QUESTIONS FROM CP
A 9-year-old mentally challenged client is hospitalized for gallbladder surgery. The client tells the nurse that she is afraid to be in the hospital and doesn't know anyone. Which is the best response by the nurse?
"Describe to me a normal day at your house."
The nurse is providing a nutrition workshop for the parents of infants. The nurse understands that further instruction is required when hearing which comments from the parents? Select all that apply.
"Food is so expensive. I can't afford for my child to leave any food on the plate." "I have tried at least 10 times with every green vegetable and I can't get my son to like them." "I let my child eat whatever he wants right now so that we don't argue about food. Hopefully he will like healthy foods when he grows up."
A 15-year-old client tells the nurse he has been having wet dreams and is ashamed and afraid he will get into trouble because he believes his parents think he is too young to understand or know about sex. To which statement would be the most appropriate for the nurse to respond?
"Wet dreams are not the result of anything you are doing but are simply the body's way of ridding itself of excess semen."
Which statement is true regarding the use of pharmacologic agents in children with anxiety disorders?
Anxiolytics and selective serotonin reuptake inhibitors (SSRIs) have been shown to help reduce anxiety.
The nurse is educating an adolescent female who needs to increase dietary iron but has expressed concern about weight gain. What dietary choices would the nurse recommend?
chicken, whole-wheat bread, watermelon Chicken, whole-wheat bread, and watermelon are all foods high in iron. The calorie content will not promote weight gain. All the other options do not include good sources of iron but are nutritious foods. The calorie content is also acceptable.
The nurse is caring for an adolescent with anorexia nervosa. What intervention should the nurse include in the care of this client?
Encourage the client and the client's family to participate in family therapy.
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 nurse is providing education on adolescent safety to a group of caregivers. Which statement by a caregiver indicates additional teaching is needed?
"Taking a course on driving safety is sufficient to teach safe driving skills."
While interviewing a depressed adolescent, it is revealed that the client has considered hurting oneself. What question is the nurse's priority?
"Tell me exactly how you would hurt yourself."
A nurse is providing care to an adolescent being treated for anorexia as an outpatient. The nurse is evaluating the adolescent's weight gain over the past week. The nurse determines that the adolescent is achieving the expected outcome when the adolescent shows a gain of how much for the week?
0.5 to 1 lb (0.27 to 0.45 kg)
The nurse is providing education to the woman about foods commonly associated with allergies in infants and young children. What items should be included in this list? Select all that apply.
cow's milk peanut butter strawberries In infants and children, certain foods are associated with allergies. These foods include cow's milk, egg whites, peanut butter and strawberries. Soy products and egg substitutes are not among those foods associated with allergies in children.
A runaway female adolescent has come to the community clinic because she is pregnant. When developing a plan of care, the nurse should identify which priority goal for this client?
safe housing
The nurse is speaking with an adolescent diagnosed with anorexia. The client states, "I do not get why everyone is so worried about what I eat. I just want to be skinny and my mom wants to control me." What response(s) by the nurse is appropriate? Select all that apply.
"I can see you are frustrated with your mom and you feel like she is controlling you. What does she do that makes you feel that way?" "We are worried because you are not eating enough food to keep your body functioning like it should." "We are worried about what you eat because not eating can cause significant health issues including death."
A teacher refers a student to the school nurse because the student is frequently falling asleep during class. After talking with the student, the nurse is most concerned by which statement by the student?
"I get 7 hours of sleep every night so I don't know why I am so tired."
During the assessment of a 15-year-old female, the nurse notes a new body piercing in the navel. Which statements by the nurse would be appropriate in regard to this new piercing? Select all that apply.
"I notice you have a new piercing. Be sure to clean it twice a day so you don't get an infection." "Did they tell you when you got your piercing how important cleaning it is? Infections can take up to a year to heal in a naval piercing."
The mother of a 9-year-old female voices concern to the nurse about her daughter developing breasts "at such a young age." How should the nurse respond?
"I understand your concern, but girls typically enter puberty around the age of 9 or 10."
The child has been diagnosed with a mental health disorder and the child's parents are beginning to incorporate behavior management techniques. Which statements by the child's parent indicate the need for further education? Select all that apply.
"I use a higher pitched voice when I communicate with her." "I am quick to point out the things that she does that make me crazy."
The nurse is evaluating the effectiveness of nutrition counseling for new mothers. Which comments by the mothers indicate the need for more instruction? Select all that apply.
"It is much healthier if I puree my own baby food and add a very small amount of salt to make it taste better." "No-spill sippy cups are a good way to limit the amount of juice that comes into contact with the baby's teeth."
An adolescent asks the nurse what the term "puberty" means. What is the nurse's best response?
"It is the age at which one first becomes capable of sexual reproduction."
A 15-year-old adolescent has been evaluated and diagnosed with major depression. The health care provider has prescribed paroxetine, a selective serotonin reuptake inhibitor. The parent refuses to let the adolescent take the medicine because the parent has read about several suicides of adolescents who have been on this medicine. What nursing response is best?
"Let's sit down and talk about your concerns." It is critical to educate the parent about the medicine. A one-on-one dialogue will allow the nurse to stress the importance of taking the medicine daily, the length of time it will take to be effective, and the importance of not stopping the medication abruptly. The nurse should stress the value of pharmacotherapy and cite the research supporting the benefits versus the anecdotal evidence in the media. Dismissing the parent's concern is not effective. It is best to address the parent's concerns in private and then elicit the support and understanding of the adolescent. Telling the parent that the adolescent must start the medicine does not address the parent's concerns.
The nurse is caring for a 10-year-old girl with a history of inappropriate behavior. Which statement by the mother would lead the nurse to suspect possible conduct disorder?
"She recently trampled our neighbor's flower bed."
The nurse is working with a group of caregivers of school-aged children diagnosed with attention deficit hyperactivity disorder (ADHD). Which statement would be most appropriate for the nurse to make to this group of caregivers?
"The medications your child is on may cause a decreased appetite."
A male adolescent comes to the clinic for a routine health care follow-up accompanied by the parents. During the visit, the parents tell the nurse, "Our son just doesn't seem to listen to us anymore. It's like he's tuning us out. Is there anything we can do to get him to hear what we're saying to him?" Which suggestions would be appropriate for the nurse to offer? Select all that apply.
"When you talk to him, speak to him face to face and be careful of your body language." "Don't be afraid to ask him questions about why he feels a certain way." "Choose words carefully to make sure that he understands you." "Talk to you son as an equal and don't talk down to him."
The nurse is meeting with parents of a child who have learned that their 11-year-old child has mild cognitive impairments that make it more difficult for their child to adapt to the new environment and make friends with other children. What is the best response by the nurse?
"Your child needs time to adjust comfortably to school routines and build a trusting relationship with other children."
A group of nursing students are preparing a presentation illustrating basic safety measures which can be utilized for infants. Which measures should the students prioritize in their presentation? Select all that apply.
Car seats should be placed in back seats. A safe temperature for hot water heaters in households with infants is 120°F (48.9°C). Crib and playpen bars should be no more than 2 3/8 inches apart.
The nurse is caring for a child with an eating disorder. Which is the priority treatment for the disorder?
Correct fluid and electrolyte imbalances
To help prevent obesity, which intervention would the nurse include in an adolescent's plan of care?
Describe a normal serving size.
A nurse is taking care of a teenager who reports involuntary discharge of semen while sleeping. The nurse observes that the client is confused and does not know about the pubertal changes that are taking place in his body. Based on this information, what is the highest priority area that should be reviewed with the client?
Educate the client about the changes that occur during adolescence.
The nurse is assessing a teenage client and notes his lower front teeth are slightly crossed over. The nurse points out to his caregiver that he should see an orthodontist about this to prevent which potential situation?
Even slight malocclusions make chewing and jaw function less efficient.
The school nurse is developing a school wellness program to promote healthy eating habits and regular physical activity. What is the most important element to emphasize to maximize compliance, healthy habits, and long-term change?
Include both parents and children in the wellness program.
A child with an intellectual disability is evaluated and found to have an intelligence quotient (IQ) of 65. The nurse interprets this as reflecting which category of intellectual disability?
Mild Mild intellectual disability involves an IQ from 50 to 70. Moderate intellectual disability involves an IQ from 35 to 50. Severe intellectual disability involves an IQ from 20 to 35. A profound intellectual disability involves an IQ less than 20.
A nurse on the pediatric floor is taking care of a child who has an intellectual disability. The child's chart lists the IQ as a score of 36. Into which classification area would this score fall?
Moderate
A 6-year-old child with cognitive disabilities presents to the emergency department with the parents, having fallen and hit the head. How will the nurse need to modify care, based on the disabilities?
Provide clear instructions on what the nurse is going to do.
The nurse is observing a 6-month-old boy for developmental progress. For which typical milestone should the nurse look?
Puts down a little ball to pick up a stuffed toy. At 6 months of age, the child is able to put down one toy to pick up another. He will be able to shift a toy to his left hand to reach for another with his right hand by 7 months. He will pick up an object with his thumb and fingertips at 8 months, and he will enjoy hitting a plastic bowl with a large spoon at 9 months.
The parents of a 10-month-old infant ask the nurse for recommendations for television programs for their infant. What will the nurse recommend?
Screen time is not recommended for infants of this age.
The nurse is assessing the psychosocial development of an adolescent. The nurse determines that the client is in the middle post-conventional phase with which observation?
The adolescent tells the nurse, "I'm starting to think that some of my friends care a lot more about what other people think of them than what I do."
The nursing instructor is leading a class discussion on the various aspects of adolescents. The instructor determines the class is successful after the students correctly choose which milestone as the beginning of adolescence?
The beginning of puberty
The nurse is educating the parents of an 8-year-old boy about his learning disorder. Which information would the nurse most likely include in the discussion?
The disorder is caused by a difference in brain development.
The physician has made a notation in the medical record of a 17-year-old that the teen is not demonstrating successful completion of Erikson's stages of development. What behavior would be consistent with this assessment?
The teen is uncertain and frequently unable to make decisions.
The father of a 15-year-old daughter is concerned she is not getting adequate nutrition to play high school basketball. Her games are on Friday nights. Which suggestion should the nurse point out will best suit the needs of this adolescent?
Three daily meals that include choices from each of the food groups; Friday's lunch eaten around 2 p.m. with a small amount of fat and a somewhat larger than usual portion of complex carbohydrates.
A male adolescent comes to the clinic for a routine health care follow-up accompanied by the parents. During the visit, the parents tell the nurse, "Our son just doesn't seem to listen to us anymore. It's like he's tuning us out. Is there anything we can do to get him to hear what we're saying to him?" Which suggestions would be appropriate for the nurse to offer? Select all that apply.
When you talk to him, speak to him face to face and be careful of your body language." "Don't be afraid to ask him questions about why he feels a certain way." "Choose words carefully to make sure that he understands you." "Talk to you son as an equal and don't talk down to him."
A nurse is working with a child who has been psychologically neglected by the parents. The nurse would anticipate which complication for this child?
developmental delay and mental health issues
The 18-month-old toddler has been brought into the pediatrician's office by his parents. The nurse interviews the parents regarding the child's abilities. Which findings are warning signs that the toddler may have autism spectrum disorder? Select all that apply.
has never "babbled" does not exhibit attempts to communicate by pointing to objects does not use any words
A parent suspects that their child has taken cocaine. What physical and psychological effects would the nurse tell the parents to monitor for in the child if this were true? Select all that apply.
increased body temperature increased heart rate and respirations euphoria
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:
schedule an immediate history and physical examination.
A nurse is presenting a workshop to parents about autism spectrum disorder (ASD). What does the nurse describe as the difficulties seen with ASD that impair everyday functioning?
social deficits, communication issues, and restricted behaviors Autism spectrum disorder (ASD) is marked by difficulties in three main areas: social deficits, communications issues, and restricted behaviors, with onset in the early developmental stages, that impair everyday functioning. Any concern that immunization may precede or cause the disorder has now been ruled out. Nurses should counsel parents about these misconceptions and educate them about evidence-based immunization data. Poor communication and bizarre behavior could be part of ASD, but receiving recent immunizations is not. (If one part of the answer is incorrect, the entire answer is considered incorrect.)
A nurse is teaching a group of parents about risks for mental health disorders in children. Which factors does the nurse include in this teaching session?
trauma, poverty, neglect