Peds mental health
The emergency room nurse documents progress notes in the above note. When completing the documentation, which information would be included? Select all that apply. A-diagram of site of injuries B-information about parent's mental health C-description, including color and measurement, of injuries D-quotes from toddler of what happened E-documentation of notifying Children and Youth Services F-objective findings from a thorough head to toe assessment
A C F
An unconscious client is brought to the emergency department following an opioid overdose. Physical assessment reveals pinpoint pupils, decreased muscle tone, pale skin, and shallow respirations with a rate of 8 breaths per minute. What is the nurse's best action? A-Administer naloxone. B-Administer atropine sulfate. C-Administer protamine sulfate. D-Administer methadone.
A
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- "ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder." B-"What do you think you might have done that could have led to causing this disorder to develop in your son?" C-"Many parents feel this way, but I doubt there's anything that you did that caused ADHD to develop in your child." D-"Let's 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."
A
What should the nurse teach a client with generalized anxiety disorder to help the client cope with anxiety? A-cognitive and behavioral strategies B+issue avoidance and denial of problems C-appropriate rest and sleep habits D-withdrawal from role expectations and role relationships
A
A 6-year-old client is diagnosed with attention deficit hyperactivity disorder (ADHD). When asking this client to complete a task, what techniques should the nurse use to communicate most effectively with him? A-Obtain eye contact before speaking, use simple language, and have him repeat what was said. Praise him if he completes the task. B-Fully explain to the client the actions required of him, and offer verbal praise and a food reward for task completion. C-Explain to the client what he is to do, the consequences if he does not comply, and follow through with praise or consequences as appropriate. D-Demonstrate to the client what he is to do, have him imitate the nurse's actions, and give a food reward if he completes the task.
A
A nurse is assessing a child who has a mild intellectual disability. The best indication of how this child is progressing can be obtained by observing in which social setting? A-at school with his teacher B-at home with his family C-in the clinic with his mother D-playing soccer with his friends
A
After hearing a client with bulimia talk about her bizarre eating binges of raw pancake batter and bowls of whipped cream, the nurse feels disgusted and feels like telling her to "snap out of it." Which action would be the best action for the nurse at this time? A-Share these feelings with the client, pointing out that the client's behavior alienates people. B-Ask the client to talk more about her eating habits, trying to understand her underlying problem. C-Suggest that another nurse work with the client because this relationship is no longer therapeutic. D-Discuss these feelings with another nurse or colleague in an attempt to help to resolve them.
D
During postprandial monitoring, a client with bulimia nervosa tells the nurse, "You can sit with me, but you're just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice." What is the nurse's best response? A-"I trust you not to purge." B-"I need to know how and when you purge." C-"Don't worry. I won't allow you to purge today." D-"I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat."
D
An elementary school nurse is conducting a program for parents on attention deficit hyperactivity disorder (ADHD). What is the most important information for the nurse to include in the program? A-Boys with ADHD show more aggression than girls with ADHD. B-Diagnosis usually occurs before the child reaches school age. C-Sleep disturbances are common for children with ADHD. D-The child will have fatigue from the increased activity level.
C
Which action is the priority when assessing a suicidal client who has ingested a handful of unknown pills? A-determining if the client was trying to self-harm B-determining if the client has a support system C-determining if the client's physical condition is life-threatening D-Determining if the client has a history of suicide attempts
C
A 3-year-old is seen in the well child clinic. The parent is concerned that the child may be autistic. Which assessment data would indicate a concern to the nurse? Select all that apply. A-inability to separate from mother B-inability to stay on task C-lack of communication abilities D-withdrawing into a private world E-inability to develop social skills
C D E
The guardian of a client diagnosed with schizophrenia indicates to the nurse a concern that the client is at risk for suicide. Which question to the client would the nurse utilize to determine the seriousness of the suicidal idealization? A-"Do you have a gun at home?" B-"Are you taking your psychiatric medications?" C-"Do you have access to poisonous chemicals at home?" D-"Are you planning on hurting yourself?"
D
A client with a diagnosis of anorexia nervosa is admitted to the psychiatric unit. The client is 5′ 8″ (1.7 m) tall, weighs only 103 lb (46.7 kg), and talks incessantly about how fat the client is. Which measure should the nurse take first when caring for this client? A-Teach the client about nutrition, calories, and a balanced diet. B-Establish a trusting relationship with the client. C-Discuss cultural stereotypes regarding thinness and attractiveness. D-Explore the reasons why the client doesn't eat.
B
The parent of a school-age child tells the nurse that, "For most of the past year, my husband was unemployed, and I worked a second job. Twice during the year I spanked my son repeatedly when he refused to obey. It hasn't happened again. Our family is back to normal." After assessing the family, the nurse decides that the child is still at risk for abuse. Which observation best supports this conclusion? A-The parents say they are taking away privileges when their son refuses to obey. B-The child has talked about family activities with the nurse. C-The parents are less negative toward the nurse. D-The child wears long sleeve shirts and long pants, even in warm weather.
D
The parent of a school-age child with autism asks the nurse how she should tell her son that he has autism. Which response by the nurse is most therapeutic? A-"Explain to your son that he has a developmental disorder that makes him different from other children his age." B-"You should let the health care professionals tell your son about his diagnosis of autism." C-"Tell your son that he is different from other kids his age and that you will always be there to support him." D-"Explain the definition of autism and emphasize your child's strengths as well as his areas of challenge."
D
A child who is of preschool age is diagnosed as having severe autism. The most effective therapy involves which intervention? A-antipsychotic medications B-group psychotherapy C-one-on-one play therapy D-social skills group
C
A client with a diagnosis of major depression and a history of several suicide attempts tells a nurse, "I have no reason to live. Nobody cares about me." Which response by the nurse is most therapeutic? A-"Do you really think you should kill yourself?" B-"Depression commonly causes people to feel like this." C-"How long have you been feeling like this?" D-"You have everything to live for."
C
A college student visited the health center almost daily during the second half of the semester, before course examinations. Physical causes for these visits have been eliminated. Based on the following progress note entry in the client's chart, the nurse should suspect 2/10/2017 1600 Throughout the semester, this student presented at the walk-in clinic an average of twice per week reporting a variety of symptoms. A full work-up was done to rule out mononucleosis, influenza, colitis, pregnancy, kidney infection, and chronic fatigue. The student presented in a dramatic and worried manner with each new complaint. She did not question any of the findings, seeming to simply suffer a repeat of a previous malady or present with a new set of symptoms. It is recommended that the client have a consult to mental health services. A-functional neurologic symptom disorder B-depersonalization-derealization disorder C-somatic symptom disorder D-generalized anxiety disorder
C
What is the priority nursing action for a client with generalized anxiety disorder who is working to develop coping skills? A-Determine whether the client has fears or obsessive thinking B-Monitor the client for overt and covert signs of anxiety C-Teach the client how to use effective communications skills D-Assist the client to identify coping mechanisms used in the past
D
A registered nurse caring for a client with generalized anxiety disorder identifies a nursing diagnosis of Anxiety. A short-term goal is established as follows: "The client will identify physical, emotional, and behavioral responses to anxiety." Which nursing interventions will help the client achieve this goal? Select all that apply. A-Avoid talking about the client's sources of stress. B-Advise the client that consuming one glass of red wine per day may lessen anxiety. C-Explain to the client that expressing feelings through journal writing may increase anxiety. D-Observe the client for overt signs of anxiety. E-Help the client connect anxiety with uncomfortable physical, emotional, or behavioral responses. F-Introduce the client to new strategies for coping with anxiety, such as relaxation techniques and exercise.
D E F
A community health nurse working with a group of 5th grade girls is planning a primary prevention to help the girls avoid developing eating disorders during their teen years. The nurse should focus on which factor? A-working with the school nurse to closely monitor the girls' weight during middle school B-limiting the girls access to media images of very thin models and celebrities C-telling the girls' parents to monitor their daughter's weight and media access D-helping the girls accept and appreciate their bodies and feel good about themselves
D
The nurse is caring for a client hospitalized for anorexia nervosa. Which interventions should the nurse include for the plan of care? Select all that apply. A-Encourage the client to talk about non-food-related topics during mealtimes. B-After the client returns from home visits, ask the client if they have brought in any food, laxatives, or diuretics. C-Collaborate with nutritional counselors and dieticians at the hospital. D-Have highly structured mealtimes. E-Provide regular meals of sufficient caloric intake to promote weight gain.
A C D E
The nurse is planning care for a client with GAD (generalized anxiety disorder). Which statements by the nurse are made in the working phase of the nurse-client relationship? Select all that apply. A-"Let's talk about how you would like to deal with your anxiety." B-"I plan to meet with you every day after breakfast for 15 minutes." C-"I know this will be difficult for you but you can do this by yourself." D-"Tell me how you have dealt with anxiety in the past." E-"I can see you are learning some of these new relaxation techniques."
A D E
A nurse is working with a client with generalized anxiety disorder (GAD) who is reluctant to try a different medication prescribed by the health care provider. Which statement from the nurse is most appropriate? A-"You can say no if you do not want to try a new medication." B-"Tell me about any concerns you may have about taking the medication." C-"Your doctor really thinks this is the best medication for you, so let's give it a try." D-"Tell me about the times you have taken a medication for your condition before."
B
An abused child is admitted to the hospital, and the nurse is aware that a court appearance may be necessary. To plan for this eventuality, what should be the priority? A-Remember the parents' and child's behavior when the child was admitted. B-Document physical findings and behaviors observed during the child's admission. C-Formulate subjective opinions about the cause of any injuries. D-Prepare answers to questions that may be asked by the attorneys.
B
The 17-year-old client with a diagnosis of bulimia nervosa is hospitalized. The client weighs 5 lb (2.26 kg) less than her ideal weight for her height. She tells the nurse, "I do not have a problem. I am not really underweight." The nurse should respond by saying: A-"Your parents told the health care provider that you do have a problem." B-"Even though your weight is almost ideal for your height, purging and using laxatives are harmful to your body." C-"We'll find out if you do have a problem while you're here." D-"It's often difficult to acknowledge our imperfections."
B
The friend of a client with depression and suicidal ideation asks the nurse, "How should I act around her?" Which response by the nurse is best? A-"Try to cheer her up." B-"Be caring and genuine." C-"Control your expressions." D-"Avoid asking how she's feeling."
B
When assessing a family suspected of abusing its 4-year-old child, which behavior is the most important criterion that would suggest abuse? A-attempts by the child to defend or verify what the parent states B-incompatibility between the history (mechanism) and the injury C-responsibility taken by the child for the act D-a complaint other than the one associated with the signs of abuse
B
The nurse is talking with a client who was diagnosed with bulimia 3 months ago. The client needs more education about the illness if she makes which comments? Select all that apply. A-"I know that this illness is chronic and intermittent. I'll always have to control it." B-"If I start severely restricting my eating, I may be building up to a bingeing episode." C-"When I'm not bingeing and purging, I can skip that eating disorder support group." D-"I've made a real effort to be more social and involved in activities." E-"My depression is gone, so I don't need my antidepressant any longer."
C E
During hospitalization, a client with bulimia stops purging but becomes fearful that she will gain weight. She tells the nurse, "I can't gain weight. I'm fat enough as it is. I'll be really disgusting if I get fatter." When responding to this client, which response by the nurse would be most therapeutic? A-Explain that the calories in her prescribed diet are not enough to cause weight gain. B-Encourage her to negotiate a calorie change with the nutritionist. C-Reassure her that the staff will take complete control of her eating and will prevent her from gaining weight in the hospital. D-Use nonjudgmental and realistic comments.
D
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-anticonvulsant medications, such as carbamazepine, and monthly blood levels D-psychostimulant medications, such as methylphenidate, and behavior modification
D
In a children's unit team meeting, the staff is working on protocols for caring for clients with autism. Which protocols would be most important? Select all that apply. A-protections from harm to self and others B-preparation for any changes in unit routines C-limitations on toys allowed D-types of verbalizations expected E-reinforcements for appropriate interactions with peers and staff
A B E
A nurse is caring for a client with bulimia nervosa. Strict management of the client's dietary intake is necessary. Which intervention is the most important? A-Fill out the client's menu and make sure the client eats at least half of what is on the tray. B-Let the client eat meals in private. Engage the client in social activities for at least 2 hours after each meal. C-Serve the client's menu choices in a supervised area and observe the client 1 hour after each meal. D-Let the client eat food brought by family, but have the client keep a strict calorie count.
C
A nurse assists a student nurse conducting an interview with the family of a preschool 4-year-old boy who is often disruptive in his class, is difficult to engage, and rarely speaks. Which question, if asked by the student, would require intervention by the nurse? A-"Has your child received all his childhood immunizations? There is evidence that childhood immunizations play a role in the development of autism." B-"Has your child been evaluated by a pediatrician? He seems to have some behaviors that are atypical for a child of his age." C-"How does your child behave at home? If you do not see acting-out behavior at home, part of his problem may be dealing with new situations, such as school." D-"How do you respond if he disobeys or acts out at home? If your techniques help stop or prevent negative behavior, perhaps the teachers can try similar measures at school."
A
A parent brings their adolescent with autism to the emergency department with a bleeding forehead laceration resulting from head banging. What order should the nurse perform the actions from first to last? All options must be used. A-Assess the head laceration. B-Ensure constant observation. C-Recommend a head computed tomography scan. D-Provide education on self-harming behavior.
A B C D
A parent of a school-age child diagnosed with attention deficit hyperactivity disorder (ADHD) is talking to the nurse about her concerns about the son's physical condition. The parent states the 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-Have the child eat a breakfast bar, banana, and a glass of milk at the same time he takes medication every morning. B-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. 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.
A
A child is being seen at the clinic for an attention deficit hyperactivity disorder (ADHD) assessment. What symptoms the nurse would expect to find? Select all that apply. A-excessive climbing and running B-excessive fidgeting C-pouting behaviors D-cannot wait to take turns E-easily distracted
A B D E
When assessing a client for suicidal risk, which method of suicide should the nurse identify as most lethal? A-overdosing on aspirin B-use of a gun to the stomach C-jumping off an 8-foot bridge D-slashing both wrists
B
The parents of a 14-year-old child voice their concern to the clinic nurse about their child showing signs of depression. The parents have reported that the client has difficulty in school and that they have brought the child to the community mental health center for further assessment and treatment. What would be the priority assessments for the nurse to preform? Select all that apply. A-Cognitive impairment B-Anxiety disorder C-Behavioral difficulties D-Labile moods E-Irritability
C E
A nurse working in the emergency department is caring for a 2-year-old child with a skull fracture. The parent states that the child rolled off the sofa, but the injuries do not match the story that the parents tell. Which of the following is the most appropriate action by the nurse? A-reporting suspected child abuse to appropriate agencies B-instructing parents in home safety precautions for toddlers C-asking the child if someone has hurt him/her D-instruct the parents in head injury care after discharge
A
