Test Bank CURRENT Diagnosis and Treatment Pediatrics 24th Edition Hay Levin

Test Bank CURRENT Diagnosis and Treatment Pediatrics 24th Edition Hay Levin Table of Contents Chapter 1 The Newborn Infant ........................................................................................................ 3 Chapter 2. Child Development and Behavior ................................................................................ 10 Chapter 3. Adolescence ............................................................................................................... 19 Chapter 4. Adolescent Substance Abuse ...................................................................................... 25 Chapter 5. Eating Disorders .......................................................................................................... 26 Chapter 6. Child and Adolescent Psychiatric Disorders ................................................................ 31 Chapter 7. Child Abuse and Neglect ............................................................................................. 40 Chapter 8. Ambulatory / Office Pediatrics ..................................................................................... 47 Chapter 9. Immunization ............................................................................................................... 57 Chapter 10. Travel Medicine ......................................................................................................... 93 Chapter 11. Normal Childhood Nutrition and Its Disorders .......................................................... 103 Chapter 12. Emergencies and Injuries ........................................................................................ 110 Chapter 13. Poisoning ................................................................................................................ 113 Chapter 14. Critical Care ............................................................................................................ 115 Chapter 15. Skin ......................................................................................................................... 122 Chapter 16. Eye .......................................................................................................................... 130 Chapter 17. Oral Medicine and Dentistry .................................................................................... 138 Chapter 18. Ear, Nose, and Throat ............................................................................................. 140 Chapter 19. Respiratory Tract and Mediastinum ......................................................................... 147 Chapter 20. Sleep Medicine ........................................................................................................ 166 Chapter 21. Cardiovascular Diseases ......................................................................................... 173 Chapter 22. Gastrointestinal Tract .............................................................................................. 190 Chapter 23. Liver and Pancreas ................................................................................................. 208 Chapter 24. Kidney and Urinary Tract ......................................................................................... 234 Chapter 25. Neurologic and Muscular Disorders ......................................................................... 242 Chapter 26. Orthopedics ............................................................................................................. 262 Chapter 27. Sports Medicine ...................................................................................................... 282 Chapter 28. Rehabilitation Medicine ........................................................................................... 289 Chapter 29. Rheumatic Diseases ............................................................................................... 297 Chapter 30. Hematologic Disorders ............................................................................................ 300 Chapter 31. Neoplastic Disease .................................................................................................. 311 Chapter 32. Pain Management and Palliative Care ..................................................................... 322 Chapter 33. Immunodeficiency ................................................................................................... 328 Chapter 34. Endocrine Disorders ................................................................................................ 336 1 | P a g eChapter 35. Diabetes Mellitus ..................................................................................................... 346 Chapter 36. Inborn Errors of Metabolism .................................................................................... 353 Chapter 37. Genetics and Dysmorphology ................................................................................. 353 Chapter 38. Allergic Disorders .................................................................................................... 364 Chapter 39. Antimicrobial Therapy .............................................................................................. 366 Chapter 40. Infections: Viral and Rickettsial ................................................................................ 368 Chapter 41. Human Immunodeficiency Virus Infection ................................................................ 376 Chapter 42. Infections: Bacterial and Spirochetal ........................................................................ 378 Chapter 43. Infections: Parasitic and Mycotic .............................................................................. 384 Chapter 44. Sexually Transmitted Infections ............................................................................... 385 Chapter 45. Fluid, Electrolyte, and Acid-Base Disorders and Therapy ........................................ 386 Chapter 46. Pediatric Laboratory Medicine and Reference Ranges show less............................. 393 2 | P a g eChapter 1 The Newborn Infant 1. Which milestone is developmentally appropriate for a 2-month-old infant when the nurse pulls the infant to a sitting position? a. Head lag is present when the infants trunk is lifted. b. The infant is able to support the head when the trunk is lifted. c. The infant is briefly able to hold the head erect. d. The infant is fully able to support and hold the head in a straight line. ANS: C A 2-month-old infant is able to hold the head erect only briefly and continues to have some head lag. It is not until 4 months of age that the infant can keep his or her head in a straight line when pulled to a sitting position. 2. Approximately what should a newborn weigh at 1 year of age if the newborns birth weight was 7 pounds 6 ounces? a. 14 3/4 pounds b. 22 1/8 pounds c. 29 1/2 pounds d. Unable to estimate weight at 1 year ANS: B An infant triples the birth weight by 1 year of age. An infant doubles the birth weight by 6 months of age. An infant quadruples the birth weight by 2 years of age. Weight at 6 months, 1 year, and 2 years of age can be estimated from the birth weight. 3. Which statement made by a parent would be consistent with a developmental delay? a. I have noticed that my 9-month-old infant responds consistently to the sound of his name. b. I have noticed that my 12-month-old child does not get herself to a sitting position or pull to stand. c. I am so happy when my 1 1/2-month-old infant smiles at me. d. My 5-month-old infant is not rolling over in both directions yet. 3 | P a g eANS: B Critical developmental milestones for gross motor development in a 12 month old include standing briefly without support, getting to a sitting position, and pulling to stand. If a 12-month- old child does not perform these activities, it may be indicative of a developmental delay. An infant who responds to his name at 9 months of age is demonstrating abilities to both hear and interpret sound. A social smile is present by 2 months of age. Rolling over in both directions is not a critical milestone for gross motor development until the child reaches 6 months of age. 4. At a healthy 2-month-old infants well-child clinic visit, the nurse should give which immunizations? a. DTaP, IPV, HepB, Hib, PCV, rotavirus b. MMR, DTaP, PVC, and IPV c. Hib, DTaP, rotavirus, and OPV d. Hib and MMR, IPV, and rotavirus ANS: A DTaP, IPV, HepB, Hib, PCV, and rotavirus are the appropriate sequence of immunizations for a healthy 2-month-old infant. MMR is given at or after 12 months of age. Oral polio vaccine (OPV) is no longer administered in the U.S. 5. The nurse advises the mother of a 3-month-old infant, exclusively breast-fed, to: a. start giving the infant a vitamin D supplement. b. start using an infant feeder and add rice cereal to the formula. c. start feeding the infant rice cereal with a spoon at the evening feeding. d. continue breast-feeding without any supplements. ANS: A Breast milk does not provide an adequate amount of dietary vitamin D. Infants who are exclusively breast-fed need vitamin D supplements to prevent rickets. An infant feeder is an inappropriate method of providing the infant with caloric intake. Solid foods and rice cereal are not recommended for a 3-month-old infant. Solid feedings do not typically begin before 4 to 6 months of age. Because breast milk is not an adequate source of fluoride, infants need to be given a fluoride supplement. 4 | P a g e6. At from view. a. 4 b. 6 c. 9 d. 20 ANS: C By 9 months of age an infant will actively search for an object that is out of sight. Four-month- old infants are not cognitively capable of searching out objects hidden from their view. Infants at this developmental level do not pursue hidden objects. Six-month-old infants have not developed the ability to perceive objects as permanent and do not search out objects hidden from their view. Twenty-month-old infants actively pursue objects not in their view and are capable of recalling the location of an object not in their view. They first look for hidden objects around the age of 9 months. 7. The parents of a newborn infant state, We will probably not have our baby immunized because we are concerned about the risk of our child being injured. Which is the best response for the nurse to make? a. It is your decision. b. Have you talked with your parents about this? They can probably help you think about this decision. c. The risks of not immunizing your baby are greater than the risks from the immunizations. d. You are making a mistake. ANS: C Although immunizations have been documented to have a negative effect in a small number of cases, an unimmunized infant is at greater risk for development of complications from childhood diseases than from the vaccines. It is the parents decision not to immunize the child; however, the nurse has a responsibility to inform parents about the risks to infants who are not immunized. Grandparents can be supportive but are not the primary decision makers for the infant. Telling parents that they are making a mistake is an inappropriate response. 8. The mother of a 9-month-old infant is concerned because the infant cries when she leaves 5 | P a g e months of age, an infant should first be expected to locate an object hiddenhim. Which is the best response for the nurse to make to the mother? a. You could consider leaving the infant more often so he can adjust. b. You might consider taking him to the doctor because he may be ill. c. Have you noticed whether the baby is teething? d. This can be a healthy sign of attachment. ANS: D Healthy attachment is manifested by stranger anxiety in late infancy. An infant who manifests stranger anxiety can be supported by the mother leaving the infant for only short periods of time. Assessing developmental needs is appropriate before taking an infant to a physician. Pain from teething expressed by the infants cries would not occur only when the mother left the room. 9. Which statement concerning physiological factors of infancy is true? a. The infant has a slower metabolic rate than an adult. b. An infant is not able to digest protein and lactase. c. Infants have a slower circulatory response than adults. d. The kidneys of an infant are less efficient in concentrating urine than an adults kidneys. ANS: D The infants kidneys are not as effective at concentrating urine compared with an adults kidneys because of immaturity of the renal system and a slower glomerular filtration rates. The infants metabolic rate is faster, not slower, than an adults. Although the newborn infants gastrointestinal system is immature, it is capable of digesting protein and lactase, but the ability to digest and absorb fat does not reach adult levels until approximately 6 to 9 months of age. 10. Which is a priority in counseling parents of a 6-month-old infant? a. Increased appetite from secondary growth spurt b. Allowing the infant to self-feed c. Securing a developmentally safe environment for the infant d. Strategies to teach infants to sit up ANS: C 6 | P a g eSafety is a primary concern as an infant becomes increasingly mobile. The infants appetite and growth velocity decrease in the second half of infancy. Fine motor development, which is refined in the second half of infancy, is necessary before the infant can self-feed. Unless the infant has a neuromuscular deficit, strategies for teaching a normally developing infant to sit up are not necessary. 11. A mother of a 2-month-old infant tells the nurse, My child doesnt sleep as much as his older brother did at the same age. What is the best response for the nurse? a. Have you tried to feed the baby more often? b. Infant sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time. c. It is helpful to keep a record of your babys eating, waking, sleeping, and elimination patterns and to come back in a week to discuss them. d. This infant is difficult. It is important for you to identify what is bothering the baby. ANS: B Newborn infants may sleep as much as 17 to 20 hours per day. Sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time. Infants typically do not need more caloric intake to improve sleep behaviors. Keeping intake, output, waking, and sleeping data is not typically helpful in discussing differences among infants behaviors. Identifying an infant as difficult without identifying helpful actions is not a therapeutic response for a parent concerned about sleep. 12. The mother of a 10-month-old infant tells the nurse that her infant really likes cows milk. Which is the best response to this mother? a. Milk is good for him. b. It is best to wait until he is a year old before giving him cows milk. c. Limit cows milk to his bedtime bottle. d. Mix his cereal with cows milk and give him formula in a bottle. ANS: B It is best to wait until the infant is at least a year old before giving him cows milk because of the risk of allergies and intestinal problems. Cows milk protein intolerance is the most common food allergy during infancy. Although milk is a good source of calcium and protein for children after 7 | P a g ethe first year of life, it is not the best source of nutrients for children younger than 1 year old. Bedtime bottles of formula or milk are contraindicated because of their high sugar content, which leads to dental decay in primary teeth. Cereal can be mixed with formula. 13. The mother of a 10-month-old infant asks the nurse about beginning to wean her child from the bottle. Which statement by the mother suggests that the child is not ready to be weaned? a. My son is frequently throwing his bottle down. b. The baby takes a few ounces of formula from the bottle. c. He is constantly chewing on the nipple. It concerns me. d. He consistently is sucking. ANS: D Consistent sucking is a sign that the child is not ready to be weaned. A decreased interest in the bottle starts between 6 and 12 months. Throwing the bottle down is a sign of a decreased interest in the bottle. When the child is taking more fluids from a cup and decreasing amounts from the bottle, the child is demonstrating a readiness for weaning. Chewing on the nipple is another sign that the infant is ready to be weaned. 14. Which is appropriate play for a 6-month-old infant? a. Pat-a-cake, peek-a-boo b. Ball rolling, hide and seek game c. Bright rattles and tactile toys d. Push and pull toys ANS: A Six-month-old children enjoy playing pat-a-cake and peek-a-boo. Nine-month-old infants enjoy rolling a ball and playing hide and seek games. Four-month-old infants enjoy bright rattles and tactile toys. Twelve-month-old infants enjoy playing with push and pull toys. 15. Which statement by a mother indicates that her 5-month-old infant is ready for solid food? a. When I give my baby solid foods, she has difficulty getting it to the back of her throat to swallow. b. She has just started to sit up without any support. 8 | P a g ec. I am surprised that she only weighs 11 pounds. I expected her to have gained some weight. d. I find that she really has to be encouraged to eat. ANS: B Sitting is a sign that the child is ready to begin with solid foods. Children who are ready to manage solid foods are able to move food to the back of their throats to swallow. Infants who weigh less than 13 pounds and demonstrate a lack of interest in eating are not ready to be started on solid foods. Infants who are difficult feeders and do not demonstrate an interest in solid foods are not ready to be started on them. 16. A mother asks the nurse, When should I begin to clean my babys teeth? What is the best response for the nurse? a. You can begin when all her baby teeth are in. b. You can easily begin now. Just put some toothpaste on a gauze pad to clean the teeth. c. I dont think you have to worry about that until she can handle a toothbrush. d. You can begin as soon as your child has a tooth. The easiest way is to take cotton swabs or a face cloth and just wipe the teeth. Toothpaste is not necessary. ANS: D An infants teeth need to be cleaned as soon as they erupt. Cleaning the teeth with cotton swabs or a face cloth is appropriate. Waiting until all the baby teeth are in is inappropriate and prolongs cleaning until 2 years of age. Because toothpaste contains fluoride and infants will swallow the toothpaste, parents should avoid its use. Even when a child has the ability to hold a toothbrush, the parent should continue cleaning the childs teeth. 1. An infants length was 20 inches at birth. What should the nurse expect the infants length to be at 6 months (in inches)? ANS: 26 During the first 6 months, infants increase their birth length by approximately 1 inch (2.54 cm) per month, slowing to 1/2 inch (1.27 cm) per month over the next 6 months. 9 | P a g eChapter 2. Child Development and Behavior 1. A nurse is reviewing developmental concepts for infants and children. Which statement best describes development in infants and children? a. Development, a predictable and orderly process, occurs at varying rates within normal limits. b. Development is primarily related to the growth in the number and size of cells. c. Development occurs in a proximodistal direction with fine muscle development occurring first. d. Development is more easily and accurately measured than growth. ANS: A Development, a continuous orderly process, provides the basis for increases in the childs function and complexity of behavior. The increases in rate of function and complexity can vary normally within limits for each child. An increase in the number and size of cells is a definition for growth. Development proceeds in a proximodistal direction with fine muscle organization occurring as a result of large muscle organization. Development is a more complex process that is affected by many factors; therefore, it is less easily and accurately measured. Growth is a predictable process with standard measurement methods. 2. Frequent developmental assessments are important for which reason? a. Stable developmental periods during infancy provide an opportunity to identify any delays or deficits. b. Infants need stimulation specific to the stage of development. c. Critical periods of development occur during childhood. d. Child development is unpredictable and needs monitoring. ANS: C Critical periods are blocks of time during which children are ready to master specific developmental tasks. Children can master these tasks more easily during particular periods of time in their growth and developmental process. Infancy is a dynamic time of development that requires frequent evaluations to assess appropriate developmental progress. Infants in a nurturing environment will develop appropriately and will not necessarily need stimulation specific to their developmental stage. Normal growth and development are orderly and proceed in a predictable pattern on the basis of each individuals abilities and potentials. 10 | P a g e3. Which factor has the greatest influence on child growth and development? a. Culture b. Environment c. Genetics d. Nutrition ANS: C Genetic factors (heredity) determine each individuals growth and developmental rate. Although factors such as environment, culture, nutrition, and family can influence genetic traits, they do not eliminate the effect of the genetic endowment, which is permanent. Culture is a significant factor that influences how children grow toward adulthood. Culture influences both growth and development but does not eliminate inborn genetic influences. Environment has a significant role in determining growth and development both before and after birth. The environment can influence how and to which extent genetic traits are manifested, but environmental factors cannot eliminate the effect of genetics. Nutrition is critical for growth and plays a significant role throughout childhood. 4. A nurse is planning a teaching session with a child. According to Piagetian theory, the period of cognitive development in which the child is able to distinguish fact from fantasy is the period of cognitive development. a. sensorimotor b. formal operations c. concrete operations d. preoperational ANS: C Concrete operations is the period of cognitive development in which childrens thinking is shifted from egocentric to being able to see anothers point of view. They develop the ability to distinguish fact from fantasy. The sensorimotor stage occurs in infancy and is a period of reflexive behavior. During this period, the infants world becomes more permanent and organized. The stage ends with the infant demonstrating some evidence of reasoning. Formal operations is a period in development in which new ideas are created through previous thoughts. Analytic reason and abstract thought emerge in this period. The preoperational stage is a period of egocentrism in which the childs judgments are illogical and dominated by magical 11 | P a g ethinking and animism. 5. The theorist who viewed developmental progression as a lifelong series of conflicts that need resolution is: a. Erikson. b. Freud. c. Kohlberg. d. Piaget. ANS: A Erik Erikson viewed development as a series of conflicts affected by social and cultural factors. Each conflict must be resolved for the child to progress emotionally, with unsuccessful resolution leaving the child emotionally disabled. Sigmund Freud proposed a psychosexual theory of development in which certain parts of the body assume psychological significance as foci of sexual energy. The foci shift as the individual moves through the different stages (oral, anal, phallic, latency, and genital) of development. Lawrence Kohlberg described moral development as having three levels (preconventional, conventional, and postconventional). His theory closely parallels Piagets. Jean Piagets cognitive theory interprets how children learn and think and how this thinking progresses and differs from adult thinking. Stages of his theory include sensorimotor, preoperations, concrete operations, and formal operations. 6. What does the nurse need to know when observing chronically ill children at play? a. Play is not important to hospitalized children. b. Children need to have structured play periods. c. Childrens play is an indication of a childs response to treatment. d. Play is to be discouraged because it tires hospitalized children. ANS: C Play for all children is an activity woven with meaning and purpose and is a mechanism for mastering their environment. For chronically ill children, play can indicate their state of wellness and response to treatment. Play is important to all children in all environments. Although childrens play activities appear unorganized and at times chaotic, play has purpose and meaning. Imposing structure on play interferes with the tasks being worked on. Children who have fewer energy reserves still require play. For these children, less-active play activities will be important. 12 | P a g e7. Which child is most likely to be frightened by hospitalization? a. A 4-month-old infant admitted with a diagnosis of bronchiolitis b. A 2-year-old toddler admitted for cystic fibrosis c. A 9-year-old child hospitalized with a fractured femur d. A 15-year-old adolescent admitted for abdominal pain ANS: B Toddlers are most likely to be frightened by hospitalization because their thought processes are egocentric, magical, and illogical. They feel very threatened by unfamiliar people and strange environments. Young infants are not as likely to be frightened as toddlers by hospitalization because they are not as aware of the environment. The 9-year-old childs cognitive ability is sufficient enough for the child to understand the reason for the hospitalization. The 15-year-old adolescent has the cognitive ability to interpret the reason for the hospitalization. 8. Which statement made by a 15-year-old adolescent with a diagnosis of neurofibromatosis (an autosomal dominant genetic disorder) best demonstrates an understanding of the mechanism of inheritance for the disease? a. My babies will probably not have neurofibromatosis. b. My babies have a 50% chance of having neurofibromatosis. c. Whether my babies have problems depends on the father. d. My babies have a 25% chance of having neurofibromatosis. ANS: B Neurofibromatosis is an autosomal dominant genetic disorder that occurs when the abnormal gene is carried on the affected chromosome with a normal gene. Because the abnormal gene is dominant, an individual with the defective gene has a 50% chance of transmitting the defect to an infant with each pregnancy. Neurofibromatosis is not a sex-linked genetic disease; therefore, either the father or the mother genetically transfers it to the infant. A parent with the defective gene will genetically transfer either a normal or abnormal gene to an infant. Because the defective gene is dominant, there is a 50% probability of the child inheriting the disease. 9. During a routine healthcare visit, a parent asks the nurse why her 9-month-old infant is not walking as her older child did at the same age. Which response by the nurse best demonstrates 13 | P a g ean understanding of child development? a. Shes a little slow. b. If she is pulling up, you can help her by holding her hand. c. Babies progress at different rates. Your infants development is within normal limits. d. Maybe she needs to see a behavioral specialist. ANS: C Ninety percent of infants walk by 14 months of age. The infant is within normal developmental limits. It is inappropriate for the nurse to state that the infant is a little slow. Infants will walk when they are developmentally ready. Hurrying an infant does not result in the developmental task being achieved at an earlier time period. Consulting a behavioral specialist for diagnostic evaluation is indicated when a child demonstrates developmental delays. The child has no evidence of a delay. 10. Which expected outcome would be developmentally appropriate for a hospitalized 4-year-old child? a. The child will be dressed and fed by the parents. b. The child will independently ask for play materials or other personal needs. c. The child will be able to verbalize an understanding of the reason for the hospitalization. d. The child will have a parent stay in the room at all times. ANS: B Erikson identifies initiative as a developmental task for the preschool child. Initiating play activities and asking for play materials or assistance with personal needs demonstrate developmental appropriateness. Parents need to foster appropriate developmental behavior in the 4-year-old child. Dressing and feeding the child do not encourage independent behavior. A 4- year-old child cannot be expected to cognitively understand the reason for his or her hospitalization. Expecting the child to verbalize an understanding for the hospitalization is an inappropriate outcome. Parents staying with the child throughout a hospitalization is an inappropriate outcome. Although children benefit from parental involvement, parents may not have the support structure to stay in the room with the child at all times. 11. A nurse has completed a teaching session with parents of preschool aged children. 14 | P a g eWhich statement made by the parent identifies an appropriate level of language development for a 4- year-old child? a. The child has a vocabulary of 300 words and uses simple sentences. b. The child uses correct grammar in sentences. c. The child is able to pronounce consonants clearly. d. The child uses language to express abstract thought. ANS: B The 4-year-old child is able to use correct grammar in sentence structure and typically has difficulty in pronouncing consonants. Simple sentences and a 300-word vocabulary are appropriate for a 2-year-old child. The use of language to express abstract thought is developmentally appropriate for the adolescent. 12. Which should the nurse evaluate before administering the Denver Developmental Screening Test II (DDST-II)? a. The childs height and weight b. The parents ability to comprehend the results c. The childs mood d. The parentchild interaction ANS: C The results of the screening test are valid if the child acted in a normal and expected manner. The childs height and weight are not relevant to the DDST-II screening process. The parents ability to understand the results of the screening is not relevant to the validity of the test. The parentchild interaction is not significantly relevant to the test results. 13. Which children are at greater risk for not receiving immunizations? a. Children who attend licensed day care programs b. Children entering school c. Children who are home schooled d. Young adults entering college 15 | P a g eANS: C Home schooled children are at risk for being underimmunized and need to be monitored. All states require immunizations for children in day care programs and entering school. Most colleges require a record of immunizations as part of a health history. 14. Which developmental assessment instrument is appropriate to assess a 5-year-old child? a. Brazelton Behavioral Scale b. Denver Developmental Screening Test II (DDST-II) c. Dubowitz Scale d. New Ballard Scale ANS: B The DDST-II is used for infants and children between birth and 6 years of age. Brazeltons Behavioral Scale is used for newborn assessment. The Dubowitz Scale is used for estimation of gestational age. The New Ballard Scale is used for newborn screening. 15. A 2-month-old child has not received any immunizations. Which immunizations should the nurse give? a. DTaP, Hib, HepB, IPV, varicella b. DTaP, Hib, HepB, MMR, IPV c. DTaP, Hib, HepB, PCV, IPV, rotavirus d. DTaP, Hib, HepB, PCV, IPV, HepA ANS: C DTaP, Hib, HepB, PCV, IPV, and rotavirus are appropriate immunizations for an unimmunized 2-month-old child. The child should not receive varicella until at or after 12 months of age. MMR is not given to children until at or after 12 months of age. HepA is recommended for all children at 1 year of age. 16. You are preparing immunizations for a 12-month-old child who is immunocompromised. Which immunization cannot be given? a. DTaP b. HepA 16 | P a g ec. IPV d. Varicella ANS: D Children who are immunologically compromised should not receive live viral vaccines. Varicella is a live vaccine, and should not be given except in special circumstances. DTaP, HepA, and IPV can be safely given. 17. Which immunization can cause fever and rash to occur 1 to 2 weeks after administration? a. HepB b. DTaP c. Hib d. MMR ANS: D MMR is a live virus vaccine and can cause fever and rash 1 to 2 weeks after administration. HepB, DTaP, and Hib do not cause fever or rash. MULTIPLE RESPONSE 1. The nurse is preparing immunizations for a healthy 11-year-old boy who has received all his primary immunizations. Which immunizations will the nurse consider? Select all that apply. a. Meningococcal b. DTaP c. OPV d. Smallpox ANS: A, B Meningococcal conjugate vaccine should be given to all children at age 11 to 12 years. The American Academy of Pediatrics recommends one dose of DTaP vaccine for children at age 11 to 12 years, as long as they have received the primary DTaP series. Oral polio vaccine is no longer administered in the U.S. The current smallpox vaccine is not recommended for healthy, low-risk children younger than 18 years of age. 17 | P a g e2. Parents of a 4-month-old child ask the nurse what they can do to help relieve the discomfort of teething. The nurse should include which suggestions for the parents? Select all that apply. a. Provide warm liquids. b. Rub the gums with aspirin. c. Over-the-counter topical medications for gum pain relief can be used as directed. d. Administer acetaminophen (Tylenol) as directed. e. Provide a hard food such as a frozen bagel for chewing. ANS: C, D, E To help parents cope with teething, nurses can suggest that they provide cool liquids and hard foods (e.g., dry toast, Popsicles, frozen bagels) for chewing. Hard, cold teethers and ice wrapped in cloth may also provide comfort for inflamed gums. Nurses should explain to parents that over- the-counter topical medications for gum pain relief should be used only as directed. Home remedies, such as rubbing the gums with whiskey or aspirin, should be discouraged, but acetaminophen administered as directed for the childs age can relieve discomfort. OTHER 1. Place in order the gross motor developmental milestones a nurse expects to assess in an infant. Begin with the earliest gross motor milestone expected and progress to the last gross motor milestone attained. a. Turns from abdomen to back b. Lifts head off of bed when in a prone position c. Walks holding on to furniture d. Turns from back to abdomen e. Sits unsupported ANS: B, A, D, E, C The infant lifts its head off of the bed when in a prone position at 3 months, turns from abdomen to back at 4 to 5 months, turns from back to abdomen at 6 to 7 months, sits unsupported at 8 to 9 months, and can walk holding on to furniture at 10 to 12 months. 18 | P a g eChapter 3. Adolescence 1. A nurse is teaching an adolescent about Tanner stages. Which statement best describes Tanner staging? a. Predictable stages of puberty that are based on chronological age b. Staging of puberty based on the initiation of menarche and nocturnal emissions c. Predictable stages of puberty that are based on primary and secondary sexual characteristics d. Staging of puberty based on the initiation of primary sexual characteristics ANS: C Tanner sexual-maturing ratings are based on the development of stages of primary and secondary sexual characteristics. They are not based on chronological age. The age at which an adolescent enters puberty is variable. The puberty stage in girls begins with breast development. The puberty stage in boys begins with genital enlargement. Primary sexual characteristics are not the basis of Tanner staging. 2. Which behavior suggests appropriate psychosocial development in the adolescent? a. The adolescent seeks validation for socially acceptable behavior from older adults. b. The adolescent is self-absorbed and self-centered and has sudden mood swings. c. Adolescents move from peers and enjoy spending time with family members. d. Conformity with the peer group increases in late adolescence. ANS: B During adolescence, energy is focused within. Adolescents concentrate on themselves in an effort to determine who they are or who they will be. Adolescents are likely to be impulsive and impatient. The peer group validates acceptable behavior during adolescence. Adolescents 19 | P a g emove from family and enjoy spending time with peers. Adolescents also spend time alone; they need this time to think and concentrate on themselves. Conformity becomes less important in late adolescence. 3. The parents of a 14-year-old girl are concerned that their adolescent spends too much time looking in the mirror. Which statement is the most appropriate for the nurse to make? a. Your teenager needs clearer and stricter limits about her behavior. b. Your teenager needs more responsibility at home. c. During adolescence, this behavior is not unusual. d. The behavior is abnormal and needs further investigation. ANS: C Narcissistic behavior is normal during this period of development. The teenager is seeking a personal identity. Stricter limits are not an appropriate response for a behavior that is part of normal development. More responsibility at home is not an appropriate response for this situation. 4. Which factor contributes to early adolescents engaging in risk-taking behaviors? a. Peer pressure b. A desire to master their environment c. Engagement in the process of separation from their parents d. A belief that they are invulnerable ANS: D During early to middle adolescence, children feel that they are exempt from the consequences of risk-taking behaviors: they believe negative consequences happen only to others. Impressing peers is more typically the factor influencing behavior of older school-age children. Mastering the environment is the task of young school-age children. Emancipation is a major issue for the older adolescent. The process is accomplished as the teenager gains an education or vocational training. 5. Which statement is the most appropriate advice to give parents of a 16-year-old teenager who is rebellious? a. You need to be stricter so that your teenager feels more secure. 20 | P a g eb. You need to allow your teenager to make realistic choices while using consistent and structured discipline. c. Increasing your teens involvement with his peers will improve his self-esteem. d. Allow your teenager to choose the type of discipline that is used in your home. ANS: B Allowing teenagers to choose between realistic options and offering consistent and structured discipline typically enhances cooperation and decreases rebelliousness. Setting stricter limits typically does not decrease rebelliousness or increase feelings of security. Increasing peer involvement does not typically increase self-esteem. Allowing teenagers to choose the method of discipline is not realistic and typically does not reduce rebelliousness. 6. Which statement by the nurse is most appropriate to a 15-year-old adolescent whose friend has mentioned suicide? a. Tell your friend to come to the clinic immediately. b. You need to gather details about your friends suicide plan. c. Your friends threat needs to be taken seriously and immediate help for your friend is important. d. If your friend mentions suicide a second time, you will want to get your friend some help. ANS: C Suicide is the third most common cause of death among American adolescents. A suicide threat from an adolescent serves as a dramatic message to others and should be taken seriously. Adolescents at risk should be targeted for supportive guidance and counseling before a crisis occurs. Instructing a 15-year-old adolescent to tell a friend to come to the clinic immediately provides the teen with limited information and does not address the concern. It is important to determine whether a person threatening suicide has a plan of action; however, the best information for the 15-year-old adolescent to have is that all threats of suicide should be taken seriously and immediate help is important. It is imperative that help is provided immediately for a teenager who is talking about suicide. Waiting until the teen discusses it a second time may be too late. 7. When planning care for adolescents, the nurse should: a. teach parents first, and they, in turn, will teach the teenager. 21 | P a g eb. provide information for their long-term health needs because teenagers respond best to long-range planning. c. maintain the parents role by providing explanations for treatment and procedures to the parents only. d. give information privately to adolescents about how they can manage the specific problems that they identify. ANS: D Problems that teenagers identify and are interested in are typically the problems that they are the most willing to address. Confidentiality is important to adolescents. Adolescents prefer to confer privately (without parents) with the nurse and healthcare provider. Teenagers are socially and cognitively at the developmental stage where the healthcare provider can teach them and can receive explanations about healthcare directly from the nurse. Teenagers are more interested in immediate healthcare needs than in long-term needs. 8. A 17-year-old adolescent tells the nurse that he is not having sex because it would make his parents very angry. This response indicates that the adolescent has a developmental lag in which area? a. Cognitive development b. Moral development c. Psychosocial development d. Psychosexual development ANS: B The appropriate moral development for a 17-year-old adolescent would include evidence that the teenager has internalized a value system and does not depend on parents to determine right and wrong behaviors. Cognitive development is related to moral development, but it is not the pivotal point in determining right and wrong behaviors. Identity formation is the psychosocial development task. Energy is focused within the adolescent, who exhibits behavior that is self- absorbed and egocentric. Although a task during adolescence is the development of a sexual identity, the teenagers dependence on the parents sanctioning of right or wrong behavior is more appropriately related to moral development. 9. The best response a nurse can make to a 15-year-old girl who has verbalized a desire to have a baby is: 22 | P a g ea. Have you talked with your parents about this? b. Do you have plans to continue school? c. Will you be able to support the baby? d. Can you tell me how your life will change if you have an infant? ANS: D Having the teenager describe how the infant will affect her life will allow the teen to think more realistically. Her description will allow the nurse to assess the teens perception and reality orientation. Asking the teenager if she has talked to her parents is not particularly helpful to the teen or the nurse and may terminate the communication. A direct question about continuing school and how the teenager will support the child will not facilitate communication. Open- ended questions encourage communication. 10. In an interview with the nurse, a mother states that she is concerned that her 14-year-old teen is critical and finding fault with her. The nurse counsels the mother that: a. the family needs to change its value system to meet the teenagers changing needs. b. the parentteen relationship is important for the teenager and conflicts are to be expected. c. teenagers create psychological distance from the parent to separate from the parent. d. parents need to relinquish their relationship with their teenager to the teens peers. ANS: C The teenager uses critical and fault-finding behavior as a mechanism to separate from the parent and become independent. Changing the familys value system to meet the teenagers needs is not realistic and will result only in the teenagers being critical of the new system. The parentteen relationship is not as important to the teenager as it was in earlier years. Friends and peers become more important. Parents should not relinquish their relationship with their teenager to the teens peers. Maintaining a consistent parental relationship with the adolescent is important. 11. A nurse is teaching adolescent boys about pubertal changes. Which is the first sign of pubertal change seen with boys? a. Testicular enlargement 23 | P a g eb. Facial hair c. Scrotal enlargement d. Voice deepens ANS: A The first sign of pubertal changes in boys is testicular enlargement in response to testosterone secretion, which usually occurs in Tanner stage 2. Slight pubic hair is present and the smooth skin texture of the scrotum is somewhat altered. As testosterone secretion increases, the penis, testes, and scrotum enlarge. During Tanner stages 4 and 5, rising levels of testosterone cause the voice to deepen and facial hair appears at the corners of the upper lip and chin. MULTIPLE RESPONSE 1. Parents of a teenager ask the nurse what signs they should look for if their child is in a gang. The nurse should include which signs when answering? Select all that apply. a. Plans to try out for the debate team at school b. Skips classes to go to the mall c. Hangs out with friends they have had since childhood d. Has an unexplained source of money e. Fears the police ANS: B, D, E Signs of gang involvement include skipping classes, unexplained sources of money, and fear of the police. Associating with new friends while ignoring old friends is another sign, so hanging out with friends they have had since childhood is not a sign of gang involvement. A change in attitude toward participating in activities is another sign of gang involvement. Plans to try out for the debate team at school are not a sign of gang involvement. OTHER 1. Place in order the signs of female sexual maturity beginning with the first sign and ending with the last. Use the following format for your answers: A, B, C, D a. Growth of pubic hair b. Menarche c. Appearance of breast buds 24 | P a g ed. Ovulation is established ANS: C, A, B, D Sexual maturation in girls begins with the appearance of breast buds (thelarche), which is the first sign of ovarian function. Thelarche occurs at approximately age 8 to 11 years and is followed by the growth of pubic hair. Linear growth slows, and menarche begins approximately 1 year after the peak height velocity (PHV). Ovulation occurs with menarche but may or may not accompany the first 2 years of menarche so it is not established until later. Chapter 4. Adolescent Substance Abuse 42. The nurse assessing a typical family with an adolescent child would more often than not find the arguments between caregivers and child to be about: a. adolescent sexuality c. drugs and drug abuse b. ANS: D Feedback Incorrect. The nurse assessing a typical family with an adolescent child would not A find the arguments between caregivers and child to be about adolescent sexuality. Incorrect. The nurse assessing a typical family with an adolescent child would not find the arguments between caregivers and child to be about religion or politics. B Incorrect. The nurse assessing a typical family with an adolescent child would not find the arguments between caregivers and child to be about drugs and drug abuse. 25 | P a g e religion or politics d. ordinary family mattersC D Correct. The nurse assessing a typical family with an adolescent child would more often than not find the arguments between caregivers and child to be about ordinary family matters. Chapter 5. Eating Disorders 1. The nurse is assessing a child admitted to the hospital for abdominal pain. Which of the following findings by the nurse would be typical of those seen in appendicitis? a. b. anorexia, nausea, and vomiting preceded the pain according to the history provided by the caregivers a subnormal temperature for the last 2 days pain that was vague and somewhat localized to the periumbilical area and gradually c. migrated to the right lower quadrant d. ANS: C Feedback Incorrect. Anorexia, nausea, and vomiting preceding the pain according to the history provided by the caregivers is not the typical finding seen in appendicitis. A B 26 | P a g e Incorrect. A subnormal temperature for the last 2 days is not the typical finding seen in appendicitis. night time chills for 1 weekCorrect. Pain that was vague and somewhat localized to the periumbilical area and gradually migrated to the right lower quadrant is the typical finding seen in C D 2.A pediatric client presents to the emergency department with acute abdominal pain followed by anorexia and nausea. The nurse suspects appendicitis. Upon palpation, the nurse anticipates identifying pain localized in which area(s) of the abdomen? Select all that apply. a. b. ANS: B, D Feedback costovertebral angle c. left lower quadrant appendicitis. Incorrect. Night time chills for 1 week is not the typical finding seen in appendicitis. right lower quadrant d. periumbilical area Correct The pain associated with appendicitis typically is localized at the periumbilical area, gradually migrating to the right lower quadrant. The pain associated with appendicitis typically is localized at the periumbilical area, gradually migrating to the right lower quadrant. Incorrect The pain of appendicitis is not associated with discomfort in the costovertebral angle. The pain of appendicitis is not associated with discomfort in the left lower quadrant. 3. The infant with hypertrophic pyloric stenosis will eventually: 27 | P a g ea. b. experience spontaneous recovery in 75% of cases stop eating and go into a life-threatening decline c. d. ANS: C Feedback Incorrect. The infant with hypertrophic pyloric stenosis will not eventually experience spontaneous recovery in 75% of cases. Treatment for pyloric stenosis is a surgical procedure called a pyloromyotomy. A Incorrect. The infant with hypertrophic pyloric stenosis is hungry and wants to be fed again, in spite of feeding and vomiting. B C Correct. The infant with hypertrophic pyloric stenosis will eventually have projectile vomitus propelled up to several feet. Incorrect. Because food does not pass through the pylorus, bowel movements are small. D 4. Which of the following is an early warning sign of hypertrophic pyloric stenosis? a. the infant looking and acting somewhat sick have projectile vomitus propelled up to several feet pass an unusually large bowel movement b. 28 | P a g e the infant being hungry and wanting to feed again very soon after vomitingc. d. ANS: B Feedback Incorrect. The infant with hypertrophic pyloric stenosis does not act or look sick. A B Correct. An early warning sign of hypertrophic pyloric stenosis is the infant being hungry and wanting to be fed again very soon after vomiting. Incorrect. An early warning sign of hypertrophic pyloric stenosis is not milk running out of the infants mouth periodically during the feeding. The infant experiences C vomiting which eventually becomes projectile, being propelled up to several feet. Incorrect. An early warning sign of hypertrophic pyloric stenosis is not unusually D loud burping sounds. 5. Diagnosis of hypertrophic pyloric stenosis can be made on history and what other finding? a. b. epigastric tenderness over several days crying without producing any tears olive-shaped mass in the epigastrium ANS: D Feedback Incorrect. Epigastric tenderness over several days is not a manifestation of hypertrophic pyloric stenosis. A 29 | P a g e milk running out of the infants mouth periodically during the feeding unusually loud burping sounds c. d. failure to gain weightIncorrect. Crying without producing any tears is a sign of dehydration. B Incorrect. Failure to gain weight accompanies hypertrophic pyloric stenosis but is not a diagnostic indicator. C Correct. Diagnosis of hypertrophic pyloric stenosis can be made on history and palpation of an olive-shaped mass in the epigastrium. D 6. Which of the following are appropriate goals in working with a child or adolescent with a diagnosis of anorexia nervosa? Select all that apply. a. b. weight gain to within 5% of ideal body weight within 1 weeks time frame weight gain to within 10% of ideal body weight at a gain of 1-2 pounds per week c. d. eat 100% of a 2,500-calorie diet each day eat a balanced diet with sufficient calories to allow weight gain ANS: B, D Feedback Correct When working with a child or adolescent with anorexia nervosa, appropriate goals include weight gain to within 10% of body weight at 1-2 pounds of weight gain per week. The client should be encouraged to eat a balanced diet with sufficient calories to allow weight gain. 30 | P a g eWeight gain to within 5% of the ideal body weight within 1 weeks time would require rapid weight to be gained too quickly. This rapid weight gain is medically unsafe and may lead to cardiac overload and death. Weight gain should not be too rapid, such as that which would occur with eating 100% of a 2,500-calorie diet daily. Chapter 6. Child and Adolescent Psychiatric Disorders 1. A nurse is assessing a child with a depressive disorder. Which symptom is likely to be manifested by the child? a. Increased nighttime waking b. Impulsivity and distractibility c. Carelessness and inattention to details d. Refusal to leave the house ANS: A Sleep pattern disturbances are often associated with depression. These include insomnia or hypersomnia. Impulsivity and distractibility are manifestations of attention-deficit hyperactivity disorder (ADHD). A diminished ability to think or concentrate, carelessness, and inattention to details are clinical manifestations of a depressive disorder. A refusal to leave the house, even to play with friends, is characteristic of separation anxiety disorder. 2. A nurse is teaching parents about symptoms associated with suicide. Which statement about suicide should the nurse include in the teaching plan? a. Children younger than 10 years of age do not attempt suicide. b. A child who attempts suicide is usually depressed and has low self-esteem. 31 | P a g ec. Suicide is usually an isolated event in a school community. d. The suicide rate among females is higher than among males. ANS: B Poor self-concept and depression contribute significantly to suicidal behaviors. Children as young as 3 years of age who have attempted suicide have been evaluated and found to be cognizant of their actions. It is common for suicide to occur in a cluster within a community (e.g., schools). Males have a higher incidence of both suicide attempts and completed suicides. 3. What is the best response for the nurse to make to an adolescent who states, I am very sad. I wish I wasnt alive.? a. Everyone feels sad once in a while. b. You are just trying to escape your problems. c. Have you told your parents how you feel? d. Have you thought about hurting yourself? ANS: D Have you thought about hurting yourself? acknowledges the adolescents suicide gesture and further assesses the adolescents condition. Everyone feels sad once in a while is a judgmental response that ignores the adolescents obvious statement indicating a need for professional help. The parents should be made aware of an adolescents precarious mental state; however, Have you told your parents how you feel? does not address the adolescents statement. 4. A nurse is teaching parents about family relationship patterns associated with eating disorders. Which family relationship pattern should the nurse teach that is consistent for an adolescent female diagnosed with an eating disorder? a. The adolescent is viewed as an extension of the parent. b. There is an overprotective mother and an emotionally distant father. c. The mother is domineering and the father is passive. d. The adolescent is the youngest child or is an only child. ANS: A 32 | P a g eOne of the most salient factors associated with eating disorders is enmeshed family relationships in which the child is considered to be an extension of the parent or is viewed as a means of meeting the parents needs. The family dynamics for males with anorexia are reported to include a mother who is overinvolved with the child and a father who typifies a strong, cultural image. A domineering mother and passive father are not characteristic of the family dynamics associated with eating disorders. Birth order and number of children in the family were not identified as factors in enmeshed family relationships. 5. The long-term treatment plan for an adolescent with an eating disorder focuses on: a. managing the effects of malnutrition. b. establishing sufficient caloric intake. c. improving family dynamics. d. restructuring the perception of body image. ANS: D The focus of treatment in individual therapy for an eating disorder involves restructuring cognitive perceptions about the individuals body image. The treatment of eating disorders is initially focused on reestablishing physiological homeostasis. Once body systems are stabilized, the next goal of treatment for eating disorders is maintaining adequate caloric intake. Although family therapy is indicated when dysfunctional family relationships exist, the primary focus of therapy for eating disorders is to help the adolescent cope with complex issues. 6. A parent of a child with a psychosocial disorder states, I dont know how my child developed this problem. The nurse should base a response on which information? a. Neurobiological, family, and sociocultural factors can contribute to the development of psychosocial disorders in children. b. Like many conditions affecting children, the etiology of psychosocial disorders is unknown. c. The majority of psychosocial disorders have a clear pattern of genetic inheritance. d. Dysfunctional family patterns are usually identified as the cause of a psychosocial disorder. ANS: A Psychosocial disorders are responses to stress and may be manifested as disturbances in 33 | P a g efeeling, body functions, behavior, or performance. The etiology of many psychosocial disorders in children can be identified. Some psychosocial disorders are inheritable disorders. Others have been identified as having a familial predisposition. Research consistently shows that psychosocial disorders are caused by a combination of predisposing or inherent factors and environmental or interactional factors. 7. A nurse is caring for a child admitted for substance abuse. The nurse plans care with the recognition that substance abuse primarily affects which organ of the body? a. Heart b. Liver c. Brain d. Lungs ANS: C The primary affect of substance abuse is on the brain and residually on the rest of the body. Although an excessive amount of a chemical can cause cardiac abnormalities, the brain is the most commonly affected organ. Long-term alcohol use is known to impair the liver; however, brain function is decreased by any amount of alcohol intake. The pulmonary system is not the primary target; however, one commonly abused drug known to cause pulmonary problems is tobacco. 8. A 14-year-old child admits to using marijuana every day. Which phase of substance abuse should the nurse assess for? a. Experimentation b. Early drug use c. True drug addiction d. Severe drug addiction ANS: C True drug addiction is identified as regular use of drugs. Physical dependence may be present. Social functioning has a drug focus. With experimentation, the individual tries the drug to see what it is like or to satisfy peers. Early drug use is identified as using drugs with some degree of regularity for their desirable effects. In severe drug addiction, the physical condition of the individual deteriorates and all activities are related to drug use. 34 | P a g e9. The school nurse observes an unkempt child dressed in inappropriate clothing who repeatedly asks for food. The nurse is concerned about which problem? a. Physical abuse b. Physical neglect c. Emotional abuse d. Sexual abuse ANS: B These physical and behavioral indicators suggest that parental attention is not being given to the childs physical needs. The child is being neglected. There are no physical indicators of actual abuse in this description. Behavioral indicators of physical abuse reflect an impaired relationship with parents and other adults. Emotional abuse is manifested by developmental problems or maladaptive behaviors. Physical indicators of sexual abuse are focused on the genitourinary system. A variety of behavioral indicators range from bizarre sexual behavior to eating and sleeping disturbances. 10. Which should be the most appropriate nursing intervention for the infant who is not gaining weight? a. Instruct the primary caregiver on proper feeding techniques. b. Observe and document the parentinfant interaction. c. Assign different nurses to care for the infant. d. Feed the infant on a predetermined schedule. ANS: B Observation and documentation of the parentinfant interaction may offer insight into the cause of malnutrition. Instruction alone is not the best teaching strategy. Role modeling and supervised practice along with parental instruction will facilitate the parents learning to feed the infant. A consistent caregiver will facilitate trust in the infant. The infants caloric intake is increased by feeding the infant on demand rather than on a schedule. 11. Which statement made by a parent of a toddler who is not gaining weight indicates the need for education about feeding small children? a. He doesnt want to eat, so I put the cereal in his bottle. 35 | P a g eb. I put him in a high chair for meals and snacks. c. I turn off the television and we eat together for every meal. d. I try to feed him at the same times every day. ANS: A Large quantities of cereal or baby food in bottles do not provide sufficient nutritional intake for the small child. The young child should be placed in a high chair for feeding. Distraction during feedings, such as watching television, is identified as a reason for inadequate nutritional intake in young children. Having the parents or others eat with the child makes meals and snacks a pleasant time. A regular pattern or schedule for meals facilitates nutritional intake. 12. Which intervention should the nurse teach parents about caring for an infant experiencing drug withdrawal? a. Keep rooms in the home well lighted. b. Play music or the television continuously. c. Organize care to minimize disruptions. d. Let the infant calm himself if irritable. ANS: C The infants care should be coordinated to limit the number of times the infant is disturbed. Light levels should be maintained at the minimum necessary level. Sound levels should be kept to the minimum necessary level. Comfort measures should be provided immediately when the infant exhibits irritability. 13. A child who has symptoms of irritable mood and changes in sleep and appetite patterns lasting 3 weeks meets the criteria for which depressive disorder? a. Major depressive disorder b. Dysthymic disorder c. Cyclothymic disorder d. Panic disorder ANS: A A 2-week (or longer) episode of depressed or irritable mood in addition to disturbances in 36 | P a g eappetite, sleep, energy, or self-esteem meets the criteria for a major depressive disorder. A dysthymic disorder is associated with a depressed or irritable mood for at least a year. A cyclothymic or bipolar mood disorder is characterized by chronic, fluctuating mood disturbances between depressive lows and highs for a year. A panic disorder is a type of anxiety disorder. 14. What is the goal of therapeutic management for a child diagnosed with attention-deficit hyperactivity (ADHD) disorder? a. Administer stimulant medications. b. Assess the child for other psychosocial disorders. c. Correct nutritional imbalances. d. Reduce the frequency and intensity of unsocialized behaviors. ANS: D The primary goal of therapeutic management for the child with ADHD is to reduce the intensity and frequency of unsocialized behaviors. Although medications are effective in managing behaviors associated with ADHD, all families do not choose to give their child medication. Administering medication is not the primary goal. Children with ADHD may have other psychosocial or learning problems; h