Chapter 23: Children and Adolescents
A nursing instructor presents a case study in which a 3-year-old child is in constant motion and is unable to sit still during story time. She asks a student to evaluate this child's behavior. Which student response indicates an appropriate evaluation of the situation? 1. "This child's behavior must be evaluated according to developmental norms." 2. "This child has symptoms of attention deficit-hyperactivity disorder." 3. "This child has symptoms of the early stages of autism spectrum disorder." 4. "This child's behavior indicates possible symptoms of oppositional defiant disorder."
ANS: 1. "This child's behavior must be evaluated according to developmental norms."
When planning care for a client, which medication classification would a nurse recognize as effective in the treatment of Tourette's syndrome? 1. Antipsychotic medications 2. Antimanic medications 3. Tricyclic antidepressant medications 4. Monoamine oxidase inhibitor medications
ANS: 1. Antipsychotic medications
A nurse assesses an adolescent client diagnosed with conduct disorder who, at the age of 8 years, was sentenced to juvenile detention. How would the nurse interpret this assessment data? 1. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood. 2. Childhood-onset conduct disorder is caused by a difficult temperament, and the child is likely to outgrow these behaviors by adulthood. 3. Childhood-onset conduct disorder is diagnosed only when behaviors emerge before the age of 5 years, and, therefore, improvement is likely. 4. Childhood-onset conduct disorder has no treatment or cure, and children diagnosed with this disorder are likely to develop progressive oppositional defiant disorder.
ANS: 1. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood.
A child diagnosed with severe autism spectrum disorder has the nursing diagnosis Disturbed Personal Identity. Which outcome would best address this client diagnosis? 1. The client will name own body parts as separate from others by day 5. 2. The client will establish a means of communicating personal needs by discharge. 3. The client will initiate social interactions with caregivers by day 4. 4. The client will not harm self or others by discharge.
ANS: 1. The client will name own body parts as separate from others by day 5.
After an adolescent diagnosed with attention deficit-hyperactivity disorder (ADHD) begins methylphenidate (Ritalin) therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. Which is the best explanation for this weight loss? 1. The pharmacological action of Ritalin causes a decrease in appetite. 2. Hyperactivity seen in ADHD causes increased caloric expenditure. 3. Side effects of Ritalin can include nausea; therefore, caloric intake is decreased. 4. Increased ability to concentrate allows the client to focus on activities rather than food.
ANS: 1. The pharmacological action of Ritalin causes a decrease in appetite.
The mother of a child diagnosed with intellectual developmental disorder asks, "How did the doctors arrive at this diagnosis?" The nurse knows that the following factors are considered in the diagnosis of intellectual developmental disorder: (Select all that apply.) 1. A family history of poor educational attainment 2. General intellectual functioning 3. Adaptive functioning 4. IQ score
ANS: 2,3,4 2. General intellectual functioning 3. Adaptive functioning 4. IQ score
Which of the following findings would a nurse identify that would contribute to a client's development of attention deficit-hyperactivity disorder (ADHD)? (Select all that apply.) 1. The client's father was a smoker. 2. The client had a low birth weight. 3. The client is lactose intolerant. 4. The client has a sibling diagnosed with ADHD. 5. The client has been diagnosed with dyslexia.
ANS: 2,4 2. The client had a low birth weight. 4. The client has a sibling diagnosed with ADHD
A child has been diagnosed with autism spectrum disorder. The distraught mother cries out, "I'm such a terrible mother. What did I do to cause this?" Which nursing response is most appropriate? 1. "Researchers really don't know what causes autism spectrum disorder, but the relationship between autistic disorder and fetal alcohol syndrome is being explored." 2. "Poor parenting doesn't cause autism spectrum disorder. Research has shown that abnormalities in brain structure or function are to blame. This is beyond your control." 3. "Research has shown that the mother appears to play a greater role in the development of autism spectrum disorder than the father." 4. "Lack of early infant bonding with the mother has shown to be a cause of autism spectrum disorder. Did you breastfeed or bottle-feed?"
ANS: 2. "Poor parenting doesn't cause autism spectrum disorder. Research has shown that abnormalities in brain structure or function are to blame. This is beyond your control."
A preschool child is admitted to a psychiatric unit with a diagnosis of autism spectrum disorder. To help the child feel more secure on the unit, which intervention would a nurse include in this client's plan of care? 1. Encourage and reward peer contact. 2. Provide consistent caregivers. 3. Provide a variety of safe daily activities. 4. Maintain close physical contact throughout the day.
ANS: 2. Provide consistent caregivers.
Which behavioral approach would a nurse use when caring for children diagnosed with disruptive behavior disorders? 1. Involving parents in designing and implementing the treatment process 2. Reinforcing positive actions to encourage repetition of desirable behaviors 3. Providing opportunities to learn appropriate peer interactions 4. Administering psychotropic medications to improve quality of life
ANS: 2. Reinforcing positive actions to encourage repetition of desirable behaviors
Which finding would a nurse expect when assessing a child diagnosed with separation anxiety disorder? 1. The child has a history of antisocial behaviors. 2. The child's mother was stressed during the pregnancy. 3. The child previously had an extroverted temperament. 4. The child's mother and father have an inconsistent parenting style.
ANS: 2. The child's mother was stressed during the pregnancy.
An angry parent brings their 10-year-old child into an outpatient clinic for evaluation. She states, "My son has been angry and defiant. He seeks to undermine my control." The nurse recognizes that which of the following is true regarding the development and diagnosis of Oppositional Defiant Disorder (ODD)? 1. The parents probably had a diagnosis of ODD in childhood as there is a strong genetic component. 2. The parents likely struggle with exercising parental control and hence a power struggle ensues between parent and child. 3. The child is likely to view their own behavior as defiant. 4. The child is too young to be diagnosed with ODD.
ANS: 2. The parents likely struggle with exercising parental control and hence a power struggle ensues between parent and child.
A mother questions the decreased effectiveness of methylphenidate (Ritalin) prescribed for her child's attention deficit-hyperactivity disorder. Which nursing response best addresses the mother's concern? 1. "The health-care provider will probably switch from Ritalin to a central nervous system stimulant." 2. "The health-care provider may prescribe an antihistamine with the Ritalin to improve effectiveness." 3. "Your child has probably developed a tolerance to Ritalin and may need a higher dosage." 4. "Your child has developed sensitivity to Ritalin and may be exhibiting an allergy."
ANS: 3. "Your child has probably developed a tolerance to Ritalin and may need a higher dosage."
A preschool child diagnosed with autism spectrum disorder has been engaging in constant head-banging behavior. Which nursing intervention is appropriate? 1. Place client in restraints until the aggression subsides. 2. Sedate the client with antipsychotic medications. 3. Hold the client's head steady and apply a helmet. 4. Distract the client with a variety of games and puzzles.
ANS: 3. Hold the client's head steady and apply a helmet.
Which would be the priority nursing intervention when caring for a child diagnosed with conduct disorder? 1. Modify environment to decrease stimulation and provide opportunities for quiet reflection. 2. Convey unconditional acceptance and positive regard. 3. Recognize escalating aggressive behavior and intervene before violence occurs. 4. Provide immediate positive feedback for appropriate behaviors.
ANS: 3. Recognize escalating aggressive behavior and intervene before violence occurs.
A client diagnosed with attention deficit-hyperactivity disorder (ADHD) is seen sitting calmly and does not run around with the other children. The child's mother is questioning the ADHD diagnosis. The nurse recognizes that: 1. This client likely does not need treatment for ADHD. 2. This client likely has hyperactive type of ADHD. 3. The client likely has inattentive type of ADHD. 4. The client likely is intellectually inferior to the other children.
ANS: 3. The client likely has inattentive type of ADHD.
In planning care for a child diagnosed with autism spectrum disorder, which would be a realistic client outcome? 1. The client will communicate all needs verbally by discharge. 2. The client will participate with peers in a team sport by day 4. 3. The client will establish trust with at least one caregiver by day 5. 4. The client will perform most self-care tasks independently.
ANS: 3. The client will establish trust with at least one caregiver by day 5.
The mother of a child diagnosed with moderate intellectual developmental disorder asks, "What educational level will my child be able to attain?" The nurse knows that a child with moderate intellectual developmental disorder would be capable of which of the following? 1. Graduating from vocational school 2. A sixth-grade level of cognitive proficiency 3. Graduating from elementary school 4. A second-grade level of cognitive proficiency
ANS: 4 A second-grade level of cognitive proficiency
A client is diagnosed with moderate intellectual developmental disorder. Which developmental characteristic would the nurse identify as typical of a client diagnosed with moderate intellectual developmental disorder? 1. The client can perform activities without supervision. 2. The client can easily adhere to social convention. 3. The client's motor development may be limited to gross motor activities. 4. The client communicates wants and needs by "acting out" behaviors.
ANS: 4 The client communicates wants and needs by "acting out" behaviors.
The mother of a child diagnosed with intellectual developmental disorder asks, "How could this have happened?" The nurse recognizes that which of the following risk factors may contribute to the development of intellectual developmental disorder? 1. A maternal history of peri-partum depression 2. A family history of low educational attainment 3. Overstimulation in early infancy, including an excess of social contact 4. A family history of Tay-Sachs disease
ANS: 4. A family history of Tay-Sachs disease
After studying the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for oppositional defiant disorder (ODD), which listed symptom would a student nurse recognize? 1. Arguing and annoying older sibling over the past year 2. Angry and resentful behavior over a 3-month period 3. Initiating physical fights for more than 18 months 4. Arguing with authority figures for more than 6 months
ANS: 4. Arguing with authority figures for more than 6 months
Which would the nurse identify as risk factors related to family dynamics for predisposition to a conduct disorder? 1. Stable residence 2. Consistency in discipline 3. Excessive supervision 4. Economic stressors
ANS: 4. Economic stressors
____________________ is defined as the trait of acting without reflection and without thought to the consequences of the behavior. This trait is common in clients exhibiting symptoms of attention deficit-hyperactivity disorder (ADHD).
ANS: Impulsivity