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

A nurse is assessing a little boy who has been diagnosed with Tourette syndrome. Which finding would the nurse expect to see? A.) Toe walking B.) Lack of eye contact C.) Speaks sudden, fast phrases out of context D.) Spinning and hand-flapping

Answer: C.) Speaks sudden, fast phrases out of context

The nurse suspects that a school-age child has Tourette syndrome. What did the nurse most likely assess in this client? A.) Flat affect B.) Shouting obscenities C.) Playing quietly alone D.) Running wildly in circles

Answer: B.) Shouting obscenities

A nurse is working at a facility that provides care to children with developmental disabilities. Which role would be the nurse's most important? A.) educator B.) care provider C.) advocate D.) counselor

Answer: C.) advocate

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.) "Was your daughter happy in her previous school?" C.) "How is the rest of the family reacting to the move?" D.) "Do you think your daughter is depressed?"

Answer: A.) "What are the specific changes you have seen in your daughter since your move?"

A nursing student learning about autism spectrum disorders correctly identifies which mannerisms as common in affected clients? Select all that apply. - hand wringing - head banging - rocking - running in circles - overeating

Answer: - hand wringing - head banging - rocking - running in circles Rationale: Children with an autism spectrum disorder may not interact with others in conversation. They may insist on certain routines and have very narrow ranges of interest. They also may have repetitive mannerisms, such as hand wringing, head banging, rocking, and running in circles. Children with an autism spectrum disorder generally have little interest in eating. Overeating is more associated with depression.

The nurse is interviewing a depressed 13-year-old adolescent. During the course of the interview, the adolescent reveals that her best friend is thinking about committing suicide. How should the nurse respond? A.) "Do you know how your friend is planning to commit suicide?" B.) "Why do you think your friend wants to commit suicide?" C.) "Do your friend's parents know about the suicidal intention?" D.) "Are you the only person who knows?"

Answer: A.) "Do you know how your friend is planning to commit suicide?"

Which statement is true regarding the use of pharmacologic agents in children with anxiety disorders? A.) Anxiolytics and selective serotonin reuptake inhibitors (SSRIs) have been shown to help reduce anxiety. B.) Mood-stabilizing medications, including lithium, divalproex, and carbamazepine, are used for their calming and antiaggressive effects. C.) Behavioral therapy, including imagery, self-talk, and cognitive techniques, is ineffective without the adjunctive use of pharmacologic agents. D.) The use of pharmacologic agents is discouraged in children because of addictive or suicidal potential.

Answer: A.) Anxiolytics and selective serotonin reuptake inhibitors (SSRIs) have been shown to help reduce anxiety.

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

Answer: A.) Not punishing the child for encopresis Rationale: 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.

A 17-year-old girl has been diagnosed with bulimia nervosa. Which complication should the nurse carefully assess for in this client? A.) Severe erosion of teeth B.) Hypertension C.) Diabetes mellitus D.) Atherosclerosis

Answer: A.) Severe erosion of teeth

Which sign or symptom suggests 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 is highly active and inattentive. C.) The child has a slight decrease in head circumference. D.) The child has a long face and prominent jaw.

Answer: A.) The child constantly opens and closes his hands.

What finding would suggest that a 5-year-old boy might have a developmental disorder? A.) The child is not able to follow directions. B.) The child must be supervised when brushing his teeth. C.) The child knows what a dog and a cat sound like. D.) The child has trouble with R, L, and Y sounds.

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

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

Answer: A.) abdomen

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

Answer: A.) inattention, impulsive, and hyperactivity

A young client enters the emergency department after being raped by a stranger. What is the first thing that the nurse should do? A.) provide a safe, private environment B.) take a thorough history of the incident C.) provide emergency contraceptive therapy, if female D.) offer sexually transmitted infection prophylaxis

Answer: A.) provide a safe, private environment

Which behavior typical of children with autism spectrum disorder (ASD) requires the nurse to maintain special care to keep them safe? A.) A fascination with bright colors B.) Insensitivity to pain C.) A craving for salt D.) Loss of hearing for high frequencies

Answer: B.) Insensitivity to pain Rationale: A number of children with autism spectrum disorder may have a hyposensitivity to pain. Thus, if they hurt themselves, they may not feel the associated pain. It is why one can see these children biting themselves or head banging and not feeling any pain. Having cravings, a fascination with colors, and hearing loss may or may not be associated with a child on the autism spectrum but these manifestations would not be associated with safety.

A 6-year-old child with cognitive disabilities presents to the emergency department with the parents, having fallen and hit the head. How will the nurse need to modify care, based on the disabilities? A.) Talk slowly and enunciate clearly. B.) Provide clear instructions on what the nurse is going to do. C.) Speak to the parents because the child will not be able to understand. D.) Provide written instructions as well as oral instructions for the child.

Answer: B.) Provide clear instructions on what the nurse is going to do.

An adolescent client has been diagnosed with bulimia nervosa. What does the nurse explain as the goal of treatment for this client? A.) removing the stressors from life that caused this B.) restoring nutritional balance and a healthy self-image C.) helping the client return to a healthy weight for height D.) family therapy as this is linked to family disturbances

Answer: B.) restoring nutritional balance and a healthy self-image

The nurse is providing teaching about medication management of attention deficit hyperactivity disorder (ADHD). Which response indicates a need for further teaching? A.) "We should give it to him after he eats breakfast." B.) "This may cause him to have difficulty sleeping." C.) "If he takes this medicine he will no longer have ADHD." D.) "We should see an improvement in his schoolwork."

Answer: C.) "If he takes this medicine he will no longer have ADHD."

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)? A.) The child is highly active and inattentive. B.) The child has a slight decrease in head circumference. C.) The child constantly pats his or her legs. D.) The child has a long face and prominent jaw.

Answer: C.) The child constantly pats his or her legs.

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? A.) The child will be given medications. B.) The child will be taken to a therapist. C.) The child will have a complete physical exam. D.) The child will be given a strict daily schedule.

Answer: C.) The child will have a complete physical exam.

During adolescence, alcohol is connected to what problem frequently seen in this age group? A.) teen suicide B.) violence C.) automobile accidents D.) drug usage

Answer: C.) automobile accidents

What potential side effect of smoking crack should the nurse teach adolescents about to ensure their understanding of the drug's possible impact? A.) a rapid high followed by a slow letdown B.) a high that lasts hours C.) cardiac arrest D.) drop in temperature

Answer: C.) cardiac arrest

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? A.) documenting the assessment findings B.) assigning different nurses to care for the child C.) ensuring that the child remains safe D.) providing physical contact if the child accepts it

Answer: C.) ensuring that the child remains safe

Which treatment modality is especially helpful for adolescents? A.) family therapy B.) play therapy C.) group therapy D.) individual therapy

Answer: C.) group therapy

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.

Answer: D.) rechewing undigested food.

A 9-year-old boy was in a car accident. The child is suffering from posttraumatic stress disorder. Which would be the best approach for treatment? A.) Psychostimulant medications B.) Antipsychotic medications C.) Individual psychotherapy sessions D.) Sensory integration technique

Answer: C.) Individual psychotherapy sessions

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

Answer: A.) "Tell me exactly how you would hurt yourself."

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.) "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." B.) "Autism spectrum disorders are curable, so make sure to let your health care provider know about your concerns as soon as possible." C.) "Once your toddler begins to speak, it will be easier to make a determination." D.) "A toddler who is on the autism spectrum may have difficulty establishing or maintaining eye contact."

Answer: A.) "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."

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

Answer D.) "Let's set up an appointment for you to come in as soon as possible. Rationale: 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.

The parents of a 13-year-old tell the nurse that they have done some research and they think their daughter has conduct disorder. The parents report the child excessively argues with them, throws tantrums when not getting her way, and stays mad at them for long periods of time. How should the nurse respond? A.) "The behavior you are describing sounds more like oppositional defiant disorder than conduct disorder." B.) "I'm not really sure if the behavior you are describing fits the criteria for conduct disorder. Where did you do your research?" C.) "I think you should let your physician do the diagnosing since they have the qualifications to do so." D.) "It's hard to say with teenagers. They all seem to have some degree of behavior issues."

Answer: A.) "The behavior you are describing sounds more like oppositional defiant disorder than conduct disorder." Rationale: Oppositional defiant disorder is characterized by excessive arguing with adults, frequent temper tantrums, active defiance, revenge-seeking behaviors, frequent resentment or anger, and touchiness or easily annoyed. Conduct disorder has a host of other behaviors for the criteria of the diagnosis.

The child has been diagnosed with a mental health disorder and the child's parents are beginning to incorporate behavior management techniques. Which statements by the child's parent indicate the need for further education? Select all that apply. - "I use a higher pitched voice when I communicate with her." - "I am quick to point out the things that she does that make me crazy." - "We have set some boundaries that are nonnegotiable." - "We tell her when she is doing something well." - "We're trying to make her accountable and responsible for her own behavior."

Answer: - "I use a higher pitched voice when I communicate with her." - "I am quick to point out the things that she does that make me crazy."

The nurse is preparing a care plan for the child diagnosed with Tourette syndrome. Which nursing interventions should the nurse include? Select all that apply. - Educate the child and family that tics may worsen during times of stress. - Inform parents that drug therapy is not recommended. - Encourage the parents to arrange for testing at school to take place in a different room than the classroom. - Support the family in pursuing different therapy options. - Suggest the family makes note if tics are less prominent during focused activity.

Answer: - Educate the child and family that tics may worsen during times of stress. - Encourage the parents to arrange for testing at school to take place in a different room than the classroom. - Support the family in pursuing different therapy options. - Suggest the family makes note if tics are less prominent during focused activity.

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. - complete blood cell count - MRI - CT scan - metabolic panel - chest X-ray

Answer: - complete blood cell count - metabolic panel Rationale: 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 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. - male gender, between 15 to 18 years of age - female gender, between 12 to 16 years of age - high level of education - history of child abuse (child mistreatment) - lack of adequate family support

Answer: - female gender, between 12 to 16 years of age - history of child abuse (child mistreatment) - lack of adequate family support

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. - making client rounds every 15 minutes - role modeling appropriate interactions with others - de-escalating aggressive or anxious behavior - discouraging family involvement in the care - instituting the liberal use of restraints

Answer: - making client rounds every 15 minutes - role modeling appropriate interactions with others - de-escalating aggressive or anxious behavior

A nurse is conducting a class for parents of adolescents on the topic of suicide prevention. What are the warning signs for suicide that the nurse will provide for this group? Select all that apply. - statements of hopelessness - changes in behavior from feeling dejected to euphoric - statements concerning appearance; feeling everyone is looking at them - displaying poor judgment - violence and truancy

Answer: - statements of hopelessness - changes in behavior from feeling dejected to euphoric - displaying poor judgment - violence and truancy Rationale: Parents need to be made aware of the warning signs for suicide in adolescents so they can monitor their children. Those signs include behavior changes and statements of hopelessness, violent behavior and truancy from school, demonstrating lack of good judgment, and rapid changes in emotions from sad to euphoric. Voicing concerns that other teens are looking at them and being concerned about their appearance is common adolescent behavior and not indicative of suicidal tendencies.

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? A.) "Your child needs time to adjust comfortably to school routines and build a trusting relationship with other children." B.) "Coping and adaptation are often affected by cognitive impairments." C.) "Maybe it would be best to ask the teacher to explain the cognitive impairment of your child to the other children." D.) "Your child's impairment means it takes more time to learn to cope, so your child needs to attend a special needs class."

Answer: A.) "Your child needs time to adjust comfortably to school routines and build a trusting relationship with other children." Rationale: 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.

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.) Methylphenidate B.) Trazodone C.) Buspirone D.) Fluoxetine

Answer: A.) Methylphenidate

The school nurse is presenting a class on substance abuse to a group of school-age children. Which tactic would be least effective in persuading these children to not begin using illegal substances? A.) Tell the children that they can die if they use them. B.) Explain how drugs affect their bodies. C.) Openly discuss the good, as well as the bad, parts of substance abuse to give the child an honest picture. D.) Set clear rules and consequences for breaking the rules related to drug abuse.

Answer: A.) Tell the children that they can die if they use them. Rationale: Adults need to be honest when talking with school-age children about substance abuse, but they should not use "scare" techniques because these techniques make the child more curious and make substance abuse seem more thrilling and dangerous. Setting clear rules regarding substance abuse makes the child less likely to begin using them because they understand the consequences of use. Knowing how drugs affect their bodies also helps them understand that drug usage is bad.

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? A.) The child may have a fear of being separated from the parent. B.) The child may be a poor student and be afraid of failing grades. C.) The child may have a language barrier. D.) The child may be bored and feels more intellectually stimulated at home.

Answer: A.) The child may have a fear of being separated from the parent. Rationale: 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.

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

Answer: A.) angry outbursts directed at authority figures Rationale: 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.

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.) hypothermia and irregular pulse D.) bradycardia with ectopy and seizures

Answer: A.) cardiac arrhythmias, confusion, seizures Raitonale: The nurse should be aware that rapid nutritional replacement in the severely malnourished can lead to refeeding syndrome. Refeeding syndrome is characterized by cardiovascular, hematologic, and neurologic complications such as cardiac arrhythmias, confusion, and seizures. Orthostatic hypotension, hypertension, and irregular and decreased pulses are complications of anorexia but do not characterize refeeding syndrome.

A group of students are reviewing the role of neurotransmitters in the development of depression. The students demonstrate a need for additional study when they identify which neurotransmitter as being involved? A.) gamma-aminobutyric acid (GABA) B.) dopamine C.) norepinephrine D.) serotonin

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

The nurse is performing a physical assessment of 16-year-old girl who is intellectually disabled. This client attended her local public elementary school through fifth grade and has since been enrolled at a special education school where she has received social and vocational training. She plans on getting a job in the coming month and on living independently in a few years. The nurse recognizes this client's level of intellectual disability as: A.) mild. B.) moderate. C.) severe. D.) profound.

Answer: A.) mild. Rationale: Children with mild intellectual disability exhibit difficulties in acquisition of academic skills and are typically more concrete in their problem solving. Socially, they are observed as less mature, have a limited understanding of risk, and demonstrate poorer affect regulation than similarly aged peers. As adults, they can usually achieve adequate social and vocational skills for minimum self-support and independent living but need guidance and assistance with complex daily living tasks. During early years, these children learn social and communication skills and are often not too distinguishable from average infants or toddlers. They continue to learn academic skills up to about a sixth-grade level. As adults, they can usually achieve social and vocational skills adequate for minimum self-support. They're able to live independently but need guidance and assistance when faced with new situations or unusual stress.

A 15-year-old student has been referred by the homeroom teacher to the school nurse for evaluation. The teacher is concerned that the student may be suffering from major depression. Who should be the primary source of information to investigate the concerns about the student? A.) the student B.) the school nurse C.) the student's parents D.) the homeroom teacher

Answer: A.) the student

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? A.) "Does your child have siblings?" B.) "Does your child come and hug you or seek comfort from you?" C.) "Do you have trouble keeping child care providers for your child?" D.) "Does your child already attend therapies such as speech therapy?"

Answer: B.) "Does your child come and hug you or seek comfort from you?"

An advance practice pediatric nurse practitioner (APPNP) is conducting a mental status examination with a 6-year-old girl. Which question would be most appropriate? A.) "Isn't it fun to play with dolls?" B.) "Why does your pink doll hit all the other dolls?" C.) "What is the name of the president of the United States?" D.) "Do you like the doll with pink hair the best or the doll with green hair?"

Answer: B.) "Why does your pink doll hit all the other dolls?" Rationale: The nurse is trying to elicit the fantasies and feelings underlying the child's play. Asking an open-ended question is likely to reveal this information. A 6-year-old might know the name of the president but the meaning is ambiguous. The other questions would elicit "yes" or "no" answers.

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

Answer: B.) Adolescents who have a family history of alcoholism may be more prone to problems with alcohol.

The nurse is caring for a child with an eating disorder. Which is the priority treatment for the disorder? A.) Develop a behavior modification plan B.) Correct fluid and electrolyte imbalances C.) Supervise and document food intake D.) Monitor urine for presence of ketones

Answer: B.) Correct fluid and electrolyte imbalances

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? A.) Remind the adolescent about the consequences of misbehavior. B.) Stress to the client that he or she is in control of the outcome of the care. C.) Encourage the caregivers to take responsibility for the adolescent. D.) Reward the client after several days of successful behavior.

Answer: B.) Stress to the client that he or she is in control of the outcome of the care. Rationale: 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.

What 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 properly dress herself. C.) The child's vision is fine but she is a poor reader. D.) The child cannot correctly copy a sentence.

Answer: B.) The child cannot properly dress herself.

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

Answer: B.) home environment where there is drug or alcohol abuse

A mother is telling the school nurse about her concerns regarding her 13-year-old daughter, who reports headaches. The child's grades have dropped, and the child is sleeping late and going to bed early every night. Which would the nurse identify as the priority? A.) discussing the situation with the teacher B.) scheduling an immediate history and physical examination C.) asking the school psychologist to do psychometric testing D.) calling for an appointment with a psychologist

Answer: B.) scheduling an immediate history and physical examination RatitonalE: The first step is to conduct a physical examination to rule out or identify illnesses or physical problems that might cause depression. Once any physical causes have been ruled out, the health care team can determine the most appropriate approach to assess the client's symptoms.

A 14-year-old girl is brought to the emergency department saying she was sexually assaulted. She tells the nurse that she feels guilty for having gone to a party where alcohol was being served. What is the nurse's best response? A.) "It would be better not to go to parties with alcohol until you're older." B.) "I can understand how you must feel; that is awful to happen." C.) "No one deserves to be raped, even going to a party with alcohol." D.) "Alcohol is never good for teenagers; something always happens."

Answer: C.) "No one deserves to be raped, even going to a party with alcohol."

The nurse is discussing health concerns and issues with a group of caregivers of adolescents. Which statement made by a caregiver would indicate a need for follow-up by the nurse? A.) "My 16-year-old spends so much time with his girlfriend, it worries me." B.) "I don't know if I want my 15-year-old son to drive; I know that at that age teens sometimes don't use good judgement." C.) "Our daughter has never had any health problems, and now she has developed so many cavities." D.) "My daughter is already 15 and she hasn't ever had a menstrual period."

Answer: C.) "Our daughter has never had any health problems, and now she has developed so many cavities." Rationale: The clues to bulimia nervosa may be few but include dental caries and erosion from frequent exposure to stomach acid, throat irritation, and endocrine and electrolyte imbalances.

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? A.) Remind her of the importance of good hygiene for better appearance. B.) Explore the girl's feelings about changes in her body with the onset of puberty. C.) Engage the girl in dialogue regarding feelings about self/personal appearance. D.) Introduce the concept of accepting differences to reduce conflict.

Answer: C.) Engage the girl in dialogue regarding feelings about self/personal appearance.

The adolescent client has become bored with the video game system, which had been the positive reward for cleaning one's room. Which intervention would be most effective intervention at this time? A.) Tell the adolescent that he or she no longer has to clean the room in order to play. B.) Tell the adolescent that he or she has to use the video game anyway because it was expensive. C.) Let the adolescent choose another reward that would be more fun. D.) Reinforce to the adolescent that he or she selected the video game and needs to stick with it.

Answer: C.) Let the adolescent choose another reward that would be more fun.

A 5-year-old child has frequent visits to the school nurse's office. Which assessment data should alert the nurse that this child may be a victim of physical neglect? A.) isolated from classmates with poor self-esteem B.) evidence of bruising on multiple parts of the body C.) malnourished with frequent absences from school D.) inappropriate knowledge of sexual terms and actions

Answer: C.) malnourished with frequent absences from school

The nurse suspects sexual maltreatment in a 10-year-old girl. The nurse would assess which primary finding to help make this determination? A.) regular menses B.) Tanner stage 4 development C.) vaginal discharge D.) decreased skin turgor

Answer: C.) vaginal discharge

The father of a 14-year-old daughter reports she has been rebelling at home. The use of a contract for behaviors has been discussed. Which response from the father indicates the need for further discussion? A.) "The establishment of rules for our home should be held with my daughter as soon as possible." B.) "If my daughter becomes angry about established rules at home it is important I remain calm and consistent." C.) "When my daughter exceeds expectations for her behavior she should be praised." D.) "I can relax rules at home if she has had a bad day."

Answer: D.) "I can relax rules at home if she has had a bad day."

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? A.) "This drug will have an effect on our child in about 2 weeks." B.) "We'll bring our child in every week to get blood levels drawn." C.) "Our child knows to take this medication once every 12 hours." D.) "Our child may have some side effects, like insomnia, headache, or stomach ache."

Answer: D.) "Our child may have some side effects, like insomnia, headache, or stomach ache."

An adolescent male tells the nurse that he has been smoking cigarettes for the last 3 years. The nurse recognizes that this adolescent is at the greatest risk of substance abuse based upon what family history finding? A.) He is from a family of higher socioeconomic status. B.) He is the oldest child in the family. C.) He is a B to C student in school. D.) He has been previously diagnosed with depression.

Answer: D.) He has been previously diagnosed with depression.

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? A.) Risk for self-directed violence related to impulsivity B.) Situational low self-esteem related to lack of successful coping strategies C.) Impaired social interaction related to short attention span and distractibility D.) Interrupted family processes related to inability of child to follow instructions

Answer: D.) Interrupted family processes related to inability of child to follow instructions Rationale : 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.

To feed lunch to a child with autism spectrum disorder (ASD), which action would be most important for the nurse to take? A.) Allow the child to ask questions about the procedure. B.) Use an authoritarian manner to gain control. C.) Do not allow the child to see the spoon approach the mouth. D.) Use a repetitive series of movements.

Answer: D.) Use a repetitive series of movements.

The nurse is talking with the parents of a child who has been identified as having a learning disability. The parents state that their child performs well on oral examinations but otherwise struggles on exams. The nurse is aware that the parents are describing which disorder? A.) dyscalculia B.) dyspraxia C.) dysgraphia D.) dyslexia

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

The nurse is educating parents of a child recently diagnosed with autism spectrum disorder. A description of the characteristics of autism spectrun disorder are explained within categories. The nurse becomes concerned when the mother states that the categories of autism spectrum disorder are associated with: A.) inability to communicate with others. B.) inability to relate to others. C.) limited activities and interests. D.) inability to properly synthesize glucose.

Answer: D.) inability to properly synthesize glucose.

A nurse is providing an in-service program on child abuse (child mistreatment) 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 as an indicator of possible child abuse (child mistreatment)? 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

Answer: D.) sexual behavior that correlates with the child's developmental age

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.) "If she loses weight, then we know the medication is working." B.) "She will probably tell us that she is hungrier than usual." C.) "Tremors and nausea are common side effects." D.) "She may notice an increase in urination"

Answer; A.) "If she loses weight, then we know the medication is working."

Which behavior by a parent would lead the postpartum nurse to become concerned about the potential for abusive parenting? A.) The mother does not choose to hold or feed her infant. B.) The father is sleeping on the couch soon after birth. C.) The mother is weepy and is nervous about being a parent. D.) The parents have difficulty deciding on a name for their baby.

Answer; A.) The mother does not choose to hold or feed her infant.

A child is being referred to a mental health specialist, and the parent expresses worry about being a bad parent and failing the child. What is the nurse's best response? A.) "I know just how you feel; I would feel the same myself." B.) "This is the best thing for your child right now." C.) "There are so many stressors on children today that can't be prevented." D.) "Don't worry, everything will turn out better when your child gets mental health care."

Answer; C.) "There are so many stressors on children today that can't be prevented."

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

Answer; D.) Menstrual problems