Review Practice Exercise 3

Health problems in children (infancy to adolescence) > Child Health

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Practice Exercise 3

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Total Questions : 4

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Question 1:

Which of the following conditions may lead to the development of obesity in children? Select all that apply

A. Physical inactivity B. Low socioeconomic status C. Use of food as a positive reinforcement of desired behaviors D. Consumption of energy-dense foods and drinks E. Positive self-esteem

Answer and Explanation

Choice A:

Reduced physical activity decreases energy expenditure, contributing to a positive energy balance and weight gain.

Choice B:

Low socioeconomic status is often associated with limited access to healthy foods, safe play areas, and healthcare, increasing obesity risk.

Choice C:

Use of food as a positive reinforcement of desired behaviors encourages emotional eating patterns and overconsumption of calorie-dense foods.

Choice D:

Consumption of energy-dense foods and drinks, such as high-calorie, nutrient-poor foods and sugar-sweetened beverages contribute significantly to excess caloric intake.R

Choice E:

Positive self-esteem is not a risk factor for childhood obesity. In fact, children with obesity often experience low self-esteem due to stigma and body image concerns.

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Question 2:

Which child should receive further diagnostic testing for chronic abdominal pain? Select all that apply

A. An 11-year-old boy with a 1-month history of generalized periumbilical pain B. An 8-year-old girl with a 1-week history of right lower quadrant pain C. A 12-year-old girl with a 6-week history of constipation D. A 6-year-old boy with a 1-month of diarrhea and a rectal fistula

Answer and Explanation

Choice A:

An 11-year-old boy with a 1-month history of generalized periumbilical pain: This description is a classic presentation of functional abdominal pain. The pain is generalized and centered around the navel, and there are no other "red flag" symptoms like fever, weight loss, or specific location of pain. While it's chronic, lasting over a month, the nature of the pain does not strongly suggest an organic cause.

Choice B:

An 8-year-old girl with a 1-week history of right lower quadrant pain: This is acute rather than chronic abdominal pain; the priority would be to evaluate for acute appendicitis or other emergent causes rather than chronic pain workup.

Choice C:

A 12-year-old girl with a 6-week history of constipation: Constipation lasting several weeks may indicate an underlying gastrointestinal disorder and requires further evaluation.

Choice D:

A 6-year-old boy with 1 month of diarrhea and a rectal fistula: Presence of a rectal fistula is an alarming sign suggestive of Crohn’s disease or other inflammatory bowel disease, necessitating prompt diagnostic workup.

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Question 3:

You are working with a family whose 7-year-old has just been diagnosed with attention-deficit/hyperactivity disorder. Which statements by the mother indicate a need for further teaching? Select all that apply

A. “My child will respond best to verbal instructions, since that will help him learn to pay attention and listen intently.” B. “A consistent schedule for homework and activities will help him be organized.” C. “I need to bring him for routine checkups while he is taking his medication because the medication can affect his appetite and growth.” D. “I am going to ask the principal if my son can change classrooms because his current teacher has too many rules and he seems to get in trouble.” E. “We might consider counseling because this has been stressful for the whole family.”

Answer and Explanation

Choice A:

Children with ADHD often have difficulty sustaining attention during lengthy verbal explanations. They benefit more from short, clear instructions, visual aids, and step-by-step guidance.

Choice B:

Proving the child with a consistent schedule for homework and activities helps him be organized structured routines improve focus and reduce forgetfulness.

Choice C:

Stimulant medications can affect appetite and growth, requiring frequent monitoring of the child’s growth.

Choice D:

Structure and clear rules actually help children with ADHD. Avoiding rules or reducing structure can worsen symptoms.Rationale for incorrect answers:

Choice E:

Family counseling is appropriate and can help with coping strategies, stress reduction, and family support.

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Question 4:

A good understanding of enuresis will help the nurse work with children and their families. Which of the following teaching points should be included? Select all that apply

A. Enuresis is primarily an alteration of neuromuscular bladder functioning and as such is benign and self-limiting. B. Spontaneous remission of nocturnal enuresis occurs in approximately 35% of cases. C. Normal bladder capacity (in ounces) is the child’s age plus 4; therefore normal bladder capacity for a 6-year-old is 10 ounces (600 ml). D. Success has also been achieved with desmopressin acetate nasal spray, which reduces nighttime urinary output to a volume less than functional bladder capacity. E. Parents need reassurance that bed-wetting is not a manifestation of emotional disturbance but just represents willful misbehavior.

Answer and Explanation

Choice A:

Enuresis, particularly nocturnal enuresis (bed-wetting), is often related to a developmental delay in the nervous system's ability to coordinate bladder control during sleep. It is not caused by a serious disease and usually resolves on its own over time.

Choice B:

A significant number of children will stop bed-wetting without any specific intervention, which supports the "self-limiting" aspect of the condition. While the exact percentage can vary slightly in different studies, this figure is a good general approximation.

Choice C:

The formula for estimating normal bladder capacity is indeed a child's age plus 2, not D. So, for a 6-year-old, the approximate bladder capacity is 8 ounces (240 ml). The calculation in the statement is incorrect, as 10 ounces is closer to 300 ml, not 600 ml. This makes the entire statement factually incorrect.

Choice D:

Desmopressin acetate (DDAVP) is a common and effective medical treatment for nocturnal enuresis. It works as an antidiuretic hormone, concentrating urine and decreasing the amount produced by the kidneys at night. This reduces the pressure on the bladder and lowers the likelihood of bed-wetting.

Choice E:

While enuresis is typically not a sign of a serious emotional disturbance, it is not a form of "willful misbehavior." The child is not doing it on purpose. Teaching parents that it's a behavioral issue can lead to punishment, shaming, and emotional distress for the child, which can in turn worsen the enuresis.

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Practice Exercise 3

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