ADN Level 3 Test 6: HUMAN DEVELOP (Developmental Delay, ADHD, Autism, Aging, Menopause), MOOD & AFFECT (Bipolar Disorder, Major Depressive Disorder, Postpartum Depression, Suicide), SEXUALITY, QI, HIT

Identify six intervention strategies one might use for an 8 y/o boy in the 3rd grade who has been diagnosed with ADHD.

1. Addressing problematic behavior through a reward system. 2. Family counseling 3. Special education programs for academic difficulties 4. Cognitive-behavioral therapy 5. Play therapy for younger children 6. Recreation and/or art therapy for older children or teens

A nurse is reviewing methods of home behavior modification that a mother uses for her 7-yearold daughter who has ADHD when she invites other children in the home for group play. Which of the following statements by the mother indicates a need for clarification? A. "I will use a calm, firm, respectful manner with my daughter." B. "I will plan quiet, low-energy activities such as painting with watercolors." C. "I'll let my daughter plan her activities for the day." D. "I'll give my daughter positive comments about appropriate behavior."

A - Children with ADHD do better with activities that involve physical exertion and energy expenditure.

A community health nurse conducts a suicide prevention program at a high school. The nurse discusses high-risk groups for suicide. The nurse knows that additional teaching is necessary if students from the group verbalize which? a) "people grieving a loss for 9 months are at risk." b) "history of previous suicide attempts put people at risk." c) "depressed people are at risk to commit suicide" d) "adolescents are at risk to commit suicide"

A - Grief is a normal human response that occurs in response to loss. The entire grieving process may take up to 3 years. c - signs of depression include low self-esteem, feelings of helplessness/hopelessness, sense of doom or failure. patients at rest are at risk to commit suicide. d - males over 50 and adolescents ages 15-19 are at risk

A nurse is caring for a client scheduled for electroconvulsive therapy. The client is anxious. Which action by the nurse is most correct? a) remain with the client to discuss his fears b) give lorazepam (Ativan) 1mg IM c) encourage the client to listen to relaxation tapes d) offer the client a cup of coffee

A - Talking to the client will convey acceptance of client and allowing the client to discuss his fears may decrease anxiety b - this may be used if level of anxiety is severe. more important for client to develop coping strategies c - nurse should remain with the client d - this client is NPO. Coffee is a stimulant that might exacerbate anxiety

When a nurse assesses the style of behavior a child habitually uses to cope with the demands and expectations of the environment, he or she is assessing a) temperament. b) resilience. c) vulnerability. d) cultural assimilation.

A - Temperament is the behavior the child habitually uses to cope with the environment. It is a constitutional factor thought to be genetically determined. It may be modified by the parent-child relationship

A 3-year-old has been diagnosed with autism. While there is an absence of language, the child does babble but is indifferent to contact with people. The nurse's initial intervention will be to A) give one-to-one attention in nonverbal parallel play. B) sit next to the child while looking at a picture book. C) feed the child snacks while talking softly. D) sit across from the child at the play table and introduce new toys.

A - The nurse should enter the child's world in a nonthreatening manner to establish trust before beginning to verbalize or engage in more intrusive attempts at play.

A child diagnosed with ADHD is reprimanded for taking the nurse's pen without asking first. He reponds by shouting, "You don't like me! You won't let me have anything, even a pen!" The nurse is most therapeutic when responding, a) "I do like you, but I don't like it when you grab my pen." Correct b) "Liking you has nothing to do with whether I will loan you my pen." c) "It sounds as though you are feeling helpless and insecure." d) "You must ask for permission before taking someone else's things.

A - This reply shows positive regard for the child while describing the behavior as undesirable. Feedback such as this helps the child feel accepted while making her aware of the effect her behavior has on others.

A nurse on the psychiatric unit finds a client crying. The client says, "Go away because you cannot help me. I hate you, and I hate myself." Which response is best? a) "you seem to be in pain, so I will stay with you." b) "it's difficult for me to communicate with you when you talk this way." c) "i'll come back later when you are in a better mood." d) "why is it that you don't like me?"

A - this statement conveys support and understanding; depressed clients frequently have anger which is displaced inwardly b - don't focus on the nurse c - don't leave the client alone d - DON'T ASK "WHY" QUESTIONS!!!!

no-suicide contract

A contract made between a nurse or counselor and a patient, outlined in clear and simple language, in which the patient states that he or she will not attempt self-harm and in which specific alternatives are given for the person instead

The family of a child diagnosed with ADHD, inattentive type, is told the evaluation of their child's care will focus on symptom patterns and severity. The focus of evaluation will be (select all that apply) a) academic performance. b) activities of daily living. c) physical growth. d) social relationships. e) personal perception.

A, B, D, and E. For the family and child with ADHD, evaluation will focus on the symptom patterns and severity. For those with ADHD, inattentive type, the focus of evaluation will be academic performance, activities of daily living, social relationships, and personal perception. For those with ADHD, hyperactive-impulsive type or combined type, the focus will be on both academic and behavioral responses.

Kevin is a 7-year-old who was recently diagnosed as having ADHD. He is taking methylphenidate (Ritalin) to help him cope with the symptoms of the disorder. As the school nurse, you are assisting in planning his care. 4. Which of the following best indicates to you that the time of Kevin's methylphenidate administration may need to be adjusted? A. Kevin has not eaten his lunch in several days, stating, "I'm just not hungry." B. Kevin's math grade has risen from 62% to 82% since the beginning of the school year. C. According to Kevin's mother, he has been sleeping well every night. D. At noon recess, Kevin has been socializing effectively with his peers

ANSWER = A A- A possible side effect of methylphenidate is anorexia. b - The desired effect of methylphenidate is to assist the child in self-regulating his behaviors that may be counterproductive to effective problem solving and socialization. Better grades in school are an indication that the medication is providing the desired effect. c - Sleeplessness is a possible side effect of methylphenidate. A child that is sleeping well through the night is not displaying evidence of this side effect. d - Effective socialization is an indication that the medication is providing the desired effect, assisting the child in self-regulating his behaviors that may be counterproductive to effective problem solving and socialization.

The client admitted to the psychiatric unit for major depressive disorder with an attempted suicide is prescribed an antidepressant medication. Which interventions should the psychiatric nurse implement? Select all that apply. a) assess the client's apical pulse and blood pressure b) check the client's serum antidepressant level c) monitor the client's liver function status d) provide for and ensure the client's safety e) evaluate the effectiveness of the medication

ANSWER = A, C, E. A - Antidepressant medications may cause orthostatic hypotension, and the nurse should question administering the medication if the blood pressure is less than 90/60. C - Many antidepressants may cause hepatotoxicity; therefore, the nurse should monitor the client's liver function tests D - The nurse should ensure the client's safety. Many antidepressants may cause orthostatic hypotension and increase the risk for dizziness, falls, and injuries. b - Antidepressant meds do NOT have a therapeutic level; the effectiveness and side effects of the med are determined by the client's behavior e - Antidepressant meds take at LEAST 3 weeks to become effective; therefore, when the client is first admitted to the psychiatric department and prescribed an antidepressant, evaluating for the effectiveness of the medication is not an appropriate intervention.

The client diagnosed with pneumonia is admitted to the medical unit. The nurse notes the client is taking an antidepressant medication. Which data best indicate the antidepressant therapy is effective?" a) the client reports a "2" on a 1-10 scale, with 10 being very depressed b) the client reports not feeling very depressed today c) the client gets out of bed and completes activities of daily living d) the client eats 90% of all meals that are served during the shift

ANSWER = A. Depression is SUBJECTIVE and the nurse does not know this client; therefore, asking the client to rate the depression on a scale best indicates the effectiveness of the medication. Any subjective data can be put on a scale to make it objective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed. b - This is a very vague statement and it is not objective; therefore, it is not the best indicator of effectiveness of the medication. c - completing ADLs indicates the client is not severely depressed, but it does not objectively support that the client's antidepressant medication is effective. d - Consuming 90% of the food may indicate the client is not depressed, but the nurse does not know how the client eats when severely depressed. Therefore, it is not the best indicator of the medication's effectiveness

The client with major depressive disorder is suicidal. The client was prescribed the tricyclic antidepressant imipramine (Tofranil) 3 weeks ago. Which priority intervention should the nurse implement? a) determine if the client has a plan to commit suicide b) assess if the client is sleeping better at night c) ask the family if the client still wants to kill himself or herself d) observe the client for signs of wanting to commit suicide

ANSWER = A. The nurse should ask if the client has a plan to commit suicide. As the client begins to recover from both psychological and physical depression, the client's energy level increases, making the client more prone to commit suicide during this time. It takes 2-6 weeks for therapeutic effects of tricyclic antidepressants to be effective. b - As the depression gets better, the client will start sleeping better, which indicates the medication is effective, but this is not a priority intervention because the client is suicidal. c - The family is an excellent resource to determine how the client is tolerating the medication, but the nurse should ask the client DIRECTLY, not the family members, if he or she has thoughts of suicide. d - If the client seriously wants to commit suicide, usually the client will NOT show OBJECTIVE signs of wanting to kill themselves.The nurse must DIRECTLY ASK the CLIENT if he or she has a plan to commit suicide.

Autism is a complex developmental disorder. Diagnostic criteria for autism include delayed or abnormal functioning in which area(s) before 3 years of age? (Select all that apply.) A) Parallel play B) Social interaction C) Gross motor development D) Inability to maintain eye contact E) Language as used in social communication

ANSWER = B, D, E Children diagnosed with autism show delayed or abnormal functioning in social interactions. A hallmark characteristic of autism is the child's inability to make and maintain eye contact. A characteristic of autism is the child's delay of language at an early age or the sudden deterioration in extant expressive speech. Parallel play is not an area in which autistic children may show delay. When interacting with other children in other forms of play they display functional limitations. Gross motor development is not an area in which autistic children show delayed or abnormal functioning.

The client with major depressive disorder is prescribed nefazodone (Serzone), an atypical antidepressant. The client tells the nurse, "I am going to take my medication at night instead of in the morning." Which statement would be the nurse's best response? a) "You really should take the medication in the morning for the best results." b) "It is all right to take the medication at night. It may help you sleep at night." c) "The medication should be taken with food so you should not take it at night." d) "Have you discussed taking the medication at night with your psychiatrist?"

ANSWER = B. Antidepressants may cause central nervous depression, which causes drowsiness. Therefore, taking the medication at night may help the client sleep at night and relieve daytime sedation. This is the nurse's best response. a - This medication does not need to be taken in the morning to be more effective. c - Antidepressants do not need to be taken with food because they do not cause gastrointestinal distress. d - The nurse can provide factual information to the client without contacting the HCP. Taking antidepressants at night is not contraindicated; therefore, the nurse can share this information with the client.

The client diagnosed with major depression who attempted suicide is being discharged from the psychiatric facility after a 2-week stay. Which discharge intervention is most important for the nurse to implement? a) provide the family with the phone number to call if the client needs assistance b) encourage the client to keep all follow-up appointments with the psychiatric clinic c) ensure the client has no more than a 7-day supply of antidepressants d) instruct the client not to take any over-the-counter medications without consulting with the HCP.

ANSWER = C. Ensuring the psychological and physiological safety of the client is priority. As antidepressant meds become more effective, the client is at a higher risk for suicide. Therefore, the nurse should ensure that the client cannot take an overdose of medication. All of the other answer choices are important interventions but they do not take priority over the psychological and physiological safety of the client.

The client diagnosed with a major depressive disorder asks the nurse, "Why did my psychiatrist prescribe an SSRI medication rather than one of the other types of antidepressants?" Which statement by the nurse would be most appropriate? a) "Probably because it is the medication that your insurance will pay for." b) "You should ask your psychiatrist why the SSRI was ordered." c) "SSRIs have fewer side effects than the other classifications." d) "The SSRI medications work faster than the other medications."

ANSWER = C. SSRIs have the same EFFICACY as MAO inhibitors and tricyclics, but SSRIs are safer because they do not have the sympathomimetic effects (tachycardia and HTN) and anticholinergic effects (dry mouth, blurred vision, urinary retention, and constipation) of the MAO inhibitors and tricyclics. a - The cost of the medication or the type of insurance should not be a reason why one med is prescribed over another. b - This is passing the buck, and the psych nurse should be knowledgeable about medications. d - ALL antidepressant meds take at least 14-21 days to become effective

Kevin is a 7-year-old who was recently diagnosed as having ADHD. He is taking methylphenidate (Ritalin) to help him cope with the symptoms of the disorder. As the school nurse, you are assisting in planning his care. Kevin's mother states that Kevin has difficulty remembering to complete tasks, such as brushing his teeth, putting dirty clothes in his hamper, and feeding his dog. Which of the following would be the most appropriate suggestion based on his developmental stage and diagnosis? a) Give Kevin a small amount of money every time he remembers to follow through on a task. b) Punish Kevin by placing him in "time out" each time he forgets to complete his assigned chores. c) Take away some of Kevin's privileges whenever he does not complete his chores. d) Suggest they make a chart to collect sticker tokens for task completion, which can then be traded in for special privileges.

ANSWER = D a - The school-age child has the cognitive ability to reason. Disciplinary techniques for the school-age child and the child with ADHD should help him control his behavior. A reward following desired events does not help the child inhibit an undesirable behavior such as forgetfulness. b - A disciplinary goal for the school-age child is to provide some reason, understandable to the child, that explains why one action is inappropriate and another action is more desirable. Behavioral modification techniques alone, such as "time out," do not take advantage of the child's cognitive ability to reason and prevent future undesirable behaviors. c - The child with ADHD requires a more highly structured environment than most children in order to foster improved organizational skills. Withholding privileges alone does not modify the environment, which is needed to help the child make more appropriate choices in the future. d - Activity charts can foster improved organization skills by structuring the environment and providing a constant reminder for the easily distracted child with ADHD.

The client diagnosed with depression is prescribed phenelzine (Nardil), a monoamine oxidase (MAO) inhibitor. Which statement by the client indicates to the nurse the medication teaching is effective? a) "I am taking the herb ginseng to help my attention span." b) "I drink extra fluids, especially coffee and iced tea." c) "I am eating three well-balanced meals a day." d) "At a family cookout I had chicken instead of a hotdog."

ANSWER = D. Taking MAO inhibitors requires adherence to strict dietary restrictions concerning tyramine-containing foods, such as processed meat (hot dogs, bologna, and salami), yeast products, beer, and red wines. Eating these foods can cause a life-threatening hypertensive crisis. a - The client should use herbs cautiously because ginseng causes headaches, tremors, mania, insomnia, irritability, and visual hallucinations. b - The client should refrain from drinking too many beverages containing caffeine. c - Eating 3 balanced meals a day is not information that the nurse would teach about MAO inhibitors.

The client with major depressive disorder has been taking amitriptyline (Elavil), a tricyclic antidepressant, for more than 1 year. The client tells the psychiatric clinic nurse that the client wants to quit taking the antidepressant. Which intervention is most important for the nurse to discuss with the client? a) ask questions to determine if the client is still depressed b) ask the client why he or she wants to stop taking the medication b) tell the client to notify the HCP before stopping the medication d) explain the importance of tapering off the medication

ANSWER = D. The client must FIRST know the importance of needing to taper off the medication because rebound dysphoria, irritability, or sleepiness may occur if the medication is discontinued abruptly. THEN the client should see the HCP to determine what action should be taken because the client doesn't want to take the medication. a - The nurse should discuss what behavior led to the client being prescribed antidepressants and determine if the client is still depressed, but the most important thing to discuss with the client is that the antidepressant medication should not be discontinued abruptly. b - The nurse should discuss why the client wants to stop taking the medication, but the most important intervention is to teach the client that the medication must be tapered. The client could quit taking medication without telling an HCP, therefore, teaching safety is priority. c - The client should notify the HCP BEFORE stopping the medication, but the most important intervention is to keep the client safe and inform the client to taper off the med.

Kevin is a 7-year-old who was recently diagnosed as having ADHD. He is taking methylphenidate (Ritalin) to help him cope with the symptoms of the disorder. As the school nurse, you are assisting in planning his care. Which of the following statements by Kevin's mother best indicates an accurate understanding of the treatment that has been planned for Kevin? A. "Kevin's medication, plus decreasing his environmental stimuli, will help him control his behavior." B. "If I can keep Kevin on a special restricted diet, he will outgrow his ADHD in 5 to 8 years." C. "Kevin's medication will make him behave appropriately and like other kids his age." D. "I am already looking forward to Kevin's puberty, when his bothersome symptoms will disappear."

Answer = A A. Management of the child with ADHD involves a multiple approach including family education and counseling, medication, proper classroom placement, environmental manipulation, and sometimes psychotherapy for the child. B. Diet modification is not often seen as a treatment option. C. Medication is prescribed to assist the child in self-regulating his or her behaviors that may be counterproductive to effective problem solving and socialization. Additional therapeutic approaches, however, are required for the management of the child with ADHD. D. ADHD is unpredictable and may remit spontaneously at any age. The number of years a child will require treatment is unknown.

Kevin is a 7-year-old who was recently diagnosed as having ADHD. He is taking methylphenidate (Ritalin) to help him cope with the symptoms of the disorder. As the school nurse, you are assisting in planning his care. While talking with you (the school nurse), Kevin's mother states, "I feel like I caused Kevin's problems." Which response would be most appropriate? a) "You shouldn't feel that way. No one really knows what causes ADHD." b) "There's no reason to feel that way. Most experts feel there is no connection between heredity or parenting skills and ADHD." c) "Sometimes parents feel that way. I can give you information about a support group for parents of children with ADHD." d) "It may be true that ADHD is inherited, but there is nothing you can do about that now."

Answer = C a - The cause of ADHD is uncertain; parents need information about the disorder and its effects to better understand the program of therapy. This statement does not validate the mother's feelings nor does it provide the mother with information to help her understand ADHD; therefore, this is not an example of therapeutic communication. b - Experts have theories regarding the etiology of ADHD that may include sex chromosome abnormalities. This statement does not validate the mother's feelings nor does it provide the mother with information to help her understand ADHD; therefore, this is not an example of therapeutic communication. c - This statement validates the mother's feelings and provides her with information that will help her learn more about the disorder. This is an example of therapeutic communication. d - Parents need information that will help them understand ADHD and its management. This statement does not provide the mother with information that will help her cope with the diagnosis and is therefore, not an example of therapeutic communication.

Describe the concept of time-out and how it could be used therapeutically with an 8 y/o boy in the 3rd grade who has been diagnosed with ADHD.

Asking a child or adolescent to take a time-out from an activity is a method for intervening to stop disruptive behaviors or assist the child in developing self-control. Taking a time-out may require going to a designated room or sitting on the periphery of an activity until self-control is regained and the episode is reviewed with a staff member. The child's individual behavioral goals are considered in setting limits on behavior and using time-out periods. If they are overused or used as an automatic response to a behavioral infraction, time-outs lose their effectiveness.

A child diagnosed with autism will demonstrate impaired development in a) adhering to routines. b) playing with other children. c) swallowing and chewing. d) eye-hand coordination.

B - Autism affects the normal development of the brain in social interaction and communication skills. Symptoms associated with autism spectrum disorders include significant deficits in social relatedness, including communication, nonverbal behavior, and age-appropriate interaction.

A nurse is evaluating the response of a client to 2-weeks of electroconvulsive therapy (ECT). Which is a sign that the treatment was effective? a) the client no longer displays dramatic overreaction to minor events b) the client is no longer mute and withdrawn c) the client no longer spends time counting objects out loud d) the client no longer experiences phobias and panic-level anxiety

B - ECT is effective for severe depression and catatonic conditions after medications have failed or when the patient is suicidal. ECT is not effective for anxiety disorders, OCD behaviors, or histrionic disorder.

Taylor is a 3-year-old boy just diagnosed with autism spectrum disorder. Taylor's mom is tearful and states, "Dr. Coolidge said we need to start therapy right away. I just don't understand how helpful it will be—he's only 3 years old!" Your best response, based on knowledge of autism treatment, is: A) "You are right, 3 years old is very young to start therapy, but it will make you feel better to be doing something." B) "Starting him on treatment now gives Taylor a much greater chance for a productive life." C) "If Taylor starts therapy now, he will be able to stop therapy sooner." D) "If you have questions, its best to ask Dr. Coolidge."

B - Early intervention for children with autism can greatly enhance their potential for a full, productive life. 3 years old is not too young to start therapy since the sooner therapy is started the better the outcome. The patient will most likely not be able to stop therapy as interventions will continue indefinitely. Telling the mother to ask her provider abdicates the nurse's responsibility to provide education to patients and families.

An appropriate intervention for a 12-year-old child demonstrating faulty personality development associated with ADHD would include a) regular entries into a personal sleep hygiene journal. b) enrollment in family and individual group therapies. Correct c) involvement in family menu planning and food shopping. d) after school tutoring to help maintain passing grades.

B - Interventions for patients with ADHD focus on correcting the faulty personality (ego and superego) development. Treatment may include hospitalization for those who present an imminent danger to self or others, but predominantly on an outpatient basis, using individual, group, and family therapy, with an emphasis on parenting issues.

The client with a major depressive disorder taking the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) calls the psychiatric clinic and reports feeling confused and restless and having an elevated temperature. Which action should the psychiatric nurse take? a) determine if the client has flulike symptoms b) instruct the client to stop taking the SSRI c) recommend the client take the medication at night d) explain that these are expected side effects

B - Serotonin Syndrome is a serious complication of SSRIs that produces mental changes (confusion, anxiety, and restlessness), HTN, tremors, sweating, hyperpyrexia (elevated temp), and ataxia Conservative treatment includes stopping the SSRI and supportive treatment. If untreated, ESE can lead to death.

A nursing diagnosis that should be considered for a child with attention deficit hyperactivity disorder is a) anxiety. b) risk for injury. c) defensive coping. d) impaired verbal communication.

B - The child's marked hyperactivity puts him or her at risk for injury from falls, bumping into objects, impulsively operating equipment, pulling heavy objects off shelves, and so forth.

A 7-year-old who is described as impulsive and hyperactive, tells the nurse, "I am a dummy, because I don't pay attention, and I can't read like the other kids." The nurse notes that these behaviors are most consistent with the DSM-5 diagnosis of a) attention deficit disorder. b) attention deficit hyperactivity disorder. c) autism. d) conduct disorder

B - The data are most consistent with attention deficit hyperactivity disorder (ADHD) as described in the DSM-5 .

A nurse at a mental health center screens new members for a depression support group. Which client would NOT benefit from participation in this group? a) a young male with 2 children whose wife died 1 year ago because of breast cancer b) a middle-aged female who started drinking after the sudden death of her husband 6 months ago c) an elderly female whose husband died 3 years ago in a car accident d) an elderly male whose estranged wife, living in another state, died from heart disease 3 months ago

B - a patient with alcoholism needs assistance with her drinking problem first in order to resolve grief

A client was hospitalized for 1 week with major depression with suicidal ideation. He is taking venlafaxine (Effexor), 75 mg three times a day, and is planning to return to work. The nurse asks the client if he is experiencing thoughts of self-harm. The client responds, "I hardly think about it anymore and wouldn't do anything to hurt myself." The nurse should make which judgment about the client? a) The client is decompensating and in need of being readmitted to the hospital. b) The client needs an adjustment or increase in his dose of antidepressant. c) The depression is improving and the suicidal ideation is lessening. d) The presence of suicidal ideation warrants a telephone call to the client's primary care provider.

C - The client's statements about being in control of his behavior and his or her plans to return to work indicate an improvement in depression and that suicidal ideation, although present, is decreasing. Nothing in his comments or behavior indicate he is decompensating. There is no evidence to support an increase or adjustment in the dose of Effexor or a call to the primary care provider. Typically, the cognitive components of depression are the last symptoms eliminated. For the client to be experiencing some suicidal ideation in the second week of psychopharmacologic treatment is not unusual.

A nurse is visiting an elderly client with depression. The client's daughter says that it is difficult for her mother to complete activities of daily living, which should the nurse suggest? a) provide frequent forceful directions to keep the client focused on the activities b) assist the client with all grooming activities c) write a schedule of activities and allow extra time for the client to complete the activities d) medicate the client before beginning activities

C - a schedule will communicate to client what is expected and then gives her the time to accomplish her tasks. depression causes decreased attention span and difficulty concentrating a - communicating clear expectations and giving client time to complete activities are more useful b - maintain client's independence by allowing her time to complete activities d - will not increase client's independence

When assessing an elderly client, the nurse expects to find various aging-related physiologic changes. These changes include: a) increased coronary artery blood flow. b) decreased posterior thoracic curve. c) decreased peripheral resistance. d) delayed gastric emptying.

D - Aging-related physiologic changes include delayed gastric emptying, decreased coronary artery blood flow, an increased posterior thoracic curve, and increased peripheral resistance.

A nurse admits a client with bipolar disorder. Which assessment requires immediate attention by the nurse? a) the client believes she has a lot of money and power b) the client is not wearing a bra c) the client has been pacing the hallway for 15 minutes d) the client has not eaten breakfast or lunch

D - Inadequate food intake must be addressed immediately. A patient diagnosed with bipolar disorder has poor judgment, which may cause dehydration and malnutrition. a- delusions of grandeur; do not argue or try to convince client they are not real b - this may indicate lack of inhibition. Priority is offering food and fluids c - indicative of mania. other indications include talking excessively, joking, easily stimulated by environment; encourage fluids and give client high-calorie finger foods

An adjustment in the medication dosage prescribed for a child diagnosed with attention deficit hyperactivity disorder (ADHD) is most likely when the child a) engages in strenuous exercise. b) is challenged to learn new cognitive material. c) experiences a loss. d) has a growth spurt.

D - Medication adjustments may be required once the child has stabilized on a pharmacotherapy regimen; however, they tend to be infrequent and are often associated with the child's physical growth and development.

A 10-year-old who is frequently disruptive in the classroom, begins to fidget in her chair and then moves on to disruptive behavior. A possible technique for managing this sort of disruptive behavior is a) therapeutic holding. b) seclusion. c) quiet room. d) touch control

D - The appropriate adult can move closer to the child and place a hand on her arm or an arm around her shoulder for a calming effect when the fidgeting is first noted. The closeness signals the child to use self-control. It is the least restrictive treatment approach and should be tried initially.

When preparing to assess a 4-year-old child to help rule out a neurodevelopmental disorder, the nurse bases interventions on the understanding that a) children of that age are very resilient. b) age make these children poor interviewees. c) poor cooperation is typical at that age. d) language skills are limited at that age.

D - Younger children are more difficult to diagnose than older children because of their limited language skills and cognitive and emotional development.

A nurse is admitting a client with depression to the psychiatric unit. It is most important for the nurse to take which action? a) ask the client to choose activities in which to participate b) introduce the client to the nursing staff c) explain all of the activities available to the client d) give the client an orientation to the unit

D - the nurse should explain information clearly and avoid long, complex explanations because a depressed patient may have slowed thinking processes a - avoid giving choices. important to provide a structured written schedule b - do not overwhelm the client. important to provide consistent daily care with the same nurse if possible c - would overwhelm the client

Name at least three realistic outcomes for a child with ASD

Follows simple rules of interactive games with peers Directs messages appropriately Expresses emotions during play activities

Which interventions do you think are the most important for a child with ASD? Identify at least six.

General nursing interventions include: 1. Explore the impact of the child's behaviors on family life and of the other members' behavior on the child. 2. Assist the immediate and extended family to access available and supportive individuals and systems. 3. Discuss how to make home a safe environment. 4. Discuss realistic behavioral goals and how to set them. 5. Solve potential problems. 6. Role-play responses to problem situations that could arise with their child. 7. Give support and encouragement as parents learn to apply new techniques. 8. Teach the parents with about medications.

Joe is an 8-year-old boy in the third grade who has been diagnosed with attention deficit hyperactivity disorder (ADHD). What clinical behaviors could he be exhibiting at home and in the classroom? Give behavioral examples for his (1) inattention, (2) hyperactivity, and (3) impulsivity.

Inattention: Has difficulty paying attention during tasks (especially those requiring sustained attention) or play, even if they are enjoyable activities Has difficulty listening, even with prompts and redirection Is easily distracted, loses things, and is forgetful in daily activities Hyperactivity: Fidgets, climbs, is unable to sit still or play quietly Does not pay attention to social cues Acts as if "driven by a motor" and constantly "on the go" Talks excessively Impulsivity: Blurts out answers before the question has been completed Has difficulty waiting for own turn or being patient Interrupts, intrudes in others' conversations and games

The use of this antidepressant necessitates the adoption of a tyramine-free diet because of potentially fatal interactions

Monoamine oxidase inhibitors (MAOIs)

What kinds of support should the family of a child diagnosed with autism spectrum disorder (ASD) receive?

Refer parents or caregivers to a local self-help group. Advocate with the educational system if special education services are needed.

What are the normal developmental milestones for a 6-year-old child?

Socially, 6-year-olds begin to: Demonstrate more independence from parents and family. Think about the future. Understand more about their place in the world. Pay attention to friendships and teamwork. Wish to be liked and accepted by friends. Intellectually, 6-year-olds begin to: Undergo rapid development of mental skills. Use better ways to describe experiences and talk about thoughts and feelings. Focus on themselves and show more concern for others.

positive reinforcement

The presentation of a reward immediately following a behavior, making the behavior more likely to occur in the future

Chris, a 5-year-old boy, has been diagnosed with autism spectrum disorder (ASD). Describe the specific behavioral data you would find on assessment in terms of (1) communication, (2) social interactions, and (3) behaviors and activities.

While ASD symptoms vary depending on the severity of the illness (it may range from mild to severe), you may find deficits in the following areas: Communication: Language delay Repetitive use of words Failure to imitate others' activities or words Social interactions: Lack of responsiveness to social interactions Limited eye contact or facial expressions Indifference to affection Inability to share enjoyment with others Failure to develop friendships with peers Behaviors and activities: Rigid adherence to rituals, with catastrophic reaction to change Repetitive motor mannerisms Preoccupation with repetitive activities

One of three phases in bipolar disorder in which individuals are at risk for injury due to alterations in self-control, sleep, hydration, and nutrition

acute phase

Drugs commonly used to treat epilepsy that suppress the rapid and excessive firing of neurons and are used as mood stabilizers

anticonvulsant drugs

Individuals with this disorder show an inappropriate degree of inattention, impulsiveness, and hyperactivity before the age of 12

attention deficit hyperactivity disorder

Complex neurobiological and developmental disabilities that typically appear during a child's first 3 years of life

autism spectrum disorders

A mood disorder that is characterized by at least one week-long manic episode that results in excessive activity and energy

bipolar I disorder

Hypomanic episodes alternate with major depression in this type of bipolar disorder

bipolar II disorder

The meaningless rhyming of words, often in a forceful manner

clang association

Disorders that occur at the same time as the psychiatric disorder and may be associated with the disorder

co-occuring disorders

An evidence-based therapeutic modality for children, adolescents, and adults that seeks to identify negative and irrational patterns of thought and challenge them based on rational evidence and thoughts

cognitive-behavioral therapy (CBT)

A condition that occurs along with another disorder

comorbid condition

Suicide attempts that result in death

completed suicides

Children with autism spectrum disorders are referred to these programs once communication and behavioral symptoms are identified, typically in the second or third year of life

early intervention programs

An effective treatment for depression in which a grand mal seizure is induced by passing an electrical current through electrodes that are applied to the temples

electroconvulsive therapy (ECT)

Rapidly moving from one emotional extreme to another

emotional lability

The ability of one person to get inside another's world, see things from the other person's perspective, and communicate this understanding to the other person

empathy

Refers to decreased erectile turgidity on 75% of sexual occasions

erectile disorder

Refers to failure to obtain and maintain an erection sufficient for sexual activity

erectile disorder

In this type of mania, individuals initially feel wonderful; however, feelings turn scary and dark as the mania progresses toward loss of control and confusion

euphoric mania (occurs in bipolar disorder)

A variety of signs and symptoms that are often side effects of the use of certain psychotropic drugs, particularly phenothiazines

extrapyramidal side effects (EPSs)

Characterized by emotional distress caused by absent or reduced interest in sexual fantasies, sexual activity, pleasure, and arousal

female sexual interest/arousal disorder

A continuous flow of speech in which the person jumps rapidly from one topic to another

flight of ideas

A person's feelings of unease about his maleness or her femaleness

gender dysphoria

The sense of maleness or femaleness

gender identity

Exaggerated belief in or claims about one's importance or identity

grandiosity

A person in this type of mania does not experience impairment in reality testing, nor do the symptoms markedly impair the person's social, occupational, or interpersonal functions

hypomania

An elevated mood with symptoms less severe than those of mania

hypomania

Admission to a psychiatric facility without a patient's consent

involuntary admission

The relative deadliness of a chosen suicide method

lethality

A mood stabilizer used in the treatment of bipolar disorder. It is a positively charged ion similar to sodium, and it may stabilize electrical activity in the brain

lithium

Known as an antimanic drug because it can stabilize the manic phase of a bipolar disorder. When effective, it can modify future manic episodes and protect against future depressive episodes

lithium carbonate

Phase in which health care providers focus on prevention of relapse and limitation of the severity and duration of future episodes

maintenance phase

A mood disorder in which a patient presents with a history of one or more major depressive episodes and no history of manic or hypomanic episodes

major depressive disorder

The male version of low interest in sex is characterized by a deficiency or absence of sexual fantasies or desire for sexual activity

male hypoactive sexual desire disorder

An unstable elevated mood in which delusion, poor judgment, and other signs of impaired reality testing are evident

mania

A state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively and fruitfully, and make a contribution to the community

mental health

A category of disorders characterized by disturbances of mood that range from elation to depression and interfere with normal functioning

mood disorders

Anticonvulsants are included in this class of drugs

mood stabilizers

Classes of drugs used to treat mood disorders characterized by highs (mania and hypomania) and lows (depression, depressive symptoms)

mood stabilizers

Lithium is included in this class of drugs

mood stabilizers

A chemical substance that functions as a neural messenger

neurotransmitter

released from the axon terminal of the presynaptic neuron when stimulated by an electrical impulse

neurotransmitter

Sending the "real" message through the tone or pitch of the voice

nonverbal behaviors

The phase of the nurse-patient relationship in which the nurse and patient meet and the nurse conducts the initial interview

orientation phase

An intervention that allows a child to symbolically express feelings such as aggression, self-doubt, anxiety, and sadness through the medium of play

play therapy

The presentation of a reward immediately following a behavior, making the behavior more likely to occur in the future

positive reinforcement

Activities that provide support, information, and education, with the goal of prevention

primary prevention

Responses from the environment that increase the probability that a behavior will be repeated

reinforcement

The ability to adapt and cope that helps people to face tragedies, loss, trauma, and severe stress

resilience

The reabsorption of neurotransmitters to the presynaptic cell that originally produced and secreted them after communication with receptors on the postsynaptic cell. Serotonin is most commonly associated with this process.

reuptake

Type of prevention that involves early detection and intervention in acute illness or situations to minimize disabling or long-term effects

secondary prevention

First-line antidepressants that block the reuptake of serotonin, permitting serotonin to act for an extended period at the synaptic binding sites in the brain

selective serotonin reuptake inhibitors (SSRIs)

A disturbance in the desire, excitement, or orgasm phases of the sexual response cycle, or pain during sexual intercourse.

sexual dysfunction