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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 fingernai...

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  • the nurse is performing the physical examination of a child with bulimia which of the following would the nurse iden

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Voorbeeld van de inhoud

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 - correct answer • 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 - correct answer 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 - correct answer 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.

,PEDs Chapt 30 Nursing Care of the Child
with a Cognitive or Mental Health
Disorder
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" - correct answer • 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 -
correct answer 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.

, PEDs Chapt 30 Nursing Care of the Child
with a Cognitive or Mental Health
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 - correct answer 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. - correct answer
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.

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