NURS113 Exam 3:Development (CP)
At the admission interview, the father of a 4-year-old boy with attention deficit hyperactivity disorder (ADHD) says to the nurse, "I know that my wife or I must have caused this disease." What is the nurse's best response? a) "What do you think you might have done that could have led to causing this disorder to develop in your son?" b) "ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder." c) "Many parents feel this way, but I doubt there is anything that you did that caused ADHD to develop in your child." d) "Let us not focus on the cause but rather on what needs to be done to help your son get better. I know that you and your wife are very interested in helping him to improve his behavior."
"ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder." Explanation: Stating that attention deficit hyperactivity disorder occurs more commonly in families takes the opportunity for teaching while also helping the father realize that he and his wife are not to blame. Parents who are commonly blamed by society for their child's behavior need help with education. Questioning the father on what he thinks he may have done implies that the parents played some role in this disorder, possibly contributing to the father's guilt. Telling the father that many parents feel this way and that the nurse does not think the parents are at fault is premature at this point. Telling the father that he should focus on what needs to be done, rather than what caused the disorder, minimizes the father's concerns and feelings.
Parents of a 7-year-old child newly diagnosed with attention deficit hyperactivity disorder (ADHD) ask the nurse whether their son will always have to take medication for this condition. The nurse should tell the parents: a) "There is just a small percentage of adults with ADHD who can manage without medications." b) "Yes, almost everyone with this disorder has to continue taking medication forever." c) "Between one third and one half of children experiencing ADHD and taking medication will need to continue to take medication as adults." d) "Most children with this disorder do not need to continue taking medications as adults."
"Between one third and one half of children experiencing ADHD and taking medication will need to continue to take medication as adults." Explanation: Studies show that usually one-third to one-half of people diagnosed with ADHD do not need medication as adults.
During a developmental screening, the nurse finds that a 3-year-old child with cerebral palsy has arrested social and language development. The nurse tells the family:
"I need to refer you for more developmental testing." Explanation: It is important to identify primary developmental delays in children with cerebral palsy and to prevent secondary and tertiary delays. The arrested development is worrisome and requires further investigation. It is possible the lack of development indicates hearing loss or may be a sign of autism. The brain damage caused by cerebral palsy is not progressive. The brain of a young child is quite plastic; assuming the child's development has peaked at age 3 would be a serious mistake. The therapy plan will need to be modified, but a better understanding of the underlying problem will lead to the greatest chance of creating a successful therapy plan.
The parent asks the nurse whether a child with hemiparesis due to spastic cerebral palsy will be able to walk normally because he can pull himself to a standing position. Which response by the nurse would be most appropriate? a) "Ask the health care provider what he thinks at your next appointment." b) "If he really wants to walk, and works hard, he probably will eventually." c) "It is difficult to predict, but his ability to bear weight is a positive factor." d) "Being able to pull to a stand really only tells us his upper-body strength is good."
"It is difficult to predict, but his ability to bear weight is a positive factor." Correct Explanation: The nurse needs to respond honestly to the mother. Most children with hemiparesis due to spastic cerebral palsy are able to walk because the motor deficit is usually greater in the upper extremity. There is no need to refer the mother to the HCP. Pulling to a stand requires both upper body and lower body strength. The will to walk is important, but without neurologic stability the child may be unable to do so.
A mother brings her child into the clinic for follow up after beginning treatment for Attention Deficit Hyperactivity Disorder (ADHD). One of the outcomes was for the child to complete homework within a one hour time interval. The mother reports that it still takes 1 1/2 hours but that is dramatically reduced from the 3 hours or more before beginning treatment. What is the best response for the nurse to make to the child? a) "You have done a great job by focusing on your homework and doing it in much less time. Do you think by your next visit that you can get it down to an hour?" b) "You will have to do better next time" c) "That's okay. I will just change the plan of care" d) "Mom, can you sit with him to make sure he meets the outcome?"
"You have done a great job by focusing on your homework and doing it in much less time. Do you think by your next visit that you can get it down to an hour?" Correct Explanation: "You have done a great job by focusing on your homework and doing it in much less time. Do you think by your next visit that you can get it down to an hour?" is a response that acknowledges that the client has not met the set outcomes but encouragement that they have made great improvement. The other responses could discourage the child towards meeting the outcome.
The parent of a child with spastic cerebral palsy and a communication disorder tells the nurse, "He seems so restless. I think he is in pain." Which action is most indicated? a) Assess the child for pain using the Faces, Legs, Activity, Cry, Consolability (FLACC) scale. b) Assess the child using the pediatric FACES scale. c) Administer prescribed pain medication. d) Notify the health care provider (HCP) of the change in behavior.
Administer prescribed pain medication. Explanation: The parent is the child's HCP and may be very in tune to subtle changes in the child's behavior. If the parent thinks the child is in pain, it is very likely to be so. The nurse should administer the pain medication and evaluate if the medication affected the child's behavior. The FLACC scale may be difficult to interpret when the child has spasticity. The FACES scale requires self-report which may not be possible in a child with a communication disorder. The HCP should be contacted regarding the change in behavior only if other available interventions are unsuccessful.
Spina bifida, cerebral palsy, Down syndrome, and muscular dystrophy are all examples of which type of disability? a) Acquired b) Developmental c) Acute nontraumatic disorder d) Age-related
Developmental Correct Explanation: Examples of developmental disabilities are spina bifida, cerebral palsy, and Down syndrome. An example of an acquired disability is a traumatic brain injury. An age-related disability is hearing loss or osteoporosis. An acute nontraumatic disorder is a stroke.
A parent of a 7-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) since he was 5 years old is talking to the nurse about her concerns about the son's physical condition. The parent states that his medication, methylphenidate extended release, controls his symptoms well but is causing him to lose weight. It is difficult to get him up and ready for school in the morning unless he is given the medication as soon as he awakens. He does not eat breakfast or very much of his lunch at school; he eats dinner, but only an average amount of food. He has lost 3 lb (1.4 kg) in the last 2 weeks. Which action should the nurse suggest the parent do first? a) Monitor the child's weight closely for 1 month since he is likely to stop losing weight when the school year ends in 2 weeks. b) Have the child eat a breakfast bar, banana, and a glass of milk at the same time he takes medication every morning. c) Suggest a change of medication to a nonstimulant drug that will treat ADHD without causing the appetite decrease. d) Suggest that the parent supplement the child's dinner with a high-protein drink or other food that will increase his caloric intake.
Have the child eat a breakfast bar, banana, and a glass of milk at the same time he takes medication every morning. Correct Explanation: Because weight loss is a common side effect of methylphenidate and because the child's symptoms are controlled with the stimulant, the first action should be to increase the child's oral intake before the medication's side effects begin. Weight should be monitored, but since the child has already lost weight, a remedy is needed as well as monitoring. The weight loss is directly due to the medication's side effects, so the child will continue to lose weight unless an intervention is made whether or not he is enrolled in school or on summer vacation. A high-protein drink could work, but then the child is taking in all his calories in the evening, which is not best nutritionally. A change of medication should be the last resort since methylphenidate is the most effective medication for ADHD and has been successful with this child.
The nurse is assessing the muscle tone of a patient with cerebral palsy. Which of the following descriptions does the nurse determine to be an expected assessment of this patient's muscle tone? a) Flaccid b) Atrophied c) Atonic d) Hypertonic
Hypertonic Correct Explanation: In patients with conditions characterized by upper motor neuron destruction, such as in cerebral palsy, the muscles are often hypertonic. However, in conditions with lower motor neuron destruction, the muscles become atonic and/or atrophied and/or flaccid.
An 8-year-old child with severe cerebral palsy is underweight and undersized for his age. He is being fed a diet of pureed foods and liquids through a syringe. The nurse determine's his biggest nutritional risk factor is: a) Increased metabolism. b) Impaired oral motor control. c) Inability to metabolize fats. d) Increased intracranial pressure.
Impaired oral motor control. Correct Explanation: A child with severe cerebral palsy commonly has a lack of oral motor control that interferes with tongue control, chewing, and swallowing. This is the reason that this child is being fed pureed foods and fluids. Lack of tongue control commonly causes the child to push the food back out of the mouth while trying to chew and swallow. A child with cerebral palsy has a nonprogressive central nervous system insult. Cerebral palsy does not affect the child's metabolism. This child should be able to absorb and metabolize ingested nutrients. Cerebral palsy does not affect the child's metabolism of fats. Ongoing increased intracranial pressure is not related to cerebral palsy.
Which of the following describes the movements of a child with spastic cerebral palsy? a) Slow, wormlike writhing movements. b) Wide-based gait and poor muscle coordination. c) Increased muscle tone and stretch reflexes. d) Tremors and lack of active movement.
Increased muscle tone and stretch reflexes. Correct Explanation: Spastic cerebral palsy, the most common clinical type, represents an upper motor neuron muscular impairment resulting in increased muscle tone and stretch reflexes, persistent reflexes, and a lack or delay of postural control. Slow, wormlike writhing movements are characteristic of the dyskinetic or athetoid type of cerebral palsy. The ataxic type of cerebral palsy is the least common type. Children have a wide-based gait and perform rapid, repetitive movements poorly. With the common athetoid type, children have tremors and a lack of active movement.
A client with quadriplegia is experiencing severe muscle spasms. To relieve them, a physician orders baclofen, 5 mg P.O. three times daily. What is the principal indication for baclofen? a) Skeletal muscle hyperactivity secondary to cerebral palsy b) Spasticity related to stroke c) Acute, painful musculoskeletal conditions d) Muscle spasms with paraplegia or quadriplegia from spinal cord lesions
Muscle spasms with paraplegia or quadriplegia from spinal cord lesions Explanation: Baclofen's principal clinical indication is for the paraplegic or quadriplegic client with spinal cord lesions, most commonly caused by multiple sclerosis or trauma. For these clients, baclofen significantly reduces the number and severity of painful flexor spasms. Baclofen isn't indicated for acute, painful musculoskeletal conditions; skeletal muscle hyperactivity secondary to cerebral palsy; or spasticity related to stroke.
A nurse is caring for a school-age child with cerebral palsy. The child has difficulty eating using regular utensils and requires a lot of assistance. Which referral is most appropriate? a) Physical therapist b) Nursing assistant c) Registered dietitian d) Occupational therapist
Occupational therapist Correct Explanation: An occupational therapist helps physically disabled clients adapt to physical limitations and is most qualified to help a child with cerebral palsy eat and perform other activities of daily living. A registered dietitian manages and plans for the nutritional needs of children with cerebral palsy but isn't trained in modifying or fitting utensils with assistive devices. A physical therapist is trained to help a child with cerebral palsy gain function and prevent further disability but not to assist the child in performing activities of daily living. A nursing assistant can help a child eat; however, the nursing assistant isn't trained in modifying utensils.
An elementary school nurse is conducting a program for parents on attention deficit hyperactivity disorder (ADHD). Which of the following is the most important information for the nurse to include in the program? a) Sleep disturbances are common for children with ADHD. b) Diagnosis usually occurs before the child reaches school age. c) The child will have fatigue from the increased activity level. d) Girls with ADHD show more aggression than boys with ADHD.
Sleep disturbances are common for children with ADHD. Correct Explanation: Sleep disturbances are common for children with ADHD. The diagnosis is commonly made after the child starts attending school and is unable to display attentive behavior in class.
Which child should the nurse assess as demonstrating behaviors that need further evaluation? a) Joey, age 2, who refuses to be toilet-trained and talks to himself b) Adrienne, age 6, who sucks her thumb when tired and has never spent the night with a friend c) Stephen, age 2, who is indifferent to other children and adults and is mute d) Curt, age 10, who frequently tells his mother that he is going to run away whenever they argue
Stephen, age 2, who is indifferent to other children and adults and is mute Indifference to other people and mutism may be indicators of autism and would require further investigation. A 2-year-old who talks to himself and refuses to cooperate with toilet training is displaying behaviors typical for this age. Occasional thumb sucking and not having spent the night with a friend would be normal at age 6. Threatening to run away when angry is considered within the range of normal behaviors for a 10-year-old child.
A nurse teaches a mother how to provide adequate nutrition for her toddler, who has cerebral palsy. Which observation indicates that teaching has been effective? a) The child lies down to rest after eating. b) The toddler stays neat while eating. c) The toddler finishes the meal within a specified period of time. d) The child eats finger foods by himself.
The child eats finger foods by himself. Correct Explanation: The child eating finger foods by himself indicates effective teaching because a child with cerebral palsy should be encouraged to be as independent as possible. Finger foods allow the toddler to feed himself. Because spasticity affects coordinated chewing and swallowing as well as the ability to bring food to the mouth, it's difficult for the child with cerebral palsy to eat neatly. In terms of a specified period of time, the child with cerebral palsy may require more time to bring food to the mouth; thus, chewing and swallowing shouldn't be rushed. A child shouldn't lie down to rest after eating because doing so may cause the child to vomit from a hyperactive gag reflex. Therefore, the child should remain in an upright position after eating to prevent aspiration and choking.
When assessing a toddler diagnosed with spastic cerebral palsy, which sign should the nurse expect to find? a) Facial grimacing. b) Wide-based gait. c) Toe-walking. d) Drooling.
Toe-walking. Correct Explanation: Spasticity can cause the toddler to stand or walk on his toes due to an upper motor neuron type of muscular weakness resulting in increased muscle tone. Drooling is associated with dyskinetic or athetoid cerebral palsy due to poor tongue and swallowing movements. Facial grimacing is found with dyskinetic or athetoid cerebral palsy due to involuntary movements of the facial muscles. A wide-based gait is typical of children with ataxic cerebral palsy.
Question: The parents of a preschool child diagnosed with autism must take their child on a plane flight and are concerned about how they can make the experience less stressful for her and their fellow travelers. The nurse suggests a dry run to the airport in which they simulate going through security and boarding a plane. In addition, the nurse suggests taking items to help the child be calm during the flight. In what order of priority from first to last should the parents employ the items listed below? All options must be used. 1 a favorite stuffed animal or other soft toy 2a favorite non-electronic game 3a DVD player with headphones and favorite games, cartoons, and child films 4 medication that can be given as needed to calm the child
a DVD player with headphones and favorite games, cartoons, and child films a favorite non-electronic game a favorite stuffed animal or other soft toy medication that can be given as needed to calm the child Explanation: Electronic games and stories are favorites of most children, but are particularly enjoyed by children on the autism spectrum. The headphones block out some of the noises that might be upsetting to a child on the autism spectrum. If the child cannot be engaged electronically, a favorite non-electronic toy would be the next choice. Stuffed animals or other soft toys can soothe a child who is starting to become upset. Medication should be a last resort as it can have a paradoxical effect if it is an antianxiety medication or may cause too much sedation during the flight.
A child with spastic cerebral palsy receiving intrathecal baclofen therapy is admitted to the pediatric floor with vomiting and dehydration. The family tells the nurse that they were scheduled to refill the baclofen pump today, but had to cancel the appointment when the child became ill. The nurse should: a) arrange for the pump to be refilled in the hospital. b) explain that the medication should be discontinued during illness. c) instruct caregivers to call for a refill when the low-volume alarm sounds. d) reschedule the pump refill for the day of discharge.
arrange for the pump to be refilled in the hospital. Correct Explanation: To prevent a baclofen withdraw, pump refills are scheduled several days before anticipated low-volume alarms. The nurse should make it a high priority to have the pump refilled as soon as possible. Discontinuing baclofen suddenly can result in a high fever, muscle rigidity, change in level of consciousness, and even death. Waiting until the child leaves the hospital for a refill may lead to a low dose or withdraw. Waiting for the low-volume alarm puts the client at risk because medication and team members who can refill the pump may not be readily available under all circumstances.
The health care provider (HCP) prescribes carbamazapine extended release for a client with a cerebral palsy who also has a seizure disorder. The client has a gastrostomy feeding tube, and carbamazapine is on the hospital's "no crush" list. In order to administer the medication, the nurse should: a) ask the pharmacist for an oral suspension. b) cut the medication into four pieces that can be placed in the feeding tube. c) contact the health care provider (HCP) to change the prescription. d) dissolve the medication in 30 mL of juice.
contact the health care provider (HCP) to change the prescription. Correct Explanation: The coating on an extended-release medication helps assure slow absorption of the medication. If the nurse crushes the medication, the medication may enter the client's system too quickly and result in toxic levels. The only appropriate action is to contact the prescriber and ask that the prescription be changed. Cutting the medication or trying to dissolve a whole tablet would have similar results as crushing it. Carbamazepine comes as an oral suspension, but it is not extended release. Therefore, a prescription would be needed to address dosing if switching to this form.
A nurse is explaining ADHD to a community parents' group. What characteristics of this disorder are exhibited by an affected child? a) inattention, impulsiveness, hyperactivity b) separation anxiety, reading difficulties, boredom c) enuresis, shyness, scoliosis d) daydreams, math difficulties, speech problems
inattention, impulsiveness, hyperactivity Correct Explanation: ADHD is a developmentally inappropriate degree of inattention, impulsiveness, and hyperactivity. To be diagnosed, the child must have manifested symptoms before the age of 7 years, and the symptoms must be present in at least two settings.
The nurse assesses the family's ability to cope with the child's cerebral palsy. Which action should alert the nurse to the possibility of their inability to cope with the disease? a) requesting teaching about cerebral palsy in general b) learning measures to meet the child's physical needs c) seeking advice on coping on social media d) limiting interaction with extended family and friends
limiting interaction with extended family and friends Correct Explanation: Limited interaction or lack of interaction with friends and family may lead the nurse to suspect a possible problem with the family's ability to cope with others' reactions and responses to a child with cerebral palsy. Learning measures to meet the child's physical needs demonstrates some understanding and acceptance of the disease. Requesting teaching about the disease suggests curiosity or a desire for understanding, thus demonstrating that the family is dealing with the situation. Participating in social media may serve as a form of support and can be a healthy coping mechanism.
The nurse judges that the mother understands the term cerebral palsy when she describes it as a term applied to impaired movement resulting from which factor? a) inflammatory brain disease caused by metabolic imbalances b) nonprogressive brain damage caused by injury c) malformed blood vessels in the ventricles caused by inheritance d) injury to the cerebrum caused by viral infection
nonprogressive brain damage caused by injury The term cerebral palsy (CP) refers to a group of nonprogressive disorders of upper motor neuron impairment that result in motor dysfunction due to injury. In addition, a child may have speech or ocular difficulties, seizures, hyperactivity, or cognitive impairment. The condition of congenital malformed blood vessels in the ventricles is known as arteriovenous malformations. Viral infection and metabolic imbalances do not cause CP.
When collaborating with the health care provider (HCP) to develop a the plan of care for a child diagnosed with attention deficit hyperactivity disorder (ADHD), the treatment plan will likely include which treatments? a) antianxiety medications, such as buspirone, and home schooling b) antidepressant medications, such as imipramine, and family therapy c) psychostimulant medications, such as methylphenidate, and behavior modification d) anticonvulsant medications, such as carbamazepine, and monthly blood levels
psychostimulant medications, such as methylphenidate, and behavior modification Correct Explanation: ADHD is typically managed by psychostimulant medications, such as methylphenidate and pemoline, along with behavior modification. Antianxiety medications, such as buspirone, are not appropriate for treating ADHD. Homeschooling commonly is not a possibility because both parents work outside the home. Antidepressants, such as imipramine, are indicated for major depressive disorders and must be used with extreme caution in children because they carry the risk of suicidal thinking. Family therapy may be a part of the treatment. Anticonvulsant medications, such as carbamazepine, are not appropriate for ADHD. Also, carbamazepine levels are obtained weekly early during therapy to avoid toxicity and ascertain therapeutic levels.
When assessing the development of a 15-month-old child with cerebral palsy, whichmilestone should the nurse expect a toddler of this age to have achieved? a) copying a circle b) using a spoon c) putting a block in cup d) walking up steps
putting a block in cup Explanation: Delay in achieving developmental milestones is a characteristic of children with cerebral palsy. Ninety percent of typically developing 15-month-old children can put a block in a cup. Walking up steps typically is accomplished at 18 to 24 months. A child usually is able to use a spoon at 18 months. The ability to copy a circle is achieved at approximately 3 to 4 years of age.
A physician orders chlorzoxazone, 500 mg P.O. t.i.d for a client. The nurse knows that chlorzoxazone, a centrally acting skeletal muscle relaxant, is commonly used to treat: a) muscle spasm caused by cerebral palsy. b) severe muscle spasm. c) chronic musculoskeletal disorder. d) lower extremity spasticity.
severe muscle spasm. Explanation: Chlorzoxazone is used to treat acute, painful musculoskeletal conditions or severe muscle spasm. Centrally acting skeletal muscle relaxants such as chlorzoxazone are ineffective in treating spasticity associated with chronic neurologic disease, such as cerebral palsy, and they treat acute musculoskeletal disorders, not chronic ones. Chlorzoxazone and the other relaxants are used to treat spasticity of any extremity, not just lower extremity spasiticity.
A 10-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) has been switched from a stimulant to atomoxetine 40 mg two times a day. The nurse is instructing the client and her mother about the change in medication. Which statement indicates that the client's mother needs further education about the medication? Select all that apply. a) "She may have nausea or dizziness for 1 or 2 months." b) "If she has mood swings, I should call her psychiatrist." c) "If her ADHD symptoms don't improve in 2 to 3 weeks, I should stop the Strattera." d) "She can't take monoamine oxidase inhibitors while on Strattera." e) "I'll have to make sure she's gaining weight appropriately." f) "I have to give her both doses before lunch."
• "I have to give her both doses before lunch." • "If her ADHD symptoms don't improve in 2 to 3 weeks, I should stop the Strattera." Explanation: Atomoxetine is a selective norepinephrine reuptake inhibitor antidepressant, not a stimulant. Therefore, a two-times-a-day dosing schedule is appropriate, with a dose given in the morning and late afternoon. It may take more than 2 to 3 weeks to see the full effects of this medication. Nausea and dizziness are transient side effects. Monoamine oxidase inhibitors are contraindicated with atomoxetine.
Which of the following behaviors demonstrated by a 6-year-old child would help the school nurse assess characteristics of attention deficit hyperactivity disorder (ADHD)? a) Is easily distracted in class b) Reverses letters and words c) Gets into fights in cafeteria d) Has speech impediments e) Does not sit still in class
• Gets into fights in cafeteria • Is easily distracted in class • Does not sit still in class Explanation: Characteristics of ADHD are impulsive behaviors, inattention, and hyperactivity, including getting into fights, being easily distracted, and not sitting still. Reversing letters and words and speech impediments are learning disabilities.
A 3-year-old is seen in the well child clinic. The mother is concerned that the child may be autistic. Which of the following assessment data would indicate a concern to the nurse? Select all that apply. a) Inability to separate from mother b) Lack of communication abilities c) Inability to stay on task d) Withdrawing into a private world e) Inability to develop social skills
• Lack of communication abilities • Withdrawing into a private world • Inability to develop social skills Correct Explanation: Children with autism spectrum disorder (ASD) fail to develop interpersonal skills. The child with ASD withdraws into a private world and is not able to develop social skills and communication abilities. Inability to separate is a behavior found in children with separation anxiety. Inattention is associated with children who are diagnosed with Attention Deficit Disorder (ADD).
A nurse is taking a medication history on a client with multiple sclerosis before administering an initial dose of baclofen. What should the nurse check before administering the drug? Select all that apply. a) Serum potassium level. b) Blood glucose level. c) History of muscle spasms. d) Presence of muscle weakness. e) Serum creatinine level.
• Presence of muscle weakness. • History of muscle spasms. • Serum creatinine level. • Blood glucose level. Explanation: The nurse should ask the client with multiple sclerosis about areas of muscle weakness because baclofen may increase the weakness. The nurse should ask the client about a history of muscle spasms. Baclofen is effective against involuntary spasms resistant to passive movement for clients with multiple sclerosis and paralysis. Baclofen is not effective against the spasticity of cerebral origin, such as with cerebral palsy and Parkinson's disease. The nurse should ask the client about his liver and renal function because baclofen is metabolized and excreted by these organs. The nurse should check the laboratory values reflecting the function of the kidneys and liver, which include serum creatinine and blood urea nitrogen levels. The nurse should also check blood glucose levels because baclofen can increase blood glucose. Clients with diabetes taking antidiabetic medication may need to adjust the dosage. Potassium is not affected by the drug, so the nurse does not need to check the serum potassium level.
In a children's unit team meeting, the staff is working on protocols for dealing with clients with autism spectrum disorder (ASD). Which of the following protocols would be most important? Select all that apply. a) Protections from harm to self and others. b) Reinforcements for appropriate interactions with peers and staff. c) Preparation for any changes in unit routines. d) Types of verbalizations expected. e) Limitations on toys allowed.
• Protections from harm to self and others. • Reinforcements for appropriate interactions with peers and staff. • Preparation for any changes in unit routines. Correct Explanation: Children with ASD may have behaviors, such as head banging or pinching, that harm themselves or others. They have a strong need for sameness and need to be prepared for changes. Any client efforts to interact appropriately need to be reinforced because social behaviors are typically limited. What toys these clients have is not as important as what they do with them, such as throwing them at others. Depending on the severity of the ASD, the clients' verbalizations vary significantly, so a protocol for this is not possible
A child with spastic cerebral palsy is to begin botulinum toxin type A injections. Which treatment goals should the health care team set for the child related to botulinum toxin? Select all that apply. a) enhanced self-esteem b) decreased pain from spasticity c) improved motor function d) reduced caregiver strain and improved self-care e) decreased speech impediments f) improved nutritional status
• decreased pain from spasticity • improved motor function • enhanced self-esteem • reduced caregiver strain and improved self-care Explanation: Botulinum toxin injections can be used to improve many aspects of quality of life for the child with cerebral palsy. The injections can help decrease pain from spasticity. Injections improve motor status by reducing rigidity and allowing for more effective physical therapy to improve range of motion. Decreased spasms enhance self-esteem. Improved motor status facilitates the ability to provide some aspects of care, especially transfers. Botulinum does not significantly affect nutritional status or speech.