411 Child development

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?

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

A nurse is observing a group of 4-year-old children in a play area. What action, when observed by the nurse, would alert the nurse to typical play for this age group?

A child pretends to be a teacher and asked another child to be the pretend student in "class."

A child with attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate hydrochloride. What should the nurse instruct the parents regarding an adverse effect of this medication?

Anorexia

The nurse is caring for a child with an eating disorder. Which is the priority treatment for the disorder?

Correct fluid and electrolyte imbalances

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?

Individual psychotherapy sessions

A nurse is assessing a little boy who has been diagnosed with Tourette syndrome. Which finding would the nurse expect to see?

Speaks sudden, fast phrases out of context

What is an example of impaired adaptive functioning in an 8-year-old girl with a developmental disorder?

The child cannot properly dress herself.

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 constantly pats his or her legs.

A nurse is developing a teaching plan for parents of preschoolers about how to address the issue of strangers and safety. Which would the nurse expect to include in the teaching? Select all that apply.

Urge children never to talk to or accept a ride from a stranger. Encourage children to tell you or another trusted adult if someone asks them to keep a secret about anything uncomfortable. Urge your children to report others who are bullying. Teach your children to say "no" to anyone whose touching makes them feel uncomfortable.

During adolescence, alcohol is connected to what problem frequently seen in this age group?

automobile accidents

A nurse observes a 3-year-old child playing with an older sibling. In which type of play would the nurse expect to see the siblings engaged?

imitative play

The nurse is examining a child with fetal alcohol spectrum disorder. Which assessment finding should the nurse expect?

low nasal bridge with short upturned nose

An 11-year-old client has come to the school nurse more than 15 times reporting somatic symptoms during the first quarter of the school year. The client has subsequently left school after each visit. Which action by the school nurse would be most appropriate?

Contact the child's parents to discuss the situation.

When assessing the growth and development of a 4-year-old, which would the nurse note as being appropriate?

tells a fantasy story about a bear and a car

Place the steps for using time-out as a disciplinary measure for a 4-year-old in proper order.

Parent knows the misbehavior was intentional. Warn the child there will be a time-out if the behavior does not stop. Move the preschool-age child to a boring spot. Set a timer for no more than 4 minutes. If the child gets up, return the child to the time-out location and restart the time.

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?

Provide clear instructions on what the nurse is going to do.

The nurse is speaking to a parent of a child diagnosed with an autism spectrum disorder. The parent states, "There are medications out there for everything. I cannot believe there is not a medication to help cure my child." What is the best response by the nurse?

"I know you must be frustrated about trying to get the best help for your child. Although there is not a medication to help treat autism spectrum disorders, with various therapies your child can function to the best of one's abilities."

The nurse is observing 4-year-old twins during their well-child appointment. Which observation by the nurse would indicate the children are demonstrating cooperative play?

They are building a house for their dolls with blocks in the room.

If the child is gaining weight at an expected rate, a child who weighs 36 lb (16.3 kg) at 3 years of age would weigh what amount at age 5?

44 to 46 lb (20 to 21 kg)

Which statement accurately reflects the effects of biologic influences on the development of mental illness in children?

An infant with a difficult temperament is thought to be at risk for later maladjustment.

A group of nursing students are completing a clinical day at a preschool. Which behaviors would they identify as common in this preschool group? Select all that apply.

Regression Telling of tall tales Imaginary friends Sibling rivalry Difficulty with sharing

To feed lunch to a child with autism spectrum disorder (ASD), which action would be most important for the nurse to take?

Use a repetitive series of movements.

When collecting data on a preschool-aged child during a well-child visit, the nurse discovers the child has gained 12 lb (5.4 kg) and grown 2.5 inches (6.3 cm) in the last year. The nurse interprets these findings to indicate which situation?

Weight is above an expected range and height is within an expected range.

A nurse is working at a facility that provides care to children with developmental disabilities. Which role would be the nurse's most important?

advocate

An extremely thin preadolescent is being assessed by the nurse. Which client statement will cause the nurse to suspect the client is experiencing anorexia nervosa?

"I feel chubby no matter what I wear.

The parents of a 4-year-old girl tell the nurse that their daughter is having frequent nightmares. Which statement indicates that the girl is having night terrors instead of nightmares?

"She screams and thrashes when we try to touch her."

The nurse has completed an education program on normal communication abilities in the preschool-age child. Which statement by a participant indicates a need for further education?

"Stating his name and address is too hard for my 5-year-old child; it will be another year before he can do that." The preschool-age child is known for asking lots of questions, and this is normal. At this age, 75% of the child's speech is understood by others outside of the family. The preschool-age child can easily count to 10, and the parents stating they were slowly working on counting higher is acceptable, as long as the parents do not push the child. A child at 5 years of age should be able to state one's name and address.

A 3½-year-old shouts, "Look out for Boo-ga-loo!" as the nurse enters the exam room. The father explains Boo-ga-loo is his daughter's imaginary friend. How should the nurse respond?

"Tell me about Boo-ga-loo."

A nurse is caring for a 10-year-old intellectually challenged girl hospitalized for a scheduled cholecystectomy. The girl expresses fear related to her hospitalization and unfamiliar surroundings. How should the nurse respond?

"Tell me about a typical day at home."

While interviewing a depressed adolescent, it is revealed that the client has considered hurting oneself. What question is the nurse's priority?

"Tell me exactly how you would hurt yourself."

During an admission assessment the nurse is discussing the developmental level of the child with the parents. Which comments by the parents demonstrate a good understanding of developmental expectations of the preschool-aged child? Select all that apply.

"We think it is important to have play dates with our friend's preschool children." "Our child attends a wonderful preschool 3 times per week." "We have been talking about enrolling in a morning preschool program since this is our only child."

The nurse is speaking with the parent of a 4-year-old child. Which statement by the parent would suggest a need for further investigation?

"When we go to the park, my child never wants to play with the other children."

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. 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.

The mother of a 4-year-old child reports she has been trying in vain to teach her son to tie his shoelaces. She states she fears he may be "slow". Which action by the nurse is most appropriate?

Explain to the parent her child likely does not have the needed motor skills to achieve this task at his current age.

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?

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?

Interrupted family processes related to inability of child to follow instructions

When teaching parents of a child with encopresis, what would the nurse stress?

Not punishing the child for encopresis

The nurse is providing teaching about good nondairy sources of calcium for preschoolers. Which of these fruits contains the most calcium?

Orange

A child is brought to the emergency department for evaluation. The caregiver states, "The child was running and tripped over the scooter on the sidewalk and landed on the left arm." The nurse assesses and records the findings (above). The nurse suspects child abuse (child mistreatment) and notifies the proper authorities. Which finding(s) will the nurse use to support this suspicion? Select all that apply.

spiral fracture bruises on the thighs bruise on the upper back

A nurse is caring for a 4-year-old child. The parents indicate that their child often reports that objects in the house are his friends. The parents are concerned because the child says that the grandfather clock in the hallway smiles and sings to him. Which response by the nurse is best?

"Attributing lifelike qualities to inanimate objects is quite normal at this age." The nurse should explain to the parents that attributing lifelike qualities to inanimate objects is quite normal for a 4-year-old child. Telling the parents that the child is demonstrating animism is correct information, but it would be better for the nurse to explain what animism is and then remind the parents that it is developmentally appropriate for their child. Asking whether the parents think the child had a recent trauma or whether there is a family history of mental disorders is inappropriate and does not teach.

The father of a preschool boy reports concerns about the short stature of his son. The nurse reviews the child's history and notes the child is 4 years old and is presently 41 in (104 cm) tall and has grown 2.5 in (6.35 cm) in the past year. Which response by the nurse is most appropriate?

"Both your son's height and rate of growth are within normal limits for his age."

The caregiver of a 6-year-old expresses concern that the child cannot yet print her first and last name. The caregiver is wondering if this is normal. Which response by the nurse would be most appropriate?

"By the age of 6, most children can print some letters and maybe their first name."

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 come and hug you or seek comfort from you?"

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 interact with you when playing?"

The nurse has completed an educational program on normal growth and development in children. Which statement by a participant would indicate a need for further education?

"I am so glad I can get rid of all of those bath toys because they take up so much room."

The nurse is caring for a family with a preschool-aged child. Which statement(s), when made by the parent, would alert the nurse to provide further teaching to the parents about the risk for obesity for their child? Select all that apply.

"I have been overweight since I was an adolescent, so I will be sure to watch for obesity as my child reaches adolescence." "I like to reward my child with a fresh sliced apple or orange if my child completes the chores each day." "I limit the amount of fruit juice my child drinks to 2 cups per day." "I make sure the servings I serve my child are 3/4 the amount I serve myself." "We are so glad our child loves to drink milk...we go through a lot of milk each day."

A nurse taking a health history from an adolescent female would become concerned about anorexia if the adolescent made which statement?

"I've been really tired lately, but I'm afraid that if I rest I will get fatter than I am already."

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?

"Individuals with bulimia have a normal weight or are slightly overweight."

During an extended stay in a hospital the nurse has observed a 5-year-old having several temper tantrums. How should the nurse address this behavior with the parents?

"Is it common for your child to throw temper tantrums at home? We have observed this behavior several times here."

A father tells the nurse that his son has been asking questions about his genitals. The father states that he is unsure how to answer the questions of a 4-year-old. How should the nurse respond?

"It's best to answer his questions using accurate anatomical names and keep your answers simple."

A 10-year-old girl with 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. What should the nurse say?

"Let's set up an appointment as soon as possible."

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 set up an appointment for you to come in as soon as possible.

A 15-year-old adolescent has been evaluated and diagnosed with major depression. The health care provider has prescribed paroxetine, a selective serotonin reuptake inhibitor. The parent refuses to let the adolescent take the medicine because the parent has read about several suicides of adolescents who have been on this medicine. What nursing response is best?

"Let's sit down and talk about your concerns."

The nurse is observing several children interacting during a community health event. Which observed behavior would be indicative of a 4-year-old child?

"Look! I am a nurse, and I am helping people feel better!"

The nurse is providing an in-service for parents of preschoolers regarding nutrition. Which comments by the parents demonstrate successful learning following the in-service? Select all that apply.

"My 4-year-old should be ingesting at least 700 mg of calcium through food daily to promote good bone health." "I generally give my child choices about foods within each food category, ensuring all food groups are represented." "We very rarely feed our child fast food and when we do we try to keep it as healthy as possible with no soda."

The nurse is discussing nutritional issues and concerns with the caregivers of preschoolers. Which statement made by a caregiver best indicates a common aspect of the diet and nutrition of the preschool child?

"My child is so picky and eats the same thing every day for days on end!"

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?

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

The nurse is working with a group of caregivers of school-aged children diagnosed with attention deficit hyperactivity disorder (ADHD). Which statement would be most appropriate for the nurse to make to this group of caregivers?

"The medications your child is on may cause a decreased appetite."

Statistics indicate that adolescents' use of heroin has increased over the last few years, although the numbers remain low. Which statement by a parent of an adolescent indicates that they understand presented education on why adolescents are at a higher risk than in years past?

"There is a decreased perception of danger from drug use by adolescents."

The parent of a 4-year-old child tells the nurse about being frustrated because all the parent seems to do lately is fight with the child over what the child wants to eat and wear. The parent notes sometimes wanting to spank the child for always disagreeing. What would be the best suggestion for the nurse to make to this parent?

"Use the time-out technique for discipline."

The mother and father of a 5-year-old boy are discussing bicycle safety with the nurse. What comment indicates further teaching is needed?

"We just got him a new bike he can grow into."

The mother of a 3-year-old tells the nurse that she is concerned that her child is not developing motor skills quickly enough. She states that, "My son can't skip and cannot stand on one foot for any length of time while playing." How should the nurse respond?

"Your child is not expected to be able to perform those activities at 3 years of age."

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?

"Your child needs time to adjust comfortably to school routines and build a trusting relationship with other children."

A nurse is providing care to an adolescent being treated for anorexia as an outpatient. The nurse is evaluating the adolescent's weight gain over the past week. The nurse determines that the adolescent is achieving the expected outcome when the adolescent shows a gain of how much for the week?

0.5 to 1 lb (0.27 to 0.45 kg)

The nurse is conducting a well-child examination of a 4-year-old and is assessing the child's height. By how much should the nurse expect the child's height to have increased since last year's examination?

2.5 to 3 inches (6.35 to 7.62 cm)

A nurse is preparing a presentation for a health fair discussing various aspects of preschoolers. Which example should the nurse use to best illustrate dramatic play?

Acting out a troubling or stressful situation

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?

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

The nurse is assessing a 3-year-old at a well-child visit and the child appears to be progressing well. Which activity will the nurse ask the child to attempt to appropriately assess the fine motor skills of this preschooler?

Button clothes.

A parent tells the nurse about being frustrated because the preschool-aged child screams every time the parent attempts to buckle the child's seat belt. What advice should the nurse give this parent?

Do not start the car until seat belts are in place. Accident prevention is important for preschool-aged children. It can best be taught by role modeling. Not starting the car until everyone is buckled up is an example. Bribing and threatening are not appropriate, nor is keeping the child home at all times. All children up to 4 years whose height meets car seat requirements should be in an approved car seat with harness and top tether. After reaching the height requirements the child can transition to a booster seat with lap and shoulder belts.

The nurse is organizing an indoor play area for preschool-age children. Which play materials are least important?

Electronic teaching toys

The mother of a 4-year-old boy reports her son has voiced curiosity about her breasts. She asks the nurse what she should do. Which information is best for the nurse to give the parent?

Encourage the parent to determine what the child's specific questions are and answer them briefly.

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?

Engage the girl in dialogue regarding feelings about self/personal appearance.

The nurse is preparing an educational program for parents of preschool-age children to promote personal safety. Which information should the nurse include in this program? Select all that apply.

Explaining who police are and what they look like Teaching to never talk with or accept a ride from a stranger Never enter into a street without an adult

Which behavior typical of children with autism spectrum disorder (ASD) requires the nurse to maintain special care to keep them safe?

Insensitivity to pain

A parent brings her 3-year-old child in for a sick visit for the third time this year. The child, who attends a preschool program, continues to develop upper respiratory infections. The parent is frustrated with the situation and asks the nurse for advice. What would be the best recommendation for the nurse to give to the parent in this situation?

Make sure that frequent handwashing is being stressed at the preschool.

A family from India has recently moved to the United States. Their 5-year-old child often visits the school nurse after lunch reporting a "stomachache." The lunch staff tell the nurse that the child eats very little for lunch. What is the best action by the nurse?

Meet with the child and parents and discuss if cultural food preferences may be hindering the amount being eaten at lunch.

A mother describes her 4-year-old girl's eating habits as "picky" and goes on to describe using coaxing and threatening measures to get her to eat. The girl is at the 40th percentile for weight and 50th percentile for height. What interventions will be suggested? Select all that apply.

Offer a variety of healthy foods including those liked and refused. Approach mealtime matter-of-factly. Allow the child to decide how much she will eat. Offer only nutritious between-meal snacks. Focus on quality, not quantity.

The nurse is caring for a 12-year-old boy who is profoundly intellectually disabled, with an IQ of 15. Which task is the most challenging that the nurse should expect this client to be able to accomplish as an adult?

Perform tooth brushing

A nurse realizes safety teaching has been successful when the parents identify which action to help prevent the leading cause of death in preschoolers?

Placing the child in an approved car seat

The nurse is presenting an in-service on the types of playing that children may engage in. The nurse determines the session is successful when the attending nurses correctly choose which example as representing cooperative play?

Playing in an organized group with each other.

A community health center is planning a seminar about the 2030 National Health Goals for preschool-age children. Which topics would be included in this seminar to address safety? Select all that apply.

Protection against second-hand smoke Providing helmets before riding a bicycle Using appropriate restraints in motor vehicles

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?

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.

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?

Stress to the client that he or she is in control of the outcome of the care.

The nurse is caring for several clients on the pediatric unit. When interacting with the preschool-age child, which action does the nurse predict will occur?

Takes in new information at a rapid rate and asks "why" and "how"

Which gross motor skill would the 4-year-old child have most recently attained?

The child can hop on one foot Gross and fine motor skills continue to develop rapidly in the preschool-aged child. Gross motor skills have to do with the development of large muscles. Balance improves around the age of 4, thus the child can hop on one foot and stand on one foot for 5 seconds. A 3-year-old child does not have the ability to accomplish these tasks. A 5-year-old child can button his/her own clothes, tie shoes, and cut his/her food.

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 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 concerned that a child is the victim of caregiver-fabricated illness (formerly Munchausen syndrome by proxy). Which assessment finding supports this concern? Select all that apply.

The child's symptoms are vague and only reported by the parent. The mother stays with the child continuously and provides care. The family makes repeated visits to the health care facility the when child is well. The mother is a student nurse and is under a great deal of stress.

The nurse is educating the parents of an 8-year-old boy about his learning disorder. Which information would the nurse most likely include in the discussion?

The disorder is caused by a difference in brain development.

A 4-year-old girl has begun stuttering. Which practice by the parents will the nurse discourage?

asking the girl to slow down and to think before she talks

Parents of a school-age child have begun a program of therapy that includes giving the child a token each time the child follows directions. Which theoretical framework provides the background for such a program?

behavioral theory

Which type of play should the nurse encourage for a preschool-age child who is hospitalized?

dressing in the mother's coat to play house

A child has been diagnosed with medical abuse by his mother. When setting goals, which goal is highest priority?

establishing the safety of the child

The nurse is assessing a 3-year-old child. Which assessment finding would the nurse identify as abnormal?

falls when bending over to touch toes Bending over easily without falling is a normal expected gross motor skill in a 3-year-old. Building a tower of nine or ten cubes, pedaling a tricycle without assistance, and unscrewing lids, bolts, or nuts are also expected gross and fine motor skills for this age.

Parents of a 3½-year-old indicate they spend time with grandparents who live near a lake. The nurse will emphasize:

having the child wear a personal flotation device whenever near or on the water.

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

A pediatric client is newly diagnosed with Tourette syndrome. Which prescription will the nurse question?

may continue athletics

The nurse is recording vital signs in the client diagnosed with complications of anorexia nervosa. Which findings are consistent with the condition? Select all that apply.

orthostatic hypotension weak pulse hypothermia

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?

patches of hair loss

Which sign is consistent with autism spectrum disorder (ASD) in a 2-year-old boy?

performs repetitive activity with toys

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?

scheduling an immediate history and physical examination

A group of nursing students are reviewing the actions of various drugs used to treat mental health disorders in children. The students demonstrate understanding of the information when they identify which drug as potentiating the activity of serotonin in the brain?

sertraline

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)?

sexual behavior that correlates with the child's developmental age

Which sign or symptom suggests depression in a child?

somatic complaints and acting-out behavior

At a physical examination, a nurse asks the father of a 4-year-old how the boy is developing socially. The father sighs deeply and explains that his son has become increasingly argumentative when playing with his regular group of three friends. The nurse recognizes that this phenomenon is most likely due to:

testing and identification of group role.

The nurse is caring for a 4-year-old girl following an appendectomy. The girl becomes fearful and starts to cry as soon as the nurse walks into the room. When the nurse asks about the crying, the girl says, "Nurses who wear shirts with flowers give shots." The nurse understands that this statement is an example of:

transduction.

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.

weight fluctuation erosion of teeth menstrual irregularity

During a well-child visit, the caregiver expresses concern that the 3-year-old child often stutters when speaking. Which response should the nurse prioritize to best assist this family?

"Children of this age may stutter while they search for just the right word."

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."

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?

"If she loses weight, then we know the medication is working."

The nurse is working closely with the parent of a 6-year-old client who was just diagnosed with attention deficit/hyperactivity disorder (ADHD). Which methods used in behavior modification would be appropriate for this child? Select all that apply.

Provide a structured environment Be fair but firm, and stick to rules Give short and clear explanations

An adolescent client has been diagnosed with bulimia nervosa. What does the nurse explain as the goal of treatment for this client?

restoring nutritional balance and a healthy self-image

What potential side effect of smoking crack should the nurse teach adolescents about to ensure their understanding of the drug's possible impact?

cardiac arrest

The parent of 3 1/2-year-old preschooler tells the nurse that the child argues quite a bit and says that the child is always right. The nurse interprets this information as indicating:

centering. At age 3 years, cognitive development is still preoperational. Although children during this period do enter a second phase called intuitional thought, they lack insight to view themselves as others see them or put themselves in another's place. This is called centering. Because preschoolers cannot make this kind of mental substitution, they feel they are always right and causes them to argue. Conservation is reflected in the child's ability to distinguish that two items of equal size are the same despite a change in form. Initiative is the developmental task of preschoolers and is reflected in the child attempting to learn as much as possible about the world around them by trying new activities or having new experiences. Guilt occurs if children are punished or criticized for attempts at initiative.

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 metabolic panel

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?

conduct disorder

Which treatment modality is especially helpful for adolescents?

group therapy Group therapy is especially helpful for adolescents for whom the influence of peers is strong. Adolescents are more likely to accept feedback and suggestions from their peers than from adults. Group therapy is less threatening than individual therapy and allows the adolescent to identify with others who have similar problems. Play therapy is more effective with younger children who may not be able to verbalize their feelings. It encourages the child to act out his or her feelings. In individual therapy, treatment occurs with a therapeutic relationship between the therapist and the child. In family therapy, the family deals with how the child's emotional issues affect the family.

The 18-month-old toddler has been brought into the pediatrician's office by his parents. The nurse interviews the parents regarding the child's abilities. Which findings are warning signs that the toddler may have autism spectrum disorder? Select all that apply.

has never "babbled" does not exhibit attempts to communicate by pointing to objects does not use any words

Which factors are possible causes of cognitive disorders? Select all that apply.

head trauma chromosomal disorders anoxia at birth very low birth weight fetal alcohol spectrum disorder

What is the most difficult risk factor for a child to overcome related to substance abuse?

home environment where there is drug or alcohol abuse

A child is suspected of having bipolar disorder. What would the nurse identify if the child was experiencing a manic episode? Select all that apply.

pressured speech decreased sleep flamboyant behavior

Rumination disorder is a poorly understood condition of young children. This refers to:

rechewing undigested food.

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?

referred for counseling

The parents of a 4-year-old child tell the school nurse that they are worried that their child will fall behind other children academically because they are not able to afford expensive toys like computer games and handheld electronic devices. Which are acceptable response(s) by the nurse? Select all that apply.

"I understand how this can be frustrating, but rest assured this does not place your child at a disadvantage academically." "All of these expensive toys that are advertised and purchased by some people are not necessary for preschoolers. Simple toys like chalk and Legos are great." "Do you play with your child and provide means of play through things like dolls, puzzles, crayons, and child-safe modeling clay? These are the types of toys suggested for preschoolers."

A nurse is teaching the parents of a client with attention deficit/hyperactivity disorder (ADHD) about medications. Which statement by the parents indicates the need for further education?

"If our child takes this medicine, he will no longer have ADHD."

After teaching the parents of a child with Tourette syndrome about motor and vocal tics, the nurse determines that the teaching was successful when the parents state:

"If we get him focused on an activity, the tics will be less pronounced."

The nurse is providing a routine wellness examination for a 5-year-old child diagnosed with autism spectrum disorder (ASD). Which response by the client's parent will cause the nurse to intervene?

"We try to be flexible and change our child's routine from day to day."

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.

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

A nurse is describing growth and development during the preschool period. What would the nurse identify as a predominant and heightened characteristic for this age group?

imagination

A father and his 4-year-old son are waiting in an exam room when the nurse enters and greets them. Which activity that the nurse observes the boy doing would best demonstrate the primary developmental task of the preschool-age child, according to Erikson?

opening drawers in the room, pulling out supplies, and examining them The developmental task for the preschool-age child is to achieve a sense of initiative versus guilt (Erikson, 1993). Children with a well-developed sense of initiative like to explore as they have discovered that learning new things is fun. Opening the drawers, pulling out supplies, and examining them is the best example of initiation and exploration among these answers. Roughhousing and singing a song learned in preschool are examples of typical play for preschool children. Reading a book at age 4 would be developmentally precocious but would not necessarily be the best example of initiative.

A type of play seen in preschool children encourages children to act out troubling situations, such as one that might occur in the hospitalized child who must undergo an upsetting procedure. This type of play is referred to as:

dramatic play. Dramatic play allows a child to act out troubling situations and to control the solution to the problem. Through dramatic play the child can express anxiety, try out new feelings and conquer fears. This is important to remember when teaching children who are going to be hospitalized. Using dolls and puppets to explain procedures makes the experience less threatening. Parallel play is the play of toddlers where two toddlers play side by side but not with each other. Independent play occurs when a group of children are all playing but each is playing something different (i.e., all may be playing with trucks but each one has a different truck and they do not do the same thing with the trucks). Solitary play is a child playing alone, even in a group. The child does not participate with other children.