactivity disorder (ADHD). Which symptom does the nurse anticipate finding with this child? a) visual impairment, hyperactivity, oppositional defiant b) inattention, impulsive, and hyperactivity c) excess motor activity, learning disability, and depression d) hyperactivity, defiant, and disruptive

b) inattention, impulsive, and hyperactivity Attention deficit hyperactivity disorder (ADHD) is characterized by three major behaviors: inattention, impulsiveness, and hyperactivity. Defiance may be present in some children, but not all, and many times ADHD causes disruption in multiple environments. Excess motor activity is present with hyperactivity, but learning disability and depression may occur as a result of having ADHD. Visual impairment must be ruled out with ADHD as sometimes children with visual impairment appear inattentive due to being unable to read the board. Hyperactivity is a part of ADHD, but not visual impairment. Oppositional defiant disorder may also present in children with ADHD, but it is not considered part of ADHD.

A nurse in a residential foster home is caring for a 17-year-old client with oppositional defiant disorder. The client is using profanity and refusing to complete assigned chores. The nurse reminds the client that there are only 5 minutes in which to finish the chores. The client throws a dirty plate at the wall. How should the nurse respond? a) "You only have a few minutes to complete your chores." b) "If you calm down right now I will give you a few extra minutes to complete your chores." c) "I am sorry you are feeling so angry tonight but you must still complete your chores." d) "I find your language offensive and you need to stop talking that way."

c) "I am sorry you are feeling so angry tonight but you must still complete your chores." An adolescent with an oppositional defiant disorder can frequently demonstrate active defiance, has frequent anger and is noncompliant with adult requests or limits. In this situation the nurse's goal is to clearly but empathetically explain the rules and firmly adhere to them. Telling the adolescent there are only a few minutes to complete the chores does not exhibit empathy. Nor does the statement "I find your language offensive." It also does not address the rules. Letting the adolescent have a few extra minutes only reinforces the negative behavior and does not respect the rules of the facility.

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? a) "What does the teacher say?" b) "Let me talk to the doctor about this." c) "Let's set up an appointment for you to come in as soon as possible. d) "Let's wait a few more weeks before we do anything."

c) "Let's set up an appointment for you to come in as soon as possible. The nurse plays a vital role in administering medicines and observing and reporting responses. A face-to-face appointment with the family and the primary health care provider or advanced practice mental health nurse can help uncover patient 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 patient.

The nurse is talking with a pregnant woman who is a carrier for a genetic disorder. The woman does not have any symptoms of the disorder. The pregnant woman asks the nurse about the risk to her unborn baby. What is the most appropriate response by the nurse? a) "Since you are only a carrier for the gene, there is no risk to your baby." b) "There is no way to assess the risk to the baby until after he is born." c) "We can only assess the potential risk after the baby's father undergoes genetic testing." d) "As a carrier of the gen,e there is a strong chance your child will be born with the disorder."

c) "We can only assess the potential risk after the baby's father undergoes genetic testing." When an individual is a carrier for a genetic disorder the risk can only be assessed after viewing the genetic profile of the other parent. If the child's father is not a carrier of the gene or have the disorder there is no risk for the child to have the disorder. The child, however, can be a carrier like the mother.

An infant with craniosynostosis from Apert syndrome becomes lethargic and starts to vomit. What is the priority nursing intervention? a) Reassess every hour and document findings b) Monitor intake and output c) Notify the doctor and prepare for surgery d) Give IV dextrose

c) Notify the doctor and prepare for surgery Explanation: The child is exhibiting signs and symptoms of increased intracranial pressure related to premature fusing of the skull joints. Surgery will be needed to relieve the pressure. IV dextrose is contraindicated with increased intracranial pressure. Waiting 1 hour to reassess may lead to brain damage and death. Monitoring intake and output is needed with a hospitalized child but is not the priority intervention based on presentation of symptoms.

A couple who are pregnant with their first child have made an appointment with a clinical geneticist to discuss prenatal screening. The man states that they, "just want to make sure that there is nothing wrong with our baby." How could the clinician best respond to this statement? a) "You need to be aware that if abnormalities are detected, termination is normally required." b) "We can't rule out all abnormalities, but a routine fetal tissue biopsy can yield useful information." c) "Prenatal screening is not usually necessary unless you are among a high-risk group." d) "Testing the umbilical blood and performing amniocentesis can give us some information, but not a guarantee."

d) "Testing the umbilical blood and performing amniocentesis can give us some information, but not a guarantee." Prenatal screening provides a useful but incomplete picture of fetal health; umbilical sampling and amniocentesis arecommon methods of screening. Fetaltissue biopsy is a rarely used screening method, and a couple need not belongto a highrisk group to benefit from prenatal screening. Abnormalities do not usually necessitate termination.

The mother of a 13-year-old girl approaches the school nurse. She is concerned because her daughter does not seem happy since the family relocated from another state and started attending a new school. The mother is upset and wants to know what she can do for her daughter. What would be the most helpful information to gather from the mother? a) "Was your daughter happy in her previous school?" b) "How is the rest of the family reacting to the move?" c) "Do you think your daughter is depressed?" d) "What are the specific changes you have seen in your daughter since your move?"

d) "What are the specific changes you have seen in your daughter since your move?" Asking about the specific changes can help the nurse compare and contrast the girl's previous behavior with her current behavior. Additionally, this open-ended question helps the nurse gather detailed information regarding moods, sleeping patterns, weight loss, and other specifics to help make an appropriate recommendation. The other questions would not provide helpful or relevant information to the nurse.

An adolescent was caught sneaking liquor out of the family liquor cabinet at home. When confronted by the parents, the adolescent admits to have been drinking daily for the last 3 years. When the parents talk to the health care provider about how to intervene for their child, what information would be appropriate to share with them? a) Adolescents who receive counseling and treatment are less likely to recover from problem drinking than adults. b) Alcoholism can be addressed and people respond well regardless of how long a person has been drinking when the problem is identified. c) Treatment for adolescents is easier than for adults because adolescents are still impressionable. d) Adolescents who have a family history of alcoholism may be more prone to problems with alcohol.

d) Adolescents who have a family history of alcoholism may be more prone to problems with alcohol. Adolescents who receive counseling and treatment for problem drinking are more likely to recover than those who have been problem drinkers for a long time. Experts know that alcoholism tendencies are hereditary for children with a family history of alcoholism. Adolescents are harder to treat because they feel like they are immortal and nothing can hurt them. Additionally, adolescents have a more rapid progression of the disease than adults. The earlier the alcohol problem is addressed, the more likely that person is to recover.

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) When discussing drugs and alcohol consumption, keep the conversation light and avoid hard facts b) Peer groups have little influence on this age group, so allowing freedom of friends is important c) If the child is experiementing with drugs or alcohol, parental anger is the best approach d) Parental modeling of drug and alcohol avoidance is vital at this age

d) Parental modeling of drug and alcohol avoidance is vital at this age Parents need to model good behavior (avoidance) of drugs and alcohol when parenting school-aged children. Peer groups are the most influencial 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.