Nokea
A child is admitted with a suspected diagnosis of Munchausen syndrome by proxy (MSBP). What is an important consideration in the care of this child?
- A. Monitoring the parents whenever they are with the child
- B. Reassuring the parents that the cause of the disorder will be found
- C. Teaching the parents how to obtain necessary specimens
- D. Supporting the parents as they cope with diagnosis of a chronic illness
Correct Answer: A
Rationale: MSBP refers to an illness that one person fabricates or induces in another. The child must be continuously observed for development of symptoms to determine the cause. MSBP is caused by an individual harming the child for the purpose of gaining attention. Nursing staff should obtain all specimens for analyzing. This minimizes the possibility of the abuser contaminating the sample. The child must be supported through the diagnosis of MSBP. The abuser must be identified and the child protected from that individual.
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When only one child is abused in a family, the abuse is usually a result of what?
- A. The child is the firstborn.
- B. The child is the same gender as the abusing parent.
- C. The parent abuses the child to avoid showing favoritism.
- D. The parent is unable to deal with the childs behavioral style.
Correct Answer: D
Rationale: The child unintentionally contributes to the abuse. The fit or compatibility between the childs temperament and the parents ability to deal with that behavior style is an important predictor. Birth order and gender can contribute to abuse, but there is not a specific birth order or gender relationship that is indicative of abuse. Being the firstborn or the same gender as the abuser is not linked to child abuse. Avoidance of favoritism is not usually a cause of abuse.
What is a significant secondary prevention nursing activity for lead poisoning?
- A. Chelation therapy
- B. Screening children for blood lead levels
- C. Removing lead-based paint from older homes
- D. Questioning parents about ethnic remedies containing lead
Correct Answer: B
Rationale: Screening children for lead poisoning is an important secondary prevention activity. Screening does not prevent the initial exposure of the child to lead. It can lead to identification and treatment of children who are exposed. Chelation therapy is treatment, not prevention. Removing lead-based paints from older homes before children are affected is primary prevention. Questioning parents about ethnic remedies containing lead is part of the assessment to determine the potential source of lead.
What statement is correct about young children who report sexual abuse?
- A. They may exhibit various behavioral manifestations.
- B. In more than half the cases, the child has fabricated the story.
- C. Their stories should not be believed unless other evidence is apparent.
- D. They should be able to retell the story the same way to another person.
Correct Answer: A
Rationale: Victims of sexual abuse have no typical profile. The child may exhibit various behavioral manifestations, none of which is diagnostic for sexual abuse. When children report potentially sexually abusive experiences, their reports need to be taken seriously. Other children in the household also need to be evaluated. In one study, approximately 96% of children who were sexually abused had normal genital and anal findings. The ability to retell the story is partly dependent on the childs cognitive level. Children who repeatedly tell identical stories may have been coached.
The nurse is teaching parents of a preschool child strategies to implement when the child delays going to bed. What strategy should the nurse recommend?
- A. Use consistent bedtime rituals.
- B. Give in to attention-seeking behavior.
- C. Take the child into the parents bed for an hour.
- D. Allow the child to stay up past the decided bedtime.
Correct Answer: A
Rationale: For children who delay going to bed, a recommended approach involves a consistent bedtime ritual and emphasizing the normalcy of this type of behavior in young children. Parents should ignore attention-seeking behavior, and the child should not be taken into the parents bed or allowed to stay up past a reasonable hour.
What is a clinical manifestation of acetaminophen poisoning?
- A. Hyperpyrexia
- B. Hepatic involvement
- C. Severe burning pain in stomach
- D. Drooling and inability to clear secretions
Correct Answer: B
Rationale: Hepatic involvement is the third stage of acetaminophen poisoning. Hyperpyrexia is a severe elevation in body temperature and is not related to acetaminophen poisoning. Acetaminophen does not cause burning pain in stomach and does not pose an airway threat.