Pediatrics 4

Question 1

Approaches for a 5 year old who is cognitively impaired (1068)

Answer 1

Break up each small task into small, specific steps, because the child will not always be able to understand the task as a whole.

Question 2

The 4 levels of cognitive impairment and the IQ that goes with it: (1067)

Answer 2

Mild: 50-70

Moderate: 40-50

Severe: 25-40

Profound: <25

Question 3

Major criteria for diagnosing a child as being cognitively impaired (1068)

Answer 3

Failing to achieve developmental milestones at an appropriate age.

Diagnostic studies: neuro examination, CT scan, serum metabolite screening, developmental screening tests, standardized intellectual tests, chromosomal and genetic screening.

Question 4

Nursing major focus in supporting a family with a cognitively impaired child (1068)

Answer 4

Promoting optimal development and providing the family with support, education, and referrals.

Encourage parents to keep their focus on the normal needs of all children - love, social interaction, and play.

Question 5

Cause of Down’s Syndrome (1069)

Answer 5

Trisomy 21 - an additional chromosome on the 21st pair.

Question 6

Types of abuse included in child abuse (1073)

Answer 6

Physical - intentional bodily harm by the caregiver.

Emotional - intentional impairment or destruction of the mental or emotional state of the child.

Sexual - commission of a sexual offense by a person responsible for the child’s care for their own sexual gratification.

Question 7

What does the law say about a nurse reporting child abuse (1072)

Answer 7

Carefully document any manifestations of abuse in the medical record along with the caretaker’s explanation of the findings.

Obligated to be alert to, assess, and report any abusive situations to proper authorities.

Question 8

Suggestions to help parents with “school avoidance” (1074)

Answer 8

Be firm in the morning.

Bring somatic complaints to the attention of the health care provider. If no organic cause then send child to school.

Reassure child that nothing is wrong physically.

Explain to the child that school attendance is non-negotiable.

Provide support and reassurance to the child who is anxious about peer or academic issues.

Question 9

What is Ritalin and what is it used for (1076)

Answer 9

Medication for improving the behaviors of children with ADHD.

Ritalin (methylphenidate) is a widely used psychostimulant.

Question 10

What things could cause depression in a child (1076)

Answer 10

Disturbance in family dynamics.

A family move.

Death of a loved one.

Divorce.

Abuse or maltreatment.

Question 11

What kinds of questions could you ask a depressed adolescent you think may be suicidal (1076, 1077)

Answer 11

Have you considered suicide?

How long have you been depressed?

Do you have a current psychiatric disorder?

Question 12

Tricyclic antidepressants (1077)

Answer 12

Serotonin reuptake inhibitors (SRIs)
Fluoxetine (Prozac)
Trazodone (Desyrel)
Sertraline (Zoloft)
Bupropion (Wellbutrin)
Venlafaxine (Effexor)
Paroxetine (Paxil)

Question 13

Signs of symptoms with recurrent abdominal pain (RAP) (1079)

Answer 13

Afebrile, vomiting, and constipation.

Abdominal pain is usually non-specific, or complaints of episodic periumbilical or epigastric pain unrelated to eating, defecation, or exercise.

Question 14

How often are children seen for RAP condition (1079)

Answer 14

Psychogenic RAP presents with episodes of recurrent abdominal pain occurring monthly for at least 3 consecutive months after other causes have been ruled out.

Question 15

Characteristics of autism (1071)

Answer 15

Hallmark sign: inability to maintain eye contact with another person. Avoidance of body contact.

Display limited functional play and sometimes interact with toys in an unusual manner. Performing distorted body movements.

They are usually constipated.

Question 16

How long do Down’s Syndrome patients usually live (1070)

Answer 16

55+ years

Question 17

Autistic that excels in other subjects (1071)

Answer 17

Savant

Question 18

Most important nursing intervention when treating for “maltreatment” (1072)

Answer 18

Most important role for any health care provider is identification of a child who is being mistreated.

Question 19

Nursing intervention for someone with “school avoidance” (1074)

Answer 19

Attendance in school is non-negotiable and send them to school. Provide support and reassurance to a child that is anxious about peer or academic issues.

Question 20

Most common developmental disability is (1067)

Answer 20

Cognitive impairment

Question 21

Care for a child with special needs - characteristics you would expect to find with your assessment (1075)

Answer 21

Manifest problems with speech, behavior, motor coordination. Failure to master basic grade appropriate skills, progressive decline in school performance.

Delayed acquisition of language milestones, deficient social skills, avoidance behavior, frustration, disorganization, and somnolence.

Question 22

Statistical rate of Down’s Syndrome occurrence (1068)

Answer 22

Most common chromosomal abnormality:

1 in 600 to 800 live birth incidence.

Question 23

Newborn suspected of having Down’s Syndrome; hallmark appearance (1069)

Answer 23

Small, round skull with a flat occiput. Upward slanting eyes with epicanthal folds, broad flat nose, protruding tongue, short thick neck, hypotonic extremities, mottled skin, low set ears, and simian crease on palmar side of the hands.

Question 24

Diagnostic test to confirm Down’s Syndrome (1070)

Answer 24

Chromosomal analysis of trisomy 21.

Question 25

Primary nursing goal for a child with Down’s (1070)

Answer 25

Supporting the family at the time of diagnosis, referring the child and family to agencies that provide support and services.

Question 26

Expected behaviors of a child diagnosed with ADHD (1075)

Answer 26

Decreased attention span, impulsivity, failure to follow instructions, hyperactivity, poor self-regulation, noncompliance, aggression, fidgeting, immature play, failure to follow rules, lack of turn taking, easily distracted by external stimuli.

Additionally, antisocial, lying, cheating, stealing, anxiety, sleep disturbances, poor relationships, limited fine motor skills.

Question 27

What signs do you need to watch for in the first two weeks of antidepressant medication treatment (1077)

Answer 27

Beware of suicidal tendencies during the first two weeks of treatment with antidepressants.

Question 28

Types of therapeutic nursing interventions for child with moderate to severe autism (1071)

Answer 28

Highly structured and intensive behavior modification programs. Promote positive reinforcement, increase social awareness of others, teach verbal communication skills, and decrease unacceptable behaviors.

Decreasing stimulation using a private room, avoiding extraneous auditory and visual distractions, and encouraging parents to bring in possessions the child recognizes. Minimum holding, minimum eye contact.

Providing a structured routine to follow is key to managing autism.

Question 29

What tasks does a child with moderate cognitive impairment struggle with (1068)

Answer 29

Delays in motor, social, cognitive, and language skills.

Difficulty with complex tasks or multi-step tasks.

Question 30

Kinds of factors that influence the personality and development of the child (1067)

Answer 30

Genetic composition, environmental, social support, and culture.

Question 31

Congenital defects associated with Down’s Syndrome (1070)

Answer 31

Prone to upper respiratory infections, frequent otitis media, congenital heart defects, leukemia, immune dysfunction, thyroid dysfunction (congenital hypothyroidism).

Question 32

Common finding during assessment of a RAP patient (1079)

Answer 32

Afebrile, occasional vomiting, constipation, nonspecific abdominal pain, episodic periumbilical or epigastric pain (unrelated to eating, defecation, or exercise).

Question 33

Which children are most at risk for abuse (1071)

Answer 33

This problem occurs at ever level of society. Not confined to one socioeconomic level, race or religion.

Question 34

Typical findings for child abuse - Physical Neglect (1073)

Answer 34

Begging, stealing, stays at school, alcohol or drugs, fatigue.

Question 35

Typical findings for child abuse - Physical Abuse (1073)

Answer 35

Frequent injuries, wary of adults, apprehension to crying, fear of going home, concealing clothing, low self-esteem, suicide attempts.

Question 36

Typical findings for child abuse - Sexual Abuse (1073)

Answer 36

Nonspecific symptoms (abdominal pain), promiscuity, withdrawal, fantasy, sexual knowledge, poor peer relationships, prostitution, rape, fear of touch, suicide attempts, low self-esteem, masturbation.

Question 37

Typical findings for child abuse - Emotional Neglect (1073)

Answer 37

Stranger anxiety, emotional withdrawal, lag in emotional and intellectual development, suicide attempts.

Question 38

Things to look for in a child that has been sexually abused (1073)

Answer 38

Difficulty walking or sitting, torn stained bloody undergarments, pain or pruritus in genital area, bleeding of genitalia including vagina or anus, STDs, pregnancy, discharge from sexual organs, foreign bodies in vagina or rectum, presence of semen, UTI.

Question 39

Parent teaching for a child with ADHD (1076)

Answer 39

Discipline, set limits, provide rewards, establish strict daily routine, dangers of controversial therapies, importance of accident prevention and safety, increased supervision, develop educational plan, reasons and importance for medication, importance of follow-up routine for medication.

Question 40

Nursing interventions for adolescent admitted for overdose (1077, 1078)

Answer 40

Overdose is the most common method of suicide.

Be direct in asking about thoughts of death and suicide; will often be surprisingly open in communication. Help child develop positive coping strategies in stressful situation.

Maintain open airway, maintain cardiac function, monitor for effective medication treatment, treat any dysrhythmias.