Chapter 22: Neurodevelopmental Disorders
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.
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.
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 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.
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.
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.
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.
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 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 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.
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
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 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.
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.
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).
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 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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 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 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 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 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.
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.
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 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.
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).
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.
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 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.
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
