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

What is the most difficult risk factor for a child to overcome related to substance abuse? a diagnosis of ADD a dysfunctional family situation home environment where there is drug or alcohol abuse peer pressure

home environment where there is drug or alcohol abuse Children who are exposed to family members who abuse alcohol or drugs are the least influenced by educational programs promoting abstinence from drugs. Their home environment has a great impact on how they view substance abuse.

A 17-year-old child has been admitted with complications of anorexia nervosa. What diagnostic tests can be anticipated in the plan of care/treatment? Select all that apply. chest X-ray complete blood cell count metabolic panel CT scan MRI

complete blood cell count metabolic panel Anorexia nervosa is characterized by dramatic weight loss as a result of decreased food intake and sharply increased physical exercise. Complications of anorexia include fluid and electrolyte imbalance, decreased blood volume, cardiac arrhythmia, esophagitis, rupture of the esophagus or stomach, tooth loss, and menstrual problems. A metabolic panel would highlight alterations in electrolyte status. Electrolyte imbalances are also associated with cardiac arrhythmia. Reduced dietary intake may result in anemia. This will be noted in the hemoglobin level. An alteration in blood volume will be reflected in the hematocrit level.

A 9-year-old mentally challenged client is hospitalized for gallbladder surgery. The client tells the nurse that she is afraid to be in the hospital and doesn't know anyone. Which is the best response by the nurse? "Have you told your mom that you are afraid?" "Don't be worried, you won't be here that long." "Describe to me a normal day at your house." "Would you like to draw or color?"

"Describe to me a normal day at your house." When a child has special needs, it is helpful to try to make as close to a normal routine or structure as possible. If the child describes to the nurse what a normal day is like, then the nurse may be able to follow that schedule or make the day in the hospital similar to home. If the nurse simply distracts the child or tells the child it won't be long, the nurse is not addressing the child's concerns. Asking the child whether she told her mother does not help comfort the child at the present time.

The parent of a 17-year-old adolescent asks the nurse about placing the child in long-term care, because the child has severe physical impairment and intellectual disability. Which question will the nurse ask first? "Do you have a standard care plan that you have been using for your adolescent?" "How much care do you need help with for your adolescent?" "Are you already connected to resources and agencies to help you with care and placement?" "Do you have other family members who could care for your adolescent at their home?"

"Do you have a standard care plan that you have been using for your adolescent?" It is important for the nurse to assess and understand the needs of the family. The nurse should always check first to see if a plan of care already exists. The parent obviously wants the child cared for and may not have any other support or family to help. Counselors and planners at many agencies and social service offices are available to assist families in need if they are not already connected.

The mother of an 8-year-old boy is concerned that her son has attention deficit hyperactivity disorder. She describes the symptoms he demonstrates. Which behavior should the nurse recognize as an example of impulsiveness? 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 Repeating words or phrases spoken by others Constantly fidgeting in his chair and shaking his foot

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

A school nurse is working with a group of adolescents. Which assessment findings might prompt the nurse to screen for eating disorders? Select all that apply. absence of hunger erosion of teeth menstrual irregularity frequent nurse visits weight fluctuation

weight fluctuation erosion of teeth menstrual irregularity Screening for eating disorders may be routine for a particular client population in some clinical settings or may be cued by clinical manifestations, such as weight fluctuation, teeth erosion, disruption of menstruation, chronic constipation, dehydration, gastric reflux, syncope, and others. Frequent nurse visits do not necessarily mean there is an eating disorder. Those with eating disorders still experience hunger but ignore it as well as signs of physical weakness and fatigue.

Parents of a 36-month-old child confide in the clinic nurse that their child does not speak and spends hours staring at their ceiling fan. They are worried that their child may have autism spectrum disorder. Which question would be important for the nurse to ask the parents? "Does your child already attend therapies such as speech therapy?" "Does your child have siblings?" "Does your child come and hug you or seek comfort from you?" "Do you have trouble keeping child care providers for your child?"

"Does your child come and hug you or seek comfort from you?" Children with autism spectrum disorder lack communication and social skills. These children often will not seek comfort, make eye contact, or develop peer relationships. It is important during the health history for the nurse to focus on the findings the parents are presenting and not on extra information that may or may not be helpful.

A parent expresses concern that the child has an autism spectrum disorder. The nurse obtains a health history of the symptoms to understand the parent's concern. Which question would the nurse ask first? "Does your child respond to his or her name?" "Is your child happy when friends come to visit?" "Does your child only eat the same food?" "Does your child interact with you when playing?"

"Does your child interact with you when playing?" Children on the autism spectrum have a very wide range of symptoms. Children have impaired social interactions and communication. They may have stereotypical behaviors and perseveration behaviors. Two indicators a child is on the autism spectrum is the lack of ability to point at objects by 18 months of age and the lack of ability to gaze jointly with another. By asking if the child interacts with the parent when playing, the nurse is seeking to determine these two cardinal signs. All of the answer choices are correct questions to ask as part of the history because the child could have a multitude of symptoms. These answer choices help provide information into the diagnosis.

A nurse is explaining the difference between anorexia nervosa and bulimia nervosa. The nurse knows the teaching was effective when the parents make which statement? "Anorexia refers to binge eating and purging by vomiting to prevent weight gain." "Russell's sign is present in anorexia nervosa." "Individuals with bulimia have a normal weight or are slightly overweight." "Neither of these disorders is life threatening, only socially unacceptable."

"Individuals with bulimia have a normal weight or are slightly overweight." Individuals with bulimia are often a normal weight or slightly overweight, and therefore the problem may escape notice from friends and family. Bulimia refers to recurrent and episodic binge eating and purging by vomiting, accompanied by awareness that the eating pattern is abnormal, and yet the individual is not able to stop the pattern. Both of these disorders are life threatening. With either type of bulimia, the combination of frequent vomiting and use of laxative or diuretics can result in such serious physical complications, notably electrolyte abnormalities, which can ultimately lead to effects as severe as cardiac arrest. In teens with anorexia, the nurse may observe significant hypotension, hypothermia, and bradycardia. If the process is allowed to continue without therapy, it can lead to starvation, serious health problems, and even death. Laboratory analysis may reveal anemia and leukopenia, an elevated BUN and creatinine levels, hypercholesterolemia, and elevated liver enzymes; endocrine studies may reveal a low T3 and T4 while reverse T3 levels may be elevated. An electrocardiogram commonly demonstrates bradycardia and may include arrhythmias or a prolonged QTc interval. Adolescents with purging may develop severe erosion of their teeth because of the constant exposure to acidic gastrointestinal juices from vomiting. Russell sign (scars or calluses on the dorsal side of the hand from repeated contact of the teeth while inducing vomiting) might be present in those who engage in purging behavior.

A 10-year-old girl with attention deficit hyperactivity disorder (ADHD) has been on methylphenidate for 6 months. The girl's mother calls and tells the nurse that the medication is ineffective and requests an immediate increase in the child's dosage. Which response by the nurse would be most appropriate? "Let's wait a few more weeks before we do anything." "What does the teacher say?" "Let me talk to the doctor about this." "Let's set up an appointment for you to come in as soon as possible.

"Let's set up an appointment for you to come in as soon as possible. The nurse plays a vital role in administering medicines and observing and reporting responses. A face-to-face appointment with the family and the primary health care provider or advanced practice mental health nurse can help uncover patient and parental factors that may be preventing success. Once it is established that the family is using the medication properly as well as instituting structure within the home, it can be determined if an increased dosage or alternate medicine would be appropriate. Deferring to the doctor will not elicit any information from the mother, and waiting will not address the current concerns. The teacher can only reveal partial information about the effectiveness of the medication, which can be reviewed once other factors have been addressed in a face-to-face visit with the family and client.

A 9-year-old child with attention deficit hyperactivity disorder (ADHD) has been placed on the stimulant methylphenidate. The nurse knows that the teaching has been effective when the parents make which statement? "We'll bring our child in every week to get blood levels drawn." "This drug will have an effect on our child in about 2 weeks." "Our child knows to take this medication once every 12 hours." "Our child may have some side effects, like insomnia, headache, or stomach ache."

"Our child may have some side effects, like insomnia, headache, or stomach ache." Insomnia, headache, and an upset stomach are common side effects of methylphenidate. The drug has a short half-life so the medication must be taken three times per day. The last dose should be right after school so as not to interfere with sleeping. Blood levels do not need to be drawn while on the medication. The medication starts working shortly after the person starts taking it, not 2 weeks later.

While interviewing a depressed adolescent, it is revealed that the client has considered hurting oneself. What question is the nurse's priority? "Tell me why you would want to hurt yourself." "Do your parents know that you want to hurt yourself?" "Have you discussed this with anyone else?" "Tell me exactly how you would hurt yourself."

"Tell me exactly how you would hurt yourself." It is important for the nurse to find out exactly how the adolescent is envisioning harming oneself. This information will help the nurse to take measures to prevent an attempted suicide. The other questions are important to ask, but are not the priority. They do not elicit the necessary information to prevent an attempt.

A pediatric client has recently been prescribed methylphenidate. The parent calls the office and insists the medication is not working. How will the nurse respond? "Tell me how you are administering the medication." "Tell me why you believe the medication is not working." "Your child's dosage may need to be increased." "Perhaps another medication will be better for your child."

"Tell me why you believe the medication is not working." Asking the parent to explain why he or she believes the medicine is not working will offer important insights into the parent's definition of effectiveness. It is important for both the parent and health care team to develop a shared definition of effectiveness and improvement. Once this is established, the nurse can suggest the next step in the treatment plan. Stating a different medication or dosage may be needed does not provide any information about the child's response to the current medication. Asking the parent about administering the medication properly could cause the parent to take offense and does not provide the necessary information.

A nurse in a residential foster home is caring for a 17-year-old girl with conduct disorder. The adolescent is using profanity and refusing to complete the assigned chores. The nurse reminds the adolescent that there are only five minutes in which to finish. The adolescent throws a dirty plate at the wall. Which response would be most appropriate? "You only have a few minutes to complete your chores." "If you calm down right now I will give you a few extra minutes to complete your chores." "You appear to be feeling very angry tonight, but you must still complete your chores." "I find your language offensive, and you need to stop talking that way."

"You appear to be feeling very angry tonight, but you must still complete your chores." The nurse's goal is to clearly and empathically explain the rules and firmly adhere to them. Telling the adolescent that there are only a few minutes to complete the chores does not exhibit empathy and is not therapeutic. Neither is the statement "I find your language offensive." This statement also does not address the rules. Letting the adolescent have a few extra minutes only reinforces the negative behavior and does not respect the rules of the facility.

The parents of an 18-month-old toddler are concerned that their toddler no longer makes eye contact, does not respond to their smiles or other facial expressions, does not point to toys, and no longer speaks. They said that their toddler used to be able to say "mama" or "dada." The parents started noticing these changes in behavior 3 months ago. Which information can be provided to the parents? "A toddler who is on the autism spectrum may have difficulty establishing or maintaining eye contact." "Once your toddler begins to speak, it will be easier to make a determination." "Autism spectrum disorders are curable, so make sure to let your health care provider know about your concerns as soon as possible." "There are many behaviors that can be thought of as signs of autism spectrum disorders, but only a health care provider can confirm the diagnosis."

"There are many behaviors that can be thought of as signs of autism spectrum disorders, but only a health care provider can confirm the diagnosis." The nurse will respond by providing current facts, which in this case is that only a health care provider can confirm a diagnosis of an autism spectrum disorder. Autism spectrum disorders are not diseases that are curable but a spectrum of disorders that affect cognitive, speech, and social interaction. Autism spectrum disorders range from mild to severe as do the behaviors. Autistic behaviors may be first noticed in infancy as developmental delays or between the age of 12 and 36 months when the toddler regresses or loses previously acquired skills. Although infants and toddlers on the autism spectrum may have difficulty establishing or maintaining eye contact, those who are not able to establish eye contact or have difficulties establishing eye contact need to be first tested for vision and hearing to rule out eye or hearing defects. It is inappropriate for the nurse to state, "when your toddler begins to speak, a determination is easier." The toddler was already speaking and stopped speaking 3 months before the visit to the health care provider.

A family includes a 9-year-old child. The nurse suspects that the family has caregiver-fabricated illness (formerly Munchausen syndrome by proxy). Which nursing intervention is best when assessing the child and family in the pediatrician's office? Turn off the video surveillance in the room. Ask to speak to the child separate from the family. Keep both parents in the room at all times. Ask the parents together how the child is doing.

Ask to speak to the child separate from the family. In caregiver-fabricated illness (formerly Munchausen syndrome by proxy), parents report prolonged, unexplained illnesses for the child. Even though the child has been seen for medical treatment, the health issues are never resolved. The parent shows a lack of concern about the symptoms and the illnesses. Symptoms usually occur when no one else is present. The nurse should speak to the child alone, video and document interactions, contact the medical team, and contact protection services for the child if needed.

An adolescent with anorexia is severely malnourished and underweight and is admitted to an inpatient facility. The nurse begins the refeeding process, and the adolescent develops cardiovascular complications. Which action is important for the nurse to take? Obtain a referral for a cardiologist. Place the adolescent on a heart monitor. Add phosphorous, calcium, and magnesium to the diet. Decrease the amount of food or enteral nutrition.

Decrease the amount of food or enteral nutrition. A client with anorexia exhibits a cachectic appearance, dry sallow skin, and a body mass index of less than 17. If the client is admitted to an inpatient facility, then a refeeding program will be started. This can be either orally, via enteral nutrition with a nasogastric tube, or by total parenteral nutrition. Refeeding should start very slowly. If it occurs too quickly, refeeding syndrome occurs. Refeeding syndrome can cause severe electrolyte imbalances. When a client is severely malnourished, the heart muscle becomes smaller. The heart is not able to handle the increased blood volume and this results in heart failure. This also causes a severe decrease in phosphorous, potassium, and magnesium resulting in cardiac arrhythmias. Calcium is not generally affected.

Parents of a school-age child experiencing encopresis are discussing the problem with the child's health care team. Their understanding of this problem is indicated when the parents respond in what manner? If there is no organic cause for the problem, the family may need to explore counseling for an emotional problem. They can help the child by trying to control his stooling pattern with medications. Encopresis always indicates that the child is constipated and needs nutritional counseling. He needs to be allowed to make his own decisions or choices about his life.

If there is no organic cause for the problem, the family may need to explore counseling for an emotional problem. If a child is experiencing encopresis and there is no organic problem found such as constipation, inadequate fiber in the child's diet, or not drinking enough liquids to soften the stool, the child and family may need counseling for an emotional problem. It is thought that either over-controlling or under-controlling the child's life may be a contributory factor, along with emotional stressors in the child's life.

With all the warnings on cigarette packages and media coverage of the side effects of tobacco use, why do school-age children and adolescents continue to smoke or chew tobacco? They see their parents or caregivers smoking and do not see the harm it is doing to them. School-age and adolescent children view the threats to their health as far in the future, and the child feels that he or she can stop at any time. They believe that smokeless tobacco does not have the health concerns of regular tobacco in cigarettes. They do not believe the information provided to them through the media.

School-age and adolescent children view the threats to their health as far in the future, and the child feels that he or she can stop at any time. Children who smoke or use tobacco cannot conceive of the future effects that tobacco will have on their bodies. They see others smoking around them and, through example, think smoking is OK for them. They do not understand the effect on their long-term health because they are focused on the here and now.

A child has been prescribed methylphenidate to take daily. Which nursing instructions are important to provide to the family? Stress the need for adequate nutrition. Advise parents to avoid grapefruit with this medicine. Encourage good dental hygiene and frequent dental checkups. Keep this medication in a dark container to prevent deterioration.

Stress the need for adequate nutrition. One of the side effects of methylphenidate is anorexia, so the nurse needs to instruct parents to monitor the child's weight and encourage adequate nutrition to prevent weight loss. Grapefruit does not affect methylphenidate, and methylphenidate does not cause dental problems. It also does not need to be kept in a dark container.

Which sign or symptom suggests that a 5-year-old child who does not maintain eye contact or speak may have autism spectrum disorder (ASD)? The child is highly active and inattentive. The child has a long face and prominent jaw. The child has a slight decrease in head circumference. The child constantly pats his or her legs.

The child constantly pats his or her legs. Repetitive motor mannerisms such as the child constantly patting his or her legs are a typical behavior pattern for autism spectrum disorder. Typical behavior for these children is repetitive activity. They demonstrate bizarre motor and stereotypic behaviors. A high level of activity and inattentiveness are typical symptoms of cognitive impairment. A decrease in head circumference suggests malnutrition or decelerating brain growth. A long face and prominent jaw are symptoms of Fragile X syndrome.

In collecting data on a 7-year-old child with a possible diagnosis of school phobia, the nurse directs questions related to the following topics. Which would most likely be a cause of the child having school phobia? The child may have a language barrier. The child may be bored and feels more intellectually stimulated at home. The child may be a poor student and be afraid of failing grades. The child may have a fear of being separated from the parent.

The child may have a fear of being separated from the parent. School-phobic children may have a strong attachment to one parent, usually the mother, and they fear separation from that parent, perhaps because of anxiety about losing her or him while away from home. Being a poor student and worrying about grades would be more common in the later school age and adolescence. A child may be anxious about language but that is generally not enough to cause phobias. If the child is bored at school the parents should ask to meet the teacher and define the child's needs. Many children need extra stimulation but that is not the same as having a phobia.

The nurse is working with school-aged children who are having enuresis or encopresis. What will most likely be the first step in this child's treatment? The child will be given medications. The child will be taken to a therapist. The child will have a complete physical exam. The child will be given a strict daily schedule.

The child will have a complete physical exam. The child with enuresis or encopresis may have a physiologic or psychological cause and may indicate a need for further exploration and treatment. A complete physical exam and assessment is done first to rule out any physical cause.

A nurse is examining a 4-year-old child with various injuries in multiple places. Which site of injury would introduce suspicion of abuse? palms of hands soles of feet abdomen ears

abdomen The abdomen is the most frequent site of physical injury where abuse is suspected in children 4 years of age and younger. If injuries to the soles and palms are present, the nurse should look into inflicted burns as a possible cause of injury.

An adolescent has been diagnosed with oppositional defiant disorder. Which symptom does the nurse anticipate? disruptive behavior toward siblings and peers typical teenage defiance behavior with parents frequent arrests and conflict with legal authorities angry outbursts directed at authority figures

angry outbursts directed at authority figures Oppositional defiant disorders (ODD) consist of a pattern of irritability, defiant behaviors, and vindictiveness that result in disturbed functioning in academic and social domains. Children and adolescents with ODD typically have difficulty controlling their temper; such anger is often directed at an authority figure. It is important to distinguish behavior that is within normal limits from behavior that is symptomatic. Many teens demonstrate some defiance toward their parents, but it typically does not disrupt their academic and social relationships like ODD. Problems do not typically occur between siblings and peers, rather with authority figures. Children with ODD may have conflict with legal authorities, but this is not something the nurse would anticipate.

During adolescence, alcohol is connected to what problem frequently seen in this age group? automobile accidents teen suicide violence drug usage

automobile accidents Adolescents who drink and drive do not realize the impact of the alcohol in their reflexes and judgment. Fine motor control and judgment are affected even at lower levels of alcohol consumption. Driving is considered another adult behavior. There are no prying adult eyes on the adolescent drivers, so they think they are invincible and can drink and drive.

A 16-year-old client is highly disruptive in class and has been in trouble at home. The parent recently found the adolescent torturing a cat. When questioned, the adolescent laughed. What condition might the client be suffering from? Asperger syndrome bipolar disorder conduct disorder Tourette syndrome

conduct disorder Adolescents with conduct disorder are often unmanageable at home and disruptive in the community. They have little empathy or concern for others. They may be callous and lack appropriate feelings of guilt, although they may express remorse superficially to avoid punishment. They often blame others for their actions. Risk-taking behaviors such as drinking, smoking, using illegal substances, experimenting with sex, and participating in crime are typical. Cruelty to animals or people, destruction of property, theft, and serious violation of rules are diagnostic criteria. Asperger syndrome is on the autism spectrum, where the child is extremely high in intelligence. Bipolar symptoms consist of wide swings between depression and mania. Tourette syndrome is a condition where motor and vocal tics occur.

A mother is suspicious that her adolescent has bulimia because the child seems to be dependent upon laxatives and vomits frequently after eating a meal. What physical finding would be most suggestive of this diagnosis? weight below the 5th percentile on the growth chart callouses in the palms of her hands dental erosions and caries recurrent strep throat

dental erosions and caries A client with bulimia will display dental caries and erosions from the chronic exposure to stomach acids from self-induced vomiting. The normal weight of a client with bulimia will be normal or slightly overweight, not below the 5th percentile. Calluses are noted in the back of the hands of a client with bulimia, not the palms, and recurrent strep throat is not associated with bulimia at all.

Parents are reluctant to accept that their preschooler has attention deficit hyperactivity disorder (ADHD), so the nurse is explaining the commonly seen characteristics of this syndrome. Which characteristics would the nurse include in the explanation? Select all that apply. failure to complete tasks before going on to another one easily distracted impulsiveness aggression bedwetting

easily distracted failure to complete tasks before going on to another one impulsiveness Children with ADHD or ADD (attention deficit disorder) usually demonstrate an inability to stay on task, are impulsive, lose things frequently, are fidgety and cannot sit still, and tend to talk all the time. Aggression and bedwetting are not part of this syndrome.

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. What follow-up will the nurse expect? put on a high-calorie, high-protein diet started on methylphenidate administered antidiarrheal medications referred for counseling

referred for counseling Encopresis is the repeated involuntary passage of feces of normal or near-normal stool in places not appropriate for that purpose. If no organic causes (e.g., worms, megacolon) exist, encopresis indicates a serious emotional problem and a need for counseling for the child and the family caregivers. Medications such as methylphenidate are used for hyperactivity. The diet needs to be high fiber. Antidiarrheals are contraindicated because they can cause more constipation. Lubricant laxatives should be used.

The nurse is conducting an examination of a boy with Tourette syndrome. Which finding should the nurse expect to observe? lack of eye contact toe walking spinning and hand flapping sudden, rapid stereotypical sounds

sudden, rapid stereotypical sounds Sudden, rapid, stereotypical sounds are a hallmark finding with Tourette syndrome. Toe walking and unusual behaviors such as hand-flapping and spinning are indicative of autism spectrum disorder (ASD). Lack of eye contact is associated with ASD but is also noted in children without a mental health disorder.

A nurse is working with the parents of a child just diagnosed with attention deficit hyperactivity disorder (ADHD). Which aspect will the nurse emphasize as crucial for the child? varying level of discipline structured learning environment medication therapy ongoing counseling

structured learning environment Although medication and counseling/support are important, a structured learning environment is crucial for children with attention deficit hyperactivity disorder (ADHD). Children and adolescents with ADHD respond best in an environment that is structured and predictable, with clear and consistent rules and expectations.

The mother of a 10-year-old boy phones the school nurse. The child has attention deficit/hyperactivity disorder (ADHD) and must go to the office to take medication at lunchtime. The child informed the mother that classmates have been making fun of him because he no longer wants to take the medication. Which is the nurse's best response? "I will tell his teacher to talk with the kids causing trouble." "You can speak with your doctor about extended-release medications for the treatment of ADHD." "He must take his medication; just tell your son to ignore the kids." "Tell your son if he doesn't take his medication, his grades may suffer."

"You can speak with your doctor about extended-release medications for the treatment of ADHD." Extended-release or once-a-day medications would eliminate the need for the boy to come in at lunch. The other responses are not therapeutic.

The nurse is meeting with parents of a child who have learned that their 11-year-old child has mild cognitive impairments that make it more difficult for their child to adapt to the new environment and make friends with other children. What is the best response by the nurse? "Maybe it would be best to ask the teacher to explain the cognitive impairment of your child to the other children." "Coping and adaptation are often affected by cognitive impairments." "Your child needs time to adjust comfortably to school routines and build a trusting relationship with other children." "Your child's impairment means it takes more time to learn to cope, so your child needs to attend a special needs class."

"Your child needs time to adjust comfortably to school routines and build a trusting relationship with other children." Cognitive impairment is a functional state in which there are significant limitations in the cognitive status and adaptive behavior development before the age of 18 years. The child is at increased risk for adjustment disorders because the child's coping strategies are not understood or recognized and his or her range of adaptive strategies may be reduced. Coping, adaptation, and social skills development are greatly dependent on abstract thinking and the ability to generalize from one situation to another. Cognitive impairment includes impairment of abstract thinking. Children who have cognitive impairment are often uncomfortable with unfamiliar surroundings and people. Time is needed to build relationships but the ability to build relationships may be dependent upon the level of the child's impairment. It is inappropriate for the nurse to recommend that the teacher inform the child's classmates. Children with cognitive impairment should be accepted as they are able to integrate into standard schools.

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

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

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

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

A 10-year-old girl has been referred for evaluation due to difficulties integrating with her peers at her new school. The counselor believes she is at risk for situational low self-esteem due to problematic relationships with both family members and peers. What is the best approach? Introduce the concept of accepting differences to reduce conflict. Engage the girl in dialogue regarding feelings about self/personal appearance. Explore the girl's feelings about changes in her body with the onset of puberty. Remind her of the importance of good hygiene for better appearance.

Engage the girl in dialogue regarding feelings about self/personal appearance. Engaging the child in dialogue about self and personal appearance may reveal self-perceptions and allow discussion of reality versus perception; this enables discussion of methods to address perceived weaknesses and to focus on strengths. Appearance may reflect self-perception, and a comment regarding hygiene might be poorly received. While pubertal changes can be stressful, a 10-year-old girl may not have entered puberty and the question may not be relevant. The concept of accepting differences is secondary to engaging the child in dialogue about self and appearance.

The mother of a school-age child is distraught over the ongoing oppositional behavior demonstrated by the child at home and at school. Which nursing diagnosis should the nurse select as appropriate for the child and family? Situational low self-esteem related to lack of successful coping strategies Impaired social interaction related to short attention span and distractibility Interrupted family processes related to inability of child to follow instructions Risk for self-directed violence related to impulsivity

Interrupted family processes related to inability of child to follow instructions Oppositional defiant disorders consist of long-term hostile, negativistic, or defiant behaviors that result in disturbed functioning in academic and social domains. Children typically have difficulty controlling their temper; such anger is often directed at an authority figure. The disorder develops most frequently in late preschool or early school age. The diagnosis most appropriate for this child and parent is interrupted family processes. There is no evidence to suggest that the child is at risk for self-directed violence, low self-esteem, or impaired social interaction.

When teaching parents of a child with encopresis, what would the nurse stress? Importance of cleaning the child immediately after an accident occurs Need for keeping the child close to bathroom facilities at all times Not punishing the child for encopresis Necessity for giving 4 to 6 tablespoons of bismuth subsalicylate per day

Not punishing the child for encopresis Encopresis (inappropriate soiling of stool) is a symptom of an underlying stress or disease. It can be the manifestation of how the child expresses the trauma or depression that is occurring. The child needs therapy to determine the cause and to treat the problem. If a child is scolded or punished for encopresis or if more than normal attention is paid to the problem, the problem will worsen. Giving medications will not prevent the encopresis. The proximity of the bathroom will not impact the situation, because with encopresis the child soils the underwear and does not go to the bathroom.

The nurse is working on forming a contract with a hospitalized adolescent diagnosed with anorexia nervosa. Which information should the nurse prioritize with the client when making the contract? Remind the adolescent about the consequences of misbehavior. Reward the client after several days of successful behavior. Encourage the caregivers to take responsibility for the adolescent. Stress to the client that he or she is in control of the outcome of the care.

Stress to the client that he or she is in control of the outcome of the care. Contract agreements are often recommended for people with eating disorders. These agreements, which are usually part of a behavioral modification plan, specify the client's and the staff's responsibilities for the diet, activity expectations for the client, and other aspects of the client's behavior. The contract also may spell out specific privileges that can be gained by meeting the contract goals. This places the client in greater control of the outcome. Some type of reward should be achieved daily to encourage continued participation in the agreement.

The nurse has been working for several days with an adolescent who has anorexia nervosa. What is an indication that the adolescent is developing trust in the nurse? The adolescent stating the desire to eat again. Saying which nurse's orders the adolescent will follow. The adolescent telling the nurse purging occurs after each meal. The adolescent stating "You're the best nurse on the unit."

The adolescent telling the nurse purging occurs after each meal. The adolescent with anorexia tends to have many fears and a high need for acceptance. Therefore, trust is difficult for this adolescent. Trust has to be gained from an adult before the adolescent can share confidences. Purging after every meal with anorexia is common and one of the goals of therapy is to stop the purging. It is often done in secret. When the adolescent has gained trust in the nurse then the adolescent will begin to share the number of times purging has been happening. When the adolescent is making statements such as liking one nurse more than another or following one nurse's instructions and not the others, this is manipulation. It is not healthy. The adolescent stating a desire to eat again could be interpreted two ways. The adolescent could be getting healthier with therapy or it could also be seen as manipulation and a way to purge more often. Either way, it is not a sign that trust has developed.

While obtaining a health history, the nurse notices that the child has a history of pica. The nurse needs to be aware of which possible condition associated with pica? The child could have a developmental or learning disability. The child has lack of supervision. The child has Down syndrome. The child is autistic.

The child could have a developmental or learning disability. It is not uncommon for a child who has a developmental or learning disability to have poor nutrition or malnutrition in the first years of his or her life. It is also common for children with these disabilities to suffer from pica. Pica includes ingesting non-nutritive material such as paint, clay, or sand. The child may later be diagnosed with autism spectrum disorder. Down syndrome is a genetically inherited disorder.

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: anxiety disorder. Asperger syndrome. Tourette syndrome. autism spectrum disorder.

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.

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 child playing in the kitchen area pretends to pour a glass of milk and repeats this over and over. A child flips the light switch off and on until the caregiver asks her to stop and join the other children in playing. 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. 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. Children with ASD become completely absorbed in strange repetitive behaviors such as spinning an object, flipping an electrical switch on and off, or walking around the room feeling the walls. If these movements are interrupted or if objects in the environment are moved, a violent temper tantrum may result. These tantrums may include self-destructive acts such as hand biting and head banging. Although infants and toddlers normally are self-centered, ritualistic, and prone to displays of temper, autistic children show these characteristics to an extreme degree coupled with an almost total lack of response to other people.

The nurse is discussing the treatment for a child with attention deficit hyperactivity disorder (ADHD) with a group of school nurses. What would be an appropriate learning setting for a child with ADHD? a classroom with a plan of study that is followed each day a classroom with windows facing a playground a classroom in which children self-select their activities a classroom with tables and chairs rather than individual desks

a classroom with a plan of study that is followed each day For the child with ADHD, the learning situations should be structured so that the child has minimal distractions and a supportive teacher. Special arrangements can be made to provide an educational atmosphere that is supportive for the child without the need for the child to leave the classroom. Having the child with ADHD face the playground would provide the child with too much distraction. Having the child with ADHD select his or her own activities or placing the child at tables instead of an individual desk means the child would not stay on task. Giving the child too many choices only serves to confuse the child and leads to increasing hyperactivity and loss of control.

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 the child has: failure to thrive. attention deficit hyperactive disorder (ADHD). an addicted caregiver. autism spectrum disorder.

attention deficit hyperactive disorder (ADHD). The child with ADHD may have these characteristics: Impulsiveness, easy distractibility, frequent fidgeting or squirming, difficulty sitting still, problems following through on instructions despite being able to understand them, inattentiveness when being spoken to, frequent losing of things, going from one uncompleted activity to another, difficulty taking turns, frequent excessive talking, and engaging in dangerous activities without considering the consequences.

A nurse is assessing a child whom the nurse suspects is a victim of physical abuse. Assessment reveals numerous bruises on the thighs and upper back in various stages of healing. The child's caregiver is present in the examination room. Which aspect of care is the priority? documenting the assessment findings providing physical contact if the child accepts it ensuring that the child remains safe assigning different nurses to care for the child

ensuring that the child remains safe Although documenting the findings and providing physical contact with the child are important, the child's safety is the priority and the utmost concern. One nurse should be assigned to care for the child so that the child can relate to one person consistently.

A nurse has been asked to conduct a presentation on human trafficking. When preparing the presentation, the nurse will include which factor(s) as placing individuals at risk? Select all that apply. lack of adequate family support female gender, between 12 to 16 years of age history of child abuse (child mistreatment) high level of education male gender, between 15 to 18 years of age

female gender, between 12 to 16 years of age history of child abuse (child mistreatment) lack of adequate family support Although trafficking can happen in any community and individuals of any age, race, gender, or nationality may be victims, women and children are the most frequent victims. Often poverty and lack of economic opportunities cause vulnerability and allow these individuals to be tricked and to become stuck in trafficking situations. Other risk factors that may lead to human trafficking include being a young girl (ages 12 to16 years old are at greatest risk), rural location, lack of education, disability, inadequate family support and protection, runaway or throwaway youth, migrant workers, and a history of childhood abuse (mistreatment).

A nurse is conducting an information session for a group of parents with children who have varying levels of intellectual disabilities. One of the parents asks, "What causes this to happen?" Which information would the nurse include as a potential cause? Select all that apply. chromosomal abnormality macrosomia lack of oxygen at birth spinal cord injury uterine infection during pregnancy

lack of oxygen at birth chromosomal abnormality uterine infection during pregnancy Common causes of intellectual disability include: chromosomal abnormalities such as Down syndrome and fragile X syndrome infection in utero, such as rubella or cytomegalic inclusion disease anoxia at birth from such causes as umbilical cord compression fetal alcohol spectrum disorder inherited metabolic disorders such as phenylketonuria or Tay-Sachs disease head trauma, lead poisoning, or hypothyroidism brain malformations such as anencephaly very low birth weight infections such as measles, encephalitis autism spectrum disorder

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

learning disorder The child appears to have a learning disorder based on challenges with reading, spelling, and writing as well as being organized and managing time. Other findings consistent with a learning disorder include delayed language development and difficulty discriminating among sounds. Autism spectrum disorder represents a range of disorders characterized by markedly abnormal or impaired development in social interaction and communication. Down syndrome is a condition in which extra genetic material causes delays in how a child develops, both physically and cognitively. Asperger syndrome is a type of autism spectrum disorder.

The nurse is examining a child with fetal alcohol spectrum disorder. Which assessment finding should the nurse expect? short philtrum with thick upper lip low nasal bridge with short upturned nose macrocephaly clubbing of fingers

low nasal bridge with short upturned nose Typical facial features in an infant with fetal alcohol spectrum disorder include a low nasal bridge with short upturned nose, flattened midface, and a long philtrum with narrow upper lip. Microcephaly rather than macrocephaly is associated with fetal alcohol spectrum disorder. Clubbing of fingers is associated with chronic hypoxia.

A child is diagnosed with a mental health disorder and is receiving milieu therapy in an inpatient psychiatric setting. Which actions would the nurse likely include to maintain a therapeutic milieu? Select all that apply. role modeling appropriate interactions with others de-escalating aggressive or anxious behavior discouraging family involvement in the care making client rounds every 15 minutes instituting the liberal use of restraints

making client rounds every 15 minutes role modeling appropriate interactions with others de-escalating aggressive or anxious behavior Milieu therapy, environmental structuring and management, is conducted in dynamic, specially structured settings designed to assist in the overall therapeutic process. During milieu therapy, the environment is arranged to promote therapeutic goals, such as diminishing aggressive behavior and developing adaptive and social skills. Client rounds are made every 15 minutes or more often if necessary. The nurse role-models appropriate interaction with clients, family members, and other staff members and closely monitors behavior of all clients, anticipating escalation of aggression, anxious behavior or any threat to the safety of the client, staff, or peers. The nurse de-escalates aggressive or anxious behavior and takes action to maintain a safe and secure milieu. Family involvement in care is encouraged. The nurse also maintains a risk-free environment.

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? dilated eyes watery eyes absence of nasal hair patches of hair loss

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.

Rumination disorder is a poorly understood condition of young children. This refers to: a habit of eating nonfood substances. rechewing undigested food. fear of moving objects. excessive worrying about friendships.

rechewing undigested food. Rumination is the rechewing of undigested food. It occurs primarily in infants and is a little-understood process. Pica is the eating of non-food substances such as clay, paint, or sand. It occurs in preschool to school-age children. Since rumination occurs in infants it is doubtful they are concerned about friendships or moving objects.

The nurse is caring for an adolescent diagnosed with anorexia nervosa. Which education will the nurse include in the client's discharge teaching? referrals to counseling services appropriate exercise routines methods for desensitization proper administration of phenelzine

referrals to counseling services Adolescents with eating disorders need to increase self-esteem or a feeling that they have control over their life. This can be achieved through extensive counseling services, which should be scheduled for this client prior to discharge. The client needs to be nutritionally stable before participating in exercise activities. Desensitization is not a method of treatment used for anorexia. It is used to diminish emotional responsiveness to a stimulus through repeated exposure. Phenelzine, a monoamine oxidase inhibitor (MAOI), is not used to treat anorexia. It is used to treat depression. Selective serotonin reuptake inhibitors (SSRIs) and antipsychotics are typically used to treat clients with anorexia nervosa.

The nurse is assessing an adolescent who tells the nurse, "I have been using cocaine for a while now. At first, I would get high after smoking just once. But now I have had to smoke more and more to get the same effect." The nurse interprets the adolescent's statement as reflecting which situation? tolerance use disorder withdrawal dependence

tolerance The adolescent's statements reflect tolerance, which is the ability of body tissues to endure and adapt to continued or increased use of a substance; this dynamic means the drug user requires larger doses of the drug to produce the desired effect. A substance use disorder is the misuse of an addictive substance that changes the user's mental state. Dependence is a compulsive need to use a substance for its satisfying or pleasurable effects. Withdrawal refers to the physical and psychological symptoms that occur when the drug is no longer being used.