Peds - Chapter 30: Nursing Care of the Child With a Cognitive or Mental Health Disorder
A 10-year-old girl with ADHD has been on Ritalin for 6 months. The girl's mother calls and tells the nurse that the medication is ineffective and requests an immediate increase in the child's dosage. What should the nurse say? a) "Let's set up an appointment as soon as possible." b) "Let me talk to the doctor about this." c) "Let's wait a few more weeks before we do anything." d) "What does the teacher say?"
"Let's set up an appointment as soon as possible."
The nurse is caring for a child with attention deficit/hyperactivity disorder who is experiencing insomnia related to the prescribed psychostimulant. The parents are considering stopping the medication and want to know if there are other options. Which response by the nurse would be most appropriate? a) "Speak to the doctor about atomoxetine." b) "Perhaps the doctor will prescribe long-acting dextroamphetamine." c) "Ask the doctor about long-acting methylphenidate." d) "Talk to the doctor about dextroamphetamine."
"Speak to the doctor about atomoxetine."
The nurse is working with a group of caregivers of school-age children diagnosed with attention deficit hyperactivity disorder. Which of the following statements would be most appropriate for the nurse to make to this group of caregivers? a) "These children function best if given a set of instructions and then left to do the task." b) "These children study better with quiet background music such as the radio or a CD." c) "The medications your child is on may cause a decreased appetite." d) "A frequent change in routine will be helpful so the child does not get bored."
"The medications your child is on may cause a decreased appetite."
A nurse is providing a routine wellness examination and follow-up for a 3-year-old recently diagnosed with autism spectrum disorder (ASD). Which response indicates a need for additional referral or follow-up? a) "We really like the treatment plan that has been created by his school." b) "We have a couple of baby sitters who know how to handle his needs." c) "We have recently completed his individualized education plan." d) "We try to be flexible and change his routine from day to day."
"We try to be flexible and change his routine from day to day."
The nurse is discussing the treatment for a child with attention deficit hyperactivity disorder (ADHD) with a group of school nurses. Which of the following would be an appropriate learning setting for a child with ADHD? a) A classroom with windows facing a playground. b) A classroom with tables and chairs rather than individual desks. c) A classroom with a plan of study that is followed each day. d) A classroom in which children self-select their activities.
A classroom with a plan of study that is followed each day.
A 6-year-old is seen in a mental health clinic for possible hyperactivity. His mother reports that he is just "all boy." He has always been active and does not like to sit still for more than a minute. Which of the following data would be most important to assess to help evaluate his behavior? a) Whether he was breastfed or bottle-fed as an infant b) Family medical history for circulatory illnesses c) A review of the boy's typical day d) Medical history for communicable diseases
A review of the boy's typical day
Which behavior typical of children with autism spectrum disorder (ASD) requires you to maintain special care to keep them safe? a) A fascination with bright colors b) A craving for salt c) Insensitivity to pain d) Loss of hearing for high frequencies
Insensitivity to pain
The nurse is caring for a 10-year-old recently diagnosed with attention deficit/hyperactivity disorder (ADHD). The nurse would expect to provide teaching regarding which medication? a) Trazodone b) Methylphenidate c) Buspirone d) Fluoxetine
Methylphenidate
A group of nursing students are reviewing the actions of various drugs used to treat mental health disorders in children. The students demonstrate understanding of the information when they identify which drug as potentiating the activity of serotonin in the brain? a) Lithium b) Sertraline c) Buspirone d) Trazodone
Sertraline Sertraline is a selective serotonin reuptake inhibitor that potentiates serotonin activity in the brain. Trazodone is an atypical antidepressant that inhibits the reuptake of serotonin. Lithium influences the reuptake of serotonin and/or norepinephrine. Buspirone blocks the reuptake of dopamine.
The nurse is conducting an examination of a boy with Tourette syndrome. Which finding should the nurse expect to observe? a) Toe walking b) Spinning and hand flapping c) Lack of eye contact d) Sudden, rapid stereotypical sounds
Sudden, rapid stereotypical sounds
Which of the following signs and symptoms suggest that a 5-year-old boy who does not maintain eye contact or speak may have autism spectrum disorder (ASD)? a) The child constantly opens and closes his hands. b) The child has a slight decrease in head circumference. c) The child has a long face and prominent jaw. d) The child is highly active and inattentive.
The child constantly opens and closes his hands.
Which of the following signs and symptoms suggest that a 5-year-old boy who does not maintain eye contact or speak may have autism spectrum disorder (ASD)? a) The child has a long face and prominent jaw. b) The child has a slight decrease in head circumference. c) The child constantly pats his legs. d) The child is highly active and inattentive.
The child constantly pats his legs.
The nurse is assessing a 6-year-old with attention deficit/hyperactivity disorder (ADHD). The nurse observes the boy making repeated clicking noises and notes he has a slight grimace. The nurse recommends the boy receive further evaluation for: a) Tourette syndrome. b) autism spectrum disorder. c) anxiety disorder. d) Asperger syndrome.
Tourette syndrome Repeated vocal tics such as sniffling, grunting, clicking, or word utterances are associated with Tourette syndrome. The syndrome consists of multiple motor tics and one or more motor tics occurring simultaneously at different times. ADHD and obsessive-compulsive disorder occur in 90% of children with Tourette syndrome. Vocal and motor tics are not typical indicators of Asperger syndrome, anxiety disorder, or autism spectrum disorder.
Many children with autistic spectrum disorder (ASD) are intellectually disabled. a) False b) True
True
A nurse is conducting a mental status examination with a 5-year-old boy who is playing with trains and blocks of different colors. He repeats the same actions with the trains over and over again throughout the examination. Which of the following questions would be most appropriate? a) Are you having fun now? b) Do you like playing with trains and blocks? c) Why does that red train keep crashing into all of the other trains? d) What year is it?
Why does that red train keep crashing into all of the other trains?
The nurse is caring for a child with ADHD. Which behavior would the nurse not expect the child to display: 1. moody, morose behavior with pouting 2. interruption and inability to take turns 3. forgetfulness and easy distractibility 4. excessive motor activities and fidgeting
moody, morose behavior with pouting
A 4-year-old has been diagnosed with Tourette syndrome. A unique manifestation of this syndrome is a) obscenity shouting. b) mutism. c) running wildly in circles. d) easily broken bones.
obscenity shouting.
Rumination disorder is a poorly understood condition of young children. This refers to a) a habit of eating nonfood substances. b) excessive worrying about friendships. c) fear of moving objects. d) rechewing undigested food.
rechewing undigested food.
The child has been diagnosed with a mental health disorder and the child's parents are beginning to incorporate behavior management techniques. Which statements by the child's parent indicate the need for further education? Select all that apply. a) "We're trying to make her accountable and responsible for her own behavior." b) "I use a higher pitched voice when I communicate with her." c) "We have set some boundaries that are nonnegotiable." d) "I am quick to point out the things that she does that make me crazy." e) "We tell her when she is doing something well."
• "I use a higher pitched voice when I communicate with her." • "I am quick to point out the things that she does that make me crazy."
The 18-month-old toddler has been brought into the pediatrician's office by his parents. The nurse interviews the parents regarding the child's abilities. Which findings are warning signs that the toddler may have autism spectrum disorder? Select all that apply. a) Cannot stand on tiptoe b) Has never "babbled" c) Does not use any words d) Does not speak in short sentences e) Does not exhibit attempts to communicate by pointing to objects
• Has never "babbled" • Does not exhibit attempts to communicate by pointing to objects • Does not use any words
The characteristics of the child with autism fall into three categories. Which of the following are the three categories that these characteristics fall in to? a) Inability to respond to verbal stimuli b) Decreased ability to meet developmental milestones c) Inability to communicate with others d) Obviously limited activities and interests. e) Inability to relate to others
• Inability to relate to others • Inability to communicate with others • Obviously limited activities and interests.
After teaching the parents of a child with Tourette syndrome about motor and vocal tics, the nurse determines that the teaching was successful when the parents state: a) "Vocal tics are harder to control than the motor tics are." b) "Drugs are the primary method for controlling the symptoms." c) "He can control the tics if he really concentrates on doing so." d) "If we get him focused on an activity, the tics will be less pronounced."
"If we get him focused on an activity, the tics will be less pronounced." Tics become more noticeable or severe during times of stress and less pronounced when the child is focused on an activity such as watching TV, reading, or playing a video game. The tics are not under voluntary control and either type can be difficult to control. Management is highly individualized and involves psychopharmacology and behavioral therapy.
The mother of a 10-year-old boy with attention deficit hyperactivity disorder (ADHD) contacts the school nurse. She is upset because her son has been made to feel different by his peers because he has to visit the nurse's office for a lunch time dose of medication. The boy is threatening to stop taking his medication. How should the nurse respond? a) "He will need to learn to ignore the children, he needs this medication." b) "You may want to talk to your physician about an extended release medication." c) "I can have the teacher speak with the other children." d) "Remind him that his schoolwork may deteriorate."
"You may want to talk to your physician about an extended release medication."
A child with ADHD is placed on methylphenidate (Ritalin) therapy. Which of the following symptoms may children on Ritalin develop? a) Rapid increase in height b) Hypotension c) Sleepiness d) Anorexia
Anorexia
The nurse is preparing a presentation for a local health fair on autism spectrum disorders. What statement would the nurse include as part of the presentation? a) Scientific evidence supports the use of complementary therapies. b) Autism cannot be cured. c) Children respond best when the environment is less structured. d) Communication therapies are of little value in treating autism.
Autism cannot be cured.
The nurse is caring for a 12-year-old boy who is profoundly cognitively challenged, with an IQ of 15. Which task is the most challenging that the nurse should expect this client to be able to accomplish as an adult? a) Contribute to his own support by performing unskilled manual labor b) Brush his teeth c) Live independently d) Dress himself
Brush his teeth
The mother of an 8-year-old boy is concerned that her son has attention-deficit/hyperactivity disorder. She describes the symptoms he demonstrates. Which of the following behaviors should the nurse recognize as an example of impulsiveness? a) Repeating words or phrases spoken by others b) Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission c) Constantly fidgeting in his chair and shaking his foot d) Inability to answer a question posed by his teacher because he was daydreaming
Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission
Which of the following signs is consistent with autism spectrum disorder (ASD)in a 2-year-old boy? a) Has below-average intellectual function b) Performs repetitive activity with toys c) Possesses excellent language development d) Shows signs of losing attained skills
Performs repetitive activity with toys
The nurse is collecting data on an 18-month-old old child with a diagnosis of autism spectrum disorder (ASD). Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) The child cries and runs to the door when the caregiver leaves the room. b) The child sits quietly in the caregivers lap during interview. c) The child smiles when the caregiver shows her a stuffed animal. d) The child does not make eye contact.
The child does not make eye contact.
The nurse in the well-child clinic observes that a 5-year-old child in the waiting room is having trouble using a crayon to color. During the visit, the same child climbs off the table several times even after the nurse has asked him to stay on the table. Each time the nurse reminds him he says, "Oh, yeah," and happily climbs back up. The nurse suspects that which of the following applies to this child? a) The child has autism spectrum disorder. b) The child has failure to thrive. c) The child has an addicted caregiver. d) The child has attention deficit hyperactive disorder (ADHD).
The child has attention deficit hyperactive disorder (ADHD).
To feed lunch to a child with autism spectrum disorder (ASD), which of the following actions would be most important to take? a) Use a repetitive series of movements. b) Use an authoritarian manner to gain control. c) Allow the child to ask questions about the procedure. d) Don't allow him to see the spoon approach his mouth.
Use a repetitive series of movements. Children with ASD typically enjoy repetitive movements or the same action over and over.
The nurse is observing a group of 2- and 3-year-olds in a play group. Which behavior noted in one of the children indicates to the nurse that the child may have autism spectrum disorder (ASD)? a) While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack. b) A child flips the light switch off and on until the caregiver asks her to stop and join the other children in playing. c) A child playing in the kitchen area pretends to pour a glass of milk and repeats this over and over. d) After another child takes a toy, the child cries and stomps his feet.
While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack.
