Prep U peds ch 31
Spiral fractures of long bones in young children are uncommon and can be seen in child abuse (child maltreatment).
A 3-month-old is brought to the emergency department by a parent who reports that the child won't stop screaming since falling off of a bed 2 hours ago. Physical examination and radiography confirm that the child has a spiral fracture of the femur. What should the nurse suspect has occurred with this infant? Spiral fractures of long bones in young children are uncommon and can be seen in child abuse (child maltreatment). Three-month-olds fall off of beds frequently, with fractures the common result. This situation was a freak accident and not intentional. The child probably has osteogenesis imperfecta (brittle bone disease).
Two have an ear infection (in one of which the eardrum is ruptured) and one has scabies.
The public health nurse is providing immunizations to a family that includes three children. Which requires investigation for possible child neglect? The children state having peanut butter and jelly sandwiches for supper. The clothing appears tattered and shoes appear large on the children. Two have an ear infection (in one of which the eardrum is ruptured) and one has scabies. The children's clothes are dirty and the oldest child is not wearing a coat.
The mother was abused as a child.
A 1-year-old is a victim of child abuse (child maltreatment). Which factor obtained on history is most apt to be associated with the risk of medical child abuse (formerly Munchausen syndrome by proxy) in children? The family has a low socioeconomic level. The mother was abused as a child. The parents are outgoing, gregarious people. The family is an extended one.
Screen for autism spectrum disorder using the Modified Checklist for Autism in Toddlers.
A 2-year-old toddler presents to the pediatrician's office for a well-child visit. The child's parent reports that the child has been less talkative over the past month and no longer uses 2- to 3-word sentences to express oneself, now using just 1 word or only points to things. The parent also reports that the child prefers to sit by oneself and does not like to cuddle like before. When asked, the parent denies the family has experienced any recent major changes. Which is the nurse's most appropriate next step? Make a referral for the child to an early intervention program. Use the Ages and Stages Questionnaire to assess for appropriate growth and development. Reassure the parent that toddlers often exhibit regressive behavior. Screen for autism spectrum disorder using the Modified Checklist for Autism in Toddlers.
Notify child protective services of the assessment findings.
A 4-month-old infant presents to the clinic for a well visit. The nurse completes an assessment and notes bruising around both upper arms. The accompanying parent explained that the bruising is from the infant's accidental roll off the bed. The nurse suspects that the infant may be suffering abuse. Which is the nurse's most appropriate action? Show the parent ways to handle the infant to avoid bruising. Notify child protective services of the assessment findings. Ask the parent how he or she copes if the infant becomes fussy. Assess the parent for a history of being abused as a child.
The nurse has the responsibility to report the incident as suspected child abuse (child maltreatment).
A 4-year-old is brought to the emergency department by a grandparent who states, "His father beat him with a belt, and he has marks all over his back." What responsibility does the nurse have to report this incident? The nurse should first call the father and get his side of the story. The nurse should have the physician report the incident to the police. The nurse has the responsibility to report the incident as suspected child abuse (child maltreatment). The nurse should tell the grandparent to call social services and report the incident.
anorexia
A child with ADHD is placed on methylphenidate therapy. What symptom may children on methylphenidate develop? rapid increase in height hypotension anorexia sleepiness
safety
A child with intellectual disability engages in self-stimulation. Which of the following would the nurse identify as the priority for this child? safety consistent routines normalizing experiences respite services
Ask to speak to the child separate from the family.
A family includes a 9-year-old child. The nurse suspects that the family has caregiver-fabricated illness (formerly Munchausen syndrome by proxy). Which nursing intervention is best when assessing the child and family in the pediatrician's office? Ask to speak to the child separate from the family. Turn off the video surveillance in the room. Keep both parents in the room at all times. Ask the parents together how the child is doing.
"It is seen when one person fabricates or induces illness in another to get attention."
A group of pediatric nurses is discussing the diagnosis of Munchausen syndrome by proxy. Which statement most accurately describes this disorder? "It is seen when one person fabricates or induces illness in another to get attention." "The disorder occurs when a child is shaken by the arms or shoulders in a repetitive manner." "Children with this diagnosis often appear worried or fearful and have nightmares." "It happens when there is sexual contact between a child and a caregiver."
medical child abuse
A mother brings her 10-year-old daughter in and tells the nurse that she believes the child has a brain tumor and quickly runs through a list of some classic symptoms associated with brain cancer. On examination and after performing routine blood work, however, the nurse finds nothing wrong with the child. The child says that she feels fine. When the nurse reviews the client's chart, she finds that this is the sixth time the mother has brought the girl in for various serious conditions in the past 6 months. Which of the following situations does the nurse suspect? medical child abuse psychological maltreatment physical neglect failure to thrive
scheduling an immediate history and physical examination
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? discussing the situation with the teacher scheduling an immediate history and physical examination asking the school psychologist to do psychometric testing calling for an appointment with a psychologist
Ask the client about eating habits.
A nurse has performed a medical history for the visit (above). Which action by the nurse will provide the best insight into the client's condition? Perform a cardiovascular assessment. Ask the client about eating habits. Assess the client for depression. Ask the client about bowel habits.
"In what manner and how often are you providing care to the hand?"
A nurse is assessing a child who is brought to the clinic for a follow-up visit following suture placement, as noted in the diagram. What would be the most appropriate question for the nurse to ask the parent during this follow-up appointment? "When did this happen and where were the stitches placed?" "Does your child scratch or pick at the stitches?" "In what manner and how often are you providing care to the hand?" "Is your child taking pain medication for the hand injury?"
abdomen
A nurse is examining a 4-year-old child with various injuries in multiple places. Which site of injury would introduce suspicion of abuse? abdomen soles of feet palms of hands ears
"Individuals with bulimia have a normal weight or are slightly overweight."
A nurse is explaining the difference between anorexia nervosa and bulimia nervosa. The nurse knows the teaching was effective when the parents make which statement? "Anorexia refers to binge eating and purging by vomiting to prevent weight gain." "Individuals with bulimia have a normal weight or are slightly overweight." "Neither of these disorders is life threatening, only socially unacceptable." "Russell's sign is present in anorexia nervosa."
"Your child has the same socialization needs as other children who don't have an intellectual disability."
A nurse is interacting in conversation with the parents of an 8-year-old child with intellectual disability who wants to join a scout club at school. The parents explain that they are uncertain if this would be a good experience for their child. Which would be the best response by the nurse? "Your child has the same socialization needs as other children who don't have an intellectual disability." "Because of your child's intellectual disability, these activities should not be encouraged." "Your child does not really have a need for socialization." "Because your child has an intellectual disability, you should encourage engagement in clubs with children with a similar disability."
potential for development of suicidality
A nurse is providing care to a 10-year-old child diagnosed with separation anxiety disorder (SAD). The child has been prescribed fluoxetine. What consideration is most important when administering this medication? potential for development of Suicidality not FDA-approved for childhood anxiety that tricyclic antidepressants may be more effective a self-reported decrease in anxiety
"A definitive cause can be found for every developmental disorder."
A nursing student is learning about developmental disorders. The nursing instructor realizes that further instruction is necessary when the student makes which statement? "Families should not be blamed for causing a developmental delay." "Families should be helped to accept the child's developmental delay." "A definitive cause can be found for every developmental disorder." "Families should work to facilitate the child's progress.
"Does your child interact with you when playing?"
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?" "Does your child only eat the same food?" "Does your child respond to his or her name?" "Is your child happy when friends come to visit?"
weight fluctuation erosion of teeth menstrual irregularity
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 absence of hunger frequent nurse visits
appetite suppression
A school-age boy is on methylphenidate for ADHD. What negative side effect should the mother be advised to monitor for in the child? headaches appetite suppression skin rash nausea and vomiting
learning disorders
A young parent brings the school-aged child to the office for a sports physical examination. During the appointment, the parent informs the nurse about being worried because the child does not like school and does not seem to be reading, writing, or spelling as well as others in the class. The parent adds that the child struggles to get organized and to manage time. What condition does the nurse suspect? autism spectrum disorder learning disorder Down syndrome Asperger syndrome
"My stomach really sticks out and looks fat."
According to the American Psychiatric Association (DSM-5, 2013), a client with anorexia nervosa has a body image disturbance in which one's body weight or shape is not experienced realistically. Which statement by a client would best validate this criterion? "I realize I am a quite thin, but I am trying to gain weight." "My stomach really sticks out and looks fat." "Being this skinny really isn't a good idea for my health." "When I see myself in the mirror, I can see my ribs."
restoring nutritional balance and a healthy self-image
An adolescent client has been diagnosed with bulimia nervosa. What does the nurse explain as the goal of treatment for this client? removing the stressors from life that caused this restoring nutritional balance and a healthy self-image helping the client return to a healthy weight for height family therapy as this is linked to family disturbances
Develop a contract with the adolescent, setting goals of behavior and her diet, as well as privileges gained by meeting the contracted goals.
An adolescent has been diagnosed with bulimia, and the parents are asking how to best deal with this problem. What suggestion should the nurse make to the parents to help care for the adolescent? Monitor the adolescent constantly to ensure that she is not binge eating. Administer antiemetics on a regular basis to reduce the urge to vomit after eating. Develop a contract with the adolescent, setting goals of behavior and her diet, as well as privileges gained by meeting the contracted goals. Minimize or ignore any comments made by the adolescent about body image distortion or being overweight and dieting.
"Learning disorders can be cured if detected early."
An instructor realizes that a student needs clarification about learning disorders when the student states which of the following? "Learning disorders remain with a client throughout life." "Learning disorders are the most common developmental disorders." "Learning disorders can be cured if detected early." "Learning disorders include problems with reasoning, math, verbal skills, reading, and writing."
a child whose X-ray shows bone fractures in various stages of healing a child who has a spiral fracture in the femur a child whose CT scan shows an unexplained cerebral hemorrhage
If the following data was collected on a group of children, which of the following would most likely be evaluated as possibly related to child abuse (child maltreatment)? Select all that apply. a child whose X-ray shows bone fractures in various stages of healing a child who has a spiral fracture in the femur a child whose CT scan shows an unexplained cerebral hemorrhage a child whose blood work shows evidence of anemia a child who has frequent nausea and diarrhea
"Does your child come and hug you or seek comfort from you?"
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 have siblings?" "Does your child come and hug you or seek comfort from you?" "Do you have trouble keeping child care providers for your child?" "Does your child already attend therapies such as speech therapy?"
Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission
The mother of an 8-year-old boy is concerned that her son has attention deficit hyperactivity disorder. She describes the symptoms he demonstrates. Which behavior should the nurse recognize as an example of impulsiveness? Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission Inability to answer a question posed by his teacher because he was daydreaming Constantly fidgeting in his chair and shaking his foot Repeating words or phrases spoken by others
Instruct the parent to weigh the child biweekly. Schedule the client for periodic liver function tests.
The nurse has performed the medical history at a follow-up client visit (above). Which intervention(s) will the nurse include in the revised plan of care? Select all that apply. Make a request to change the prescribed medication. Instruct the parent to weigh the child biweekly. Ensure the medication is administered at night. Assess for the development of suicidality. Schedule the client for periodic liver function tests.
attention deficit hyperactive disorder (ADHD).
The nurse in the well-child clinic observes that a 5-year-old child in the waiting room is having trouble using a crayon to color. During the visit, the same child climbs off the table several times even after the nurse has asked him to stay on the table. Each time the nurse reminds him he says, "Oh, yeah," and happily climbs back up. The nurse suspects that the child has: attention deficit hyperactive disorder (ADHD). autism spectrum disorder. failure to thrive. an addicted caregiver.
partially healed bruising on the trunk bruise on the lower leg in a ropelike pattern spiral fracture of the ulna from a reported fall
The nurse is assessing a 2-year-old child for clinical manifestations of abuse. Which finding(s) require further follow up by the nurse? Select all that apply. partially healed bruising on the trunk bruise on the lower leg in a ropelike pattern spiral fracture of the ulna from a reported fall independence-seeking behaviors nighttime awakening
Indifferent attachment to a parent
The nurse is assessing a child diagnosed with autism spectrum disorder (ASD). Which finding will the nurse expect to assess? Slow motor actions Frequently losing things Engaging in dangerous activities Indifferent attachment to a parent
report of genital itchiness
The nurse is assessing a school-aged child for clinical manifestations of abuse. Which finding requires further follow up by the nurse? report of genital itchiness bruise on the elbow, partially healed bruise on the knee that appears new the child's picky eating habits
He stares at a rotating wheel on his crib mobile.
The nurse is caring for a 12-month-old with autism spectrum disorder (ASD). What description would you expect to elicit from his mother on history-taking? He responds warmly to his father but not to his mother. He sleeps at least 12 out of every 24 hours. He stares at a rotating wheel on his crib mobile. He already speaks in complete sentences.
"He seems to be speaking words less and less frequently."
The nurse is caring for a 3-year-old boy. The parents are concerned that he is exhibiting signs of cognitive delays. Which statement by the parents would lead the nurse to suspect autism spectrum disorder rather than possible learning disability? "He is not speaking in complete sentences." "We can understand a lot of what he says, but no one else can." "He seems to be speaking words less and less frequently." "He is unable to sit still for a short story."
a classroom with a plan of study that is followed each day
The nurse is discussing the treatment for a child with attention deficit hyperactivity disorder (ADHD) with a group of school nurses. What would be an appropriate learning setting for a child with ADHD? a classroom with a plan of study that is followed each day a classroom with windows facing a playground a classroom in which children self-select their activities a classroom with tables and chairs rather than individual desks
inability to properly synthesize glucose.
The nurse is educating parents of a child recently diagnosed with autism spectrum disorder. A description of the characteristics of autism spectrun disorder are explained within categories. The nurse becomes concerned when the mother states that the categories of autism spectrum disorder are associated with: inability to communicate with others. inability to relate to others. limited activities and interests. inability to properly synthesize glucose.
"His brother just plays too rough with him."
The nurse is interviewing the caregiver of a 5-year-old child who has been admitted with bruises on the abdomen and thighs as well as additional bruises in various stages of healing. Which statement made by the caregiver might alert the health care team to the possibility of child abuse (child maltreatment)? "His brother just plays too rough with him." "My child goes to day care after school." "He just learned to ride his bicycle." "When he is in trouble I make him go to his room."
While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack.
The nurse is observing a group of 2- and 3-year-olds in a play group. Which behavior noted in one of the children indicates to the nurse that the child may have autism spectrum disorder (ASD)? After another child takes a toy, the child cries and stomps his feet. A child playing in the kitchen area pretends to pour a glass of milk and repeats this over and over. While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack. A child flips the light switch off and on until the caregiver asks her to stop and join the other children in playing.
"Children with autism spectrum disorder enrolled in public schools can have an individualized educational plan to help meet their specific needs."
The nurse is speaking with the parent of a 2-year-old toddler recently diagnosed with autism spectrum disorder. The parent asks about educational programs for the toddler. What is the best response by the nurse? "Children with autism spectrum disorder can go to specialized schools, not public schools. You will receive information about this when your child turns 4 years of age." "Children with autism spectrum disorder enrolled in public schools can have an individualized educational plan to help meet their specific needs." "Children with autism spectrum disorder tend to be able to function well independently at school and do not need any special support at school." "Children with autism spectrum disorder are not eligible to participate in specialized educational programs since they are only open to children with intellectual impairment."
Promotion of normal development Learning Social interaction Specific language development
The nurse is talking with the parents of a child diagnosed with autism spectrum disorder. Together, they set specific goals of care for the child. Which goals may be included? Select all that apply. Promotion of normal development Promotion of a low-carbohydrate diet Learning Social interaction Specific language development
Stress to the client that he or she is in control of the outcome of the care.
The nurse is working on forming a contract with a hospitalized adolescent diagnosed with anorexia nervosa. Which information should the nurse prioritize with the client when making the contract? Remind the adolescent about the consequences of misbehavior. Stress to the client that he or she is in control of the outcome of the care. Encourage the caregivers to take responsibility for the adolescent. Reward the client after several days of successful behavior.
A lack of concentration
The nurse suspects that a child is demonstrating signs of attention deficit hyperactivity disorder (ADHD). What behavior did the nurse most likely assess in this child? Unrealistic fears A lack of concentration Persistent disobedience A lack of affection for others
play therapy
The nurse working in a pediatric mental health clinic is assessing a 4-year-old child who has suffered from physical abuse. Which type of therapy does the nurse anticipate will be most helpful in developing a trusting relationship as well as assisting in determining the client's current emotional state? behavioral therapy play therapy cognitive behavioral therapy family therapy
physical abuse abusive head trauma (shaken baby syndrome) caregiver-fabricated illness (formerly Munchausen syndrome by proxy) emotional/psychological abuse neglect sexual abuse
The nursing student learning about child abuse (child maltreatment) correctly identifies which of the following as types of abuse in children? Select all that apply. physical abuse abusive head trauma (shaken baby syndrome) sudden infant death syndrome caregiver-fabricated illness (formerly Munchausen syndrome by proxy) emotional/psychological abuse neglect sexual abuse
"Rocking can be seen as a form of self-stimulation."
The parent of an 11-month-old infant is concerned that the infant is developing an autism spectrum disorder because the infant likes to rock on the hands and knees in the crib before going to sleep. How should the nurse respond to this parent's concern? "Rocking means your infant is hungry." "Rocking is abnormal behavior associated with autism spectrum disorders." "Rocking can be seen as a form of self-stimulation." "Be sure to pad the crib, so your infant does not hurt the head while rocking."
tends to be a perfectionist may demonstrate signs of depression adheres to a rigorous exercise program has rigid study habits
The school health nurse is educating a group of teachers regarding anorexia nervosa in adolescents. The discussion includes which of the following as possible indicators of the illness? Select all that apply. tends to be a perfectionist may demonstrate signs of depression lives in a chaotic, unstructured bedroom adheres to a rigorous exercise program has rigid study habits
Use a repetitive series of movements.
To feed lunch to a child with autism spectrum disorder (ASD), which action would be most important for the nurse to take? Allow the child to ask questions about the procedure. Use an authoritarian manner to gain control. Do not allow the child to see the spoon approach the mouth. Use a repetitive series of movements.
Language delay
When reviewing the medical record of a child, what would the nurse interpret as the most sensitive indicator of intellectual disability? History of seizures Preterm birth Vision deficit Language delay
Insensitivity to pain
Which behavior typical of children with autism spectrum disorder (ASD) requires the nurse to maintain special care to keep them safe? A fascination with bright colors Insensitivity to pain A craving for salt Loss of hearing for high frequencies
Forgets to turn in homework, does not follow directions, cannot stay in the assigned seat in class and is always talking excessively and inappropriately.
Which observation would demonstrate that the adolescent client suffers from attention deficit hyperactivity disorder (ADHD)? Forgets to turn in homework, does not follow directions, cannot stay in the assigned seat in class and is always talking excessively and inappropriately. Is withdrawn in social contexts but energetic and engaging with family. Is stubborn, resistant to directions, and unwilling to negotiate. Shows cruelty to animals, callousness, and lack of guilt and remorse.
The child constantly opens and closes his hands.
Which sign or symptom suggests that a 5-year-old boy who does not maintain eye contact or speak may have autism spectrum disorder (ASD)? The child constantly opens and closes his hands. The child is highly active and inattentive. The child has a slight decrease in head circumference. The child has a long face and prominent jaw.
"I feel chubby no matter what I wear."
Which statement by an adolescent with anorexia nervosa would be most typical of an adolescent with this disorder? "I'd like to gain weight but just can't." "I feel chubby no matter what I wear." "I'd like to grow up to be a model." "I'm afraid that someone is poisoning my food."