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What is an appropriate nursing intervention for a hospitalized child who is autistic?
- A. Place the child in a location where she can watch all of the activity on the unit.
- B. Use the child's chronological age as a guide for communication.
- C. Keep the child's room free of toys or objects that she might want to take home with her.
- D. Organize care to provide as few disruptions to the routine as possible.
Correct Answer: D
Rationale: During hospitalization, the nurse should provide a highly structured environment with few disruptions for a child who is autistic.
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Which statement made by a parent of an adolescent with anorexia nervosa indicates an understanding of this condition?
- A. There really isn't anything to worry about. Don't they say you can never be too thin?'
- B. My daughter just doesn't have much of an appetite.'
- C. She is just trying to punish me for divorcing her father.'
- D. She seems to see herself as fat, even though her weight is below normal.'
Correct Answer: D
Rationale: Individuals with anorexia nervosa have a disturbed body image, which this parent correctly recognizes.
The nurse asks, 'Do your parents drink every day?' The adolescent suddenly shouts, 'I'm not going to talk about that! It's none of your business, anyway! Leave me alone!' How does the nurse interpret the adolescent's behavior?
- A. The adolescent is acting out and needs to be brought under control so the conference can continue.
- B. The adolescent is trying to shift the focus of the conference away from himself, and the nurse needs to refocus.
- C. The adolescent is demonstrating that this problem requires the assistance of a psychiatrist.
- D. The adolescent is responding to the discrediting of his parents, which causes anxiety.
Correct Answer: D
Rationale: Discrediting parents threatens the child's security and creates anxiety.
A nurse is hired to work in a psychiatric facility on a unit specializing in obsessive-compulsive disorders (OCD). Which diagnoses might the nurse expect to encounter? (Select all that apply.)
- A. Trichotillomania
- B. Hoarding disorder
- C. Excoriation disorder
- D. Body dysmorphic disorder
- E. Oppositional defiant disorder
Correct Answer: A,B,C,D
Rationale: Trichotillomania, hoarding disorder, excoriation disorder, and body dysmorphic disorder are forms of OCD, while oppositional defiant disorder is not.
The school nurse cautions a group of parents about the prevalence of children who get high by inhaling hydrocarbons and fluorocarbons. Which products contain these substances? (Select all that apply.)
- A. Glue
- B. Chlorine
- C. Cleaning fluid
- D. Copy machine toner
- E. Aerosol sprays
Correct Answer: A,C,E
Rationale: The most frequently used products for inhaling hydrocarbons and fluorocarbons are glue, cleaning fluid, and aerosol sprays.
When the nurse is collecting a nursing history, an adolescent states that she has tried speed. For what does the nurse recognize this as the street name?
- A. Barbiturates
- B. Cocaine
- C. Methamphetamine
- D. Marijuana
Correct Answer: C
Rationale: Speed' is the street name for methamphetamine.