adhd nclex
af·flu·ence
the state of having a great deal of money; wealth.
The parents of a school-age child newly diagnosed with attention-deficit/hyperactivity disorder (ADHD) ask why the child needs a physical in addition to examinations made at home and at school. Which response should the nurse make?
Rationale: A physical examination will rule out neurologic diseases and other health problems that may mimic ADHD or affect its treatment. There are no physical characteristics of ADHD that can be found with a physical exam. ADHD is diagnosed from a careful psychosocial history and questionnaires. The nurse is equally as qualified as the healthcare provider to provide strategies to help the client focus. A mental health specialist diagnoses other mental health issues using interviews and questionnaires, not a physical exam.
The school nurse is helping to create an individualized education plan (IEP) for a young client with attention-deficit/hyperactivity disorder (ADHD). Which behavioral goal should the nurse include in the plan of care?
Rationale: An appropriate behavioral goal for the client with ADHD is respecting the boundaries of others. Because the client is a child, it is not appropriate to expect the client to manage medication administration. The client should demonstrate an increase, not decrease, in attentiveness. An appropriate goal is for the client to achieve school performance to maximum potential, not merely minimum competency.
Which is characteristic of attention-deficit/hyperactivity disorder (ADHD)? (Select all that apply.)
Rationale: Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattention, hyperactivity, and impulsivity. Exposure to excess lead can contribute to the development of ADHD. There is a strong link between heredity and the development of ADHD. Thirty to seventy percent of ADHD cases persist into adulthood. Hyperactivity and impulsivity often improve as the client gets older, with inattentiveness becoming the most persistent characteristic in adults. Some children with ADHD have a deficit in dopamine and norepinephrine, not acetylcholine.
The parents state that the behavior of a child with attention-deficit/hyperactivity disorder (ADHD) is creating stress for the environment in their home. Which suggestion should the nurse encourage the parents to consider to minimize this stress? (Select all that apply.)
Rationale: Boundaries and consequences should be set for the child. When the child meets expected behaviors, appropriate rewards such as playing outside or riding a bike for 30 minutes should be allowed to continue to reinforce positive behaviors. Additionally, providing a schedule of activities, meals, and bedtime will provide structure within the home. The child should not listen to music during study time. And the child should not be allowed as many choices as possible because the child needs specific boundaries and expectations.
Which intervention should the nurse teach the parents of a school-age client with attention-deficit/hyperactivity disorder (ADHD)? (Select all that apply.)
Rationale: Children with ADHD do best with structured and consistent routines, which include maintaining a consistent time and routine for bedtime and praising all positive behaviors. Reducing environmental stimuli by turning off the television will also help the child with ADHD. To reduce stimulant abuse, drug holidays during weekends and school breaks, when the child does not take medication, can be discussed with the healthcare provider. Like positive behaviors, all negative behaviors should have consistent consequences, not just the worst ones.
The nurse is teaching the parents of a client with attention-deficit/hyperactivity disorder (ADHD) about the prescribed medication methylphenidate (Ritalin). Which statement from the parents reflects an understanding of the medication regimen?
Rationale: Clients on stimulant medications go on a drug holiday during the summer breaks. Clients who are on stimulant medications can experience insomnia and anorexia; thus, calories would not be restricted. Excessive sleepiness is generally not observed.
The nurse is teaching the parents of a very young client newly diagnosed with attention-deficit/hyperactivity disorder (ADHD) regarding therapeutic interventions. Which intervention should the nurse encourage the parents to implement during study time at home? (Select all that apply.)
Rationale: During study time, the client should have a quiet, clutter-free area to study and complete homework assignments. Giving the child a snack would provide a distraction during study time, so this should happen either before or after study time. Minimizing screen time is an important environmental control that should be implemented. Stimulant medications are administered first thing in the morning, not prior to tasks.
Which intervention should the nurse include in the plan of care for a young client with attention-deficit/hyperactivity disorder (ADHD)? (Select all that apply.)
Rationale: Encouraging therapeutic play, using time-outs, and promoting self-esteem are all appropriate nursing interventions for the young client with ADHD. Environmental stimulation should be minimized, not increased, and consequences for negative behaviors should be consistent, not varied.
The mother of a teenage female client recently diagnosed with attention-deficit/hyperactivity disorder (ADHD) tells the nurse, "Our daughter has a male cousin who has ADHD, but he doesn't act anything like her." Which response should the nurse make to explain the difference?
Rationale: Girls with ADHD tend to show less aggression and impulsiveness than boys with ADHD. However, girls show more anxiety, mood swings, social withdrawal, rejection, and cognitive and language problems. Girls are usually older, not younger, than boys at the time of diagnosis.
Which characteristic is typically seen less in girls, when compared with boys, having attention-deficit/hyperactivity disorder (ADHD)?
Rationale: Girls with ADHD typically show less aggression and impulsiveness than boys. Girls tend to show more anxiety, mood swings, social withdrawal, rejection, and cognitive and language problems.
The nurse is teaching a group of parents about attention-deficit/hyperactivity disorder (ADHD). Which psychosocial history consideration should the nurse include when addressing this group? (Select all that apply.)
Rationale: Hyperactivity, impulsivity, and inattentiveness in the client with ADHD often manifest as excessive talking and interruption of others. Because of these disruptive behaviors, clients with ADHD are also often ostracized by their peer group and have low self-esteem. ADHD can cause difficulty at school and work, so clients are often viewed as underachievers, not overachievers.
The nurse is addressing a group of high-risk teen mothers. Which risk factor that can lead to attention-deficit/hyperactivity disorder (ADHD) in teens should the nurse include in the discussion? (Select all that apply.)
Rationale: Risk factors for ADHD in teens include improper parenting, exposure to high levels of lead, prenatal exposure to alcohol, and poor nutrition. Poverty is an environmental risk factor, not affluence.
The nurse is observing a teen client with attention-deficit/hyperactivity disorder (ADHD) at home. Which observation should indicate to the nurse that client outcomes have been met?
Rationale: Text messaging is an age-appropriate social interaction for the client. While they can be distracting and can cause the client to lose focus, the client did ask permission before responding, which indicates that the client is controlling impulsivity and inattentiveness. An inability to complete tasks and follow directions indicates that client goals have not been met. Excessive talking is another sign that client goals have not been met.
The parents of a young client newly diagnosed with attention-deficit/hyperactivity disorder (ADHD) are concerned about the school environment and the child's grades. Which suggestion should the nurse encourage the parents to discuss with the child's teacher? (Select all that apply.)
Rationale: The child should be placed in the front of the classroom, not in the back of the classroom. A quiet area to take examinations and additional time if necessary would be encouraged. The child should not be called out in front of the class. The child should be allowed to do special tasks or run errands, within reason, to provide additional opportunities for movement.
The nurse is caring for an adolescent client newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). Which nursing diagnosis should the nurse prioritize for this client?
Rationale: The client with ADHD is at increased risk for injury because the impulsivity and inattentiveness seen with this disorder are risk factors for antisocial behavior, substance abuse, and serious accidents. Mobility: Physical, Impaired; Pain, Chronic; and Development: Delayed, Risk for are not appropriate nursing diagnoses for clients with ADHD. (NANDA-I ©2014)
An adult client recently diagnosed with attention-deficit/hyperactivity disorder (ADHD) asks about treatment options. Which treatment option should the nurse recommend?
Rationale: The nonstimulant medication atomoxetine (Strattera) is approved for use in adults. Stimulant medications such as dexmethylphenidate (Focalin) are not approved for use in adults. Environmental modifications that decrease stimulation, such as maintaining a quiet environment and having an orderly work area, are beneficial to clients with ADHD. Having a structured routine is more helpful to clients with ADHD than a loose, flexible schedule.
An adult client with attention-deficit/hyperactivity disorder (ADHD) is being prescribed medication. About which medication should the nurse prepare teaching for this client?
Rationale: The nonstimulant medication atomoxetine (Strattera) is used for children over age 6 years, adolescents, and adults to control the symptoms of ADHD. Stimulants like dextroamphetamine and methylphenidate are approved for use in adults; however, there is a higher risk of adverse effects on the cardiovascular system. There is no information about guanfacine use in adults.
The nurse is teaching the parents of a very young client newly diagnosed with attention-deficit/hyperactivity disorder (ADHD) about the newly prescribed medication methylphenidate (Ritalin). Which instruction should the nurse include?
Rationale: The parents should give the medication first thing in the morning to ensure attentiveness and alertness during the day at school. This medication should not be given at bedtime because it can cause insomnia. The client should be observed for insomnia, rather than excessive sleepiness. Lastly, the client should be encouraged to consume an adequate amount of calories because this medication can also cause anorexia.
A parents group asks the nurse what they should look for if they suspect their school-age child has attention-deficit/hyperactivity disorder (ADHD). Which observation should the nurse instruct the parents to report to their child's healthcare provider (HCP) for further assessment? (Select all that apply.)
Rationale: The required findings for a diagnosis of ADHD are limited attention span, an inability to stay on an assigned task, and excessive motor activity with the inability to sit still for more than a few minutes. Clients with ADHD are frequently labeled as poor achievers with difficulty learning. While many of the behaviors of ADHD in adolescence and adulthood could be considered antisocial, such as destruction of property, this type of behavior would be less likely to occur in a younger child. Both children and adolescents with ADHD sometimes struggle with making and maintaining friends. Next Question
A client with attention-deficit/hyperactivity disorder (ADHD) taking atomoxetine (Strattera) asks about eliminating sugar from the diet and taking ginkgo biloba to control symptoms. Which response should the nurse make about complementary and alternative therapies for ADHD?
Rationale: To date, there is no consistent evidence that elimination diets, dietary supplements, or herbs are effective in treating ADHD. Telling this to the client in a factual, nonjudgmental manner is the best response. The nurse does not have the authority to change the client's treatment regimen without approval from the healthcare provider, even if the nurse tells the client to tell the provider about the change. Neither suggesting a new medication nor minimizing the client's concerns addresses the client's interest in alternative therapies, and they do not acknowledge the client's concerns.