PEDs Chapt 30 Nursing Care of the Child with a Cognitive or Mental Health Disorder

The nurse is performing the physical examination of a child with bulimia. Which of the following would the nurse identify as supporting this disorder? Select all that apply. a) Pink moist gums b) Eroded dental enamel c) Dry sallow skin d) Bradycardia e) Split fingernails • Split fingernails • Eroded dental enamel Explanation: The adolescent with bulimia will be of normal weight or slightly overweight. The hands will show calluses on the backs of the knuckles and split fingernails. The mouth and oropharynx will exhibit eroded dental enamel, red gums, and an inflamed throat from self-induced vomiting. Bradycardia and dry sallow skin suggest anorexia. The nurse is conducting an examination of a boy with Tourette's syndrome. Which of the following would the nurse expect to observe? a) Sudden, rapid stereotypical sounds b) Spinning and hand flapping c) Toe walking d) Lack of eye contact Sudden, rapid stereotypical sounds Correct Explanation: Sudden, rapid, stereotypical sounds are a hallmark fi ding with Tourette's syndrome. Toe walking and unusual behaviors such as hand-flapping and spinning are indicative of autism spectrum disorder (ASD). Lack of eye contact is associated with ASD but is also noted in children without a mental health disorder. The nurse is caring for a child who has been hospitalized repeatedly at multiple hospitals. There is no clear medical diagnosis and the mother is threatening to leave the hospital against medical advice. The nurse suspects which of the following? a) Anxiety disorder b) Bipolar disorder c) Munchhausen syndrome by proxy d) Sexual abuse Munchhausen syndrome by proxy Correct Explanation: Repeated hospitalizations that fail to produce a medical diagnosis, transfers to other hospitals, and discharges against medical advice are warning signs of Munchhausen syndrome by proxy. The 18-month-old toddler has been brought into the pediatrician's office by his parents. Which of the following findings are warning signs that the toddler may be autistic based on what he should be able to do according to his age? Select all that apply. a) The child does not use any words b) The child cannot jump rope c) The child does not speak in short sentences d) The toddler does not exhibit attempts to communicate by pointing to objects e) The parents stated that the toddler has never "babbled" • The child does not use any words • The toddler does not exhibit attempts to communicate by pointing to objects • The parents stated that the toddler has never "babbled" Correct Explanation: An 18-month-old toddler should have babbled by 12 months. He should be using gestures and using single words to communicate. The use of sentences to communicate and the ability to jump rope would be expected later. 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 of the following behaviors should the nurse recognize as an example of impulsiveness? a) Constantly fidgeting in his chair and shaking his foot b) Repeating words or phrases spoken by others c) Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission d) Inability to answer a question posed by his teacher because he was daydreaming Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission Correct Explanation: The disorder is characterized by three major behaviors: inattention, impulsiveness, and hyperactivity. Inattention makes children become easily distracted and often may not seem to listen or complete tasks effectively. Impulsiveness causes them to act before they think and therefore to have difficulty with such tasks as awaiting turns. With hyperactivity, children may shift excessively from one activity to another, exhibit excessive or exaggerated muscular activity, such as excessive climbing onto objects, constant fidgeting, or aimless or haphazard running. Repeating words or phrases spoken by others is echolalia and is associated with autistic spectrum disorder. The nurse is caring for a girl with anorexia who has been hospitalized with unstable vital signs and food refusal. The girl requires enteral nutrition. The nurse is alert for which of the complications that signal re-feeding syndrome? a) Bradycardia with ectopy b) Hypothermia and irregular pulse c) Cardiac arrhythmias, confusion, seizures d) Orthostatic hypotension Cardiac arrhythmias, confusion, seizures Correct Explanation: The nurse should be aware that rapid nutritional replacement in the severely malnourished can lead to refeeding syndrome. Refeeding syndrome is characterized by cardiovascular, hematologic, and neurologic complications such as cardiac arrhythmias, confusion, and seizures. Orthostatic hypotension, hypertension, and irregular and decreased pulses are complications of anorexia but do not characterize refeeding syndrome. The nurse is caring for a 13-year-old girl with a nursing diagnosis of ineffective coping related to inability to deal with life stressors as evidenced by few or no meaningful friendships and low self-esteem. Which intervention would be the priority to promote coping skills? a) Set clear limits on behavior. b) Role model appropriate social and conversation skills. c) Encourage her to discuss her thoughts and feelings. d) Demonstrate unconditional acceptance of the child as a person. Encourage her to discuss her thoughts and feelings. Explanation: The priority intervention is to encourage her to discuss her thoughts and feelings, as this is an initial step toward learning to deal with them appropriately. The other interventions are appropriate, but the priority intervention is to encourage discussion and obtain information from the child. This way the nurse can develop and refine the interventions based on the child's thoughts and feelings. The nurse is discussing the treatment for a child with attention deficit hyperactivity disorder with a group of school nurses. Which of the following would be an appropriate learning setting for a child with ADHD? a) A classroom with windows facing a playground. b) A classroom with tables and chairs rather than individual desks. c) A classroom with a plan of study that is followed each day. d) A classroom in which children self-select their activities. A classroom with a plan of study that is followed each day. Correct Explanation: For the child with ADHD the learning situations should be structured so that the child has minimal distractions and a supportive teacher. Special arrangements can be made to provide an educational atmosphere that is supportive for the child without the need for the child to leave the classroom. You have been working with an adolescent with an eating disorder for several days. Which of the following is an indication that she is developing trust in you? a) Her saying to you that she'll follow your orders but not those of the nurse on the next shift b) Her saying to you that she trusts you more than anyone else c) Her telling you that she is now ready to eat again d) Her telling you that she is still inducing vomiting after each meal Her telling you that she is still inducing vomiting after each meal Correct Explanation: An adolescent has to be able to trust an adult before she can share confidences. A 7-year-old child is diagnosed with a learning disability involving reading, writing, and spelling. The nurse identifies this as which of the following? a) Dyslexia b) Dyspraxia c) Dyscalculia d) Dysgraphia Dyslexia Correct Explanation: Dyslexia is a learning disability that involves reading, writing, and spelling. Dyscalculia is a learning disability that involves mathematics and computation. Dyspraxia is a learning disability that involves problems with manual dexterity and coordination. Dysgraphia is a learning disability that involves problems producing the written word. The nurse is preparing a plan to educate the parents of a 10-year-old boy with a learning disorder. Which of the following will be part of this plan? a) Explain the child's strengths and weaknesses. b) Encourage parents to give the child personal space. c) Tell parents to check on the child regularly. d) Have parents learn the child's facial expressions. Explain the child's strengths and weaknesses. Correct Explanation: The nurse will explain the nature of the child's disorder but will also point out the strengths the child possesses as part of the plan. Encouraging parents to provide a personal space for the child is an intervention meant to promote autonomy and responsibility for a child with delayed growth and development. Regularly checking up on the child is a preventive measure to promote safety for a child with a developmental disorder. Learning facial expressions is important when a child has impaired communication skills. Which statement by an adolescent with anorexia nervosa would be most typical of an adolescent with this disorder? a) "I'd like to gain weight but just can't." b) "I'm afraid that someone is poisoning my food." c) "I'd like to grow up to be a model." d) "I feel chubby no matter what I wear."