3220 EXAM #4
The nurse is caring for a child with attention deficit/hyperactivity disorder 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 doctor about atomoxetine." b) "Perhaps the doctor will prescribe long-acting dextroamphetamine." c) "Ask the doctor about long-acting methylphenidate." d) "Talk to the doctor about dextroamphetamine."
"Speak to the doctor about atomoxetine."
A nurse is caring for a 10-year-old intellectually challenged girl hospitalized for a scheduled cholecystectomy. The girl expresses fear related to her hospitalization and unfamiliar surroundings. How should the nurse respond? a) "Don't worry, you will be going home soon." b) "Tell me about a typical day at home." c) "Have you talked to your parents about this?" d) "Do you want some art supplies?"
"Tell me about a typical day at home."
An 11-year-old boy has recently been prescribed Ritalin. The mother calls the pediatrician's office to speak with the advance practice pediatric nurse practitioner (APPNP). This mother has been extremely resistant to medication and insists that the medication is not working. How should the nurse respond? a) "Do you want to increase the dosage?" b) "Tell me why you believe the medication is not working." c) "Are you sure you are administering it properly?" d) "Do you want to try a different medication?"
"Tell me why you believe the medication is not working."
When describing intellectual disability to a group of parents, a nurse would identify which intelligent quotient (or less) as the usual threshold? A. 70 B. 50 C. 60 D. 80
A. 70
After teaching a group of nursing students about pharmacotherapy and attention deficit hyperactivity disorder (ADHD), the instructor determines that the education was successful when they identify which agent as one of the first-line choices for treatment? A. Atomoxetine B. Clonidine C. Guanfacine D. Bupropion
A. Atomoxetine
A nurse is assessing a child who had an episode of passing feces in the classroom. The child has no other disabilities. The nurse concludes that the child had intentional encopresis. Which other condition is the child likely to have? A. Conduct disorder B. Expressive language disorder C. Tourette's disorder D. Rett's disorder
A. Conduct disorder
Which is a disturbance of the normal fluency and time patterning of speech? A. Stuttering B. Expressive language disorder C. Phonologic disorder D. Mixed receptive-expressive language disorder
A. Stuttering
When a client repeatedly vocalizes an obscene phrase and imitates the motions of a staff member, the nurse documents that the client is most likely exhibiting symptoms of what disorder? A. Tourette's syndrome B. Autism spectrum disorder C. Mixed receptive-expressive language disorder D. Phonological disorder
A. Tourette's syndrome
Which are nursing actions that support active listening? Select all that apply. A. Use appropriate vocabulary B. Use reflective comments C. Use a computer to write out observations D. Sit with arms and legs crossed E. Interrupt conversations to ask more questions
A. Use appropriate vocabulary B. Use reflective comments
At approximately _____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. a. 20 c. 28 b. 24 d. 30
ANS: C - These milestones human development occur at approximately 28 weeks.
3. An adolescent states "I am very sad. I wish I was not alive." What is the best response by the nurse? a. "Everyone feels sad once in a while." b. "You are just trying to escape your problems." c. "Have you told your parents how you feel?" d. "Have you thought about hurting yourself?"
ANS: D This response acknowledges the adolescent's suicide gesture and further assesses the adolescent's condition. It is judgmental and belittles the teen's feelings to tell the teen that everyone is sad once in a while or to accuse the teen of trying to escape problems. The parents should be made aware of an adolescent's precarious mental state; however, this response does not address the adolescent's statement. It also does not begin to provide safety for the teen.
The drug most commonly abused by children and adolescents is which of the following? a) Ecstasy b) Alcohol c) Marijuana d) Percocet
Alcohol
A mother brings her 4d/o infant to the clinic with vomiting and poor feeding. The newborn was really healthy at birth. The nurse should suspect: 1. Sturge-Weber syndrome 2. An inborn error or metabolism 3. Trisomy 18 4. Turner syndrome
An inborn error or metabolism
Which medication is effective in 70% to 80% of children with attention deficit hyperactivity disorder (ADHD)? A. Pemoline B. Methylphenidate C. Dextroamphetamine D. Amphetamine
B. Methylphenidate
Which type of intervention may be helpful for children who are bullies? A. Art therapy B. Social skills training C. Bibliotherapy D. Play therapy
B. Social skills training
Which medication classification is used in the treatment of tic disorders? A. Antimanics B. Anxiolytics C. Antipsychotics D. Antidepressants
C. Antipsychotics
Nurses who work in a pediatric psychiatric-mental health facility should do what? A. Ensure that their own physical and mental health needs are placed above those of the clients. B. Use self-disclosure of personal struggles with problems of childhood and adolescence with clients. C. Develop self-awareness of issues that remind them of their own childhood and adolescence. D. Ensure that their professional life is a higher priority than their personal life.
C. Develop self-awareness of issues that remind them of their own childhood and adolescence.
A nurse is conducting a physical examination of an adolescent girl with suspected bulimia. Which assessment finding should the nurse expect? a) Dry sallow skin b) Soft sparse body hair c) Thinning scalp hair d) Eroded dental enamel
Eroded dental enamel
The nurse admits a child suspected of having autism spectrum disorder (ASD). Which test to aid in the diagnosis should the nurse question? Electrocardiogram (EEG) Computerized tomography (CT) scan Lead screening Head x-ray
Head x-rayThere is no laboratory test or imaging that can diagnose autism. Diagnosis is based on the presence of certain criteria contained in the DSM-5. However, testing should be completed first to rule out a medical cause of the child's behavior. Tests may include neuroimaging (CT scan or MRI), lead screening, DNA analysis, and electroencephalography. CT or MRI would be of more value in ruling out medical causes than a head x-ray.
When describing genetic disorders to a group of childbearing couples, the nurse would identify which as an example of an autosomal dominant inheritance disorder? a) Phenylketonuria b) Cystic fibrosis c) Huntington's disease d) Sickle cell disease
Huntington's disease Correct Explanation: Huntington's disease is an example of an autosomal dominant inheritance disorder. Sickle cell disease, phenylketonuria, and cystic fibrosis are examples of autosomal recessive inheritance disorders.
The nurse is examining a child with fetal alcohol syndrome (FAS). Which assessment finding should the nurse expect? a) Clubbing of fingers b) Low nasal bridge with short upturned nose c) Short philtrum with thick upper lip d) Macrocephaly
Low nasal bridge with short upturned nose
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) Trazodone b) Methylphenidate c) Buspirone d) Fluoxetine
Methylphenidate
Three sisters decide to have genetic testing done because their mother and their maternal grandmother died of breast cancer. Each of the sisters has the BRCA1 gene mutation. The nurse explains that just because they have the gene does not mean that they will develop breast cancer. What does the nurse explain their chances of developing breast cancer depend on? a) Susceptibility b) Their lifestyles c) Penetrance d) What other gene mutations they have
Penetrance Correct Explanation: A woman who has the BRCA1 hereditary breast cancer gene mutation has a lifetime risk of breast cancer that can be as high as 80%, not 100%. This quality, known as incomplete penetrance, indicates the probability that a given gene will produce disease. The other answers are incorrect because lifestyles, other gene mutations, and susceptibility are not the deciding factor in getting breast cancer if you have the BRCA1 gene mutation.
A number of inherited diseases can be detected in utero by amniocentesis. Which of the following diseases can be detected by this method? a) Diabetes mellitus b) Phenylketonuria c) Trisomy 21 d) Impetigo
Trisomy 21 Correct Explanation: Karyotyping for chromosomal defects can be carried out using amniocentesis.
Many children with autistic spectrum disorder (ASD) are intellectually disabled. a) False b) True
True
A 14-year-old is admitted to the hospital for the second time for treatment of anorexia nervosa. Her response to your questions on admission are either yes, no, or no response. Initially, your primary nursing goal in caring for this adolescent would be to a) decrease her anxiety. b) develop rapport for a trusting relationship. c) encourage her to eat a nutritious diet. d) relieve her anger.
develop rapport for a trusting relationship.
A gene that is expressed when paired with another gene for the same trait is called a) recessive. b) dominant. c) heterozygous. d) homozygous.
dominant. Correct Explanation: A dominant gene is one that will be expressed when paired with a like gene.
The nurse is caring for a child with ADHD. Which behavior would the nurse not expect the child to display: 1. moody, morose behavior with pouting 2. interruption and inability to take turns 3. forgetfulness and easy distractibility 4. excessive motor activities and fidgeting
moody, morose behavior with pouting
A 4-year-old has been diagnosed with Tourette syndrome. A unique manifestation of this syndrome is a) obscenity shouting. b) mutism. c) running wildly in circles. d) easily broken bones.
obscenity shouting.
A nursing student correctly identifies that a person's outward appearance or expression of genes is referred to as which of the following? a) allele b) genome c) phenotype d) genotype
phenotype Correct Explanation: Alleles are two like genes. Phenotype refers to a person's outward appearance or the expression of genes. Genotype refers to his or her actual gene composition. Genome is the complete set of genes present in a person.
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) ask the school psychologist to do psychometric testing. b) call for an appointment with a psychologist. c) schedule an immediate history and physical examination. d) discuss the situation with her teacher.
schedule an immediate history and physical examination.
Girls with Turner Syndrome will usually exhibit a) short stature b) progressive dementia c) chorealike movements d) painful joints
short stature Correct Explanation: 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's disease.
The nurse is caring for a child with Turner syndrome admitted to the unit for tratment of a kidney infection. What characteristics associated with this syndrome may the nurse expect to find upon assessment? 1. microcephaly, polydactyly 2. low set ears, cleft lip 3. short stature, webbed neck 4. gynecomastia, taller than average
short stature, webbed neck
An adolescent girl who has been receiving treatment for anorexia nervosa has failed to gain weight over the past week despite eating all of her meals and snacks. What is the priority nursing intervention? 1. increase the teen's daily caloric tinake by at least 500 calories 2. ensure that the teen's entire fluid intake includes calories 3. supervise the teen for 2h post meals/snacks 4. assess the teen's anxiety level to determine need for medication
supervise the teen for 2h post meals/snacks
The nurse working in a women's health clinic determines that genetic counceling may be appropriate for a woman: 1. who just had her first miscarriage at 10wk 2. who is 30y/o and planing to conceive 3. whose history reveals a close relative with fragile X syndrome 4. Who is 18 wk pregnanct and whose triple screen came back normal
whose history reveals a close relative with fragile X syndrome
Which teaching point is important for the nurse to include in the plan of care for a client who is diagnosed with autism spectrum disorder (ASD)? A. Establishing a routine B. Maintaining the home as a treatment-free zone C. Keeping the same pediatric healthcare provider for all children in the family D. Focusing on limitations in order to see progress in care
A Rationale: Clients who are diagnosed with ASD thrive when routines are established and followed. The family should consider seeking a healthcare provider who has experience in treating a child with ASD. Therapies must be practiced and implemented in the home environment in order to be effective. The family would focus on the child's strengths, not the child's limitations.
The nurse admitting a child who is suspected of having autism spectrum disorder (ASD) knows that it is necessary to rule out medical causes for the child's behavior before diagnosing ASD. Which diagnostic test should the nurse anticipate will be ordered for the client? (Select all that apply.) A. Electroencephalography B. CT scan C. KUB x-ray D. DNA analysis E. ABG
A,B,D Rationale: To rule out medical causes for behavior in a suspected ASD client, the healthcare provider should order a CT scan or MRI, DNA analysis, lead screening, and electroencephalography. A KUB x-ray is a radiograph of the kidneys, ureters, and bladder. ABGs are arterial blood gases and are used to measure the amounts of oxygen and carbon dioxide in the blood. They are not used to rule out ASD.
The nurse is reviewing the medical record of a 6-year-old client diagnosed with autism spectrum disorder (ASD). Which item in the health history should the nurse consider may have been a factor in the client developing ASD? A. Fetal alcohol syndrome B. Appropriate adaptation to new environments C. Childhood vaccinations D. Postterm birth
A. Rationale: The ingestion of alcohol, tobacco, and toxic substances has been known to cause birth defects. Therefore, fetal alcohol syndrome could possibly be a factor in the development of ASD. Childhood vaccinations have not been proven to cause ASD. Appropriate adaptation to new environments and postterm birth have no link to ASD
The nurse is obtaining the history of an adolescent female who is suspected of having anorexia nervosa. What findings would the nurse expect? Select all that apply. a) Syncope b) Diarrhea c) Warm hands and feet d) Secondary amenorrhea e) Desire for perfectionism
• Syncope • Secondary amenorrhea • Desire for perfectionism
An adolescent comes to the office of the school nurse and after being quiet for several minutes states, "I think the world will be better when I am gone." Which of the following statements should be the nurse's first response to this adolescent? a) "What is your relationship with your parents like?" b) "Are you and your friends here at school having problems?" c) "You need to be seen immediately by a counselor." d) "Have you made a plan to commit suicide?"
"Have you made a plan to commit suicide?"
A couple has just learned that their son will be born with Down's syndrome. The nurse shows a lack of understanding when making which of the following statements? a) "I will alert your entire family about this so you don't have to." b) "We have counseling services available, and I recommend them to everyone facing these circumstances." c) "I will support you in any decision that you make." d) "I will give you as much information as I can about this condition."
"I will alert your entire family about this so you don't have to." Correct Explanation: It is necessary to maintain confidentiality at all times, which prevents healthcare providers from alerting family members about any inherited characteristic unless the family member has given consent for the information to be revealed.
A 10-year-old girl with ADHD has been on Ritalin 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. What should the nurse say? a) "Let's set up an appointment as soon as possible." b) "Let me talk to the doctor about this." c) "Let's wait a few more weeks before we do anything." d) "What does the teacher say?"
"Let's set up an appointment as soon as possible."
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? a) "She argues excessively with her teachers." b) "She blames everyone else for her problems." c) "She recently trampled our neighbor's flower bed." d) "She has frequent temper tantrums."
"She recently trampled our neighbor's flower bed."
An advance practice pediatric nurse practitioner (APPNP) is conducting a mental status examination with a 6-year-old girl. Which of the following questions would be most appropriate? a) "Why does your pink doll hit all the other dolls?" b) "Do you like the doll with pink hair the best or the doll with green hair?" c) "What is the name of the president of the United States?" d) "Isn't it fun to play with dolls?"
"Why does your pink doll hit all the other dolls?"
Cliff has been attending group counseling for depression and has been expressing more hopelessness in the last few days. When the nurse provides the group with a homework assignment to be completed and returned to the group the next day, Cliff responds "I don't need to bother." Which of these responses by the nurse is most appropriate? 1) "Are you having suicidal thoughts?" 2) "Trust me, it will be beneficial." 3) "Why don't you want to cooperate?" 4) "This assignment will help you combat the hopelessness."
1 Rationale Hopelessness is a risk factor for suicide, and the client's statement may be a veiled suicide threat, so it is most important to assess for suicide risk in response.
Bill is a 70-year-old man who is diagnosed with major depressive disorder. He is married and has two adult children who are alcoholics. He currently lives in a rural neighborhood and works part-time at a convenience mart. Which of these demographics is a risk factor for suicide? 1) 70-year-old male 2) Parent of alcoholic children 3) Lives in a rural neighborhood 4) Works part-time
1 Rationale Suicide is highest among persons over 50, and men are at higher risk than females.
A woman who has a recessive gene for sickle cell anemia marries a man who also has a recessive gene for sickle cell anemia. Their first child is born with sickle cell anemia. The chance that their second child will develop this disease is a) 0 in 4. b) 3 in 4. c) 1 in 4. d) 2 in 4.
1 in 4. Explanation: Autosomal recessive inherited diseases occur at a 1-in-4 incidence in offspring. The possibility of a chance happening does not change for a second pregnancy.
A nurse is reviewing an article about genetic disorders and patterns of inheritance. The nurse demonstrates understanding of the information by identifying which of the following as an example of an autosomal dominant genetic disorder? A) Neurofibromatosis B) Cystic fibrosis C) Tay-Sachs disease D) Sickle cell disease
A) Neurofibromatosis
A 4-year-old child is seen in a clinic for a hearing impairment. What action does the nurse observe in the child to confirm hearing impairment? Select all that apply. The child: 1 Screeches happily when looking at a toy. 2 Has difficulty trying to read a book. 3 Does not respond when an alarm sounds. 4 Points at his tummy to indicate hunger. 5 Speaks fast, stutters, and has speech delay.
1, 3, 4 A child with a hearing impairment yells or screeches in pleasure because the child cannot hear how loud these sounds are. The child also does not respond to loud sounds and prefers nonverbal communication such as pointing. A child who has difficulty reading a book may have a visual impairment. Rapid speech with stuttering and speech delay are symptoms of fragile X syndrome.
Which is a DSM-IV-TR criterion for the diagnosis of attention-deficit/hyperactivity disorder? 1. Inattention. 2. Recurrent and persistent thoughts. 3. Physical aggression. 4. Anxiety and panic attacks.
1. According to the DSM-IV-TR, inatten- tion, along with hyperactivity and impul- sivity, describes the essential criteria of ADHD. Children with this disorder are highly distractible and have extremely limited attention spans.
A client diagnosed with oppositional defiant disorder has an outcome of learning new coping skills through behavior modification. Which client statement indicates that behavioral modification has occurred? 1. "I didn't hit Johnny. Can I have my Tootsie Roll?" 2. "I want to wear a helmet like Jane wears." 3. "Can I watch television after supper?" 4. "I want a puppy right now."
1. The question infers that the client defen- sively copes with frustration by lashing out and hitting people. New coping skills have been achieved through behavior modification when the client's states, "I didn't hit Johnny. Can I have my Tootsie Roll?" The intervention used to achieve this outcome is a reward system that rec- ognizes and appreciates appropriate behavior, modifying that which was previ- ously unacceptable.
A visually impaired child is hospitalized for eye surgery. What nursing intervention should be included in the plan of care to encourage the child to be independent? The nurse: 1 Does not keep a stool or small desk near the bed. 2 Instructs the cleaner not to move the furniture around. 3 Gives the child work to do while the child is in the hospital. 4 Does not educate the child about the treatment procedures.
2 Changing furniture positions can result in accidents, so this must be avoided. A small stool or a desk should be placed near the bed to support the child so that he or she can climb into bed easily. The child is a patient in the hospital and should not be asked to work while there. Educating the child about the procedures that will be carried out for the treatment will help the child understand and mentally prepare for them.
Early detection of a hearing impairment is critical because of its effect on areas of a child's life. The nurse should evaluate further for effects of the hearing impairment on: 1 reading development. 2 speech development. 3 relationships with peers. 4 performance at school
2 The ability to hear sounds is essential for the development of speech. Babies imitate the sounds that they hear. The child will have greater difficulty learning to read, but the primary issue of concern is the effect on speech. Relationships with peers and performance at school will be affected by the child's lack of hearing. The effect will be augmented by difficulties with oral communication.
A child diagnosed with an autistic disorder has a nursing diagnosis of impaired social interaction. The child is currently making eye contact and allowing physical touch. Which of the following statements addresses the evaluation of this child's behavior? 1. The nurse is unable to evaluate this child's ability to interact socially based on the observed behaviors. 2. The child is experiencing improved social interaction as evidenced by making eye contact and allowing physical touch. 3. The nurse is unable to evaluate this child's ability to interact socially because the child has not experienced these behaviors for an extended period. 4. The child's making eye contact and allowing physical touch are indications of improved personal identity, not improved social interaction.
2. By making eye contact and allowing phys- ical touch, this child is experiencing improved social interaction, making this an accurate evaluative statement.
Which is a predisposing factor in the diagnosis of autism? 1. Having a sibling diagnosed with mental retardation. 2. Congenital rubella. 3. Dysfunctional family systems. 4. Inadequate ego development.
2. Children diagnosed with congenital rubella, postnatal neurological infections, phenylke- tonuria, or fragile X syndrome are predis- posed to being diagnosed with autism.
A client diagnosed with Tourette's disorder has a nursing diagnosis of social isolation. Which charting entry documents a successful outcome related to this client's problem? 1. "Compliant with instructions to use bathroom before bedtime." 2. "Made potholder at activity therapy session." 3. "Able to distinguish right hand from left hand." 4. "Able to focus on TV cartoons for 30 minutes."
2. During activity therapy, clients interact with peers and staff. This participation in a social activity reflects a successful out- come for the nursing diagnosis of social isolation.
A 10-year-old child has moderate cognitive impairment. With which activity would a teacher expect the child to need help? 1 Copying information from the board 2 Learning safe and healthy habits 3 Performing arithmetic calculations 4 Communicating with classmates
3 Students with moderate cognitive impairment (IQ of 50-55) have difficulty with functional reading and arithmetic calculations. The student can perform simple manual skills, such as copying information from the board, learning safe and healthy habits, and communicating with classmates.
The nurse recognizes that which individual or couple would most benefit from obtaining genetic counseling? a) 30-year-old female with a normal alpha-fetoprotein screening b) 23-year-old female, 25-year-old-male, both with family history of sickle cell disorder c) 25-year-old female, 40-year-old male, both with no significant past medical history d) 32-year-old female, 25-year-old male with one pregnancy loss
23-year-old female, 25-year-old-male, both with family history of sickle cell disorder Correct Explanation: A family history of sickle cell disorder increases the risk of passing the disorder to offspring; genetic counseling would benefit this couple most. The usual standard for counseling for pregnancy loss is two or more, not a single loss. A normal alpha-fetoprotein screening is not a criterion for genetic counseling. All ages listed here do not exceed the criterion for advanced maternal or paternal age.
What should the nurse do to communicate with a patient who is cognitively impaired and speaks a foreign language? 1 Insert the patient's hearing aids. 2 Use verbal expressions. 3 Use a language translator. 4 Use visual aids and drawings.
3 A language translator should be used when any patient speaks a foreign language, no matter what his or her cognitive level is. Inserting the patient's hearing aids will help the patient hear, but it will not break the language barrier. Verbal expressions can be helpful, but they are not as effective as having a translator speaking the patient's language. Visual aids and drawings may be helpful, but not everything is easily communicated with these methods.
The parents of a 3-year-old child report seeing a whitish glow in the child's eyes. The nurse begins to examine the child. What information should the nurse give to the parents before assessment? "The child: 1 Needs hematologic assessment for confirmation of diagnosis." 2 May not be able to distinguish between colors." 3 May not see clearly for some time after the examination." 4 Needs immediate hospitalization after the examination."
3 A strange light in the eyes indicates that the child may have retinoblastoma. It is diagnosed by ophthalmoscopic examination, which involves dilation of the pupil. During this procedure, the eyes become sensitive, and the child may not be able to see clearly for some time. Informing the parents about it will reduce anxiety. Hematologic assessment is not used to diagnose retinoblastoma. A retinoblastoma can be diagnosed by ophthalmoscopic examination under general anesthesia and with imaging studies, including ultrasonography and computed tomography. A child with visual impairment may have difficulty distinguishing between colors, but it is not helpful for the parents to learn about it before the child's illness is diagnosed. The child may need immediate hospitalization after the examination depending on the severity of tumor, but the nurse should not tell the parents about hospitalization because it could make them panic.
A 10-year-old child is diagnosed with an autism spectrum disorder (ASD). The parents ask the nurse about the cause of the disorder. Which answer given by the nurse is most appropriate? 1 "Autism is caused by a high intake of proteins during pregnancy." 2 "The disorder is caused by vaccines that contain thimerosal." 3 "The exact cause of autism spectrum disorders is unknown." 4 "Alcohol consumption during pregnancy is linked to autism."
3 Although the exact cause of ASD is not known, the nurse should always help parents understand that they are not responsible for the child's condition. There are many theories about the cause of ASD, but nothing is definitive. High intake of proteins is necessary during pregnancy because it promotes proper growth and development of the fetus. Vaccines containing thimerosal are not associated with ASD. Thimerosal is a preservative found in some vaccines. Consumption of alcohol during pregnancy leads to fetal alcohol syndrome, not autism.
The parents of a cognitively impaired child ask the nurse for guidance with discipline. The nurse's best response is: 1 "Discipline is ineffective with cognitively impaired children." 2 "Discipline is not necessary for cognitively impaired children." 3 "Behavior modification is an excellent form of discipline." 4 "Physical punishment is the most appropriate form of discipline."
3 Behavior modification with positive reinforcement is effective in children with cognitive impairment. Discipline is essential in assisting the child in developing boundaries. Positive behaviors and desirable actions should be reinforced. Most children with cognitive impairment will not be able to understand the reason for the physical punishment; consequently behavior will not change as a result of the punishment.
A child with a temporary visual impairment was admitted to the hospital for treatment. What nursing intervention would make the child feel most comfortable in the hospital? The nurse: 1 Explains the different departments of the hospital. 2 Understands the child's behavior and daily routine. 3 Describes the surroundings of the room and the unit. 4 Asks the cleaner to move the furnishings around
3 The nurse helps the child become familiar with the room so that the child knows the layout in order to avoid injury while moving around the room. Explaining to the child about the hospital departments is not necessary to make the child feel comfortable. Understanding the child's daily routine is necessary to plan activities for the child but does not increase comfort. The cleaning personnel are asked to maintain the décor of the room to avoid accidents; therefore changes should be avoided.
The nurse is caring for a child with cognitive impairment. Which statement made by the nurse to the parents is a reason for concern? 1 "I need to know more about cognitive impairment." 2 "I will ask the other staff to help with the child's care." 3 "I do not know what is going on with this child's health." 4 "I'll ask the health care provider to clarify my question."
3 The statement "I do not know what is going on with this child's health" is inappropriate because it indicates that the nurse does not understand the child's needs. The statement "I need to know more about cognitive impairment" shows the nurse's desire to learn about the disorder and help treat the child better. The statement "I will ask the other staff to help with the child's care" shows the nurse's desire to increase his or her skill level. The statement "I will ask the health care provider to clarify my question" is an inappropriate statement made by the nurse. It implies that the nurse is not aware of the care that should be given to a cognitively impaired child.
A child in the clinic exhibits reduced visual acuity in one eye despite appropriate optical correction. The nurse expects the child's health care provider to diagnosis the child with: 1 myopia. 2 hyperopia. 3 amblyopia. 4 astigmatism.
3 Visual acuity in one eye despite appropriate optical correction is amblyopia. Myopia is nearsightedness, which is the ability to see objects up close but not clearly at a distance. Hyperopia is farsightedness, which is the ability to see distant objects clearly but not those up close. Astigmatism is an alteration in vision caused by unequal curvature in the refractive apparatus of the eye.
A client is prescribed citalopram (Celexa), 20 mg daily. Available are six 10-mg tablets. This medication will supply the client with the necessary dosage for ________ days.
3 days Rationale 3 days is the recommended maximum number of days a person with depression should be given at one time to prevent an overdose.
A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change? 1. The client gained two pounds in one week. 2. The client focused conversations on nutritious food. 3. The client demonstrated healthy coping mechanisms that decreased anxiety. 4. The client verbalized an understanding of the etiology of the disorder.
3 ~ The nurse should identify that a client who demonstrates healthy coping mechanisms to decrease anxiety indicates a positive behavioral change. Stress and anxiety can increase bingeing, which is followed by inappropriate compensatory behavior.
A client's altered body image is evidenced by claims of feeling fat, even though the client is emaciated. Which is the appropriate outcome criterion for this clients problem? 1. The client will consume adequate calories to sustain normal weight. 2. The client will cease strenuous exercise programs. 3. The client will perceive personal ideal body weight and shape as normal. 4. The client will not express a preoccupation with food.
3 ~ The nurse should identify that the appropriate outcome for this client is to perceive personal ideal body weight and shape as normal. Additional goals include accepting self based on self-attributes instead of appearance and to realize that perfection is unrealistic.
A couple visits the hospital for a prenatal checkup. On reviewing the genetic analysis report, the nurse finds that the male partner has fragile X syndrome. What should the nurse interpret from these findings? Select all that apply. 1 All of their sons will have a 50% chance of being affected. 2 All of their sons will be carriers for fragile X syndrome. 3 The chance of a daughter being affected is 50%. 4 All daughters will be carriers for fragile X syndrome. 5 All sons will be carriers and will have fragile X syndrome.
3, 4 Fragile X syndrome is an X-linked dominant syndrome with reduced penetrance. About 50% of daughters with fathers affected by fragile X syndrome will be affected because the dominant X chromosome can be from the affected father. All daughters with an affected father will be carriers. The sons get Y chromosomes from the father, so they are not necessarily carriers of the syndrome or affected by the syndrome. The sons can be carriers or affected if the syndrome is passed from the mother.
Which charting entry would document an appropriate nursing intervention for a client diagnosed with profound mental retardation? 1. "Rewarded client with lollipop after independent completion of self-care." 2. "Encouraged client to tie own shoelaces." 3. "Kept client in line of sight continually during shift." 4. "Taught the client to sing the alphabet 'ABC' song."
3. A client diagnosed with profound mental retardation requires constant care and supervision. Keeping this client in line of sight continually during the shift is an appropriate intervention for a child with an IQ level 20.
When admitting a child diagnosed with a conduct disorder, which symptom would the nurse expect to assess? 1. Excessive distress about separation from home and family. 2. Repeated complaints of physical symptoms such as headaches and stomachaches. 3. History of cruelty toward people and animals. 4. Confabulation when confronted with wrongdoing.
3. A history of physical cruelty toward peo- ple and animals is commonly associated with conduct disorder. These children may bury animals alive and set fires intending to cause harm and damage.
A child diagnosed with a conduct disorder is disruptive and noncompliant with rules in the milieu. Which outcome, related to this client's problem, should the nurse expect the client to achieve? 1. The child will maintain anxiety at a reasonable level by day 2. 2. The child will interact with others in a socially appropriate manner by day 2. 3. The child will accept direction without becoming defensive by discharge. 4. The child will contract not to harm self during this shift.
3. Accepting direction without becoming defensive by discharge is a specific, meas- urable, positive, realistic, client-centered outcome for this child. The disruption and noncompliance with rules on the milieu is this child's defensive coping mechanism. Helping the child to see the correlation between this defensiveness and the child's low self-esteem, anger, and frustration would assist in meeting this outcome.
A child newly admitted to an in-patient psychiatric unit with a diagnosis of major depressive disorder has a nursing diagnosis of high risk for suicide R/T depressed mood. Which nursing intervention would be most appropriate at this time? 1. Encourage the child to participate in group therapy activities daily. 2. Engage in one-on-one interactions to assist in building a trusting relationship. 3. Monitor the child continuously while no longer than an arm's length away. 4. Maintain open lines of communication for expression of feelings.
3. Keeping a child who is at high risk for suicide safe from self-harm would take immediate priority over any other inter- vention. Monitoring the child continu- ously while no longer than an arm's length away would be an appropriate nursing intervention. This observation would allow the nurse to note self-harm behaviors and intervene immediately if necessary.
Which factors does Mahler attribute to the etiology of attention-deficit/hyperactivity disorder? 1. Genetic factors. 2. Psychodynamic factors. 3. Neurochemical factors. 4. Family dynamic factors.
3. Mahler's theory suggests that a child with ADHD has psychodynamic problems. Mahler describes these children as fixed in the symbiotic phase of development. They have not differentiated self from mother. Ego development is retarded, and impul- sive behavior, dictated by the id, is mani- fested.
A foster child diagnosed with oppositional defiant disorder is spiteful, vindictive, and argumentative, and has a history of aggression toward others. Which nursing diagno- sis would take priority? 1. Impaired social interaction R/T refusal to adhere to conventional social behavior. 2. Defensive coping R/T unsatisfactory child-parent relationship. 3. Risk for violence: directed at others R/T poor impulse control. 4. Noncompliance R/T a negativistic attitude.
3. Risk for violence: directed at others is defined as behaviors in which an individ- ual demonstrates that he or she can be physically, emotionally, or sexually harm- ful to others. Children diagnosed with ODD have a pattern of negativistic, spite- ful, and vindictive behaviors. The foster child described in the question also has a history of aggression toward others. Because maintaining safety is a critical responsibility of the nurse, risk for vio- lence: directed at others would be the priority nursing diagnosis.
A child diagnosed with severe mental retardation displays failure to thrive related to neglect and abuse. Which nursing diagnosis would best reflect this situation? 1. Altered role performance R/T failure to complete kindergarten. 2. Risk for injury: self-directed R/T poor self esteem. 3. Altered growth and development R/T inadequate environmental stimulation. 4. Anxiety R/T ineffective coping skills.
3. The nursing diagnosis of altered growth and development related to inadequate environmental stimulation would best address this child's problem of failure to thrive. Failure to thrive frequently results from neglect and abuse.
The nursing instructor is preparing to teach nursing students about oppositional defiant disorder (ODD). Which fact should be included in the lesson plan? 1. Prevalence of ODD is higher in girls than in boys. 2. The diagnosis of ODD occurs before the age of 3. 3. The diagnosis of ODD occurs no later than early adolescence. 4. The diagnosis of ODD is not a developmental antecedent to conduct disorder.
3. The symptoms of ODD usually appear no later than early adolescence. A child diag- nosed with ODD presents with a pattern of negativity, disobedience, and hostile behavior toward authority figures. This pattern of behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.
The parent of a visually impaired infant says to the nurse, "I am afraid that my child may not be able to bond with me because my child cannot maintain eye contact with me." The nurse teaches the parent about other signs that indicate that the child is responding. What should the nurse include in the explanation? 1 "The child compensates by increasing listening to your voice and smiling." 2 "The child's attention span decreases when a parent is trying to communicate." 3 "The child does not make throaty sounds when a parent is trying to communicate." 4 "The child's breathing or activity increases when the child is in contact with or near a parent."
4 Changes in respiratory patterns and increasing activity reflect the child's excitement about being close to the parent. The child is able to hear the parent's voice but is not able to smile when hearing the parent's voice at this age. This happens after about 2 years of age. Decreased attention span could be caused by lack of interest in the communication. When a child makes sounds in response to the parent's communication, it is sign of intimate bonding between the child and parent.
The parents brought their child to the emergency department after a needle penetrated the child's eye. Which action should the nurse perform while caring for the child? 1 Examine the eye to look for foreign bodies. 2 Irrigate the eye to remove the needle from the eye. 3 Evert the upper eyelid to wash the eye thoroughly. 4 Observe for hyphema and reaction of the pupil to light.
4 If a child has a penetrating eye injury of any kind, the nurse should examine the eye to determine whether any aqueous humor has leaked from the penetration site. The nurse should observe the presence of hyphema, or bleeding from the eye. The nurse should also assess for pupillary reaction to light because it helps assess the functioning of the pupil. The nurse does not need to examine the eye for foreign bodies because there is already a foreign body in the eye. If the child is experiencing a penetrating eye injury, the nurse does not irrigate the eye to remove the object because this can further damage the cornea. In the case of chemical burns, the nurse rinses the eye by everting the upper eyelid.
A client is being treated with sertraline (Zoloft) for major depression. The client tells the nurse, "I've been taking this drug for only a week, but I'm sleeping better and my appetite has improved." Which is the most appropriate response by the nurse? 1) "It will take a minimum of 3 to 4 weeks for therapeutic effects to occur." 2) "Sleep disturbances and appetite problems are not affected by Zoloft." 3) "A change in your environment and activity is the reason for this improvement." 4) "The initiation of Zoloft therapy can improve insomnia and appetite within 1 week."
4 Rationale Zoloft is known to improve middle and terminal insomnia, appetite disturbances, and anxiety as early as 1 week after initiation of treatment.
The diagnosis of cognitive impairment is based on the presence of: 1 intelligence quotient (IQ) of 75 or less. 2 IQ of 70 or less. 3 subaverage intellectual functioning, deficits in adaptive skills, and onset at any age. 4 subaverage intellectual functioning, deficits in adaptive skills, and onset before 18 years of age.
4 The diagnosis of cognitive impairment includes subaverage intellectual functioning and deficits in adaptive skills, including an onset before age 18. IQ is only one component of the diagnosis of cognitive impairment. The onset of the deficit must be before age 18 to meet the diagnosis of cognitive impairment.
A nurse is teaching a client diagnosed with an eating disorder about behavior-modification programs. Why is this intervention the treatment of choice? 1. It helps the client correct a distorted body image. 2. It addresses the underlying client anger. 3. It manages the client's uncontrollable behaviors. 4. It allows clients to maintain control.
4 ~ Behavior-modification programs are the treatment of choice for clients diagnosed with eating disorders, because these programs allow clients to maintain control. Issues of control are central to the etiology of these disorders. Behavior modification techniques function to restore healthy weight.
A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects insight related to this disorder? 1. Skaters need to be thin to improve their daily performance. 2. All the skaters on the team are following an approved 1200-calorie diet. 3. The exercise of skating reduces my appetite but improves my energy level. 4. I am angry at my mother. I can only get her approval when I win competitions.
4 ~ The client reflects insight when referring to feelings toward family dynamics that may have influenced the development of the disease. Families who are overprotective and perfectionistic can contribute to the development of anorexia nervosa.
A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states, "My parents watch me like a hawk and never let me out of their sight." Which nursing diagnosis would take priority at this time? 1. Altered nutrition less than body requirements 2. Altered social interaction 3. Impaired verbal communication 4. Altered family processes
4 ~ The nurse should determine that once the client has been medically cleared, the diagnosis of altered family process should take priority. Clients diagnosed with anorexia nervosa have a need to control and feel in charge of their own treatment choices. Behavioral-modification therapy allows the client to maintain control of eating.
Which short-term outcome would take priority for a client who is diagnosed with moderate mental retardation, and who resorts to self-mutilation during times of peer and staff conflict? 1. The client will form peer relationships by end of shift. 2. The client will demonstrate adaptive coping skills in response to conflicts. 3. The client will take direction without becoming defensive by discharge. 4. The client will experience no physical harm during this shift.
4. A child diagnosed with moderate mental retardation who resorts to self-mutilation during times of peer and staff conflict must be protected from self-harm. A real- istic, measurable outcome would be that the client would experience no physical harm during this shift.
The nurse on an in-patient pediatric psychiatric unit is admitting a client diagnosed with an autistic disorder. Which would the nurse expect to assess? 1. A strong connection with siblings. 2. An active imagination. 3. Abnormalities in physical appearance. 4. Absence of language.
4. One of the first characteristics that the nurse would note is the client's abnormal language patterning or total absence of language. Children diagnosed with autism display an uneven development of intellec- tual skills. Impairments are noted in verbal and nonverbal communication. These chil- dren cannot use or understand abstract language, and they may make unintelligible sounds or say the same word repeatedly.
The mother of a 9-year-old child with Down syndrome discusses the childs language abilities. The nurse is not surprised to learn which information about the childs language development? A: Can take turns during conversation B: Has good grammar C: Can speak a foreign language D; Has difficulty in carrying on a conversation
A
The nurse is discussing the treatment for a child with attention deficit hyperactivity disorder (ADHD) with a group of school nurses. Which of the following would be an appropriate learning setting for a child with ADHD? a) A classroom with windows facing a playground. b) A classroom with tables and chairs rather than individual desks. c) A classroom with a plan of study that is followed each day. d) A classroom in which children self-select their activities.
A classroom with a plan of study that is followed each day.
The parents of a child with autism spectrum disorder (ASD) tell the nurse that they have decided to try nutrition therapy. Which diet should the nurse expect will be suggested for the child? A gluten-free, casein-free diet A low-fat, low-sodium diet The Paleo diet The Atkins diet
A gluten-free, casein-free diet A popular option for treating ASD is a gluten-free, casein-free diet. Since there is anecdotal evidence that the behavior of some children improves on this diet, many parents opt to try it with their children. A low-fat, low-sodium diet and the Paleo diet are used to treat heart disease. The Atkins diet is a reduced-carbohydrate diet.
A 6-year-old is seen in a mental health clinic for possible hyperactivity. His mother reports that he is just "all boy." He has always been active and does not like to sit still for more than a minute. Which of the following data would be most important to assess to help evaluate his behavior? a) Whether he was breastfed or bottle-fed as an infant b) Family medical history for circulatory illnesses c) A review of the boy's typical day d) Medical history for communicable diseases
A review of the boy's typical day
Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa? a. Assist the patient to identify triggers to binge eating. b. Provide corrective consequences for weight loss. c. Explore patient needs for health teaching. d. Assess for signs of impulsive eating.
A ~ For most patients with bulimia nervosa, certain situations trigger the urge to binge; purging then follows. The triggers are often anxiety-producing situations. Identifying these triggers makes it possible to break the binge-purge cycle. Because binge eating and purging directly affect physical status, the need to promote physical safety assumes the highest priority. The question calls for an intervention rather than an assessment.
The nurse is obtaining the health history for a 15-month-old boy from the parents. The child is not yet speaking. Which finding would be eliminated as a risk factor for a possible genetic disorder? A) The child is male and Caucasian. B) The grandmother and father have hearing impairments. C) The child was a breech delivery 3 weeks early. D) The mother was 37 when she became pregnant.
A) The child is male and Caucasian.
A group of students are reviewing information about major and minor congenital disorders. The students demonstrate understanding of the information when they identify which of the following as a minor disorder? A) Webbed neck B) Omphalocele C) Cutaneous hemangioma D) Facial asymmetry
A) Webbed neck
Which of the following would lead the nurse to suspect that a child has Turner syndrome? A) Webbed neck B) Microcephaly C) Gynecomastia D) Cognitive delay
A) Webbed neck
Which instruction should the nurse include when teaching the parents of a 3-year-old child with autism spectrum disorder (ASD)? (Select all that apply.) A. Teaching problem solving regarding client issues B. Providing for play with other children of the same age C. Providing methods to decrease the incidence of head banging D. Administering stimulants to calm repetitive motions E. Establishing therapies to assist with building play skills
A,B,C,E Rationale: Clients with ASD have behaviors that interfere with functioning and can be harmful to them, such as banging their head or hitting solid objects. Provide clients who have ASD with early physical and occupational therapy that may be beneficial in developing some play and social skills. Clients with ASD may keep themselves in isolation, and assisting the clients to be able to be in the presence of others is a focus of treatment. The client with autism spectrum disorder may not progress to living independently; therefore, parents need to learn problem-solving skills to assist them and the client throughout life. Stimulants are a pharmacologic, not nonpharmacologic, treatment for autism spectrum disorder.
Which intervention is an appropriate nonpharmacologic treatment for the nurse to include in the plan of care for a client with autism spectrum disorder (ASD)? (Select all that apply.) A. Teaching the family about studies on complementary care B. Creating an environment that is conducive to positive behavior management C. Establishing support for the parents and family D. Encouraging parents not to vaccinate their children E. Promoting enhanced communication
A,B,C,E Rationale: Children with ASD will benefit from the following nonpharmacologic treatment options: establishing support for the parents and family; creating an environment that is conducive to positive behavior management; promoting enhanced communication; and educating the family about studies on the use of complementary care. Discouraging parents from vaccinating their children is not an appropriate treatment option for children with ASD.
27. The nurse is assessing a 2-day-old newborn and suspects Down syndrome based on which of the following? Select all answers that apply. A) Flat facial profile B) Downward slant to the eyes C) Large tongue compared to mouth D) Simian crease E) Epicanthal folds F) Rigid joints
A,C,D,E Feedback: Common clinical manifestations of Down syndrome include flat facial profile, upward slant to the eyes (oblique palpebral fissures), tongue that is large in comparison to the mouth size, simian, crease, epicanthal folds, and loose joints.
A child with an existing diagnosis of attention deficit hyperactivity disorder shows signs and symptoms of depression. Which would most likely be prescribed? A. Selective serotonin and norepinephrine reuptake inhibitor (SSNRI) B. Monoamine oxidase inhibitor C. Mood stabilizer D. Tricylic antidepressant
A. Selective serotonin and norepinephrine reuptake inhibitor (SSNRI)
4. The long-term treatment plan for an adolescent with an eating disorder focuses on which of the following? a. Managing the effects of malnutrition b. Establishing sufficient caloric intake c. Improving family dynamics d. Restructuring perception of body image
ANS: A The treatment of eating disorders is initially focused on reestablishing physiologic homeostasis. Once body systems are stabilized, the next goal of treatment for eating disorders is maintaining adequate caloric intake. Although family therapy is indicated when dysfunctional family relationships exist, the primary focus of therapy for eating disorders is to help the adolescent cope with complex issues. The focus of treatment in individual therapy for an eating disorder involves restructuring cognitive perceptions about the individual's body image.
4. A baby is born with blood type AB. The father is type A, and the mother is type B. The father asks why the baby has a blood type different from those of his parents. The nurse's answer should be based on the knowledge that a. both A and B blood types are dominant. b. the baby has a mutation of the parents' blood types. c. type A is recessive and links more easily with type B. d. types A and B are recessive when linked together.
ANS: A Types A and B are equally dominant, and the baby can thus inherit one from each parent. The infant has inherited both blood types from the parents; it is not a mutation.
1. The nurse is assessing a 3-year-old child who has characteristics of autism. Which observed behaviors are associated with autism? (Select all that apply.) a. The child flicks the light in the examination room on and off repetitiously. b. The child has a flat affect. c. The child demonstrates imitation and gesturing skills. d. The mother reports the child has no interest in playing with other children. e. The child is able to make eye contact.
ANS: A, B, D Self-stimulation is common and usually involves repetition of a sensory stimulus. Autistic children show a fixed, unchanging response to a particular stimulus. Autistic children play alone or involve others only as mere objects. Autistic children lack imitative skills. These children lack social ability and make poor eye contact.
When performing a physical examination on a small child, the nurse observes approximately 8 to 10 light-brown spots concentrated primarily on the trunk and extremities, two small lumps on the posterior trunk, and axillary freckling. The nurse interprets these findings to suggest which of the following? A) Klinefelter syndrome B) Neurofibromatosis C) Fragile X syndrome D) Sturge-Weber syndrome
B) Neurofibromatosis
14. The nurse is working in an OB/GYN office and commonly obtains patient histories and performs initial assessments. Which woman is likely to be referred for genetic counseling after her first visit? a. A pregnant woman who will be 40 years or older when her infant is born b. A woman whose partner is 41 years of age c. A patient who carries a Y-linked disorder d. An anxious woman with a normal quadruple screening result
ANS: B A genetics referral should be made if the woman's (male) partner is over the age of 40 at conception. Other reasons for referral include pregnant women who will be 35 or older at the time of birth or abnormal quadruple (or other) screening results. Women do not carry Y chromosomes.
When teaching the parents of a child with phenylketonuria, the nurse would instruct them to include which of the following foods in the child's diet? A) Milk B) Oranges C) Meat D) Eggs
B) Oranges
5. Which statement is true of multifactorial disorders? a. They may not be evident until later in life. b. They are usually present and detectable at birth. c. The disorders are characterized by multiple defects. d. Secondary defects are rarely associated with multifactorial disease.
ANS: B Multifactorial disorders result from an interaction between a person's genetic susceptibility and environmental conditions that favor development of the defect. They are characteristically present and detectable at birth. They are usually single isolated defects, although the primary defect may cause secondary defects. Secondary defects can occur with multifactorial disorders.
5. Anticipatory guidance for the family of a preadolescent with a cognitive dysfunction should include information about a. institutional placement. b. sexual development. c. sterilization. d. appropriate clothing.
ANS: B Preadolescents who have a cognitive dysfunction may have normal sexual development without the emotional and cognitive abilities to deal with it. It is important to assist the family and child through this developmental stage. The child may or may not need institutional placement at some point. Sterilization is not an appropriate intervention when a child has a cognitive dysfunction. By the time a child reaches preadolescence, the family should have received counseling on age-appropriate clothing.
13. A nurse is giving a parent information about autism. Which statement made by the parent indicates understanding of the teaching? a. Autism is characterized by periods of remission and exacerbation. b. The onset of autism usually occurs before 3 years of age. c. Children with autism have imitation and gesturing skills. d. Autism can be treated effectively with medication.
ANS: B The onset of autism usually occurs before 3 years of age. Autism does not have periods of remission and exacerbation. Autistic children lack imitative skills. Medications are of limited use in children with autism.
8. A newborn assessment shows separated sagittal suture, oblique palpebral fissures, depressed nasal bridge, protruding tongue, and transverse palmar creases. These findings are most suggestive of a. microcephaly. b. Down syndrome. c. cerebral palsy. d. fragile X syndrome.
ANS: B These are characteristics associated with Down syndrome. The infant with microcephaly has a small head. Cerebral palsy is a diagnosis not usually made at birth. No characteristic physical signs are present. The infant with fragile X syndrome has increased head circumference; long, wide, and/or protruding ears; long, narrow face with prominent jaw; hypotonia; and high arched palate
15. Developmental delays, self-injury, fecal smearing, and severe temper tantrums in a preschool child are symptoms of a. Down syndrome. b. intellectual disability. c. psychosocial deprivation. d. separation anxiety.
ANS: B These are symptoms of intellectual disability. Down syndrome is often identified at birth by characteristic facial and head features, such as brachycephaly (disproportionate shortness of the head); flat profile; inner epicanthal folds; wide, flat nasal bridge; narrow, high-arched palate; protruding tongue; and small, short ears, which may be low set. Although intellectual impairment may be present, the symptoms listed are not the primary ones expected in the diagnosis of Down syndrome. Psychosocial deprivation may be a cause of mild intellectual disability. The symptoms listed are characteristic of severe intellectual disability. Symptoms of separation anxiety include protest, despair, and detachment.
12. The child with Down syndrome should be evaluated for which condition before participating in some sports? a. Hyperflexibility b. Cutis marmorata c. Atlantoaxial instability d. Speckling of iris (Brushfield spots)
ANS: C Children with Down syndrome are at risk for atlantoaxial instability. Before participating in sports that put stress on the head and neck, a radiologic examination should be done. Although hyperflexibility is characteristic of Down syndrome, it does not affect the child's ability to participate in sports. Although cutis marmorata is characteristic of Down syndrome, it does not affect the child's ability to participate in sports. Although Brushfield spots are characteristic of Down syndrome, they do not affect the child's ability to participate in sports.
13. In practical terms regarding genetic health care, nurses should be aware that a. genetic disorders equally affect people of all socioeconomic backgrounds, races, and ethnic groups. b. genetic health care is more concerned with populations than individuals. c. the most important related nursing function is providing emotional support to the family during counseling. d. taking genetic histories is usually only done at large universities and medical centers.
ANS: C Nurses should be prepared to help with a variety of stress reactions from a couple facing the possibility of a genetic disorder. Although anyone may have a genetic disorder, certain disorders appear more often in certain ethnic and racial groups. Genetic health care is highly individualized, because treatments are based on the phenotypic responses of the individual. Individual nurses at any facility can take a genetic history and provide basic genetic information, although larger facilities may have better support services.
7. A 14-year-old admits to using marijuana every day with friends after attending school. What phase of substance abuse does this behavior exemplify? a. Experimentation b. Early drug use c. True drug addiction d. Severe drug addiction
ANS: C True drug addiction is identified as regular use of drugs. Physical dependence may be present. Social functioning has a drug focus. With experimentation, the individual tries the drug to see what it is like or to satisfy peers. Early drug use is identified as using drugs with some degree of regularity for their desirable effects. In severe drug addiction, the physical condition of the individual deteriorates, and all activities are related to drug use.
The measurement of lecithin in relation to sphingomyelin (L/S ratio) is used to determine fetal lung maturity. Which ratio reflects maturity of the lungs? a. 1.4:1 c. 2:1 b. 1.8:1 d. 1:1
ANS: C - A ratio of 2:1 indicates a two-to-one ratio of L/S, an indicator of lung maturity. Ratios of 1.4:1, 1.8:1, and 1:1 indicate immaturity of the fetal lungs.
3. The father of a child recently diagnosed with developmental delay is very rude and hostile toward the nurses. This father was cooperative during the child's evaluation a month ago. What is the best explanation for this change in parental behavior? a. The father is exhibiting symptoms of a psychiatric illness. b. The father may be abusing the child. c. The father is resentful of the time he is missing from work for this appointment. d. The father is experiencing a symptom of grief.
ANS: D After a child is diagnosed with a developmental delay, families typically experience a cycle of grieving that is repeated when developmental milestones are not met. One cannot determine that a parent is exhibiting symptoms of a psychiatric illness on the basis of a single situation. The scenario does not give any information to suggest child abuse. Although the father may have difficulty balancing his work schedule with medical appointments for his child, a more likely explanation for his behavior change is that he is grieving the loss of a normal child.
11. Which behavior demonstrated by an adolescent should alert the school nurse to a problem of substance abuse? a. States feelings of worthlessness b. Increased desire for social conformity c. Does not feel need for peer approval d. Deterioration of relationships with family members
ANS: D Deterioration of relationships with family members, irregular school attendance, low grades, rebellious or aggressive behavior, and excessive dependence on peer influence are behaviors that may indicate substance abuse. Feelings of worthlessness are suggestive of a depressive disorder. An adolescent with a substance abuse problem may be depressed, but this behavior is not a manifestation of substance abuse. The clinical manifestations of substance abuse are marked by an increase in antisocial behavior as the desire for social conformity decreases and the need for the substance increases. The adolescent with a substance abuse problem may demonstrate an excessive dependence on peer influence.
10. Which question by the nurse will most likely promote sharing of sensitive information during a genetic counseling interview? a. "How many people in your family are mentally retarded or handicapped?" b. "What kinds of defects or diseases seem to run in the family?" c. "Did you know that you can always have an abortion if the fetus is abnormal?" d. "Are there any family members who have learning or developmental problems?"
ANS: D The nurse should probe gently by using lay-oriented terminology rather than direct questions or statements.
A child is noted to have lymphedema, webbed neck, and low posterior line hairline. Which of the following diagnoses is most appropriate? A. Turner's Syndrome. B. Down Syndrome. C. Marfan's Syndrome. D. Klinefelter's Syndrome.
Answer A - These are the 3 key assessments found in Turner's Syndrome. If the child is diagnosed early in age, proper treatment can be offered to the family. All newborns should be screen for possible congenital effects.
A client comes into the clinic for a physical examiantio, a required prerequisite for him to participate with his high school basketball team. He is a tall, lean male with long, slender fingers. His mother mentions that he will have his first game next week, and she is concerned about his heatlh. The parent has heard about high school athletes dying on the court during games. What congenital anomaly could the parent be referring to and what is the associated life-threatening defect? A. Down syndrome and Atrial-Ventricular (AV) canal B. Marfan's Syndrome and aortic dilatation C. Phenylketonuria (PKU) and seizures D. Turner's Syndrome and hypothyroidism
Answer B - The physical characteristics of the client are consistent with Marfan's Syndrome The connective tissue disorder can involve the heart and specifically the aorta and can lead to a fatal aortic aneurysm.
11) Which child should the nurse refer for further assessment due to a probable diagnosis for autism spectrum disorder (ASD)? 1. A 4-year-old girl who doesn't make eye contact with mother and resists the mother's touch 2. A 3-year-old boy who joins one group of children, then moves to another group of children without joining their activities 3. An 18-month-old child who walks around the area using the furniture to provide balance 4. A 6-year-old boy who chatters constantly to anyone who will listen
Answer: 1 Explanation: 1. Although boys are affected more often than girls, lack of eye contact and resistance to physical touch are common symptoms of autism. 2. Although this child is not interacting with other children, it is obvious that the child is aware of other children and interested in their activities, actions that are not indicative of autism. 3. This child may be developmentally delayed, as this behavior is typical of a 10- to 12-month-old child. 4. Children with autism often have language delays and impairment. This child does not have any obvious language issues. Page Ref: 1489-1490 Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55.4 Describe characteristics of common cognitive alterations of childhood. MNL Learning Outcome: 8.1.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children.
Which of the following would lead the nurse to suspect that an adolescent has bulimia? A) Body mass index less than 17 B) Calluses on back of knuckles C) Nail pitting D) Bradycardia
B
Cystic fibrosis is an example of which type of inheritance? a) Multifactorial b) Autosomal dominant c) X-linked recessive d) Autosomal recessive
Autosomal recessive Correct Explanation: Cystic fibrosis is an autosomal recessive inherited condition. Huntington disease would be an example of an autosomal dominant inherited condition. Hemophilia is an X-linked recessive inherited condition. Cleft lip is a multifactorial inherited condition.
. An autistic child is hospitalized with asthma. The nurse should plan care so that the: A: parents expectations are met. B: childs routine habits and preferences are maintained. C: child is supported through the autistic crisis. D: parents need not be at the hospital.
B
A nurse is caring for a 5-year-old girl with depression. The girl is having difficulty coping with her feelings of sadness and fear, which stem from her parents' separation and recent divorce. The girl has been prescribed antidepressant medication but the mother thinks the girl would benefit from therapy. The nurse anticipates a referral to a therapist specializing in which type of therapy? A) Individual therapy B) Play therapy C) Behavioral therapy D) Hypnosis
B
A nurse is conducting a screening program for autism in infants and children. Which of the following would the nurse identify as a warning sign? A) Lack of babbling by 6 months B) Inability to say a single word by 16 months C) Lack of gestures by 8 months D) Inability to use two words by 18 months
B
Anticipatory guidance for the family of a preadolescent with a cognitive dysfunction should include information about: A: institutional placement. B: sexual development. C: sterilization. D: clothing.
B
22. A nursing instructor is preparing a class discussion on the benefits and drawbacks associated with genetic advances and the Human Genome Project. Which of the following would the instructor address as a potential problem? A) Early detection possibilities B) Risk profiling C) Focus on causes D) Rapid diagnosis
B Feedback: Although current and potential applications of the Human Genome Project to health care are numerous, risk profiling presents a potential problem. Risk profiling based on an individual's unique genetic makeup can be used to tailor prevention, treatment, and ongoing management of health conditions, but it will raise issues associated with client privacy and confidentiality related to workplace discrimination and access to health insurance. Early detection possibilities, focus on causes, and rapid diagnosis are benefits to the information gained from the Human Genome Project.
5. The nurse is teaching the parents of a 1-month-old girl with Down syndrome how to maintain good health for the child. Which instruction would the nurse be least likely to include? A) Getting cervical radiographs between 3 and 5 years of age B) Adhering to the special dietary needs of the child C) Getting an echocardiogram before 3 months of age D) Monitoring for symptoms of respiratory infection
B Feedback: Children with Down syndrome do not require a special diet unless underlying gastrointestinal disease is present. However, a balanced, high-fiber diet and regular exercise are important. Getting cervical radiographs between 3 and 5 years of age is the screening method for atlantoaxial instability, which is seen in about 14% of children with Down syndrome. Evaluation by a pediatric cardiologist before 3 months of age, including an echocardiogram, is important since children with Down syndrome are at higher risk for heart disease. The child will be more susceptible to infectious diseases.
Nursing Care of the client with Klinefelter's Syndrome focuses mainly on which of the following areas? A. Fluid and electrolyte balance. B. Body image. C. Preventing complications. D. Development of fine motor skills.
B - The adolescent client with Klinefelter's Syndrome is a tall, lean male with no secondary sex characteristics. Body image is the appropriate nursing diagnosis for the adolescent.
26. A child is diagnosed with cri-du-chat syndrome. Which of the following would the nurse expect to assess? Select all answers that apply. A) Hypertonia B) Short stature C) Simian crease D) Wide and flat nasal bridge E) Hydrocephaly
B, C, D Feedback: Manifestations of cri-du-chat syndrome include hypotonia, short stature, microcephaly, moon-like round face, bilateral epicanthal folds, wide and flat nasal bridge, and simian crease.
The nurse assesses a child suspected of having autism spectrum disorder (ASD). Which behavior noted in the assessment supports the diagnosis? (Select all that apply.) A. Deep set eyes B. Echolalia C. Emotional calm D. Stereotypy E. An aversion to being touched
B,D,E Rationale: Behaviors indicative of ASD include stereotypy (rigid and obsessive behavior), echolalia (the compulsive parroting of a word or phrase just stated by another), and an aversion to being touched. Emotional lability (rapid, significant mood changes), not emotional calm, is a clinical manifestation of ASD. ASD does not manifest in any physical signs.
Which term describes the use of socially unacceptable words, which are frequently obscene? A. Palilalia B. Coprolalia C. Echolalia D. None of the above
B. Coprolalia
During a comprehensive assessment of a child, which person does the nurse interview first? A. grandparents B. child C. parent D. caregiver
B. child
A variety of areas are assessed during the mental status examination. Which are sections of the mental status examination? Select all that apply. A. religious background B. cognition C. gross and fine motor movement D. academic interests E. intellectual functioning
B. cognition C. gross and fine motor movement E. intellectual functioning
A nurse is reviewing the medical record of an 11-year-old child with a conduct disorder. Which of the following would the nurse identify as characteristic of this disorder? Select all answers that apply. A) Easily annoyed B) Initiator of physical fights C) Temper tantrums D) Truancy E) Arrest for arson
BDE
The graduate nurse is caring for a family with a child who was recently diagnosed with autism spectrum disorder (ASD) and is discussing treatment options for the child. Which goal of collaborative therapy would require correction from the preceptor? Advocating for parent support and coping groups Use of focusing techniques and behavior management Implementing treatments that decrease maladaptive behaviors such as rigidity and stereotype Behavior modification through electroconvulsive therapy
Behavior modification through electroconvculsive therapy The goals of therapy for a child with ASD and their family include advocating for parent support and coping groups, using focused techniques and behavior management, and implementing treatments that decrease maladaptive behaviors. While behavior modification may be a goal of treatment, electroconvulsive therapy is not a treatment option for children with ASD.
The parents of a child who is diagnosed with autism spectrum disorder (ASD) tell the nurse that they wish to put their child on a gluten-free, casein-free diet. Which foods should the nurse instruct the parents to avoid feeding their child? Bread and milk Fish and fruit Red meat and green, leafy vegetables Rice and eggs
Bread and milk A gluten-free, casein-free diet eliminates the proteins found in wheat and dairy products. The child should avoid bread, milk, and cheese because they are made from grains or dairy. All other foods can be consumed.
The nurse is caring for a 12-year-old boy who is profoundly cognitively challenged, with an IQ of 15. Which task is the most challenging that the nurse should expect this client to be able to accomplish as an adult? a) Contribute to his own support by performing unskilled manual labor b) Brush his teeth c) Live independently d) Dress himself
Brush his teeth
A child with depression is prescribed fluoxetine. The nurse identifies this as belonging to which class of drugs? A) Atypical antidepressant B) Tricyclic antidepressant C) Selective serotonin reuptake inhibitor D) Psychostimulant
C
A nurse is caring for a 10-year-old boy with a nursing diagnosis of ineffective coping related to an inability to deal with stressors secondary to anxiety. Which of the following would be most important for the nurse to do first? A) Set clear limits on the child's behavior B) Teach the child problem-solving skills C) Encourage a discussion of the child's thoughts and feelings D) Role model appropriate social and conversation skills
C
The home care nurse is visiting a child diagnosed with autism spectrum disorder (ASD). Which intervention is appropriate for the nurse to include in the treatment plan for this family? A. Focusing on the child's limitations B. Recommending that the home be a therapy-free zone C. Providing appropriate education regarding what to expect for the child D. Encouraging the family to get over negative feelings regarding the diagnosis
C Rationale: An appropriate intervention for the family of a child diagnosed with ASD is for the nurse to provide education about what to expect. The nurse would encourage the family to grieve the loss of the "perfect child" and encourage the parents to focus on the child's strengths and talents. In order for therapy to be effective, the nurse would recommend that treatments be continued at home.
17. After teaching a class about inborn errors of metabolism, the instructor determines that additional teaching is needed when the class identifies which of the following as an example of an inborn error of metabolism? A) Galactosemia B) Maple syrup urine disease C) Achondroplasia D) Tay-Sachs disease
C Feedback: Achondroplasia is an autosomal dominant genetic disorder, not an inborn error of metabolism. Galactosemia, maple syrup urine disease, and Tay-Sachs are considered inborn errors of metabolism.
8. The nurse is caring for a 1-month-old girl with low-set ears and severe hypotonia who was diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely? A) Interrupted family process related to the child's diagnosis B) Deficient knowledge deficit related to the genetic disorder C) Grieving related to the child's poor prognosis D) Ineffective coping related to stress of providing care
C Feedback: Grieving related to the child's prognosis is a diagnosis specific to this child's care. The prognosis for trisomy 18 is that the child will not survive beyond the first year of life. Ineffective coping related to the stress of providing care, deficient knowledge related to the genetic disorder, and interrupted family process due to the child's diagnosis could be appropriate for any family of a child with a genetic disorder.
4. The nurse is assessing a 4-year-old boy whose mother was 40 years old when he was born. Which of the following findings suggests this child has a genetic disorder? A) Inquiry determines the child had feeding problems. B) Observation shows nasal congestion and excess mucus. C) Inspection reveals low-set ears with lobe creases. D) Auscultation reveals the presence of wheezing.
C Feedback: Low-set ears are associated with numerous genetic dysmorphisms. Additionally, the mother's age during pregnancy is a risk factor for genetic disorders. Feeding problems could have been due to low birthweight, prematurity, or a variety of other reasons. The nasal congestion may be a cold. The wheezing could be bronchiolitis or asthma.
While providing health teaching for a patient diagnosed with bulimia nervosa, a nurse should emphasize information about: a. self-monitoring of daily food and fluid intake. b. establishing the desired daily weight gain. c. recognizing symptoms of hypokalemia. d. self-esteem maintenance.
C ~ Hypokalemia results from potassium loss associated with vomiting. Physiologic integrity can be maintained if the patient can self-diagnose potassium deficiency and adjust the diet or seek medical assistance. Self-monitoring of daily food and fluid intake is not useful if the patient purges. Daily weight gain may not be desirable for a patient with bulimia nervosa. Self-esteem is an identifiable problem but is of lesser priority than the risk for hypokalemia.
As a patient admitted to the eating disorders unit undresses, a nurse observes that the patients body is covered by fine, downy hair. The patient weighs 70 pounds and is 5 feet, 4 inches tall. Which condition should be documented? a. Amenorrhea b. Alopecia c. Lanugo d. Stupor
C ~ The fine, downy hair noted by the nurse is called lanugo. It is frequently seen in patients with anorexia nervosa. None of the other conditions can be supported by the data the nurse has gathered.
After teaching a class about inborn errors of metabolism, the instructor determines that additional teaching is needed when the class identifies which of the following as an example of an inborn error of metabolism? A) Galactosemia B) Maple syrup urine disease C) Achondroplasia D) Tay-Sachs disease
C) Achondroplasia
Which is considered a hyperactive/impulsive behavior seen in attention deficit hyperactivity disorder (ADHD)? A. Frequent forgetfulness in daily activities B. Avoiding tasks requiring mental effort C. Inability to play quietly D. Making careless mistakes
C. Inability to play quietly
A nurse is assessing a child who is suspected of having attention deficit hyperactivity disorder. Which would the nurse identify as reflecting impulsiveness in the child? A. Restlessness B. Inability to wait the child's turn C. Risk-taking behavior D. Difficulty completing a task
C. Risk-taking behavior
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? a) Cardiac arrhythmias, confusion, seizures b) Orthostatic hypotension and hypothermia c) Bradycardia with ectopy and seizures d) Hypothermia and irregular pulse
Cardiac arrhythmias, confusion, seizures
Which type of genetic test would be used to detect the possibility of Down syndrome? a) Complete blood count (CBC) b) DNA analysis c) Hemoglobin electrophoresis d) Chromosomal analysis
Chromosomal analysis Correct Explanation: Chromosomal analysis is part of the genetic testing for Down syndrome. DNA analysis may be used in the detection of Huntington disease. Hemoglobin electrophoresis may be used in genetic testing for sickle cell anemia. A complete blood count (CBC) may be used as part of testing for a thalassemia
You care for a child with Down syndrome (trisomy 21). This is an example of which type of inheritance? a) Mendelian dominant b) Phase 2 atrophy c) Chromosome nondisjunction d) Mendelian recessive
Chromosome nondisjunction Correct Explanation: Down syndrome occurs when an ovum or sperm cell does not divide evenly, permitting an extra 21st chromosome to cross to a new cell.
Upon assessment, the nurse notices that the infant's ears are low-set. What is the priority action by the nurse? a) Inform the parents that low-set ears are a sign of Down syndrome b) Place the infant on a cardiac monitor c) Continue to assess the infant to look for other abnormalities d) Give a vitamin B12 injection to combat the metabolic disorder
Continue to assess the infant to look for other abnormalities Correct Explanation: Continue to assess for major and minor congenital anomalies because major anomalies may require immediate medical attention. Three or more minor anomalies increase the chance of a major anomaly. Low-set ears can be a symptom of a variety of genetic disorders. Mentioning Down syndrome without further investigation can cause undue stress in parents. The infant may not need cardiac monitoring; further assessment will provide clues. Diagnostic testing is needed to determine whether the child is afflicted with a metabolic disorder.
A child with attention deficit/hyperactivity disorder is prescribed long-acting methylphenidate. Which of the following would the nurse include when teaching the child and his parents about this drug? A) "Give the drug three times a day: morning, midday, and after school." B) "This drug may cause drowsiness, so be careful when doing things." C) "Some increase in appetite may occur, so watch how much you eat." D) "Take this drug every day in the morning when you wake up."
D
A nurse is providing an in-service program on child abuse 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 of the following as an indicator of possible child abuse? A) Consistent delays in seeking treatment for the child's injuries B) Frequent changes in history information with visits C) Injuries that are inconsistent with the reported traumatic event D) Sexual behavior that correlates with the child's developmental age
D
Intense stress and isolation as a result of caring for a child with developmental disabilities often lead parents to: a. heightened parental achievement. b. overuse of the healthcare system. c. overindulgence and obesity. d. child abuse.
D
Parents of a child with fragile X syndrome ask the nurse about genetic transmission of this syndrome. In response, the nurse correctly explains that fragile X syndrome is: a. most commonly seen in girls. b. acquired after birth. c. usually transmitted by the male carrier. d. usually transmitted by the female carrier.
D
The best setting for daytime care for a 5-year-old autistic child whose mother works is: A: private day care. B: public school. C: his own home with a sitter. D: a specialized program that facilitates interaction by use of behavioral methods.
D
The father of a child recently diagnosed with developmental delay is very rude and hostile toward the nurses. This father was cooperative during the childs evaluation a month ago. What is the best explanation for this change in parental behavior? A: The father is exhibiting symptoms of a psychiatric illness. B; The father may be abusing the child. C: The father is resentful of the time he is missing from work for this appointment. D; The father is in the anger stage of the grief process.
D
14. When providing guidance to the parents of a child with Down syndrome, which of the following would be most appropriate? A) Encourage the parents to home-school the child. B) Advise the parents that the child will need monthly thyroid testing. C) Instruct them on the need for yearly dental visits. D) Teach the parents about the need for a high-fiber diet.
D Feedback: A high-fiber intake is important for children with Down syndrome because their lack of muscle tone may decrease peristalsis, leading to constipation. Early intervention programs with special education are important to promote growth and development. The child should be integrated into mainstream education whenever possible. Children with Down syndrome should undergo thyroid testing yearly and see the dentist every 6 months.
2. The nurse is caring for a couple who is having a triple screen done. The nurse would least likely expect which of the following to be tested? A) a-Fetoprotein B) Human chorionic gonadotropin C) Unconjugated estriol D) Testosterone
D Feedback: A triple screen tests a-fetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3). Testosterone is not included.
The nurse is assessing a child diagnosed with expressive language disorder. During the assessment, the parents tell the nurse the child had normal speech development until around 3 years of age when the child was involved in a serious car accident. Which part of the body may be affected in the child? A. Tongue B. Vocal cords C. Auditory canal D. Brain
D. Brain
The nurse is teaching a client's parents about managing the child's tic disorder. The nurse explains that it is extremely important for the child to get plenty of rest. What is the primary reason for the nurse to provide this education? Choose the best answer. A. Mental stress from the disorder could make the child depressed. B. Good sleep may normalize the transmission of dopamine. C. Repetitive motor movements cause fatigue, and the child needs rest. D. Physical stress and fatigue can increase symptoms in tic disorder.
D. Physical stress and fatigue can increase symptoms in tic disorder.
Nondisjunction of a chromosome results in which of the following diagnoses? a) Duchenne muscular dystrophy b) Down syndrome c) Marfan syndrome d) Huntingon disease
Down syndrome Correct Explanation: When a pair of chromosomes fails to separate completely (nondisjunction) the resulting sperm or oocyte contains two copies of a particular chromosome. Nondisjunction can result in a fertilized egg having trisomy 21 or Down syndrome. Huntington disease is one example of a germ-line mutation. Duchenne muscular dystrophy, an inherited form of muscular dystrophy, is an example of a genetic disease caused by structural gene mutations. Marfan syndrome is a genetic condition that may occur in a single family member as a result of spontaneous mutation.
A Caucasian female client of Jewish ancestry is pregnant. The nurse is aware that the client may be a carrier for which of the following conditions? a) Tay Sachs disease b) Phenylketonuria c) Dupuytrens d) Krabbe disease
Tay Sachs disease Correct Explanation: Because the client is of Jewish ancestry, there is an increased risk of her being a carrier of the Tay Sachs disease gene. Norwegians are at a greater risk for Dupuytrens and Phenylketonuria, while Icelanders have an increased risk for Phenylketonuria.
The nurse is working with school-age children who are having enuresis or encopresis. Which of the following will most likely be the first step in this child's treatment? a) The child will be taken to a therapist. b) The child will be given a strict daily schedule. c) The child will be given medications. d) The child will have a complete physical exam.
The child will have a complete physical exam.
What is the main purpose of nurses having basic genetic knowledge? a) To advocate for a cure for genetic disorders b) To provide support and education to families c) To understand all genetic disorders, allowing for improved quality of life d) To ensure proper medical diagnosis
To provide support and education to families Correct Explanation: The purpose of the nurse knowing about basic genetics is that it helps her to provide support and education to families. Nurses can advocate for a cure, but this is not the main purpose of attaining basic knowledge of genetics. Providing a medical diagnosis is beyond the scope of practice for a nurse. It would be impossible for the nurse to understand all genetic disorders; it is more reasonable for the nurse to be familiar with the most common genetic disorders
The nurse is meeting with a family that has learned that their 11-year-old daughter has some intellectual disabilities. They tell the nurse that she is having trouble coping with different situations at school. What is the best response the nurse could give? a) "Just give her some time, she will learn to adjust." b) "Maybe it would be best if she did not play with those kids at school." c) "Coping and adaptation are often affected by intellectual disabilities." d) "It takes time to learn to cope and adjust, give her some more time."
"Coping and adaptation are often affected by intellectual disabilities."
Which statement by a parent regarding mitochrondrial disorders requires further education? a) "It is passed from female to female. That's why my son cannot be affected." b) "The cells most affected are the ones that require high levels of energy." c) "My child can exhibit signs and symptoms of the disorder at any point in his life." d) "Mitochondrial disorders usually worsen over time."
"It is passed from female to female. That's why my son cannot be affected." Explanation: Mitochondrial disorders usually are inherited from the mother and affect offspring regardless of sex. Mitochondrial disorders are progressive, and onset of signs and symptoms can occur from infancy to adulthood. The disorder affects cells that require high levels of energy
A parent asks why a physical therapist is needed for the 6-month-old child diagnosed with Down syndrome. What is the best response by the nurse? a) "To optimize the child's development and functioning" b) "The earlier the intervention, the more likely we are to cure the problem." c) "To prevent contractures" d) "To ensure that the child meets all developmental milestones on time"
"To optimize the child's development and functioning" Correct Explanation: Interventional therapy is started early to promote the child's development and optimize functioning. The Down syndrome child usually meets developmental milestones at a slower pace. There is no cure for genetic disorders. Range-of-motion activities can prevent contractures; Down syndrome does not require physical therapy.
The nurse is describing some of the developmental milestones the mother of a 3-month-old boy with Down syndrome can expect to see in her child. Which statement describes the milestones that are expected in a child with Down syndrome? a) "He will be speaking in sentences at 21 months of age." b) "Bladder training can be expected by 2.5 to 3 years of age." c) "You can expect him to eat with his hands by age 12 months." d) "He'll be crawling all over the house by 9 months of age."
"You can expect him to eat with his hands by age 12 months." Correct Explanation: Children with Down syndrome will accomplish eating with their hands by about 12 months of age. They will develop the skills of typical children, but at an older age. The child with Down syndrome will speak in sentences at 24 months rather than 21 months. Bladder training would occur by 48 months rather than 32 months. A child with Down syndrome will crawl at 11 months rather than 9 months.
You are counceling a couple, one of whom is affeced by neurofibromatosis, an autosomal dominant disorder. They want to know the risk of transmitting the disorder. The nurse should tell them that each offspring has a: 1. 1 in 4, 25% chance 2. 1 in 8, 12.5% chance 3. 1 in 1, 100% chance 4. 1 in 2, 50% chance
1 in 2, 50% chance
A morbidly obese client is prescribed an anorexiant medication. The nurse should expect to teach the client about which medication? 1. Phentermine (Mirapront) 2. Dexfenfluramine (Redux) 3. Sibutramine (Meridia) 4. Pemoline (Cylert)
1 ~ The nurse should teach the client that phentermine is an anorexiant medication prescribed for morbidly obese clients. Phentermine works on the hypothalamus to stimulate the adrenal glands to release norepinephrine, a neurotransmitter that signals a fight-or-flight response, reducing hunger. Dexfenfluramine has been removed from the market because of its association with serious heart and lung disease. Several deaths have been associated with the use of sibutramine by high-risk clients. Based on pressure from the FDA, the manufacturer issued a recall of the drug in October 2010. Withdrawal from anorexiants can result in rebound weight gain, lethargy, and depression.
The physician orders fluoxetine (Prozac) for a client diagnosed with depression. Which information is true about this medication? 1) Prozac is a tricyclic antidepressant. 2) The therapeutic effect of Prozac occurs 2 to 4 weeks after treatment is begun. 3) Aged cheese, yogurt, soy sauce, and bananas should not be eaten while the client is taking this drug. 4) Prozac may be administered in combination with monoamine oxidase inhibitors (MAOIs).
2 Rationale It is true that the full therapeutic effect of Prozac may not occur for 2 to 4 weeks after initiation of treatment. Prozac is a selective serotonin reuptake inhibitor
When teaching a class about trisomy 21, the instructor would identify this disorder as due to which of the following? A) Nondisjunction B) X-linked recessive inheritance C) Genomic imprinting D) Autosomal dominant inheritance
A) Nondisjunction
A group of nursing students are reviewing information about neurocutaneous syndromes. The students demonstrate an understanding of these disorders when they identify which of the following as an example? A) Sturge-Weber syndrome B) Marfan syndrome C) Apert syndrome D) Achondroplasia
A) Sturge-Weber syndrome
A nurse is caring for a child with enuresis. The child does not have any abnormalities associated with development or behavior. Which drug would the child be prescribed to treat the condition? A. Imipramine B. Atomoxetine C. Risperidone D. Dextroamphetamine
A. Imipramine
A nurse is preparing a teaching session for a group of parents with children newly diagnosed with attention deficit/hyperactivity disorder (ADHD). When explaining this disorder to the parents, which of the following would the nurse include as being involved? Select all answers that apply. A) Impulsivity B) Inattention C) Distractibility D) Hyperactivity E) Defiance F) Anxiety
ABCD
2. The nurse knows that which of the following chromosomal abnormalities are structural in nature? (Select all that apply.) a. Part of a chromosome is missing. b. The material within a chromosome is rearranged. c. One or more sets of chromosomes are added. d. An entire single chromosome is added. e. Two chromosomes adhere to each other.
ANS: A, B, E Characteristics of structural abnormalities include part of a chromosome missing or added, rearrangement of material within chromosomes, two chromosomes that adhered to each other, and fragility of a specific site on the X chromosome. The addition of a single chromosome (trisomy), the deletion of a single chromosome (monosomy), and one or more added sets of chromosomes (polyploidy) are numerical abnormalities.
1. The parents of a teen suspect their child is using amphetamines. Manifestations of amphetamine use include (Select all that apply.) a. weight gain. b. excessive talking and activity. c. excessive sleeping. d. insomnia. e. agitation.
ANS: B, D, E Euphoria, hyperactivity, agitation, irritability, insomnia, weight loss, tachycardia, and hypertension are expected behaviors and effects of amphetamine abuse. The adolescent using amphetamines is likely to have weight loss, not weight gain. Excessive sleeping may be associated with alcohol abuse or abuse of barbiturates.
The foul-smelling, frothy characteristic of the stool in cystic fibrosis results from the presence of large amounts of which of the following? A. Sodium and chloride B. Undigested fat C. Semidigested carbohydrates D. Lipase, trypsin, and amylase.
Answer B - The client with cystic fibrosis absorbs fat poorly because of the thick secretions blocking the pancreatic duct. The lack of natural pancreatic enzyme leads to poor absorption of predominantly fats in the duodenum. Foul-smelling frothy stool is termed steatorrhea.
The nurse is caring for an adolescent girl with anorexia nervosa. Which of the following findings would indicate to the nurse that the girl requires hospitalization? A) Weight gain of one-half pound per week B) Food refusal C) Body mass index of 18 D) Soft, sparse body hair and dry, sallow skin
B
A pregnant woman is to undergo testing to evaluate for chromosomal abnormalities. Which test would the nurse expect to be done the earliest? A) Amniocentesis B) Chorionic villi sampling C) Triple screen D) Fetal nuchal translucency
B) Chorionic villi sampling
A child is prescribed trazodone. Which of the following would the nurse be least likely to include in the plan of care related to this drug? A) Monitoring blood pressure for orthostatic hypotension B) Assessing the child for sedation and drowsiness C) Administering the drug with a snack D) Monitoring for tardive dyskinesia
D
28. When describing Prader-Willi syndrome to a group of nursing students, the instructor would describe this condition as one affecting which chromosome? A) 4 B) 5 C) 11 D) 15
D Feedback: Prader-Willi syndrome involves an abnormality on chromosome 15. Cri-du-chat involves an abnormality on chromosome 5; Wolf-Hirschhorn syndrome involves an abnormality on chromosome 4; and Beckwith-Wiedemann syndrome involves an abnormality on chromosome 11.
Steve, a 15-year-old Vietnamese boy, has been referred by his homeroom teacher to the school nurse for evaluation. The teacher is concerned that Steve may be suffering from major depression. Who should be the primary source of information to investigate the concerns about Steve? a) Steve's school nurse b) Steve's homeroom teacher c) Steve's parents d) Steve
Steve
The nurse is preparing an education plan to help the family to learn about their child's developmental disorder and its treatment. Which of the following interventions will be part of the plan? a) Conducting developmental assessments of the child b) Teaching how to plan schedules and routines c) Providing education to build social skills d) Linking the family to support groups
Teaching how to plan schedules and routines
A woman with both heart disease and osteoarthritis has come to the genetics clinic for genetic screening. What would the nurse know about these two diseases? a) They are direct result of the patient's lifestyle b) They are multifactorial c) They do not have a genetic basis d) They are caused by a single gene
They are multifactorial Correct Explanation: Genomic or multifactorial influences involve interactions among several genes (gene-gene interactions) and between genes and the environment (gene-environment interactions), as well as the individual's lifestyle.
A woman is to undergo chorionic villus sampling as part of a risk assessment for genetic disorders. Which of the following would the nurse include when describing this test to the woman? a) "A needle will be inserted directly into your fetus's umbilical vessel to collect blood for testing." b) "An intravaginal ultrasound measures fluid in the space between the skin and spine." c) "A small piece of tissue from the fetal placenta will be removed and analyzed." d) "A small amount of amniotic fluid will be withdrawn and collected for analysis."
"A small piece of tissue from the fetal placenta will be removed and analyzed." Correct Explanation: Percutaneous umbilical cord sampling involves the insertion of a needle into the umbilical vessel. An amniocentesis involves the collection of amniotic fluid from the amniotic sac. Fetal nuchal translucency involves the use of intravaginal ultrasound to measure fluid collected in the subcutaneous space between the skin and cervical spine of the fetus. Chorionic villus sampling involves the removal of a small tissue specimen from the fetal portion of the placenta
The nurse is caring for a child who is diagnosed with autism spectrum disorder (ASD). The child's parents ask the nurse, "What is the cause of ASD in our child?" Which response by the nurse is accurate? "ASD is caused by problems in the parietal and frontal lobes of your child's brain." "ASD is caused by trauma that happened at birth." "ASD is most likely caused due a problem with the neurons in the frontal and temporal lobes of your child's brain." "ASD is caused by arrested development of the brain in the uterus."
"ASD is most likely caused due a problem with the neurons in the frontal and temporal lobes of your child's brain." While the exact cause of ASD is unknown, it is thought to result from genetic abnormalities of the neurons in the frontal and temporal lobes. The construction of the brain is atypical in comparison to those without autism. MRIs and other imaging have shown there are abnormalities of neurons of the cerebral cortex. The frontal and temporal lobes are particularly susceptible to these abnormal neuron patches. The frontal lobe is responsible for social behaviors, motor function, problem solving, and other higher functions. The temporal lobe is responsible for language and sensory input. It is not caused by issues in the parietal lobe, by trauma at birth, or arrested development in utero.
The nurse is interviewing a depressed 13-year-old girl. During the course of the interview, the girl reveals that her best friend is thinking about committing suicide. How should the nurse respond? a) "Why do you think she wants to kill herself?" b) "Do you know how she is planning to kill herself?" c) "Are you the only person who knows?" d) "Do her parents know she wants to kill herself?"
"Do you know how she is planning to kill herself?"
The nurse is discussing the need for early diagnosis and treatment of autism spectrum disorder (ASD) with parents of children suspected of having the condition. Which statement should the nurse include? "Early diagnosis and treatment provides the only means for a cure of ASD." "Early diagnosis and treatment gives your child the best chance of becoming a fully functioning adult." "Early diagnosis and treatment provides the best way to ensure that your child can be admitted to an assisted living facility as an adult." "Early diagnosis and treatment prevents your child from developing any other mental condition."
"Early diagnosis and treatment gives your child the best chance of becoming a fully functioning adult." Early diagnosis and treatment of ASD provides access to treatments and therapies that give patients the best chance to become fully functioning adults. Undiagnosed or untreated ASD decreases quality of life and the likelihood that comorbid conditions such as depression will be identified. ASD is a lifelong condition and is not "cured." Early detection and treatment does not prevent the development of any other mental condition but allows for the early diagnosis and treatment of depression or anxiety. It does not help the adult with ASD enter into an assistive living facility.
The parent of a child diagnosed with Duchenne muscular dystrophy asks why gene therapy is not being used to treat her child. What is the best response by the nurse? a) "Clinical trials are very successful, and you should find one immediately." b) "Gene therapy remains experimental and is used only in clinical trials." c) "Genetic testing is unethical." d) "Gene therapy does not work for muscular dystrophy."
"Gene therapy remains experimental and is used only in clinical trials." Correct Explanation: Gene therapy in the United States is currently experimental and is used only in clinical trials. Clinical trials have resulted in minimal success. No documentation supports the statement that gene therapy would not work for muscular dystrophy. Genetic testing is used to diagnose illness; therefore, it is widely accepted as ethical when used to diagnose disorders. Gene therapy may be viewed by some as unethical, but the nurse should provide information in a nonjudgmental manner.
The nurse is caring for an adolescent who says, "I'm sick of this. I wish I weren't alive anymore." What is the best response by the nurse? 1. "I often feel sad and sick of things." 2. "Have you thought about hurting yourself." 3. "Are you trying to escape your problems?" 4. "Do your parents know about this feeling?"
"Have you thought about hurting yourself."
A young couple who underwent preconceptual genetic counseling and testing have learned that they are at high risk for having a child with Down syndrome. They have decided not to have children. Which of the following would be the most appropriate response for the nurse to give? a) "I think you made the right decision. After all, I never had children, and I'm perfectly happy." b) "I appreciate your decision, but I urge you to think through this further. Having a child, even one with Down syndrome, is so rewarding." c) "I understand. In case you would like to discuss this further with a genetic counselor, here is the contact information for the genetic counseling center." d) "I understand and support your decision. The risk is just not worth it."
"I understand. In case you would like to discuss this further with a genetic counselor, here is the contact information for the genetic counseling center." Correct Explanation: Even if a couple decides not to have more children, be certain they know genetic counseling is available for them should their decision change. It is never appropriate for a health care provider to impose his or her own values or opinions on others. Individuals with known inherited diseases in their family must face difficult decisions, such as how much genetic testing to undergo or whether to terminate a pregnancy that will result in a child with a specific genetic disease. Be certain couples have been told all the options available to them, and then leave them to think about the options and make their decision by themselves. Help them to understand nobody is judging their decision because they are the ones who must live with the decision in the years to come.
Which statement by the parent of a 12-month-old child diagnosed with Down syndrome shows the need for further education? a) "Thyroid testing is needed every year." b) "I will need to delay any further immunizations." c) "In a couple of years, my child will need an x-ray of the neck." d) "I will watch closely for development of respiratory infection."
"I will need to delay any further immunizations." Correct Explanation: Down syndrome children are at higher risk for infection because of a lowered immune system. Delaying immunizations may expose the child to illnesses that could have been prevented. Down syndrome children are at greater risk for developing thyroid disorders, 1st and 2nd vertebrae disorders, and respiratory infections.
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? a) "Tremors and nausea are common side effects." b) "She will probably tell us that she is hungrier than usual." c) "She may notice an increase in urination" d) "If she loses weight, then we know the medication is working."
"If she loses weight, then we know the medication is working."
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) "Vocal tics are harder to control than the motor tics are." b) "Drugs are the primary method for controlling the symptoms." c) "He can control the tics if he really concentrates on doing so." d) "If we get him focused on an activity, the tics will be less pronounced."
"If we get him focused on an activity, the tics will be less pronounced." 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 discussing clinical manifestations with a group of parents of children who have been diagnosed with autism spectrum disorder (ASD). Which statement by a parent should lead the nurse to question the diagnosis of their child? "My child is not able to react to social cues." "My child engages in repetitive behaviors." "My child understands the language of older children." "My child displays self-destructive behavior."
"My child understands the language of older children." While children with autism may have high IQs, they do not understand the nuances of language and therefore do not comprehend well beyond the complexity of their age, so this is not a clinical manifestation that supports the diagnosis. Clinical manifestations that support the diagnosis of ASD include the inability to react accordingly to social cues, engaging in repetitive behaviors, and displaying self-destructive behavior.
A community health nurse is visiting her 16-year-old patient, a new mother. The nurse explains to the patient and her mother the genetic screening that is required by the state's law. The patient asks why it is important to have the testing done on the infant. What is the nurse's best response? a) "This testing is required and you will not be able to refuse it. It usually is free so there is no reason to refuse it." b) "Genetic testing is a way to determine the rate of infectious disease." c) "It is important to test newborns for PKU, congenital hypothyroidism, and galactosemia." d) "PKU, congenital hypothyroidism, and galactosemia are conditions that could result in disability or death if untreated."
"PKU, congenital hypothyroidism, and galactosemia are conditions that could result in disability or death if untreated." Correct Explanation: The first aim is to improve management, that is, identify people with treatable genetic conditions that could prove dangerous to their health if left untreated. The other answers are incorrect because genetic testing does not determine the rate of infectious disease. Answer B does not adequately explain the rationale for newborn testing. Answer D fails to inform the patient of the rationale for newborn testing.
The parents of a child diagnosed with Tay-Sachs inquire about progression of the disorder. Which statement by the nurse is accurate? a) "Anticonvulstants will be given to prolong life and prevent further brain damage." b) "Lifetime steroid therapy will reverse the blindness." c) "The child will experince decreased muscular and neurologic functioning until death occurs." d) "Symptoms can be controlled by eliminating dairy products."
"The child will experince decreased muscular and neurologic functioning until death occurs." Correct 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 nurse is counseling a couple who are concerned that their children might inherit sickle cell disease. Which of the following responses from the couple indicate a need for further teaching? a) "The disorder can be passed on to the children only if both parents have the gene." b) "If both parents have the gene, there is a 25% chance of the children having the disorder." c) "The father cannot pass the disorder onto his son or the mother to her daughter." d) "Even if the children do not get the disease they can still be carriers of the gene."
"The father cannot pass the disorder onto his son or the mother to her daughter." Correct Explanation: The father can pass the gene to his sons and the mother can pass the gene to her daughters. Sickle cell disease is an autosomal recessive disease. This means that both parents must have the disease or be carriers of the gene in order to pass it onto their children. If the parents are both carriers, then there is a 25% chance that they will pass it onto a child. The children can be carriers even if they don't have the disease.
The nurse is presenting to a group of parents whose children are suspected of having autism spectrum disorder (ASD). Which statement by the nurse should be included? "The features of autism are typically apparent by the time a child is 3 years of age." "You should notice deficits in your child by the age of 5." "A feature of ASD is the ability to understand nonverbal behavior." "A child with ASD should be able to successfully engage in imaginative play."
"The features of autism are typically apparent by the time a child is 3 years of age." The essential features of ASD (social deficits, language impairment, and repetitive behaviors) typically become apparent by the time a child is 3 years of age, not 5. The child with ASD is unable to read nonverbal behavior or engage in imaginative play.
Which statement by the nurse accurately describes the term phenotype? a) "The genetic makeup of an individual" b) "The somatic cells of an individual" c) "The individual's outward appearance" d) "Only the homozygous genes outwardly expressed"
"The individual's outward appearance" Correct Explanation: Phenotype is the outward characteristic of an individual. The genetic makeup of an individual is a genotype. A somatic cell is an individual cell that combines with others to form an organism. Phenotype can be determined by both homozygous genes and heterozygous genes.
The nurse is working with a group of caregivers of school-age children diagnosed with attention deficit hyperactivity disorder. Which of the following statements would be most appropriate for the nurse to make to this group of caregivers? a) "These children function best if given a set of instructions and then left to do the task." b) "These children study better with quiet background music such as the radio or a CD." c) "The medications your child is on may cause a decreased appetite." d) "A frequent change in routine will be helpful so the child does not get bored."
"The medications your child is on may cause a decreased appetite."
Which statement by the nurse is most accurate when counseling a couple about transmitting Huntington's disease from father to child? a) "A daughter cannot be a carrier of the disease because it is an X-linked recessive disorder." b) "There is a 50% chance of transmission of the disorder because it is an autosomal dominant disorder." c) "You will transmit the disorder to a son because it is an X-linked dominant disorder." d) "There is a 75% chance that your offspring will express the disorder because it is an autosomal recessive disorder."
"There is a 50% chance of transmission of the disorder because it is an autosomal dominant disorder." Correct Explanation: An offspring of an autosomal dominant disorder has a 50% chance of acquiring the gene to be affected by the disorder. Huntington's is an autosomal dominant disorder. Female offspring of an X-linked recessive disorder have the possibility of being a carrier or of being afflicted with the disorder. With autosomal recessive disorders, there is only a 25% chance that the offspring will express the disorder.
A nurse is teaching about autosomal dominant and recessive genetics. Which statement by the nurse is accurate? a) "Two abnormal genes, one from each parent, are required to produce the phenotype in an autosomal recessive disorder." b) "An autosomal dominant disorder is classified as X-linked." c) "One abnormal autosomal recessive gene is needed for outward presentation of the disorder." d) "An autosomal dominant disorder has a lower risk of phenotyping than an autosomal recessive disorder."
"Two abnormal genes, one from each parent, are required to produce the phenotype in an autosomal recessive disorder." Correct 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.
The nurse is addressing a group of parents whose children are suspected of having autism spectrum disorder (ASD). Which statement by the parents indicates that additional teaching is necessary? "The essential features of autism are typically noticed by 3 years of age." "We should notice deficits in our children by the age of 5." "A feature of ASD is the inability to understand nonverbal behavior." "A child with ASD should will not engage in imaginative play."
"We should notice deficits in our children by the age of 5." The essential features of ASD (social deficits, language impairment, and repetitive behaviors) typically become apparent by the time a child is 3 years of age, not 5. The child with ASD is unable to read nonverbal behavior or engage in imaginative play.
A nurse is providing a routine wellness examination and follow-up for a 3-year-old recently diagnosed with autism spectrum disorder (ASD). Which response indicates a need for additional referral or follow-up? a) "We really like the treatment plan that has been created by his school." b) "We have a couple of baby sitters who know how to handle his needs." c) "We have recently completed his individualized education plan." d) "We try to be flexible and change his routine from day to day."
"We try to be flexible and change his routine from day to day."
The nurse is performing discharge teaching for a child who is diagnosed with autism spectrum disorder (ASD) with the child's parents. Which statement by the parents indicates that the teaching was successful? "We will remind our child that he will never be normal." "We will avoid all childhood vaccinations until our child reaches adulthood." "We will repeat treatments performed at the clinic and hospital at home." "We will feed our child a diet that is rich in gluten.
"We will repeat treatments performed at the clinic and hospital at home." The nurse would encourage repetition of treatments for the patient at home in order to enhance effective treatment. It is not appropriate for the nurse to emphasize that the patient will never be normal. It is not necessary to avoid childhood vaccinations. The nurse would educate the patient not to consume foods rich in gluten.
The nurse is teaching parents how to communicate with their child who is diagnosed with autism spectrum disorder (ASD). Which statement by the parents indicates that further teaching is necessary? "We will use more complete sentences in talking with our child." "We will use pictures in talking with our child." "We will take our child to speech and language therapy." "We will try using sign language with our child."
"We will use more complete sentences in talking with our child." Patients with ASD have difficulties communicating. To improve communication, parents should use short, direct sentences. Pictures or other visual aids or sign language may also be used to enhance communication. The patient should benefit from speech and language therapy.
The nurse is planning care for a young, nonverbal patient with autism spectrum disorder. In order to plan the best care for the child, which question is most important for the nurse to ask the child's parents? "What are some of your child's rituals that we can incorporate into daily care?" "How do you supervise your child to prevent infection?" "Which one method of communication is best to use with your child?" "How do you complete the activities for daily living for your child?"
"What are some of your child's rituals that we can incorporate into daily care?" An appropriate intervention for a patient with ASD is to incorporate the patient's rituals into daily care. The nurse would supervise the patient closely to enhance safety, not to prevent infection. The nurse would adapt communication style to meet the needs of the patient. The nurse would encourage the patient to participate fully in care. Therefore, the nurse would not complete all activities of daily living for the patient.
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) "What are the specific changes you have seen in your daughter since your move?" b) "How is the rest of the family reacting to the move?" c) "Do you think your daughter is depressed?" d) "Was your daughter happy in her previous school?"
"What are the specific changes you have seen in your daughter since your move?"
A 16-year-old recently diagnosed with Marfan syndrome states, "I feel fine. Why do I need to have this testing done?" What is the best response by the nurse? a) "You want to live a long time, right?" b) "You are at risk of rupturing your aorta, and the echocardiogram will let us know if there are any problems." c) "This is routine. Nothing to worry about." d) "The lab work will let us know if you are developing diabetes as a complication."
"You are at risk of rupturing your aorta, and the echocardiogram will let us know if there are any problems." Correct Explanation: Marfan sydrome is a disorder that affects connective tissue. The aorta is susceptible to weakening because of the connective tissue disorder, leading to sudden death from aortic dissection. Diabetes is not a complication of Marfan. The other two choices offer no information and dismiss the teen's concerns.
The mother of a 10-year-old boy with attention deficit hyperactivity disorder (ADHD) contacts the school nurse. She is upset because her son has been made to feel different by his peers because he has to visit the nurse's office for a lunch time dose of medication. The boy is threatening to stop taking his medication. How should the nurse respond? a) "He will need to learn to ignore the children, he needs this medication." b) "You may want to talk to your physician about an extended release medication." c) "I can have the teacher speak with the other children." d) "Remind him that his schoolwork may deteriorate."
"You may want to talk to your physician about an extended release medication."
A child with autism spectrum disorder is hospitalized for a treatment that will last about 1 week. How should the nurse make the child comfortable? 1 Ask the parents to accompany the child. 2 Modify the room according to the child's needs. 3 Explain the surroundings of the room. 4 Help the child perform daily routine tasks.
1 Children with autism spectrum disorders often are uncomfortable in a new environment and may not like to be with strangers. Therefore children with an autism spectrum disorder must be accompanied by their parents during hospitalization. While caring for a visually impaired child, the nurse modify the room according to the needs of the child. This helps prevent accidents. Because the child is not visually impaired, the nurse need not explain the surroundings of the room. Children with autism spectrum disorders often do not like assistance and prefer to perform their daily chores by themselves. Therefore the nurse should not help the child with such activities.
The nurse is assessing a newborn with Down syndrome. The newborn's parent tells the nurse, "We are having a hard time holding our baby. We didn't have this hard of a time with our other children." What would be the nurse's best response? 1 "Children with Down syndrome have lower muscle tone." 2 "This happens in some children because of undeveloped bonding." 3 "Are you more apprehensive because your child has Down syndrome?" 4 "You should see a counselor to help you cope with your child's condition."
1 Newborns with Down syndrome have joint hyperflexibility and low muscle tone. This can make it difficult to hold the newborn because he or she can go limp like a rag doll. This makes it difficult for the parents to embrace and provide warmth to their newborn. This may make parents feel that the newborn is not bonding with them, but difficulty holding the child does not indicate impaired bonding between the child and parents. Inability to understand the child's needs and nonverbal communication indicates undeveloped bonding. Asking the parents whether they are more apprehensive does not answer their question. It is also a closed-ended question, which is not therapeutic communication. Telling the parents they need to see a counselor is not appropriate. They just need support and teaching.
A week-old newborn is assessed for body weight, birth marks, and height. The birth weight is lower than what it should be for height. Which physical feature of the newborn makes the nurse conclude that the newborn is affected by Down syndrome? 1 Short and broad neck 2 Long and thin fingers 3 Short and thin lips 4 Broad and long nose
1 One of the characteristics of Down syndrome is a short, broad neck. These children have an impaired immune system and are at risk for spinal cord compression. Physical features such as long and thin fingers, short and thin lips, and broad and long nose are all common in a normal child and do not indicate any abnormality.
A client has a history of major depressive disorder (MDD). Police escort the client to the ED after finding the client nude at an ATM, screaming for money to pay off credit card debt. What would make the ED psychiatrist question the client's prior diagnosis? 1) The client is experiencing symptoms of mania. 2) The client is experiencing symptoms of a severe anxiety disorder. 3) The client is experiencing symptoms of an amnestic disorder. 4) The client is experiencing symptoms of a histrionic personality disorder.
1 Rationale The DSM-5 criteria for the diagnosis of MDD rule out this diagnosis if the client has ever experienced a manic episode. The symptoms described in the question indicate that this client is experiencing a manic episode. Therefore, it would be appropriate for the ED psychiatrist to question the diagnosis of MDD.
A client being treated for depression asks the nurse what causes this illness. Which response by the nurse is the most accurate, evidence-based statement? 1) "The etiology of depression is unclear. Evidence supports there may be several different causative factors." 2) "Depression has been proven to be the result of an imbalance in certain neurotransmitters." 3) "Depression is transmitted by a specific gene for the illness." 4) "Depression has been proven to develop as a result of negative thinking patterns."
1 Rationale This is the most accurate, evidence-based statement about causative factors for depression. Although several theories have been advanced, no single cause for depression has been identified conclusively.
A woman carries a recessive gene for sickle cell anemia. If her sexual partner also has this recessive gene, the chance that her first child will develop sickle cell anemia is a) 0 in 4. b) 2 in 4. c) 1 in 4. d) 3 in 4.
1 in 4. Correct Explanation: Autosomal recessive inherited diseases occur at a 1-in-4 incidence in offspring.
A nurse is counseling a client diagnosed with bulimia nervosa about the symptom of tooth enamel deterioration. Which explanation for this complication of bulimia nervosa, should the nurse provide? 1. The emesis produced during purging is acidic and corrodes the tooth enamel. 2. Purging causes the depletion of dietary calcium. 3. Food is rapidly ingested without proper mastication. 4. Poor dental and oral hygiene leads to dental caries.
1 ~ The nurse should explain to the client diagnosed with bulimia nervosa that her teeth will eventually deteriorate, because the emesis produced during purging is acidic and corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance.
A nurse is attempting to differentiate between the symptoms of anorexia nervosa and the symptoms of bulimia. Which statement delineates the difference between these two disorders? 1. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not. 2. Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not. 3. Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not. 4. Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not.
1 ~ The nurse should understand that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia do not. Anorexia is characterized by a morbid fear of obesity and often results in low caloric and nutritional intake. Bulimia is characterized by episodic, rapid consumption of large quantities of food followed by purging.
A nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions? (SATA) 1. Binge eating with a diagnosis of obesity 2. Bingeing and purging with a diagnosis of bulimia nervosa 3. Weight loss with a diagnosis of anorexia nervosa 4. Amenorrhea with a diagnosis of anorexia nervosa 5. Emaciation with a diagnosis of bulimia nervosa
1, 2 ~ The nurse should identify that topiramate is the drug of choice when treating binge eating with a diagnosis of obesity or bingeing and purging with a diagnosis of bulimia nervosa. Topiramate is an anticonvulsant that produces a significant decline in binge frequency and reduction in body weight.
The nurse is assessing a child with autism for prognostic factors. What findings in the child suggest a better prognosis? Select all that apply. 1 Male sex 2 Early recognition 3 Functional speech 4 Lower intelligence 5 Behavioral impairment
1, 2, 3 Male sex carries a more favorable prognosis than female sex. Early recognition allows early intervention to help the child recover. Children with functional speech have a better prognosis than those who do not have functional speech. Children with higher intelligence have a more favorable prognosis than children with lesser intelligence. Children who do not have behavioral impairment have a better prognosis than children with behavioral impairment.
A client diagnosed with major depression is being discharged from the hospital with a prescription for fluoxetine (Prozac). The nurse's discharge teaching should include which of the following? Select all that apply. 1) "It may take a few weeks before you begin to feel better; however, continue taking Prozac as prescribed." 2) "Make sure that you follow up with scheduled outpatient psychotherapy." 3) "If significant mood elevation is noted, your psychiatrist may discontinue this medication within 6 months to a year." 4) "You should avoid foods with tyramine, including beer, beans, processed meats, and red wine." 5) "You can discontinue the Prozac when you are feeling better."
1, 2, 3 Rationale Feedback 1: The nurse should inform the client that it is important to take Prozac as prescribed and that the therapeutic effect can take up to 4 weeks to be realized. Feedback 2: Along with medication compliance, the nurse should also stress the importance of follow-up psychotherapy. Feedback 3: The nurse should advise the client to discontinue the medication only under a doctor's supervision. Although the medication may be tapered and stopped after 6 months, there is a risk for further depressive episodes. Feedback 4: Avoidance of foods with tyramine would hold true if the client were taking an MAOI, not a selective serotonin reuptake inhibitor, such as Prozac. Feedback 5: The client should be advised to not stop taking Prozac abruptly. To do so might produce withdrawal symptoms such as nausea, vertigo, insomnia, headache, malaise, and nightmares.
The nurse is conducting an assessment for Leroy, a 65-year-old man who presented at the health clinic with complaints of depression. He lists several medications he has been taking. Of the following medications on his list, which are known to produce a depressive syndrome? Select all that apply. 1) Prednisone 2) Cimetidine (Tagamet) 3) Ampicillin 4) Ibuprofen (Advil) 5) Aspirin
1, 2, 3, 4 Rationale Feedback 1: Prednisone is a steroid medication that can produce depression. Feedback 2: Cimetidine is an anti-ulcer medication that can produce depression. Feedback 3: Ampicillin is an antibacterial medication that can produce depression. Feedback 4: Ibuprofen is an analgesic/anti-inflammatory medication that can produce depression. Feedback 5: Aspirin has not been associated with producing depression.
The nurse is assessing a child with autism. What characteristic features of autism does the nurse expect to find in the child? Select all that apply. 1 Verbal impairment 2 Stereotyped behavior patterns 3 Hearing and visual impairment 4 Nonrepetitive behavioral patterns 5 Decreased involvement in play
1, 2, 5 Children with autism usually have verbal impairment caused by poor language development. Autistic children exhibit stereotyped behavioral patterns caused by impaired neuromuscular function. Such children show decreased interest in functional play activities. Autistic children do not usually have hearing and visual impairment. Autistic children exhibit repetitive behavioral patterns.
A pregnant woman is diagnosed with a rubella infection during a prenatal checkup. What does the nurse expect the health care provider will tell the patient? Select all that apply. "The newborn may: 1 Have vision difficulties." 2 Have growth impairment." 3 Have difficulty hearing." 4 Develop breathing problems." 5 Not be able to concentrate."
1, 3 Rubella infections during pregnancy may cause hearing and visual loss in the newborn. However, these impairments may disappear as the child grows. Rubella infections do not cause growth retardation. Growth hormone deficiency or Turner syndrome can lead to growth impairment. Respiratory disorders or allergic reactions can result from hypersensitivities and can cause difficulty breathing in the newborn. A decreased ability to concentrate indicates impaired cognition. It usually results from inadequate intake of omega-3 fatty acids by the mother during pregnancy.
The nurse is assessing a patient with strabismus. Which finding would suggest the cause of strabismus? Select all that apply. 1 Poor vision 2 Short eyeball 3 Congenital defect 4 Muscle imbalance 5 Unequal curvature in the lens
1, 3, 4 Strabismus may result from poor vision and the resulting straining of eye muscles. Strabismus may result from a congenital defect as a developmental anomaly. Strabismus may also result from muscle imbalance caused by neuromuscular disorders. Short eyeball results in development of hyperopia, not strabismus. Unequal curvature of lens results in astigmatism, not strabismus.
Which of the following would contribute to a clients excessive weight gain? (SATA) 1. A hypothalamus lesion 2. Hyperthyroidism 3. Diabetes mellitus 4. Cushings disease 5. Low levels of serotonin
1, 3, 4 ~ Lesions in the appetite and satiety centers in the hypothalamus may contribute to overeating and lead to obesity. Hypothyroidism, not hyperthyroidism, is a problem that interferes with basal metabolism and may lead to weight gain. Weight gain can also occur in response to the decreased insulin production of diabetes mellitus and the increased cortisone production of Cushing's disease. New evidence also exists to indicate that low levels of the neurotransmitter serotonin may play a role in compulsive eating.
A client has been diagnosed with major depression. The psychiatrist prescribes imipramine (Tofranil). Which of the following medication information should the nurse include in discharge teaching? Select all that apply. 1) "The medication may cause dry mouth." 2) "The medication may cause urinary incontinence." 3) "The medication should not be discontinued abruptly." 4) "The medication may cause photosensitivity." 5) "The medication may cause nausea."
1, 3, 4, 5 Rationale Feedback 1: Dry mouth can occur with all antidepressants, including imipramine. Feedback 2: Urinary retention, not incontinence, may occur when taking imipramine. Feedback 3: Antidepressants such as imipramine must be tapered and not stopped abruptly. Feedback 4: Tricyclic antidepressants such as imipramine can cause photosensitivity, whereas other types of antidepressants do not. Therefore, the client must be educated specifically about this potential side effect. Feedback 5: Nausea can occur with all antidepressants, including imipramine.
A nursing instructor is teaching about the DSM-5 criteria for the diagnosis of binge-eating disorder. Which of the following student statements indicates that further instruction is needed? (SATA) 1. In this disorder, binge eating occurs exclusively during the course of bulimia nervosa. 2. In this disorder, binge eating occurs, on average, at least once a week for three months. 3. In this disorder, binge eating occurs, on average, at least two days a week for six months. 4. In this disorder, distress regarding binge eating is present. 5. In this disorder, distress regarding binge eating is absent.
1, 3, 5 ~ According to the DSM-5 criteria for the diagnosis of binge-eating disorder, binge eating should not occur exclusively during the course of anorexia nervosa or bulimia nervosa. The new time frame criteria in the DSM-5 states that binge eating must occur, on average, at least once a week for three months not two days a week for six months. The DSM-5 criteria states that distress regarding binge eating would be present.
A child diagnosed with severe mental retardation becomes aggressive with staff members when faced with the inability to complete simple tasks. Which nursing diagnosis would reflect this client's problem? 1. Ineffective coping R/T inability to deal with frustration. 2. Anxiety R/T feelings of powerlessness and threat to self-esteem. 3. Social isolation R/T unconventional social behavior. 4. Risk for injury R/T altered physical mobility.
1. A child diagnosed with severe mental retardation (IQ level 20 to 34) who strikes out at staff members when not being able to complete simple tasks is using aggres- sion to deal with frustration. Ineffective coping related to inability to deal with frustration is the appropriate nursing diagnosis for this child.
Which of the following signs and symptoms supports a diagnosis of depression in an adolescent? Select all that apply. 1. Poor self-esteem. 2. Insomnia and anorexia. 3. Sexually acting out and inappropriate anger. 4. Increased serotonin levels. 5. Exaggerated psychosomatic complaints.
1. A symptom of depression in adolescence is poor self-esteem. Puberty and maturity are gradual process and vary among indi- viduals. An adolescent may experience a lack of self-esteem when his or her expec- tations of maturity are not met or when they compare themselves unfavorably with peers. 2. Eating and sleeping disturbances are common signs and symptoms of depression in adolescents. 3. Acting out sexually and expressing inap- propriate anger are symptoms of depres- sion in adolescence. The fluctuating hormone levels that accompany puberty contribute to these behaviors. A manifestation of behavioral change that lasts for several weeks is the best indicator of a mood disorder in an adolescent. 5. Exaggerated psychosomatic complaints are symptoms of depression in adolescence. Between the ages of 11 and 16, normal rapid changes to the body occur, and psy- chosomatic complaints are common. These complaints must be differentiated from the exaggerated psychosomatic complaints that occur in adolescent depression.
The theory of family dynamics has been implicated as contributing to the etiology of conduct disorders. Which of the following are factors related to this theory? Select all that apply. 1. Frequent shifting of parental figures. 2. Birth temperament. 3. Father absenteeism. 4. Large family size. 5. Fixation in the separation individuation phase of development.
1. According to the theory of family dynam- ics, frequent shifting of parental figures has been implicated as a contributing factor in the predisposition to conduct disorder. An example of frequent shifting of parental figures may include, but is not limited to, divorce, death, and inconsistent foster care. 3. According to the theory of family dynam- ics, the absence of a father, or the pres- ence of an alcoholic father, has been implicated as a contributing factor to the diagnosis of conduct disorder. 4. According to the theory of family dynam- ics, large family size has been implicated as a contributing factor in the predisposition to conduct disorder. The quality of family relationships needs to be assessed for evi- dence of overcrowding, poverty, neglect, and abuse to determine this risk factor.
Which is a description of the etiology of autism from a genetic perspective? 1. Parents who have one child diagnosed with autism are at higher risk for having other children with the disorder. 2. Amygdala abnormality in the anterior portion of the temporal lobe is associated with the diagnosis of autism. 3. Decreased levels of serotonin have been found in individuals diagnosed with autism. 4. Congenital rubella is implicated in the predisposition to autistic disorders.
1. Research has revealed strong evidence that genetic factors may play a significant role in the etiology of autism. Studies show that parents who have one child with autism are at an increased risk for having more than one child with the dis- order. Also, monozygotic and dizygotic twin studies have provided evidence of genetic involvement.
A client diagnosed with moderate mental retardation suddenly refuses to participate in supervised hygiene care. Which short-term outcome would be appropriate for this individual? 1. The client will comply with supervised hygiene by day 3. 2. The client will be able to complete hygiene without supervision by day 3. 3. The client will be able to maintain anxiety at a manageable level by day 2. 4. The client will accept assistance with hygiene by day 2.
1. With appropriately implemented inter- ventions that direct the client back to previously supervised hygiene perform- ance, the short-term outcome of client compliance and participation by day 2 can be a reasonable expectation. To achieve this outcome, interventions might include exploring reasons for non- compliance; maintaining consistency of staff members; or providing the client with familiar objects, such as an old ver- sus new toothbrush.
The nurse assesses an infant at birth for height, weight, and other vital signs. What should the nurse include in the assessment to identify a conductive hearing disorder? The nurse assesses: 1 To see whether the infant's eyes move toward a flashlight. 2 The infant's response to an auditory stimulus. 3 The infant's vocal expressions during vocal communication. 4 The infant's physical activity toward a large moving object.
2 Assessment of an infant's response to auditory stimulation is used to detect a conductive hearing impairment in the newborn. Because the nurse suspects hearing impairment, the infant might have failed to respond to auditory stimulus. Eye movement following a flashlight helps in assessing the infant's vision. Vocal expressions or sounds produced in response to communication may indicate whether the infant has a speech or hearing impairment. Assessment of infant's physical activity toward a large moving object is useful to assess the child's muscle coordination. It also tests the infant's visual abilities.
The parent of a 2-year-old child tell the nurse that the child likes to play alone and asks people to repeat questions several times. The parent also says that the child uses gestures to communicate. What should the nurse infer from this? The child has: 1 Cognitive impairment. 2 Difficulty hearing. 3 Normal development. 4 Chronic mental illness.
2 Children 2 to 3 years old understand the common language used at home, and they try to communicate with family members in the same language. If the child has difficulty understanding and responding after the parent repeats a statement several times, this may indicate the child has a hearing problem. The child does not have lack of orientation, so the nurse should not infer that the child has cognitive impairment. Children stop using gestures and start communicating verbally around the age of 15 months. Therefore the child does not have normal development. The child is not bullying or being aggressive, so the nurse should not infer that the child has a chronic mental illness.
When teaching about the tricyclic group of antidepressant medications, which information should the nurse include? 1) Strong or aged cheese should not be eaten while the client is taking this group of medications. 2) The full therapeutic potential of tricyclics may not be reached for 4 weeks. 3) Tricyclics may cause hypomania or recent memory impairment. 4) Tricyclics should not be given with antianxiety agents.
2 Rationale A client needs to be advised that it may take several weeks for tricyclic medications to reach their full therapeutic effect.
Chloe is suffering from depression and not responding to antidepressant treatment. She asks the nurse to tell her more about transcranial magnetic stimulation (TMS). Which of the following responses is accurate with regard to this treatment modality? 1) TMS uses magnetic energy to induce a seizure. 2) One study concluded that electroconvulsive therapy was more effective than TMS for short-term treatment of depression. 3) TMS is a safe and inexpensive treatment for depression. 4) TMS has been demonstrated to be more effective than any other treatment modality for depression.
2 Rationale This is an accurate, evidence-based statement. Patients often rely on nurses to provide current accurate information about new or experimental treatment modalities, so it is important for nurses to continue to evaluate current evidence in order to provide patients with the most up-to-date, accurate information.
The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing response? 1. Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions. 2. Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve. 3. Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support. 4. Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed.
2 ~ The nurse should educate the family on the correlation between certain familial patterns and anorexia nervosa. Families engaging in conflict avoidance and struggling with issues of power and control may contribute to the development of anorexia nervosa.
Janice is diagnosed with major depressive disorder and is beginning to participate in a cognitive therapy group. As the nurse is orienting Janice to the group, which of the following statements about cognitive therapy are accurate? Select all that apply. 1) Cognitive therapy is designed to focus on emotional dysregulation. 2) Cognitive distortions, such as negative expectations about oneself, serve as the basis for depression. 3) Cognitive therapy focuses on altering mood by changing the way one thinks. 4) Cognitive distortions arise out of a defect in cognitive development. 5) Cognitive therapy explores pent-up rage that has been turned against oneself because of identification with the loss of a loved object.
2, 3, 4 Rationale Feedback 1: In cognitive therapy the focus is on cognitive distortions. Emotional dysregulation is the central focus of dialectical behavior therapy. Feedback 2: Beck et al. (1979) postulated that negative and irrational thinking contribute to depression. These are referred to as cognitive distortions. Feedback 3: A primary assumption in cognitive therapy is that changing the way one thinks will change one's mood. Specifically, developing patterns of more rational and positive thinking will improve one's mood. Feedback 4: In cognitive theory, it is assumed that cognitive distortions arise from a defect in cognitive development, which culminates in an individual thinking that he or she is worthless, inadequate, and rejected by others. These patterns of thinking need to be corrected to promote a positive change in mood. Feedback 5: The concept of rage turned inward is based in psychoanalytical theory, not cognitive theory.
Emily has been receiving treatment for major depressive disorder over several weeks. She is taking an antidepressant and attending cognitive behavioral therapy group once a week. When the nurse evaluates her progress in treatment, which of the following are indications that the depression is improving? Select all that apply. 1) Emily is taking the antidepressant medication as ordered. 2) Emily is expressing hope that she can return to her university classes soon and continue her education. 3) Emily demonstrates ability to make decisions concerning her own self-care. 4) Emily reports that suicide ideas have subsided. 5) Emily is engaging in activities that she enjoys.
2, 3, 4, 5 Rationale Feedback 1: Adherence to the medication regime does not presume effectiveness. More relevant indications would be the patient's report of improved mood, improved sleep and rest, and increase in energy. Feedback 2: Hopelessness is a characteristic symptom in major depressive disorder, and a return to expressing hopefulness is an indicator of improvement. Feedback 3: Indecisiveness is a symptom in depression, and a return to the ability to make decisions is an indication of improvement. Feedback 4: Suicide ideas can be pervasive and troubling symptoms in depression. When they begin to abate, it may be an indication that the depression is lifting. Feedback 5: One of the symptoms in major depressive disorder is lack of interest in activities that one used to enjoy. The return of interest in activities and in social interaction are indications that the depression is abating.
Susan is being seen in the emergency department. Her sister brought her in with concern that Susan is depressed and might be suicidal. Which of the following questions are priorities for the nurse to ask when assessing for suicide risk? Select all that apply. 1) "Why are you feeling depressed and suicidal?" 2) "Are you having thoughts of hurting or killing yourself?" 3) "When you have these thoughts, do you have a plan in mind?" 4) "Do you ever feel like you want to hurt someone else?" 5) "Are you currently using any drugs or alcohol?"
2, 3, 5 Rationale Feedback 1: This question is not relevant and, in general, is nontherapeutic. It challenges the client and does not identify level of suicide risk. Feedback 2: Asking this question elicits information about whether the client is having suicide ideation and promotes further assessment of how often, how intrusive, and how intentional the person perceives these ideas to be. Feedback 3: Asking this question allows the nurse to assess whether the client's thoughts have become more specific and intentional. It also allows the nurse to assess the lethality of means, which is important information in assessing suicide risk. Additional assessment should include an assessment of whether or not the client has access to the identified means for attempting suicide. Feedback 4: This question is directed toward assessing other directed violence and/or homicidal ideation rather than suicidal ideation. Feedback 5: This is a priority question, since evidence supports that substance abuse by people with depression and suicidal ideation increases the risk for suicide.
A child diagnosed with an autistic disorder withdraws into self and, when spoken to, makes inappropriate nonverbal expressions. The nursing diagnosis impaired verbal communication is documented. Which intervention would address this problem? 1. Assist the child to recognize separateness during self-care activities. 2. Use a face-to-face and eye-to-eye approach when communicating. 3. Provide the child with a familiar toy or blanket to increase feelings of security. 4. Offer self to the child during times of increasing anxiety.
2. A child diagnosed with an autistic disorder has impairment in communication affect- ing verbal and nonverbal skills. Nonverbal communication, such as facial expression, eye contact, or gestures, is often absent or socially inappropriate. Eye-to-eye and face-to-face contact expresses genuine interest in, and respect for, the individual. Using an "en face" approach role-models correct nonverbal expressions.
Which is associated with the etiology of Tourette's disorder from a biochemical per- spective? 1. An inheritable component, as suggested by monozygotic and dizygotic twin studies. 2. Abnormal levels of several neurotransmitters. 3. Prenatal complications, including low birth weight. 4. Enlargement of the caudate nucleus of the brain.
2. Abnormalities in levels of dopamine, sero- tonin, dynorphin, gamma-aminobutyric acid, acetylcholine, and norepinephrine have been associated with Tourette's dis- order. This etiology is from a biochemical perspective.
A child diagnosed with oppositional defiant disorder begins yelling at staff members when asked to leave group therapy because of inappropriate language. Which nursing intervention would be appropriate? 1. Administer PRN medication to decrease acting-out behaviors. 2. Accompany the child to a quiet area to decrease external stimuli. 3. Institute seclusion following agency protocol. 4. Allow the child to stay in group therapy to monitor the situation further.
2. Accompanying the child to a quiet area to decrease external stimuli is the most ben- eficial action for this child. This action would aid in decreasing anger and hostility expressed by the child's outburst and inappropriate language. Later, the nurse may sit with the child and develop a system of rewards for compliance with therapy and consequences for noncompliance. This can be accomplished by starting with minimal expectations and increasing these expectations as the child begins to mani- fest evidence of control and compliance.
A child admitted to an in-patient psychiatric unit is diagnosed with separation anxiety disorder. This child is continually refusing to go to bed at the designated time. Which nursing diagnosis best documents this child's problem? 1. Noncompliance with rules R/T low self-esteem. 2. Ineffective coping R/T hospitalization and absence of major attachment figure. 3. Powerlessness R/T confusion and disorientation. 4. Risk for injury R/T sleep deprivation.
2. Ineffective coping is defined as the inability to form a valid appraisal of the stressors, ineffective choices of practice responses, or inability to use available resources. A child diagnosed with separation anxiety often refuses to go to school or bed because of fears of separation from home or from individuals to whom the child is attached. The child in the question is refusing to go to bed as a way to cope with fear and anxiety. The nursing diagnosis of ineffective coping would be an appropriate documentation of this client's problem.
A child with fragile X syndrome was prescribed clonidine (Catapres) to improve attention and decrease hyperactivity. What other intervention may improve the child's cognitive ability? 1 Aromatherapy and hydrotherapy 2 Protein replacement and gene therapy 3 Language and occupational therapy 4 Hormone and biologic therapy
3 Children with fragile X syndrome have impaired cognitive development and may be prescribed clonidine (Catapres) to improve attention span and decrease hyperactivity. Other interventions that can improve cognitive ability in these children include speech and language therapies, occupational therapy, and special educational programs. Aromatherapy and hydrotherapy are useful for reducing stress and anxiety. Protein and gene replacement involves replacing the defected gene. It does not improve cognitive ability. Hormone therapy can be given to treat endocrine disorders. Biotherapy is given to strengthen the patient's immunity.
Lamont has been scheduled for electroconvulsive therapy (ECT) and asks the nurse, "Is it true what I heard, that ECT causes brain damage?" Which of these would be the most appropriate, evidence-based response by the nurse? 1) "ECT has no effect on brain function at all." 2) "ECT has only been shown to cause brain damage in the elderly population." 3) "There is no evidence that ECT causes permanent changes in brain structure or function." 4) "Current evidence suggests that brain damage after ECT treatments is related to the anesthetic agents, not the treatment itself."
3 Rationale This is the most accurate statement, based on current evidence. It is identified, however, as an area that needs continuing study.
Ursula has sought counseling for persistent depressive disorder. She identifies that she has "always had low self-esteem" and says "I just let people walk all over me." The nurse is providing psycho-educational groups on improving self-esteem. Ursula would likely benefit from education on which of the following topics? 1) Antipsychotic medications 2) Anger management 3) Assertive communication 4) Alcoholics Anonymous groups
3 Rationale Education in assertive communication is recognized as an intervention to build positive self-esteem. Ursula's statement that she lets people walk all over her is an indication that this would be beneficial education for her.
Hannah is being evaluated for postpartum depression after she reported to her family physician that she just doesn't think she can take care of her baby. She expresses fear that God will take her children from her for being a bad mother. Which of the following is the highest priority for the nurse to assess during the initial interview? 1) The number of children Hannah is currently trying to care for. 2) Availability of support systems in Hannah's family. 3) Risks for suicide and/or infanticide. 4) What time of day the symptoms occur.
3 Rationale The risks for suicide and/or infanticide should not be overlooked. Hannah's concern that she can't care for the baby and that God might take her children raises additional concern that further assessment for these risks is a priority.
A child with strabismus is undergoing treatment for impaired vision of the left eye. The nurse covers the child's right eye with an occlusion patch. Why does the nurse do so? 1 To protect the right eye from dust 2 To reduce intraocular pressure in the left eye 3 To increase vision in the left eye 4 To prevent the child from rubbing the right eye
3 While caring for a child with strabismus, the nurse should cover the unaffected eye with an occlusive patch because it helps stimulate vision and movement in the weaker eye. The main reason for applying an ocular patch is to improve vision in the left eye, not to protect the right eye from dust. Applying an ocular patch on the right eye does not reduce intraocular pressure in the left eye; antiglaucoma medications can be used to reduce intraocular pressure. Applying an occlusion patch will not prevent the child from rubbing his or her eyes. The nurse should explain to the child that rubbing the eyes may cause further damage.
Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which statement regarding a client's home environment should a nurse associate with the development of anorexia nervosa? 1. The home environment maintains loose personal boundaries. 2. The home environment places an overemphasis on food. 3. The home environment is overprotective and demands perfection. 4. The home environment condones corporal punishment.
3 ~ The nurse should assess that a home environment that is overprotective and demands perfection may be a major influence in the development of anorexia nervosa. In adolescence, distorted eating patterns may represent a rebellion against the parents viewed by the child as a means of gaining and remaining in control.
The nurse is assessing a child with Down syndrome. What findings in the child should alert the nurse to report to the health care provider immediately? Select all that apply. 1 Loss of pain sensation 2 Loss of impulse control 3 Loss of established motor skill 4 Loss of established bowel control 5 Loss of established bladder control
3, 4, 5 Loss of established motor skill and bowel and bladder control indicate spinal cord compression and must be reported immediately. The child with Down syndrome may have persistent neck pain caused by spinal cord compression. These children do not have impaired pain sensation. Children with Down syndrome are not aggressive. Loss of impulse control is not seen in such children.
The nursing instructor is explaining the risk factors and pathogenesis of Down syndrome to a group of nursing students. What information should the nurse include in the explanation? Select all that apply. 1 It is caused by a mutation of chromosomes. 2 It is more likely to occur if the paternal age is more than 35 years. 3 It is more likely to occur if the maternal age is more than 35 years. 4 It is caused by acquisition of an extra sex chromosome. 5 It is caused by acquisition of an extra autosomal chromosome.
3, 5 Maternal age more than 35 years increases the risk of having babies with Down syndrome. Down syndrome is caused by the presence of an extra autosomal chromosome. Down syndrome is not caused by a mutation of chromosomes. Advanced paternal age is not a risk factor for Down syndrome. There is no extra sex chromosome in children with Down syndrome.
Which short-term outcome would be considered a priority for a hospitalized child diagnosed with a chronic autistic disorder who bites self when care is attempted? 1. The child will initiate social interactions with one caregiver by discharge. 2. The child will demonstrate trust in one caregiver by day 3. 3. The child will not inflict harm on self during the next 24-hour period. 4. The child will establish a means of communicating needs by discharge.
3. A child diagnosed with a chronic autistic disorder who bites self when care is attempted is at risk for injury R/T self- mutilation. Self-injurious behaviors, such as head banging and hand and arm biting, are used as a means to relieve tension. Considering that the nurse's primary responsibility is client safety, expecting the child to refrain from inflicting self-harm during a 24-hour period is the short-term outcome that should take priority.
A child diagnosed with an autistic disorder makes no eye contact; is unresponsive to staff members; and continuously twists, spins, and head bangs. Which nursing diagnosis would take priority? 1. Personal identity disorder R/T poor ego differentiation. 2. Impaired verbal communication R/T withdrawal into self. 3. Risk for injury R/T head banging. 4. Impaired social interaction R/T delay in accomplishing developmental tasks.
3. Children diagnosed with an autistic disorder frequently head bang because of neurologi- cal alterations, increased anxiety, or catastrophic reactions to changes in the envi- ronment. Because the nurse is responsible for ensuring client safety, the nursing diag- nosis risk for injury takes priority.
A child diagnosed with mild to moderate mental retardation is admitted to the medical/ surgical floor for an appendectomy. The nurse observes that the child is having difficulty making desires known. Which nursing diagnosis reflects this client's problem? 1. Ineffective coping R/T developmental delay. 2. Anxiety R/T hospitalization and absence of familiar surroundings. 3. Impaired verbal communication R/T developmental alteration. 4. Impaired adjustment R/T recent admission to hospital.
3. Impaired verbal communication R/T developmental alteration is the appropri- ate nursing diagnosis for a child diagnosed with mild to moderate mental retardation who is having difficulties making needs and desires understood to staff members. Clients diagnosed with mild to moderate retardation often have deficits in commu- nication.
A child diagnosed with autistic disorder has a nursing diagnosis of impaired social interaction R/T shyness and withdrawal into self. Which of the following nursing interventions would be most appropriate to address this problem? Select all that apply. 1. Prevent physical aggression by recognizing signs of agitation. 2. Allow the client to behave spontaneously, and shelter the client from peers. 3. Remain with the client during initial interaction with others on the unit. 4. Establish a procedure for behavior modification with rewards to the client for appro- priate behaviors. 5. Explain to other clients the meaning behind some of the client's nonverbal gestures and signals.
3. The nurse assumes the role of advocate and social mediator when the nurse remains with the client during initial interactions with others on the unit. The presence of a trusted individual provides a feeling of security and supports the client while learning appropriate socialization skills. 4. Positive reinforcements can contribute to desired changes in socialization behaviors. These privileges are individually deter- mined as staff members learn the client's likes and dislikes. 5. By explaining to peers the meaning behind some of the client's nonverbal gestures, signals, and communication attempts, the nurse facilitates social inter- actions. With this understanding, others in the client's social setting would be more receptive to social interactions.
Tara experienced the death of a parent 2 years ago. She has not been able to work since the death, cannot look at any of the parent's belongings, and cries daily for hours at a time. Which nursing diagnosis most accurately describes Tara's problem? 1) Post-trauma syndrome R/T parent's death. 2) Anxiety R/T parent's death. 3) Coping, ineffective, R/T parent's death. 4) Grieving, complicated, R/T parent's death.
4 Rationale The excessive reactions that the individual continues to exhibit, such as daily crying, inability to return to work, and inability to look at the parent's belongings after a 2-year period, are indicative of dysfunctional or complicated grieving. This individual's grieving response has arrested in the anger stage of grief and is manifested by exaggerated grieving behaviors.
Shelly is a patient on the inpatient psychiatric unit and was diagnosed with major depressive disorder. She is staying in her room and sleeping most of the day. Which of the following approaches by the nurse would best facilitate getting Shelly involved in the occupational therapy group on the unit? 1) "Would you like to go to occupational therapy? It is starting right now." 2) "Let me know what activities you want to be involved in and I'll give you a schedule." 3) "If you don't go to occupational therapy today, you will have to stay in your room for the entire evening." 4) "Occupational therapy is starting in 30 minutes; I'll help you get ready."
4 Rationale This response by the nurse uses an active approach (stating the expected behavior rather than encouraging the patient to decide), provides time to prepare, and offers assistance in the process. This approach would most likely facilitate Shelly's participation in the occupational therapy activities.
The nurse is evaluating a child for suspected autism. Which finding in the child suggests autism? 1 Limited functional play 2 Avoidance of body contact 3 Language delay at an early age 4 Inability to maintain eye contact
4 The hallmark of autism is an inability to maintain eye contact with another person. Limited functional play may be seen in children with autism, but it is not a hallmark of autism. Autistic children also avoid body contact, but it is not a hallmark finding. Language delay at an early age is not a hallmark of autism; however, children with autism may exhibit language delay at an early age.
What nursing care should be provided to a school-aged child with cognitive impairment? 1 Periodic testing of thyroid function 2 Education on sexuality 3 Education on self-care skills for the child 4 Speech therapy referral for the child
4 The nurse should refer the child with cognitive impairment for speech therapy. It helps improve communication and promotes social behavior of the child. Periodic testing of the thyroid function is done if the child has Down syndrome. Thyroid function is not altered in all children with cognitive impairment. Sexual information is given to adolescents with cognitive impairment. Younger school-age children with cognitive impairment may not understand information regarding sexuality. Self-care skills should be taught by the parents to children with cognitive impairment.
A client has been diagnosed with an IQ level of 60. Which client social/communication capability would the nurse expect to observe? 1. The client has almost no speech development and no socialization skills. 2. The client may experience some limitation in speech and social convention. 3. The client may have minimal verbal skills, with acting-out behavior. 4. The client is capable of developing social and communication skills.
4. A client with mild mental retardation (IQ level 50 to 70) would be capable of developing social and communication skills. The client would function well in a struc- tured, sheltered setting.
Which developmental characteristic would be expected of an individual with an IQ level of 40? 1. Independent living with assistance during times of stress. 2. Academic skill to 6th grade level. 3. Little, if any, speech development. 4. Academic skill to 2nd grade level.
4. An IQ level of 40 is within the range of moderate mental retardation (IQ level 35 to 49). Academic skill to 2nd grade level would be a developmental characteristic expected of an individual in this IQ range.
A nurse is counseling a couple who have a 5-year-old daughter with Down syndrome. The nurse recognizes that their daughter's genome is represented by which of the following? a) 47XY21+ b) 46XX5p- c) 46XX d) 47XX21+
47XX21+ Correct Explanation: In Down syndrome, the person has an extra chromosome 21, so this is abbreviated as 47XX21+ (for a female) or 47XY21+ (for a male). 46XX is a normal genome for a female. The abbreviation 46XX5p- is the abbreviation for a female with 46 total chromosomes but with the short arm of chromosome 5 missing (Cri-du-chat syndrome).
A 25-year-old woman who recently underwent genetic testing has just learned that she is heterozygous dominant for Huntington disease. Her husband, however, who also underwent the testing, is free from the trait. What are the odds that the couple will have a child who will inherit the disorder? a) 25% b) 50% c) 75% d) 100%
50% Correct Explanation: If a person who is heterozygous or has a dominant illness gene opposing a recessive healthy gene mates with a person who is free of the trait, the chances are even (50%) a child born to the couple would have the disorder or would be disease and carrier free (that is, carrying no affected gene for the disorder).
A child is receiving therapy in which he is learning to replace automatic negative thought patterns with alternative ones. The nurse interprets this as which type of therapy? A) Cognitive therapy B) Behavioral therapy C) Milieu therapy D) Individual therapy
A
A child with Asperger syndrome has also been diagnosed with depression. The nurse understands that two or more disorders in an individual is termed: A: comorbidity. B: congenital syndrome. C: mental retardation. D: developmental impairment.
A
A nurse is preparing a program for a parent group about various techniques that can be used to manage behavior. Which of the following would the nurse be least likely to include? A) Focus the child's attention on the negative behavior. B) Set limits with the child for responsible behavior. C) Ignore inappropriate behaviors. D) Provide positive feedback for self-control efforts.
A
A school-age child diagnosed with depression is receiving antidepressant therapy. The nurse would instruct the parents to notify the physician immediately if the child demonstrates which of the following? A) Loss of interest B) Gastric upset C) Sedation D) Urinary retention
A
Parents have learned that their 6-year-old child is autistic. The nurse may help the parents to cope by explaining that the child will: A: have abnormal ways of interacting with other children and adults. B: outgrow the condition by early adulthood. C: have average social skills. D: probably have age-appropriate language skills.
A
The nurse identifies a nursing diagnosis of impaired social interaction related to altered social skills as evidenced by impulsivity and intrusive behavior. The nurse plans to identify factors that aggravate the child's behavior for which reason? A) Minimize stimuli that exacerbate the child's undesired behaviors B) Improve the child's ability to deal with external stressors C) Promote increased ability to follow through D) Encourage the child to adopt expectations into his routine
A
The nurse is caring for a 13-year-old boy with a history of inappropriate behavior. Which statement by the mother would lead the nurse to suspect oppositional defiant disorder rather than conduct disorder? A) "He has frequent temper tantrums." B) "He was pulling the neighbor's dog around by his leash." C) "He is constantly lying to me." D) "He has stolen hundreds of dollars from my purse."
A
The nurse is caring for a child with bipolar disorder. The child is taking lithium as ordered. The parents inquire about the potential side effects. Which response by the nurse would be most appropriate? A) "You might see excessive urination and thirst, tremor, nausea, weight gain, and diarrhea." B) "He might experience a significant decrease in his appetite and difficulty sleeping." C) "You need to watch for dry mouth, urinary retention, and constipation." D) "This medication can cause seizures, agitation, headache, and nausea."
A
What is the best intervention when a child with autism is hospitalized? A: Limit the individuals who enter the childs room. B: Perform all of the childs activities of daily living for her. C: Make sure the nurses know this child may be violent. D: Assign the strongest nurse to control the child.
A
20. A group of students are reviewing information about major and minor congenital disorders. The students demonstrate understanding of the information when they identify which of the following as a minor disorder? A) Webbed neck B) Omphalocele C) Cutaneous hemangioma D) Facial asymmetry
A Feedback: A minor congenital anomaly is webbed neck. Omphalocele, cutaneous hemangioma, and facial asymmetry are considered major congenital anomalies.
24. A nursing student is preparing an oral presentation about autosomal recessive inheritance. Which of the following must occur for an offspring to demonstrate signs and symptoms of the disorder with this type of inheritance? A) Both parents must be heterozygous carriers. B) One parent must have the disease. C) The mother must be a carrier. D) The father must be affected by the disease.
A Feedback: Autosomal recessive inheritance occurs when two copies of the mutant or abnormal gene in the homozygous state are necessary to produce the phenotype. In other words, two abnormal genes are needed for the individual to demonstrate signs and symptoms of the disorder. Both parents of the affected person must be heterozygous carriers of the gene (clinically normal, but carriers of the gene).
7. The nurse is obtaining the health history for a 15-month-old boy from the parents. The child is not yet speaking. Which finding would be eliminated as a risk factor for a possible genetic disorder? A) The child is male and Caucasian. B) The grandmother and father have hearing impairments. C) The child was a breech delivery 3 weeks early. D) The mother was 37 when she became pregnant.
A Feedback: Being male and Caucasian are risk factors for acute lymphoblastic leukemia, not genetic disorders. The fact that the child's grandmother and father have hearing impairments suggests a genetic disorder. The facts that the mother was 37 when she became pregnant and had a breech delivery 3 weeks early are also risk factors for genetic disorders.
3. The nurse is caring for 3-day-old girl with Down syndrome whose mother had no prenatal care. Which of the following will be the priority nursing diagnosis? A) Imbalanced nutrition, less than body requirements related to the effects of hypotonia B) Deficient knowledge related to the presence of a genetic disorder C) Delayed growth and development related to a cognitive impairment D) Impaired physical mobility related to poor muscle tone
A Feedback: Children with Down syndrome may have difficulty sucking and feeding due to lack of muscle tone and the structure of their mouths and tongues. This can lead to poor nutritional intake and makes this the priority diagnosis. This also uses the strategy that physiologic needs have priority using Maslow's hierarchy of needs. Deficient knowledge due to lack of information about the disorder is a close second in priority, as the mother did not know of her daughter's condition before birth and has much to learn now. This child is at risk for a number of complications such as infection, heart disease, and leukemia and will require frequent assessment. Most children with Down syndrome experience some degree of intellectual disability, but early intervention will allow the child maximum development within the limits of the disease. Mobility is delayed but should not be a problem at this time.
15. Which of the following would lead the nurse to suspect that a child has Turner syndrome? A) Webbed neck B) Microcephaly C) Gynecomastia D) Cognitive delay
A Feedback: Manifestations of Turner syndrome include webbed neck, low posterior hairline, wide-spaced nipples, edema of the hands and feet, amenorrhea, and absence of secondary sex characteristics, along with short stature and slow growth. Microcephaly is commonly associated with trisomy 13. Gynecomastia and cognitive delay are associated with Klinefelter syndrome.
23. A nurse is reviewing an article about genetic disorders and patterns of inheritance. The nurse demonstrates understanding of the information by identifying which of the following as an example of an autosomal dominant genetic disorder? A) Neurofibromatosis B) Cystic fibrosis C) Tay-Sachs disease D) Sickle cell disease
A Feedback: Neurofibromatosis is an example of an autosomal dominant genetic disorder. Cystic fibrosis, Tay-Sachs disease, and sickle cell disease are examples of autosomal recessive genetic disorders.
29. A group of nursing students are reviewing information about neurocutaneous syndromes. The students demonstrate an understanding of these disorders when they identify which of the following as an example? A) Sturge-Weber syndrome B) Marfan syndrome C) Apert syndrome D) Achondroplasia
A Feedback: Sturge-Weber syndrome is an example of a neurocutaneous syndrome. Marfan syndrome, Apert syndrome, and achondroplasia are autosomal dominantly inherited genetic disorders.
11. When teaching a class about trisomy 21, the instructor would identify this disorder as due to which of the following? A) Nondisjunction B) X-linked recessive inheritance C) Genomic imprinting D) Autosomal dominant inheritance
A Feedback: Trisomy 21 is an example of a genetic disorder involving an abnormality in chromosomal number due to nondisjunction. X-linked recessive inheritance disorders, such as hemophilia and Duchenne muscular dystrophy, involve altered genes on the X chromosome. Genomic imprinting disorders, such as Prader-Willi syndrome, involve expression of only the maternal or paternal allele, with the other being inactive. Autosomal dominant inheritance disorders, such as neurofibromatosis and achondroplasia, involve a single gene in the heterozygous state that is capable of producing the phenotype, thus overshadowing the normal gene.
A gene that produces the same characteristics when it is either presented as a homozygous or heterozygous chromosome is called which of the following? A. Autosomal dominant. B. Autosomal recessive. C. Familial. D. Multifactorial.
A - An autosomal dominant trait can be present alone or as a pair and lead to a significant congenital disorder. As a result, the disorder has a higher incident and there is not "carrier" status.
A nurse syndrome. is assessing a newborn for facial feature characteristics associated with fetal alcohol Which characteristics should the nurse expect to assess? Select all that apply. A: Short palpebral fissures B: Smooth philtrum C: Low set ears D: Inner epicanthal folds E: Thin upper lip
A B E
A nurse should plan to implement which interventions for a child admitted with inorganic failure to thrive? Select all that apply. a. Observation of parent child interactions B: Assignment of different nurses to care for the child from day to day C: Use of 28 calorie per ounce concentrated formulas D: Administration of daily multivitamin supplements E: Role-modeling appropriate adultchild interactions
A D E
Munchausen syndrome by proxy Correct Explanation: Munchausen syndrome by proxy refers to a parent who repeatedly brings a child to a health care facility and reports symptoms of illness when, in fact, the child is well. For example, a parent might report symptoms such as seizures, excessive sleepiness, or abdominal pain in a child. Because of these symptoms, the child is submitted to needless diagnostic procedures or therapeutic regimens. There is no evidence of psychological maltreatment, physical neglect, or failure to thrive in this case.
A mother brings her 10-year-old daughter in and tells the nurse that she believes the child has a brain tumor and quickly runs through a list of some classic symptoms associated with brain cancer. On examination and after performing routine blood work, however, the nurse finds nothing wrong with the child. The child says that she feels fine. When the nurse reviews the patient's chart, she finds that this is the sixth time the mother has brought the girl in for various serious conditions in the past 6 months. Which of the following situations does the nurse suspect? a) Physical neglect b) Psychological maltreatment c) Failure to thrive d) Munchausen syndrome by proxy
"He tells me that he is sorry and that he will never hit me again." Correct Explanation: During phase 3 of the cycle, the perpetrator becomes kind, contrite, and loving, begging for forgiveness and promising never to inflict abuse again until the next time. The actual violence occurs in phase 2. Yelling at the client for not having dinner ready and calling her stupid and incompetent reflect phase 1 or tension building.
A nurse is interviewing a client who is a survivor of abuse. The client is telling the nurse about how the violence occurred. Which statement would the nurse interpret as reflecting phase 3 of the cycle of violence? a) "He threw me against the wall and started punching my face." b) "He calls me stupid and incompetent, asking himself why he ever married me." c) "He yells at me for not having dinner waiting for him when he came home." d) "He tells me that he is sorry and that he will never hit me again."
You prepare a couple to have a karyotype performed. Which of the following describes a karyotype? a) The gene carried on the X or Y chromosome b) A visual presentation of the chromosome pattern of an individual c) The dominant gene that will exert influence over a correspondingly located recessive gene d) A blood test that will reveal an individual's homozygous tendencies
A visual presentation of the chromosome pattern of an individual Correct Explanation: A karyotype is a photograph of a person's chromosomes aligned in order.
"It's very brave of you to tell me all this. Help is available if you choose it." Correct Explanation: When talking with a woman who is a victim of intimate partner violence, it is important not to uses expressions of emotionality or judgement such as, "Oh my goodness" or "I feel terrible for you." It is also important to validate the victim's story and tell her you believe what happened. Encouraging her to say more while informing her that help is available is the best therapeutic answer.
A woman has just confided in the nurse that her partner slapped and kicked her that morning. What is the best response by the nurse? a) "Oh my goodness, I cannot believe that happened to you. You poor thing, I feel terrible for you." b) "It's very brave of you to tell me all this. Help is available if you choose it." c) "Maybe he didn't mean to do it. Have you talked with him about it?" d) "Is this the first and only time he has done anything?"
A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and has lost 25% of body weight. A nurse asks, "Describe what you think about your present weight and how you look." Which response by the patient is most consistent with the diagnosis? a. I am fat and ugly. b. What I think about myself is my business. c. I am grossly underweight, but that's what I want. d. I am a few pounds overweight, but I can live with it.
A ~ Patients diagnosed with anorexia nervosa do not recognize their thinness. They perceive themselves to be overweight and unattractive. The patient with anorexia will usually disclose perceptions about self to others. The patient with anorexia will persist in trying to lose more weight.
Which statement is a nurse most likely to hear from a patient diagnosed with anorexia nervosa? a. I would be happy if I could lose 20 more pounds. b. My parents don't pay much attention to me. c. I'm thin for my height. d. I have nice eyes.
A ~ Patients with eating disorders have distorted body images and cognitive distortions. They see themselves as overweight even when their weight is subnormal. I'm thin for my height is therefore unlikely to be heard from a patient with anorexia nervosa. Poor self-image precludes making positive statements about self, such as I have nice eyes. Many patients with eating disorders see supportive others as intrusive and out of tune with their needs.
One bed is available on the inpatient eating disorders unit. Which patient should be admitted? The patient whose weight dropped from: a. 150 to 100 pounds over a 4-month period. Vital signs: temperature, 35.9 C; pulse, 38 beats/min; blood pressure, 60/40 mm Hg b. 120 to 90 pounds over a 3-month period. Vital signs: temperature, 36 C; pulse, 50 beats/min; blood pressure, 70/50 mm Hg c. 110 to 70 pounds over a 4-month period. Vital signs: temperature, 36.5 C; pulse, 60 beats/min; blood pressure, 80/66 mm Hg d. 90 to 78 pounds over a 5-month period. Vital signs: temperature, 36.7 C; pulse, 62 beats/min; blood pressure, 74/48 mm Hg
A ~ Physical criteria for hospitalization include weight loss of more than 30% of body weight within 6 months, temperature below 36 C (hypothermia), heart rate less than 40 beats/min, and systolic blood pressure less than 70 mm Hg.
Physical assessment of a patient diagnosed with bulimia nervosa often reveals: a. prominent parotid glands. b. peripheral edema. c. thin, brittle hair. d. amenorrhea.
A ~ Prominent parotid glands are associated with repeated vomiting. The other options are signs of anorexia nervosa and are not usually observed in bulimia.
A patient diagnosed with anorexia nervosa has a body mass index (BMI) of 14.8 kg/m2. Which assessment finding is most likely to accompany this value? a. Cachexia b. Leukocytosis c. Hyperthermia d. Hypertension
A ~ The BMI value indicates extreme malnutrition. Cachexia is a hallmark of this problem. The patient would be expected to have leukopenia rather than leukocytosis. Hypothermia and hypotension are likely assessment findings.
An outpatient diagnosed with anorexia nervosa has begun re-feeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should: a. assess lung sounds and extremities. b. suggest the use of an aerobic exercise program. c. positively reinforce the patient for the weight gain. d. establish a higher goal for weight gain the next week.
A ~ Weight gain of more than 2 to 5 pounds weekly may overwhelm the hearts capacity to pump, leading to cardiac failure. The nurse must assess for signs of pulmonary edema and congestive heart failure. The incorrect options are undesirable because they increase the risk for cardiac complications.
A nursing student is preparing an oral presentation about autosomal recessive inheritance. Which of the following must occur for an offspring to demonstrate signs and symptoms of the disorder with this type of inheritance? A) Both parents must be heterozygous carriers. B) One parent must have the disease. C) The mother must be a carrier. D) The father must be affected by the disease.
A) Both parents must be heterozygous carriers.
The nurse is assessing a 2-day-old newborn and suspects Down syndrome based on which of the following? Select all answers that apply. A) Flat facial profile B) Downward slant to the eyes C) Large tongue compared to mouth D) Simian crease E) Epicanthal folds F) Rigid joints
A) Flat facial profile
The nurse is caring for 3-day-old girl with Down syndrome whose mother had no prenatal care. Which of the following will be the priority nursing diagnosis? A) Imbalanced nutrition, less than body requirements related to the effects of hypotonia B) Deficient knowledge related to the presence of a genetic disorder C) Delayed growth and development related to a cognitive impairment D) Impaired physical mobility related to poor muscle tone
A) Imbalanced nutrition, less than body requirements related to the effects of hypotonia
Which instruction should the nurse include when teaching parents strategies to enhance communication with a child diagnosed with autism spectrum disorder (ASD)? (Select all that apply.) A. Using pictures, computers, or other visual aids B. Considering using sign language C. Using complex words to stimulate the child's vocabulary D. Using short, direct sentences E. Speaking loudly
A,B,D Rationale: Clients with ASD have impaired communication skills. Strategies to improve communication include using short, direct sentences that are easy to understand, supplementing verbal communication with the use of pictures, computers, or other visual aids, and using sign language. Deafness is not a clinical manifestation of ASD, so speaking loudly will not improve communication and will distress the client. Simple, not complex, words and sentences are best for communication with the client with ASD.
A child with attention deficit hyperactivity disorder (ADHD) has been prescribed dextroamphetamine. For what effects should the nurse tell the parents to monitor the child? Select all that apply. A. Insomnia B. Hypotension C. Weight loss D. Appetite suppression E. Weight gain
A. Insomnia C. Weight loss D. Appetite suppression
A school nurse is working with the parents of an 8-year-old who has Tourette syndrome on how best to accommodate the child. Which of the following would be most helpful? Select all answers that apply. A) Allowing for breaks when tics occur B) Providing for "time-outs" during the day C) Using a tape recorder to take notes D) Ensuring a specified amount of time for test taking E) Implementing a reward system for behavior
AC
9. A child who has symptoms of irritable mood, changes in sleep and appetite patterns, decreased self-esteem, and disengagement from family and friends lasting 3 weeks meets the criteria for which depressive disorder? a. Major depressive disorder b. Dysthymic disorder c. Cyclothymic disorder d. Panic disorder
ANS: A A 2-week (or longer) episode of depressed or irritable mood in addition to disturbances in appetite, sleep, energy, or self-esteem meets the criteria for a major depressive disorder. A dysthymic disorder is associated with a depressed or irritable mood for at least a year. A cyclothymic or bipolar mood disorder is characterized by chronic, fluctuating mood disturbances between depressive lows and highs for a year. A panic disorder is a type of anxiety disorder.
5. A parent of a child with an anxiety disorder states, "I don't know how my child developed this problem." On what information should the nurse base a response? a. Genetic factors, hormonal imbalances, and societal influences all contribute to the development of anxiety disorders in children. b. Like many conditions affecting children, the etiology of anxiety disorders is unknown. c. The majority of anxiety disorders has a clear pattern of genetic inheritance. d. Dysfunctional family patterns are usually identified as the cause of an anxiety disorder.
ANS: A Anxiety disorders are responses to stress and may be manifested as disturbances in feeling, body functions, behavior, or performance. Children with a history of verbal, physical, or sexual abuse; frequent separation from or loss of loved ones; drug use, incarceration, or lower socioeconomic status; homosexuality; chronic illness; behavioral disorders; and dysfunctional families are more likely than peers with healthy family patterns to have anxiety disorders. The etiology of many anxiety disorders in children can be identified. Some anxiety disorders are inheritable disorders. Others have been identified as having other origins. Research consistently shows that psychosocial disorders are caused by a combination of predisposing or inherent factors and environmental or interactional factors.
17. A student nurse is working with a child in foster care. The child was removed from the home due to abuse. The child is crying for the parents and the student is confused. What information does the registered nurse provide? a. Children will grieve the loss of parents, even if they were abusive. b. The child needs therapy from a qualified therapist. c. Play therapy will alleviate this behavior. d. The parents may not have been the abusers.
ANS: A Children removed from the home will grieve that loss. Play therapy can be beneficial, but its purpose is not to alleviate displays of grief. The child probably does need therapy, but this does not explain the behavior to the student. Stating that someone else may have abused the child also does not explain the situation.
1. Which sign or symptom is likely to be manifested by an adolescent with a depressive disorder? a. Abuse of alcohol b. Impulsivity and distractibility c. Carelessness and inattention to details d. Refusal to leave the house
ANS: A Depression often manifests in conjunction with substance abuse, so children who abuse substances should be evaluated for depression as well. Impulsivity and distractibility are manifestations of attention-deficit/hyperactivity disorder (ADHD). A diminished ability to think or concentrate, carelessness, and inattention to details is a clinical manifestation of ADHD. A refusal to leave the house, even to play with friends, is characteristic of separation anxiety disorder.
6. Both members of an expectant couple are carriers for phenylketonuria (PKU), an autosomal recessive disorder. In counseling them about the risk to their unborn child, the nurse should tell them that a. the child has a 25% chance of being affected. b. the child will be a carrier, like the parents. c. the child has a 50% chance of being affected. d. one of four of their children will be affected.
ANS: A Each child born to a couple who carries an autosomal recessive trait has a 25% chance of having the disorder, because the child receives either a normal or an abnormal gene from each parent. If one member of the couple has the autosomal recessive disorder, all of their children will be carriers. If both parents are carriers, each child has a 50% chance of being a carrier. Each child has the identical odds of being affected.
16. A nurse is creating a pedigree for a couple whose son has Tay-Sachs disease. What information from the pedigree would the nurse most likely find? a. Parental consanguinity b. Disease has skipped a generation. c. Only men have had this disorder. d. Only women have had this disorder.
ANS: A Parental consanguinity increases the risk for autosomal recessive disorders such as Tay-Sachs disease. The pedigree would not show the disease skipping generations. Males and females are equally affected by this disorder.
3. People who have two copies of the same abnormal autosomal dominant gene will usually be a. more severely affected by the disorder than will people with one copy of the gene. b. infertile and unable to transmit the gene. c. carriers of the trait but not affected with the disorder. d. mildly affected with the disorder.
ANS: A People who have two copies of an abnormal gene are usually more severely affected by the disorder because they have no normal gene to maintain normal function. Infertility may or may not be caused by chromosomal defects. A carrier of a trait has one recessive gene. Those mildly affected with the disorder will have only one copy of the abnormal gene.
13. Which finding noted by the nurse on a physical assessment is most suggestive that a child has been sexually abused? a. Swelling of the genitalia and pain on urination b. Smooth philtrum and thin upper lip c. Speech and physical development delays d. History of constipation, drowsiness, and constricted pupils
ANS: A Physical indicators of sexual abuse may include swelling or itching of the genitalia and pain on urination. Other indicators may include bruises, bleeding, or lacerations of the external genitalia, vagina, or anal area. The infant with fetal alcohol syndrome may have microphthalmia or abnormally small eyes or short palpebral fissures, a thin upper lip, and a poorly developed philtrum. Children who have been emotionally abused may exhibit speech disorders, lags in physical development, failure to thrive, or hyperactive and disruptive behaviors. Although there is a possibility for speech and developmental delays, these are not more suggestive of sexual abuse than swollen genitalia and pain on urination. Opiates can cause detachment and apathy, drowsiness, constricted pupils, constipation, slurred speech, and impaired judgment.
8. A woman tells the nurse at a prenatal interview that she has quit smoking, only has a glass of wine with dinner, and has cut down on coffee to four cups a day. What response by the nurse will be most helpful in promoting lifestyle changes? a. "You have made some great progress toward having a healthy baby. Let's talk about the changes you have made." b. "You need to do a lot better than that. You may still be hurting your baby right now." c. "Here are some pamphlets for you to study. They will help you find more ways to improve." d. "Those few things won't cause any trouble. Good for you."
ANS: A Praising her for making positive changes is an effective technique for motivating a patient. She still has to identify the risk factors to optimize the results so a discussion with the nurse can facilitate that. Telling her she has to do better is belittling to the patient. She will be less likely to confide in the nurse. The nurse is not acknowledging the efforts that the woman has already accomplished by simply giving her pamphlets. Those accomplishments need to be praised to motivate the woman to continue. Plus before giving written material, the nurse must assess the woman's literacy level. Alcohol and coffee consumption are still major risk factors and need to be addressed in a positive, nonjudgmental manner.
6. What should be the major consideration when selecting toys for a child with an intellectual or developmental disability? a. Safety b. Age appropriateness c. Ability to provide exercise d. Ability to teach useful skills .
ANS: A Safety is the primary concern in selecting recreational and exercise activities for all children. This is especially true for children who are intellectually disabled. Age appropriateness should be considered in the selection of toys, but safety is of paramount importance since their intellectual age will be less than their chronological age. Ability to provide exercise and teach skills is also important but not as vital as safety.
20. Parents have learned that their 6-year-old child has autism. The nurse may help the parents to cope by explaining that the child may a. have an extremely developed skill in a particular area. b. outgrow the condition by early adulthood. c. have average social skills. d. have age-appropriate language skills.
ANS: A Some children with autism have an extremely developed skill in a particular area such as mathematics or music. This information may be comforting, although the nurse should avoid giving false hope. No evidence supports that autism is outgrown. Autistic children have abnormal ways of relating to people (social skills). Speech and language skills are usually delayed in autistic children.
2. Which statement about suicide is correct? a. Children younger than 10 years of age are least likely to attempt suicide. b. Suicide risk decreases with age. c. Suicide is usually an isolated event in a school community. d. The prevalence of suicide attempts is higher among males.
ANS: A Suicide by children under the age of 10 is uncommon although it is the third leading cause of death in children ages 5 to 10. The risk of suicide increases with age. It is common for suicide to occur in a cluster within a community (e.g., schools). Males have a 4% rate of suicide attempts compared to 8% in females; however, males are more likely to die after a suicide attempt.
A maternity nurse should be aware of which fact about the amniotic fluid? a. It serves as a source of oral fluid and a repository for waste from the fetus. b. The volume remains about the same throughout the term of a healthy pregnancy. c. A volume of less than 300 mL is associated with gastrointestinal malformations. d. A volume of more than 2 L is associated with fetal renal abnormalities.
ANS: A - Amniotic fluid serves as a source of oral fluid, serves as a repository for waste from the fetus, cushions the fetus, and helps maintain a constant body temperature. The volume of amniotic fluid changes constantly. Too little amniotic fluid (oligohydramnios) is associated with renal abnormalities. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.
A key finding from the Human Genome Project is: a. Approximately 20,000 genes make up the genome. b. All human beings are 80.99% identical at the DNA level. c. Human genes produce only one protein per gene; other mammals produce three proteins per gene. d. Single gene testing will become a standardized test for all pregnant clients in the future.
ANS: A - Approximately 20,500 genes make up the human genome; this is only twice as many as make up the genomes of roundworms and flies. Human beings are 99.9% identical at the DNA level. Most human genes produce at least three proteins. Single gene testing (e.g., alpha-fetoprotein) is already standardized for prenatal care.
The nurse caring for the laboring woman should know that meconium is produced by: a. Fetal intestines. c. Amniotic fluid. b. Fetal kidneys. d. The placenta.
ANS: A - As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium.
The placenta allows exchange of oxygen, nutrients, and waste products between the mother and fetus by: a. Contact between maternal blood and fetal capillaries within the chorionic villi. b. Interaction of maternal and fetal pH levels within the endometrial vessels. c. A mixture of maternal and fetal blood within the intervillous spaces. d. Passive diffusion of maternal carbon dioxide and oxygen into the fetal capillaries.
ANS: A - Fetal capillaries within the chorionic villi are bathed with oxygen-rich and nutrient-rich maternal blood within the intervillous spaces. The endometrial vessels are part of the uterus. There is no interaction with the fetal blood at this point. Maternal and fetal blood do not normally mix. Maternal carbon dioxide does not enter into the fetal circulation.
Many parents-to-be have questions about multiple births. Maternity nurses should be able to tell them that: a. Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. b. Dizygotic twins (two fertilized ova) have the potential to be conjoined twins. c. Identical twins are more common in white families. d. Fraternal twins are same gender, usually male.
ANS: A - If the parents-to-be are older and have taken fertility drugs, they would be very interested to know about twinning and other multiple births. Conjoined twins are monozygotic; they are from a single fertilized ovum in which division occurred very late. Identical twins show no racial or ethnic preference; fraternal twins are more common among African-American women. Fraternal twins can be different genders or the same gender. Identical twins are the same gender.
The nurse is assessing the knowledge of new parents with a child born with maple syrup urine disease (MSUD). This is an autosomal recessive inherited disorder, which means that: a. Both genes of a pair must be abnormal for the disorder to be expressed. b. Only one copy of the abnormal gene is required for the disorder to be expressed. c. The disorder occurs in males and heterozygous females. d. The disorder is carried on the X chromosome.
ANS: A - MSUD is a type of autosomal recessive inheritance disorder in which both genes of a pair must be abnormal for the disorder to be expressed. MSUD is not an X-linked dominant or recessive disorder or an autosomal dominant inheritance disorder.
With regard to prenatal genetic testing, nurses should be aware that: a. Maternal serum screening can determine whether a pregnant woman is at risk of carrying a fetus with Down syndrome. b. Carrier screening tests look for gene mutations of people already showing symptoms of a disease. c. Predisposition testing predicts with near certainty that symptoms will appear. d. Presymptomatic testing is used to predict the likelihood of breast cancer.
ANS: A - Maternal serum screening identifies the risk for the neural tube defect and the specific chromosome abnormality involved in Down syndrome. Carriers of some diseases, such as sickle cell disease, do not display symptoms. Predisposition testing determines susceptibility, such as for breast cancer. presymptomatic testing indicates that symptoms are certain to appear if the gene is present.
The nurse caring for a pregnant client knows that her health teaching regarding fetal circulation has been effective when the client reports that she has been sleeping: a. In a side-lying position. b. On her back with a pillow under her knees. c. With the head of the bed elevated. d. On her abdomen.
ANS: A - Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously it was believed that the left lateral position promoted maternal cardiac output, enhancing blood flow to the fetus. However, it is now known that the side-lying position enhances uteroplacental blood flow. If a woman lies on her back with the pressure of the uterus compressing the vena cava, blood return to the right atrium is diminished. Although having the head of the bed elevated is recommended and ideal for later in pregnancy, the woman still must maintain a lateral tilt to the pelvis to avoid compression of the vena cava. Many women find lying on her abdomen uncomfortable as pregnancy advances. Side-lying is the ideal position to promote blood flow to the fetus.
A new mother asks the nurse about the white substance covering her infant. The nurse explains that the purpose of vernix caseosa is to: a. Protect the fetal skin from amniotic fluid. b. Promote normal peripheral nervous system development. c. Allow transport of oxygen and nutrients across the amnion. d. Regulate fetal temperature.
ANS: A - Prolonged exposure to amniotic fluid during the fetal period could result in breakdown of the skin without the protection of the vernix caseosa. Normal development of the peripheral nervous system is dependent on nutritional intake of the mother. The amnion is the inner membrane that surrounds the fetus. It is not involved in the oxygen and nutrient exchange. The amniotic fluid aids in maintaining fetal temperature.
The nurse must be cognizant that an individuals genetic makeup is known as his or her: a. Genotype. c. Karyotype. b. Phenotype. d. Chromotype.
ANS: A - The genotype comprises all the genes the individual can pass on to a future generation. The phenotype is the observable expression of an individuals genotype. The karyotype is a pictorial analysis of the number, form, and size of an individuals chromosomes. Genotype refers to an individuals genetic makeup.
A woman asks the nurse, What protects my babys umbilical cord from being squashed while the babys inside of me? The nurses best response is: a. Your babys umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby. b. Your babys umbilical floats around in blood anyway. c. You dont need to worry about things like that. d. The umbilical cord is a group of blood vessels that are very well protected by the placenta.
ANS: A - Your babys umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby is the most appropriate response. Your babys umbilical floats around in blood anyway is inaccurate. You dont need to worry about things like that is an inappropriate response. It negates the clients need for teaching and discounts her feelings. The placenta does not protect the umbilical cord. The cord is protected by the surrounding Wharton jelly.
Congenital disorders refer to conditions that are present at birth. These disorders may be inherited and caused by environmental factors or maternal malnutrition. Toxic exposures have the greatest effect on development between 15 and 60 days of gestation. For the nurse to be able to conduct a complete assessment of the newly pregnant client, she should understand the significance of exposure to known human teratogens. These include(Select all that apply): a. Infections. b. Radiation. c. Maternal conditions. d. Drugs. e. Chemicals.
ANS: A, B, C, D, E - Exposure to radiation and numerous infections may result in profound congenital deformities. These include but are not limited to varicella, rubella, syphilis, parvovirus, cytomegalovirus, and toxoplasmosis. Certain maternal conditions such as diabetes and phenylketonuria may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medication and some antibiotics as well as chemicals, including lead, mercury, tobacco, and alcohol, also may result in structural and functional abnormalities.
2. A nurse is assessing a newborn for facial feature characteristics associated with fetal alcohol syndrome. Which characteristics should the nurse expect to assess? (Select all that apply.) a. Short palpebral fissures b. Smooth philtrum c. Low-set ears d. Inner epicanthal folds e. Thin upper lip
ANS: A, B, C, E Infants with fetal alcohol syndrome may have characteristic facial features, including short palpebral fissures, a smooth philtrum (the vertical groove in the median portion of the upper lip), low-set ears, and a thin upper lip. Low-set ears and inner epicanthal folds are associated with Down syndrome.
Which congenital malformations result from multifactorial inheritance (Select all that apply)? a. Cleft lip b. Congenital heart disease c. Cri du chat syndrome d. Anencephaly e. Pyloric stenosis
ANS: A, B, D, E - All these congenital malformations are associated with multifactorial inheritance. Cri du chat syndrome is related to a chromosome deletion.
Along with gas exchange and nutrient transfer, the placenta produces many hormones necessary for normal pregnancy. These include (select all that apply) a. Human chorionic gonadotropin (hCG) b. Insulin c. Estrogen d. Progesterone e. Testosterone
ANS: A, C, D - hCG causes the corpus luteum to persist and produce the necessary estrogens and progesterone for the first 6 to 8 weeks. Estrogens cause enlargement of the womans uterus and breasts; cause growth of the ductal system in the breasts; and, as term approaches, play a role in the initiation of labor. Progesterone causes the endometrium to change, providing early nourishment. Progesterone also protects against spontaneous abortion by suppressing maternal reactions to fetal antigens and reduces unnecessary uterine contractions. Other hormones produced by the placenta include hCT, hCA, and numerous growth factors. Human placental lactogen promotes normal nutrition and growth of the fetus and maternal breast development for lactation. This hormone decreases maternal insulin sensitivity and utilization of glucose, making more glucose available for fetal growth. If a Y chromosome is present in the male fetus, hCG causes the fetal testes to secrete testosterone necessary for the normal development of male reproductive structures.
3. The generalist nurse working with child-bearing families understands that his or her practice related to genetics includes which of the following? (Select all that apply.) a. Identifying families at risk and providing referrals b. Interpreting genetic test results for the family c. Assessing the couple's concern about genetic alterations d. Helping create a family tree or pedigree e. Providing support in all phases of genetic counseling
ANS: A, C, D, E The nurse who works with women and families in the childbearing years is in a wonderful position to help identify families at risk and provide referrals, assess concerns, create pedigrees, and provide support. Interpreting genetic test results is provided by those who have advanced training and education in that area and would not be expected of the generalist nurse.
2. A nurse working on the pediatric unit should be aware that children admitted with which of the following assessment findings are suggestive of physical child abuse? (Select all that apply.) a. Bruises in various stages of healing b. Bruises over the shins or bony prominences c. Burns on the palms of the hands d. A fracture of the right wrist from a sports accident e. Rib fractures in an infant
ANS: A, C, E Bruises in various stages of healing and burns on the palms of the hand may be indicative of physical abuse. Rib fractures in an infant are another indicator of physical abuse. Bruises over the shins or bony prominences are seen in children beginning to walk. A fracture of the right wrist can occur as the child begins to participate in sports activities.
3. The nurse is aware that suicide risk increases if the child displays which characteristics? (Select all that apply.) a. Previous suicide attempt b. No previous exposure to violence in the home c. Recent loss d. Effective social network e. History of physical abuse
ANS: A, C, E The risk of suicide increases if the child has had a previous suicide attempt, a recent loss, or a history of physical abuse. No previous violence in the home or having an effective social network decreases the risk of suicide.
3. A nurse should plan to implement which interventions for a child admitted with inorganic failure to thrive? (Select all that apply.) a. Observation of parent-child interactions b. Assignment of different nurses to care for the child from day to day c. Use of 28-calorie-per-ounce concentrated formulas d. Administration of daily multivitamin supplements e. Role-modeling appropriate adult-child interactions
ANS: A, D, E The nurse should plan to assess parent-child interactions when a child is admitted for nonorganic failure to thrive. The observations should include how the child is held and fed, how eye contact is initiated and maintained, and the facial expressions of both the child and the caregiver during interactions. Role-modeling and teaching appropriate adult-child interactions (including holding, touching, and feeding the child) will facilitate appropriate parent-child relationships, enhance parents' confidence in caring for their child, and facilitate expression by the parents of realistic expectations based on the child's developmental needs. Daily multivitamin supplements with minerals are often prescribed to ensure that specific nutritional deficiencies do not occur in the course of rapid growth. The nursing staff assigned to care for the child should be consistent. Providing a consistent caregiver from the nursing staff increases trust and provides the child with an adult who anticipates his or her needs and who is able to role-model child care to the parent. Caloric enrichment of food is essential, and formula may be concentrated in titrated amounts up to 24 calories per ounce. Greater concentrations can lead to diarrhea and dehydration.
4. The faculty member teaches students that which of the following are examples of autosomal recessive disorders or traits? (Select all that apply.) a. Blood group O b. Tay-Sachs disease c. Huntington disease d. Neurofibromatosis e. Hemophilia A
ANS: A,B Autosomal recessive traits and disorders include blood group O, Tay-Sachs disease, and cystic fibrosis. Huntington disease and neurofibromatosis are examples of autosomal dominant disorders. Hemophilia A is an X-linked disorder.
21. A child with autism is hospitalized with asthma. The nurse should plan care so that the a. parents' expectations are met. b. child's routine habits and preferences are maintained. c. child is supported through the autistic crisis. d. parents need not be at the hospital.
ANS: B Children with autism are often unable to tolerate even slight changes in routine. The child's routine habits and preferences are important to maintain. Focus of care is on the child's needs rather than on the parent's desires. Autism is a life-long condition. The presence of the parents is almost always required when an autistic child is hospitalized.
2. A parent asks the nurse why a developmental assessment is being conducted for a child during a routine well-child visit. The nurse answers based on the knowledge that routine developmental assessments during well-child visits are a. not necessary unless the parents request them. b. the best method for early detection of cognitive disorders. c. frightening to parents and children and should be avoided. d. valuable in measuring intelligence in children.
ANS: B Early detection of cognitive disorders can be facilitated through assessment of development at each well-child examination. Developmental assessment is a component of all well-child examinations. Developmental assessments are not as frightening when the parent and child are educated about the purpose of the assessment. Developmental assessments are not intended to measure intelligence.
12. Which behavior verbalized by a school-age child should alert the school nurse to a problem of possible obsessive-compulsive disorder (OCD)? a. States feelings of worthlessness and sadness every day b. Feels need to ride a bike around the tree in front of the house seven times every day before entering the house c. Recurrent episodes of chest pain, heart palpitations, and shortness of breath when entering the computer classroom d. Deterioration of relationships with family members
ANS: B Obsessive-compulsive disorder (OCD) manifests repetitive unwanted thoughts (obsessions) or ritualistic actions (compulsions) or both. Feelings of worthlessness and sadness are suggestive of a depressive disorder. Panic disorders often cause recurrent episodes of chest pain, heart palpitations, and shortness of breath. These symptoms may be accompanied by a feeling of impending doom. Deterioration of relationships with family members, irregular school attendance, low grades, rebellious or aggressive behavior, and excessive dependence on peer influence are behaviors that may indicate substance abuse.
7. Appropriate interventions to facilitate socialization of the cognitively impaired child include a. providing age-appropriate toys and play activities. b. providing peer experiences, such as scouting, when older. c. avoiding exposure to strangers who may not understand cognitive development. d. emphasizing mastery of physical skills because they are the most delayed.
ANS: B The acquisition of social skills is a complex task. Children of all ages need peer relationships. Parents should enroll the child in preschool. When older, they should have peer experiences similar to other children such as group outings, Boy and Girl Scouts, and Special Olympics. Providing age-appropriate toys and play activities is important. However, peer interactions will better facilitate social development. Parents should expose the child to strangers so that the child can practice social skills. Verbal skills are delayed more than physical skills.
1. A parent whose child has been diagnosed with a cognitive deficit should be counseled that intellectual impairment a. is usually due to a genetic defect. b. may be caused by a variety of factors. c. is rarely due to first trimester events. d. is usually caused by parental intellectual impairment.
ANS: B There are a multitude of causes for intellectual impairment. In most cases, a specific cause has not been identified. Only a small percentage of children with intellectual impairment are affected by a genetic defect. One third of children with intellectual impairment are affected by first trimester events. Intellectual impairment can be transmitted to a child only if the parent has a genetic disorder.
8. The school nurse observes an unkempt child dressed in inappropriate clothing who repeatedly asks for food. About which problem is the nurse concerned? a. Physical abuse b. Physical neglect c. Emotional abuse d. Sexual abuse
ANS: B These physical and behavioral indicators suggest that parental attention is not being given to the child's physical needs. The child is being neglected. There are no indicators of physical, emotional, or sexual abuse in this scenario.
11. A maternal-newborn nurse is caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis is the most essential in caring for the mother of this infant? a. Disturbed body image b. Interrupted family processes c. Anxiety d. Risk for injury
ANS: B This mother likely will experience a disruption in the family process related to the birth of a baby with an inherited disorder. Family disruption is common, and the strain of having a child with a serious birth defect may lead to divorce. Siblings may feel neglected because the child with a disorder requires more of their parents' time and attention. Women commonly experience body image disturbances in the postpartum period, but this is unrelated to giving birth to a child with Down syndrome. The mother likely will have a mix of emotions that may include anxiety, guilt, and denial, but this is not the most essential nursing diagnosis for this family. Risk for injury is not applicable.
2. The karyotype of a person is 47, XY, +21. This person is a a. normal male. b. male with Down syndrome. c. normal female. d. female with Turner syndrome.
ANS: B This person is male because his sex chromosomes are XY. He has one extra copy of chromosome 21 (for a total of 47 instead of 46), resulting in Down syndrome. A normal male has 46 chromosomes. A normal female has 46 chromosomes and XX for the sex chromosomes. A female with Turner syndrome has 45 chromosomes; the sex chromosomes have just one X.
16. A teen has told the school nurse about recent suicidal thoughts. What action by the nurse is best? a. Call the police and the teen's parents. b. Ask if the teen has access to firearms. c. Assess the teen for substance abuse. d. Report the finding to the principal.
ANS: B When a child or adolescent (or adult) admits to having suicidal thoughts, the nurse must ensure that person's safety. Along with asking if the person has a definite plan, the nurse must assess for access to weapons. The teen's parents and principal should be notified, but the police do not need to be called. Assessing for substance abuse is not the priority.
A woman who is 16 weeks pregnant asks the nurse, Is it possible to tell by ultrasound if the baby is a boy or girl yet? The best answer is: a. A babys sex is determined as soon as conception occurs. b. The baby has developed enough that we can determine the sex by examining the genitals through ultrasound. c. Boys and girls look alike until about 20 weeks after conception, and then they begin to look different. d. It might be possible to determine your babys sex, but the external organs look very similar right now.
ANS: B - Although gender is determined at conception, the external genitalia of males and females look similar through the ninth week. By the twelfth week, the external genitalia are distinguishable as male or female.
With regard to chromosome abnormalities, nurses should be aware that: a. They occur in approximately 10% of newborns. b. Abnormalities of number are the leading cause of pregnancy loss. c. Down syndrome is a result of an abnormal chromosome structure. d. Unbalanced translocation results in a mild abnormality that the child will outgrow.
ANS: B - Aneuploidy is an abnormality of number that also is the leading genetic cause of mental retardation. Chromosome abnormalities occur in less than 1% of newborns. Down syndrome is the most common form of trisomal abnormality, an abnormality of chromosome number (47 chromosomes). Unbalanced translocation is an abnormality of chromosome structure that often has serious clinical effects.
In presenting to obstetric nurses interested in genetics, the genetic nurse identifies the primary risk(s) associated with genetic testing as: a. Anxiety and altered family relationships. b. Denial of insurance benefits. c. High false-positive results associated with genetic testing. d. Ethnic and socioeconomic disparity associated with genetic testing.
ANS: B - Decisions about genetic testing are shaped by socioeconomic status and the ability to pay for the testing. Some types of genetic testing are expensive and are not covered by insurance benefits. Anxiety and altered family relationships, high false-positive results, and ethnic and socioeconomic disparity are factors that may be difficulties associated with genetic testing, but they are not risks associated with testing.
A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. The best answer is: a. You should have felt the baby move by now. b. Within the next month, you should start to feel fluttering sensations. c. The baby is moving; however, you cant feel it yet. d. Some babies are quiet, and you dont feel them move.
ANS: B - Maternal perception of fetal movement usually begins 16 to 20 weeks after conception. Because this is her first pregnancy, movement is felt toward the later part of the 16- to 20-week time period. Stating that you should have felt the baby move by now is incorrect and may be alarming to the patient. Fetal movement should be felt by 16 to 20 weeks. If movement is not felt by the end of that time, further assessment will be necessary.
A mans wife is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. This type of testing is known as: a. Occurrence risk. c. Predictive testing. b. Recurrence risk. d. Predisposition testing.
ANS: B - The couple already has a child with a genetic disease so they will be given a recurrence risk test. If a couple has not yet had children but are known to be at risk for having children with a genetic disease, they are given an occurrence risk test. Predictive testing is used to clarify the genetic status of an asymptomatic family member. Predisposition testing differs from presymptomatic testing in that a positive result does not indicate 100% risk of a condition developing.
As relates to the structure and function of the placenta, the maternity nurse should be aware that: a. As the placenta widens, it gradually thins to allow easier passage of air and nutrients. b. As one of its early functions, the placenta acts as an endocrine gland. c. The placenta is able to keep out most potentially toxic substances such as cigarette smoke to which the mother is exposed. d. Optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing.
ANS: B - The placenta produces four hormones necessary to maintain the pregnancy. The placenta widens until week 20 and continues to grow thicker. Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. Optimal circulation occurs when the woman is lying on her side.
You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis would be the most essential in caring for the mother of this infant? a. Disturbed body image c. Anxiety b. Interrupted family processes d. Risk for injury
ANS: B - This mother likely will experience a disruption in the family process related to the birth of a baby with an inherited disorder. Women commonly experience body image disturbances in the postpartum period; however, this is unrelated to giving birth to a child with Down syndrome. The mother likely will have a mix of emotions that may include anxiety, guilt, and denial, but this is not the most essential nursing diagnosis for this family. Risk for injury is not an applicable nursing diagnosis.
1. A patient at 34 weeks of gestation has reported to the OB triage unit for assessment of oligohydramnios. The nurse assigned to care for this patient is aware that prolonged oligohydramnios may result in (Select all that apply.) a. intrauterine limb amputations. b. clubfoot. c. delayed lung development. d. other fetal abnormalities. e. fetal deformations.
ANS: B, C, D Oligohydramnios, an abnormally small volume of amniotic fluid, reduces the cushion surrounding the fetus and may result in deformations such as clubfoot. Prolonged oligohydramnios interferes with fetal lung development because it does not allow normal development of the alveoli. Oligohydramnios may not be the primary fetal problem but rather may be related to other fetal anomalies. This does not lead to intrauterine limb amputations or fetal deformations.
4. A nurse is providing anticipatory guidance to parents of a child with an intellectual disability. Which safety information is correct based on the child's age? (Select all that apply.) a. Elementary age: safe use of grooming products b. High school age: safety while cooking c. Preschool age: keep hands inside car d. High school age: stranger danger e. Elementary age: water safety
ANS: B, C, E Many factors related to anticipatory guidance and safety will be similar for the cognitively impaired child as for the other children, based on the child's intellectual age. Teaching high school-age children about safety in the kitchen, preschool-age children to keep their hands inside the car, and elementary-age children water safety are appropriate areas to start with, tailored to intellectual age. Elementary-age children are too young for grooming product safety, and high school-age children are too old for stranger danger.
14. What should the nurse keep in mind when planning to communicate with a child who has autism? a. The child has normal verbal communication. b. Expect the child to use sign language. c. The child may exhibit monotone speech and echolalia. d. The child is not listening if she is not looking at the nurse.
ANS: C Children with autism have abnormalities in the production of speech such as a monotone voice or echolalia or inappropriate volume, pitch, rate, rhythm, or intonation. The child has impaired verbal communication and abnormalities in the production of speech. Some autistic children may use sign language, but it is not assumed. Children with autism often are reluctant to initiate direct eye contact.
15. A home health care nurse is working with a child whose parents seem to be quite rigid in their rules and expectations and seem very distrustful of the nurse. What action by the nurse is most appropriate? a. Ask the parents why they don't trust outsiders. b. Interview the parents separately. c. Monitor the child for signs of abuse. d. Assess the parents for substance abuse.
ANS: C Families that hold very rigid rules and expectations and who are distrustful of outsiders fit some of the characteristics of an abusive family. The nurse should be alert for signs of abuse in the child. Asking "why" questions puts people on the defensive. There is no need to separate the parents to interview them. Substance abuse is not indicated.
17. Which statement best describes fragile X syndrome? a. Chromosomal defect affecting only females. b. Chromosomal defect that follows the pattern of X-linked recessive disorders. c. It is a common genetic cause of cognitive impairment. d. Most common cause of noninherited cognitive impairment.
ANS: C Fragile X syndrome is the most common inherited cause of cognitive impairment and the second most common cause of cognitive impairment after Down syndrome. Fragile X primarily affects males. Fragile X follows the pattern of X-linked dominant with reduced manifestation of the syndrome in female and moderate to severe dysfunction in males. Fragile X is inherited.
1. How can a woman avoid exposing her fetus to teratogens? a. Update her immunizations during the first trimester of her pregnancy. b. Use saunas and hot tubs during the winter months only. c. Use only class A drugs during her pregnancy. d. Use alcoholic beverages only in the first and third trimesters of pregnancy.
ANS: C In well-controlled studies, class A drugs have no demonstrated fetal risk. Immunizations, such as rubella, are contraindicated in pregnancy. Maternal hyperthermia is an important teratogen. Alcohol is an environmental substance known to be teratogenic.
12. A couple has been counseled for genetic anomalies. They ask the nurse, "What is karyotyping?" Which of the following is the nurse's best response? a. "Karyotyping will reveal if the baby's lungs are mature." b. "Karyotyping will reveal if your baby will develop normally." c. "Karyotyping will provide information about the number and structure of the chromosomes." d. "Karyotyping will detect any physical deformities the baby has."
ANS: C Karyotyping provides genetic information, such as gender and chromosomal structure. Karyotyping is completed by photographing or using computer imaging to arrange chromosomes in pairs from largest to smallest. The karyotype can then be analyzed. Karyotyping does not determine lung maturity or if the baby is developing normally. Although karyotyping can detect genetic anomalies, not all such anomalies display obvious physical deformities. The term deformities is a nondescriptive word. Furthermore, physical anomalies may be present that are not detected by genetic studies (e.g., cardiac malformations).
16. Throughout their life span, cognitively impaired children are less capable of managing environmental challenges and are at risk for a. nutritional deficits. b. visual impairments. c. physical injuries. d. psychiatric problems.
ANS: C Safety is a challenge for cognitively impaired children. Decreased capability to manage environmental challenges may lead to physical injuries. Nutritional deficits are related more to dietary habits and the caregivers' understanding of nutrition. Visual impairments are unrelated to cognitive impairment. Psychiatric problems may coexist with cognitive impairment; however, they are not environmental challenges.
14. Which manifestation is atypical of ADHD? a. Talking incessantly b. Blurting out the answers to questions before the questions have been completed c. Acting withdrawn in social situations d. Fidgeting with hands or feet
ANS: C The child with ADHD tends to be talkative, often interrupting conversations, rather than withdrawn in social situations. Talking excessively, blurting out the answers to questions, and fidgeting are all characteristics of impulsivity/hyperactivity.
11. What action is contraindicated when a child with Down syndrome is hospitalized? a. Determine the child's vocabulary for specific body functions. b. Assess the child's hearing and visual capabilities. c. Encourage parents to leave the child alone to encourage adaptation. d. Have meals served at the child's usual meal times.
ANS: C The child with Down syndrome needs routine schedules and consistency. Having familiar people present, especially parents, helps to decrease the child's anxiety. To communicate effectively with the child, it is important to know the child's particular vocabulary for specific body functions. Children with Down syndrome have a high incidence of hearing loss and vision problems and should have hearing and vision assessed whenever they are in a health care facility. Routine schedules and consistency are important to children.
9. A 35-year-old woman has an amniocentesis performed to find out whether her baby has a chromosome defect. Which statement by this patient indicates that she understands her situation? a. "The doctor will tell me if I should have an abortion when the test results come back." b. "I know support groups exist for parents who have a baby with birth defects, but we have plenty of insurance to cover what we need." c. "When all the lab results come back, my husband and I will make a decision about the pregnancy." d. "My mother must not find out about all this testing. If she does, she will think I'm having an abortion."
ANS: C The final decision about genetic testing and the future of the pregnancy lies with the patient. She will involve only those people whom she chooses in her decisions. The final decision about the future of the pregnancy lies with the patient only. Support groups are extremely important for parents of a baby with a defect. Insurance will help cover expenses, but the defect also takes a toll on the emotional, physical, and social aspects of the parents' lives. The nurse should ensure the woman understands that her care is confidential.
4. The most appropriate nursing diagnosis for a child with a cognitive dysfunction is a. impaired social interaction. b. deficient knowledge. c. risk for injury. d. ineffective coping. P
ANS: C The nurse needs to know that limited cognitive abilities to anticipate danger lead to risk for injury. Safety is a priority for all children with cognitive dysfunction. Impaired social interaction is indeed a concern for the child with a cognitive disorder but does not address the limited ability to anticipate danger. Because of the child's cognitive deficit, knowledge will not be retained and will not decrease the risk for injury. Ineffective individual coping does not address the limited ability to anticipate danger.
6. In counseling an adolescent who is abusing alcohol, the nurse explains that alcohol abuse primarily affects which organ of the body? a. Heart b. Liver c. Brain d. Lungs
ANS: C The primary effect of substance abuse is on the brain and residually on the rest of the body. Alcohol affects the entire brain by decreasing its responsiveness. Although an excessive amount of a chemical can cause cardiac abnormalities, the brain is the most commonly affected organ. Long-term alcohol use is known to impair the liver; however, brain function is decreased by any amount of alcohol intake. The pulmonary system is not the primary target; however, one commonly abused drug known to cause pulmonary problems is tobacco.
With regard to the development of the respiratory system, maternity nurses should be understand that: a. The respiratory system does not begin developing until after the embryonic stage. b. The infants lungs are considered mature when the lecithin/sphingomyelin (L/S) ratio is 1:1, at about 32 weeks. c. Maternal hypertension can reduce maternal-placental blood flow, accelerating lung maturity. d. Fetal respiratory movements are not visible on ultrasound scans until at least 16 weeks.
ANS: C - A reduction in placental blood flow stresses the fetus, increases blood levels of corticosteroids, and accelerates lung maturity. Development of the respiratory system begins during the embryonic phase and continues into childhood. The infants lungs are mature when the L/S ratio is 2:1, at about 35 weeks. Lung movements have been seen on ultrasound scans at 11 weeks.
A pregnant woman at 25 weeks gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate? a. That must have been a coincidence; babies cant respond like that. b. The fetus is demonstrating the aural reflex. c. Babies respond to sound starting at about 24 weeks of gestation. d. Let me know if it happens again; we need to report that to your midwife.
ANS: C - Babies respond to sound starting at about 24 weeks of gestation is an accurate statement. That must have been a coincidence; babies cant respond like that is inaccurate. Acoustic stimulations can evoke a fetal heart rate response. There is no such thing as an aural reflex. The statement, Let me know if it happens again; we need to report that to your midwife is not appropriate; it gives the impression that something is wrong.
The nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should: a. Tell the couple they need to have an abortion within 2 to 3 weeks. b. Explain that the fetus has a 50% chance of having the disorder. c. Discuss options with the couple, including amniocentesis to determine whether the fetus is affected. d. Refer the couple to a psychologist for emotional support.
ANS: C - Genetic testing, including amniocentesis, would need to be performed to determine whether the fetus is affected. The couple should be given information about the likelihood of having another baby with this disorder so that they can make an informed decision. A genetic counselor is the best source for determining genetic probability ratios. The couple eventually may need emotional support, but the status of the pregnancy must be determined first.
A couple has been counseled for genetic anomalies. They ask you, What is karyotyping? Your best response is: a. Karyotyping will reveal if the babys lungs are mature. b. Karyotyping will reveal if your baby will develop normally. c. Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes. d. Karyotyping will detect any physical deformities the baby has.
ANS: C - Karyotyping provides genetic information such as gender and chromosome structure. The L/S, not karyotyping, reveals lung maturity. Although karyotyping can detect genetic anomalies, the range of normal is nondescriptive. Although karyotyping can detect genetic anomalies, not all such anomalies display obvious physical deformities. The term deformities is a nondescriptive word. Physical anomalies may be present that are not detected by genetic studies (e.g., cardiac malformations).
In practical terms regarding genetic health care, nurses should be aware that: a. Genetic disorders affect people of all socioeconomic backgrounds, races, and ethnic groups equally. b. Genetic health care is more concerned with populations than individuals. c. The most important of all nursing functions is providing emotional support to the family during counseling. d. Taking genetic histories is the province of large universities and medical centers.
ANS: C - Nurses should be prepared to help with various stress reactions from a couple facing the possibility of a genetic disorder. Although anyone may have a genetic disorder, certain disorders appear more often in certain ethnic and racial groups. Genetic health care is highly individualized because treatments are based on the phenotypic responses of the individual. Individual nurses at any facility can take a genetic history, although larger facilities may have better support services.
A womans cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? a. We dont really know when such defects occur. b. It depends on what caused the defect. c. They occur between the third and fifth weeks of development. d. They usually occur in the first 2 weeks of development.
ANS: C - The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week. We dont really know when such defects occur is an inaccurate statement. Regardless of the cause, the heart is vulnerable during its period of development, the third to fifth weeks. They usually occur in the first 2 weeks of development is an inaccurate statement.
A father and mother are carriers of phenylketonuria (PKU). Their 2-year-old daughter has PKU. The couple tells the nurse that they are planning to have a second baby. Because their daughter has PKU, they are sure that their next baby wont be affected. What response by the nurse is most accurate? a. Good planning; you need to take advantage of the odds in your favor. b. I think youd better check with your doctor first. c. You are both carriers, so each baby has a 25% chance of being affected. d. The ultrasound indicates a boy, and boys are not affected by PKU.
ANS: C - The chance is one in four that each child produced by this couple will be affected by PKU disorder. This couple still has an increased likelihood of having a child with PKU. Having one child already with PKU does not guarantee that they will not have another. These parents need to discuss their options with their physician. However, an opportune time has presented itself for the couple to receive correct teaching about inherited genetic risks. No correlation exists between gender and inheritance of the disorder because PKU is an autosomal recessive disorder.
Sally comes in for her first prenatal examination. This is her first child. She asks you (the nurse), How does my baby get air inside my uterus? The correct response is: a. The babys lungs work in utero to exchange oxygen and carbon dioxide. b. The baby absorbs oxygen from your blood system. c. The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream. d. The placenta delivers oxygen-rich blood through the umbilical artery to the babys abdomen.
ANS: C - The placenta functions by supplying oxygen and excreting carbon dioxide to the maternal bloodstream. The fetal lungs do not function for respiratory gas exchange in utero. The baby does not simply absorb oxygen from a womans blood system. Blood and gas transport occur through the placenta. The placenta delivers oxygen-rich blood through the umbilical vein and not the artery.
19. Which is the best setting for daytime care for a 5-year-old autistic child whose mother works? a. Private day care b. Public school c. His own home with a sitter d. A specialized program that uses behavioral methods
ANS: D Autistic children can benefit from specialized educational programs that address their special needs. Day care programs generally do not have resources to meet the needs of severely impaired children. To best meet the needs of an autistic child, the public school may refer the child to a specialized program. A sitter might not have the skills to interact with an autistic child.
10. Many of the physical characteristics of Down syndrome present feeding problems. Care of the infant should include a. delaying feeding solid foods until the tongue thrust has stopped. b. modifying diet as necessary to minimize the diarrhea that often occurs. c. providing calories appropriate to child's age. d. using special bottles that may assist the infant with feeding.
ANS: D Breastfeeding may not be possible if the infant's muscle tone or sucking reflex is immature. Mothers should be encouraged to pump breast milk and use special bottles for assistance with feeding. Some children with Down syndrome can breastfeed adequately. The child has a protruding tongue, which makes feeding difficult. The parents must persist with feeding while the child continues the physiologic response of the tongue thrust. The child is predisposed to constipation. Calories should be appropriate to the child's weight and growth needs, not age.
7. Which statement should a nurse make when telling a couple about the prenatal diagnosis of genetic disorders? a. Diagnosis can be obtained promptly through most hospital laboratories. b. Common disorders can quickly be diagnosed through blood tests. c. A comprehensive evaluation will result in an accurate diagnosis. d. Diagnosis may be slow and could be inconclusive.
ANS: D Even the best efforts at diagnosis do not always yield the information needed to counsel patients. They may require many visits over several weeks. Some tests must be sent to a special laboratory, which requires a longer waiting period for results. There is no quick blood test available at this time to diagnose genetic disorders. Despite a comprehensive evaluation, a diagnosis may never be established.
15. A nurse is seeing a pregnant woman who has had genetic testing on her unborn fetus and has been given the results. The nurse notes the results confirm that the husband could not be the father. What action by the nurse is best? a. Do not discuss this information with the mother. b. Inform the mother genetic testing does not establish paternity. c. Call the husband immediately to break the news. d. Be available and offer support as the mother absorbs the news.
ANS: D Genetic testing can reveal paternity; hopefully the couple was informed that this can occur before the testing was done. The nurse should offer support to the woman as she tries to absorb the news and determine what to do next. Refusing to discuss the information may leave the woman feeling abandoned and does not address her emotional needs. The nurse should not call the husband.
18. The nurse is providing counseling to the mother of a child diagnosed with fragile X syndrome. She explains to the mother that fragile X syndrome is a. most commonly seen in girls. b. acquired after birth. c. usually transmitted by the male carrier. d. usually transmitted by the female carrier.
ANS: D The gene causing fragile X syndrome is transmitted by the mother. Fragile X syndrome is most common in males. Fragile X syndrome is congenital. Fragile X syndrome is not transmitted by a male carrier.
10. What is the goal of therapeutic management for a child diagnosed with ADHD? a. Administer stimulant medications. b. Assess the child for other psychosocial disorders. c. Correct nutritional imbalances. d. Reduce the frequency and intensity of unsocialized behaviors.
ANS: D The primary goal of therapeutic management for the child with ADHD is to reduce the intensity and frequency of unsocialized behaviors. Although medications are effective in managing behaviors associated with ADHD, all families do not choose to give their child medication. Administering medication is not the primary goal. Children with ADHD may have other psychosocial or learning problems; however, diagnosing these is not the primary goal. Interventions to correct nutritional imbalances are the primary focus of care for eating disorders.
The most basic information a maternity nurse should have concerning conception is that: a. Ova are considered fertile 48 to 72 hours after ovulation. b. Sperm remain viable in the womans reproductive system for an average of 12 to 24 hours. c. Conception is achieved when a sperm successfully penetrates the membrane surrounding the ovum. d. Implantation in the endometrium occurs 6 to 10 days after conception.
ANS: D - After implantation, the endometrium is called the decidua. Ova are considered fertile for about 24 hours after ovulation. Sperm remain viable in the womans reproductive system for an average of 2 to 3 days. Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed.
The _____ is/are responsible for oxygen and carbon dioxide transport to and from the maternal bloodstream. a. Decidua basalis c. Germ layer b. Blastocyst d. Chorionic villi
ANS: D - Chorionic villi are fingerlike projections that develop out of the trophoblast and extend into the blood-filled spaces of the endometrium. The villi obtain oxygen and nutrients from the maternal bloodstream and dispose of carbon dioxide and waste products into the maternal blood. The decidua basalis is the portion of the decidua (endometrium) under the blastocyst where the villi attach. The blastocyst is the embryonic development stage after the morula. Implantation occurs at this stage. The germ layer is a layer of the blastocyst.
A woman who is 8 months pregnant asks the nurse, Does my baby have any antibodies to fight infection? The most appropriate response by the nurse is: a. Your baby has all the immune globulins necessary: IgG, IgM, and IgA. b. Your baby wont receive any antibodies until he is born and you breastfeed him. c. Your baby does not have any antibodies to fight infection. d. Your baby has IgG and IgM.
ANS: D - During the third trimester, the only immune globulins that crosses the placenta, IgG, provides passive acquired immunity to specific bacterial toxins. The fetus produces IgM by the end of the first trimester. IgA is not produced by the baby. By the third trimester, the fetus has IgG and IgM. Breastfeeding supplies the baby with IgA. Your baby does not have any antibodies to fight infection is an inaccurate statement.
With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that: a. With a dominant disorder, the likelihood of the second child also having the condition is 100%. b. An autosomal recessive disease carries a one in eight risk of the second child also having the disorder. c. Disorders involving maternal ingestion of drugs carry a one in four chance of being repeated in the second child. d. The risk factor remains the same no matter how many affected children are already in the family.
ANS: D - Each pregnancy is an independent event. The risk factor (e.g., one in two, one in four) remains the same for each child, no matter how many children are born to the family. In a dominant disorder, the likelihood of recurrence in subsequent children is 50% (one in two). An autosomal recessive disease carries a one in four chance of recurrence. In disorders involving maternal ingestion of drugs, subsequent children would be at risk only if the mother continued to take drugs; the rate of risk would be difficult to calculate.
Some of the embryos intestines remain within the umbilical cord during the embryonic period because the: a. Umbilical cord is much larger at this time than it will be at the end of pregnancy. b. Intestines begin their development within the umbilical cord. c. Nutrient content of the blood is higher in this location. d. Abdomen is too small to contain all the organs while they are developing.
ANS: D - The abdominal contents grow more rapidly than the abdominal cavity, so part of their development takes place in the umbilical cord. By 10 weeks of gestation, the abdomen is large enough to contain them. Intestines begin their development within the umbilical cord, but only because the liver and kidneys occupy most of the abdominal cavity. Blood supply is adequate in all areas.
A pregnant client has heard about Down syndrome and wants to know about the risk factors associated with it. Which of the following would the nurse include as a risk factor? a) Advanced maternal age b) Recurrent miscarriages c) Advanced paternal age d) Family history of condition
Advanced maternal age Correct Explanation: 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.
While assessing a 5-year-old boy with autism spectrum disorder (ASD), the nurse notices that the boy is standing near his mother playing with a teddy bear and does not respond to the nurse's greeting. Which approach is most appropriate for the nurse to use? Explaining that this is not at all unusual and that there is not much that can be done, because this is the normal progression of the disorder Allowing the patient to stay next to his mother with the teddy bear and speaking to him calmly and concisely Engaging as little as possible with the patient, so as not to upset him more, and keeping to the task at hand Telling the mother that her son is too old to play with teddy bears
Allowing the patient to stay next to his mother with the teddy bear and speaking to him calmly and concisely It is best to allow the patient to stay near his mother and keep the teddy bear, which will help him accept the new environment and activities that will be taking place. Using the patient's name before saying hello will help him recognize that he is being spoken to. The other answers would not be helpful to the patient.
Which children would be best characterized as having a separation-anxiety disorder? a) A 10-year-old who says he has a headache if he has a test in school b) A 7-year-old who withdraws from contact with all strangers. c) An 8-year-old who will not stay overnight at a friend's house d) An 8-month-old who cries when he is left with strangers
An 8-year-old who will not stay overnight at a friend's house
A woman in her third trimester has just learned that her fetus has been diagnosed with cri-du-chat syndrome. The nurse recognizes that this child will likely have which of the following characteristics? a) Small and nonfunctional ovaries b) Cleft lip and palate c) Rounded soles of the feet (rocker-bottom) d) An abnormal, cat-like cry
An abnormal, cat-like cry Correct Explanation: Cri-du-chat syndrome is the result of a missing portion of chromosome 5. In addition to an abnormal cry, which sounds much more like the sound of a cat than a human infant's cry, children with cri-du-chat syndrome tend to have a small head, wide-set eyes, a downward slant to the palpebral fissure of the eye, and a recessed mandible. They are severely cognitively challenged. Rounded soles of the feet are characteristic of trisomy 18 syndrome. Cleft lip and palate are characteristic of trisomy 13 syndrome. Small and nonfunctional ovaries are characteristic of Turner syndrome.
A child with ADHD is placed on methylphenidate (Ritalin) therapy. Which of the following symptoms may children on Ritalin develop? a) Rapid increase in height b) Hypotension c) Sleepiness d) Anorexia
Anorexia
Mr. and Mrs. W are the parents of a baby with Down Syndrome. Through genetic counseling, the baby has been identified as having a chromosome 21 translocation. Which of the following represents the risk that this couple will conceive another child with Trisomy 21? A. 5 to 15 percent B. 10 percent C. 25 percent D. No increased risk
Answer A - Translocation has an increase risk of 5 to 15 percent for subsequent births to Trisomy 21. Nondisjunction is the most common and has a minimal increase in risk of reoccurrence. This information is important to disclose to the family during genetic counseling.
The nurse has considered oxygen administration because of a client's obvious respiratory distress and circumoral cyanosis. What factor should the nurse consider when administering the oxygen in a client with cystic fibrosis? A. Children with CF respond poorly to oxygen administration. B. Administration of oxygen can decrease the respiratory drive. C. Oxygen would antagonize the cosmic field. D. Oxygen should only be administered via facemask.
Answer B - Clients with chronic carbon dioxide retention (Hypercapnia) are dependent on oxygen to drive the respiratory system. Too much oxygen will decrease the body's desire to breathe. Therefore, the nurse should monitor the respiratory status/rate of a client with CF for potential apnea.
10) Which information should the nurse include in the teaching plan for the parents of a child who is diagnosed with autism spectrum disorder (ASD) as methods to increase the child's socialization? 1. Create a reward system when the child interacts with a person. 2. Punish the child when the child's social behaviors are inappropriate. 3. Use dolls to demonstrate appropriate social interactions to the child. 4. Enroll the child in a day care facility to encourage interaction with other children.
Answer: 1 Explanation: 1. This is appropriate treatment involving behavior modification. 2. Behavior modification uses positive, not negative, reinforcement to encourage the desired behavior. 3. This activity would be a component of play therapy. 4. Enrolling the child in a day care facility may help with interactions, but this is not a description of behavior modification. Page Ref: 1491-1492 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 55.6 Establish and evaluate expected outcomes of care for the child with a cognitive alteration. MNL Learning Outcome: 8.1.3. Apply the nursing process in providing care for the child and family.
17) Which clinical manifestations should the nurse expect when conducting an assessment for a child who is diagnosed with autism spectrum disorder (ASD)? Select all that apply. 1. Arm flapping 2. Language delays 3. Ritualistic behavior 4. Impulsive behavior 5. Sleep disturbances
Answer: 1, 2, 3 Explanation: 1. Arm flapping is a clinical manifestation associated with ASD. 2. Language delay is a clinical manifestation associated with ASD. 3. Ritualistic behavior is a clinical manifestation associated with ASD. 4. Impulsive behavior is a clinical manifestation associated with attention deficit hyperactivity disorder, not ASD. 5. Sleep disturbance is a clinical manifestation associated with attention deficit hyperactivity disorder, not ASD. Page Ref: 1489; 1493 Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55.2 Discuss the clinical manifestations of the major mental health alterations of childhood and adolescence. MNL Learning Outcome: 8.1.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children; 8.2.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children.
1) The nurse is assessing a 4-year-old child with a possible alteration in mental health. Which findings indicate a need for further investigation? Select all that apply. 1. Fails to make eye contact 2. Flinches when touched on the arm 3. History of limited prenatal care and precipitate delivery 4. Head circumference has not changed in over 1 year 5. Flat facial expressions
Answer: 1, 2, 3, 5 Explanation: 1. Making eye contact with the nurse and caregiver is part of the child's overall affect and social skills. A child who fails to make eye contact may have an alteration in mental health. 2. Flinching may indicate a desire to avoid contact; this can indicate a mental health issue and should be further evaluated. 3. History of prenatal care and delivery can help determine potential alterations in mental health in a child. 4. Head circumference is not measured in a 4-year-old. 5. Affect can be determined by facial expression and response to the nurse, helping to determine mental health. Page Ref: 1487 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55.1 Define mental health and describe major mental health alterations in childhood. MNL Learning Outcome: 8.1.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children; 8.2.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children.
19) Which interventions should the nurse include in the plan of care for a child who is diagnosed with an intellectual disability? Select all that apply. 1. Providing emotional support to the family 2. Maintaining a safe environment for the client 3. Educating the family that maintenance of activities of daily living (ADL) is impossible to achieve 4. Participating in the individualized education program (IEP) process 5. Recommending permanent institutionalization
Answer: 1, 2, 4 Explanation: 1. The nurse should include interventions in the plan of care for a child diagnosed with an intellectual disability that support the family. 2. The nurse should include interventions in the plan of care for a child diagnosed with an intellectual disability that maintain a safe environment. 3. Maintenance of ADL will be determined by the severity of the intellectual disability. 4. The nurse should participate in the IEP process for a child who is diagnosed with an intellectual disability. 5. Permanent institutionalization is no longer recommended for children diagnosed with an intellectual disability. Page Ref: 1510 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 55.5 Use evidence-based practice to plan nursing management for children with cognitive alterations. MNL Learning Outcome: 8.1.3. Apply the nursing process in providing care for the child and family.
9) The nurse is planning care for a school-age child diagnosed with separation anxiety disorder. Which aspects of cognitive-behavior therapy (CBT) should the nurse include in the teaching plan for the child's family? Select all that apply. 1. Self-talking 2. Relaxation 3. Hypnosis 4. Antidepressant medications 5. Recognition of feelings
Answer: 1, 2, 5 Explanation: 1. Self-talking helps a child to focus the inner thoughts on the desired behavior. 2. Teaching self-relaxation skills can help the child to reduce anxiety. 3. Hypnosis is not a component of cognitive-behavioral therapy. 4. Although medications may be a part of the treatment plan, it is not a component of cognitive-behavioral therapy. 5. Recognition and acceptance of feelings helps the child to move forward toward a desired behavior. Page Ref: 1500 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 55.3 Plan for the nursing management of children and adolescents with mental health alterations in the hospital and community settings. MNL Learning Outcome: 8.2.4. Apply the nursing process in providing care for the child and family.
20) Which items noted in a pediatric client's medical record indicate the child may be experiencing a learning disability? Select all that apply. 1. Dyslexia 2. Dysphagia 3. Dyspraxia 4. Scoliosis 5. Hypotonia
Answer: 1, 3 Explanation: 1. Dyslexia is the medical term indicating problems with reading, writing, and spelling. This indicates the child may be experiencing a learning disability. 2. Dysphagia is a medical term indicating problems with swallowing. This would not indicate the child is experiencing a learning disability. 3. Dyspraxia is the medical term indicating problems with manual dexterity and coordination. This indicates the child may be experiencing a learning disability. 4. Scoliosis is curvature of the spine. This does not indicate the child may be experiencing a learning disability; however, this is often associated with Down syndrome. 5. Hypotonia is decreased muscle tone. This does not indicate the child may be experiencing a learning disability; however, this is often associated with Fragile X syndrome. Page Ref: 1506; 1508 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Learning Outcome: 55.4 Describe characteristics of common cognitive alterations of childhood. MNL Learning Outcome: 8.1.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children.
16) Which statements should the nurse include in the definition of mental health during a health maintenance fair for pediatric clients? Select all that apply. 1. Mental health is the change in thought that occurs during childhood. 2. Mental health is foundational to a sense of personal well-being. 3. Mental health does not impact physical health. 4. Mental health involves successful engagement in activities. 5. Mental health changes over time.
Answer: 2, 4 Explanation: 1. Cognition, not mental health, is the change in thought that occurs during childhood; therefore, the nurse should not include this information. 2. Mental health is foundational to a sense of personal well-being; therefore, the nurse should include this information in the presentation. 3. Mental health does impact physical health; therefore, the nurse should not include this information. 4. Mental health does involve successful engagement in activities; therefore, the nurse should include this information in the presentation. 5. Cognition, not mental health, changes over time; therefore, the nurse should not include this information. Page Ref: 1484 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Teaching and Learning Learning Outcome: 55.1 Define mental health and describe major mental health alterations in childhood. MNL Learning Outcome: 8.1.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children; 8.2.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children.
4) Which statement from the parent of a child diagnosed with attention deficit/hyperactivity disorder (ADHD) indicates the need for further education by the nurse? 1. "I will develop a reward system for desired behaviors." 2. "I will take my child to the physician every 3 months for a weight and height check." 3. "I will let him do his homework while he is watching his favorite television show." 4. "I will stick to the same routine each day after school."
Answer: 3 Explanation: 1. A reward system is a part of behavior modification and is appropriate to help the child behave appropriately. 2. Children with ADHD should be screened regularly for height and weight to monitor growth, which can be affected by medication. 3. This child should do homework in a quiet environment, away from distractions. 4. Maintaining the same daily routine helps the child know expectations, and a nighttime routine helps counteract insomnia. Page Ref: 1493 Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 55.2 Discuss the clinical manifestations of the major mental health alterations of childhood and adolescence. MNL Learning Outcome: 8.1.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children; 8.2.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children.
5) A child diagnosed with autism spectrum disorder (ASD) is admitted to the hospital with dehydration. Which should the nurse include in the plan of care for this child? 1. Discourage the parents from bringing favorite toys from home that might be lost. 2. Take the child on a tour of the pediatric unit. 3. Assign the child to a single-bed hospital room. 4. Take the child to the playroom for arts and crafts.
Answer: 3 Explanation: 1. Children with autism often carry a special toy. This should be kept with the child. 2. Taking a child with autism on a tour of the pediatric unit would be too much stimulation for this child. A quiet, controlled environment is best for a child with autism. 3. A single room is the best place for an autistic child if the child must be hospitalized. 4. Arts and crafts might be appropriate for an autistic child if they are done in the child's room. Going to the playroom would be too much stimulation for this child. Page Ref: 1491-1492 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 55.3 Plan for the nursing management of children and adolescents with mental health alterations in the hospital and community settings. MNL Learning Outcome: 8.2.4. Apply the nursing process in providing care for the child and family.
6) A school-age child is diagnosed with a learning disorder that is characterized by problems with manual dexterity and coordination. Which term should the nurse use when documenting this child's disorder in the medical record? 1. Dysgraphia 2. Dyscalculia 3. Dyspraxia 4. Dyslexia
Answer: 3 Explanation: 1. Children with dysgraphia have difficulty with writing, spelling, and composition. 2. Children with dyscalculia have problems with mathematics and computation problems. 3. Children with dyspraxia have problems with manual dexterity and coordination. 4. Children with dyslexia have difficulty with writing, reading, and spelling. Page Ref: 1506 Cognitive Level: Applying Client Need/ Sub: Safe and Effective Care Environment/Management of Care Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Communication and Documentation Learning Outcome: 55.4 Describe characteristics of common cognitive alterations of childhood. MNL Learning Outcome: 8.1.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children.
7) The nurse is assessing a child with Down syndrome. Which illness should the nurse monitor for due to the increased risk for children with Down syndrome? 1. Rheumatic heart disease 2. Glomerulonephritis 3. Leukemia 4. Hepatitis
Answer: 3 Explanation: 1. Heart defects might be seen with Down syndrome, but not rheumatic heart disease, which is associated with group A beta-hemolytic streptococcus infection. 2. Glomerulonephritis is not seen in association with Down syndrome. 3. Children with Down syndrome have a significantly higher than average risk of developing leukemia. 4. Hepatitis is not associated with Down syndrome. Page Ref: 1507 Cognitive Level: Applying Client Need/Sub: Physiological Integrity/Physiological Adaptation Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55.4 Describe characteristics of common cognitive alterations of childhood. MNL Learning Outcome: 8.1.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children.
2) Which factor, noted by the nurse during the pediatric health history portion of the assessment process, would indicate the child is at risk for attention deficit/hyperactivity disorder (ADHD)? 1. Measles, mumps, and rubella vaccine 2. Advanced parental age 3. Prenatal exposure to smoke 4. Immune response
Answer: 3 Explanation: 1. Measles, mumps, and rubella vaccine has been thought to be associated with autism spectrum disorder, though a relationship has never been established through research. 2. Advanced parental age has been associated with autism spectrum disorders. 3. Research shows that a mother's use of cigarettes during pregnancy can increase the risk for ADHD. 4. Immune response can be associated with autism spectrum disorders. Page Ref: 1492 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55.2 Discuss the clinical manifestations of the major mental health alterations of childhood and adolescence. MNL Learning Outcome: 8.1.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children; 8.2.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children.
14) Which nursing action assists in the diagnosis of mental health and cognitive disorders that occur during childhood? 1. Monitoring vital signs 2. Administering prescribed medications 3. Conducting a developmental assessment 4. Documenting an accurate history and physical
Answer: 3 Explanation: 1. Monitoring vital signs is not a nursing action that assists in the diagnosis of mental health and cognitive disorders in pediatric clients. 2. Administering prescribed medications is not a nursing action that assists in the diagnosis of mental health and cognitive disorders in pediatric clients. 3. Conducting a developmental assessment is a nursing action that assists in the diagnosis of mental health and cognitive disorders in pediatric clients. 4. Documenting an accurate history and physical is not a nursing action that assists in the diagnosis of mental health and cognitive disorders in pediatric clients. Page Ref: 1484 Cognitive Level: Understanding Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55.2 Discuss the clinical manifestations of the major mental health alterations of childhood and adolescence. MNL Learning Outcome: 8.1.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children; 8.2.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children.
13) A school-age client presents to the pediatric clinic with a history of abdominal pain 3 to 4 mornings per week over the last 2 months. The mother states the child usually complains on school days and always seems to be better by afternoon. Which mental health disorder does the nurse suspect? 1. Separation anxiety 2. Depression 3. School phobia 4. Bipolar disorder
Answer: 3 Explanation: 1. Separation anxiety is most common in girls between the ages of 7 and 9 and may be accompanied by depression when separated. The child was able to successfully separate for a nonschool activity. 2. Depression is often manifested by sleep issues, avoidance of social interactions, and low energy. 3. The child is using somatic complaints to avoid attending school. 4. Bipolar disorder involves periods of hyperactivity alternating with periods of lethargy. Page Ref: 1501 Cognitive Level: Understanding Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55.2 Discuss the clinical manifestations of the major mental health alterations of childhood and adolescence. MNL Learning Outcome: 8.1.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children; 8.2.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children.
15) The mother of a 22-month-old child states, "My child does not seem to be developing like my sister's daughter, who is the same age." Which screening test should the nurse plan to conduct based on the current data? 1. Magnetic resonance imaging (MRI) of the head 2. An electroencephalogram (EEG) 3. A Denver II 4. Chromosomal study
Answer: 3 Explanation: 1. The MRI is a diagnostic test, not a screening test, and it is not performed by the nurse. 2. An electroencephalogram evaluates brains wave activity of the brain. It does not evaluate the child's behavior. 3. The Denver Developmental Screening Test II is a tool used by the nurse that evaluates language and development. 4. A chromosomal test is not a screening test but a diagnostic test. It is not performed to determine developmental delay. Page Ref: 1484 Cognitive Level: Analyzing Client Need/ Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 55.5 Use evidence-based practice to plan nursing management for children with cognitive alterations. MNL Learning Outcome: 8.1.3. Apply the nursing process in providing care for the child and family.
3) Which data, noted by the nurse during the physical assessment, would indicate the need to refer an adolescent client for further treatment due to possible depression? Select all that apply. 1. Agoraphobia 2. Somatic complaints 3. Focus on violence 4. Poor self-care 5. Poor school performance
Answer: 3, 4, 5 Explanation: 1. Agoraphobia, which is a fear of being in places or situations from which escape might be difficult or embarrassing, is seen in children with a panic disorder, not with depression. 2. Somatic complaints are more commonly associated with depression in the younger school-age child. 3. Focus on violence can be associated with depression in the adolescent. 4. Poor self-care can be associated with depression in an adolescent. 5. Poor school performance is associated with depression in the adolescent with depression. Page Ref: 1497 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55.2 Discuss the clinical manifestations of the major mental health alterations of childhood and adolescence. MNL Learning Outcome: 8.1.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children; 8.2.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children.
12) Which activities should the nurse include in the plan of care for a child diagnosed with attention deficit/hyperactivity disorder (ADHD) to improve behavior and learning? Select all that apply. 1. Asking the mother to seek a prescription for methylphenidate (Ritalin) for the child 2. Placing the child's desk at the back of the room to reduce distractions 3. Developing a consistent routine for the classroom 4. Limiting the decorations in the classroom 5. Determining areas where the child performs well and using these areas to promote self-esteem
Answer: 3, 4, 5 Explanation: 1. It is not the nurse's or teacher's place to suggest medications for this child. 2. The child's desk should be placed at the front of the room to promote attention. 3. Consistency is important for the child with ADD/ADHD and reduces impulsive behavior. 4. Decorations are distracting and should be limited. 5. This is appropriate and will help reduce "acting out" behaviors. Page Ref: 1495-1496 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 55.5 Use evidence-based practice to plan nursing management for children with cognitive alterations. MNL Learning Outcome: 8.1.3. Apply the nursing process in providing care for the child and family.
8) Which children should the nurse identify as exhibiting a delay in meeting developmental milestones? Select all that apply. 1. An 18-month-old toddler who is unable to speak in sentences 2. A 2-year-old child who is unable to cut with scissors 3. A 2-year-old child who cannot recite her phone number 4. A 6-year-old child who is unable to sit still for a short story 5. A 5-year-old child who is unable to button his shirt
Answer: 4, 5 Explanation: 1. An 18-month-old toddler is not usually able to speak in sentences. This is a skill to be accomplished by the age of 2.5 years. 2. A child who cannot cut with scissors by kindergarten age is considered abnormal. 3. A 2-year-old child is not expected to be able to recite a phone number. 4. A 6-year-old child should be able to sit still for a short story. A 3- to 5-year-old child should be able to sit still through a short story. 5. A 5-year-old child should be able to button his shirt. Page Ref: 1490 Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55.4 Describe characteristics of common cognitive alterations of childhood. MNL Learning Outcome: 8.1.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children.
18) Which clinical manifestations should the nurse expect when conducting an assessment for a child who is diagnosed with attention deficit/ hyperactivity disorder (ADHD)? Select all that apply. 1. Arm flapping 2. Language delays 3. Ritualistic behavior 4. Impulsive behavior 5. Sleep disturbances
Answer: 4, 5 Explanation: 1. Arm flapping is a clinical manifestation associated with autism spectrum disorder, not ADHD. 2. Language delay is a clinical manifestation associated with autism spectrum disorder, not ADHD. 3. Ritualistic behavior is a clinical manifestation associated with autism spectrum disorder, not ADHD. 4. Impulsive behavior is a clinical manifestation associated with ADHD. 5. Sleep disturbance is a clinical manifestation associated with ADHD. Page Ref: 1489; 1493 Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise and evidence | AACN Essential Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety: Knowledge: Current best practices | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 55.2 Discuss the clinical manifestations of the major mental health alterations of childhood and adolescence. MNL Learning Outcome: 8.1.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children; 8.2.1. Examine etiology, risk factors, pathophysiology, and clinical manifestations as seen in children.
The nurse is discussing medications that are used in treatment of autism spectrum disorder (ASD) with a parent of a child who was recently diagnosed with the condition. Which statement by the parent indicates the need for further teaching? "I will monitor my child closely with any new medications." I will note if my child has any increase in negative behaviors from medication." "I will give my child aspirin to help with the symptoms of ASD." "I will watch to see if my child has any suicidal thoughts."
Antipyretic agents are used to decrease body temperature and would not be appropriate for use in the treatment of a patient diagnosed with ASD. Children with autism might not respond to medications as other children do. Some negative behaviors might increase with medications. Other medications may cause severe depression and suicidal thoughts. Children with autism should be monitored closely when starting new medications.
The nurse is teaching the parents of a young child who was recently diagnosed with autism spectrum disorder (ASD). Which nonpharmacologic intervention should the nurse include? Applied behavior analysis Chelation therapy Mineral solutions Echolalia
Applied behavior analysis Applied behavior analysis is a form of behavior modification therapy that rewards the patient with ASD for positive behaviors like making eye contact or completing a sentence. Chelation therapy and mineral solutions are unproven and dangerous therapies. Echolalia is a compulsive parroting of a word or phrase just spoken by another.
The nurse is discussing nonpharmacologic interventions with the parents of a young child who was recently diagnosed with autism spectrum disorder (ASD). Which statement by the parents indicates that teaching was successful? "I'm contacting my doctor to request starting chelation therapy." "We are going to investigate applied behavior analysis as treatment." "I'm going to begin to give my child mineral solutions." "We will start encouraging echolalia in our child's speech."
Applied behavior analysis is a form of behavior modification therapy that rewards the patient with ASD for positive behaviors like making eye contact or completing a sentence. Chelation therapy and mineral solutions are unproven and dangerous therapies. Echolalia is a compulsive parroting of a word or phrase that has just been spoken by another.
The nurse is completing a physical assessment of a young adult who is being evaluated for anorexia. Which component should the nurse include in the nursing assessment? (Select all that apply.) Attitude toward food Condition of the teeth Body mass index (BMI) Current medication list Cognitive function findings
Attitude toward food Condition of the teeth Body mass index (BMI) Current medication list BMI is an important means of determining whether the client's weight is normal for the client's height. Exploring attitudes toward food gives insight regarding a healthy or unhealthy relationship with food and potential problems. A current medication list aids determination of whether weight loss or gain is a side effect and whether the client is using laxatives, diuretics, or diet aids. The condition of the client's teeth can reveal a history of vomiting. Cognitive function tests are not usually indicated in clients with eating disorders.
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 cannot be cured. c) Children respond best when the environment is less structured. d) Communication therapies are of little value in treating autism.
Autism cannot be cured.
A nurse is giving a parent information about autism. Which statement made by the parent indicates understanding of the teaching? A: Autism is characterized by periods of remission and exacerbation. B: The onset of autism usually occurs before 2 1/2 years of age. C: Children with autism have imitation and gesturing skills. D:Autism can be treated effectively with medication.
B
A parent asks the nurse why a developmental assessment is being conducted for a child during a routine well-child visit. The nurse answers based on the knowledge that routine developmental assessments during well-child visits are: A- not necessary unless the parents request them. B- the best method for early detection of cognitive disorders. C- frightening to parents and children and should be avoided. D- valuable in measuring intelligence in children.
B
A parent whose child has been diagnosed with a cognitive deficit should be counseled that intellectual impairment: A: is usually due to a genetic defect. B: may be caused by a variety of factors. C; is rarely due to first-trimester events. D: is usually caused by parental intellectual impairment.
B
Self-injury, fecal smearing, and severe temper tantrums in a preschool child are symptoms of: A: mild intellectual impairment. B: severe intellectual impairment. C: psychosocial deprivation. D: separation anxiety.
B
The nurse is caring for a 5-year-old. The child's mother reports that he is extremely sensitive to sounds that most people do not notice and that he prefers complete silence. She explains that the boy is resisting going to school due to the noise and commotion. Additionally, the mother states that he will only wear 100% cotton clothing with all of the tags cut out. The nurse interprets these findings as indicating which of the following? A) Anxiety disorder B) Sensory integration dysfunction C) Depression D) Obsessive-compulsive disorder
B
The nurse is teaching the mother of a 12-year-old boy about the risk factors associated with drug and alcohol abuse. Which response by the mother indicates a need for further teaching? A) "A family history of alcoholism is a risk factor for substance abuse." B) "Just because his friends are experimenting does not mean that he will." C) "If my husband or I have a substance abuse problem it could increase his risk." D) "Negative life events are a potential risk factor."
B
The parents of a child born at 36 weeks of gestation who had respiratory problems requiring 3 days of oxygen therapy are concerned that the infant may have an intellectual impairment. The best nursing statement to the parents is which of the following? A: A diagnosis of intellectual impairment is not made until the child enters school and experiences academic failure. B: Routine assessment of development during pediatric visits is the best method of early detection. C: The baby is not at risk for an intellectual impairment. D: Tests for intellectual impairments are not reliable for children younger than 3 years.
B
25. A pregnant woman is to undergo testing to evaluate for chromosomal abnormalities. Which test would the nurse expect to be done the earliest? A) Amniocentesis B) Chorionic villi sampling C) Triple screen D) Fetal nuchal translucency
B Feedback: Chorionic villi sampling is performed at 7 to 11 weeks' gestation. Amniocentesis usually is performed after 15 weeks' gestation. A triple screen is usually done between 16 and 19 weeks' gestation. Fetal nuchal translucency must be performed between 11 and 14 weeks.
18. When teaching the parents of a child with phenylketonuria, the nurse would instruct them to include which of the following foods in the child's diet? A) Milk B) Oranges C) Meat D) Eggs
B Feedback: Foods that contain phenylalanine are to be avoided. These include milk, meat, and eggs. Foods such as oranges would be allowed.
10. The nurse is teaching a couple about X-linked disorders. They are concerned that they might pass on hemophilia to their children. Which of the following responses indicates the need for further teaching? A) "The father can't be a carrier if he doesn't have hemophilia." B) "If the father doesn't have it, then his kids won't either." C) "If the mother is a carrier, her daughter could be one too." D) "If the mother is a carrier, her sons may have hemophilia."
B Feedback: Hemophilia is an X-linked recessive disorder. This means that both the father and the mother must have the gene for hemophilia to pass it on to their children. Also, their male children will have hemophilia, while their female children have only a 50% chance of having the disorder. If the father has hemophilia and the mother has hemophilia, their children will have the disease. If the father has hemophilia and the mother is a carrier, all their children have a 50% chance of getting the disease.
19. When providing support and education to the family of a child who is diagnosed with a serious genetic abnormality, which of the following would be the highest priority? A) Assisting with scheduling follow-up visits B) Establishing a trusting relationship C) Teaching the family what to expect D) Using measures to promote growth and development
B Feedback: Regardless of the genetic abnormality, learning of a genetic abnormality may be shattering to the family. Therefore, the initial priority is to establish a trusting relationship. Once this is accomplished, other aspects of care, such as assisting with scheduling follow-up visits, teaching, and implementing measures to promote growth and development, can be addressed.
16. When performing a physical examination on a small child, the nurse observes approximately 8 to 10 light-brown spots concentrated primarily on the trunk and extremities, two small lumps on the posterior trunk, and axillary freckling. The nurse interprets these findings to suggest which of the following? A) Klinefelter syndrome B) Neurofibromatosis C) Fragile X syndrome D) Sturge-Weber syndrome
B Feedback: The hallmark of neurofibromatosis is café-au-lait spots appearing all over the body, particularly the trunk and extremities. Additional findings include benign tumors, axillary freckling, and pigmented nevi. Klinefelter syndrome is associated with a lack of secondary sex characteristics, decreased facial hair, gynecomastia, decreased pubic hair, and hypogonadism. Fragile X syndrome is manifested by minor dysmorphic features and developmental delay. Sturge-Weber syndrome is associated with facial nevus, seizures, hemiparesis, and intracranial calcifications.
13. The nurse is caring for a couple who have just learned that their infant has a genetic disorder. Which of the following would be least appropriate for the nurse to do at this time? A) Actively listening to the parents' concerns B) Teaching the parents about the child's medical needs C) Providing time for the parents to ask questions D) Offering suggestions for support services
B Feedback: The parents are most likely overwhelmed with learning the diagnosis and are dealing with a wide range of emotions and reactions. Therefore, it would be inappropriate at this time to attempt teaching them. Rather, the nurse would provide emotional support, actively listening to the parents, allowing time for questions, and offering suggestions for support to assist them in dealing with this new challenge. Teaching can be done at a later time.
Which of the following treatment guidelines would be contraindicated when counseling the family of an infant with fragile X syndrome? Select all that apply. A: Advise genetic testing for family members. B: Delay speech therapy until the child is 2 years of age. C: Educate the family that their child will probably have normal intelligence. D: Refer the family to an early intervention program.
B C
A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain? a. Because severe anxiety concerning eating is expected, objective and subjective data must be routinely collected. b. Patient involvement in decision-making increases a sense of control and promotes compliance with the treatment. c. A team approach to planning the diet ensures that physical and emotional needs of the patient are met. d. Because of increased risk for physical problems with re-feeding, obtaining patient permission is required.
B ~ A sense of control for the patient is vital to the success of therapy. A diet that controls weight gain can allay patient fears of a too-rapid weight gain. Data collection is not the reason for contracting. A team approach is wise but is not a guarantee that the patient's needs will be met. Permission for treatment is a separate issue. The contract for weight gain is an additional aspect of treatment.
What behavior by a nurse caring for a patient diagnosed with an eating disorder indicates the nurse needs supervision? a. The nurses comments are nonjudgmental. b. The nurse uses an authoritarian manner when interacting with the patient. c. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene. d. The nurse refers the patient to a self-help group for individuals with eating disorders.
B ~ In the effort to motivate the patient and take advantage of the decision to seek help and be healthier, the nurse must take care not to cross the line toward authoritarianism and assume the role of a parent. The helpful nurse uses a problem-solving approach and focuses on the patient's feelings of shame and low self-esteem. Referral to a self-help group is an appropriate intervention.
An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient to: a. eat a small meal after purging. b. avoid skipping meals or restricting food. c. concentrate oral intake after 4 PM daily. d. understand the value of reading journal entries aloud to others.
B ~ One goal of health teaching is the normalization of eating habits. Food restriction and skipping meals lead to rebound bingeing. Teaching the patient to eat a small meal after purging will probably perpetuate the need to induce vomiting. Teaching the patient to concentrate intake after 4 PM will lead to late-day bingeing. Journal entries are private.
Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. She wears layered, loose clothing and now has amenorrhea. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely? a. Binge eating disorder b. Anorexia nervosa c. Bulimia nervosa d. Pica
B ~ Overly controlled eating behaviors, extreme weight loss, amenorrhea, preoccupation with food, and wearing several layers of loose clothing to appear larger are part of the clinical picture of an individual with anorexia nervosa. The individual with bulimia usually is near normal weight. The binge eater is often overweight. Pica refers to eating nonfood items.
Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa? a. Carefree flexibility b. Rigidity, perfectionism c. Open displays of emotion d. High spirits and optimism
B ~ Rigid thinking, inability to demonstrate flexibility, and difficulty changing cognitions are characteristic of patients diagnosed with eating disorders. The incorrect options are rare in a patient with anorexia nervosa. Inflexibility, controlled emotions, and pessimism are more the norm.
Which nursing intervention has priority as a patient diagnosed with anorexia nervosa begins to gain weight? a. Assess for depression and anxiety. b. Observe for adverse effects of re-feeding. c. Communicate empathy for the patients feelings. d. Help the patient balance energy expenditure and caloric intake.
B ~ The nursing intervention of observing for adverse effects of re-feeding most directly relates to weight gain and is a priority. Assessing for depression and anxiety and communicating empathy relate to coping. Helping the patient balance energy expenditure and caloric intake is an inappropriate intervention.
The nurse is teaching a couple about X-linked disorders. They are concerned that they might pass on hemophilia to their children. Which of the following responses indicates the need for further teaching? A) "The father can't be a carrier if he doesn't have hemophilia." B) "If the father doesn't have it, then his kids won't either." C) "If the mother is a carrier, her daughter could be one too." D) "If the mother is a carrier, her sons may have hemophilia."
B) "If the father doesn't have it, then his kids won't either."
The nurse is teaching the parents of a 1-month-old girl with Down syndrome how to maintain good health for the child. Which instruction would the nurse be least likely to include? A) Getting cervical radiographs between 3 and 5 years of age B) Adhering to the special dietary needs of the child C) Getting an echocardiogram before 3 months of age D) Monitoring for symptoms of respiratory infection
B) Adhering to the special dietary needs of the child
When providing support and education to the family of a child who is diagnosed with a serious genetic abnormality, which of the following would be the highest priority? A) Assisting with scheduling follow-up visits B) Establishing a trusting relationship C) Teaching the family what to expect D) Using measures to promote growth and development
B) Establishing a trusting relationship
A nursing instructor is preparing a class discussion on the benefits and drawbacks associated with genetic advances and the Human Genome Project. Which of the following would the instructor address as a potential problem? A) Early detection possibilities B) Risk profiling C) Focus on causes D) Rapid diagnosis
B) Risk profiling
A child is diagnosed with cri-du-chat syndrome. Which of the following would the nurse expect to assess? Select all answers that apply. A) Hypertonia B) Short stature C) Simian crease D) Wide and flat nasal bridge E) Hydrocephaly
B) Short stature C) Simian crease D) Wide and flat nasal bridge
The nurse is caring for a couple who have just learned that their infant has a genetic disorder. Which of the following would be least appropriate for the nurse to do at this time? A) Actively listening to the parents' concerns B) Teaching the parents about the child's medical needs C) Providing time for the parents to ask questions D) Offering suggestions for support services
B) Teaching the parents about the child's medical needs
The nurse is assessing a client who is obese and reports eating to the point of discomfort at least twice a week for the past year. The client denies the use of laxatives, self-induced vomiting, ipecac syrup, or enemas and reports feeling unable to control the behavior. The client feels embarrassed and has stopped going out with friends. Which eating disorder should the nurse suspect? Purging Anorexia nervosa Binge-eating disorder Bulimia nervosa
Binge-eating disorder The information shared by the client describes the classic manifestations of binge-eating disorder, not bulimia nervosa or anorexia nervosa. Purging is a symptom, not an eating disorder in and of itself.
A client is discussing her feelings regarding her eating disorder with the nurse. The client shares that when she looks in a mirror, she sees herself as fat even though her BMI is 18. With which thought pattern is this statement consistent? Therapeutic relationship Deception Purging Body image distortion
Body image distortion In body image distortion, a person's view of her image is different from the reality, representing a distorted thought pattern. A therapeutic relationship is one in which there is respect, consistency, trust, and patience between a client and the healthcare provider. Purging is the act of removing all food from the body. Deception is the act of not being truthful.
After teaching the parents of a child with attention deficit/hyperactivity disorder about ways to control the child's behavior, the nurse determines a need for additional teaching when the parents state which of the following? A) "If he starts to act out, we'll have him do a time-out to help him refocus." B) "We can use a reward system when he behaves appropriately." C) "If he misbehaves, we need to punish him instead of reward him." D) "We need to help him set realistic goals that he can achieve."
C
An appropriate nursing diagnosis for a child with a cognitive dysfunction who has a limited ability to anticipate danger is: A:Impaired social interaction. B: Deficient knowledge. C: Risk for injury. D: Ineffective coping.
C
The nurse is caring for a 3-year-old boy. The parents are concerned that he is exhibiting signs of cognitive delays. Which statement by the parents would lead the nurse to suspect autism spectrum disorder rather than possible learning disability? A) "He is not speaking in complete sentences." B) "We can understand a lot of what he says, but no one else can." C) "He seems to be speaking words less and less frequently." D) "He is unable to sit still for a short story."
C
The nurse is caring for a 7-year-old with Tourette syndrome. The nurse would be alert for which of the following comorbid conditions? A) Depression B) Anxiety disorder C) Attention deficit/hyperactivity disorder D) Asperger syndrome
C
The nurse is reviewing the medical record of a child who has dyspraxia. The nurse understands that this child experiences difficulty with which of the following? A) Reading and writing B) Mathematics and computation C) Manual dexterity and coordination D) Composition and spelling
C
Throughout their life span, cognitively impaired children are less capable of managing environmental challenges and are at risk for which problem? A: Nutritional deficits B: Visual impairments C: Physical injuries D: Psychiatric problems
C
Which action is contraindicated when a child with Down syndrome is hospitalized? A: Determine the childs vocabulary for specific body functions. B: Assess the childs hearing and visual capabilities. C: Encourage parents to leave the child alone. D: Have meals served at the childs usual meal times.
C
Which should the nurse keep in mind when planning to communicate with a child who is autistic? a. The child has normal verbal communication. b. Expect the child to use sign language. c. The child may exhibit monotone speech and echolalia. d. The child is not listening if she is not looking at the nurse.
C
21. The nurse is assessing an infant and notes that the infant's urine has a musty odor. Which of the following would the nurse suspect? A) Maple syrup urine disease B) Tyrosinemia C) Phenylketonuria D) Trimethylaminuria
C Feedback: The urine of a child with phenylketonuria has a mousy or musty odor. For the child with maple syrup urine disease, excretions have a maple syrup odor. With tyrosinemia, excretions have a cabbage-like or rancid butter odor. With trimethylaminuria, excretions smell like rotting fish.
A patient who is referred to the eating disorders clinic has lost 35 pounds in the past 3 months. To assess the patient's oral intake, the nurse should ask: a. Do you often feel fat? b. Who plans the family meals? c. What do you eat in a typical day? d. What do you think about your present weight?
C ~ Although all the questions might be appropriate to ask, only "What do you eat in a typical day?" focuses on the eating patterns. Asking if the patient often feels fat focuses on distortions in body image. Questions about family meal planning are unrelated to eating patterns. Asking for the patient's thoughts on present weight explores the patient's feelings about weight.
The nurse is caring for a 1-month-old girl with low-set ears and severe hypotonia who was diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely? A) Interrupted family process related to the child's diagnosis B) Deficient knowledge deficit related to the genetic disorder C) Grieving related to the child's poor prognosis D) Ineffective coping related to stress of providing care
C) Grieving related to the child's poor prognosis
The nurse is assessing a 4-year-old boy whose mother was 40 years old when he was born. Which of the following findings suggests this child has a genetic disorder? A) Inquiry determines the child had feeding problems. B) Observation shows nasal congestion and excess mucus. C) Inspection reveals low-set ears with lobe creases. D) Auscultation reveals the presence of wheezing.
C) Inspection reveals low-set ears with lobe creases.
The nurse is assessing an infant and notes that the infant's urine has a musty odor. Which of the following would the nurse suspect? A) Maple syrup urine disease B) Tyrosinemia C) Phenylketonuria D) Trimethylaminuria
C) Phenylketonuria
Which medication should the nurse expect to find on the medication administration record (MAR) for a child with autism spectrum disorder (ASD)? (Select all that apply.) A. Beta blocker B. Angiotensin-converting enzyme (ACE) inhibitor C. Mood stabilizer D. Selective serotonin reuptake inhibitor (SSRI) E. Stimulant
C,D,E Rationale: While there is no medication to cure ASD, medications are prescribed to manage behaviors and symptoms. These medications include stimulants, SSRIs, and mood stabilizers. ACE inhibitors and beta blockers are used to treat hypertension.
A pregnant woman has a child at home who has been diagnosed with neurofibromatosis She asks the nurse what she should look for in the new baby that would indicate that it also has neurofibromatosis. What sign should the nurse instruct the woman to look for in the new baby? a) Projectile vomiting b) Café-au-lait spots c) Xanthoma d) Increased urination
Café-au-lait spots Correct Explanation: Physical assessment may provide clues that a particular genetic condition is present in a person and family. Family history assessment may offer initial guidance regarding the particular area for physical assessment. For example, a family history of neurofibromatosis type 1, an inherited condition involving tumors of the central nervous system, would prompt the nurse to carry out a detailed assessment of closely related family members. Skin findings such as café-au-lait spots, axillary freckling, or tumors of the skin (neurofibromas) would warrant referral for further evaluation, including genetic evaluation and counseling. A family history of familial hypercholesterolemia would alert the nurse to assess family members for symptoms of hyperlipidemias (xanthomas, corneal arcus, abdominal pain of unexplained origin). As another example, increased urination could indicate type 1 diabetes. Projectile vomiting is indicative of pyloric stensosis.
A 9-year-old girl with an anxiety disorder is experiencing a panic attack in the waiting room of the pediatrician's office. Which is the first action the nurse should take? a) Calmly move the child to a quiet, comfortable area. b) Quickly find the pediatrician to administer medication. c) Calmly tell the child to relax. d) Quickly enlist the assistance of the child's parent.
Calmly move the child to a quiet, comfortable area.
A nursing student is reviewing information about inheritance and genetic disorders. The student demonstrates understanding of the information by identifying which of the following as an example of a disorder involving multifactorial inheritance? a) Cystic fibrosis b) Hypophosphatemic rickets c) Hemophilia d) Cleft palate
Cleft palate Correct Explanation: Cleft palate is attributed to multifactorial inheritance. Hemophilia follows an X-linked recessive inheritance pattern. Hypophosphatemic rickets follows an X-linked dominant inheritance pattern. Cystic fibrosis follows an autosomal recessive inheritance pattern.
For which of the following clients is preimplantation genetic diagnosis (PGD) a viable option? a) Clients carrying cystic fibrosis gene b) Prevention of Pyloric stenosis c) Prevention of DiGeorge syndrome d) Client in the second week of pregnancy
Clients carrying cystic fibrosis gene Correct Explanation: Preimplantation genetic diagnosis (PGD) is a viable option for clients carrying the cystic fibrosis gene. PGD does not help prevent DiGeorge syndrome or pyloric stenosis. PGD is not a viable option for pregnant clients.
The adolescent with Marfan's Syndrome should be monitored for which potentially lethal complication? A. Aortic rupture. B. Retinal Detachment. C. Hyperextended joints. D. Seizure.
Correct A - The connective tissue disorder of Marfan's Syndrome can include aortic insufficiency, which can lead to aortic rupture or dissection, which is the primary cause of death for this syndrome.
A child born with the karyotype showing XXY is a candidate for which of the following? A. Turner's Syndrome B. Klinefelter's Syndrome C. Down Syndrome D. Marfan's Syndrome
Correct Answer B - The child with Klinefelter's Syndrome has an extra "X" and possible replication of "Y". The karyotype shows the pictorial analysis of the chromosomes of an individual.
Which of the following responses is best when a nurse is asked by the family about why a client with Huntington's chorea should be given thickened liquids? A. The client is at risk for dehydration. B. The client is at risk for aspiration. C. The client may have difficulty chewing. D. The client may have pain on swallowing.
Correct B - An individual with Huntington's Disease develops chorea (rapid, jerky movements) and might have difficulty swallowing liquids, which could lead to the potential of aspiration of nonthickened liquids.
The infant with Down syndrome is closely monitored during the first year of life for which condition? A: Thyroid complications B: Orthopedic malformations C: Dental malformation D: Cardiac abnormalities
D
The nurse is caring for an adolescent girl with a suspected anxiety disorder. The girl states that she is constantly double-checking that she has unplugged her curling iron and must make sure that everything is in perfect order in her room before she leaves the house. The nurse interprets these findings as indicating which of the following? A) Generalized anxiety disorder B) Posttraumatic stress disorder C) Social phobia D) Obsessive-compulsive disorder
D
When assessing the adolescent with anorexia, which of the following would the nurse expect to find? A) Tachycardia B) Hypertension C) Fever D) Murmur
D
When reviewing the medical record of a child, which of the following would the nurse interpret as the most sensitive indicator of intellectual disability? A) History of seizures B) Preterm birth C) Vision deficit D) Language delay
D
Which intervention is most appropriate for the nurse to include in the plan of care for a child with autism spectrum disorder (ASD)? A. Putting the television on loud to provide stimulation for the client B. Rearranging the hospital room until a comfortable arrangement is found C. Scheduling procedures for different times each day D. Encouraging the client's family to bring in familiar objects from home
D
9. The nurse is caring for a 9-year-old boy with achondroplasia. Which of the following would the nurse expect to assess? A) Narrow passages from the nose to the throat B) Slim stature, hypotonia, and a narrow face C) Craniosynostosis and a small nasopharynx D) Trident hand and persistent otitis media
D Feedback: Achondroplasia results in disordered growth with an average adult height of 4 feet for males or females. Other distinguishing symptoms are a separation between the middle and ring fingers, called trident hand, and persistent otitis media and middle ear dysfunction. Narrow passages from nose to throat are a symptom of CHARGE syndrome. Slim stature, hypotonia, and a narrow face are symptoms of Marfan syndrome. Craniosynostosis and a small nasopharynx are symptoms of Apert syndrome.
12. The nurse is preparing a presentation to a local community group about genetic disorders and the types of congenital anomalies that can occur. Which of the following would the nurse include as a major congenital anomaly? A) Overlapping digits B) Polydactyly C) Umbilical hernia D) Cleft palate
D Feedback: Cleft palate is considered a major congenital anomaly, one that creates a significant medical problem or requires surgical or medical management. Overlapping digits, polydactyly, and umbilical hernia are considered minor congenital anomalies because they do not cause an increase in morbidity in and of themselves.
6. The nurse is counseling a couple who suspect that they could bear a child with a genetic abnormality. Which of the following would be most important for the nurse to incorporate into the plan of care when working with this family? A) Gathering information from at least three generations B) Informing the family of the need for a wide range of information C) Maintaining the confidentiality of the information D) Presenting the information in a nondirective manner
D Feedback: It is essential to respect client autonomy and present information in a factual, nondirective manner. In these situations, the nurse needs to understand that the choice is the couple's to make. Gathering information for three generations obtains a broad overview of what has been seen in both sides of the family. Maintaining confidentiality of the information is as important as with any other client information gathered. Informing family of the need for information is necessary because of its personal nature.
1. The nurse is teaching a couple about the pros and cons of genetic testing. Which of the following statements best describes the capabilities of genetic testing? A) "Various genetic tests help the physician choose appropriate treatments." B) "Genetic testing helps couples avoid having children with fatal diseases." C) "Genetic tests identify people at high risk for preventable conditions." D) "Some genetic tests can give a probability for developing a disorder."
D Feedback: The fact that some tests only provide a probability for developing a disorder raises a problem. A serious limitation of these susceptibility tests is that some people who carry a disease-associated mutation never develop the disease. The other statements affirm the value of genetic tests.
When a nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight, the nurse should state: a. You and I will have to sit down and discuss this problem. b. It bothers me to see you exercising. You'll lose more weight. c. Lets discuss the relationship between exercise and weight loss and how that affects your body. d. According to our agreement, no exercising is permitted until you have gained a specific amount of weight.
D ~ A matter-of-fact statement that the nurses perceptions are different helps avoid a power struggle. Treatment plans have specific goals for weight restoration. Exercise is limited to promote weight gain. Patients must be held accountable for required behaviors.
Disturbed body image is the nursing diagnosis for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor? a. Weight, muscle, and fat are congruent with height, frame, age, and sex. b. Calorie intake is within the required parameters of the treatment plan. c. Weight reaches the established normal range for the patient. d. Patient expresses satisfaction with body appearance.
D ~ Body image disturbances are considered improved or resolved when the patient is consistently satisfied with his or her own appearance and body function. This consideration is subjective. The other indicators are more objective but less related to the nursing diagnosis.
A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of: a. maintaining patient's concentration and attention. b. shifting the patient's focus from food to psychotherapy. c. focusing on weight control mechanisms and food preparation. d. processing the heightened anxiety associated with eating.
D ~ Eating produces high anxiety for patients with eating disorders. Anxiety levels must be lowered if the patient is to be successful in attaining therapeutic goals. Shifting the patient's focus from food to psychotherapy and focusing on weight control mechanisms and food preparation are not desirable. Maintaining patient's concentration and attention is important, but not the primary purpose of the schedule.
Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important outcome related to the nursing diagnosis: Imbalanced nutrition: less than body requirements. Within 1 week, the patient will: a. weigh self accurately using balanced scales. b. limit exercise to less than 2 hours daily. c. select clothing that fits properly. d. gain 1 to 2 pounds.
D ~ Only the outcome of a gain of 1 to 2 pounds can be accomplished within 1 week when the patient is an outpatient. The focus of an outcome is not on the patient weighing self. Limiting exercise and selecting proper clothing are important, but weight gain takes priority.
The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention Monitor for complications of re-feeding. Which body system should a nurse closely monitor for dysfunction? a. Renal b. Endocrine c. Central nervous d. Cardiovascular
D ~ Re-feeding resulting in a too-rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse. Focused assessment becomes a necessity to ensure patient physiologic integrity. The other body systems are not initially involved in the re-feeding syndrome.
Which assessment finding for a patient diagnosed with an eating disorder meets a criterion for hospitalization? a. Urine output: 40 ml/hr b. Pulse rate: 58 beats/min c. Serum potassium: 3.4 mEq/L d. Systolic blood pressure: 62 mm Hg
D ~ Systolic blood pressure less than 70 mm Hg is an indicator for inpatient care. Many people without eating disorders have bradycardia (pulse less than 60 beats/min). Urine output should be more than 30 ml/hr. A potassium level of 3.4 mEq/L is within the normal range.
A psychiatric clinical nurse specialist uses cognitive therapy techniques with a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy? a. What are your feelings about not eating the food that you prepare? b. You seem to feel much better about yourself when you eat something. c. It must be difficult to talk about private matters to someone you just met. d. Being thin does not seem to solve your problems. You are thin now but still unhappy.
D ~ The correct response is the only strategy that attempts to question the patients distorted thinking.
A nursing diagnosis for a patient diagnosed with bulimia nervosa is: Ineffective coping, related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related to this diagnosis is, Within 2 weeks the patient will: a. appropriately express angry feelings. b. verbalize two positive things about self. c. verbalize the importance of eating a balanced diet. d. identify two alternative methods of coping with loneliness.
D ~ The outcome of identifying alternative coping strategies is most directly related to the diagnosis of Ineffective coping. Verbalizing positive characteristics of self and verbalizing the importance of eating a balanced diet are outcomes that might be used for other nursing diagnoses. Appropriately expressing angry feelings is not measurable.
Which nursing diagnosis is more applicable for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient diagnosed with bulimia nervosa who purges? a. Powerlessness b. Ineffective coping c. Disturbed body image d. Imbalanced nutrition: less than body requirements
D ~ The patient with bulimia nervosa usually maintains a close to normal weight, whereas the patient with anorexia nervosa may approach starvation. The incorrect options may be appropriate for patients with either anorexia nervosa or bulimia nervosa.
A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and has lost 25% of body weight. The patient's current serum potassium is 2.7 mg/dl. Which nursing diagnosis applies? a. Adult failure to thrive, related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss b. Disturbed energy field, related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia c. Ineffective health maintenance, related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia d. Imbalanced nutrition: less than body requirements, related to malnutrition as evidenced by loss of 25% of body weight and hypokalemia
D ~ The patient's history and laboratory results support the correct nursing diagnosis. Available data do not confirm that the patient uses laxatives, induces vomiting, or exercises excessively. The patient has hypokalemia rather than hyperkalemia.
A patient being admitted to the eating disorders unit has a yellow cast to the skin and fine, downy hair covering the body. The patient weighs 70 pounds; height is 5 feet, 4 inches. The patient is quiet and says only, "I won't eat until I look thin." What is the priority initial nursing diagnosis? a. Anxiety, related to fear of weight gain b. Disturbed body image, related to weight loss c. Ineffective coping, related to lack of conflict resolution skills d. Imbalanced nutrition: less than body requirements, related to self-starvation
D ~ The physical assessment shows cachexia, which indicates imbalanced nutrition. Addressing the patient's self-starvation is the priority above the incorrect responses.
The nurse is teaching a couple about the pros and cons of genetic testing. Which of the following statements best describes the capabilities of genetic testing? A) "Various genetic tests help the physician choose appropriate treatments." B) "Genetic testing helps couples avoid having children with fatal diseases." C) "Genetic tests identify people at high risk for preventable conditions." D) "Some genetic tests can give a probability for developing a disorder."
D) "Some genetic tests can give a probability for developing a disorder."
When describing Prader-Willi syndrome to a group of nursing students, the instructor would describe this condition as one affecting which chromosome? A) 4 B) 5 C) 11 D) 15
D) 15
The nurse is preparing a presentation to a local community group about genetic disorders and the types of congenital anomalies that can occur. Which of the following would the nurse include as a major congenital anomaly? A) Overlapping digits B) Polydactyly C) Umbilical hernia D) Cleft palate
D) Cleft palate
The nurse is counseling a couple who suspect that they could bear a child with a genetic abnormality. Which of the following would be most important for the nurse to incorporate into the plan of care when working with this family? A) Gathering information from at least three generations B) Informing the family of the need for a wide range of information C) Maintaining the confidentiality of the information D) Presenting the information in a nondirective manner
D) Presenting the information in a nondirective manner
When providing guidance to the parents of a child with Down syndrome, which of the following would be most appropriate? A) Encourage the parents to home-school the child. B) Advise the parents that the child will need monthly thyroid testing. C) Instruct them on the need for yearly dental visits. D) Teach the parents about the need for a high-fiber diet.
D) Teach the parents about the need for a high-fiber diet.
The nurse is caring for a couple who is having a triple screen done. The nurse would least likely expect which of the following to be tested? A) a-Fetoprotein B) Human chorionic gonadotropin C) Unconjugated estriol D) Testosterone
D) Testosterone
The nurse is caring for a 9-year-old boy with achondroplasia. Which of the following would the nurse expect to assess? A) Narrow passages from the nose to the throat B) Slim stature, hypotonia, and a narrow face C) Craniosynostosis and a small nasopharynx D) Trident hand and persistent otitis media
D) Trident hand and persistent otitis media
The mental health nurse assesses for the most common mental health disorder found in children when asking which question? A. "Do you ever hear voices in your head telling you what to do?" B. "What makes you afraid or nervous?" C. "Are you sad often?" D. "Do you ever get scolded at school for not sitting still?
D. "Do you ever get scolded at school for not sitting still?
A nurse is speaking to the parents of a child with attention deficit hyperactivity disorder (ADHD). The parents ask the nurse about the reason for the child's underachievement in academics. What explanation given by the nurse is most appropriate? A. "Your child does not attend classes." B. "Your child has impaired cognitive abilities." C. "Your child has difficulty with reading and writing." D. "Your child has trouble following the teacher's directions."
D. "Your child has trouble following the teacher's directions."
The nurse understands the importance of developing rapport with family members before the evaluation when caring for children with psychiatric disorders. The main reason for doing this is what? A. Reducing cost of stay B. Reducing fear of rejection C. Reducing length of stay D. Reducing anxiety
D. Reducing anxiety
Which condition is characterized by multiple motor tics and one or more vocal tics many times throughout the day for 1 year or more? A. Attention deficit hyperactivity disorder B. Asperger's syndrome C. Trichotillomania D. Tourette syndrome
D. Tourette syndrome
The nurse is working with an adult who has been dealing with an eating disorder for the past year. The client asks the nurse about mindfulness as an approach. Which evidence concerning mindfulness should the nurse include in the response to the client? (Select all that apply.) Decreases binge eating Decreases food cravings Limits the likelihood of relapse Decreases body image concerns Promotes a more complete recovery
Decreases binge eating Decreases food cravings Decreases body image concerns Research concerning the use of mindfulness indicates that it decreases binge-eating behaviors, food cravings, and body image concerns. The use of fluoxetine is known to reduce the likelihood of relapse and cognitive-behavioral therapy promotes a more complete recovery because it is a more holistic approach.
A pregnant woman undergoes maternal serum alpha-fetoprotein (MSAFP) testing at 16 to 18 weeks' gestation. Which of the following would the nurse suspect if the woman's level is decreased? a) Cardiac defects b) Open neural tube defect c) Down syndrome d) Sickle-cell anemia
Down syndrome Explanation: Decreased levels might indicate Down syndrome or trisomy 18. Sickle cell anemia may be identified by chorionic villus sampling. MSAFP levels would be increased with cardiac defects, such as tetralogy of Fallot. A triple marker test would be used to determine an open neural tube defect.
A 45-year-old man has just been diagnosed with Huntington disease. He and his wife are concerned about their four children. What will the nurse explain about the children's possibility of inheriting the gene for the disease? a) Each child will have no chance of inheriting the disease b) Each child will have a 50% chance of inheriting the disease c) Each child will have a 25% chance of inheriting the disease d) Each child will have a 75% chance of inheriting the disease
Each child will have a 50% chance of inheriting the disease Correct Explanation: Huntington disease is an autosomal dominant disorder. Autosomal dominant inherited conditions affect female and male family members equally and follow a vertical pattern of inheritance in families. A person who has an autosomal dominant inherited condition carries a gene mutation for that condition on one chromosome pair. Each of that person's offspring has a 50% chance of inheriting the gene mutation for the condition and a 50% chance of inheriting the normal version of the gene. Based on this information, the choices of 25%, 75%, or no chance of inheriting the disease are incorrect.
Which statement should the nurse include in a presentation regarding eating disorders? (Select all that apply.) Eating disorders can cause malnutrition. Teenagers are the only age group with eating disorders. Excessive exercise can be associated with an eating disorder. Diet pills and laxatives are not used by people with eating disorders. Electrolyte imbalance is a common problem associated with eating disorders.
Eating disorders can cause malnutrition. Excessive exercise can be associated with an eating disorder. Electrolyte imbalance is a common problem associated with eating disorders.
The nurse is caring for a 1-year-old boy with Down syndrome. Which of the following would the nurse be least likely to include in the child's plan of care? a) Promoting annual vision and hearing tests b) Describing the importance of a high-fiber diet c) Explaining developmental milestones to parents d) Educating parents about how to deal with seizures
Educating parents about how to deal with seizures Correct Explanation: It is unlikely that the parents will need to know how to deal with seizures. It will be helpful to provide parents with growth and developmental milestones that are unique to children with Down syndrome. More than 60% of children with Down syndrome have hearing loss, so promoting annual vision and hearing tests is the priority intervention. Special diets are usually not necessary; however, a balanced, high-fiber diet and exercise are important because constipation is frequently a problem.
The nurse is collecting data from the caregiver of an 8-year-old child who recently started soiling his underwear each day rather than using the toilet to defecate. This behavior indicates a symptom of which of the following? a) Echolalia b) Encopresis c) Enuresis d) Encephalopathy
Encopresis
The nurse is caring for a 13-year-old girl 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) Demonstrate unconditional acceptance of the child as a person. c) Encourage her to discuss her thoughts and feelings. d) Role model appropriate social and conversation skills.
Encourage her to discuss her thoughts and feelings.
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. Which of the following is the best approach? a) Introduce the concept of accepting differences to reduce conflict. b) Engage the girl in dialogue regarding feelings about self/personal appearance. c) Remind her of the importance of good hygiene for better appearance. d) Explore the girl's feelings about changes in her body with the onset of puberty.
Engage the girl in dialogue regarding feelings about self/personal appearance.
When counseling potential parents about genetic disorders, which of the following statements would be appropriate? a) Genetic disorders primarily follow Mendelian laws of inheritance. b) Environmental influences may affect multifactorial inheritance. c) All genetic disorders involve a similar number of abnormal chromosomes. d) The absence of genetic disorders in both families eliminates the possibility of having a child with a genetic disorder.
Environmental influences may affect multifactorial inheritance. Correct Explanation: It is difficult to predict with certainty the incidence of genetic disorders because in some disorders, more than one gene is involved and environmental insults may play a role (cleft palate, for example).
The nurse is conducting a teaching session for parents of children who have been diagnosed with autism spectrum disorder (ASD). A parent asks, "My child is high functioning. What should I expect of him as an adult?" Which response by the nurse is best? "Your child will comprehend nonverbal cues." "Your child will most likely continue to struggle with communication skills." "Your child will function normally with social interaction." "Your child will most likely function independently."
Eve"Your child will most likely continue to struggle with communication skills." n high-functioning adults with ASD continue to struggle with communication skills, especially understanding nonverbal communication and socialization. Many adults with ASD cannot function independently.
The nurse is preparing a plan to educate the parents of a 10-year-old boy with a learning disorder. Which of the following will be part of this plan? a) Encourage parents to give the child personal space. b) Have parents learn the child's facial expressions. c) Tell parents to check on the child regularly. d) Explain the child's strengths and weaknesses.
Explain the child's strengths and weaknesses.
The incidence of Down syndrome is 1:1600 in women older than 40 years of age, compared with 1:100 in women younger than 20 years. a) True b) False
False Correct Explanation: The incidence of Down syndrome is 1:100 in women older than 40 years of age, compared with 1:1600 in women younger than 20 years.
The nurse is counseling a teen with anorexia nervosa (AN) who is trying to manage the disorder. Which type of therapy should the nurse discuss with the client? Schema-focused therapy Dialectical behavior therapy Family therapy Daily fluoxetine therapy
Family therapy Systemic family therapy and family-based therapy are focused on family strengths and family narratives. These are often used with adolescent anorexic clients, mobilizing the family as the primary resource in feeding and restoring health to the undernourished client. Fluoxetine is approved by the FDA for use with bulimia only, not with anorexia. Schema-focused therapy and dialectical behavior therapy are used for personality disorders, not anorexia.
The nurse is reviewing the medical record of a 6-year-old patient who is diagnosed with autism spectrum disorder (ASD). Which item in the health history should the nurse consider may have been a factor in the patient's development of ASD? Fetal alcohol syndrome Appropriate adaptation to new environments Fetal alcohol syndrome Childhood vaccinations Cystic fibrosis
Fetal alcohol syndrome History of maternal alcohol use during pregnancy may have contributed to the development of ASD. Childhood vaccinations and cystic fibrosis are not linked to ASD. The ability to adapt to new environments is an appropriate goal, not a cause, for a patient who is diagnosed with ASD.
After teaching a class of students about genetics and inheritance, the instructor determines that the teaching was successful when the students identify which of the following as the basic unit of heredity? a) Allele b) Autosome c) Chromosome d) Gene
Gene Correct Explanation: A gene is the basic unit of heredity of all traits. A chromosome is a long, continuous strand of DNA that carries genetic information. An allele refers to one of two or more alternative versions of a gene at a given position on a chromosome that imparts the same characteristic of that gene. An autosome is a non-sex chromosome.
A client who is 37 years of age presents to the health care clinic for her first prenatal check up. Due to her advanced age, the nurse should prepare to talk with the client about her increased risk for what complication? a) Incompetent cervix b) Genetic disorders c) Gestational diabetes d) Preterm labor
Genetic disorders Correct Explanation: Women over the age of 35 are at increased risk of having a fetus with an abnormal karyotype or other genetic disorders. Gestational diabetes, an incompetent cervix, and preterm labor are risks for any pregnant woman.
The parents of a child diagnosed with autism spectrum disorder (ASD) are trying to determine why their child has the disorder. In response, the nurse should include which etiology? Genetic factors Chemical factors Psychological factors Toxins
Genetic factors are seen as being one of the associated causes of autism spectrum disorder. Those with autism have defects in the genes and gene expression in the areas of cell-cycle expression. The other responses are not thought to cause ASD.
The nurse takes a team approach to help a middle-age patient who is diagnosed with autism spectrum disorder (ASD) achieve their full potential. The nurse uses a community center to help find a job for the patient. Which strategy should the nurse engage to allow this patient to have the best opportunity for success? Making sure the job is an easy one Helping the patient find a position that will allow them to use their strongest talents Partnering the patient with someone else at work so that they can keep an eye on them at all times None, as those with ASD generally cannot work because the disorder is too debilitating to allow them to be productive community members
Helping the patient find a position that will allow them to use their strongest talents Individuals with ASD have the greatest chance of success with training and finding opportunities that use their strengths. Many are active members of the community, while others need more support.
You have been working with an adolescent with an eating disorder for several days. Which of the following is an indication that she is developing trust in you? a) Her telling you that she is now ready to eat again b) Her saying to you that she trusts you more than anyone else c) Her saying to you that she'll follow your orders but not those of the nurse on the next shift d) Her telling you that she is still inducing vomiting after each meal
Her telling you that she is still inducing vomiting after each meal
An 18-year-old male patient is diagnosed with Klinefelter syndrome. What signs and symptoms are consistent with this diagnosis? a) Hypergonadism and decreased pubic hair b) Hypogonadism and gynecomastia c) Long torso and decreased facial hair d) Enlaged testes and tall stature
Hypogonadism and gynecomastia Correct Explanation: Klinefelter syndrome affects males, causing only testosterone deficiency. Males may develop female-like characteristics such as gynecomastia and may experience hypogonadism. Decreased pubic and facial hair, along with tall stature, are characteristic of the disorder. The corresponding signs and symptoms listed in the other answer selections are not signs and symptoms of the disorder.
Sixteen-year-old Candace is being seen for a long overdue checkup. Her caregiver has come with her. Candace is calm, pleasant, and in good spirits. The caregiver reports to the nurse that she is relieved because for the past six months Candace has been lethargic, angry, and sad. The mother reports that since she got her driver's license two days earlier, her child's mood has changed dramatically. Rather than resist this appointment, Candace had simply smiled and said, "It won't matter much, but okay, I'll be ready in a minute." The nurse recognizes that the child's seeming well-being and drastic change in behavior should be further investigated to determine which of the following? a) If the child has been smoking marijuana. b) If the child is excited that she can drive now. c) If the child is planning to commit suicide. d) If the child is experimenting with alcohol.
If the child is planning to commit suicide.
The nurse is caring for a patient who is diagnosed with autism spectrum disorder (ASD). Which nursing intervention is most appropriate for the nurse to use? Supervising the patient closely to prevent infection Incorporating the patient's rituals into daily care Using one method of communication with the patient Completing activities of daily living for the patient
Incorporating the patient's rituals into daily care An appropriate intervention for a patient with ASD is to incorporate the patient's rituals into daily care. The nurse would supervise the patient closely to enhance safety, not to prevent infection. The nurse would adapt communication style to meet the needs of the patient. The nurse would encourage the patient to participate fully in care. Therefore, the nurse would not complete all activities of daily living for the patient.
Which behavior typical of children with autism spectrum disorder (ASD) requires you to maintain special care to keep them safe? a) A fascination with bright colors b) A craving for salt c) Insensitivity to pain d) Loss of hearing for high frequencies
Insensitivity to pain
A couple wants to start a family. They are concerned that their child will be at risk for cystic fibrosis because they each have a cousin with cystic fibrosis. They are seeing a nurse practitioner for preconceptual counseling. What would the nurse practitioner tell them about cystic fibrosis? a) It is an X-linked inherited disorder b) It is an autosomal dominant disorder c) It is an autosomal recessive disorder d) It is passed by mitochondrial inheritance
It is an autosomal recessive disorder Correct Explanation: Cystic fibrosis is autosomal recessive. Nurses also consider other issues when assessing the risk for genetic conditions in couples and families. For example, when obtaining a preconception or prenatal family history, the nurse asks if the prospective parents have common ancestors. This is important to know because people who are related have more genes in common than those who are unrelated, thus increasing their chance for having children with autosomal recessive inherited condition such as cystic fibrosis. Mitochondrial inheritance occurs with defects in energy conversion and affects the nervous system, kidney, muscle, and liver. X-linked inheritance, which has been inherited from a mutant allele of the mother, affects males. Autosomal dominant is an X-linked dominant genetic disease
Which statement about nondisjunction of a chromosome is true? a) Only the X chromosomes are affected. b) Only 4% of Down syndrome cases are attributed to this defect. c) It may result from genomic imprinting. d) It is failure of the chromosomal pair to separate.
It is failure of the chromosomal pair to separate. Correct Explanation: Nondisjunction simply means failure to separate. Nondisjunction can happen at any chromosome and is attributed to 95% of Down syndrome cases. Genomic imprinting is a different genetic disorder that is not related to nondisjunctioning.
The nurse is orienting a new nurse in the inpatient care unit. Which statement should the nurse include in the orientation regarding a nurse-client relationship that would ensure effective treatment of clients with eating disorders? It is hard for clients to be open about eating disorders, so nurses must be respectful and patient and develop trust. It is best not to trust what clients tell you about their eating habits; they hide their behaviors. These clients can be very manipulative, and their behavior must be recognized so that it can be addressed immediately and effectively. Very clear structure is necessary for these clients, and avoiding opportunities for the client to split staff is absolutely crucial.
It is hard for clients to be open about eating disorders, so nurses must be respectful and patient and develop trust. Clients with eating disorders have generally been very secretive about their disorders, so it is a major challenge for them to become open about them. To support this openness, nurses must establish a therapeutic relationship based on trust, which requires patience, respect, and consistency. Though these clients can be secretive, telling the new nurse not to trust them would impede development of a therapeutic relationship. Most inpatient programs do have a structure, which is important for nurses to follow, but this does not best support the development of a therapeutic relationship with clients. Manipulative behaviors are characteristic of many mental health issues, but recognition of them does not best support effective treatment through the nurse-client relationship.
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 of the following behaviors should the nurse recognize as an example of impulsiveness? a) Repeating words or phrases spoken by others b) Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission c) Constantly fidgeting in his chair and shaking his foot d) Inability to answer a question posed by his teacher because he was daydreaming
Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission
A client with an eating disorder has been hospitalized for medical stabilization. Which intervention should the nurse include to address energy expenditure? Monitoring cardiovascular and respiratory response to activity Limiting the client's activity and restricting exercise Monitoring vital signs and electrolyte levels Eliminating caffeine and other stimulants from the client's diet
Limiting the client's activity and restricting exercise In clients with eating disorders who are hospitalized for medical stabilization, it is important to limit activity and manage energy expenditure. Monitoring of vital signs, electrolyte levels, and cardiovascular/respiratory responses to exercise may also be included, but these interventions do not directly address energy expenditure. Eliminating caffeine and other stimulants from the client's diet can help decrease anxiety but does not directly address energy expenditure. OK
When assessing newborns for chromosomal disorders, which assessment would be most suggestive of a problem? a) Low-set ears b) Bowed legs c) Short neck d) Slanting of the palpebral fissure
Low-set ears Correct Explanation: A number of common chromosomal disorders, such as trisomies, include low-set ears.
The nurse is teaching about autism spectrum disorder to a group of community members. Which risk factor should the nurse include? Maternal age over 40 Female gender Paternal age less than 20 Parents who are close in age
Maternal age over 40 Risk factors for autism spectrum disorder (ASD) include advanced maternal age (greater than 40), paternal age greater than 50, male gender, and having parents with an age disparity of greater than 10 years.
The nurse is performing a physical assessment of 16-year-old girl who is cognitively challenged. 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 cognitive challenge as which of the following? a) Moderate b) Severe c) Profound d) Mild
Mild
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? a) Mild b) Severe c) Moderate d) Profound
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.
The parents of a teenage girl bring their daughter to the healthcare provider, citing their increasing concern about the teen's weight and their suspicion that their daughter has anorexia nervosa (AN). During assessment, the nurse notes a BMI of 16.75 kg/m2. In which category does the client fall, according to DSM-5 criteria and considering the severity of anorexia nervosa? Mild Moderate Extreme Severe
Moderate The DSM-5 identifies BMI as an important clinical indicator of the severity of AN. A BMI of 16.75 kg/m2 would be classified as moderate category anorexia. A BMI of 17 kg/m2 or greater is categorized as mild anorexia. A BMI of 15 to 15.99 kg/m2 is categorized as severe. A BMI of less than 15 kg/m2 is considered to represent extreme anorexia.
9. The infant with Down syndrome is closely monitored during the first year of life for what serious condition? a. Thyroid complications b. Orthopedic malformations c. Dental malformation d. Cardiac abnormalities
NS: D The high incidence of cardiac defects in children with Down syndrome makes assessment for signs and symptoms of these defects important during the first year. Clinicians recommend the child be monitored frequently throughout the first 12 months of life, including a full cardiac workup. Infants with Down syndrome are not known to have thyroid complications although they can manifest later. Orthopedic malformations may be present, but special attention is given to assessment for cardiac and gastrointestinal abnormalities. Dental malformations are not a major concern compared with the life-threatening complications of cardiac defects.
When teaching parents of a child with encopresis, which of the following would you stress? a) Need for keeping the child close to bathroom facilities at all times b) Necessity for giving 4 to 6 tablespoons of Kaopectate per day c) Not punishing the child for encopresis d) Importance of cleaning the child immediately after an accident occurs
Not punishing the child for encopresis
An infant with craniosynostosis from Apert syndrome becomes lethargic and starts to vomit. What is the priority nursing intervention? a) Give IV dextrose b) Monitor intake and output c) Notify the doctor and prepare for surgery d) Reassess every hour and document findings
Notify the doctor and prepare for surgery Correct 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.
The healthcare provider has diagnosed a binge-eating disorder in a client. Which common complication of this disorder requires further testing? (Select all that apply.) Obesity Osteoporosis Heart disease Type 2 diabetes Gallbladder disease
Obesity Heart disease Type 2 diabetes Gallbladder disease Clients found to have binge-eating disorder should undergo a full physical examination to screen for complications of the illness, including obesity, heart disease, type 2 diabetes, and gallbladder disease. Osteoporosis is a complication of anorexia nervosa, not binge-eating disorder.
The nurse is performing a physical examination on a 1-week-old girl with trisomy 13. Which of the following would the nurse expect to assess? a) Inspection reveals hypoplastic fingernails. b) Observation discloses severe hypotonia. c) Inspection shows a clenched fist with overlapping fingers. d) Observation reveals a microcephalic head.
Observation reveals a microcephalic head. Correct Explanation: Children with trisomy 13 have microcephalic heads with malformed ears and small eyes. Severe hypotonia, hypoplastic fingernails, and clenched fists with index and small fingers overlapping the middle fingers are typical symptoms of trisomy 18.
A nurse teaching a couple says that when X-linked recessive inheritance is present in a family, the genogram will reveal which of the following? a) Only males in the family have the disorder. b) Sons of an affected man are also affected. c) A history of boys dying at birth for unknown reasons often exists. d) The parents of the affected man have the disorder.
Only males in the family have the disorder. Correct Explanation: When X-linked recessive inheritance is in a family, a genogram will reveal only males in the family with the disorder, a history of girls dying at birth for unknown reasons, unaffected sons of affected men, and parents of affected children not having the disorder
A female patient has the Huntington's disease gene. She and her husband want to have a child but are apprehensive about possibly transmitting the disease to their newborn child. They have strong views against abortion. They would also like to have their "own" child and would consider adopting only as a last resort. Which of the following would be most appropriate in this situation? a) Chancing the conception and birth of a child b) Using donor gametes for conception of a child c) Opting for a preimplantation genetic diagnosis d) Undergoing prenatal diagnosis with prenatal choice of continuing pregnancy
Opting for a preimplantation genetic diagnosis Correct Explanation: The most appropriate choice would be opting for a preimplantation genetic diagnosis (PGD). A PGD is a genetic evaluation of the embryo created through IVF which will reveal whether the Huntington's disease gene is present in the embryo. Undergoing prenatal diagnosis with prenatal choice of continuing pregnancy is not an option because the client and her husband are against abortion. Chancing the conception and birth of a child involves the risk of passing the gene to the newborn child. Using donor gametes may reduce the risk, but it is against the client's preferences.
The nurse is caring for a 10-year-old girl with an anxiety disorder. During a physical examination, which physical finding would the nurse expect? a) Dilated eyes b) Patches of hair loss c) Watery eyes d) Absence of nasal hair
Patches of hair loss 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
Which of the following signs is consistent with autism spectrum disorder (ASD)in a 2-year-old boy? a) Has below-average intellectual function b) Performs repetitive activity with toys c) Possesses excellent language development d) Shows signs of losing attained skills
Performs repetitive activity with toys
Which of the following conditions is a part of normal newborn screening? a) Down syndrome b) Cystic fibrosis c) Sickle cell anemia d) Phenylketonuria
Phenylketonuria Correct Explanation: Phenylketonuria is part of normal newborn screening. Prenatal screening includes Down syndrome. Preconception screening includes sickle cell anemia and cystic fibrosis.
A nurse is assessing a child diagnosed with Sturge-Weber syndrome. Which of the following would the nurse expect to find when assessing the skin? a) Pigmented nevi b) Café-au-lait spots c) Port wine stain d) Tumors
Port wine stain Correct Explanation: Facial nevus or port wine stain is most often seen on the forehead and on one side of the face. Café-au-lait spots are commonly associated with neurofibromatosis. Tumors are associated with tuberous sclerosis and neurofibromatosis. Pigmented nevi are associated with neurofibromatosis.
A client is hospitalized for anorexia nervosa. The client's BMI on admission is 14.8 kg/m2. The client has been started on an antidepressant, cognitive-behavioral therapy (CBT), and a weight-restoration plan. Monitoring for which possible complication should be a priority for the nurse as the client begins eating again? Refeeding syndrome Increased depression Purging Edema
Refeeding syndrome The nurse should monitor the client for refeeding syndrome, which is dangerous and a potentially fatal condition that can occur when clients who are severely malnourished begin eating again. The other items are not as serious of priorities as refeeding syndrome.
A preschool-age patient was recently diagnosed with autism spectrum disorder (ASD). The nurse should consider which observation of the patient to be supportive of the diagnosis? Sitting quietly during the assessment Wanting to be held by the parent during the assessment Actively participating with the nurse during the assessment Rocking on the exam table
Rocking on the exam table Performing a physical assessment of patients with ASD can present many challenges. Patients diagnosed with ASD may not sit still for the assessment and can display flapping, rocking or head-banging as a way to self-soothe during the assessment process. Patients who have sensory deficits or behaviors often do not like being touched and show a disinterest in being cuddled. These patients also do not like quick transitions and generally will not actively participate in the assessment process.
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) Sertraline c) Buspirone d) Trazodone
Sertraline 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.
A 17-year-old girl has been diagnosed with bulimia nervosa. Which of the following complications should the nurse carefully assess for in this client? a) Atherosclerosis b) Diabetes mellitus c) Severe erosion of teeth d) Hypertension
Severe erosion of teeth
The nurse is performing an assessment of a 6-year-old girl with Turner syndrome. Which of the following would the nurse most likely assess? a) Pectus carinatum b) Enlarged thyroid gland c) Short stature and slow growth d) Short, stubby trident hands
Short stature and slow growth Correct Explanation: Short stature and slow growth are frequently the first indication of Turner syndrome. While children with Turner syndrome are more prone to thyroid problems, these problems are not as likely to occur as in other symptoms. Pectus carinatum is typical of children with Marfan syndrome. Short, stubby trident hands are typical of achondroplasia.
An African American couple presents for a genetic counseling appointment. They are pregnant and are concerned about their child. What would a patient of African American heritage have genetic carrier testing for? a) Sickle cell anemia b) Asthma c) Rubella d) Meckel's diverticulum
Sickle cell anemia Correct Explanation: Assessing ancestry and ethnicity is important to help identify individuals and groups who could benefit from genetic testing for carrier identification, such as African Americans routinely offered testing for sickle cell anemia. The other answers are incorrect because they are not identified with the African American race
A client presents at the urgent care clinic and states, "My heart feels like it's skipping beats." The client also reports always feeling cold, and has a BMI of 18. The nurse suspects anorexia. Which other clinical manifestation should the nurse assess? (Select all that apply.) Strenuous exercise Feelings of euphoria Extreme perfectionism Obsession over body shape Rigidity and the need to control situations
Strenuous exercise Extreme perfectionism Obsession over body shape Rigidity and the need to control situations Clinical manifestations of anorexia nervosa include obsession with body shape; obsession with food; extreme perfectionism; rigidity and the need to control situations; and over-exercise. Depression, not euphoria, is also a common manifestation.
Contract agreements are often recommended for patients with eating disorders. In forming a contract with a hospitalized adolescent diagnosed with anorexia nervosa, the nurse should make a point to do which of the following? a) Stress to the patient that she is in control of the outcome of her care b) Remind the adolescent about the consequences of misbehavior c) Reward the patient after several days of successful behavior d) Encourage the caregivers to take responsibility for the adolescent
Stress to the patient that she is in control of the outcome of her care
The nurse is conducting an examination of a boy with Tourette syndrome. Which finding should the nurse expect to observe? a) Toe walking b) Spinning and hand flapping c) Lack of eye contact d) Sudden, rapid stereotypical sounds
Sudden, rapid stereotypical sounds
Which of the following is an example of impaired adaptive functioning in an 8-year-old girl with a developmental disorder? a) The child cannot correctly copy a phone number. b) The child cannot correctly copy a sentence. c) The child's vision is fine but she is a poor reader. d) The child cannot properly dress herself.
The child cannot properly dress herself.
Which of the following signs and symptoms suggest that a 5-year-old boy who does not maintain eye contact or speak may have autism spectrum disorder (ASD)? a) The child constantly opens and closes his hands. b) The child has a slight decrease in head circumference. c) The child has a long face and prominent jaw. d) The child is highly active and inattentive.
The child constantly opens and closes his hands.
Which of the following signs and symptoms suggest that a 5-year-old boy who does not maintain eye contact or speak may have autism spectrum disorder (ASD)? a) The child has a long face and prominent jaw. b) The child has a slight decrease in head circumference. c) The child constantly pats his legs. d) The child is highly active and inattentive.
The child constantly pats his legs.
The nurse is collecting data on an 18-month-old old child with a diagnosis of autism spectrum disorder (ASD). Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) The child cries and runs to the door when the caregiver leaves the room. b) The child sits quietly in the caregivers lap during interview. c) The child smiles when the caregiver shows her a stuffed animal. d) The child does not make eye contact.
The child does not make eye contact.
The nurse in the well-child clinic observes that a 5-year-old child in the waiting room is having trouble using a crayon to color. During the visit, the same child climbs off the table several times even after the nurse has asked him to stay on the table. Each time the nurse reminds him he says, "Oh, yeah," and happily climbs back up. The nurse suspects that which of the following applies to this child? a) The child has autism spectrum disorder. b) The child has failure to thrive. c) The child has an addicted caregiver. d) The child has attention deficit hyperactive disorder (ADHD).
The child has attention deficit hyperactive disorder (ADHD).
Which of the following characteristics are commonly noted in the child with anorexia nervosa? a) The child has trouble sitting still and is figety. b) The child is inactive and participates in sedentary activites. c) The child has rigid study skills and ritualistic behavior. d) The child is impulsive and inattentive when spoken to.
The child has rigid study skills and ritualistic behavior.
Which of the following would suggest that a 5-year-old boy might have a developmental disorder? a) The child has trouble with r, l, and y sounds. b) The child is not able to follow directions. c) The child knows what a dog and a cat sound like. d) The child must be supervised when brushing his teeth.
The child is not able to follow directions.
The nurse is collecting data on a 16-year-old adolescent girl with the diagnosis of bulimia. Which of the following would the nurse most likely note in this child? a) The child socializes with friends and shares all her dreams and secrets with them. b) The child is of normal weight for her height according to the growth charts. c) The child has a ritualistic program of exercise that she does every day after school. d) The child is a perfectionist and tries hard to please her parents and teachers.
The child is of normal weight for her height according to the growth charts.
The nurse is working with a child diagnosed with encopresis. After a complete medical workup has been done, no organic cause has been found for the disorder. The nurse will anticipate that which of the following will be done next? a) The child will be put on a high-calorie, high-protein diet. b) The child will be started on methylphenidate (Ritalin). c) The child will be referred for counseling. d) The child will be placed in a foster home.
The child will be referred for counseling.
The nurse is preparing a plan of care for a client whose anorexia nervosa is complicated by dehydration and a cardiac arrhythmia. Which outcome should the nurse consider positive for this client? (Select all that apply.) The client remained free of injury. The client increased nutritional intake by 20%. The client had a 24-hour fluid intake of 600 mL. The client attended therapy sessions as scheduled. The client stated that she liked how she looked in the new dress.
The client remained free of injury. The client increased nutritional intake by 20%. The client attended therapy sessions as scheduled. The client stated that she liked how she looked in the new dress. Positive outcomes for clients with an eating disorder include remaining free of injury, increasing nutritional intake, viewing themselves positively, and attending therapy on a consistent schedule. A fluid intake of 600 mL/day is insufficient.
The nurse is reviewing a questionnaire completed by an adolescent client. Which predisposing factor may increase the client's risk for an eating disorder? (Select all that apply.) The client reports a history of childhood abuse. The client's mother has a history of bulimia nervosa. The client lists alprazolam (Xanax) on the home medication list. The client lists "checkout clerk in a grocery store" as the occupation. The client reports good family support and a healthy friendship network
The client reports a history of childhood abuse. The client's mother has a history of bulimia nervosa. The client lists alprazolam (Xanax) on the home medication list. Familial risk factors for an eating disorder include a history of physical or sexual abuse or a genetic predisposition to an eating disorder. Anxiety requiring a prescription for alprazolam (Xanax) may be a psychological factor in the development of an eating disorder. Working in a grocery store, good family support, and a healthy friendship network are not risk factors.
The nurse and a client with an eating disorder have set up a behavioral contract to guide the client toward healthier eating patterns. Which goal should be incorporated in the contract? (Select all that apply.) The client will not engage in purging behaviors. The client will maintain adequate calorie intake. The client will attend and participate in therapy. The client will limit exercise to 30 minutes per day. The client will stop compulsive thinking about weight.
The client will not engage in purging behaviors. The client will maintain adequate calorie intake. The client will attend and participate in therapy. The client will limit exercise to 30 minutes per day. As part of an inpatient program for eating disorders, a behavioral contract may involve refraining from purging behaviors, maintaining adequate caloric intake, avoiding excessive exercise, and participating in therapy as part of the treatment program. Clients with eating disorders may not be able to control or stop their compulsive thoughts, so including thought stopping as a goal in the behavioral contract is not realistic.
The nurse is educating the parents of a 6-year-old boy about his learning disorder. Which of the following facts would be included in the discussion? a) The disorder requires comprehensive special education. b) The disorder is caused by a difference in brain architecture. c) Learning disorders indicate lower intelligence. d) Learning disorders are synonymous with learning deficits.
The disorder is caused by a difference in brain architecture.
The nurse is caring for an elderly patient with a history of autism spectrum disorder (ASD). For which condition should the nurse screen the patient? Depression Schizophrenia Diabetes mellitus Gout
The elderly patient with ASD has an increased likelihood of developing depression. Schizophrenia does not develop as a result of ASD. There is no evidence that patients with ASD are more likely to develop gout or diabetes mellitus than the normal population.
The child has a burn that has not been treated. Correct Explanation: Burns are a common type of injury seen in the abused child. Although burns may be accidental in young children, certain types of burns are highly suspicious. Cigarette burns, or burns from immersion of a hand in hot liquid, from a hot register (as evidenced by the grid pattern), from a steam iron, or from a curling iron are common abuse injuries. Caregivers have been known to immerse the buttocks of a child in hot water if they thought the child was uncooperative in toilet training. Children often injure themselves and may have fractured bones or bruises on knees and elbows that are not from child abuse. Hyperactivity and anger are not physical signs of child abuse; they are emotional signs.
The nurse is assisting with a physical exam on a child who has been admitted with a diagnosis of possible child abuse. Which of the following findings might alert the nurse to this possibility that the child may have been abused? a) The child has bruises on the knees and elbows. b) The child has a fractured bone. c) The child is hyperactive and angry. d) The child has a burn that has not been treated.
A baby is born with what the physician believes is a diagnosis of trisomy 21. This means that the infant has three number 21 chromosomes. What factor describes this genetic change? a) The mother also has genetic mutation of chromosome 21 b) The patient has a nondisjunction occurring during meiosis c) The patient will have a single X chromosome and infertility d) During meiosis, a reduction of chromosomes resulted in 23
The patient has a nondisjunction occurring during meiosis Correct Explanation: During meiosis, a pair of chromosomes may fail to separate completely, creating a sperm or oocyte that contains either two copies or no copy of a particular chromosome. This sporadic event, called nondisjunction, can lead to trisomy. Down syndrome is an example of trisomy. The mother does not have a mutation of chromosome 21, which is indicated in the question. Also, Trisomy does not produce a single X chromosome and infertility. Genes are packaged and arranged in a linear order within chromosomes, which are located in the cell nucleus. In humans, 46 chromosomes occur in pairs in all body cells except oocytes and sperm, which contain only 23 chromosomes.
The nurse is planning the care for a patient who is admitted to the hospital for a tonsillectomy. The patient is also diagnosed with autism spectrum disorder (ASD). Which goal is appropriate for the nurse to include in the plan of care for the patient? The patient will try new foods during hospitalization. The patient will allow the nurse to perform all activities of daily living. The patient will not socialize with other children in the same age group. The patient will demonstrate behavior that is not self-destructive.
The patient will demonstrate behavior that is not self-destructive. An appropriate goal for this patient is to demonstrate behaviors that are not self-destructive. It is important for the child who is diagnosed with ASD to maintain home rituals. Therefore, it is not appropriate for the patient to try new foods during hospitalization. The patient should have a goal of independently performing activities of daily living during hospitalization. The nurse would encourage socialization with other children in the same age group, not discourage it.
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) Tourette syndrome. b) autism spectrum disorder. c) anxiety disorder. d) Asperger syndrome.
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 child born with a single transverse palmar crease, a short neck with excessive skin at the nape, a depressed nasal bridge, and cardiac defects is most likely to have with autosomal abnormality? 1. Trisomy 21 2. Trisomy 18 3. Trisomy 14 4. Trisomy 13
Trisomy 21 (down syndrome)
Women having in vitro fertilization (IVF) can have both the egg and sperm examined for genetic disorders of single gene or chromosome concerns before implantation. a) True b) False
True
A client is brought to the emergency department after being found unconscious by her daughter. The daughter reports that her mother has been struggling with eating disorders for "as long as I can remember" and has been in and out of treatment programs for bulimia nervosa. Which test should the nurse expect the healthcare provider to order? (Select all that apply.) Urinalysis Electrocardiography (ECG) Blood glucose monitoring Computerized tomography (CT) scan Comprehensive metabolic panel (CMP)
Urinalysis Electrocardiography (ECG) Blood glucose monitoring Comprehensive metabolic panel (CMP) Electrolyte imbalances are common in clients with eating disorders. A CMP is necessary to learn whether serum potassium is decreased, which could cause cardiac arrhythmias. Blood glucose monitoring may indicate hypoglycemia or diabetic ketoacidosis if the client is purging or diabetic. Electrocardiography is used to detect any cardiac arrhythmias resulting from electrolyte imbalances; some arrhythmias associated with eating disorders are fatal. Urinalysis indicates the presence of ketones. A CT scan is not indicated for clients with eating disorders.
To feed lunch to a child with autism spectrum disorder (ASD), which of the following actions would be most important to take? a) Use a repetitive series of movements. b) Use an authoritarian manner to gain control. c) Allow the child to ask questions about the procedure. d) Don't allow him to see the spoon approach his mouth.
Use a repetitive series of movements. Children with ASD typically enjoy repetitive movements or the same action over and over.
The nurse is assessing a 3-year-old child for symptoms of autism spectrum disorder (ASD). Which assessment finding should lead the nurse to question the diagnosis? Inability to react accordingly to social clues Engages in repetitive behaviors Comprehends language well beyond the complexity of age Displays self-destructive behavior
WHAT YOU NEED TO KNOW Comprehends language well beyond the complexity of age While children with autism may have high IQs, they do not understand the nuances of language and therefore do not comprehend well beyond the complexity of their age, so this is not a clinical manifestation that supports the diagnosis. Clinical manifestations that support the diagnosis of ASD include the inability to react accordingly to social cues, engaging in repetitive behaviors, and displaying self-destructive behavior.
Emotional Correct Explanation: The six types of elder abuse are physical (injury by hitting, kicking, pushing, slapping, burning, and so on), sexual (unconsented sexual act), emotional (harm of self-worth or emotional well-being), neglect (failure to meet the older adult's basic needs of shelter, food, and so on), abandonment (leaving an older adult alone and no longer providing care), and financial (illegally misusing money, property, or assets).
Which type of elder abuse involves harm of self-worth? a) Neglect b) Abandonment c) Physical d) Emotional
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)? a) 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. b) A child flips the light switch off and on until the caregiver asks her to stop and join the other children in playing. c) A child playing in the kitchen area pretends to pour a glass of milk and repeats this over and over. d) After another child takes a toy, the child cries and stomps his feet.
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.
A nurse is conducting a mental status examination with a 5-year-old boy who is playing with trains and blocks of different colors. He repeats the same actions with the trains over and over again throughout the examination. Which of the following questions would be most appropriate? a) Are you having fun now? b) Do you like playing with trains and blocks? c) Why does that red train keep crashing into all of the other trains? d) What year is it?
Why does that red train keep crashing into all of the other trains?
The nurse meets the family of a teen who has been struggling with an eating disorder. The family expresses a preference to try complementary approaches initially to address the teen's behaviors. Which complementary therapies should the nurse recommend? (Select all that apply.) Yoga Herbs Massage Meditation Acupuncture
Yoga Massage Meditation Acupuncture Yoga, massage, acupuncture, and meditation are all potential complementary therapies for clients with eating disorders. Because of their laxative and weight loss effects and the potential for abuse, herbs are not typically used in the treatment of eating disorders.
The nurse is assessing a toddler client for an upper respiratory infection. The nurse suspects the child may have autism spectrum disorder (ASD). Which behavior caused the nurse's suspicion? A. Having a tantrum when touched by the nurse B. Playing with the other children and toys while awaiting the nurse C. Crying after the administration of immunizations D. Speaking to the nurse in sentences
a Rationale: An assessment finding that supports the diagnosis of ASD is having a tantrum when touched by the healthcare provider. It is not uncommon for the child with ASD to display an inability to attend and systematize situational reactions. Playing with other children, speaking to the nurse in sentences, and crying after the administration of immunizations are not findings that support ASD. These assessment findings are age appropriate for the client.
The therapy you would expect to see prescribed for an adolescent with anorexia nervosa would be a) a desensitization program. b) counseling her to accept more adult-like behavior. c) administration of an antiemetic drug. d) counseling to improve feelings of control over her body.
counseling to improve feelings of control over her body.
When an infant is born with a genetic disorder, it is appropriate to advise the parents that a) experiences the mother had during pregnancy are probably not related. b) not all genetic disorders are inherited. c) the disorder has probably occurred in the family before. d) it is likely that the mother drank alcohol during early cell division.
experiences the mother had during pregnancy are probably not related. Explanation: As genetic disorders occur at the moment of conception, events during pregnancy occur after the problem is already present.
When trying to manage aggressive or impulsive behaviors in children or adolescents, what is the best nursing intervention? 1. train the child to be assertive 2. provide consistency and limit setting 3. allow the child to negotiate the rules 4. encourage the child to express feelings
provide consistency and limit setting
Rumination disorder is a poorly understood condition of young children. This refers to a) a habit of eating nonfood substances. b) excessive worrying about friendships. c) fear of moving objects. d) rechewing undigested food.
rechewing undigested food.
The nurse is caring for a child with Down syndrome. What should the nurse's focus be? 1. teaching hygiene skills to the child in order to increase self-esteem 2. screening for anomalies and teaching about prevention of respiratory infection 3. finding opportunities to increase socialization for the child and family 4. expecting walking at age of 1 year and toilet training competion at age 2 years.
screening for anomalies and teaching about prevention of respiratory infection
A 15y/o girl has been making demands all day, exaggerating her every need. She is now crying, saying she has nothing to live for and threatening to kill herself. What is the priority nursing action? 1. ignore her continured exaggerated and melodramatic behavior 2. consult with the physician or NP to increase her antidepressant dose 3. leave the girl alone for a little whle unitl she compses herself 4. take the girl's suicidal threat seriously and provide close supervision
take the girl's suicidal threat seriously and provide close supervision
The family of a teen with anorexia nervosa is discussing treatment options with the nurse. They would like to find an inpatient program to treat their child, who has a BMI of 17 kg/m2. How should the nurse respond? "An inpatient stay would be a good idea if you can afford it as they have the highest success rates." "At this point, family and group therapy would be a better option than an inpatient program." "What would your child rather do? If the client isn't interested in an inpatient program, it probably won't be effective." "Initially, it is best to start with a structured day treatment program rather than an inpatient stay."
"Initially, it is best to start with a structured day treatment program rather than an inpatient stay." Day treatment programs are considered the first-line treatment approach, so the nurse would indicate that this would be the best way to begin treatment, especially since the client has mild anorexia as indicated by the BMI. Family and group therapy will not provide the more intensive structure of a day program. An inpatient program is the next line of treatment if a day treatment program does not produce the desired outcome and the client continues to lose weight.
The nurse plans care for a client being treated for an eating disorder. Which question should the nurse ask to encourage the client to re-experience positive emotions? "Can you describe things that trigger eating disordered behaviors for you?" "What kinds of things did you enjoy doing before the eating disorder took over?" "Do you use alcohol to help deal with the feelings and emotions you're experiencing?" "Do you feel that the environment you live and work in contributes to high amounts of stress for you?"
"What kinds of things did you enjoy doing before the eating disorder took over?" Encouraging clients to reconnect with activities and experiences that they previously enjoyed can help them begin to regain control over their own behaviors and re-experience positive emotions. Questions about triggers, alcohol use, and environmental stressors are also important but would not directly elicit information to support development of an intervention to promote re-experiencing of positive emotions.
The nurse is providing a teaching session to care providers concerning the identification of eating disorders (EDs) in the pediatric population. Which statement would help pediatric care providers identify EDs in younger clients? "Unwillingness to try new foods is an early indication of EDs in young clients." "EDs in younger clients are often associated with anxiety disorders." "EDs are less likely in younger clients with a history of obesity." "Younger clients with EDs tend to be boys."
"Younger clients with EDs tend to be boys." EDs in younger clients are underdiagnosed by pediatric care providers. The rate of EDs in younger clients is higher in boys than in girls; the male/female ratio is 6:1. EDs are more, not less, likely in younger clients with a history of obesity. EDs in adolescents are often associated with anxiety disorders. Unwillingness to try new foods is characteristic of a picky eater; while a child with an ED may have some picky-eating behaviors, the primary criterion is inadequate (restrictive) intake, manifested by a disinterest in food; the intake does not support the child's nutritional or energy needs.
The nurse is developing a plan of care for a client diagnosed with autism spectrum disorder (ASD). Which nursing diagnosis is most appropriate for the nurse to include? A. Communication: Verbal, Impaired B. Airway Clearance, Ineffective C. Macrocephaly, Risk for D. Infection, Risk for
A Rationale: Communication: Verbal, Impaired is an appropriate nursing diagnosis for a client with ASD. Macrocephaly, Risk for is not a nursing diagnosis. The client with ASD is not at risk for infection or ineffective airway clearance.
Which assessment finding should the nurse expect in a child with autism spectrum disorder (ASD)? (Select all that apply.) A. Reiteration of questions as opposed to answering them B. Use of the word you to represent I C. Stuttering D. Echolalia E. Enchantment with rhythmic repetition of verse or song
A,B,D,E Rationale: Echolalia (parroting a particular word or phrase), repetition of inquiries rather than responding to them, using you to represent I, and fascination with things that are lyrical in nature such as a song or verse are typical speech pattern abnormalities for children diagnosed with ASD. Stuttering is not a clinical manifestation associated with ASD.
The nurse is assessing a high-functioning adult client who is diagnosed with autism spectrum disorder (ASD). Which characteristic of ASD should the nurse anticipate this client will demonstrate during the nursing assessment? (Select all that apply.) A. Understanding body language B. Displaying problems with sentence structure C. Having trouble with double meanings D. Choosing inappropriate topics to discuss E. Lacking the ability to participate in small talk
A,C,D,E Rationale: Socialization and communication, especially understanding nonverbal communication, are lifelong struggles for the adult with ASD. Behaviors that the nurse will anticipate during the assessment include choosing inappropriate topics to discuss, not engaging in small talk, understanding body language, and having trouble with double meanings. The nurse would not expect the adult client with ASD to display problems with sentence structure.
Which resource should the nurse expect the healthcare provider to use to confirm the diagnosis of autism spectrum disorder (ASD)? A. Diagnostic and Statistical Manual of Mental Disorders B. The Mental Health Rights Manual C. The Autism Handbook D. Teaching Social Communication to Families with Autism
A. Rationale: Criteria for diagnosis can be found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), which includes screening tests to identify tendencies consistent with ASD. Although the other resources may be helpful in teaching the client and the family about ASD, they are not used as a diagnostic tool.
The nurse is planning care for a client who is diagnosed with autism spectrum disorder (ASD). Which goal is appropriate for the nurse to include? A. The client will remain free from infection. B. The client will display developmental progress. C. The client will demonstrate negative communication skills. D. The client will engage in private activities to stimulate learning.
B Rationale: An appropriate goal when providing care to a client diagnosed with ASD is for the client to display developmental progress. Other appropriate goals include the client remaining free of injury, the client demonstrating positive communication skills, and the client participating in activities with family members or small groups of peers.
The nurse is teaching the family of a client diagnosed with autism spectrum disorder (ASD) about a gluten-free and casein-free diet. Which food should the nurse include? (Select all that apply.) A. Yogurt B. Cheese C. Cornmeal D. Grilled salmon E. Soy milk
C,D,E Rationale: A gluten-free and casein-free diet eliminates wheat and dairy products. Foods that support a gluten-free and casein-free diet include cornmeal, grilled salmon, and soy milk. Cheese and yogurt are casein-rich foods. Therefore, they should be avoided.
The nurse is teaching the parents of a child recently diagnosed with autism spectrum disorder (ASD). Which etiologies should the nurse include? (Select all that apply.) A. Neurotransmitters B. Environmental factors C. Mercury-containing vaccinations D. Genetics E. Immunologic factors
a,b,d,e Rationale: The etiology of ASD is uncertain, but it is believed to be the result of an intricate co-action between genetic, immunologic, and environmental circumstances. There is research being conducted on the role of neurotransmitters, such as dopamine and serotonin. There is no evidence that mercury-containing vaccinations cause autism.
The nurse is assessing a 3-year-old child with autism spectrum disorder (ASD). In which area should the nurse expect to find impairments? (Select all that apply.) A. Ability to engage in complex thought process B. Communication C. Social adaptability D. Ability to organize responses to situations E. Social interactions
b,c,d,e Rationale: Impairments are noted in the social interactions and ability to adapt socially at the appropriate age level. The young child with ASD will have a decreased ability to communicate as well as an inability to organize situational responses. Developmentally, the 3-year-old is not old enough for complex thought.
The parents of an adolescent are concerned about his mental health and have brought the adolescent into the physician's office for an evaluation. Which statements by the parents indicate that the child may have a mental health disorder? Select all that apply. a) "He has lost 10 pounds over the last 4 months." b) "He has started sleeping for only 3 hours each night." c) "He hangs out with the same kids he always has." d) "He still enjoys playing a lot of baseball." e) "He used to be a straight-A student and now he's bringing home Cs and Ds."
• "He has lost 10 pounds over the last 4 months." • "He has started sleeping for only 3 hours each night." • "He used to be a straight-A student and now he's bringing home Cs and Ds."
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. a) "We're trying to make her accountable and responsible for her own behavior." b) "I use a higher pitched voice when I communicate with her." c) "We have set some boundaries that are nonnegotiable." d) "I am quick to point out the things that she does that make me crazy." e) "We tell her when she is doing something well."
• "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 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. a) Cannot stand on tiptoe b) Has never "babbled" c) Does not use any words d) Does not speak in short sentences e) Does not exhibit attempts to communicate by pointing to objects
• Has never "babbled" • Does not exhibit attempts to communicate by pointing to objects • Does not use any words
The characteristics of the child with autism fall into three categories. Which of the following are the three categories that these characteristics fall in to? a) Inability to respond to verbal stimuli b) Decreased ability to meet developmental milestones c) Inability to communicate with others d) Obviously limited activities and interests. e) Inability to relate to others
• Inability to relate to others • Inability to communicate with others • Obviously limited activities and interests.
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) Loss of interest in activity c) Decreased energy d) Decreased sleep e) Pressured speech
• Pressured speech • Decreased sleep • Flamboyant behavior
