Question 1

A couple comes to the sleep disorder clinic because their 3-year-old daughter has problems falling asleep every night.The parents say that it takes their daughter 1 to 2 hours each night to fall asleep,and one of the parents ends up having to lie down with her.Which intervention should the nurse first suggest?

Accepted Answer

One of the first steps in dealing with problems with sleep is following a bedtime ritual each night so as to establish a restful sleep pattern.Additional interventions include limiting watching television.The other options do not establish a restful bedtime ritual that will encourage sleep.

Question 2

Breath-holding spells typically occur when a child becomes extremely frustrated,cries,and either intentionally or unintentionally holds his or her breath.This rarely occurs in children younger than the age of __________.

Accepted Answer

Breath holding usually does not occur prior to this age,but it can occur until approximately 5 years of age.Breath holding resolves itself in 30 to 60 seconds.After the first incident,the child should be examined by a physician,but if no problems are identified,the best intervention for future incidents is ignoring the behavior.

Question 3

A mother of a 9-year-old is concerned because her child complains of frequent stomach aches in the morning before leaving for school.No medical reason has been found for this condition.The family has recently moved to the area after the woman and her husband divorced,and the child is attending a new school.What is the most appropriate response the nurse can give to this mother?

Accepted Answer

A somatoform disorder is one in which the child (or adult)has the signs or symptoms of illness without a traceable physical cause.Somatic symptoms are common in school-age children.They are thought to be expressions of stress,anxiety,or underlying conflict.It is important to remember that children with somatoform disorders need understanding and reassurance rather than punishment or concessions.The child should not be ignored.

Question 4

A 10-year-old male client is 20 pounds overweight.Which intervention by the nurse is the most effective in this situation?

Accepted Answer

Early intervention and education are the best interventions for the treatment and prevention of childhood obesity.Teaching about healthy eating habits provides the tools necessary to correct the problem with long-term success.Placing the client on a strictly controlled calorie-restricted diet provides no education and most likely will cause a rebound effect.Talking to the client about why he is overweight may be an intervention that would occur later in the treatment process after further assessment is completed.Making a list of restricted foods also may cause a rebound effect.

Question 5

Social and emotional development occurs at a more simple level in the child who is:

Accepted Answer

A child's reasoning is simple and uncomplicated until the nervous system completely develops;therefore,the younger child's social and emotional development moves from simple to complex with age.

Question 6

The parents of a 3-year-old boy are concerned because their son seems to speak very slowly and has an odd rhythm to his speech pattern.What is this child most likely experiencing?

Accepted Answer

An expressive language disorder is a disorder of communication that is of concern if the problem persists or interferes with the child's daily activities or ability to learn and function at the expected academic level.A reading disorder most likely would be difficult to determine at this age;a phonological disorder refers to an inability to use sounds and speech as expected at a given age;and a stuttering disorder refers to frequent repetition of sounds or portions of words.

Question 7

The emotional developmental task of industry vs.inferiority that occurs in childhood is characteristic of which age group?

Accepted Answer

Industry vs.inferiority is the developmental task of school-age children.The developmental task of infancy is trust vs.mistrust;of early childhood is autonomy vs.shame and doubt;and of preschool-age children is initiative vs.guilt.

Question 8

A 7-year-old male client displays behaviors such as an inability to make eye contact with others,inappropriate facial expressions,difficulty in making friends,and showing little emotion with family members.He talks with adults but is awkward in his conversation.Given these behaviors,what is this client most likely experiencing?

Accepted Answer

These classic behaviors are associated specifically with Asperger's syndrome.Childhood disintegrative disorder describes a condition in which the child regresses in various areas after 2 years of normal development.Dyslexia is a learning disorder in which individuals have difficulty integrating visual information.Rett syndrome refers to problems with motor,language,and social development between the ages of 5 months and 4 years.

Question 9

As the caregiver for a male client whose mental retardation level is classified at a moderate level,the nurse's most appropriate action is to:

Accepted Answer

A client at a moderate level of mental retardation has good communication skills,functions academically at a second grade level,benefits from vocational training by becoming employed in supervised settings,and is successful in living in the community with supervision.Living in an apartment alone applies to a client with mild retardation;living in a group home applies to a client with severe retardation;and placement in a long-term setting for clients with cognitive disabilities applies to a client with profound retardation.

Question 10

For children older than 4 years,separation anxiety should last for no longer than:

Accepted Answer

If separation anxiety (a child's fear of being apart from his parents)lasts longer than a few weeks,it is likely that there is a problem,and treatment should be sought.High levels of anxiety in children sometimes result in obsessive-compulsive behaviors.

Question 11

The parents of a 2-year-old boy seek assistance at a family therapy clinic because their son throws a temper tantrum every time he is not allowed to throw his food on the floor during meals.Which therapeutic intervention does the nurse suggest?

Accepted Answer

Distracting the child may lessen his frustration and prevent the tantrum from occurring,and rewarding positive behavior encourages future positive behavior.Leaving him may frighten him and/or he could hurt himself during the tantrum.Holding the child down will increase his frustration,and putting him in the corner is not effective during a tantrum because his behavior is out of control,so he won't understand the importance of the punishment.

Question 12

Poverty influences the growth and development of children and is often a precursor to mental health disorders in children.Nearly __________ of children in the United States come from families that live at the poverty level.

Accepted Answer

Children who live in poverty score lower on IQ tests and exhibit higher rates of anxiety,unhappiness,and fearfulness than do children who are not living in poverty.

Question 13

The parents of a 9-year-old girl with mental retardation voice concerns to the nurse regarding their child's eating insects and leaves.The parents report that this behavior has been occurring for almost 4 months.From what is this child most likely suffering?

Accepted Answer

Pica is an eating disorder that is most commonly seen in children with mental retardation,pervasive developmental disorders,such as autism,or severe vitamin or mineral deficiencies.Treatment is aimed at keeping the child away from the items consumed and/or replacing the consumed item with a healthy food product.Rumination disorder describes a disorder in infants in which regurgitation and rechewing of the food occur.Enuresis is bedwetting,and encopresis is repeated defecation in inappropriate places.

Question 14

The school nurse meets with the parents of a 7-year-old child who frequently shows a lack of respect for his teacher and the rules of the classroom.His parents report that he fights with his siblings and has tried to run away from home when they have attempted to take away privileges.Based on this assessment,what does the nurse understand about his future?

Accepted Answer

The long-term outlook for children with conduct disorders is poor if the problems are present before the child is 10 years old.This behavior is not typical,and relaxing rules and discipline will not aid in his recovery.

Question 15

A 12-year-old female client with a normal IQ has difficulty with math at school.She performs well in all subjects except math,for which she is unable to earn above a grade of "D," no matter how much she studies.What is this client most likely suffering from?

Accepted Answer

Because this client performs well in all other areas and has a normal IQ,she most likely has a learning disorder.Learning disorders typically affect a child's thinking,reading,writing,calculating,spelling,or listening abilities.The client does not have mental retardation because her IQ is normal;pervasive developmental disorder indicates difficulties with social interactions and communication skills;and an anxiety disorder refers to a vague feeling of uneasiness that persists.

Question 16

The Denver II is a tool that is used for assessment of early childhood development.What is this tool used to assess?

Accepted Answer

In addition to motor skill assessment,the Denver II assesses language and social skills.Temperament is assessed with several tools,such as the Toddler Developmental Scale and the Middle Childhood Questionnaire;maturation is assessed with the Preschool Readiness Screening Scale tool;and speech development is assessed with the Early Language Milestone Scale.

Question 17

Adult disorders such as chronic anxiety and depression often are associated with childhood:

Accepted Answer

Abuse experienced as a child often is assessed in adults with physical,behavioral,and emotional disorders.Illnesses,fears,and education are not typical causes of adult depression and chronic anxiety.

Question 18

Due to the proximal to distal physical development of the child,which of the following motor skills is able to be accomplished by the toddler?

Accepted Answer

Eating finger foods is a gross motor skill.Tying shoes,buttoning shirts,and cutting with a knife require fine motor development.

Question 19

The parents of a 5-year-old are concerned because he has recently starting wetting himself during the day while at school.They inform their pediatrician about this when they bring their newborn daughter in for her first immunizations.After ruling out any physical cause,the pediatrician informs the parents that this is due to:

Accepted Answer

Secondary enuresis develops when a bladder-trained child becomes incontinent.Usually it follows a stressful event,such as the birth of a sibling or a divorce.

Question 20

During the interview process with a homeless client,which is an appropriate nursing action?

Accepted Answer

Asking these questions later in the interview will allow for some development of rapport and trust,so the client will more freely discuss these topics.In addition,the client may be ashamed to admit to not having an address.Asking the client about his or her highest level of education early in the conversation would make the client feel inadequate and would prevent the establishment of good rapport with the client.Asking the client about a sleeping location would occur during discharge planning,and encouraging immediate bathing would belittle the client.

Quiz 13: Problems of Childhood