ch 22 NCLEX questions, Chapter 22, Chapter 22: Neurodevelopmental Disorders, Psych CH 22

The parents of a 2-year-old child complain to the nurse that their child is always dismantling toys, scribbling on the walls, and running all around the place and that it is very difficult to control the child's behavior. What is the most appropriate response from the nurse? "At this child's age, these behaviors are expected." "Your child may develop violent behavior in the future." "I will refer your child to the psychology clinic." "Therapy will help to calm your child."

"At this child's age, these behaviors are expected." Dismantling toys, scribbling on the walls, and running around the place are all normal behaviors for a child 2 years of age. The nurse should tell the parents to not to worry and that their child is perfectly normal. On the basis of these behaviors, the nurse cannot predict whether the child will have to be referred to a psychology clinic. The behaviors of the child are not abnormal; hence no therapy is needed for the child. Future violent behavior cannot be predicted from the child's present behavior.

The parents of a 2-year-old child complain to the nurse that their child is always dismantling toys, scribbling on the walls, and running all around the place and that it is very difficult to control the child's behavior. What is the most appropriate response from the nurse? "Therapy will help to calm your child." "Your child may develop violent behavior in the future." "I will refer your child to the psychology clinic." "At this child's age, these behaviors are expected."

"At this child's age, these behaviors are expected." Explanation: Dismantling toys, scribbling on the walls, and running around the place are all normal behaviors for a child 2 years of age. The nurse should tell the parents to not to worry and that their child is perfectly normal. On the basis of these behaviors, the nurse cannot predict whether the child will have to be referred to a psychology clinic. The behaviors of the child are not abnormal; hence no therapy is needed for the child. Future violent behavior cannot be predicted from the child's present behavior.

A nurse tells the child and caregiver that the nurse will interview each of them separately. The caregiver questions why this needs to occur. What is the nurse's best response? "Both interviews provide unique and meaningful information." "Parents know best and I will determine this during the interview." "By interviewing separately I can validate all the information." "Research shows that information validates the child's feeling."

"Both interviews provide unique and meaningful information." To get an accurate picture of the child, the nurse should interview the child and parent individually because each can provide unique meaningful information. Research has shown that when parent and child are interviewed separately the children provide information about internalizing symptoms and the parents provide information about externalizing symptoms.

The mental health nurse assesses for the most common mental health disorder found in children when asking which question? "What makes you afraid or nervous?" "Are you sad often?" "Do you ever hear voices in your head telling you what to do?" "Do you ever get scolded at school for not sitting still?

"Do you ever get scolded at school for not sitting still? Explanation: One in five to 10 children and adolescents surveyed exhibited symptoms of attention deficit hyperactivity disorder, which can sometimes be evidenced by an inability to sit still in school.

The mental health nurse assesses for the most common mental health disorder found in children when asking which question? "Do you ever get scolded at school for not sitting still? "Do you ever hear voices in your head telling you what to do?" "Are you sad often?" "What makes you afraid or nervous?"

"Do you ever get scolded at school for not sitting still? One in five to 10 children and adolescents surveyed exhibited symptoms of attention deficit hyperactivity disorder, which can sometimes be evidenced by an inability to sit still in school.

The nurse is preparing to meet with the parents after interviewing the child. Which is the nurse's best opening question to the parents? "Can you describe a situation where your child has had problems with peer socialization?" "Tell me about the school issues of your child." "Describe the current problem and what are the leading causes of the problem." "How have things been in your family?"

"How have things been in your family?" Explanation: The parents need to be able to describe the presenting problem in their own words and to speak freely about the situation without being constrained with concern for the child's feelings. The nurse should encourage them to talk by asking a general question such as "What brings you here today" or "How have things been in your family?". Asking to describe the problem already places a label on the issues and the parent may feel constrained by the child's feelings. Social issues and peer socialization is important to discuss but not initially.

A nurse is assessing a 7-year-old child in a school. The nurse suspects that the child has an insecure relationship with the parents. Which statement said by the child would have led the nurse to this conclusion? "I love playing with friends." "My mom and dad do not play with me." "I love my dad and mom very much." "Please don't tell my mom anything we've talked about."

"Please don't tell my mom anything we've talked about." An insecure attachment forms when a child has learned fear and helplessness because of intimidation, abuse, or excessive control by parents. The child demonstrates having a fear-based relationship with the mother. This indicates that the child has an insecure relationship with parents. The statement that the child loves playing with friends doesn't indicate anything about the relationship of the child with the parents. The statement that the client loves their parents suggests that the child has a secure relationship with the parents. The statement that the client's parents do not play with the client indicates that the child feels neglected by the parents.

A nurse is using limit setting with a child hospitalized for a psychiatric disorder. Which statement made by the nurse would reflect appropriate limit setting? Select all that apply. "Swearing is a sign of disrespect." "Swearing is not allowed here on the unit." "When you feel like swearing come and talk to me." "You will lose television privileges for 24 hours if you ignore a unit rule." "Unit rules are made to keep everyone safe."

"Swearing is not allowed here on the unit." "When you feel like swearing come and talk to me." "You will lose television privileges for 24 hours if you ignore a unit rule." Rationale:Limit setting involves three steps: 1. Inform clients of the rule or limit. 2. Explain the consequences if clients exceed the limit. 3. State expected behavior. The remaining options are explanations as to why swearing is not allowed.

A nurse is using limit setting with a child hospitalized for a psychiatric disorder. Which statement made by the nurse would reflect appropriate limit setting? Select all that apply. "Swearing is not allowed here on the unit." "When you feel like swearing come and talk to me." "Swearing is a sign of disrespect." "Unit rules are made to keep everyone safe." "You will lose television privileges for 24 hours if you ignore a unit rule."

"Swearing is not allowed here on the unit." "You will lose television privileges for 24 hours if you ignore a unit rule." "When you feel like swearing come and talk to me." Explanation: Limit setting involves three steps:1. Inform clients of the rule or limit.2. Explain the consequences if clients exceed the limit.3. State expected behavior.The remaining options are explanations as to why swearing is not allowed.

When asking about a client's spiritual life, which question is appropriate? "Do you believe in God?" "Can you share with me about your parent's religious preference?" "Tell me about your faith background." "Do you go to church?"

"Tell me about your faith background." Explanation: Questioning about a client's spiritual life should include interviewing strategies that are unbiased and facilitate understanding of the client's spiritual values. Questions can include but not limited to child's and family's specific faith background, level of activity with that group, support received from spiritual practices, religious rituals of importance, and religious influences on lifestyle and health choices.

A 9-year-old client with attention deficit hyperactivity disorder (ADHD) has been placed on the stimulant methylphenidate. The nurse knows that the teaching has been effective when the client's parents state what? "The client may have some side effects, like insomnia, loss of appetite, or weight loss, but they are rare." "The client knows that the client only needs to take this medication once every 12 hours." "We'll bring the client in every week to get blood levels drawn." "The client will have an effect from this drug in about 2 weeks."

"The client may have some side effects, like insomnia, loss of appetite, or weight loss, but they are rare." Explanation: The most common side effects of common medications used to treat ADHD, such as methylphenidate, include insomnia, loss of appetite, and weight loss or failure to gain weight.

A 9-year-old client with attention deficit hyperactivity disorder (ADHD) has been placed on the stimulant methylphenidate. The nurse knows that the teaching has been effective when the client's parents state what? "The client will have an effect from this drug in about 2 weeks." "The client knows that the client only needs to take this medication once every 12 hours." "The client may have some side effects, like insomnia, loss of appetite, or weight loss, but they are rare." "We'll bring the client in every week to get blood levels drawn."

"The client may have some side effects, like insomnia, loss of appetite, or weight loss, but they are rare." Rationale:The most common side effects of common medications used to treat ADHD, such as methylphenidate, include insomnia, loss of appetite, and weight loss or failure to gain weight.

A nurse is assessing language development of a 2-year-old. What is a normal language pattern for a 2-year-old? "Apple pie" "Want eat" "Go" "Mama"

"Want eat" Explanation: By age 2 years, children should speak in short, telegraphic sentences consisting of a verb and noun.

Which question is an appropriate question that provides information regarding a child's self-concept? "Do you have friends at school?" "Do you get along with your parents about food?" "If you were stranded on an island, what three things would you want to have?" "What do you want to do when you grow up?"

"What do you want to do when you grow up?" Explanation: Other ways to assess a child's self-concept include asking the child what the child wants to do when they grow up, what their best subjects are in school, what things they are really good at, and how well liked they are at school.

A nurse is speaking to the parents of a child with attention deficit hyperactivity disorder (ADHD). The parents ask the nurse about the reason for the child's underachievement in academics. What explanation given by the nurse is most appropriate? "Your child has trouble following the teacher's directions." "Your child does not attend classes." "Your child has difficulty with reading and writing." "Your child has impaired cognitive abilities."

"Your child has trouble following the teacher's directions." Explanation: Children with ADHD tend to be have difficulty following directions in school and this leads to careless mistakes in their work. This can cause underachievement in academics. Unlike children with conduct disorder, the child with ADHD does not have the tendency to miss classes. Cognition is not impaired in children with ADHD. Unlike children with a learning disorder, the child with ADHD does not have difficulty with reading and writing.

Assessment of an 8-year-old client reveals communication difficulties and an inability to manage age-appropriate tasks. The child undergoes standardized testing. An intelligent quotient (IQ) of which would support a diagnosis of intellectual disability? 65 95 75 85

65 Explanation: The usual threshold for intellectual disability is an IQ of 70 or less (i.e., two standard deviations below the population mean).

Below average intellectual functioning is initially diagnosed when an intelligence quotient (IQ) is below which level? 20 50 35 70

70 Explanation: The essential feature of intellectual disability is below-average intellectual functioning (IQ less than 70) accompanied by significant limitations in areas of adaptive functioning such as communication skills, self-care, home living, social or interpersonal skills, use of community resources, self-direction, academic skills, work, leisure, and health and safety.

When describing intellectual disability to a group of parents, a nurse would identify which intelligent quotient (or less) as the usual threshold? 50 60 70 80

70 Explanation: The usual threshold for intellectual disability is an intelligence quotient of 70 or less (i.e., two standard deviations below the population mean).

Below average intellectual functioning is initially diagnosed when an intelligence quotient (IQ) is below which level? 70 50 35 20

70 The essential feature of intellectual disability is below-average intellectual functioning (IQ less than 70) accompanied by significant limitations in areas of adaptive functioning such as communication skills, self-care, home living, social or interpersonal skills, use of community resources, self-direction, academic skills, work, leisure, and health and safety.

A nurse has been asked to identify children with attention deficit hyperactivity disorder (ADHD) in a school. Which children should the nurse identify as having ADHD? Select all that apply. A child who verbally abuses other children in the class A child who has limited facial expressions and poor eye contact A child who does not follow instructions in class A child who makes excessive noise by tapping the desk A child who is not able to dress himself or herself independently

A child who makes excessive noise by tapping the desk A child who does not follow instructions in class Children with ADHD exhibit hyperactive behaviors, like making excessive noise by tapping the desk. They are extremely impatient and inattentive; they cannot wait and listen for instructions before starting to work. Unlike children with a learning disorder, children with ADHD do not have difficulty with reading and writing. Motor skill development is not impaired in children with ADHD; therefore, they are able to dress themselves independently. Abusing other children in the class is indicative of disruptive behavior. A child with ADHD may not have disruptive behavior.

A nurse completes a Global Assessment of Functioning (GAF) scale on an adolescent during an assessment. The nurse calculates a 55. What is the analysis of the score? No impairment A low level of impairment A high level of impairment A moderate level of impairment

A moderate level of impairment Explanation: The GAF scale ranges from 0 to 100; the lower the score, the higher level of impairment, with a greater likelihood of psychiatric symptoms and serious impairment in communication or judgement. Moderate scores are 51 to 69. Children in this category are not homicidal or suicidal and usually respond well to outpatient interventions. Low is 70 to 100; in this case the child is functioning well in relation to school, peers, family, and community.

When describing intellectual disability to a group of parents, a nurse would identify which intelligent quotient (or less) as the usual threshold? A. 70 B. 50 C. 60 D. 80

A. 70

After teaching a group of nursing students about pharmacotherapy and attention deficit hyperactivity disorder (ADHD), the instructor determines that the education was successful when they identify which agent as one of the first-line choices for treatment? A. Atomoxetine B. Clonidine C. Guanfacine D. Bupropion

A. Atomoxetine

A nurse is assessing a child who had an episode of passing feces in the classroom. The child has no other disabilities. The nurse concludes that the child had intentional encopresis. Which other condition is the child likely to have? A. Conduct disorder B. Expressive language disorder C. Tourette's disorder D. Rett's disorder

A. Conduct disorder

A nurse is caring for a child with enuresis. The child does not have any abnormalities associated with development or behavior. Which drug would the child be prescribed to treat the condition? A. Imipramine B. Atomoxetine C. Risperidone D. Dextroamphetamine

A. Imipramine

A child with attention deficit hyperactivity disorder (ADHD) has been prescribed dextroamphetamine. For what effects should the nurse tell the parents to monitor the child? Select all that apply. A. Insomnia B. Hypotension C. Weight loss D. Appetite suppression E. Weight gain

A. Insomnia C. Weight loss D. Appetite suppression

A child with an existing diagnosis of attention deficit hyperactivity disorder shows signs and symptoms of depression. Which would most likely be prescribed? A. Selective serotonin and norepinephrine reuptake inhibitor (SSNRI) B. Monoamine oxidase inhibitor C. Mood stabilizer D. Tricylic antidepressant

A. Selective serotonin and norepinephrine reuptake inhibitor (SSNRI)

Which is a disturbance of the normal fluency and time patterning of speech? A. Stuttering B. Expressive language disorder C. Phonologic disorder D. Mixed receptive-expressive language disorder

A. Stuttering

When a client repeatedly vocalizes an obscene phrase and imitates the motions of a staff member, the nurse documents that the client is most likely exhibiting symptoms of what disorder? A. Tourette's syndrome B. Autism spectrum disorder C. Mixed receptive-expressive language disorder D. Phonological disorder

A. Tourette's syndrome

Which are nursing actions that support active listening? Select all that apply. A. Use appropriate vocabulary B. Use reflective comments C. Use a computer to write out observations D. Sit with arms and legs crossed E. Interrupt conversations to ask more questions

A. Use appropriate vocabulary B. Use reflective comments

Which medication classification is used in the treatment of tic disorders? Anxiolytics Antipsychotics Antidepressants Antimanics

Antipsychotics Explanation: Tic disorders are usually treated with risperidone or olanzapine.

Which medication classification is used in the treatment of tic disorders? Antidepressants Antimanics Anxiolytics Antipsychotics

Antipsychotics Rationale:Tic disorders are usually treated with risperidone or olanzapine.

Which action provides first-hand information about the issue and reinforces interest in the child's viewpoint during the assessment? Inquire about the school report card. Solicit information regarding after school activities the child is involved in. Request that the child interpret the parent's concerns. Ask about the history of the current problem.

Ask about the history of the current problem. Explanation: Directly asking the child as many questions as possible is generally the best way to get accurate, first-hand information and reinforces interest in the child's viewpoint. Some areas to ask about include the history of the current problem, previous psychiatric experiences, family psychiatric history, medical problems, peer relationship, and family functioning.

Which is an antidepressant used to treat attention deficit hyperactivity disorder (ADHD)? Pemoline Dextreamphetamine Amphetamine Atomoxetine

Atomoxetine Explanation: Atomexetine is an antidepressant used for the treatment of ADHD. All of the other options are stimulants.

After teaching a group of nursing students about pharmacotherapy and attention deficit hyperactivity disorder (ADHD), the instructor determines that the education was successful when they identify which agent as the first line choice? Atomoxetine Bupropion Clonidine Guanfacine

Atomoxetine Explanation: The first-line recommended medications for ADHD symptoms are the psychostimulants and atomoxetine. It is not unusual for two psychostimulants or a psychostimulant and atomoxetine to be prescribed together for maximum response. Second-line medications include bupropion and other antidepressants (tricyclic antidepressants). Then, if symptoms are not improved, alpha agonists (guanfacine or clonidine) are usually used.

Which is an antidepressant used to treat attention deficit hyperactivity disorder (ADHD)? Atomoxetine Amphetamine Dextreamphetamine Pemoline

Atomoxetine Rationale:Atomexetine is an antidepressant used for the treatment of ADHD. All of the other options are stimulants.

After teaching a group of nursing students about pharmacotherapy and attention deficit hyperactivity disorder (ADHD), the instructor determines that the education was successful when they identify which agent as the first line choice? Atomoxetine Bupropion Clonidine Guanfacine

Atomoxetine The first-line recommended medications for ADHD symptoms are the psychostimulants and atomoxetine. It is not unusual for two psychostimulants or a psychostimulant and atomoxetine to be prescribed together for maximum response. Second-line medications include bupropion and other antidepressants (tricyclic antidepressants). Then, if symptoms are not improved, alpha agonists (guanfacine or clonidine) are usually used.

Which is the most common disorder of childhood? Conduct disorder Attention deficit hyperactivity disorder (ADHD) Intellectual disability Autism

Attention deficit hyperactivity disorder (ADHD) ADHD, the most common disorder of childhood, results in poor academic performance, strained family relations, and rejection of peers.

Which common disorder of childhood accounts for the most referrals in children? Autism Intellectual disability Conduct disorder Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) Rationale:ADHD, a common disorder of childhood, accounts for most referrals in children. A child who suffers from ADHD often exhibits poor academic performance, strain family relations, and is rejected by peers.

Which term describes the use of socially unacceptable words, which are frequently obscene? A. Palilalia B. Coprolalia C. Echolalia D. None of the above

B. Coprolalia

Which medication is effective in 70% to 80% of children with attention deficit hyperactivity disorder (ADHD)? A. Pemoline B. Methylphenidate C. Dextroamphetamine D. Amphetamine

B. Methylphenidate

Which type of intervention may be helpful for children who are bullies? A. Art therapy B. Social skills training C. Bibliotherapy D. Play therapy

B. Social skills training

During a comprehensive assessment of a child, which person does the nurse interview first? A. grandparents B. child C. parent D. caregiver

B. child

A variety of areas are assessed during the mental status examination. Which are sections of the mental status examination? Select all that apply. A. religious background B. cognition C. gross and fine motor movement D. academic interests E. intellectual functioning

B. cognition C. gross and fine motor movement E. intellectual functioning

Which medication classification is used in the treatment of tic disorders? A. Antimanics B. Anxiolytics C. Antipsychotics D. Antidepressants

C. Antipsychotics

Nurses who work in a pediatric psychiatric-mental health facility should do what? A. Ensure that their own physical and mental health needs are placed above those of the clients. B. Use self-disclosure of personal struggles with problems of childhood and adolescence with clients. C. Develop self-awareness of issues that remind them of their own childhood and adolescence. D. Ensure that their professional life is a higher priority than their personal life.

C. Develop self-awareness of issues that remind them of their own childhood and adolescence.

Which is considered a hyperactive/impulsive behavior seen in attention deficit hyperactivity disorder (ADHD)? A. Frequent forgetfulness in daily activities B. Avoiding tasks requiring mental effort C. Inability to play quietly D. Making careless mistakes

C. Inability to play quietly

A nurse is assessing a child who is suspected of having attention deficit hyperactivity disorder. Which would the nurse identify as reflecting impulsiveness in the child? A. Restlessness B. Inability to wait the child's turn C. Risk-taking behavior D. Difficulty completing a task

C. Risk-taking behavior

A nurse is assessing a child who had an episode of passing feces in the classroom. The child has no other disabilities. The nurse concludes that the child had intentional encopresis. Which other condition is the child likely to have? Expressive language disorder Conduct disorder Tourette's disorder Rett's disorder

Conduct disorder Explanation: Intentional passing of feces in inappropriate places like the classroom is referred to as intentional encopresis. This condition is mostly associated with conduct disorder or oppositional defiant disorder. The child does not show any impairment in normal functioning. Rett's disorder is a type of pervasive developmental disorder characterized by the development of multiple deficits over a period of normal functioning. In Tourette's disorder, the child engages in multiple motor and vocal stereotypical behaviors. In expressive language disorder, the child has difficulty communicating through verbal or sign language. Such behavior is not evident in the assessment.

A nurse is assessing a child who had an episode of passing feces in the classroom. The child has no other disabilities. The nurse concludes that the child had intentional encopresis. Which other condition is the child likely to have? Tourette's disorder Conduct disorder Rett's disorder Expressive language disorder

Conduct disorder Intentional passing of feces in inappropriate places like the classroom is referred to as intentional encopresis. This condition is mostly associated with conduct disorder or oppositional defiant disorder. The child does not show any impairment in normal functioning. Rett's disorder is a type of pervasive developmental disorder characterized by the development of multiple deficits over a period of normal functioning. In Tourette's disorder, the child engages in multiple motor and vocal stereotypical behaviors. In expressive language disorder, the child has difficulty communicating through verbal or sign language. Such behavior is not evident in the assessment.

A nurse is assessing a child who had an episode of passing feces in the classroom. The child has no other disabilities. The nurse concludes that the child had intentional encopresis. Which other condition is the child likely to have? Conduct disorder Tourette's disorder Expressive language disorder Rett's disorder

Conduct disorder Rationale:Intentional passing of feces in inappropriate places like the classroom is referred to as intentional encopresis. This condition is mostly associated with conduct disorder or oppositional defiant disorder. The child does not show any impairment in normal functioning. Rett's disorder is a type of pervasive developmental disorder characterized by the development of multiple deficits over a period of normal functioning. In Tourette's disorder, the child engages in multiple motor and vocal stereotypical behaviors. In expressive language disorder, the child has difficulty communicating through verbal or sign language. Such behavior is not evident in the assessment.

Which term describes the use of socially unacceptable words, which are frequently obscene? Palilalia Coprolalia Echolalia None of the above

Coprolalia Coprolalia is the use of socially unacceptable words, which are frequently obscene. Palilalia is the repeating of one's own words or sounds. Echolalia is the repeating of the last heard sound, word, or phrase.

Which term describes the use of socially unacceptable words, which are frequently obscene? Palilalia Coprolalia None of the above Echolalia

Coprolalia Explanation: Coprolalia is the use of socially unacceptable words, which are frequently obscene. Palilalia is the repeating of one's own words or sounds. Echolalia is the repeating of the last heard sound, word, or phrase.

Which term describes the use of socially unacceptable words, which are frequently obscene? None of the above Palilalia Coprolalia Echolalia

Coprolalia Rationale:Coprolalia is the use of socially unacceptable words, which are frequently obscene. Palilalia is the repeating of one's own words or sounds. Echolalia is the repeating of the last heard sound, word, or phrase.

The mental health nurse assesses for the most common mental health disorder found in children when asking which question? A. "Do you ever hear voices in your head telling you what to do?" B. "What makes you afraid or nervous?" C. "Are you sad often?" D. "Do you ever get scolded at school for not sitting still?

D. "Do you ever get scolded at school for not sitting still?

A nurse is speaking to the parents of a child with attention deficit hyperactivity disorder (ADHD). The parents ask the nurse about the reason for the child's underachievement in academics. What explanation given by the nurse is most appropriate? A. "Your child does not attend classes." B. "Your child has impaired cognitive abilities." C. "Your child has difficulty with reading and writing." D. "Your child has trouble following the teacher's directions."

D. "Your child has trouble following the teacher's directions."

The nurse is assessing a child diagnosed with expressive language disorder. During the assessment, the parents tell the nurse the child had normal speech development until around 3 years of age when the child was involved in a serious car accident. Which part of the body may be affected in the child? A. Tongue B. Vocal cords C. Auditory canal D. Brain

D. Brain

The nurse is teaching a client's parents about managing the child's tic disorder. The nurse explains that it is extremely important for the child to get plenty of rest. What is the primary reason for the nurse to provide this education? Choose the best answer. A. Mental stress from the disorder could make the child depressed. B. Good sleep may normalize the transmission of dopamine. C. Repetitive motor movements cause fatigue, and the child needs rest. D. Physical stress and fatigue can increase symptoms in tic disorder.

D. Physical stress and fatigue can increase symptoms in tic disorder.

The nurse understands the importance of developing rapport with family members before the evaluation when caring for children with psychiatric disorders. The main reason for doing this is what? A. Reducing cost of stay B. Reducing fear of rejection C. Reducing length of stay D. Reducing anxiety

D. Reducing anxiety

Which condition is characterized by multiple motor tics and one or more vocal tics many times throughout the day for 1 year or more? A. Attention deficit hyperactivity disorder B. Asperger's syndrome C. Trichotillomania D. Tourette syndrome

D. Tourette syndrome

There are two steps necessary in an assessment interview between a child and caregiver. Which are the steps? Select all that apply. Develop a treatment alliance. Assess interactions between child and caregiver. Determine school goals for the child. Diagnosis problems and develop a plan of care.

Develop a treatment alliance. Assess interactions between child and caregiver. Explanation: The assessment interview is the initial contact between the child and caregiver. The first step is to establish a treatment alliance and the second step is to assess the interactions between the child and parent.

Nurses who work in a pediatric psychiatric-mental health facility should do what? Ensure that their professional life is a higher priority than their personal life. Ensure that their own physical and mental health needs are placed above those of the clients. Develop self-awareness of issues that remind them of their own childhood and adolescence. Use self-disclosure of personal struggles with problems of childhood and adolescence with clients.

Develop self-awareness of issues that remind them of their own childhood and adolescence. Explanation: To care for themselves, nurses need to recognize and discuss their job-related stressors. They should acknowledge and deal with issues that remind them of their own childhood and adolescence. Equally important, they need to attend to their own physical and mental health. Proper nutrition, rest and sleep, exercise, health care, maturity, and balance in personal and professional lives maximize the energy available to work therapeutically with youth and their families.

Nurses who work in a pediatric psychiatric-mental health facility should do what? Use self-disclosure of personal struggles with problems of childhood and adolescence with clients. Develop self-awareness of issues that remind them of their own childhood and adolescence. Ensure that their professional life is a higher priority than their personal life. Ensure that their own physical and mental health needs are placed above those of the clients.

Develop self-awareness of issues that remind them of their own childhood and adolescence. To care for themselves, nurses need to recognize and discuss their job-related stressors. They should acknowledge and deal with issues that remind them of their own childhood and adolescence. Equally important, they need to attend to their own physical and mental health. Proper nutrition, rest and sleep, exercise, health care, maturity, and balance in personal and professional lives maximize the energy available to work therapeutically with youth and their families.

The nurse working with pediatric clients knows the importance of checking for developmental delays, which not only slow the child's progress but also are often associated with what? Resilience Bullying Normalization Development of poor self-esteem

Development of poor self-esteem Developmental delays not only slow a child's progress but also can interfere with the development of positive self-esteem.

The nurse working with pediatric clients knows the importance of checking for developmental delays, which not only slow the child's progress but also are often associated with what? Bullying Normalization Resilience Development of poor self-esteem

Development of poor self-esteem Explanation: Developmental delays not only slow a child's progress but also can interfere with the development of positive self-esteem.

A nurse is assessing an 8-year-old child. The child is unable to dress the self and is not able to manipulate toys, such as building blocks. The child stutters while talking. The child does not have impaired motor coordination. What is the most likely diagnosis of the child? Developmental coordination disorder Tic disorder Cerebral palsy Learning disorder

Developmental coordination disorder Explanation: Developmental coordination disorder is characterized by impaired coordination, which interferes with activities such as dressing and manipulating toys. A communication disorder, such as stuttering, often coexists with the condition. The child does not show any stereotypical motor or vocal behavior, thus the child does not have tic disorder. An inability to read, write, and do math is not found in this child; thus the child does not have a learning disorder. Motor coordination is not impaired; this indicates that the child does not have a motor disorder, such as cerebral palsy or muscular dystrophy.

The nurse is developing a care plan for a client diagnosed with attention deficit hyperactivity disorder (ADHD). The nurse teaches the client to take the last dose of dextroamphetamine when? At 6 p.m. At noon At 9 p.m. Early in the afternoon

Early in the afternoon Rationale:Giving stimulants during daytime hours usually effectively combats insomnia, which is a side effect of stimulants.

Which aspect of managing a child with attention deficit hyperactivity disorder (ADHD) may often be overlooked in the treatment plan? Effects on school performance Effects on parents' coping styles Effects on the marriage Effects on siblings

Effects on siblings Explanation: Family members of children with ADHD may experience disrupted routines and the strain of caretaking. The client may victimize siblings, who may feel unprotected because the parents are too emotionally overwhelmed to deal successfully with the situation.

A school-aged child tells that nurse that the child does not like school anymore and their parent is upset about their poor grades. Which is main concern about this client? Mental issues to perform the tasks necessary for performance in the classroom Religious issues and ability to conform to them while in the school setting Emotional problems focusing on peer adjustment and school Social issues regarding participating in school activities

Emotional problems focusing on peer adjustment and school Explanation: Falling grades, loss of interest in normal activities, decrease concentration, or withdrawal from or aggression toward peers may indicate the child is experiencing emotional problems. Peers are an important aspect of adolescent social development, and assessment of peer relationships provides a rich source of information about the adolescent.

The nurse is assessing a child with autism spectrum disorder. After reading the medical history, the nurse finds that the child engages in stereotypical motor behavior. Which observation of the child made by the nurse might be indicative of stereotypical motor behavior? Not being able to engage in play activities Unusual reactions to sounds, smells, and other sensory experiences Using limited gestures to communicate Flapping hands repeatedly

Flapping hands repeatedly Stereotypical motor behavior refers to repetitive or ritualistic movement of a body part, such as repeated flapping of the hands. Using limited gestures while communicating, an inability to engage in play activities, and having unusual reactions to sounds, smells, and other sensory experiences are behaviors typically seen in children with autism spectrum disorder. These behaviors, howerver, cannot be referred to as stereotypical motor behaviors.

An adolescent is being observed for attention deficit hyperactivity disorder (ADHD). Which circumstance would demonstrate evidence to support this diagnosis? Is stubborn, resistant to directions, and unwilling to negotiate. Shows cruelty to animals, callousness, and lack of guilt and remorse. Forgets to turn in homework, does not follow directions, cannot stay in assigned seat in class, and is always talking excessively and inappropriately. Is withdrawn in social contexts but energetic and engaging with family.

Forgets to turn in homework, does not follow directions, cannot stay in assigned seat in class, and is always talking excessively and inappropriately. ADHD is characterized by distractibility, lack of concentration, and excessive activity.

A nurse is studying the brain images of children with attention deficit hyperactivity disorder (ADHD). In these images, the nurse would find abnormalities related to which area of the brain? Temporal lobe Frontal lobe Occipital lobe Parietal lobe

Frontal lobe Studies have proven that ADHD is associated with malfunction of the frontal lobe. Decreased metabolism and decreased perfusion to the frontal lobe are the physiological alterations known to cause ADHD. Dysfunction of the parietal lobe would cause abnormalities in sensory perception. Dysfunction of the occipital lobe would cause abnormalities in vision. Dysfunction of the temporal lobe would cause dysfunction in communication.

The parents of a toddler are distraught that the toddler has been diagnosed with autism spectrum disorder. When providing care for the child and the parents, the nurse understands that autism spectrum disorder is thought to be caused by what? Genetic factors Immunizations containing mercury Perinatal hypoxia Impaired attachment in infancy

Genetic factors Approximately 70% of idiopathic autism spectrum disorder cases appear to be an inherited form of an affective disorder. Studies also suggest that autism spectrum disorder is caused by interactions of multiple genes. The disorder is not caused by immunizations. Neither impaired attachment nor perinatal hypoxia has been identified as an etiologic factor.

The parents of a toddler are distraught that the toddler has been diagnosed with autism spectrum disorder. When providing care for the child and the parents, the nurse understands that autism spectrum disorder is thought to be caused by what? Perinatal hypoxia Genetic factors Immunizations containing mercury Impaired attachment in infancy

Genetic factors Explanation: Approximately 70% of idiopathic autism spectrum disorder cases appear to be an inherited form of an affective disorder. Studies also suggest that autism spectrum disorder is caused by interactions of multiple genes. The disorder is not caused by immunizations. Neither impaired attachment nor perinatal hypoxia has been identified as an etiologic factor.

After teaching a group of nursing students about intellectual disability, the instructor determines that the teaching was successful when the students identify which as the most common etiology? Perinatal complications Genetic syndromes Exposure to hazardous chemicals Environment

Genetic syndromes Although exposure to toxins, perinatal complications, and environmental effects are associated with intellectual disability, the most common etiology is related to genetic syndromes.

After teaching a group of nursing students about intellectual disability, the instructor determines that the teaching was successful when the students identify which as the most common etiology? Perinatal complications Environment Genetic syndromes Exposure to hazardous chemicals

Genetic syndromes Explanation: Although exposure to toxins, perinatal complications, and environmental effects are associated with intellectual disability, the most common etiology is related to genetic syndromes.

Which intervention assists the nurse to gain rapport with the child and parent? Greet the child in friendly, personal way. Give paperwork to caregiver to complete. Discuss the history with the caregiver. Introduce child and caregiver to staff.

Greet the child in friendly, personal way. Explanation: The assessment interview is the initial contact between the child and parent or caregiver and the nurse. The first step is to establish rapport by greeting the child or adolescent in a friendly, polite, open manner and putting him or her at ease.

A child is taking methylphenidate for treatment of attention deficit hyperactivity disorder (ADHD). Which side effect much be monitored in this child? Polyuria Weight gain Increased appetite Growth delays

Growth delays Nursing considerations when administering methylphenidate include monitoring appetite suppression or growth delays.

A child is taking methylphenidate for treatment of attention deficit hyperactivity disorder (ADHD). Which side effect must be monitored in this child? Growth delays Increased appetite Weight gain Polyuria

Growth delays Rationale:Nursing considerations when administering methylphenidate include monitoring appetite suppression or growth delays.

A nurse is developing the plan of care for a 6-year-old child diagnosed with attention deficit hyperactive disorder (ADHD). The nurse identifies interventions to address which behavior issues? Select all that apply. Has a habit of not waiting for a turn Frequently acts out during class "quiet time" Does not acknowledge others' right to select group activities Throws a temper tantrum when asked to clean up toys Gently asks a peer to share a particular toy

Has a habit of not waiting for a turn Frequently acts out during class "quiet time" Does not acknowledge others' right to select group activities Throws a temper tantrum when asked to clean up toys Rationale:The care plan of a 6-year-old child diagnosed with ADHD includes interventions to help manage the client's temper tantrums and acting out, refusal to acknowledge others' right to select group activities, and habit of not waiting for their turn, and to prevent physically intrusive behavior while playing.

When attention deficit hyperactivity disorder (ADHD) is present, the child will most likely exhibit which core symptoms? Quiet, impulsive, excessively attentive, and psychotic Overly friendly, able to follow directions, impulsive, and active Highly distractible, excitable, impulsive, and excessively active Affective disturbances, autism, psychosis, and excessive talkativeness

Highly distractible, excitable, impulsive, and excessively active Highly distractible, excitable, impulsive, and excessively active are the four core symptoms associated with this disorder. Although talking excessively is an associated behavior, affective disturbances, autism, and psychosis are not accurate. Although impulsivity and being excessively active are core symptoms, being overly friendly and being able to follow directions are not accurate.

A nurse is talking to a 7-year-old. The child describes in detail a family pet who recently died. Which response by the nurse is appropriate? I am sad for your loss. How long did you have the dog? I need to interview another client. When are you going to get another dog?

I am sad for your loss. Explanation: The number of stressful events that a child experiences, the supports that the child has in place, and the child's developmental stage may influence his or her ability to cope with stressors. A nurse should recognize the stress and express empathy to the child.

A nurse is caring for a child with enuresis. The child does not have any abnormalities associated with development or behavior. Which drug would the child be prescribed to treat the condition? Imipramine Atomoxetine Dextroamphetamine Risperidone

Imipramine Rationale:Imipramine is an antidepressant drug with a side effect of urinary retention. This drug is commonly used to treat enuresis. The child has no abnormalities associate with behavior, thus the child will not be prescribed psychotropic drug like risperidone. Atomoxetine is an antidepressant drug used to treat attention deficit hyperactivity disorder; this drug is not prescribed for a child with enuresis. Dextroamphetamine is also an antidepressant drug used to treat hyperactivity, impulsivity, and mood lability in children with attention deficit hyperactivity disorder.

A nurse is assessing a child with attention deficit hyperactivity disorder. Which assessment finding is the nurse likely to see in this child? Select all that apply. Impulsiveness Overactivity Stuttering Attentiveness Stereotypical movements

Impulsiveness Overactivity Rationale:Attention deficit hyperactivity disorder is characterized by behaviors like overactivity, impulsiveness, and inattentiveness. Stuttering is a language disorder; it is not associated with attention deficit hyperactivity disorder. The child has attention deficit. Unlike in tic disorder, stereotypical movements are not seen in children with attention deficit hyperactivity disorder.

Which is considered a hyperactive/impulsive behavior seen in attention deficit hyperactivity disorder (ADHD)? Inability to play quietly Avoiding tasks requiring mental effort Frequent forgetfulness in daily activities Making careless mistakes

Inability to play quietly Inability to play quietly is a hyperactive/impulsive behavior seen in ADHD. Inattentive behaviors include avoiding tasks that require mental effort, making careless mistakes, and being forgetful in daily activities.

Which is considered a hyperactive/impulsive behavior seen in attention deficit hyperactivity disorder (ADHD)? Avoiding tasks requiring mental effort Making careless mistakes Frequent forgetfulness in daily activities Inability to play quietly

Inability to play quietly Rationale:Inability to play quietly is a hyperactive/impulsive behavior seen in ADHD. Inattentive behaviors include avoiding tasks that require mental effort, making careless mistakes, and being forgetful in daily activities.

A child with attention deficit hyperactivity disorder (ADHD) has been prescribed dextroamphetamine. For what effects should the nurse tell the parents to monitor the child? Select all that apply. Weight loss Appetite suppression Insomnia Weight gain Hypotension

Insomnia Weight loss Appetite suppression Dextroamphetamine is a commonly prescribed drug to treat symptoms of ADHD. Insomnia, weight loss, and appetite suppression are the common side effects associated with this drug. The nurse should educate the parents on monitoring these effects. Hypotension and weight gain are not common side effects of this drug.

A child with attention deficit hyperactivity disorder (ADHD) has been prescribed dextroamphetamine. For what effects should the nurse tell the parents to monitor the child? Select all that apply. Weight loss Weight gain Hypotension Insomnia Appetite suppression

Insomnia Weight loss Appetite suppression Explanation: Dextroamphetamine is a commonly prescribed drug to treat symptoms of ADHD. Insomnia, weight loss, and appetite suppression are the common side effects associated with this drug. The nurse should educate the parents on monitoring these effects. Hypotension and weight gain are not common side effects of this drug.

After educating a group of students on attention deficit hyperactivity disorder (ADHD), the instructor determines that additional education is required when the group identifies which as a typical characteristic? Language difficulty Inattention Impulsiveness Hyperactivity

Language difficulty A persistent pattern of inattention, hyperactivity, and impulsiveness that interferes with functioning characterizes ADHD. Language difficulties are not associated with ADHD.

After educating a group of students on attention deficit hyperactivity disorder (ADHD), the instructor determines that additional education is required when the group identifies which as a typical characteristic? Hyperactivity Inattention Impulsiveness Language difficulty

Language difficulty Explanation: A persistent pattern of inattention, hyperactivity, and impulsiveness that interferes with functioning characterizes ADHD. Language difficulties are not associated with ADHD.

An adolescent client says the client has become bored with the video game that has been used as a reward for positive behavior. Which is the most effective intervention for this client? Tell the client that the client no longer has to clean the client's room in order to play. Reinforce to the client that the client selected the video game and the client needs to stick with it. Tell the client that the client has to use this video game to ensure understanding of value. Let the client choose another reward that would be more fun.

Let the client choose another reward that would be more fun. Explanation: Positive rewards need to be viewed as desirable to motivate desired behavior changes.

An adolescent client says the client has become bored with the video game that has been used as a reward for positive behavior. Which is the most effective intervention for this client? Reinforce to the client that the client selected the video game and the client needs to stick with it. Tell the client that the client no longer has to clean the client's room in order to play. Let the client choose another reward that would be more fun. Tell the client that the client has to use this video game to ensure understanding of value.

Let the client choose another reward that would be more fun. Positive rewards need to be viewed as desirable to motivate desired behavior changes.

Which medication is effective in 70% to 80% of children with attention deficit hyperactivity disorder (ADHD)? Amphetamine Pemoline Dextroamphetamine Methylphenidate

Methylphenidate Explanation: Methylphenidate, a common medication for treating ADHD, is effective in 70% to 80% of children who have ADHD. The other stimulants dextroamphetamine and pemoline, and the amphetamine compound Adderall are used to treat ADHD, but they are not as effective as methylphenidate.

Which medication is effective in 70% to 80% of children with attention deficit hyperactivity disorder (ADHD)? Pemoline Dextroamphetamine Amphetamine Methylphenidate

Methylphenidate Rationale:Methylphenidate, a common medication for treating ADHD, is effective in 70% to 80% of children who have ADHD. The other stimulants dextroamphetamine and pemoline, and the amphetamine compound Adderall are used to treat ADHD, but they are not as effective as methylphenidate.

Which medication is the most effective treatment for attention deficit hyperactivity disorder (ADHD)? Amphetamine Methylphenidate Pemoline Dextroamphetamine

Methylphenidate The most effective treatment for ADHD is methylphenidate.

Which is an inattentive behavior seen in attention deficit hyperactivity disorder (ADHD)? Missing details Interrupting Talking excessively Fidgeting

Missing details Rationale:Missing details is an inattentive behavior seen in ADHD. Hyperactive/impulsive behaviors include fidgeting, interrupting, and talking excessively.

The nurse is counseling a family whose child has autism. When describing this condition, which would the nurse most likely include? Onset before child is 2.5 years old Connection to ineffective parental practices Detection after the child enters school Girls are more frequently affected than boys

Onset before child is 2.5 years old Autism typically occurs before the age of 30 months. It is also marked by severe disturbances in social relatedness and occurs more often in boys than in girls.

The nurse is counseling a family whose child has autism. When describing this condition, which would the nurse most likely include? Connection to ineffective parental practices Onset before child is 2.5 years old Girls are more frequently affected than boys Detection after the child enters school

Onset before child is 2.5 years old Explanation: Autism typically occurs before the age of 30 months. It is also marked by severe disturbances in social relatedness and occurs more often in boys than in girls.

What materials would assist the preschool age child to develop rapport with the nurse? Select all that apply. Paint and an easel Puppets Video games Puzzles Dress up clothes

Paint and an easel Puppets Dress up clothes Explanation: When interviewing preschool-aged children, the nurse should understand that these children may have difficulty putting their feelings into works and their thinking is very concrete. The nurse can achieve rapport with preschool-aged children by joining their world by play using paper, pencils, crayons, paints, paint brushes, easels, clay, blocks, balls, dolls, doll houses, puppets, animals, dress-up clothes, and water.

The nurse is teaching a client's parents about managing the child's tic disorder. The nurse explains that it is extremely important for the child to get plenty of rest. What is the primary reason for the nurse to provide this education? Choose the best answer. Mental stress from the disorder could make the child depressed. Good sleep may normalize the transmission of dopamine. Physical stress and fatigue can increase symptoms in tic disorder. Repetitive motor movements cause fatigue, and the child needs rest.

Physical stress and fatigue can increase symptoms in tic disorder. Physical fatigue and stress may exacerbate the symptoms of the tic disorder. As a result, children with this condition require a good amount of sleep. Sleeping would prevent physical fatigue and stress. Tic disorder is caused by abnormal transmission of dopamine. Good sleep does not normalize the transmission of dopamine. Repetitive motor movements may cause fatigue, but the requirement of sleep is not related to it. Mental stress from the disorder would make the child depressed. The depression may not be relieved by sleep.

The nurse understands the importance of developing rapport with family members before the evaluation when caring for children with psychiatric disorders. The main reason for doing this is what? Reducing cost of stay Reducing length of stay Reducing anxiety Reducing fear of rejection

Reducing anxiety Explanation: To reduce anxiety about the evaluation, the nurse must develop rapport with the family members. The other options do not reflect the right reasons for developing rapport.

Assessment of a child with autism spectrum disorder reveals stereotypic behavior. Which behavior would the nurse most likely document being demonstrated by the child? Rocking Head banging Pronoun reversal Hand flapping Word repetition

Rocking Head banging Hand flapping Rationale:Stereotypic behavior incudes self-stimulating, nonfunctional, repetitive behaviors such as rocking, hand flapping, and head banging. Word repetition (echolalia) and pronoun reversal are communication difficulties.

A child with an existing diagnosis of attention deficit hyperactivity disorder shows signs and symptoms of depression. Which would most likely be prescribed? Selective serotonin and norepinephrine reuptake inhibitor (SSNRI) Tricylic antidepressant Monoamine oxidase inhibitor Mood stabilizer

Selective serotonin and norepinephrine reuptake inhibitor (SSNRI) Antidepressant medications, most likely SSNRIs, are used for anxiety, depression, and primarily for ADHD. Mood stabilizers are prescribed primarily for bipolar disorder. These medications may be prescribed off-label. However, there is controversy surrounding the use of SSNRIs and selective serotonin reuptake inhibitors (SSRIs) in children. Nurses need to keep in mind that all medications involve a risk-benefit equation. Given the modest benefit of the SSNRIs and SSRIs and the potential for adverse behavioral effects, these medications merit careful monitoring in children and adolescents.

A child with an existing diagnosis of attention deficit hyperactivity disorder shows signs and symptoms of depression. Which would most likely be prescribed? Tricylic antidepressant Selective serotonin and norepinephrine reuptake inhibitor (SSNRI) Mood stabilizer Monoamine oxidase inhibitor

Selective serotonin and norepinephrine reuptake inhibitor (SSNRI) Explanation: Antidepressant medications, most likely SSNRIs, are used for anxiety, depression, and primarily for ADHD. Mood stabilizers are prescribed primarily for bipolar disorder. These medications may be prescribed off-label. However, there is controversy surrounding the use of SSNRIs and selective serotonin reuptake inhibitors (SSRIs) in children. Nurses need to keep in mind that all medications involve a risk-benefit equation. Given the modest benefit of the SSNRIs and SSRIs and the potential for adverse behavioral effects, these medications merit careful monitoring in children and adolescents.

When performing a spiritual assessment on a child, the nurse and child discuss church attendance and practices that are most important to the child. Which domain is the nurse addressing when doing this assessment? All of the above Biologic Psychological Social

Social Explanation: Spiritual assessment is an important part of a mental health assessment. It is part of the social domain. Growing research suggests that religious and spiritual practices may promote both physical and mental health.

When performing a spiritual assessment on a child, the nurse and child discuss church attendance and practices that are most important to the child. Which domain is the nurse addressing when doing this assessment? Social All of the above Psychological Biologic

Social Spiritual assessment is an important part of a mental health assessment. It is part of the social domain. Growing research suggests that religious and spiritual practices may promote both physical and mental health.

Which type of intervention may be helpful for children who are bullies? Social skills training Bibliotherapy Art therapy Play therapy

Social skills training Explanation: Social skills training may be particularly helpful for children who are bullies or rejected by their peers.

Which type of intervention may be helpful for children who are bullies? Art therapy Play therapy Social skills training Bibliotherapy

Social skills training Social skills training may be particularly helpful for children who are bullies or rejected by their peers.

Which is a disturbance of the normal fluency and time patterning of speech? Phonologic disorder Stuttering Mixed receptive-expressive language disorder Expressive language disorder

Stuttering Explanation: Stuttering is a disturbance of the normal fluency and time patterning of speech. Phonologic disorder involves problems with articulation. Mixed receptive-expressive language disorder includes problems of expressive language disorder along with difficulty understanding and determining the meaning of words and sentences. Expressive language disorder involves an impaired ability to communicate through verbal and sign language.

Which is a disturbance of the normal fluency and time patterning of speech? Phonologic disorder Mixed receptive-expressive language disorder Stuttering Expressive language disorder

Stuttering Rationale:Stuttering is a disturbance of the normal fluency and time patterning of speech. Phonologic disorder involves problems with articulation. Mixed receptive-expressive language disorder includes problems of expressive language disorder along with difficulty understanding and determining the meaning of words and sentences. Expressive language disorder involves an impaired ability to communicate through verbal and sign language.

Which is a disturbance of the normal fluency and time patterning of speech? Mixed receptive-expressive language disorder Phonologic disorder Stuttering Expressive language disorder

Stuttering Stuttering is a disturbance of the normal fluency and time patterning of speech. Phonologic disorder involves problems with articulation. Mixed receptive-expressive language disorder includes problems of expressive language disorder along with difficulty understanding and determining the meaning of words and sentences. Expressive language disorder involves an impaired ability to communicate through verbal and sign language.

A nursing student is aware that which accounts for more deaths, illnesses, and disabilities across the life span than any other preventable condition? Substance abuse disorders Falls Mood disorders Motor vehicle accidents

Substance abuse disorders Substance abuse disorders across the life span account for more deaths, illnesses, and disabilities than any other preventable health condition.

The parents of a child with attention deficit hyperactivity disorder (ADHD) bring the child for a follow-up visit. During the visit, they tell the nurse that the child receives the first dose of methylphenidate at about 7:30 a.m. every morning before leaving for school. The teacher and school nurse have noticed a return in the child's overactivity and distractibility just before lunch. The child's second dose is scheduled for about 12 p.m. Which might the nurse suggest as a possible solution to control the child's symptoms a bit more effectively? Switch to a longer-acting preparation. Switch to another class of medication. Give the second dose at 1 p.m. or later. Split the early morning dose in half.

Switch to a longer-acting preparation. Methylphenidate has a total duration of action of about 4 hours. Thus, parents or teachers often describe a return of overactivity and distractibility as the first dose of medication wears off. This "rebound effect" can often be managed by moving the second dose of the day slightly closer to the first dose. Longer-acting preparations of methylphenidate or amphetamine-dextroamphetamine do not require frequent dosing and may be a better fit with a school day schedule. Splitting the dose in half would affect the duration. Switching to another class of medication would be appropriate if the drug was ineffective in controlling the symptoms even with a change in the dosage schedule or after a switch to a longer acting preparation.

A 7-year-old client experiences tics, which have become increasingly frequent in recent months. How should the nurse educate the client's teacher to respond to the tics? Provide rewards when the client goes long periods without having any tics. Place the client in a private, low-stimulation environment whenever possible to prevent the client's tics. Set firm limits about where, when, and how the client exhibits the tics. Teach the client's classmates that the tics are not something that the client can control.

Teach the client's classmates that the tics are not something that the client can control. Explanation: Tics are largely involuntary, especially in younger children. Establishing a pattern of rewards or consequences would be ineffective and inappropriate. A calm environment may be of some benefit, but the priority would be teaching others that the client's behavior is not deliberate.

A nurse is assessing a 2-year-old child diagnosed with autism spectrum disorder. Which findings does the nurse expect to find on assessment? Select all that apply. The child is extremely playful. The child becomes upset with minor changes in routine. The child avoids eye contact. The child becomes frightened when left alone. The child does not relate to parents.

The child avoids eye contact. The child does not relate to parents. The child becomes upset with minor changes in routine. Children with autism spectrum disorder tend to avoid eye contact with people. They do not identify or relate to their parents and remain detached. These children get upset with minor changes in routine. Children with autism spectrum disroder do not enjoy engaging in play or make-believe with toys. These children do not get frightened if left alone; in fact, they prefer being left alone.

A nurse is assessing a 2-year-old child diagnosed with autism spectrum disorder. Which findings does the nurse expect to find on assessment? Select all that apply. The child becomes frightened when left alone. The child becomes upset with minor changes in routine. The child avoids eye contact. The child is extremely playful. The child does not relate to parents.

The child avoids eye contact. The child does not relate to parents. The child becomes upset with minor changes in routine. Explanation: Children with autism spectrum disorder tend to avoid eye contact with people. They do not identify or relate to their parents and remain detached. These children get upset with minor changes in routine. Children with autism spectrum disroder do not enjoy engaging in play or make-believe with toys. These children do not get frightened if left alone; in fact, they prefer being left alone.

A nurse is assessing a 2-year-old child diagnosed with autism spectrum disorder. Which findings does the nurse expect to find on assessment? Select all that apply. The child becomes upset with minor changes in routine. The child does not relate to parents. The child is extremely playful. The child avoids eye contact. The child becomes frightened when left alone.

The child becomes upset with minor changes in routine. The child does not relate to parents. The child avoids eye contact. Rationale:Children with autism spectrum disorder tend to avoid eye contact with people. They do not identify or relate to their parents and remain detached. These children get upset with minor changes in routine. Children with autism spectrum disroder do not enjoy engaging in play or make-believe with toys. These children do not get frightened if left alone; in fact, they prefer being left alone.

A nurse is working with a child undergoing behavioral modification therapy for attention deficit hyperactivity disorder (ADHD). The nurse finds that the child is thin. What could be the most likely reason for this observation? The child cannot sit through meals. The child is genetically predisposed to being thin. The child finds food distasteful. The child has decreased appetite.

The child cannot sit through meals. Children with ADHD are not patient enough to sit through meals. This results in reduced dietary intake. This is the most likely reason for children with ADHD to be thin. Children with ADHD do not have impaired taste sensation. These children do not have loss of appetite unless they are on drugs like methylphenidate. It is not known whether children with ADHD are genetically predisposed to being thin.

A nurse is working with a child undergoing behavioral modification therapy for attention deficit hyperactivity disorder (ADHD). The nurse finds that the child is thin. What could be the most likely reason for this observation? The child finds food distasteful. The child has decreased appetite. The child is genetically predisposed to being thin. The child cannot sit through meals.

The child cannot sit through meals. Explanation: Children with ADHD are not patient enough to sit through meals. This results in reduced dietary intake. This is the most likely reason for children with ADHD to be thin. Children with ADHD do not have impaired taste sensation. These children do not have loss of appetite unless they are on drugs like methylphenidate. It is not known whether children with ADHD are genetically predisposed to being thin.

The nurse is assessing a child with tic disorder. The nurse documents in the assessment sheet that the child exhibits coprolalia. What might be be interpreted from this? The child continuously repeats socially unacceptable words. The child continuously repeats the last heard phrase. The child grunts repeatedly. The child repeatedly shrugs the shoulders.

The child continuously repeats socially unacceptable words. Coprolalia is a complex vocal tic in which a child with tic disorder continuously repeats socially unacceptable, often obscene, words. Grunting and shrugging of the shoulders are common simple vocal and motor tics, respectively. Repeating the last heard phrase is a type of vocal tic known as echolalia.

The nurse is assessing a child with tic disorder. The nurse documents in the assessment sheet that the child exhibits coprolalia. What might be be interpreted from this? The child grunts repeatedly. The child continuously repeats socially unacceptable words. The child continuously repeats the last heard phrase. The child repeatedly shrugs the shoulders.

The child continuously repeats socially unacceptable words. Explanation: Coprolalia is a complex vocal tic in which a child with tic disorder continuously repeats socially unacceptable, often obscene, words. Grunting and shrugging of the shoulders are common simple vocal and motor tics, respectively. Repeating the last heard phrase is a type of vocal tic known as echolalia.

The nurse expects the child with expressive language disorder is likely to present with which nursing assessment finding? The child is mute. The child has difficulty understanding the meaning of words. The child stutters while speaking. The child has difficulty forming complete sentences.

The child has difficulty forming complete sentences. The child with expressive language disorder may have difficulty communicating through verbal or sign language. The child does not have impaired ability to produce sound. The child may not stutter while speaking but would not be able to organize words to make sentences while speaking. The child does not have receptive language disorder, thus the child would not have difficulty understanding the meaning of words and sentences.

A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The child is given medication and behavioral modification therapy to treat the condition. Which outcome achieved within 3 days would indicate successful therapy? The child is able to express positive statements about the self. The child is able to demonstrate successful interaction with family members over a long period of time. The child is able to interact and to develop successful peer relationships. The child is able to complete assignments or tasks with assistance.

The child is able to complete assignments or tasks with assistance. Explanation: If within 3 days of starting treatment the child with ADHD is able to complete work or assignments with assistance, then this indicates successful therapy. Being able to express positive statements about himself or herself cannot be expected of the child after only 3 days of therapy. The child's ability to develop peer relationships would also not be demonstrated within this time. After 3 days of therapy, the children with ADHD would be able to demonstrate changes like being able to listen to others. They would not be able to interact with family members for a long period of time.

A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The child is given medication and behavioral modification therapy to treat the condition. Which outcome achieved within 3 days would indicate successful therapy? The child is able to demonstrate successful interaction with family members over a long period of time. The child is able to express positive statements about the self. The child is able to complete assignments or tasks with assistance. The child is able to interact and to develop successful peer relationships.

The child is able to complete assignments or tasks with assistance. If within 3 days of starting treatment the child with ADHD is able to complete work or assignments with assistance, then this indicates successful therapy. Being able to express positive statements about himself or herself cannot be expected of the child after only 3 days of therapy. The child's ability to develop peer relationships would also not be demonstrated within this time. After 3 days of therapy, the children with ADHD would be able to demonstrate changes like being able to listen to others. They would not be able to interact with family members for a long period of time.

A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The child is given medication and behavioral modification therapy to treat the condition. Which outcome achieved within 3 days would indicate successful therapy? The child is able to complete assignments or tasks with assistance. The child is able to demonstrate successful interaction with family members over a long period of time. The child is able to express positive statements about the self. The child is able to interact and to develop successful peer relationships.

The child is able to complete assignments or tasks with assistance. Rationale:If within 3 days of starting treatment the child with ADHD is able to complete work or assignments with assistance, then this indicates successful therapy. Being able to express positive statements about himself or herself cannot be expected of the child after only 3 days of therapy. The child's ability to develop peer relationships would also not be demonstrated within this time. After 3 days of therapy, the children with ADHD would be able to demonstrate changes like being able to listen to others. They would not be able to interact with family members for a long period of time.

A nurse is speaking to the peers of a child with attention deficit hyperactivity disorder (ADHD). The nurse finds that these children do not like the child and do not want to include the child during play. What are the likely reasons for the children feeling this way? Select all that apply. The child doesn't follow the rules of the game. The child constantly interrupts while playing. The child cannot move or play as quickly as the other children. The child is not cooperative while playing. The child abuses other children.

The child is not cooperative while playing. The child constantly interrupts while playing. The child doesn't follow the rules of the game. Explanation: Children with ADHD are often disliked by their peers and are usually not involved in play activities. The reasons for peers responding this way are that children with ADHD do not cooperate while playing and tend to constantly interrupt others during play. Children with ADHD lack attention and are too hurried to listen to the rules of play. As a result, peers become frustrated because the child with ADHD does not follow the game rules. Children with ADHD do not lack the ability to play and are not too slow. Unlike children with disruptive disorder, children with ADHD are not abusive.

A nurse is assessing a child with attention deficit hyperactivity disorder (ADHD). For every question asked by the nurse, the child answers, "I don't know." What is the most likely reason for the child to respond in this way? The child is not willing to answer the nurse. The child is not able to understand what the nurse is asking. The child does not like talking to the nurse. The child is not paying attention to the nurse's questions.

The child is not paying attention to the nurse's questions. Explanation: Children with ADHD are unable to pay attention and cannot stop their minds from racing. This is the reason for the child with ADHD responding "I don't know" to every question the nurse asks. It is not likely that the child dislikes the nurse. Unlike children with disruptive behavior, children with ADHD are not intentionally unwilling to respond to questions. Children with ADHD do not lack cognition. If they were able to be attentive, they would be able to understand the nurse's question easily.

The nurse is teaching the parents of a child with involuntary enuresis about methods to manage the condition. Which intervention does the nurse recommend to the parents? The child's dietary patterns should be changed. The child should begin therapeutic play. The child needs to be taught special exercises. The child should use pads with a warning bell.

The child should use pads with a warning bell. Explanation: The use of pads with a warning bell as well as positive reinforcement has been shown to help resolve the elimination disorder. This behavioral modification may help the child to void urine voluntarily over a period of time. The child does not pass urine voluntarily, so a change in diet will not help the child. Exercise does not help treat involuntary enuresis. Therapeutic play is used to promote communication in children.

The nurse is teaching the parents of a child with involuntary enuresis about methods to manage the condition. Which intervention does the nurse recommend to the parents? The child should use pads with a warning bell. The child should begin therapeutic play. The child needs to be taught special exercises. The child's dietary patterns should be changed.

The child should use pads with a warning bell. Rationale:The use of pads with a warning bell as well as positive reinforcement has been shown to help resolve the elimination disorder. This behavioral modification may help the child to void urine voluntarily over a period of time. The child does not pass urine voluntarily, so a change in diet will not help the child. Exercise does not help treat involuntary enuresis. Therapeutic play is used to promote communication in children.

A 6-year-old client who has been diagnosed with autism spectrum disorder would be expected to display which behavior? The client has multiple motor tics and several vocal tics. The client has an irresistible urge to pull out the client's own hair. The client spends time alone and shows little interest in making friends. The client becomes overly attached to those around the client.

The client spends time alone and shows little interest in making friends. Children with autism develop language slowly or not at all. They may use words without attaching meaning to them or communicate with only gestures or noises. They spend time alone and show little interest in making friends. Approximately 80% of people with autism also are classified as intellectually disabled. Their most distinctive feature, however, is their seeming isolation from the world around them. This detachment and aloofness help distinguish people with autism from those who are solely diagnosed as intellectually disabled.

The client is 6-year-old who has been diagnosed with autism spectrum disorder. Which symptom would the client display? The client becomes overly attached to those around the client. The client has multiple motor tics and several vocal tics. The client spends time alone with little interest in making friends. The client has an irresistible urge to pull out the client's own hair.

The client spends time alone with little interest in making friends. Children with autism spectrum disorder develop language slowly or not at all. They may use words without attaching meaning to them or communicate with only gestures or noises. They spend time alone and show little interest in making friends. Autism spectrum disorder is not associated with over attachment, pulling out hair, or tics.

The client is 6-year-old who has been diagnosed with autism spectrum disorder. Which symptom would the client display? The client has multiple motor tics and several vocal tics. The client has an irresistible urge to pull out the client's own hair. The client becomes overly attached to those around the client. The client spends time alone with little interest in making friends.

The client spends time alone with little interest in making friends. Explanation: Children with autism spectrum disorder develop language slowly or not at all. They may use words without attaching meaning to them or communicate with only gestures or noises. They spend time alone and show little interest in making friends. Autism spectrum disorder is not associated with over attachment, pulling out hair, or tics.

A nurse is developing the plan of care for a 6-year-old child diagnosed with attention deficit hyperactive disorder (ADHD). The nurse identifies interventions to address which behavior issues? Select all that apply. Does not acknowledge others' right to select group activities Frequently acts out during class "quiet time" Throws a temper tantrum when asked to clean up toys Gently asks a peer to share a particular toy Has a habit of not waiting for a turn

Throws a temper tantrum when asked to clean up toys Does not acknowledge others' right to select group activities Frequently acts out during class "quiet time" Has a habit of not waiting for a turn Explanation: The care plan of a 6-year-old child diagnosed with ADHD includes interventions to help manage the client's temper tantrums and acting out, refusal to acknowledge others' right to select group activities, and habit of not waiting for their turn, and to prevent physically intrusive behavior while playing.

A nurse is caring for a child with attention deficit hyperactivity disorder. The nurse asks the child to draw pictures of the child and family members. What is the most likely rationale for this intervention? To reduce hyperactivity in the child To reward the child for adaptive behavior To help the child self-express To release excessive energy

To help the child self-express Explanation: Creative play techniques such as having children draw pictures of themselves and of their family are useful for children who are unwilling to express themselves verbally. Children's excess energy can be released and hyperactivity reduced by engaging them in activities such as pounding pegs and running. It is unlikely that the child will view sitting and drawing as a reward, therefore, using this intervention as a reward is not realistic.

Which condition is characterized by multiple motor tics and one or more vocal tics many times throughout the day for 1 year or more? Attention deficit hyperactivity disorder Asperger's syndrome Tourette syndrome Trichotillomania

Tourette syndrome Explanation: Tourette syndrome, the most severe tic disorder, is characterized by multiple motor tics and one or more vocal tics many times throughout the day for 1 year or more.

When a client repeatedly vocalizes an obscene phrase and imitates the motions of a staff member, the nurse documents that the client is most likely exhibiting symptoms of what disorder? Tourette's syndrome Autism spectrum disorder Mixed receptive-expressive language disorder Phonological disorder

Tourette's syndrome Explanation: Tourette's syndrome, or Gilles de la Tourette's syndrome, is described as a combination of motor tics and involuntary vocal and verbal utterances that often are obscene (coprolalia); imitating someone else's movements (echokinesis) may be present

A psychiatric-mental health nurse is reviewing an article about genetics and the role in the development of a childhood psychiatric disorder. The nurse demonstrates understanding of this information by identifying which disorder as being genetically transmitted? Tourette's syndrome depression anxiety disorder bulimia

Tourette's syndrome Rationale:Many childhood psychiatric disorders, such as autism, intellectual disability, developmental learning disorders, some language disorders (e.g., dyslexia), attention deficit hyperactivity disorder (ADHD), and Tourette's syndrome, appear to be genetically transmitted. Research increasingly shows that major psychiatric disorders (e.g., depression, anxiety disorder, schizophrenia, bipolar disorder, substance abuse) run in families but are not necessarily identified as being genetically transmitted.

Which are nursing actions that support active listening? Select all that apply. Sit with arms and legs crossed Interrupt conversations to ask more questions Use reflective comments Use a computer to write out observations Use appropriate vocabulary

Use appropriate vocabulary Use reflective comments During the comprehensive assessment, the nurse needs to be a good, active listener. Using appropriate vocabulary, tolerating a child's anxious, angry or sad behavior, and use of reflective comments are useful listening skills.

Which are nursing actions that support active listening? Select all that apply. Interrupt conversations to ask more questions Use a computer to write out observations Use appropriate vocabulary Use reflective comments Sit with arms and legs crossed

Use appropriate vocabulary Use reflective comments Explanation: During the comprehensive assessment, the nurse needs to be a good, active listener. Using appropriate vocabulary, tolerating a child's anxious, angry or sad behavior, and use of reflective comments are useful listening skills.

During a comprehensive assessment of a child, which person does the nurse interview first? child parent caregiver grandparents

child Explanation: The child should be interviewed first during a comprehensive assessment, then the parents or other caregivers. The grandparents are not interviewed unless the child lives with them.

Which is an example of egocentrism by an adolescent? only eats food from a particular store does not talk much because they think they are being watched by others is willing to assist with any social event shares stories about parents and siblings

does not talk much because they think they are being watched by others Explanation: Egocentrism is a preoccupation with one's own appearance, behavior, thoughts, and feelings. Egocentrism is increased when emotions associated with uncertainty increase. Because teenagers have a heightened sense of self-conciousness, they may not want to share information during the interview because they think others are watching.

A variety of areas are assessed during the mental status examination. Which are sections of the mental status examination? Select all that apply. gross and fine motor movement intellectual functioning religious background cognition academic interests

intellectual functioning gross and fine motor movement cognition Explanation: The nurse can assess for developmental delays by asking questions from specific sections of the mental status examination. Areas covered on the exam include intellectual functioning, gross and fine motor functioning, cognition, thinking and perception and social interactions and play.

Which activity would assist the adolescent to establish rapport with the nurse? dress up clothes board games interview video games

interview Explanation: During early adolescence, cognitive changes include increased self-consciousness, feeling ashamed, and demands for privacy and secrecy. An adolescent's willingness to talk to a nurse will depend partly on his or her perception of the degree of rapport between them. At the start of the interview, the nurse should clearly convey to the adolescent what information will and will not be shared with parents.

Which are included in the mental health comprehensive evaluation of children and adolescents? Select all that apply. school records laboratory values medical history a full set of vital signs mental status examination

medical history mental status examination school records Explanation: A comprehensive evaluation includes a history, mental status examination, records of the child's school performance and medical-physical history, screening tools, and information from other agencies.