AQ Assignment 10 (Psych)

A nurse is assessing a patient with conduct disorder. Which assessment findings would indicate suicidal risk in the patient? Select all that apply.

feelings of despair, impulsive behavior, past suicide attempts Feelings of despair, hopelessness, or changes in energy levels increase the risk of suicide. Impulsive behavior or poor judgment increases the patient's risk of suicidal behavior. A history of suicidal attempts increases the patient's chances of repeating suicidal behavior. Fine coping skills show better adaptability, whereas patients with decreased coping skills are at an increased risk of suicide. Improved decision making shows positive performance; decreased decision-making ability indicates low self-esteem and an increased risk of suicide.

The nurse is teaching the family of a patient with intermittent explosive disorder. What conditions may be associated with intermittent explosive disorder? Select all that apply.

hypertension diabetes anxiety disorders Intermittent explosive disorder can lead to hypertension, diabetes, and anxiety disorders. This is probably because the patient is under a lot of stress and in an agitated state for a prolonged period. Depression is a comorbid condition, as is kleptomania. Attention deficit hyperactivity disorder is a predisposing factor in child- and adolescent-onset conduct disorder that is seen in children. Intermittent explosive disorder is an adult-onset disorder.

A nurse is assessing an adolescent boy from an upper-class family. He has an irresistible desire to steal objects from others' bags. What does the nurse diagnose this condition as?

kleptomania Kleptomania is characterized by an uncontrolled desire to steal objects and failing to resist the urge. The urge does not have to be related to actual need. Defiance in oppositional defiant disorder is characterized by irritability, getting angry, and being defiant and vindictive. Pyromania is the uncontrolled desire to deliberately set fire and experiencing pleasure by doing so. Callousness is a lack of sensitivity and empathy for others.

A nurse is caring for a child who has callousness as a type of conduct disorder. Which behaviors does the nurse identify as features of this disorder? Select all that apply.

lack of empathy, indifference to family commitments, unconcerned about other's emotions Callousness means having a lack of empathy and an inability to appreciate other's feelings. Callous persons are indifferent to family members and ignore their family commitments. They are unemotional and seem unconcerned about others' emotions. They do not care about schoolwork or other responsibilities. Callous persons are unexpressive and superficial.

A nurse observed that during play therapy, a patient is unable to follow the rules of the game and has conflict with peers. Which of these drugs would you anticipate would be administered to the patient?

methylphenidate A patient with attention-deficit/hyperactivity disorder does not follow rules in a game and has conflicts with peers. Methylphenidate is a physicostimulant drug used in attention-deficit/hyperactivity disorder. Botulinum toxin type A is given in Tourette syndrome to calm the muscles. Naltrexone is an opioid antagonist that is usually given in Tourette syndrome to block the euphoric responses. Diphenhydramine is an antihistaminic drug prescribed for allergies.

The nurse is providing information about dialectical behavioral therapy to the parents of a patient with conduct disorder. Which skills are taught in this therapy? Select all that apply.

mindfulness, emotional regulation, distress tolerance, personal effectiveness Dialectical behavioral therapy is a specific kind of cognitive-behavioral treatment that focuses on impulse control. Skills taught include mindfulness, emotional regulation, distress tolerance, and personal effectiveness. Cognitive-behavioral treatment teaches patients to recognize the onset of the impulse to explode or act aggressively, to identify circumstances or triggers that are associated with the onset, and to develop methods to prevent the maladaptive behaviors from occurring. Role-playing is a counseling technique in which the nurse and the patient or a group of patients act out a specified script or role to enhance their understanding of that role, learn and practice new behaviors or skills, and practice specific situations. Psychodynamic psychotherapy helps the patient to uncover underlying feelings and reasons behind rage or anger. This may help patients to develop better ways to think about and control their behavior.

The nurse prepares to conduct an oppositional defiant disorder (ODD) assessment for a pediatric patient. Which question will the nurse include in the assessment?

"Do you ever bother people on purpose?" Asking if the patient ever bothers other people on purpose is an appropriate question to ask, as this can help the nurse gauge the child's behaviors that are characteristic of ODD. Asking if the patient has ever bullied or scared other people, been physically mean to animals, or ran away from home are more appropriate for assessing conduct disorder, not ODD.

A 3-year-old boy recently has been diagnosed with autism spectrum disorder. His mom is tearful and states, "The doctor said we need to start therapy right away. I just don't understand how helpful it will be—he's so young!" What is the nurse's response?

"Starting him on treatment now gives your child a much greater chance for a productive life." Early intervention for children with autism can enhance greatly their potential for a full, productive life. Three years old is not too young to start therapy because the sooner therapy is started the better the outcome. The patient most likely will not be able to stop therapy because interventions will continue indefinitely. Telling the mother to ask her health care provider about questions abdicates the nurse's responsibility to provide education to patients and families.

The nurse is caring for a preschooler with a mental disorder. The nurse identifies that the preschooler refuses to attend school and feels isolated. What does the nurse report to the primary health care provider about this preschooler?

"The child has ineffective coping skills." Children with intellectual developmental disorders have decreased ability in social, conceptual, and practical functioning. Ineffective coping skills are a sign of intellectual development disorders. Preschoolers with ineffective coping abilities find difficulty with peer interaction and lack interest in attending school. These conditions do not indicate impaired verbal communication, delayed growth and development, or risk of suicidal ideation. Impaired verbal communication is characterized by repetitive usage of language. Delayed growth and development is characterized by an inability to perform activities such as feeding, bathing, and dressing. Risk of suicidal ideation is characterized by signs such as difficulty in concentration and depression.

A nurse is teaching a group of teachers about managing children with disruptive behaviors. What suggestion can help the teachers plan their activities to prevent these children from getting frustrated?

Alternate physical and mental activities Alternating physical and mental activities can help in preventing children from getting overstimulated and avoiding frustration. Long hours of sports should be avoided as they can make them physically tired and overstimulated and can result in frustration. Long classes should be avoided as they can wear them out or overstimulate them, which can result in frustration. Mental activities only should be avoided as they can wear them out or overstimulate them, which can result in frustration.

What question will the nurse ask when engaging in long-term goal-setting for an adolescent diagnosed with attention-deficient/hyperactivity disorder (ADHD)? Select all that apply.

Are the stated goals realistic for this particular child? Has the child been involved actively in the setting of the goals? Is there a good relationship between the child, family, and multidisciplinary team? Is the child and family aware of and able to interact with additional service providers? ADHD is chronic and unremitting and symptoms often persist into adulthood. It is important that the goals reflect the patient and that the family set realistic expectations as the child prepares to transition to postsecondary education or a vocation. Other pertinent questions include the following: Has the patient assumed primary responsibility for treatment planning and symptom management? Have the patient and family been linked with the additional resources needed to assist in a smooth transition? Do the patient and family interact well with the multidisciplinary team so that they foster a positive ongoing relationship, leading to improved outcomes?

When working with a patient demonstrating impulse control disorders, all of the following nursing interventions have priority except

Confronting the patient concerning the disruptive behavior The three most important interventions with this population are to promote a climate of safety for the patient and for others, establish rapport with the patient, and set limits and expectations.

What statement is true regarding children diagnosed with specific learning disorders? Select all that apply.

Diagnosis generally is made during the school years. Diagnosis involves a series of assessment evaluations. Learning disabilities are associated with poor reading, writing, or math skills. Poor self-esteem is a common long-term outcome associated with learning disorders. Children with specific learning disorders are identified during the school years. A learning disorder is diagnosed when a child demonstrates persistent difficulty in the acquisition of reading (dyslexia), mathematics (dyscalculia), or written expression (dysgraphia), and the child's performance is well below the expected performance of his or her peers. Diagnosis of a learning disorder is made through the evaluation of multiple assessments, including formal psychological evaluations, and is not explained better in the context of another mental illness. Long-term outcomes for children with learning disorders include low self-esteem, poor social skills, higher rates of school dropout, difficulties with attaining and maintaining employment, and poorer social adjustment. Such a diagnosis is not dependent on a comorbid mental health condition.

A nurse has to prepare a treatment plan for a patient with reduced nonverbal communication and reduced social relatedness. Which appropriate strategy should the nurse include in the treatment plan?

Give a star to the patient when he or she learns a new skill. Autism spectrum disorder is characterized by reduced nonverbal communication and social relatedness. The treatment plan should aim for behavior management. The patient should be rewarded. A nurse can give a star or sticker to encourage when the patient learns a new activity. Consistency should be maintained in the daily routines of the patient. The patient's schedule should not be changed frequently as it can confuse the patient. The patient should be encouraged to improve nonverbal communication skills by providing speech therapy. The patient should also be involved in structured activities with the help of parents. These activities should have a definite process and not require frequent changes.

When treating impulse control disorders, psychodynamic psychotherapy is directed toward

Identifying the triggers of the rage Psychodynamic psychotherapy focuses on underlying feelings and motivations and explores conscious and unconscious thought processes. In working with impulse control problems, the therapist may help the patient to uncover underlying feelings and reasons behind rage or anger. This may help the patient to develop better ways to think about and control his or her behavior.

A nurse is assessing a young man who has repeated outbursts of aggression. The family complains that the man seems to calm down initially but then explodes with rage and may even hit others. What does the nurse identify this condition as?

Intermittent explosive disorder Intermittent explosive disorder is seen when a person is unable to control aggressive impulses. A person with conduct disorder violates other's rights and social norms. Oppositional defiant disorder is characterized by irritability, getting angry, and being defiant and vindictive. Obsessive-compulsive disorder is characterized by repetitive thoughts or a strong urge to perform a task or activity repetitively.

A nurse prepares to assess an adolescent with recent reports of serious behavioral problems at school. Which resources should the nurse use to complete the assessment? Select all that apply.

Interview the adolescent Gather information from the adolescent's family Obtain information from the adolescent's teachers and school Methods of collecting data include interviewing, screening, testing (neurologic, psychological, intelligence), observing, and interacting with the child or adolescent. Histories are taken from multiple sources, including parents, teachers, other caregivers, and the child or adolescent when possible. Parents and teachers can complete structured questionnaires and behavior checklists. Interviewing the adolescent's friends would violate confidentiality. Viewing the adolescent's recent activity on social networking sites violates rights to privacy.

The parents of a child with attention-deficit/hyperactivity disorder (ADHD) have become concerned that the child is entering high school, and they have heard that the adolescent's medication is often abused. Which medication is most likely to be diverted?

Methylphenidate Methylphenidate is a stimulant and is a schedule II medication, meaning it is highly susceptible to abuse and diversion. Atomoxetine is a nonstimulant and is not controlled. Clonidine and guanfacine are alpha-2 agonists and are also not controlled substances.

A family who has recently immigrated from Bangladesh is discussing their child's development with the pediatrician. The physician suggests that the child may be depressed or anxious. The parents strongly disagree, saying "This does not happen with our people." What is most important for the nurse to consider?

Recognize culture may play a role in stigmatizing patients with these disorders. Due to the lack of child and adolescent mental health services in Bangladesh and a tendency toward somatization, the parents' response is most likely a fear of stigma. It is a form of denial, but more specifically, this is due to the potential for stigma. Bangladeshi patients do experience depression and anxiety, but it is not well documented or addressed. There is a limited amount of data to consult.

A registered nurse has decided to seclude a child. Which measure should the registered nurse take care of to ensure the patient's safety? Select all that apply.

Release the patient immediately once there is no danger. Encourage discussion about the patient's behavior among the staff. Monitor the patient's vital signs every 15 minutes. Seclusion can be an effective treatment for patients who display aggressive behavior and have become a danger to themselves or others. Patients in seclusion should be released as soon as they become calm. Staff members may talk with the secluded patient when the patient becomes calm. Seclusion helps in evaluating the emotional responses that made the patient aggressive. A new care plan can be made to enhance the patient's care. Vital signs must be monitored every 15 minutes while the patient is in seclusion. The nurse should take care that the restraint is prompt, firm, and nonretaliatory. The restrainer should not cause injury to the patient or staff. The patient's family must be informed about the seclusion. The nurse should discuss with the patient's family how to help reduce the recurrence of behavior that necessitated the seclusion. A new treatment plan can be bought into action.

The nurse performs an assessment on a 12-year-old child. Which finding does the nurse identify as a risk factor for conduct disorder?

Slower resting heart rate A slower resting heart rate is associated with conduct disorder. Increased blood pressure, elevated normal temperature, and decreased respirations are not risk factors associated with conduct disorder.

Which communication disorder is the latest to be identified and accepted?

Social communication disorder Social communication disorder was not identified until 2013. It was first considered on the autism spectrum. Receptive language disorders are characterized by the child's inability to understand language and follow directions. Expressive language disorder occurs when the child cannot form clear sentences and find the right words to convey their message. Fluency disorder is more commonly known as stuttering. Receptive language, expressive language, and fluency disorders were all established prior to social communication disorder.

A nurse taking care of an adolescent patient with appendicitis identifies that the patient is unable to eat and take a bath. What appropriate diagnosis can the nurse make about the patient's neurodevelopmental status?

The patient has delayed growth and development. A patient with intellectual development disorder has reduced intellectual functioning, social functioning, and ability to perform daily life activities when compared with peers. The nurse can diagnose this condition by observing the patient's symptoms. Inability of the patient to feed and bathe himself indicates that the patient has delayed growth and development. A patient who lacks responsiveness or interest has an impaired social interaction. A patient who does not cooperate and play with peers has activity intolerance and situational low self-esteem. A patient who intentionally ignores body needs may have reduced self-care.

The health care provider considers medication for a 14 year old diagnosed with conduct disorder. This adolescent's behavior shows aggression, impulsivity, and hyperactivity. The nurse will prepare educational materials regarding which type of medication?

antipsychotics Antipsychotic medications for persons diagnosed with conduct disorder are directed at problematic behaviors such as aggression, impulsivity, and hyperactivity. Beta-blocking medications also may help to calm individuals with intermittent explosive disorder by slowing the heart rate and reducing blood pressure. Medications for intermittent explosive disorder might include the selective serotonin reuptake inhibitors (SSRIs) or mood stabilizers, such as lithium or an anticonvulsant agent. Antianxiety medications, such as benzodiazepines, should be avoided because they reduce inhibitions and self-control in a similar way as alcohol.

Which of the following would not be considered a predisposing factor for conduct disorder?

being an only child Predisposing factors for conduct disorder are ADHD, oppositional child behaviors, parental rejection, inconsistent parenting with harsh discipline, early institutional living, chaotic home life, large family size, absent or alcoholic father, antisocial and drug-dependent family members, and association with delinquent peers.

A nurse is caring for a patient with impulse control disorders. What nursing diagnosis is appropriate when the patient shows clenched fists and has a rigid body posture?

Risk of violence to others Rigid body posture and clenched fists signal increased chances of inflicting violence on others. Risk of suicide is noted when the person has a history of suicidal attempts, talks about suicidal thoughts, or shows impulsivity. Ineffective coping is observed when the person blames others for his or her behaviors. Impaired parenting includes an unsafe home environment or hostility or rejection by the child's family.

A child in a pediatric mental health facility has depression and occasionally gets violent. The nurse decides to design a seclusion room where the child would be transferred next time he or she becomes violent. The nurse keeps few soft toys in the room. What is the reason for the nurse to keep these soft toys?

The child will express anger by punching the toys. The nurse is designing a seclusion room where children can be kept when they get violent. Ideally, the room should be nonstimulating. A child should be able to regain self-control in this room. The purpose for keeping soft toys is that children can throw or punch the soft toy to release anger. This would help the child to express anger in a nondestructive manner. The soft toys are not necessarily helpful in inducing sleep in the child. The child is aggressive and violent and it is unlikely that the child plays with the toys in such a state. Seeing the toys would not calm down the child directly.

The nurse is assessing a 5-year-old child. After completing the general assessment, the nurse reassesses the child using the Denver II developmental scale. What is the reason for the nurse to use this assessment tool?

The child's behavior is inappropriate for their chronological age. The Denver II developmental scale is an assessment tool for identifying the developmental strengths or deficits of a child in relation to his or her chronologic age. The nurse would have suspected that the child's behavior is inappropriate for the child's chronologic age and thus would have used this assessment tool to assess the deficit. This scale is not helpful in assessing whether a child is stressed. The Youth Risk Behavior Survey for children and adolescents is used for assessment of risky behaviors in children. The Denver II developmental scale is not used to determine to what extent the child's physical disability is interfering with his or her functional abilities.

A school nurse observes a child in one of the classes who often slaps his own face, bangs his head against the wall, and uses repetitive language patterns. What appropriate suggestion should the nurse give to the parents and caregivers of the patient?

The nurse should suggest hospitalizing the child briefly. A child who often slaps his own face, bangs his head, and uses repetitive language is likely suffering from intellectual development disorder. The nurse should suggest that the child be hospitalized for a short-term evaluation. The education provided should be supportive to the child and match his or her cognitive level and nature of illness, but that does not always mean the child must be removed from school permanently. A nurse cannot suggest medications because they can only be prescribed by a primary health care provider. The child should be encouraged to mingle with his or her peer group and play. Playing helps children express thoughts and emotions.

A nurse counsels parents of a child diagnosed with moderate autism spectrum disorder (ASD). The parents say, "We are going to move our child to a different bedroom in our home. We think the change will be intellectually stimulating." Select the nurse's therapeutic response.

"Children with autism spectrum disorder usually prefer for things to stay the same." The child with ASD usually has stereotypical behavior, interests, and activities along with overadherence to routines or rituals and fixations with particular objects. Changing the child's room will be disruptive. The nurse should offer other ideas for intellectually engaging the child but avoid overstimulation, which may result in agitation. Sharing a bedroom could be disruptive to other children in the family. Parents have an ongoing responsibility to supervise the child, regardless of where the child's bedroom is located.

Which question directed to the parents would focus on the broad categories addressed during a mental health assessment of their school-aged child? Select all that apply.

"Has your child ever intentionally hurt himself or others?" "What does the teacher say about your child's behavior in school?" "How would you describe your child's level of physical activity?" "What are your child's favorite toys and activities?" Assessment of mental status of children includes the following broad categories: safety, general appearance, socialization, activity level, speech, coordination and motor function, affect, manner of relating, intellectual function, thought processes and content, and characteristics of play. Parental preference is not as relevant.

A patient has an impulse-control disorder. The nurse is teaching the patient's family how to prevent an aggressive response from the patient. What statements made by a family member indicate a need for further education? Select all that apply.

"I should avoid using matter-of-fact sentences." "I should avoid setting limits consistently." Nurses, staff, and family should use matter-of-fact sentences while communicating with such patients to reduce confrontation. One of the best ways to communicate with a hostile patient is by consistently setting limits. It provides a climate of safety for the patient and others. High-expressed emotion, such as criticism, resentment, or annoyance in the treatment environment is a major cause of aggressive response from patients with an impulse-control disorder. The nurse, the hospital staff, or the family members should not stand too close and should not act in an authoritative manner. Such behavior may indicate aggression and may generate an aggressive response, including violence, from the patient.

A parent tells the nurse, "I am worried about my child. When anxious, my child becomes aggressive and starts slapping himself." Which statement made by the nurse is appropriate about the child's condition?

"Your child may have attention-deficit/hyperactivity disorder." Children with attention-deficit/hyperactivity disorder (ADHD) experience a peak level of impulsiveness and hyperactivity. Observation for disruptive behaviors such as anger, hyperaggressiveness, and harming others are the parameters for the detection of this disorder in patients. Such patients do not maintain peer relationships or participate in age-appropriate activities. A hyperaggressive nature is associated with self-harm or harming others and does not indicate a communication disorder, a specific learning disorder, or an intellectual development disorder. Communication disorders are characterized by difficulty in making and differentiating sounds. Specific learning disorders are characterized by dyslexia, dyscalculia, and dysgraphia. Intellectual development disorders are characterized by an inability in thinking, abstracting, and reasoning.

The parent of a child diagnosed with Tourette syndrome says to the nurse, "I think my child is faking the tics because they occur in different places at different times." Select the correct response by the nurse

"The movements are real. Tics can occur anywhere in the body and can change in frequency and severity." Motor tics usually involve the head but can involve the torso or limbs. They change in location, frequency, and severity over time. The nurse should provide accurate information to the parent. The child may be embarrassed if tics occur in the community.

Which question is focused on the assessment of a child with a possible diagnosis of oppositional defiant disorder? Select all that apply.

"What seems to trigger your outbursts?" "What would help you control your outbursts?" "How do your outbursts make your parents feel?" "What do your parents do when you won't do as they ask?" Assessment guidelines that focus on oppositional defiant disorder include: identifying issues that result in power struggles and triggers for outbursts—when they begin and how they are handled, assessing the child's or adolescent's view of his or her behavior and its impact on others, and exploring feelings of empathy and remorse; exploring how the child or adolescent can exercise control and take responsibility, problem solving for situations that occur, and planning to handle things differently in the future; and assessing barriers and motivation to change and potential rewards to engage the patient. Discussing the child's interest in school and learning are not associated with the problems demonstrated with this disorder.

What should the nurse ask a 3-year-old child while assessing the child's relationship with his or her parents?

"Would you draw me a picture of your family?" The nurse is performing an assessment of a 3-year-old child so the nurse should ask the child to interact using play activities, drawings, and puppets. The child may be too young to give verbal answers to the nurse's questions. Thus, the nurse should ask the child to draw a picture of the family. This picture would help the nurse to understand the child's perception of the family. Asking the child about who helps in studies, about family vacations, and whom the child relies on the most would not be appropriate for a child of this age. The child lacks the maturity to answer these questions.

The nurse is identifying students in a school who are susceptible to substance use and abuse later in life. The nurse is planning to give behavioral therapy to such students. Which student does the nurse include in the program? Select all that apply.

A student who is extremely shy A student who has aggressive behavior A student whose behavior is rebellious Behavioral traits in children are powerful predictors of substance use and abuse in the future. Shyness, aggressive behavior, or a rebellious nature make a child susceptible to develop a habit of substance abuse in the future. Children who engage in maladaptive behavior tend to repress feelings and do not socialize with others much. It has been found that talkative children do not usually experience substance abuse in the future. Interest in play activities is a normal behavior seen in a child. The nurse cannot predict that this child is susceptible to future substance abuse.

Which factors are considered when determining a patient is at high risk for suicide? Select all that apply.

Attempted suicide two years ago Father committed suicide at age 45 Reports excessive reliance upon alcohol Factors that increase this patient's risk for suicide include a past history, family member who successfully committed suicide, and the abuse of alcohol. Poor academics and living with family are not strong predictors of such behavior.

The primary health care provider has administered a botulinum toxin type A injection to a child with tic disorder. How will this drug benefit the child?

By relaxing the muscles associated with tics Botulinum toxin type A injections are used to relax the muscles associated with tics. Naltrexone is used to block euphoric responses associated with the behaviors of those with stereotypic movement disorder. Conventional antipsychotics like haloperidol are used for reducing the intensity of tic disorder. Clonazepam is used to reduce the anxiety and therefore the resultant tics.

During an assessment, the nurse finds that a patient says "wabbit" for "rabbit" and omits most of the sounds. Which neurodevelopmental disorder is the patient likely to have?

Communication disorder

When a child demonstrates a temperament that prompts the mother to say, "She is just so different from me; I just can't seem to connect with her," the nurse will

Counsel the mother regarding ways to better bond with her child All people have temperaments, and the fit between the child and parent's temperament is critical to the child's development. The caregiver's role in shaping that relationship is of primary importance, and the nurse can intervene to teach parents ways to modify their behaviors to improve the interaction.

A 3-year-old has been diagnosed with autism. Although 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

Give one-to-one attention in nonverbal parallel play 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 9-year-old patient has deficits in social and intellectual functioning and cannot manage practical aspects of daily life and functioning. These symptoms/signs support which diagnosis?

Intellectual development disorder (IDD) IDD is characterized by severe deficits in three major areas of functioning: intellectual, social, and managing daily life. Specific learning disorder is diagnosed when a child demonstrates persistent difficulty in the acquisition of reading (dyslexia), mathematics (dyscalculia), or written expression (dysgraphia), and his or her performance is well below the expected performance of peers. Autism is characterized by severe problems in communication skills and social interaction. ADHD is characterized by inattention, impulsivity, and hyperactivity.

The nurse is caring for a toddler with a mental disorder. The nurse identifies that the toddler finds it difficult to communicate with the staff. What action does the nurse take next during the assessment?

Make use of play therapy. Play therapy is an effective medium for children with difficulties in verbal communication. Children are provided with toys, art supplies, molding clay, blocks, and puppets. Toddlers with mental disorders communicate with help of these toys as models. Bibliotherapy, journaling therapy, and therapeutic drawing are not used for assessing toddlers with mental disorders because these children may not have adequate cognitive development to perform these tasks. Bibliotherapy is used for older patients who are able to read and understand the materials provided. Journaling therapy is effective when designing treatment protocols for adolescents. Therapeutic drawing is used for younger patients who are able to express their views in the form of pictographic representation.

The nurse is preparing to set goals for a 10-year-old diagnosed with an impulse control disorder. To best ensure the expected therapeutic outcomes, the nurse includes goals that are

Patient centered and include the patient's input Whenever possible, outcomes should be patient centered and agreed on by both the nurse and the patient or the patient's designee. Although goals that are age appropriate, achievable in a short period, simple, easily defined, family centered, and long term in nature should be considered when possible, the primary factor that should be considered is that the goals be patient centered and made with patient input because that will have a positive effect on the patient's compliance.

A child diagnosed with an autism spectrum disorder (ASD) will demonstrate impaired development in

Playing with other children 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.

Which nursing interventions are helpful when working with parents or caregivers of children and adolescents with impulse disorders? Select all that apply.

Teach them role-playing techniques. Show them how to make home a safe environment. Refer parents and caregivers to local self-help groups. Role-playing is a behavior modification technique. It helps parents and caregivers to tackle different problem situations that might arise with their child or adolescent. Patients who show aggressive behavior may become violent. In such situations, family members should be aware of weapons, drugs, and attempts by the patient to talk separately with other family members. When the family knows these things it can make the home a safe environment in which to live. Local self-help groups teach good parenting skills that have a positive effect on the child's behavior. If parents or caregivers are overly controlling, the child may suffer detrimental effects at the developmental point at which the trauma occurs. This may precipitate an aggressive response and the disorder may worsen. If parents engage in physical power, this shows confrontational behavior with the patient, which may further increase the patient's aggression.

What statement regarding the implementation of play therapy is true? Select all that apply.

The child learns coping mechanisms through playing with toys. Limits are set only to promote security and provide a sense of reality. The expression of feelings is supported through the use of a variety of toys. The acting out of situations with dolls and puppets substitutes for verbal discussions. The guiding principles of play therapy are to accept the child as he or she is and follow his or her lead; establish a warm, friendly relationship that fosters the expression of feelings completely; and set limits only to provide reality and security. Through the use of an appropriate medium, a child can express thoughts or emotions that he or she may not be able to express verbally. The dolls, puppets, and dollhouse provide the child with opportunities to act out conflicts and situations involving the family, work through feelings, and develop more adaptive ways of coping.

The nurse is assessing a 10-year-old child who is performing poorly in school. On assessment, the nurse finds that the child has a learning disability. Which observation has led the nurse to come to this conclusion? Select all that apply.

The child was unable to read a storybook. The child was unable to write properly on paper. The child was unable to perform basic calculations.

Which assessment is of importance for supporting a diagnosis of oppositional defiant disorder?

The issues that result in power struggles and triggers for outbursts Oppositional defiant disorder is characterized by defiant behavior, power struggles, outbursts, and arguing with adults, so assessment of these factors would be important. Assessing for violent outbursts refers to assessment for intermittent explosive disorder. Oppositional defiant disorder is not characterized by violent behaviors. Assessing for the ability to understand the impact of hurtful behaviors on others refers to assessment for conduct disorder. Birth order is not known to play a part in oppositional defiant disorder.

Which classification of medication may be prescribed in intermittent explosive disorder?

anticonvulsants Although considered off-label use, anticonvulsants may reduce outbursts and contribute to mood stabilization. Psychostimulants, benzodiazepines, and MAO inhibitors are incorrect for use in intermittent explosive disorder.

What is the most common condition associated with oppositional defiant disorder?

attention deficit disorder Attention deficit disorder is the most common condition associated with oppositional defiant disorder. Nearly 40% of individuals with oppositional defiant disorder also have attention deficit disorder. Type 1 diabetes, hypotension, and obesity are not common comorbidities for oppositional defiant disorder.

The nurse is interviewing the family of a patient with a history of oppositional defiant disorder and notes that the patient blames coworkers and family for his own behavior and states that he is better than the rest of them. What nursing diagnosis does this reflect?

defensive coping Defensive coping mechanisms are observed when a patient blames others for his own behavior, shows grandiosity, or has a hostile laugh. Risk for other-directed violence is when a patient has a rigid posture, clenches fist and jaws, paces, or often fights. A nursing diagnosis of risk for suicide is appropriate when a patient has a history of suicide attempts, aggression and impulsivity, or conflicting relationships. Impaired parenting includes rejection of or hostility toward a child and a disturbed relationship between parents or caregivers and the child.

Which facts about autism spectrum disorders are true? Select all that apply.

early intervention is crucial they are partly genetic in origin Antipsychotics and antidepressants may be prescribed. There is at least some level of genetic component to autism, as evidenced by twin studies. Early intervention is critical, as is the family's role in these interventions. Second-generation antipsychotics as well as selective serotonin reuptake inhibitors may be prescribed. There is no correlation between childhood vaccinations and autism. Intellectual disabilities in patients with autism occur in about half of the cases, not all.

An adjustment in the medication dosage prescribed for a child diagnosed with attention-deficit/hyperactivity disorder (ADHD) is appropriate when the child

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

A patient says, "When I go to the mall, I steal things. I don't know why I do it because I take things I don't need." Which term applies to this behavior?

kleptomania Kleptomania is a repeated failure to resist urges to steal objects not needed for personal use or monetary value. The person experiences a buildup of tension before taking the object, followed by relief or pleasure following the theft. Eustress is a positive type of stress. Pyromania refers to repeated deliberate fire setting. Dysthymia refers to a type of depressed mood.

A patient with attention-deficit/hyperactivity disorder (ADHD) is prescribed methylphenidate transdermal patch. How often should the nurse change the patch?

once a day Methylphenidate is available as a transdermal patch. It is prescribed for patients of the age group 6 to 12. Changing the patch should be scheduled for once a day because its duration of action is for 10 to 12 hours and up to 3 hours after removal of the patch.

Which factor can help explain why one child in a family might develop a mental disorder while another does not?

resilience Resilience is considered to be an inborn trait that is shaped by both internal and external factors. Genetics would be an explanation of similarities in mental health history, not differences. Environment and culture would also affect both siblings in equal measure.

A nursing diagnosis that should be considered for a child with attention-deficit/hyperactivity disorder is

risk for injury 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.

The nurse is assessing a child with tic disorder. The child repeatedly bites his or her own forearm. What is the nursing diagnosis for this patient?

risk for trauma If a child repeatedly bites his or her own forearm, the nursing diagnosis for this abnormal behavior would likely be at risk for trauma. If a child demonstrates lack of cooperation with peers during play, then the most likely nursing diagnosis would be activity intolerance. If the child is extremely depressed, then the nursing diagnosis would be stress overload. If the child fails to follow age-appropriate social norms, then the nursing diagnosis would be ineffective coping.

What are the familial risk factors associated with child psychiatric disorders? Select all that apply.

severe martial discord, foster care placement, low socioeconomic status The familial risk factors associated with child psychiatric illness include severe marital discord, low socioeconomic status, and foster care placement. Such children are more likely to develop psychiatric disorders because they have ineffective coping skills. Children belonging to a single-child family tend to be well looked after and thus are unlikely to develop psychiatric problems. A child belonging to a nuclear family would be given more attention compared with a child who belongs to a large family. Thus these children are less susceptible to developing psychiatric illnesses.

To confirm the diagnosis of attention-deficit/hyperactivity disorder (ADHD), a child's symptoms of hyperactivity, inattention, and impulsivity must meet which criteria?

They occur both at home and at school. For ADHD to be diagnosed, the symptoms have to be present in two settings, such as home and school, with onset occurring before the age of 7 years. Worsening symptoms in times of severe stress and confirmation by supervised clinical observations and a diagnostic testing tool do not describe two settings.

The health history for an adolescent diagnosed with conduct disorder indicates frequent callous behavior toward others. When this adolescent reaches adulthood, which personality disorder is most likely to emerge?

antisocial Callousness may be a predictor of a future antisocial personality disorder in adults. Callousness refers to a lack of empathy, such as disregarding and being unconcerned about the feelings of others, lack of remorse or guilt, unconcerned about meeting obligations, and demonstrating a shallow, unexpressive, and superficial affect. Histrionic, dependent, and schizotypal disorders are associated with other behaviors.