The Point Chapter 50 Nursing Care of the Child with an Alteration in Behavior, Cognition, or Development

The nurse is providing teaching about the potential side effects of lithium for the parents of a child recently diagnosed with bipolar disorder. Which statement by the parents indicates a need for additional teaching? a. "If our child loses weight, then we know the medication is working." b. "Our child will probably tell us about being hungrier than usual." c. "Our child may notice an increase in urination" d. "Tremors and nausea are common side effects."

a. "If our child loses weight, then we know the medication is working." Rationale: Weight gain, not weight loss, is a side effect of the drug. An increased appetite occurs with lithium. Lithium is associated with tremors and nausea. Polyuria occurs with lithium.

The nurse is caring for a child with attention deficit hyperactivity disorder (ADHD) who is experiencing insomnia related to the prescribed psychostimulant. The parents are considering stopping the medication and want to know if there are other options. Which response by the nurse would be most appropriate? a. "Speak to the healthcare provider about atomoxetine." b. "Perhaps the health care provider will prescribe long-acting dextroamphetamine." c. "Talk to the health care provider about dextroamphetamine." d. "Ask the health care provider about long-acting methylphenidate."

a. "Speak to the healthcare provider about atomoxetine." Rationale: The nurse could suggest that the parents speak to the healthcare provider about atomoxetine, a nonstimulant norepinephrine reuptake inhibitor that does not contribute to insomnia. Dextroamphetamine, long-acting dextroamphetamine, and long-acting methylphenidate are psychostimulants; the child is already taking a psychostimulant and having difficulty with insomnia, so these would not be good options.

A group of students are reviewing the role of neurotransmitters in the development of depression. The students demonstrate a need for additional study when they identify which neurotransmitter as being involved? a. ?-Aminobutyric acid (GABA) b. Serotonin c. Dopamine d. Norepinephrine

a. ?-Aminobutyric acid (GABA) Rationale: Both norepinephrine and dopamine play a role in mood. When alterations in the neurotransmission of norepinephrine and dopamine occur, the symptoms of depression (apathy, loss of interest and pleasure) result. Decreased levels of serotonin have also been implicated in depressive symptoms. GABA is associated with anxiety disorders.

A group of nursing students are reviewing medications used to treat attention deficit hyperactivity disorder (ADHD). The group demonstrates understanding of the information when they identify what as a nonstimulant norepinephrine reuptake inhibitor? a. Atomoxetine b. Methylphenidate c. Pemoline d. Lisdexamfetamine

a. Atomoxetine Rationale: Atomoxetine is a nonstimulant norepinephrine reuptake inhibitor used to treat ADHD. Methylphenidate is a psychostimulant used to treat ADHD. Lisdexamfetamine is a psychostimulant used to treat ADHD. Pemoline is a psychostimulant used to treat ADHD.

The nurse is obtaining the history of an adolescent who is suspected of having anorexia nervosa. What findings would the nurse expect? (Select all that apply.) a. Desire for perfectionism b. Warm hands and feet c. Diarrhea d. Syncope e. Secondary amenorrhea

a. Desire for perfectionism d. Syncope e. Secondary amenorrhea Rationale: The adolescent with anorexia may have a history of constipation, syncope, secondary amenorrhea, abdominal pain, and periodic episodes of cold hands and feet. In addition, the child's self-concept reveals multiple fears, high need for acceptance, disordered body image, and perfectionism.

The nurse is talking with the parents of a child who has been identified as having a learning disability. The parents state that their child performs well on oral examinations but struggles otherwise on exams. The nurse is aware that the parents are describing which disorder? a. Dyslexia b. Dyspraxia c. Dyscalculia d. Dysgraphia

a. Dyslexia Rationale: Children with dyslexia have difficulty with reading, writing, and spelling. Children with dyscalculia have problems with mathematics and computation. Children with dyspraxia have problems with manual dexterity and coordination. Children with dysgraphia have difficulty producing the written word.

The nurse is performing the physical examination of a child with bulimia. What findings would the nurse identify as supporting this disorder? (Select all that apply.) a. Eroded dental enamel b. Pink moist gums c. Bradycardia d. Split fingernails e. Dry sallow skin

a. Eroded dental enamel d. Split fingernails Rationale: The adolescent with bulimia will be of normal weight or slightly overweight. The hands will show calluses on the backs of the knuckles and split fingernails. The mouth and oropharynx will exhibit eroded dental enamel, red gums, and an inflamed throat from self-induced vomiting. Bradycardia and dry sallow skin suggest anorexia.

A child is suspected of having bipolar disorder. What would the nurse identify if the child was experiencing a manic episode? (Select all that apply.) a. Flamboyant behavior b. Decreased sleep c. Decreased energy d. Loss of interest in activity e. Pressured speech

a. Flamboyant behavior b. Decreased sleep e. Pressured speech Rationale: Manifestations associated with a manic episode include rapid, pressured speech; increased energy; decreased sleep; flamboyant behavior; and irritability. The child also may demonstrate an increase in risk-taking behaviors, resulting in accidents and sexual promiscuity.

The nursing educator has completed an educational program for new nurses on eating disorders in adolescents. Which statement by a participant would indicate a need for further education? a. "Meal time should be structured but pleasant and relaxed without distractions." b. "If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something." c. "We need to allow the client to participate in developing the treatment plan." d. "We need to stay with them for at least 30 minutes after they eat so they don't try to vomit or dispose of the food."

b. "If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something." Rationale: Withdraw attention if the child refuses to eat: secondary gain is minimized if refusal to eat is ignored rather than with continuous attention. Mutually establish a contract related to treatment to promote the child's sense of control. Provide mealtime structure, as clear limits let the child know what the expectations are. Provide continuous supervision during the meal and for 30 minutes following it so that the child cannot conceal or dispose of food or induce vomiting.

The nurse is caring for a 10-year-old child with a history of inappropriate behavior. Which statement by the parent would lead the nurse to suspect possible conduct disorder? a. "Our child has frequent temper tantrums." b. "Our child recently trampled our neighbor's flower bed." c. "Our child blames everyone else for his or her problems." d. "Our child argues excessively with teachers."

b. "Our child recently trampled our neighbor's flower bed." Rationale: Destruction of the property of others points to conduct disorder. Frequent temper tantrums suggest oppositional defiant disorder. Blaming others for problems is an indicator of oppositional defiant disorder. Excessive arguing with adults suggests oppositional defiant disorder.

The nurse is preparing a presentation for a local health fair on autism spectrum disorders. What statement would the nurse include as part of the presentation? a. Scientific evidence supports the use of complementary therapies. b. Autism spectrum disorders cannot be cured. c. Children respond best when the environment is less structured. d. Communication therapies are of little value in treating autism spectrum e. disorders.

b. Autism spectrum disorders cannot be cured. Rationale: There are no medications or treatment available to cure autism spectrum disorders. Behavioral and communication therapies are very important in caring for a child with an autism spectrum disorder. Children with an autism spectrum disorder respond very well to highly structured educational environments. To date, complementary and alternative medical therapies have not been scientifically proven to improve autism spectrum disorders.

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

b. Methylphenidate Rationale: 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 a 7-year-old child with conduct disorder. The child is very aggressive and at risk for self-harm. To promote the child's adaptive and social skills, the nurse refers the family to a therapist who specializes in which type of therapy? a. Play therapy b. Milieu therapy c. Family therapy d. Cognitive therapy

b. Milieu therapy Rationale: The therapeutic goal of milieu therapy is to promote the child's adaptive and social skills. It is a safe and supportive environment for children who are at risk for self-harm, very ill, or very aggressive. Play therapy encourages children to act out feelings of sadness, fear, hostility, or anger. Cognitive therapy teaches children to change their reactions so that automatic negative thought patterns are replaced with healthier ones. Family therapy explores the emotional issues of the child and their effects on family members.

The nurse is speaking with the parent of a 2-year-old child recently diagnosed with an autism spectrum disorder. The parent asks about educational programs for her child. What is the best response by the nurse? a. "Children with an autism spectrum disorder are able to function on their own and do not need any special support at school." b. "Children with an autism spectrum disorder are not eligible to participate in any of the local early educational programs provided since they are only open to children with cognitive impairment." c. "Children with an autism spectrum disorder enrolled in public schools can have an individualized educational plan to help meet their specific needs." d. "Children with an autism spectrum disorder can only go to special schools, not public schools, so you will need to get your name on a waiting list soon."

c. "Children with an autism spectrum disorder enrolled in public schools can have an individualized educational plan to help meet their specific needs." Rationale: Children enrolled in public schools need to have an individualized educational plan (IEP) in place. Children with an autism spectrum disorder can go to public or private schools. No matter the school setting, the child will need assistance of some kind. Children under 36 months can receive services via the local early intervention program.

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: a. "Drugs are the primary method for controlling the symptoms." b. "Our child can control the tics if our child really concentrates on doing so." c. "If we get our child focused on an activity, the tics will be less pronounced." d. "Vocal tics are harder to control than the motor tics are."

c. "If we get our child focused on an activity, the tics will be less pronounced." Rationale: Tics become more noticeable or severe during times of stress and less pronounced when the child is focused on an activity such as watching TV, reading, or playing a video game. The tics are not under voluntary control and either type can be difficult to control. Management is highly individualized and involves psychopharmacology and behavioral therapy.

The nurse is caring for a child who has been hospitalized repeatedly at multiple hospitals. There is no clear medical diagnosis and the parent is threatening to leave the hospital against medical advice. The nurse suspects what issue? a. Sexual abuse b. Anxiety disorder c. Medical child abuse d. Bipolar disorder

c. Medical child abuse Rationale: Repeated hospitalizations that fail to produce a medical diagnosis, transfers to other hospitals, and discharges against medical advice are warning signs of Medical child abuse (Münchhausen syndrome by proxy).

A child with a cognitive impairment is evaluated and found to have an intelligence quotient (IQ) of 65. The nurse interprets this as reflecting which category of impairment? a. Moderate b. Profound c. Mild d. Severe

c. Mild Rationale: Mild cognitive impairment involves an IQ from 50 to 70. Moderate cognitive impairment involves an IQ from 35 to 50. Severe cognitive impairment involves an IQ from 20 to 35. A profound cognitive impairment involves an IQ less than 20.

The nurse is caring for a 10-year-old child with an anxiety disorder. During a physical examination, which physical finding would the nurse expect? a. Watery eyes b. Absence of nasal hair c. Patches of hair loss d. Dilated eyes

c. Patches of hair loss Rationale: Patches of hair loss that occur with repetitive hair twisting or pulling are associated with anxiety. Watery, dilated eyes and the absence of nasal hair are often signs of substance abuse.

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? a. Lithium b. Buspirone c. Sertraline d. Trazodone

c. Sertraline Rationale: Sertraline is a selective serotonin reuptake inhibitor that potentiates serotonin activity in the brain. Trazodone is an atypical antidepressant that inhibits the reuptake of serotonin. Lithium influences the reuptake of serotonin and/or norepinephrine. Buspirone blocks the reuptake of dopamine.

The nurse on a pediatric mental health unit notices one of the clients continually avoids joining the other clients in the dining room for meals. The nurse is aware that the client is demonstrating characteristics of which disorder? a. Generalized anxiety disorder b. Separation anxiety c. Social phobia d. Selective mutism

c. Social phobia Rationale: Social phobia is a disorder characterized by the child or teen demonstrating a persistent fear of speaking or eating in front of others, using public restrooms, or speaking to authorities. Generalized anxiety disorder (GAD) is characterized by unrealistic concerns over past behavior, future events, and personal competence. Selective mutism refers to a persistent failure to speak. With separation anxiety the child may need to remain close to the parents, and the child's worries focus on separation themes.

A 7-year-old child is diagnosed with a learning disability involving reading, writing, and spelling. The nurse identifies this as: a. dyspraxia. b. dyscalculia. c. dyslexia. d. dysgraphia.

c. dyslexia. Rationale: Dyslexia is a learning disability that involves reading, writing, and spelling. Dyscalculia is a learning disability that involves mathematics and computation. Dyspraxia is a learning disability that involves problems with manual dexterity and coordination. Dysgraphia is a learning disability that involves problems producing the written word.

The nurse is caring for a 13-year-old adolescent 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. Set clear limits on behavior. b. Role model appropriate social and conversation skills. c. Demonstrate unconditional acceptance of the adolescent as a person. d. Encourage the adolescent to discuss thoughts and feelings.

d. Encourage the adolescent to discuss thoughts and feelings. Rationale: The priority intervention is to encourage the adolescent to discuss 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 adolescent. This way the nurse can develop and refine the interventions based on the adolescent's thoughts and feelings.

The nurse is assessing a newly admitted 14-year-old adolescent and notes that the adolescent makes very little eye contact, becomes very frustrated with questions and conversation, and does not smile or laugh. What nursing diagnoses will the nurse add to the care plan based on these assessment findings? (Select all that apply.) a. Delayed growth and development b. Imbalanced nutrition, less than body requirements c. Disturbed thought process d. Ineffective individual coping e. Impaired social interaction

d. Ineffective individual coping e. Impaired social interaction Rationale: Limited eye contact, lack of smiling support the nursing diagnosis of impaired social interaction. Becoming frustrated easily with conversation supports both impaired social interaction and ineffective individual coping.

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

d. Tourette syndrome. Rationale: 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.

The history of a 2-year-old child reveals ingestion of clay over the past 6 weeks. The nurse documents this as: a. rumination. b. bulimia. c. anorexia. d. pica.

d. pica. Rationale: Pica is an eating disorder in which the child ingests over at least a 1-month period a nonnutritive material such as paint, clay, or sand. Rumination is an eating disorder occurring in infants in which the baby regurgitates partially digested food or formula and expels or swallows it. Anorexia nervosa is characterized by dramatic weight loss as a result of decreased food intake and sharply increased physical exercise. Bulimia refers to a cycle of normal food intake, followed by binge-eating and then purging.