PrepU Ch. 36 Pediatric Clients

The nurse is interviewing an 11-year-old girl diagnosed with bulimia. An appropriate question to ask the child during the initial interview is ... a) "Do you ever feel anxious?" b) "Are you feeling sad?" c) "Have you ever heard of thorazine?" d) "Have you ever had delusions?"

"Are you feeling sad?" Explanation: Children have a narrower vocabulary and are more concrete in their thinking. The nurse should use the terms "sad" or "nervous" rather than depressed or anxious.

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

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

The nurse is beginning an assessment interview with an girl age 8 years who has been brought in for counseling by her parents. When beginning the interview, which question would be most appropriate for the nurse to ask first? a) "Has anyone told you about why you are here today?" b) "Why do you think I'm talking to you alone without your parents here? c) "How old are you?" d) "How are you feeling?"

"Has anyone told you about why you are here today?" Explanation: When assessing a school-aged child, the nurse should begin the interview with a broad opening question that addresses the child's understanding of why he or she is there. This question often helps to identify children's misperceptions that could create barriers to working with him or her. Asking about how the child is feeling or the child's age would occur later in the interview. Asking the child why he or she is being interviewed alone opens the door for misinterpretation and promotes feelings of isolation that could lead to increased anxiety.

An 11-year-old child talks to the school nurse about a single episode of disruptive behavior in class. The child states, "I had a stomach ache and felt like vomiting. I couldn't help it. I was just so mad at my dad." The most appropriate response by the nurse would be ... a) "If you can get rid of your anger, perhaps your stomachache will go away." b) "I can understand your anger, but you can't disrupt the classroom." c) "Perhaps it would be helpful if you let your dad know you're angry." d) "I can see that you're angry. Let's look at better ways to express it."

"I can see that you're angry. Let's look at better ways to express it." Explanation: A child at this age may have difficulty expressing negative or intense emotions verbally; the nurse's response helps teach the child appropriate expressions of anger.

The nurse is caring for an adolescent in the outpatient psychiatric setting. To help the adolescent feel more in control of the initial therapy sessions, which statement by the nurse would be most appropriate? a) "Your parents care a great deal about you. That's why you are here." b) "If something is uncomfortable for you, you don't have to talk about it." c) "Adolescents often feel a distrust of authority figures. Is that true with you?" d) "I won't share anything with your parents that you don't want me to share."

"If something is uncomfortable for you, you don't have to talk about it." Explanation: To help an adolescent feel more in control, an appropriate statement by the nurse is, "If something is uncomfortable for you, you don't have to talk about it." Adolescents are likely to be defensive in front of their parents and concerned with confidentiality. At the start of the interview, the nurse should clearly convey to the adolescent what information will and will not be shared with the adolescent's parents. Adolescents generally prefer a straightforward, candid approach to the interview because they often distrust those in authority. However, it is not necessary for the nurse to question the adolescent about his view. Telling the adolescent that his parents care a great deal does nothing to support the adolescent's need for control.

Jeremy, a 9-year-old with ADHD, has been placed on the stimulant methylphenidate (Ritalin, Concerta). The nurse knows that the teaching has been effective when his parents state which of the following? a) "Jeremy may have some side effects, like insomnia, headache, or stomach ache, but they are rare." b) "Jeremy will have an effect from this drug in about 2 weeks." c) "Jeremy knows that he only needs to take this medication once every 12 hours." d) "We'll bring Jeremy in every week to get his blood levels drawn."

"Jeremy may have some side effects, like insomnia, headache, or stomach ache, but they are rare." Explanation: Insomnia, headache, and stomach upset are common side effects of methylphenidate.

A nurse is interviewing a child age 12 years in an outpatient psychiatric setting. Which of the following would be most appropriate for the nurse to say to establish a high degree of credibility? a) "You'd get along better with your parents if you'd follow their advice." b) "How would you describe your parents?" c) "I have several teddy bears; would you like one to hold?" d) "Tell me about your best friend."

"Tell me about your best friend." Explanation: The nurse can establish a high degree of credibility simply by taking note of, and asking about, things that are obviously important to children (e.g., a sport the child participates in, a rock group displayed on a shirt, a toy the child may have brought in). However, children have an uncanny natural "radar" for phony adult behavior. Attempts to establish rapport work only when the nurse is genuinely interested in the child's life. Asking a child to describe his or her parents would not necessarily reflect something that is important to the child. Instead, the question focuses on the parents and not the child. Asking a 12-year-old child about holding a teddy bear may be interpreted as demeaning to a child of this age. Suggesting that the child follow his parents' advice is nontherapeutic and judgmental.

Which of the following statements would indicate that medication teaching for the parents of a 6-year-old child with attention deficit hyperactivity disorder (ADHD) has been effective? a) "We'll be sure he takes the Ritalin at the same time every day, just before bedtime." b) "We'll be sure to record his weight on a weekly basis." c) "We'll teach him the proper way to take the medication so he can manage it independently." d) "We're so glad that Ritalin will eliminate the problems of ADHD."

"We'll be sure to record his weight on a weekly basis." Explanation: Stimulant medications used to treat ADHD can suppress appetite, and the child may lose or fail to gain weight properly. The client is too young to manage his medications independently. Ritalin should be given in divided doses. Ritalin reduces hyperactivity, impulsivity, and mood lability and helps the child to pay attention more appropriately.

The nurse is assessing the self-concept of a child age 8 years. Which of the following would be least appropriate for the nurse to ask? a) "What did you have for breakfast this morning?" b) "What would you like to be when you grow up?" c) "If you had three wishes, what would you wish for?" d) "What subjects do you like best in school?"

"What did you have for breakfast this morning?" Explanation: The question about breakfast evaluates the child's recent memory. The questions about what he would wish for, what he would like to be when he grows up, and what subjects he likes best in school reflect self-concept.

A child age 3 years has been admitted to the hospital after an automobile accident. Which statement by the nurse would be most appropriate when discussing the type of behavior the parents can expect their child to display while hospitalized? a) "Your child may seem unduly anxious in the presence of strangers." b) "Your child may experience some guilt feelings associated with the accident." c) "Your child will exhibit intermittent periodic mood swings, but these should be brief." d) "Your child may not be able to accept how the injury has changed your child's appearance."

"Your child may seem unduly anxious in the presence of strangers." Explanation: Infants and children younger than school age are particularly vulnerable to separation anxiety during illness and may regress to earlier levels of anxiety about strangers, becoming fearful of health care providers. Young children often have magical thinking about the illness, and their tendency to process information in concrete terms may lead to misperceptions about the illness and treatment procedures. Adolescents may be concerned about body image and maintaining their sense of independence and control. Parents often experience guilt about the injury.

A nurse is assessing a 9-year-old child diagnosed with conduct disorder. Which advice should the nurse give the child's parents regarding treatment of the disorder? a) "Your child needs to be incarcerated." b) "Your child should be sent to boot camp." c) "Your child requires individualized behavioral therapy." d) "Your child requires your support and motivation."

"Your child requires your support and motivation." Explanation: Family therapy is most desirable to treat a 9 year old child with conduct disorder. Interventions like sending the child to boot camp or incarceration can worsen the symptoms in the child. Unlike adolescents, school-aged children with conduct disorder do not usually require individualized behavioral therapy.

A nurse is assessing a 9-year-old child diagnosed with conduct disorder. Which advice should the nurse give the child's parents regarding treatment of the disorder? a) "Your child requires your support and motivation." b) "Your child should be sent to boot camp." c) "Your child needs to be incarcerated." d) "Your child requires individualized behavioral therapy."

"Your child requires your support and motivation." Explanation: Family therapy is most desirable to treat a 9 year old child with conduct disorder. Interventions like sending the child to boot camp or incarceration can worsen the symptoms in the child. Unlike adolescents, school-aged children with conduct disorder do not usually require individualized behavioral therapy.

The nurse is assessing a child who is suspected of having Tourette's disorder. The nurse is reviewing the child's history, keeping in mind that for the diagnosis to be made, the tics must be present for at least which time frame? a) 1 month b) 1 year c) 6 months d) 2 years

1 year Explanation: Tourette's disorder, the most severe tic disorder, is defined by multiple motor and phonic tics for at least one year.

Which of the following IQs correlate with moderate retardation? a) 20 to 35 b) 35 to 50 c) 50 to 70 d) Less than 20

35 to 50 Explanation: Moderate retardation is an IQ between 35 and 50. Mild retardation is an IQ between 50 and 70. Severe retardation is an IQ between 20 and 35. Profound retardation is an IQ of less than 20.

The nurse is caring for a family with a 3-year-old child who has autism disorders. When developing the teaching plan for the parents, which of the following would the nurse most likely include? a) The child's IQ will typically be higher than that of other children. b) The child is at higher risk for seizure disorders as well. c) A structured physical environment is an important aspect. d) Dyslexia also may be a comorbid condition.

A structured physical environment is an important aspect. Explanation: The nurse should explain to the parents of a child with autism disorders that a structured physical environment will most likely be important. The nurse should identify the child's specific needs for structure in the physical environment and what happens when the physical environment is changed. Approximately 25% of autistic children have seizure disorders, and about 50% have mental retardation. Dyslexia is associated with a learning disorder.

Ground rules for nurses to follow when establishing rapport with children include what? a) Accepting the child and discussing undesirable behavior b) Tailoring your speech to fit the child by using child-like language c) Imitating the child's nonverbal behavior to establish rapport d) Letting the child know that you are in charge by setting the rules quickly

Accepting the child and discussing undesirable behavior Explanation: Accepting the child and discussing inappropriate behavior are important. The nurse should not tailor speech to fit the child, exhibit controlling behaviors, or imitate the child's nonverbal behaviors.

In a discussion with a group of high school teachers about oppositional defiant disorder (ODD), the nurse says that behavior modification of the parents and teachers toward such children forms the basis of therapy. What is the most appropriate rationale that the nurse gives when asked about this strategy? a) Adolescents with ODD are closest to their parents and teachers. b) Adolescents with ODD learn maladaptive behavior at home and school. c) Adolescents with ODD are less aggressive toward parents and teachers. d) Adolescents with ODD only fear their parents and teachers.

Adolescents with ODD learn maladaptive behavior at home and school. Explanation: The treatment of ODD is based on parental behavioral interventions. It is believed that problem behaviors in ODD are learned and reinforced in the home and at school, hence the approach of the parents and teachers toward the child may help to eliminate this disorder at earlier ages. In adolescents, behavioral therapy may also be required along with parental management. It may not be true that these children are closest to their parents. Such clients are usually very aggressive and lack a sense of fear of anybody.

Children with conduct disorder may be diagnosed with which of the following disorders as adults? a) Depression b) Schizophrenia c) Antisocial personality disorder d) Bipolar disorder

Antisocial personality disorder Explanation: As many as 30% to 50% of children diagnosed with conduct disorder are diagnosed with antisocial personality disorder as adults.

Susan's parents have begun a program of therapy that includes giving Susan a token each time she follows directions. The following theoretical framework provides the background for such a program: a) Behavioral theory. b) Psychodynamic theory. c) Systems theory. d) Token economy theory.

Behavioral theory. Explanation: Reinforcing behaviors with rewards reflects a basic principle of behavioral therapy.

A nurse is providing care to several chronically ill children. Which of the following children would the nurse identify as having the greatest risk for developing a psychiatric problem? a) Client age 8 years who has chronic renal disease b) Client age 5 years with cerebral palsy c) Client age 10 years with a heart murmur d) Client age 12 years with diabetes mellitus

Client age 5 years with cerebral palsy Explanation: Although most children with chronic illnesses and their families are remarkably resilient and adjust to the stressors and regimens involved in their care, children with chronic health conditions are three to four times more likely to experience psychiatric symptoms than are their healthy peers. Conditions that affect the central nervous system (CNS) (e.g., infections, metabolic diseases, CNS malformations, brain and spinal cord trauma) are particularly likely to result in psychiatric difficulties.

Which of the following is the primary assessment tool in child psychiatry? a) Clinical interview with child b) Interview with siblings c) DSM-IV-TR assessment d) Interview with parents

Clinical interview with child Explanation: The clinical interview is the primary assessment tool used in child and adolescent psychiatry. Although use of the DSM-IV-TR and an interview with parents and siblings may be important, none of these is the primary assessment tool.

Which of the following is the primary assessment tool in child psychiatry? a) Interview with parents b) Clinical interview with child c) DSM-IV-TR assessment d) Interview with siblings

Clinical interview with child Explanation: The clinical interview is the primary assessment tool used in child and adolescent psychiatry. Although use of the DSM-IV-TR and an interview with parents and siblings may be important, none of these is the primary assessment tool.

Which of the following childhood disorders is characterized by serious violations of social norms, such as destruction of property? a) Obsessive-compulsive disorder (OCD) b) Oppositional defiant disorder (ODD) c) Attention deficit hyperactivity disorder (ADHD) d) Conduct disorder

Conduct disorder Explanation: Conduct disorder is characterized by serious violations of social norms, including aggressive behavior, destruction of property, and cruelty of animals. ODD is characterized by a persistent pattern of disobedience, argumentativeness, angry outbursts, low frustration tolerance, and tendency to blame others for misfortunes. OCD is characterized by intrusive thoughts that are difficult to dislodge (obsessions) or ritualized behaviors that the child feels driven to perform (compulsions). ADHD is a persistent pattern of inattention, hyperactivity, and impulsiveness that is pervasive and inappropriate for developmental level.

The child's response to divorce is similar to which of the following? a) Death b) Sibling rivalry c) Physical illness d) Bullying

Death Explanation: The child's response to divorce is similar to the response to death.

In the biopsychosocial psychiatric nursing assessment of children, assessment of the psychological domain includes assessing the child's temperament. Which type of temperament is characterized by a negative response to new stimuli and high emotional intensity? a) Difficult b) Easy c) Slow to warm up d) Challenging

Difficult Explanation: The classic New York Longitudinal Study (Thomas, Chess, & Birch, 1968) identified three main patterns of temperament seen in infancy that often extend into childhood and later life. A difficult temperament is characterized by irregular sleep and eating patterns, negative response to new stimuli, slow adaptation, a negative mood, and high emotional intensity. An easy temperament is characterized by a positive mood, regular patterns of eating and sleeping, a positive approach to new situations, and low emotional intensity. A slow-to-warm-up temperament is characterized by a negative, mildly emotional response to new situations that is expressed with intensity and initially slow adaptation but evolves into a positive response. Challenging is not one of the three main patterns of temperament.

After educating a class of students on childhood and adolescent mental health, the instructor determines that additional education is needed when the class identifies which of the following as promoting mental health in children? a) Secure attachment b) Age-appropriate physical development c) Normal psychosocial development d) Difficult temperament

Difficult temperament Explanation: Children are more likely to be mentally healthy if they have normal physical and psychosocial development, an easy temperament (adaptable, low intensity, positive mood), and secure attachment through the emotional bonds formed between children and their parents at an early age.

A child is suspected of having obsessive-compulsive disorder. Which of the following would be the first step in assessing the child? a) The amount of interference the rituals have on the child's functioning b) Distinguishing between normal childhood rituals and worries and those that are pathologic c) The severity of the family's response to the child's behavior d) The frequency of which the child engages in the compulsions

Distinguishing between normal childhood rituals and worries and those that are pathologic Explanation: Although frequency, amount of interference and severity of the family's response would be important, the first step in the assessment of OCD in children is to distinguish between normal childhood rituals and worries, and pathologic rituals and obsessional thoughts.

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

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 of the following would be an appropriate intervention for a child diagnosed with conduct disorder? a) Allow the child increased control over situations b) Allow self-monitoring of the child's own behavior c) Have the child accept responsibility for his own behavior d) Avoid limiting setting to decrease confrontation

Have the child accept responsibility for his own behavior Explanation: The child diagnosed with conduct disorder needs to accept responsibility for his or her own actions. The nurse must protect others from the manipulative or aggressive behaviors with these clients.

The nurse who provides care under the auspices of a group home is planning the care of a 12-year-old boy who has been referred to the home by the court system. Knowing that the boy has a documented history of conduct disorder, which of the following nursing diagnoses should the nurse prioritize during the boy's transition into the group home? a) Risk for Injury related to poor safety awareness b) Impaired Social Interaction due to withdrawal c) Impaired Social Interaction due to alienation from others secondary to aggressive acts d) Hopelessness related to separation from family

Impaired Social Interaction due to alienation from others secondary to aggressive acts Explanation: The aggression, acting out, and antisocial behavior associated with conduct disorder create the potential for social alienation in a group setting. Such individuals are less likely to withdraw, injure themselves, or experience hopelessness.

A child with attention deficit hyperactivity disorder is taking methylphenidate (Ritalin) in divided doses. If the child takes the first dose at 8 AM, the school nurse might expect to see which of the following behaviors at noon? a) Social isolation from peers b) Lack of appetite for lunch c) Sleepiness or drowsiness d) Increased impulsivity or hyperactive behavior

Increased impulsivity or hyperactive behavior Explanation: Ritalin has a short half-life, so doses are needed about every 4 hours during the day to maintain symptom control. Giving stimulants during daytime hours usually effectively combats insomnia.

When providing care to a client who consistently attempts to manipulate the staff, the nurse maintains a therapeutic milieu best by ... a) Encouraging questions and discussing the client's concerns b) Accepting the client while making it clear that the behavior is not acceptable c) Scheduling staff one-on-one time with the client d) Instructing the staff to enforce all unit rules consistently

Instructing the staff to enforce all unit rules consistently Explanation: Being consistent in expectations regarding rules and regulations for all clients will minimize the threat of manipulation. The other options provided are appropriate but do not represent the best way to minimize manipulation.

The nurse is planning a counseling session with a group of "at-risk" adolescents on the topic of drug abuse. Which education strategy would be most effective? a) Giving information by lecturing and using pre- and posttest quizzing about the information. b) Involving peers in teaching the effective group problem-solving skills. c) Handing out educational pamphlets and showing slides of car accidents related to teen drug use. d) Showing informational videotapes and providing Internet addresses on the topic of drug addiction.

Involving peers in teaching the effective group problem-solving skills. Explanation: Several approaches to mental health promotion with adolescents are recommended. First, intervening at the peer group level through education programs, alternative recreation activities, and peer counseling is most successful. Additionally, training in values clarification, problem solving, social skills, and assertiveness helps give adolescents the skills to cope with situations in which they are pressured by their peers. Simply providing information or education is not as effective as skills training (e.g., assertiveness or behavior training and programs).

The nurse is planning a counseling session with a group of "at-risk" adolescents on the topic of drug abuse. Which education strategy would be most effective? a) Handing out educational pamphlets and showing slides of car accidents related to teen drug use. b) Showing informational videotapes and providing Internet addresses on the topic of drug addiction. c) Giving information by lecturing and using pre- and posttest quizzing about the information. d) Involving peers in teaching the effective group problem-solving skills.

Involving peers in teaching the effective group problem-solving skills. Explanation: Several approaches to mental health promotion with adolescents are recommended. First, intervening at the peer group level through education programs, alternative recreation activities, and peer counseling is most successful. Additionally, training in values clarification, problem solving, social skills, and assertiveness helps give adolescents the skills to cope with situations in which they are pressured by their peers. Simply providing information or education is not as effective as skills training (e.g., assertiveness or behavior training and programs).

The nurse is planning a counseling session with a group of "at-risk" adolescents on the topic of drug abuse. Which education strategy would be most effective? a) Showing informational videotapes and providing Internet addresses on the topic of drug addiction. b) Involving peers in teaching the effective group problem-solving skills. c) Handing out educational pamphlets and showing slides of car accidents related to teen drug use. d) Giving information by lecturing and using pre- and posttest quizzing about the information.

Involving peers in teaching the effective group problem-solving skills. Explanation: Several approaches to mental health promotion with adolescents are recommended. First, intervening at the peer group level through education programs, alternative recreation activities, and peer counseling is most successful. Additionally, training in values clarification, problem solving, social skills, and assertiveness helps give adolescents the skills to cope with situations in which they are pressured by their peers. Simply providing information or education is not as effective as skills training (e.g., assertiveness or behavior training and programs).

A child has profound mental retardation. This type of mental retardation correlates with which of the following IQ values? a) 20 to 35 b) Less than 20 c) 50 to 70 d) 35 to 50

Less than 20 Explanation: Profound mental retardation is diagnosed as being less than 20. Mild retardation is an IQ between 50 and 70. Moderate retardation is an IQ between 35 and 50. Severe retardation is an IQ between 20 and 35.

ADHD is characterized by inattentiveness, overactivity, and impulsiveness. According to the DSM-IV-TR, which of the following is an inattentive behavior seen in ADHD? a) Fidgets b) Missing details c) Interrupts d) Talks excessively

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

The adjustment to an out-of-home placement can be viewed through the conceptual framework of Bowlby's stages of coping with parental separation. According to Bowlby (1960), the child initially responds to separation from parents with which of the following? a) Mourning b) Protest c) Despair d) Detachment

Protest Explanation: According to Bowlby, the child initially responds to separation from his or her parents with protest (crying, kicking, screaming, pleading, and attempting to elicit the parent's return). Despair, detachment, and mourning occur after the initial stage.

Which of the following approaches is included in milieu therapy for the child with autism? a) Activities that promote interpersonal interaction b) Having a playroom with climbing structures and rolling chairs c) Providing a routine and predictive environment d) Scheduling a group in which the children talk about school

Providing a routine and predictive environment Explanation: Verbal and nonverbal communication is impaired in children with autism; therefore, a group modality would not be appropriate. Children with autism have difficulty with interpersonal interaction; thus, these activities would increase anxiety and acting-out behaviors. Having a playroom with climbing structures and rolling chairs would increase the child's risk for injury. Maintaining a routine and predictable environment would be therapeutic for the client with autism.

Which of the following approaches is included in milieu therapy for the child with autism? a) Scheduling a group in which the children talk about school b) Providing a routine and predictive environment c) Having a playroom with climbing structures and rolling chairs d) Activities that promote interpersonal interaction

Providing a routine and predictive environment Explanation: Verbal and nonverbal communication is impaired in children with autism; therefore, a group modality would not be appropriate. Children with autism have difficulty with interpersonal interaction; thus, these activities would increase anxiety and acting-out behaviors. Having a playroom with climbing structures and rolling chairs would increase the child's risk for injury. Maintaining a routine and predictable environment would be therapeutic for the client with autism.

An 8-year-old boy has been diagnosed with ADHD. His mother is shocked that he will be prescribed a psychostimulant, stating, "His whole problem is that he's too stimulated, not understimulated!" Which of the following facts should underlie the nurse's response to the mother? a) Controlled, medication-induced stimulation helps children become more comfortable and functional during times of high stimulation. b) Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior. c) Psychostimulants are a form of aversion therapy in which the child becomes uncomfortable with overstimulation. d) Brain stimulation is inversely proportionate to motor stimulation.

Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior. Explanation: Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior, with the resulting effect of improved self-control.

The mother of a child with Asperger disorder tells the nurse that her child has few playmates. She states, "He has such poor social skills with other children, and he strongly rejects any change in his routine by throwing a tantrum." Based on this information, the nurse identifies which nursing diagnosis as the priority? a) Risk for Social Isolation related to poor social skills of the child b) Ineffective Family Coping related to having a child with Asperger disorder c) Risk for Injury related to Asperger disorder d) Self-Care Deficits related to repeated tantrums

Risk for Social Isolation related to poor social skills of the child Explanation: Based on the mother's comments, the priority nursing diagnosis is Risk for Social Isolation related to poor social skills of the child. This nursing diagnosis is substantiated by the mother's statement that the child has few playmates. There is no information provided to suggest a self-care deficit or risk for injury. Statements about the family's issues with the child and his disorder would support a nursing diagnosis of Ineffective Family Coping.

When working with the parents of child with separation anxiety disorder, the nurse would include teaching about which of the following? a) Benzodiazepines b) Antipsychotics c) SSRIs d) Stimulants

SSRIs Explanation: Effective treatment includes child and parent psychoeducation, school consultation, cognitive-behavioral therapy, and selective serotonin reuptake inhibitors (SSRIs). Antipsychotics, benzodiazepines, and stimulants are not used to treat separation anxiety disorders.

The nurse asking to speak to the child alone can provide reassurance to the child by ... a) Speaking to the child in an assertive voice and telling the child that you will not hurt him or her b) Allowing the parent to stay if the child requests c) Showing the child that the waiting area is close by, where the parents will wait for the child d) Telling the child that we will only be together for a short time

Showing the child that the waiting area is close by, where the parents will wait for the child Explanation: After talking with the parent and child together, the nurse should ask to speak with the child alone for a while. Young children may fear separating from their parents. The nurse can reassure children by showing the child where the waiting area is and telling him or her, "Mommy and Daddy are going to be waiting right here for you. You and I are going to be in a room close by."

The nurse working with a child using instruction, feedback, support, and practice with learning behaviors that help children to interact more effectively with peers and adults refers to ... a) Normalization b) Acclimatization c) Bibliotherapy d) Social skills training

Social skills training Explanation: Social skills training involves instruction, feedback, support, and practice with learning behaviors that help children to interact more effectively with peers and adults.

The nurse working with a child using instruction, feedback, support, and practice with learning behaviors that help children to interact more effectively with peers and adults refers to ... a) Acclimatization b) Bibliotherapy c) Normalization d) Social skills training

Social skills training Explanation: Social skills training involves instruction, feedback, support, and practice with learning behaviors that help children to interact more effectively with peers and adults.

A group of nursing students is reviewing information about stress and coping in children. The students demonstrate a need for additional study when they identify which of the following as a stressful experience for a child? a) Death of a pet b) Chronic illness c) Racial discrimination d) Social support

Social support Explanation: Stressful experiences for children include the death of a loved one or pet, parental divorce, violence, physical illness (especially chronic illness), mental illness, social isolation (not social support), racial discrimination, neglect, and physical and sexual abuse.

A group of nursing students is reviewing information about stress and coping in children. The students demonstrate a need for additional study when they identify which of the following as a stressful experience for a child? a) Racial discrimination b) Social support c) Death of a pet d) Chronic illness

Social support Explanation: Stressful experiences for children include the death of a loved one or pet, parental divorce, violence, physical illness (especially chronic illness), mental illness, social isolation (not social support), racial discrimination, neglect, and physical and sexual abuse.

A nurse assessing for suicide and violent thoughts of children should ask ... a) Straightforward questions about suicide and violence b) Avoid assessing children at the age of 7 as it is not applicable c) Questions about suicide and telling them before asking that this information will be shared with others if anyone is in danger d) Indirect questions about how they feel

Straightforward questions about suicide and violence Explanation: The nurse must ask the child about any suicidal or violent thoughts. The best way to assess these areas is to ask straightforward questions.

The parents of a child with ADHD bring the child for a follow-up visit. During the visit, they tell the nurse that the child receives his first dose of methylphenidate (Ritalin) at about 7:30 AM 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 noon. Which of the following might the nurse suggest as a possible solution to control the child's symptoms a bit more effectively? a) Switching to another class of medication. b) Switching to a longer acting preparation. c) Giving the second dose at 1 PM or later. d) Splitting the early morning dose in half.

Switching to a longer acting preparation. Explanation: Methylphenidate (Ritalin) has a total duration of action of about 4 hours (Box 35.4). 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 such as Concerta, Ritalin LA, and Metadate or amphetamine-dextroamphetamine (Adderall) 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 boy experiences tics, which have become increasingly frequent in recent months. How should the nurse educate the boy's teacher to respond to his tics? a) Provide rewards when the boy goes long periods without having any tics. b) Teach the boy's classmates that his tics are not something that he can control. c) Place the boy in a private, low-stimulation environment whenever possible to prevent his tics. d) Set firm limits about where, when, and how he exhibits his tics.

Teach the boy's classmates that his tics are not something that he 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 boy's behavior is not deliberate.

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

Teach the boy's classmates that his tics are not something that he 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 boy's behavior is not deliberate.

A nurse is assessing a 15-year-old adolescent with conduct disorder. Which appearance might the nurse see in the adolescent? a) The adolescent has poor physical hygiene. b) The adolescent appears terrified. c) The adolescent has lots of cuts on the face and body. d) The adolescent has lots of tattoos and body piercings.

The adolescent has lots of tattoos and body piercings. Explanation: Adolescents with conduct disorder appear normal for their age group but may have an extreme appearance, such as having tattoos and body piercings. They appear normal in terms of personal hygiene. These adolescents have no guilt associated with their behavior, thus they probably will not look terrified. The nurse is unlikely to observe changes associated with self-harm.

A nurse is assessing an adolescent with conduct disorder. The nurse finds that the adolescent has been prescribed risperidone (Risperdol) by the primary healthcare provider. What would be the most likely reason for the healthcare provider to prescribe this drug to the client? a) The adolescent's behavior poses a danger to others. b) The adolescent is depressed because of the inappropriate behavior. c) The adolescent has poor social behavior. d) The adolescent is experiencing disturbances in concentration.

The adolescent's behavior poses a danger to others. Explanation: Risperidone (Risperdol) is given to those clients with conduct disorder whose behavior poses a threat to others. Poor social behavior and disturbances in concentration need not be treated with drugs. Unlike in intermittent explosive disorder, the client with conduct disorder has no remorse, guilt, or depression after behaving violently.

A nurse is assessing an adolescent with conduct disorder. The nurse finds that the adolescent has been prescribed risperidone (Risperdol) by the primary healthcare provider. What would be the most likely reason for the healthcare provider to prescribe this drug to the client? a) The adolescent's behavior poses a danger to others. b) The adolescent is experiencing disturbances in concentration. c) The adolescent has poor social behavior. d) The adolescent is depressed because of the inappropriate behavior.

The adolescent's behavior poses a danger to others. Explanation: Risperidone (Risperdol) is given to those clients with conduct disorder whose behavior poses a threat to others. Poor social behavior and disturbances in concentration need not be treated with drugs. Unlike in intermittent explosive disorder, the client with conduct disorder has no remorse, guilt, or depression after behaving violently.

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? a) The child repeatedly shrugs the shoulders. b) The child continuously repeats socially unacceptable words. c) The child grunts repeatedly. d) The child continuously repeats the last heard phrase.

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.

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? a) The child is not able to understand what the nurse is asking. b) The child does not like talking to the nurse. c) The child is not paying attention to the nurse's questions. d) The child is not willing to answer the nurse.

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 assessing an adolescent with conduct disorder. The nurse finds that the adolescent is not interested in seeking summer employment. What is the most likely reason for the client's disinterest in getting a job? a) The client feels that he will not be efficient in the workplace. b) The client prefers stealing money over working for it. c) The client feels that his depression and anxiety would interfere with working. d) The client feels that he is too disturbed to work.

The client prefers stealing money over working for it. Explanation: The adolescent with conduct disorder is most likely to steal money for survival instead of earning it through employment. Feeling too disturbed to be able to work and feeling that he would be inefficient at work are not behaviors related to clients with conduct disorder. Depression and anxiety are not present in clients with conduct disorder.

With regard to the rate of recovery from a single episode of major depression in children and adolescents, which of the following is true? a) Children and adolescents do not respond as well as adults to interventions for depression. b) Childhood and adolescent depression is more superficial, so such clients recover more quickly. c) The same interventions that work in adult depression are effective in childhood depression. d) The majority of youths with depression can be treated effectively, and the recovery rate is relatively high.

The majority of youths with depression can be treated effectively, and the recovery rate is relatively high. Explanation: The recovery rate from a single episode of major depression in children and adolescents is relatively high.

With regard to the rate of recovery from a single episode of major depression in children and adolescents, which of the following is true? a) The majority of youths with depression can be treated effectively, and the recovery rate is relatively high. b) Children and adolescents do not respond as well as adults to interventions for depression. c) Childhood and adolescent depression is more superficial, so such clients recover more quickly. d) The same interventions that work in adult depression are effective in childhood depression.

The majority of youths with depression can be treated effectively, and the recovery rate is relatively high. Explanation: The recovery rate from a single episode of major depression in children and adolescents is relatively high.

A nurse is caring for a client with conduct disorder who injures people around him when he is angry. Which is the primary goal for intervention in this case? a) To ensure safety of others. b) To help the client express his/her feelings. c) To reduce the aggression of the client. d) To help the client develop good peer relationships.

To ensure safety of others. Explanation: With a physically agressive client, the nurse should first ensure the safety of others. Reducing the aggression of the client, helping the client express his feelings, and helping the client to develop good peer relationships are all goals of treatment. These outcomes are of a comparatively lesser priority than safety

The nurse is counseling a couple who have just gotten divorced. The wife has custody of the two children, ages 7 and 9 years. The nurse should instruct the couple that divorce can affect the children and that ... a) sibling rivalry may develop after the couple divorces. b) children usually adjust quickly if remarriage occurs for one parent. c) it takes many years for the children to accept the reality. d) a structured home and school environment can lessen the emotional problems.

a structured home and school environment can lessen the emotional problems. Explanation: The first 2 or 3 years following the marital break up are the hardest. A structured home and school environment can serve as a protective factor against the development of emotional problems in the children.

A 3-year-old child has been admitted to the hospital after an automobile accident. The nurse can anticipate that the child will exhibit ... a) mood swings. b) guilt related to the accident. c) body image disturbance. d) anxiety around strangers.

anxiety around strangers. Explanation: Children of this age often regress to earlier behaviors when hospitalized. The child will likely exhibit anxiety around strangers such as health care providers. They may also have magical thinking about their illness.

When interviewing a 12-year-old child in an outpatient psychiatric setting, the nurse can establish a high degree of credibility by ... a) giving the child a transitional object to hold. b) asking the child to describe his or her parents. c) asking about things that are important to the child. d) providing advice to the child about his or her parents.

asking about things that are important to the child. Explanation: The nurse can establish a high degree of credibility by asking about things important to the child such as a sport the child participates in or an object he or she has brought.

When a nurse is interviewing a parent and a child in a psychiatric setting, the nurse recognizes that parents generally provide better information about the child's ... a) sleep patterns. b) behavior disturbances. c) moods. d) suicide ideation.

behavior disturbances. Explanation: Generally, parents provide better information about externalizing symptoms such as behavior disturbances or parent-child relationships.

When a nurse is interviewing a parent and a child in a psychiatric setting, the nurse recognizes that parents generally provide better information about the child's ... a) suicide ideation. b) sleep patterns. c) behavior disturbances. d) moods.

behavior disturbances. Explanation: Generally, parents provide better information about externalizing symptoms such as behavior disturbances or parent-child relationships.

Nurses can achieve rapport with preschoolers by joining their world of play. For children, play can ... a) measure factors of attachment. b) help assess the child's cognition. c) encourage verbalizations. d) serve as reminders of their abilities.

encourage verbalizations. Explanation: For preschoolers, play encourages verbalizations, promotes manual strength, and teaches rules and problem solving.

A four-year-old child who has been assessed about the reactions to his parents divorcing states, "My mom and dad are getting a divorce." This describes the child's awareness of the reality but the child may not understand the concept. The nurse would attempt to ... a) ask the parents to join in the assessment at this point. b) ask the child how they feel about this upcoming change. c) express sadness toward this and ask the child how you could help. d) express empathy and attempt to assess the child's level of understanding of the divorce.

express empathy and attempt to assess the child's level of understanding of the divorce. Explanation: The child has a basic awareness of the reality of parents' divorce, but may not understand this concept. Nurse expresses empathy and attempts to assess the child's level of understanding of the divorce.

According to Piaget, adolescents who have reached the final stage of cognitive development are in a stage termed ... a) formal operations. b) preoperational. c) sensorimotor. d) concrete.

formal operations. Explanation: The final stage of cognitive development includes the ability for abstract thought. This is termed the "formal operations stage."

Preschool programs that target children's social and emotional competencies are an example of ... a) primary prevention. b) quaternary prevention. c) secondary prevention. d) tertiary prevention.

primary prevention. Explanation: Educating children in healthy inter- and intrapersonal skills prevents the development of social and emotional dysfunction during the years of significant personality development.

A nurse is assessing a client with oppositional defiant disorder (ODD). What questions related to the disorder should the nurse ask the parents while taking the history of the client? Select all that apply. a) "Is your child extremely obsessed with sports?" b) "Does your child get confused much of the time?" c) "Does your child have difficulty paying attention?" d) "Does your child suddenly wake up at night from nightmares?" e) "Does your child get extremely upset for getting poor grades in school?

• "Does your child get confused much of the time?" • "Does your child have difficulty paying attention?" • "Does your child get extremely upset for getting poor grades in school? Explanation: Children with ODD may have impaired decision-making ability, which may render them confused most of the time. Attention deficit hyperactivity disorder is known to coexist with ODD. Therefore, the nurse should assess whether the condition exists. Children with ODD are not known to have nightmares or bad dreams. Being obsessed with sports is normal behavior in a school-age child. Children with ODD fail to make associations between their behavior and its consequences. They are unlikely to be upset for getting poor grades in school

A nurse is assessing a client with oppositional defiant disorder (ODD). What questions related to the disorder should the nurse ask the parents while taking the history of the client? Select all that apply. a) "Does your child get confused much of the time?" b) "Does your child have difficulty paying attention?" c) "Is your child extremely obsessed with sports?" d) "Does your child suddenly wake up at night from nightmares?" e) "Does your child get extremely upset for getting poor grades in school?

• "Does your child get confused much of the time?" • "Does your child have difficulty paying attention?" • "Does your child get extremely upset for getting poor grades in school? Explanation: Children with ODD may have impaired decision-making ability, which may render them confused most of the time. Attention deficit hyperactivity disorder is known to coexist with ODD. Therefore, the nurse should assess whether the condition exists. Children with ODD are not known to have nightmares or bad dreams. Being obsessed with sports is normal behavior in a school-age child. Children with ODD fail to make associations between their behavior and its consequences. They are unlikely to be upset for getting poor grades in school.

Abuse can have lifelong effects on development. Children who have been maltreated are more prone to do which of the following? Select all that apply. a) Abuse drugs b) Develop eating disorders c) Enter aggressive relationships d) Become depressed e) Develop self-confidence

• Abuse drugs • Develop eating disorders • Enter aggressive relationships • Become depressed Explanation: Children who have been maltreated are more likely to enter aggressive relationships, abuse drugs or alcohol to numb emotions, develop eating disorders, become depressed, and engage in self-destructive behavior. Abused children are more prone to develop low self-esteem than self-confidence.

Changes in behavior at school may be evidenced by which of the following? Select all that apply. a) Aggression towards peers b) Decreased concentration c) Physical disability d) Falling grades e) Withdrawal from peers

• Aggression towards peers • Decreased concentration • Falling grades • Withdrawal from peers Explanation: Falling grades, loss of interest in normal activities, decreased concentration, or withdrawal from or aggression toward peers may indicate that the child is experiencing emotional problems

Changes in behavior at school may be evidenced by which of the following? Select all that apply. a) Falling grades b) Physical disability c) Decreased concentration d) Withdrawal from peers e) Aggression towards peers

• Aggression towards peers • Decreased concentration • Falling grades • Withdrawal from peers Explanation: Falling grades, loss of interest in normal activities, decreased concentration, or withdrawal from or aggression toward peers may indicate that the child is experiencing emotional problems

A child with attention deficit hyperactivity disorder has been prescribed Dextroamphetamine (Dexedrine). For what effects should the nurse tell the parents to monitor the child? Select all that apply. a) Insomnia b) Appetite suppression c) Weight loss d) Weight gain e) Hypotension

• Appetite suppression • Weight loss • Insomnia Explanation: Dextroamphetamine (Dexedrine) 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 has been prescribed Dextroamphetamine (Dexedrine). For what effects should the nurse tell the parents to monitor the child? Select all that apply. a) Hypotension b) Appetite suppression c) Weight loss d) Weight gain e) Insomnia

• Appetite suppression • Weight loss • Insomnia Explanation: Dextroamphetamine (Dexedrine) 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.

Abuse can have lifelong effects on development. Children who have been maltreated are more prone to do which of the following? Select all that apply. a) Develop eating disorders b) Enter aggressive relationships c) Develop self-confidence d) Abuse drugs e) Become depressed

• Enter aggressive relationships • Abuse drugs • Develop eating disorders • Become depressed Explanation: Children who have been maltreated are more likely to enter aggressive relationships, abuse drugs or alcohol to numb emotions, develop eating disorders, become depressed, and engage in self-destructive behavior. Abused children are more prone to develop low self-esteem than self-confidence.

A nurse is assessing an adolescent with oppositional defiant disorder (ODD). Other than disruptive behavior, what other findings might the nurse expect to see during the assessment? Select all that apply. a) Impaired attention b) Impaired memory c) Impaired sense of direction d) Impaired problem-solving abilities e) Impaired decision making

• Impaired decision making • Impaired attention • Impaired problem-solving abilities Explanation: Other than disruptive behavior, clients with ODD have impaired decision making and deficiencies in attention and problem-solving abilities. Memory impairment and impaired sense of direction are not associated with ODD.

When the nurse is conducting a biopsychosocial assessment of a child, which of the following techniques can be used to establish rapport with family members? Select all that apply. a) Maintain eye contact. b) Make the interview nurse centered. c) Show acceptance. d) Speak slowly. e) React subjectively.

• Maintain eye contact. • Show acceptance. • Speak slowly. Explanation: Establishing rapport can be facilitated by maintaining appropriate eye contact; speaking slowly, clearly, and calmly with friendliness and acceptance; using a warm and expressive tone; reacting to communications from interviewees objectively; showing interest in what the interviewees are saying; and making the interview a joint undertaking.

A nurse is reassessing a school-age child with conduct disorder who has been receiving behavioral therapy for 3 months. What changes might the nurse expect when reassessing the child? Select all that apply. a) The child has been able to communicate with peers. b) The child has had perfect attendance for 10 weeks. c) The child has stopped behaving in an aggressive manner. d) The child has been able to give speeches on age-related topics. e) The child has been getting excellent grades in school.

• The child has been able to communicate with peers. • The child has had perfect attendance for 10 weeks. • The child has stopped behaving in an aggressive manner. Explanation: The nurse should understand that a client with conduct disorder will take time to become a "model" child. For a child with conduct disorder who has received behavioral therapy, the nurse should expect that the child has started attending school, is able to communicate with peers, and has stopped behaving in an aggressive manner. The nurse should not expect the child to have received excellent grades in school or given speeches on age-related topics; such expectations are unrealistic.

A nurse is developing a plan of care for a client with conduct disorder. Which of the following would be treatment outcomes for this client? Select all that apply. a) The client will not hurt others or damage property. b) The client will be relieved of anxiety and depression. c) The client will learn effective problem-solving skills. d) The client will have a hygienic lifestyle. e) The client will engage in socially acceptable behavior.

• The client will learn effective problem-solving skills. • The client will not hurt others or damage property. • The client will engage in socially acceptable behavior. Explanation: If a client undergoes successful treatment, he or she should be able to behave in a socially acceptable manner, display appropriate problem-solving skills, no longer hurt others or damage property. Clients with conduct disorder usually do not have issues related to personal hygiene. Such clients do require relief from anxiety or depression, as they are considered unemotional and do not show regret or feel any remorse after inappropriate behavior.

Which of the following is accurate regarding the completion of a mental health assessment of a child? Select all that apply. a) The nurse should corroborate information offered by the child with other sources b) The nurse should use simple phrasing with children c) Children have a less specific sense of time than adults d) Children have a more developed memory than adults e) Children can sequence events well

• The nurse should corroborate information offered by the child with other sources • The nurse should use simple phrasing with children • Children have a less specific sense of time than adults Explanation: Children have a less specific sense of time than adults. The nurse should use simple phrasing with children and corroborate information offered by them with other resources. Children cannot sequence events well and do not have more developed memories than adults.

While interviewing a client with conduct disorder, the nurse asks the client about having friends in school. What is the most likely response of the client? a) "I don't want to interact or be friends with dumb and meek people in school." b) "I am not a social person. It is difficult for me to make friends." c) "I prefer doing useful productive work instead of making friends." d) "I am such an awful person. Who will be friends with me?"

"I don't want to interact or be friends with dumb and meek people in school." Explanation: In clients with conduct disorder, good peer relationships are often not seen. These clients view their peers who follow rules as dumb or afraid. Clients with conduct disorders are not likely to get involved in 'productive' work such as studies. In this disorder, the client does not accept his negative qualities such as not being a social person. These clients have a low self esteem but they do not show this externally. Depressive, guilt laden behavior is not seen in this client.

The mother of a 6-year-old boy with attention deficit hyperactivity disorder asks to speak to the nurse about her son's disruptive behavior. The nurse would be most therapeutic by saying which of the following? a) "Your son is a cute child, but he needs to calm down." b) "It must be difficult to handle your son at home." c) "You need to take a firmer approach with your son." d) "Your son sure is active."

"It must be difficult to handle your son at home." Explanation: Parents need support and reassurance; making a statement about the difficulties of handling the child at home validates the mother's feelings. Answer A is not appropriate. Answers C may put the parents on the defensive with regard to parenting skills used in the home. Answer D is not the most therapeutic response.

A 10-year-old child with Tourette's disorder is receiving haloperidol as part of his treatment plan. When assessing the child at a follow up visit, which statement by the child would lead the nurse to suspect that he is experiencing a side effect of the drug? a) "Sometimes I feel like I'm so sleepy." b) "I'm eating about the same amount as before." c) "My muscles seem pretty flexible lately." d) "I think I'm much more alert with this drug."

"Sometimes I feel like I'm so sleepy." Explanation: The most frequently encountered side effects associated with medication therapy such as haloperidol include drowsiness, dulled thinking, muscle stiffness, akathisia, increased appetite and weight gain, and acute dystonic reactions.

To establish rapport with a child 10 years of age who is hospitalized in a psychiatric setting, which statement by the nurse would be most appropriate? a) "Let's compare your situation to that of Cinderella's in the fairy tale." b) "I'm going to use the DECA tool to measure your self-control and initiative." c) "Would you like to play a game of checkers with me?" d) "Let's have you draw a picture of yourself."

"Would you like to play a game of checkers with me?" Explanation: Nurses can establish rapport with school-age children by using competitive board games such as checkers. Comparing the child with Cinderella may be interpreted by a 10-year-old child as demeaning and below his or her level. This technique would be more appropriate for a preschooler. Self-drawings are effective for preschoolers. The DECA tool measures self-control and initiative in children 2 to 5 years of age.

A nurse is interviewing a child age 12 years in an outpatient psychiatric setting. Which of the following would be most appropriate for the nurse to say to establish a high degree of credibility? a) "How would you describe your parents?" b) "I have several teddy bears; would you like one to hold?" c) "You'd get along better with your parents if you'd follow their advice." d) "Tell me about your best friend."

"Tell me about your best friend." Explanation: The nurse can establish a high degree of credibility simply by taking note of, and asking about, things that are obviously important to children (e.g., a sport the child participates in, a rock group displayed on a shirt, a toy the child may have brought in). However, children have an uncanny natural "radar" for phony adult behavior. Attempts to establish rapport work only when the nurse is genuinely interested in the child's life. Asking a child to describe his or her parents would not necessarily reflect something that is important to the child. Instead, the question focuses on the parents and not the child. Asking a 12-year-old child about holding a teddy bear may be interpreted as demeaning to a child of this age. Suggesting that the child follow his parents' advice is nontherapeutic and judgmental.

Which of the following statements would indicate that medication teaching for the parents of a 6-year-old child with attention deficit hyperactivity disorder (ADHD) has been effective? a) "We'll be sure to record his weight on a weekly basis." b) "We'll be sure he takes the Ritalin at the same time every day, just before bedtime." c) "We're so glad that Ritalin will eliminate the problems of ADHD." d) "We'll teach him the proper way to take the medication so he can manage it independently."

"We'll be sure to record his weight on a weekly basis." Explanation: Stimulant medications used to treat ADHD can suppress appetite, and the child may lose or fail to gain weight properly. The client is too young to manage his medications independently. Ritalin should be given in divided doses. Ritalin reduces hyperactivity, impulsivity, and mood lability and helps the child to pay attention more appropriately.

When teaching the parents of a child with attention deficit hyperactivity disorder (ADHD), which of the following statements by the parents would indicate the need for further teaching? a) "We'll have him do his homework at the kitchen table with his brothers and sisters." b) "We'll make sure he completes one task before going on to another." c) "We'll set up rules with specific times for eating, sleeping, and playing." d) "We'll use simple, clear directions and instructions."

"We'll have him do his homework at the kitchen table with his brothers and sisters." Explanation: The child with ADHD cannot accomplish complex tasks, such as homework, in a noisy or chaotic setting where there are a lot of distractions. Answers B, C, and D do not indicate the need for further teaching.

The nurse is assessing the self-concept of a child age 8 years. Which of the following would be least appropriate for the nurse to ask? a) "If you had three wishes, what would you wish for?" b) "What would you like to be when you grow up?" c) "What did you have for breakfast this morning?" d) "What subjects do you like best in school?"

"What did you have for breakfast this morning?" Explanation: The question about breakfast evaluates the child's recent memory. The questions about what he would wish for, what he would like to be when he grows up, and what subjects he likes best in school reflect self-concept.

The nurse is teaching the parents of a child with conduct disorder about methods to deal with their child's detention from school for breaking science equipment. What advice should the nurse give the parents to deal with the situation? a) "You should punish your child so that he never repeats the same mistake at school." b) "You should be supportive of your child as she might be very depressed after receiving detention." c) "You should file a case against the school for punishing your child so severely." d) "You should be supportive of the school for taking this step regarding your child's inappropriate behavior."

"You should be supportive of the school for taking this step regarding your child's inappropriate behavior." Explanation: The nurse should explain to the parents that the child has received detention for behaving inappropriately in school and that they should support the school for this instead of blaming it. Using severe punishment is not a recommended treatment strategy for conduct disorder. The child with conduct disorder is unlikely to be depressed or guilty for receiving detention from school.

The nurse is counseling a family whose 4-year-old child has mild mental retardation. The nurse is working with the family on realistic long-term goals. Which of the following would be most appropriate? a) Locating suitable residential placement for the child b) Achieving independent functioning of the child as an adult c) Preventing the onset of psychiatric disorders in the child d) Finding a foster home for the child

Achieving independent functioning of the child as an adult Explanation: The long-term goal for this family and child is to achieve independent functioning of the child as an adult. Independence may be delayed but is not impossible.

In a discussion with a group of high school teachers about oppositional defiant disorder (ODD), the nurse says that behavior modification of the parents and teachers toward such children forms the basis of therapy. What is the most appropriate rationale that the nurse gives when asked about this strategy? a) Adolescents with ODD learn maladaptive behavior at home and school. b) Adolescents with ODD only fear their parents and teachers. c) Adolescents with ODD are less aggressive toward parents and teachers. d) Adolescents with ODD are closest to their parents and teachers.

Adolescents with ODD learn maladaptive behavior at home and school. Explanation: The treatment of ODD is based on parental behavioral interventions. It is believed that problem behaviors in ODD are learned and reinforced in the home and at school, hence the approach of the parents and teachers toward the child may help to eliminate this disorder at earlier ages. In adolescents, behavioral therapy may also be required along with parental management. It may not be true that these children are closest to their parents. Such clients are usually very aggressive and lack a sense of fear of anybody.

Which of the following children is most likely to be diagnosed with oppositional defiant disorder or conduct disorder? a) An 11-year-old boy who was caught breaking into a home to steal money b) A 6-year-old boy who finds school profoundly stressful due to his inability to relate to others c) A 13-year-old boy who experiences tics and has occasional outbursts of obscenities for no apparent reason d) A 14-year-old girl who admits to having had four different sex partners in the past several months

An 11-year-old boy who was caught breaking into a home to steal money Explanation: Crime is a common manifestation of oppositional defiant disorder and conduct disorder. High-risk sexual behavior may accompany the disorders but is not diagnostic. Tics and verbal outbursts are characteristic of Tourette's syndrome. Difficulty in relating to others is characteristic of autism spectrum disorders.

Impaired attachment in infancy and childhood may manifest in which of the following ways later in life? a) Substance use b) Schizophrenia c) Somatic delusions d) Anxiety and aggression

Anxiety and aggression Explanation: Children who have difficulty with attachment often exhibit anxiety and aggressive behavior and are more likely to have difficult relationships with parents, peers, and teachers.

Which of the following is the least restrictive on the continuum of mental health care? a) Group home b) Institution c) Partial psychiatric hospitalization d) Assertiveness training

Assertiveness training Explanation: The least restrictive option along the mental health continuum is assertiveness training. The most restrictive is institutionalization. Placement in a group home and partial psychiatric hospitalization are in between the previous two on the continuum.

When assessing children, the nurse needs to ask more of which type of question compared with assessment of adults? a) Open ended b) Abstract c) Closed ended d) Nonspecific

Closed ended Explanation: Children think in more concrete terms; thus, the nurse needs to ask more specific and fewer open-ended questions than would typically be asked of adults.

Which of the following childhood disorders is characterized by serious violations of social norms, such as destruction of property? a) Obsessive-compulsive disorder (OCD) b) Attention deficit hyperactivity disorder (ADHD) c) Oppositional defiant disorder (ODD) d) Conduct disorder

Conduct disorder Explanation: Conduct disorder is characterized by serious violations of social norms, including aggressive behavior, destruction of property, and cruelty of animals. ODD is characterized by a persistent pattern of disobedience, argumentativeness, angry outbursts, low frustration tolerance, and tendency to blame others for misfortunes. OCD is characterized by intrusive thoughts that are difficult to dislodge (obsessions) or ritualized behaviors that the child feels driven to perform (compulsions). ADHD is a persistent pattern of inattention, hyperactivity, and impulsiveness that is pervasive and inappropriate for developmental level.

Which of the following childhood disorders is characterized by serious violations of social norms, such as destruction of property? a) Oppositional defiant disorder (ODD) b) Attention deficit hyperactivity disorder (ADHD) c) Obsessive-compulsive disorder (OCD) d) Conduct disorder

Conduct disorder Explanation: Conduct disorder is characterized by serious violations of social norms, including aggressive behavior, destruction of property, and cruelty of animals. ODD is characterized by a persistent pattern of disobedience, argumentativeness, angry outbursts, low frustration tolerance, and tendency to blame others for misfortunes. OCD is characterized by intrusive thoughts that are difficult to dislodge (obsessions) or ritualized behaviors that the child feels driven to perform (compulsions). ADHD is a persistent pattern of inattention, hyperactivity, and impulsiveness that is pervasive and inappropriate for developmental level.

A group of nursing students is reviewing information about disruptive behavior disorders. The students demonstrate understanding of the topic when they identify which of the following as an externalizing disorder? a) Schizophrenia b) Depression c) Anxiety d) Conduct disorder

Conduct disorder Explanation: The disruptive behavior disorders, which include oppositional defiant disorder and conduct disorder, are a group of syndromes marked by significant problems of conduct. Because these disorders are characterized by "acting out" behaviors, they are sometimes referred to as externalizing disorders. In contrast, disorders of mood (e.g., anxiety, depression) are classified as internalizing disorders because the symptoms tend to be within the child. Schizophrenia is not characterized by acting out behaviors.

Kyle is a 7-year-old boy whose parents have recently announced their intention to divorce. In the weeks following, he has been experiencing night terrors and complains of frequent stomachaches. As well, he has lost interest in playing baseball with his friends and older brother and his mother describes him as "surly." Which of the following psychiatric-mental health problems may Kyle be experiencing? a) Conduct disorder b) Depression c) Psychosis d) ADHD

Depression Explanation: Depression in children may be indicated by apathy, night terrors, somatic complaints, and irritability. These symptoms are not suggestive of ADHD, conduct disorder, or psychosis.

Studies of attachment show that the quality of the emotional bond between the child and parental figure is a ... a) Determinant of overprotection of the parent b) Determinant of the success of later relationships c) Sign of an enmeshed family d) Sign of poor coping skills with their peers

Determinant of the success of later relationships Explanation: Studies of attachment show that the quality of the emotional bond between the child and parental figure is an important determinant of the success of later relationships.

A helpful approach used by nurses working with adolescents is ... a) Discussion b) Talking down to c) "Talking at" d) Repeating concepts

Discussion Explanation: Nurses working with teenagers find it helpful to use a discussion approach that encourages questioning and argument, as opposed to talking down to or "talking at" teenagers.

A child is suspected of having obsessive-compulsive disorder. Which of the following would be the first step in assessing the child? a) The amount of interference the rituals have on the child's functioning b) The frequency of which the child engages in the compulsions c) Distinguishing between normal childhood rituals and worries and those that are pathologic d) The severity of the family's response to the child's behavior

Distinguishing between normal childhood rituals and worries and those that are pathologic Explanation: Although frequency, amount of interference and severity of the family's response would be important, the first step in the assessment of OCD in children is to distinguish between normal childhood rituals and worries, and pathologic rituals and obsessional thoughts.

A nurse is preparing a care plan for a child with autistic disorder. Which of the following would be an appropriate nursing diagnosis for this client? a) Risk for Other-Directed Violence related to a history of aggressive acts b) Disturbed Sensory Perception related to diminished awareness of stimuli c) Disturbed Sleep Pattern related to excessive hyperactivity d) Hopelessness related to separation from parents

Disturbed Sensory Perception related to diminished awareness of stimuli Explanation: An appropriate nursing diagnosis for a child with autistic disorder would include Disturbed Sensory Perception. Hopelessness may be related to conduct disorder. Disturbed Sleep Pattern would be appropriate for clients with ADHD. Risk for Other-Directed Violence correlates with conduct disorder.

The mental health nurse assesses for the most common mental health disorder found in children when asking a) "What makes you afraid or nervous?" b) "Are you sad often?" c) "Do you ever hear voices in your head telling you what to do?" d) "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 ten children and adolescents surveyed exhibited symptomology of attention deficit/hyperactivity disorder, which can sometimes be evidenced by an inability to sit still in school.

The nurse is developing a care plan for a client diagnosed with ADHD. The nurse teaches the client to take the last dose of dextroamphetamine (Dexedrine) a) At 6 p.m. b) Early in the afternoon c) At 9 p.m. d) At noon

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

A child's parents are getting a divorce. Which type of thinking may cause the child to believe that he or she is the root of the parents' problems? a) Egocentric b) Fantasy c) Idealistic d) Irrational

Egocentric Explanation: Egocentric thinking, which is normal for children, may cause the child to believe that he or she is at the root of the problem. It is important to make it clear to children that divorce is not caused by them. Fantasy, irrational, and idealistic thinking are not types of thinking that may cause children to believe that they are at the root of their parents' problems.

A child's parents are getting a divorce. Which type of thinking may cause the child to believe that he or she is the root of the parents' problems? a) Idealistic b) Fantasy c) Egocentric d) Irrational

Egocentric Explanation: Egocentric thinking, which is normal for children, may cause the child to believe that he or she is at the root of the problem. It is important to make it clear to children that divorce is not caused by them. Fantasy, irrational, and idealistic thinking are not types of thinking that may cause children to believe that they are at the root of their parents' problems.

When developing the plan of care for the family of a child with a neurodevelopmental disorder, which of the following would be least appropriate to include? a) Modeling appropriate behavior modification techniques b) Excluding the parents from being included in the plan of care c) Helping to coordinate support systems for the family. d) Assisting the family in resolving their sense of loss

Excluding the parents from being included in the plan of care Explanation: Useful nursing interventions focusing on the family include: interpreting the treatment plan for parents and child; modeling appropriate behavior modification techniques; including the parents as cotherapists for the implementation of the care plan; assisting the family in identifying and resolving their sense of loss related to the diagnosis; coordinating support systems for parents, siblings, and family members; and maintaining interdisciplinary collaboration.

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? a) Not being able to engage in play activities b) Flapping hands repeatedly c) Unusual reactions to sounds, smells, and other sensory experiences d) Using limited gestures to communicate

Flapping hands repeatedly Explanation: 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.

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? a) Using limited gestures to communicate b) Unusual reactions to sounds, smells, and other sensory experiences c) Flapping hands repeatedly d) Not being able to engage in play activities

Flapping hands repeatedly Explanation: 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, however, cannot be referred to as stereotypical motor behaviors.

After a series of interviews with a pediatric psychiatrist, a 9-year-old boy has just been diagnosed with depression. The nurse who is providing care for the boy should anticipate that he may be treated with what? a) Amphetamine (Adderall) b) Fluoxetine (Prozac) c) Olanzapine (Zyprexa) d) Electroconvulsive therapy (ECT)

Fluoxetine (Prozac) Explanation: Fluoxetine is the SSRI of choice in the treatment of depression in young clients. A trial of medication management would likely precede ECT, and neither amphetamine nor olanzapine addresses the signs and symptoms of depression.

After a series of interviews with a pediatric psychiatrist, a 9-year-old boy has just been diagnosed with depression. The nurse who is providing care for the boy should anticipate that he may be treated with what? a) Olanzapine (Zyprexa) b) Amphetamine (Adderall) c) Electroconvulsive therapy (ECT) d) Fluoxetine (Prozac)

Fluoxetine (Prozac) Explanation: Fluoxetine is the SSRI of choice in the treatment of depression in young clients. A trial of medication management would likely precede ECT, and neither amphetamine nor olanzapine addresses the signs and symptoms of depression.

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? a) Temporal lobe b) Parietal lobe c) Frontal lobe d) Occipital lobe

Frontal lobe Explanation: 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 he has been diagnosed with autism. When providing care for the child and his parents, the nurse understands that autism is thought to be caused by what? a) Immunizations containing mercury b) Genetic factors c) Perinatal hypoxia d) Impaired attachment in infancy

Genetic factors Explanation: Approximately 70% of idiopathic autism cases appear to be an inherited form of an affective disorder. Studies also suggest that autism 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 he has been diagnosed with autism. When providing care for the child and his parents, the nurse understands that autism is thought to be caused by what? a) Impaired attachment in infancy b) Genetic factors c) Perinatal hypoxia d) Immunizations containing mercury

Genetic factors Explanation: Approximately 70% of idiopathic autism cases appear to be an inherited form of an affective disorder. Studies also suggest that autism 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.

During a nurse's assessment, the nurse should assess the child's gross motor coordination. To do this, the nurse can ask the child to ... a) Display mannerisms b) Hop on one foot c) Pick up sticks d) Tie his or her shoes

Hop on one foot Explanation: The nurse can ask young children to hop on one foot, skip, or walk from toe to heel to assess gross motor coordination.

The nurse who provides care under the auspices of a group home is planning the care of a 12-year-old boy who has been referred to the home by the court system. Knowing that the boy has a documented history of conduct disorder, which of the following nursing diagnoses should the nurse prioritize during the boy's transition into the group home? a) Hopelessness related to separation from family b) Impaired Social Interaction due to alienation from others secondary to aggressive acts c) Risk for Injury related to poor safety awareness d) Impaired Social Interaction due to withdrawal

Impaired Social Interaction due to alienation from others secondary to aggressive acts Explanation: The aggression, acting out, and antisocial behavior associated with conduct disorder create the potential for social alienation in a group setting. Such individuals are less likely to withdraw, injure themselves, or experience hopelessness.

About half of children diagnosed with autism also have which of the following? a) Motor decline b) Intellectual disability c) Hypertension d) Seizure disorder

Intellectual disability Explanation: About half of children with autism have intellectual disability, and about 25% have seizure disorders. Hypertension and motor decline are not associated with autism.

During a mental status examination of a child, the nurse observes the child's sentence structure and vocabulary for a general sense of ... a) Ability to focus on the conversation b) Ability to respond accurately to questions asked c) Listening skills without interrupting d) Intellectual functioning

Intellectual functioning Explanation: The nurse should observe the child's sentence structure and vocabulary for a general sense of the child's intellectual functioning.

During a mental status examination of a child, the nurse observes the child's sentence structure and vocabulary for a general sense of ... a) Listening skills without interrupting b) Intellectual functioning c) Ability to respond accurately to questions asked d) Ability to focus on the conversation

Intellectual functioning Explanation: The nurse should observe the child's sentence structure and vocabulary for a general sense of the child's intellectual functioning.

The nurse must protect others from the manipulative or aggressive behaviors seen in adolescents diagnosed with conduct disorders. Which of the following would be the most appropriate intervention for these adolescents? a) Limit setting b) Self-esteem enhancement c) Time out d) Social skills training

Limit setting Explanation: Limit setting involves three steps: informing the client of the rule or limit; explaining the consequences if the client exceeds the limit; and stating the expected behavior.

The nurse is planning an initial therapy session with a client age 20 years whose parents had alcoholism. The nurse anticipates that the client would most likely exhibit symptoms of which of the following? a) Extroversion b) Paranoid delusions c) Low self-concept d) Delusions

Low self-concept Explanation: For children who do not experience significant psychopathology, the experience of growing up in a family with substance abuse can lead to a poor self-concept, as children feel responsible for their parents' behavior, become isolated, and start to mistrust their own perceptions because the family denies the reality of the addiction.

A child has been diagnosed with ADHD. Which medication is the most effective treatment for ADHD? a) Methylphenidate (Ritalin) b) Pemoline (Cylert) c) Dextroamphetamine (Dexedrine) d) Amphetamine (Adderell)

Methylphenidate (Ritalin) Explanation: The most effective treatment for ADHD is Ritalin.

Which medication is the most effective treatment for ADHD? a) Dextroamphetamine (Dexedrine) b) Methylphenidate (Ritalin) c) Amphetamine (Adderell) d) Pemoline (Cylert)

Methylphenidate (Ritalin) Explanation: The most effective treatment for ADHD is Ritalin.

ADHD is characterized by inattentiveness, overactivity, and impulsiveness. According to the DSM-IV-TR, which of the following is an inattentive behavior seen in ADHD? a) Talks excessively b) Fidgets c) Missing details d) Interrupts

Missing details Explanation: 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 of the following would the nurse most likely include? a) Girls are more frequently affected than boys b) Connection to ineffective parental practices c) Detection after the child enters school d) Onset before child is 2.5 years old

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.

A nurse is preparing to interview a preschooler age 4 years. Which of the following would be most effective to use for the assessment? a) Children's Depression Inventory b) Direct, simple questions c) Pediatric anxiety rating scale d) Play materials such as blocks

Play materials such as blocks Explanation: The nurse can achieve rapport with preschool-age children by joining their world of play. Play is an activity by which the child transforms an experience from real life into a symbolic, nonliteral representation. Play encourages verbalizations, promotes manual strength, teaches rules and problem solving, and helps children master control over their environment. Useful materials are paper, pencils, crayons, paints, paint brushes, easels, clay, blocks, balls, dolls, doll houses, puppets, animals, dress-up clothes, and a water supply. Preschoolers may have difficulty putting their feelings into words, and their thinking is very concrete. Thus, questions would not be the best choice. The pediatric anxiety rating scale is useful in children from 6 to 17 years of age. The Children's Depression Inventory is an assessment tool for children ages 7 to 17 years.

A client is diagnosed with oppositional defiant disorder (ODD). Which assessment finding would indicate that the client needs medications? a) Extreme hostile behavior toward the parents b) Less than 3 years of age c) Use of abusive language by the client d) Presence of comorbid psychiatric disorders

Presence of comorbid psychiatric disorders Explanation: Clients with ODD are likely to have comorbid psychiatric symptoms related to conditions like attention deficit hyperactivity disorder (ADHD). Pharmacological therapy for these comorbid conditions can be helpful in reducing the severity of ODD symptoms. Children less than 3 years of age are expected to exhibit behavior similar to ODD, but this is considered normal and does not require any therapy. Use of abusive language and hostile behavior toward parents are signs consistent with ODD and do not require pharmacological therapy.

A 13-year-old boy who has been diagnosed with oppositional defiant disorder has taunted the nurse when she bent over to pick something up and mocked her weight. How should then nurse respond? a) Say, "That's not an acceptable thing to say." b) Say, "How would you like it if someone said that to you?" c) Say, "That makes me feel embarrassed and I don't appreciate it." d) Pretend not to hear the boy and leave the room.

Say, "That's not an acceptable thing to say." Explanation: A direct, matter-of-fact approach to hostile or inappropriate behavior is beneficial when engaging with adolescents.

The nurse asking to speak to the child alone can provide reassurance to the child by ... a) Allowing the parent to stay if the child requests b) Showing the child that the waiting area is close by, where the parents will wait for the child c) Telling the child that we will only be together for a short time d) Speaking to the child in an assertive voice and telling the child that you will not hurt him or her

Showing the child that the waiting area is close by, where the parents will wait for the child Explanation: After talking with the parent and child together, the nurse should ask to speak with the child alone for a while. Young children may fear separating from their parents. The nurse can reassure children by showing the child where the waiting area is and telling him or her, "Mommy and Daddy are going to be waiting right here for you. You and I are going to be in a room close by."

The nurse is assessing a child's temperament as part of the psychological assessment. Which type of temperament is characterized by a negative, mildly emotional response to new situations that is expressed with intensity and initially slow adaptation but evolves into a positive response? a) Slow to warm up b) Difficult c) Challenging d) Easy

Slow to warm up Explanation: The classic New York Longitudinal Study (Thomas, Chess, & Birch, 1968) identified three main patterns of temperament seen in infancy that often extend into childhood and later life. A difficult temperament is characterized by irregular sleep and eating patterns, negative response to new stimuli, slow adaptation, a negative mood, and high emotional intensity. An easy temperament is characterized by a positive mood, regular patterns of eating and sleeping, a positive approach to new situations, and low emotional intensity. A slow-to-warm-up temperament is characterized by a negative, mildly emotional response to new situations that is expressed with intensity and initially slow adaptation but evolves into a positive response. Challenging is not one of the three main patterns of temperament

Which disorder across the lifespan accounts for more deaths than any other preventable health condition? a) Eating disorders b) Schizophrenia c) Personality disorders d) Substance abuse disorders

Substance abuse disorders Explanation: 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 ADHD bring the child for a follow-up visit. During the visit, they tell the nurse that the child receives his first dose of methylphenidate (Ritalin) at about 7:30 AM 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 noon. Which of the following might the nurse suggest as a possible solution to control the child's symptoms a bit more effectively? a) Giving the second dose at 1 PM or later. b) Switching to a longer acting preparation. c) Splitting the early morning dose in half. d) Switching to another class of medication.

Switching to a longer acting preparation. Explanation: Methylphenidate (Ritalin) has a total duration of action of about 4 hours (Box 35.4). 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 such as Concerta, Ritalin LA, and Metadate or amphetamine-dextroamphetamine (Adderall) 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.

The nurse is preparing to interview a girl 6 years of age and her mother in an outpatient psychiatric setting. To establish a treatment alliance with the child, the nurse should do what? a) Talk to the child while standing up and looking down at her. b) Tell the child she watches Sesame Street all the time. c) Tell the child that this must be a bit scary for her. d) Ask the parent if the child can be interviewed alone.

Tell the child that this must be a bit scary for her. Explanation: To establish a treatment alliance with the child, the nurse should recognize the child's individuality and show respect and concern for the child. The nurse should demonstrate sensitivity, objectivity, and confidentiality. The statement about it being scary for the child demonstrates sensitivity for the child's situation. Telling the child about watching Sesame Street makes the assumption that the child indeed does so. The nurse needs to be on the child's level. Asking if the child can be interviewed alone would not allow the nurse to observe the child-parent interaction. After talking with the parent and child together, the nurse should ask to speak with the child alone for awhile. Young children may fear separating from their parents.

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? a) The child is not willing to answer the nurse. b) The child does not like talking to the nurse. c) The child is not able to understand what the nurse is asking. d) 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.

Why would a nurse ask a female adolescent client with conduct disorder to maintain a diary? a) To help learn socially acceptable behavior. b) To help identify her feelings. c) To ipmrove provlem solving skills. d) To help reduce the chances of having outbursts of anger.

To help identify her feelings. Explanation: Clients with conduct disorder are tough on the exterior but have difficulty expressing their feelings and emotions. Keeping a diary can be very useful to help these clients to identify and express their emotions and feelings. Keeping a diary would not improve problem solving or teach socially acceptable behavior. It also does not reduce the chances of an angry outburst. The nurse should teach problem-solving skills, continually involve the client in age-appropriate discussions, and use techniques such as timeout to address these challenges.

A four-year-old child who has been assessed about the reactions to his parents divorcing states, "My mom and dad are getting a divorce." This describes the child's awareness of the reality but the child may not understand the concept. The nurse would attempt to ... a) ask the child how they feel about this upcoming change. b) express empathy and attempt to assess the child's level of understanding of the divorce. c) ask the parents to join in the assessment at this point. d) express sadness toward this and ask the child how you could help.

express empathy and attempt to assess the child's level of understanding of the divorce. Explanation: The child has a basic awareness of the reality of parents' divorce, but may not understand this concept. Nurse expresses empathy and attempts to assess the child's level of understanding of the divorce

A 14-year-old client's behavior meets the criteria for a conduct disorder when the nursing assessment documents that the child has (Select all that apply.) a) Been regularly accused by family members of "stealing their stuff" b) Served after-school detention for repeatedly disobeying the teaching staff c) Been caught lying on a regular basis d) Confessed to hurting the neighbor's dog e) Resorted to threatening to cut himself when angry

• Been regularly accused by family members of "stealing their stuff" • Served after-school detention for repeatedly disobeying the teaching staff • Been caught lying on a regular basis • Confessed to hurting the neighbor's dog Explanation: A 14-year-old client's behavior meets the criteria for a conduct disorder when the nursing assessment documents that the child has done the following: confessed to hurting the neighbor's dog, served detention, been accused of stealing, and been caught lying.

A nurse is describing the various etiologies and risk factors associated with ADHD. Which of the following would the nurse include? Select all that apply. a) Genetics b) Family stress c) Marital discord d) Poverty e) Overcrowded living conditions

• Family stress • Poverty • Overcrowded living conditions • Genetics • Marital discord Explanation: Although genetic endowment clearly plays a fundamental role in the etiology of ADHD, psychosocial factors are also important risk factors, particularly related to inattention (Freitag et al., 2011). Family stress, marital discord, and parental substance use are also associated with ADHD (Palcic, Jurbergs, & Kelley, 2009). Other implicated psychosocial factors are poverty, overcrowded living conditions, and family dysfunction.

The nurse is assessing an adolescent client who was diagnosed with autism spectrum disorder as a child. On current assessment the nurse finds that the client's autistic behavior has deteriorated. What may be the possible causes of this change? Select all that apply. a) Inability to perform well in school b) Increased parental and peer pressure c) Hormonal changes d) Administration of MMR vaccine e) Need for more attention

• Inability to perform well in school • Increased parental and peer pressure • Hormonal changes Explanation: Deterioration of autistic behavior during adolescence is due to hormonal changes and the difficulty in meeting excess social demands. Increased social demands may be due to pressure from peers and parents and to the inability to perform well in school and play. Autistic people do not prefer being paid attention to; they prefer being alone. MMR vaccines are administered in childhood. Moreover, recent studies have found that autism is not related to MMR vaccinations.

A nurse is developing a plan of care for a client with conduct disorder. Which of the following would be treatment outcomes for this client? Select all that apply. a) The client will have a hygienic lifestyle. b) The client will learn effective problem-solving skills. c) The client will be relieved of anxiety and depression. d) The client will not hurt others or damage property. e) The client will engage in socially acceptable behavior.

• The client will learn effective problem-solving skills. • The client will not hurt others or damage property. • The client will engage in socially acceptable behavior. Explanation: If a client undergoes successful treatment, he or she should be able to behave in a socially acceptable manner, display appropriate problem-solving skills, no longer hurt others or damage property. Clients with conduct disorder usually do not have issues related to personal hygiene. Such clients do require relief from anxiety or depression, as they are considered unemotional and do not show regret or feel any remorse after inappropriate behavior.

Which of the following is accurate regarding the completion of a mental health assessment of a child? Select all that apply. a) The nurse should use simple phrasing with children b) Children have a more developed memory than adults c) Children have a less specific sense of time than adults d) Children can sequence events well e) The nurse should corroborate information offered by the child with other sources

• The nurse should use simple phrasing with children • Children have a less specific sense of time than adults • The nurse should corroborate information offered by the child with other sources Explanation: Children have a less specific sense of time than adults. The nurse should use simple phrasing with children and corroborate information offered by them with other resources. Children cannot sequence events well and do not have more developed memories than adults.