MHVide beck Ch22 NCLEX
NCLEX Chapter 22: Autism spectrum disorder signs in toddlers & vaccine safety concerns. Includes key behaviors, nurse response strategies, and evidence-based practice for pediatric care.
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1. Chapter 22 The nurse is assessing a 16 -month-old child during a well-
baby checkup. Which of the following behaviors would be consistent with
autism spectrum disorder? Select all that apply.
1. A) The child displays little eye contact with others.
2. B) The child thrives on changes in routine.
3. C) The child makes few facial expressions toward others.
4. D) The child does not like repetition.
5. E) The child answers questions verbally.
Ans: A, C, D
Feedback:
Children with autism display little eye contact with and make few facial
expressions toward others; they use limited gestures to communicate. They
have limited capacity to relate to peers or parents. They lack spontaneous
enjoyment express no moods or emotional affect and cannot engage in play
or make-believe with toys. There is little intelligible speech. These children
engage in stereotyped motor behaviors such as hand flapping, body twisting,
or head banging.
2. A mother expresses concern to the nurse that the child's regularly
scheduled vaccines may not be safe. The mother states that she has heard
reports that they cause autism. The most appropriate response by the nurse
is,
1. A) ilt is recommended that you wait until the child is older to
vaccinate.!
2. B) iThere are safer alternative immunizations available now.i
3. C) iThere has been no research to establish a relationship between
vaccines and
autism.i
4. D) iThe risks do not outweigh the benefits of immunization against
childhood
diseases!
Ans: C
baby checkup. Which of the following behaviors would be consistent with
autism spectrum disorder? Select all that apply.
1. A) The child displays little eye contact with others.
2. B) The child thrives on changes in routine.
3. C) The child makes few facial expressions toward others.
4. D) The child does not like repetition.
5. E) The child answers questions verbally.
Ans: A, C, D
Feedback:
Children with autism display little eye contact with and make few facial
expressions toward others; they use limited gestures to communicate. They
have limited capacity to relate to peers or parents. They lack spontaneous
enjoyment express no moods or emotional affect and cannot engage in play
or make-believe with toys. There is little intelligible speech. These children
engage in stereotyped motor behaviors such as hand flapping, body twisting,
or head banging.
2. A mother expresses concern to the nurse that the child's regularly
scheduled vaccines may not be safe. The mother states that she has heard
reports that they cause autism. The most appropriate response by the nurse
is,
1. A) ilt is recommended that you wait until the child is older to
vaccinate.!
2. B) iThere are safer alternative immunizations available now.i
3. C) iThere has been no research to establish a relationship between
vaccines and
autism.i
4. D) iThe risks do not outweigh the benefits of immunization against
childhood
diseases!
Ans: C
Feedback:
The National Institute of Child Health and Human Development, Centers for
Disease control (CDC) and the Academy of Pediatrics have all conducted
research studies for several years and have concluded that there is no
relationship between vaccines and autism and that the MMR vaccine is safe.
Page 1
3. A parent is concerned that his child might suffer from attention deficit
hyperactivity disorder (ADHD). Which of the following behaviors reported by
the parent would be consistent with this diagnosis?
1. A) The child interrupts others.
2. B) The child has been hoarding objects.
3. c) The child has lots of friends.
4. D) The child is excelling academically in school..
Ans: A
Feedback:
By the time the child starts school, symptoms of ADHD begin to interfere
significantly with behavior and performance. He or she cannot listen to
directions or complete tasks. The child interrupts and blurts out answers
before questions are completed. Academic performance suffers because the
child makes hurried, careless mistakes in schoolwork, often loses or forgets
homework assignments, and fails to follow directions. Socially, peers may
ostracize or even ridicule the child for his or her behavior. The child often
loses necessary things.
4. Which of the following symptoms are characteristic of ADHD? Select all
that apply.
1. A) Enuresis
2. B) Inattentiveness
3. C) Encopresis
4. D) Overactivity
5. E) Impulsiveness
The National Institute of Child Health and Human Development, Centers for
Disease control (CDC) and the Academy of Pediatrics have all conducted
research studies for several years and have concluded that there is no
relationship between vaccines and autism and that the MMR vaccine is safe.
Page 1
3. A parent is concerned that his child might suffer from attention deficit
hyperactivity disorder (ADHD). Which of the following behaviors reported by
the parent would be consistent with this diagnosis?
1. A) The child interrupts others.
2. B) The child has been hoarding objects.
3. c) The child has lots of friends.
4. D) The child is excelling academically in school..
Ans: A
Feedback:
By the time the child starts school, symptoms of ADHD begin to interfere
significantly with behavior and performance. He or she cannot listen to
directions or complete tasks. The child interrupts and blurts out answers
before questions are completed. Academic performance suffers because the
child makes hurried, careless mistakes in schoolwork, often loses or forgets
homework assignments, and fails to follow directions. Socially, peers may
ostracize or even ridicule the child for his or her behavior. The child often
loses necessary things.
4. Which of the following symptoms are characteristic of ADHD? Select all
that apply.
1. A) Enuresis
2. B) Inattentiveness
3. C) Encopresis
4. D) Overactivity
5. E) Impulsiveness
Ans: B, D, E
Feedback:
ADHD is characterized by inattentiveness, overactivity, and impulsiveness.
Encopresis is the repeated passage of feces into inappropriate places such
as clothing or the floor by a child who is at least 4 years of age either
chronologically or developmentally. Enuresis is the repeated voiding of urine
during the day or at night into clothing or bed by a child at least 5 years of
age either chronologically or developmentally. Encopresis and enuresis are
elimination disorders that are unrelated to ADHD.
Page 2
5. Which of the following are common coexisting psychiatric disorders for
adults with ADHD? Select all that apply.
1. A) Social phobia
2. B) Bipolar disorder
3. C) Obsessivencompulsive disorder
4. D) Major depression
5. E) Alcohol dependence
Ans: A, B, D, E
Feedback:
Approximately 70% to 75% of adults with ADHD have at least one coexisting
psychiatric diagnosis, with social phobia, bipolar disorder, major depression,
and alcohol dependence being the most common.
6. A nurse asks an assigned client, iHow are you doing today?i The client
responds with idoing today, doing today, doing today.i Which speech pattern
disturbance is this an example of?
1. A) Reactive attachment disorder
2. B) Stereotypic movement disorder
3. C) Selective mutism
4. D) Echolalia
Ans: D
Feedback:
ADHD is characterized by inattentiveness, overactivity, and impulsiveness.
Encopresis is the repeated passage of feces into inappropriate places such
as clothing or the floor by a child who is at least 4 years of age either
chronologically or developmentally. Enuresis is the repeated voiding of urine
during the day or at night into clothing or bed by a child at least 5 years of
age either chronologically or developmentally. Encopresis and enuresis are
elimination disorders that are unrelated to ADHD.
Page 2
5. Which of the following are common coexisting psychiatric disorders for
adults with ADHD? Select all that apply.
1. A) Social phobia
2. B) Bipolar disorder
3. C) Obsessivencompulsive disorder
4. D) Major depression
5. E) Alcohol dependence
Ans: A, B, D, E
Feedback:
Approximately 70% to 75% of adults with ADHD have at least one coexisting
psychiatric diagnosis, with social phobia, bipolar disorder, major depression,
and alcohol dependence being the most common.
6. A nurse asks an assigned client, iHow are you doing today?i The client
responds with idoing today, doing today, doing today.i Which speech pattern
disturbance is this an example of?
1. A) Reactive attachment disorder
2. B) Stereotypic movement disorder
3. C) Selective mutism
4. D) Echolalia
Ans: D
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