Attention-Deficit/Hyperactivity Disorder, Mod 25a
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.) A. Encouraging therapeutic play B. Using time-outs C. Promoting self-esteem D. Varying consequences for negative behaviors E. Increasing environmental stimulation
Encouraging therapeutic play Using time-outs Promoting self-esteem 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 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.) A. Excessive talking B. Viewed as overachiever C. High self-esteem D. Interrupts others E. Ostracized by peer group
Excessive talking Interrupts others Ostracized by peer group 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 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.) A. Provide a quiet area for examinations and extra time if necessary. B. Don't allow the child to do special tasks or run errands without supervision. C. Place the child in the front of the classroom close to the teacher. D. Place the child in the back of the classroom. E. Remind the child to pay attention in front of the class.
Provide a quiet area for examinations and extra time if necessary. Place the child in the front of the classroom close to the teacher. 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 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? A. The client will accurately manage medication administration. B. The client will respect the boundaries of others. C. The client will demonstrate a decrease in attentiveness. D. The client will achieve school performance to minimum competency.
The client will respect the boundaries of others. 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 characteristic is typically seen less in girls, when compared with boys, having attention-deficit/hyperactivity disorder (ADHD)? A. Impulsiveness B. Cognitive problems C. Anxiety D. Mood swings
impulsiveness 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 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? A. "We need to rule out neurologic diseases and other health problems in your child that may affect treatment of ADHD." B. "We need to see whether your child has the physical characteristics that go along with the behaviors of ADHD to correctly diagnose ADHD." C. "The healthcare provider will be able to give you better strategies for helping your child focus at home and at school." D. "The physical exam will allow the healthcare provider to explore the possibility of other mental health issues, such as depression, anxiety, learning disorder, or conduct disorder your child may have."
"We need to rule out neurologic diseases and other health problems in your child that may affect treatment of ADHD." 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.
An adult client with attention-deficit/hyperactivity disorder (ADHD) is being prescribed medication. About which medication should the nurse prepare teaching for this client? A. Guanfacine (Intuniv) B. Atomoxetine (Strattera) C. Dextroamphetamine (Adderall) D. Methylphenidate (Ritalin)
Atomoxetine (Strattera) 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.
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.) A. Excessive motor activity B. Deliberately destroying other people's property C. Inability to stay on an assigned task to completion D. Having difficulty with learning at school E. Limited attention span when speaking with parent
Excessive motor activity Inability to stay on an assigned task to completion Having difficulty with learning at school Limited attention span when speaking with parent 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.
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? A. Give the medication first thing in the morning. B. Observe the child for excessive sleepiness. C. Give the medication prior to going to bed at night. D. Restrict the amount of calories that the client eats each day.
Give the medication first thing in the morning. 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.
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.) A. Lack of proper parenting B. Affluence C. Poor nutrition D. Drinking alcohol during pregnancy E. Exposure to high levels of lead in childhood
Lack of proper parenting Poor nutrition Drinking alcohol during pregnancy Exposure to high levels of lead in childhood 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.
Which is characteristic of attention-deficit/hyperactivity disorder (ADHD)? (Select all that apply.) A. Often persists into adulthood B. Linked to heredity C. Linked to exposure to excess lead D. Impulsivity persists in adults E. Acetylcholine deficit in some children
Often persists into adulthood Linked to heredity Linked to exposure to excess lead 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 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.) A. Administer stimulant medication at least 30 minutes prior to studying. B. Reduce environmental stimuli such as music and television. C. Provide a clutter-free area to study. D. Give the child a snack to eat during study time. E. Allow the child as much screen time as he desires.
Reduce environmental stimuli such as music and television. Provide a clutter-free area to study. 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.
An adult client recently diagnosed with attention-deficit/hyperactivity disorder (ADHD) asks about treatment options. Which treatment option should the nurse recommend? A. Minimizing all changes in the home and work environment B. Requesting a nonstimulant medication from the healthcare provider C. Having a loose, flexible schedule so that activities can be adjusted quickly D. Requesting a stimulant medication from the healthcare provider
Requesting a nonstimulant medication from the healthcare provider 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.
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.) A. Set boundaries and consequences. B. Make a schedule for bedtime, meals, and recreational activities. C. Allow the child as many choices as possible to decrease conflict in the home. D. Provide appropriate rewards when the child meets expected behavior. E. Allow the child to listen to music during study time.
Set boundaries and consequences. Make a schedule for bedtime, meals, and recreational activities. Provide appropriate rewards when the child meets expected behavior. 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.
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? A. The client receives poor grades on homework for not completing assignments as requested. B. The client receives several text messages from friends and does not respond until after asking permission to do so. C. The client talks incessantly, jumping from one topic to another. D. The client folds half a basket of laundry and leaves the rest to read a magazine
The client receives several text messages from friends and does not respond until after asking permission to do so. 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.
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? A. "Taking medication isn't really that bad, especially since it is the only effective way to control your symptoms and let you live a normal life." B. "Why don't we ask your healthcare provider to prescribe a different medication instead of the one you're taking, if you're worried about it?" C. "You can replace your medication with these alternative treatments if you like, but be sure to tell your healthcare provider about them." D. "These are popular alternative treatments, but scientific evidence does not consistently support their effectiveness."
These are popular alternative treatments, but scientific evidence does not consistently support their effectiveness." 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.
Which intervention should the nurse teach the parents of a school-age client with attention-deficit/hyperactivity disorder (ADHD)? (Select all that apply.) A. Giving time-outs only for the worst negative behaviors B. Turning off the television when the client is doing homework C. Praising all positive behaviors D. Asking the healthcare provider to provide drug holidays every other week E. Maintaining a consistent bedtime routine and time
Turning off the television when the client is doing homework Praising all positive behaviors Maintaining a consistent bedtime routine and time 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 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? A. "Girls with ADHD tend to be diagnosed earlier than boys." B. "Girls with ADHD tend to show fewer language problems than boys with ADHD." C. "Girls with ADHD tend to show more aggression than boys with ADHD." D. "Girls with ADHD tend to show less impulsiveness than boys with ADHD."
"Girls with ADHD tend to show less impulsiveness than boys with ADHD." 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.
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? A. "We should restrict calories due to possible weight gain." B. "We can stop giving the medication during the summer." C. "We should observe for excessive sleepiness during the day." D. "The medication can be given any time of the day."
"We can stop giving the medication during the summer." 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 caring for an adolescent client newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). Which nursing diagnosis should the nurse prioritize for this client? A. Injury, Risk for B. Pain, Chronic C. Development: Delayed, Risk for D. Mobility: Physical, Impaired
Injury, Risk for 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)
