Ch 37: Mental Health Disorders of Childhood and Adolescence

a) Serotonin reuptake inhibitors Pg. 734 The most commonly used antidepressant medications for children and adolescents are the SSRIs. Side effects, especially nausea, headache, and stomachache, are minimal, especially when the starting dose is low with a gradual increase to a therapeutic level.

10. A 15-year-old boy being treated for depression will most likely be given which of the following first-line pharmacologic treatments? a) Serotonin reuptake inhibitors b) Benzodiazepines c) Monoamine oxidase inhibitors d) Tricyclic antidepressants

c) Tourette's syndrome Pg. 731 Tourette's syndrome, or Gilles de la Tourette's syndrome, is described as a combination of motor tics and involuntary vocal and verbal utterances that often are obscene (coprolalia); imitating someone else's movements (echokinesis) may be present.

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

d) Anxiety and aggression Pg. 722 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.

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

b) Atomoxetine Pg. 726 Atomoxetine was the first nonstimulant medication specifically designed and tested for ADHD. The primary stimulant drugs now used to treat ADHD are methylphenidate, amphetamine, and lisamphetamine.

45. A parent is concerned about a child being given stimulant medication for attention-deficit/hyperactivity disorder (ADHD). The nurse tells the parent that which medication was the first nonstimulant medication specifically designed and tested for ADHD? a) Lisamphetamine b) Atomoxetine c) Amphetamine d) Methylphenidate

a) "We'll have him do his homework at the kitchen table with his brothers and sisters" Pg. 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.

1. 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"

c) "We need to remember that our son is not a bad kid; he just has difficulty with impulse control and attention" Pg. 727-728 Educating clients and families on the biological basis of ADHD helps parents understand that these children are not "bad" kids but that they have problems with impulse control and attention. It may be helpful to review the purposes of the medications and assure the parents that there is evidence that medications help most children. Studies show that treatment of ADHD is not associated with a risk of substance disorders. The physician, not the parents, would determine when it would be appropriate to take a drug holiday to evaluate the need for continued medication therapy. Regular routines are important, but so are clear limits with clear consequences when these limits are violated.

11. After educating the parents of a child diagnosed with ADHD on the disorder and its treatment, the nurse determines that the education has been effective when the parents state which of the following? a) "We need to be careful so he doesn't develop a substance abuse problem as he grows older" b) "We should stop the medication after two months to see how effective it is in really controlling his symptoms" c) "We need to remember that our son is not a bad kid; he just has difficulty with impulse control and attention" d) "We should set up regular routines for him, but not worry if he violates the limits once in a while"

b) Frontal Pg. 723 Brain images of people with ADHD have suggested decreased metabolism in the frontal lobes, which are essential for attention, impulse control, organization, and sustained goal-directed activity.

12. Brain images of people with ADHD have suggested decreased metabolism in which of the following cerebral lobes? a) Temporal b) Frontal c) Parietal d) Occipital

a) Schizophrenia c) Major depressive disorder d) Bipolar disorder Pg. Although learning disability and ADHD occur in children, major depressive disorder, schizophrenia, and bipolar disorder are among the main causes of neuropsychiatric disability worldwide among individuals ages 10 to 24 years of age. Alcohol use is another major contributor to neuropsychiatric disability.

13. When discussing the various psychiatric disorders affecting children, which condition would the nurse address as being a main cause of neuropsychiatric disability worldwide in young people between the ages of 10 and 24 years? Select all that apply. a) Schizophrenia b) Learning disability c) Major depressive disorder d) Bipolar disorder e) Attention deficit hyperactivity disorder (ADHD)

a) Focus on positive actions to improve situations and/or behaviors c) Avoid a "blaming" attitude toward clients and/or families e) Remember to focus on the client's strengths and assets, as well as their problems Pg. 728 Points to consider when working with clients with disruptive behavior disorders and their families include remembering to focus on the client's strengths and assets, as well as their problems and avoiding a blaming attitude toward clients and/or families. The nurse should focus on positive actions to improve situations and/or behaviors. There is a familial tendency for behavior disorders, but that is not the only cause for behavior disorders and the nurse cannot assume that the client's parents also had a conduct disorder. Conduct disorders are not common in all children, but it can be difficult to distinguish normal child behavior from conduct disorders at times.

14. Which are important points for the nurse to consider when working with clients with disruptive behavior disorders and their families? Select all that apply. a) Focus on positive actions to improve situations and/or behaviors b) Most behavior disorders are caused by being raised by parents who had behavior disorders in their own childhoods c) Avoid a "blaming" attitude toward clients and/or families d) Transient conduct disorders are common in all children e) Remember to focus on the client's strengths and assets, as well as their problems

d) "Missing class is against the rules" Pg. Reinforcing rules avoids a power struggle; the nurse must set limits on the unacceptable behavior of missing class. The nurse can negotiate with a client a behavioral contract outlining expected behaviors, limits, and rewards to increase treatment compliance. The nurse must avoid responses that will exacerbate conflict, like "Why do you keep fighting the system?" and "You and I both know you're lying." It would be inappropriate to comply with the adolescent's desire to miss school because this contravenes the rules.

15. A 14-year-old client is being treated for conduct disorder. The client refuses to attend class today, stating that yesterday the other nurse told the client that the client did not have to go to class if the client did not want to. Which would be the best response by the nurse? a) "Why do you keep fighting the system?" b) "You and I both know you're lying" c) "Fine, but you're confined to your room" d) "Missing class is against the rules"

c) Emphasize the need to seek medical help if suicidal thoughts arise Pg. 734 Selective serotonin re-uptake inhibitor antidepressant medications may increase the risk of suicidal thinking and behavior in some children and adolescents. Close monitoring of suicidal thinking is warranted for the first four weeks of treatment with this medication. Drowsiness is a common and nonthreatening side effect of this medication that can last for up to four weeks after treatment is initiated. The client should be told to expect this side effect but not to stop taking the medication because of it. Appetite loss is a side effect that is common in the first four weeks of treatment. It does not persist throughout treatment. Giving the client this information would be inaccurate. Sleep changes are common in the first four to six weeks of treatment with this medication. The client should be warned to expect this change rather than informing the client that it is not common.

16. A health care provider in an outpatient clinic has prescribed fluoxetine (Prozac) to a client with intermittent explosive disorder. What should the nurse include in teaching about this medication? a) Tell the client to stop taking the medication if the client experiences drowsiness b) Inform the client appetite loss is a side effect that will persist throughout treatment c) Emphasize the need to seek medical help if suicidal thoughts arise d) Remind the client it is uncommon to experience sleep changes with this medication

b) Keep to regular routines c) Maintain a calm environment e) Set clear limits with consequences Pg. 728 Interventions that can help the parents of a child with ADHD include: setting clear limits with clear consequences, using few words and simplifying instructions; establishing and maintaining a predictable environment with clear rules and regular routines for eating, sleeping, and playing; promoting attention by maintaining a calm environment with few stimuli; establishing eye contact before giving directions and asking the child to repeat what was heard; encouraging the child to do homework in a quiet place outside of a traffic pattern; and assisting the child to work on one assignment at a time (reward with a break after each completion).

17. When assisting the parents of a child diagnosed with ADHD, which of the following would the nurse suggest? Select all that apply. a) Let him work on several things at once b) Keep to regular routines c) Maintain a calm environment d) Provide extensive explanations e) Set clear limits with consequences

c) Noradrenergic reuptake inhibitor Pg. 734 Atomoxetine (Strattera), a noradrenergic reuptake inhibitor, is not classified as a stimulant and is effective in the treatment of ADHD. Antipsychotics are rarely used to treat ADHD. Methylphenidate is a stimulant. Alpha agonists include guanfacine and clonidine.

18. After teaching a group of students about medications used to treat ADHD, the instructor determines that the education was successful when the group identifies atomoxetine as which of the following? a) Antipsychotic b) Stimulant c) Noradrenergic reuptake inhibitor d) Alpha-agonist

c) Attending group-based parenting classes Pg. Parental behavior profoundly influences children's behavior. Group-based parenting classes have been proven to be effective in dealing with problem behaviors in children and preventing later development of conduct disorders. This is a proactive approach to conduct disorders that is preferred over reactive interventions such as medication. Limit setting enhances the management of problem behaviors. Overprotective parenting can inhibit the development of responsibility and overall psychosocial development.

19. Which is an effective way for parents to deal with problem behaviors in children and to prevent later development of conduct disorders? a) Avoiding setting limits b) Administering medications c) Attending group-based parenting classes d) Being overprotective of the child

a) "Sometimes I feel like I'm so sleepy" Pg. 732 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.

2. 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 think I'm much more alert with this drug" c) "I'm eating about the same amount as before" d) "My muscles seem pretty flexible lately"

d) 70 Pg. 720 The usual threshold for intellectual disability is an intelligence quotient of 70 or less (i.e., two standard deviations below the population mean).

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

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

21. ADHD is characterized by inattentiveness, overactivity, and impulsiveness. Which of the following would the nurse identify related to inattentiveness? a) Fidgeting b) Talking excessively c) Interrupting d) Missing details

d) It can lead to increased risk of other mental health disorders Pg. 729 Disruptive behavior disorders occur more in males than females. Females who have been diagnosed with disruptive behavior disorder display more sexual behaviors than males. Males display physical as well as relational aggression, whereas females tend to display relational aggression. Individuals who are diagnosed with this type of disorder are more likely to have other mental health disorders, such as anxiety, mood disorders, and/or substance use disorders.

22. A nurse is reviewing information about disruptive behavior disorders in children. Which finding best describes this clinical diagnosis? a) It is more likely to occur in females than males b) Sexual promiscuity is seen equally across genders c) Behavioral responses are consistent across genders d) It can lead to increased risk of other mental health disorders

a) Onset before child is 2.5 years old Pg. 716 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.

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

b) Increased impulsivity or hyperactive behavior Pg. 723 Ritalin has a short half-life, so doses are needed about every 4 hours during the day to maintain symptom control. The child's symptoms may worsen four hours after a dose. Giving stimulants during daytime hours usually effectively combats insomnia. Social isolation is likely to be an ongoing, long term problem that is unrelated to the precise timing of doses. A loss of appetite is more likely when serum levels of the drug are higher.

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

d) Providing a structured, routine environment Pg. 722 Milieu management—a consistent, structured environment with predictable routines for activities, mealtimes, and bedtimes—is necessary for successful treatment. Changes in routine may provoke disorganization in the child, leading to emotional disequilibrium and explosive behavior. Children with autism spectrum disorder often have social deficits, therefore a group talk or activites that promote interpersonal interaction would be inappropriate. Climbing structures and rolling chairs would be problematic and impose a safety risk. Listening to the parents feelings and frustrations would fall in the psychosocial domain of treatment for a child with ASD.

27. Which of the following approaches is included in milieu management for the child with autism spectrum disorder? a) Scheduling a group in which the children talk about school b) Listen to the parents feelings and frustrations c) Having a playroom with climbing structures and rolling chairs d) Providing a structured, routine environment

a) Weight loss c) Insomnia e) Appetite suppression Pg. 726 Dextroamphetamine is a commonly prescribed drug to treat symptoms of ADHD. Insomnia, weight loss, and appetite suppression are the common side effects associated with this drug. The nurse should educate the parents on monitoring these effects. Hypotension and weight gain are not common side effects of this drug.

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

c) It is retreat to a neutral place, so clients can regain self-control Pg. 730 Time-out is retreat to a neutral place, so clients can regain self-control. It is not a punishment. When a client's behavior begins to escalate, such as when he or she yells at or threatens someone, a time-out may prevent aggression or acting out. It can be used as a proactive strategy, not a last resort. Eventually, the goal for clients is to recognize signs of increasing agitation and take a self-instituted time-out to control emotions and outbursts.

30. Which is true of the time-out strategy that may be used for persons with conduct disorder? a) It is not a permanent solution; eventually, the goal is for the client to avoid time-out b) It should only be used as a last resort c) It is retreat to a neutral place, so clients can regain self-control d) It is a punishment

d) Decreased social interaction Pg. 736 A delay in speech or language development can adversely affect the child's socialization and education. For example, peers may rebuff or tease a child with an articulation defect or stutter, contributing to withdrawal and a negative self-image. The resulting isolation could limit opportunities to negotiate rules, take turns, and learn cooperation.

31. A nurse is assessing a child with a communication disorder. The nurse would anticipate a problem involving: a) A head injury b) Lack of play therapy opportunities c) Overprotective parents d) Decreased social interaction

b) Avoid artificial sweeteners Pg. 726 The Feingold diet identified certain food content (dietary salicylates, artificial sweeteners, food colors and flavors, and preservatives) as potential triggers to ADHD. Avoiding artificial sweeteners would be a component of this diet plan. Increasing fluids has no direct correlation with ADHD. Limiting dairy products and caffeine intake is not part of the Feingold diet for ADHD.

33. A nurse working with a family whose child has been diagnosed with attention deficit hyperactivity disorder (ADHD) asks about what dietary modifications should be implemented. What is the best nursing response? a) Limit caffeine intake b) Avoid artificial sweeteners c) Limit dairy products d) Increase fluids

c) Teach the client's classmates that the tics are not something that the client can control Pg. 731 Tics are largely involuntary, especially in younger children. Establishing a pattern of rewards or consequences would be ineffective and inappropriate. A calm environment may be of some benefit, but the priority would be teaching others that the client's behavior is not deliberate.

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

b) Anxiolytics and selective serotonin reuptake inhibitors (SSRIs) have been shown to help reduce anxiety Pg. The anxiolytic buspirone (BuSpar) or the SSRI paroxetine (Paxil) helps reduce anxiety.

35. Which of the following statements is true regarding the use of pharmacologic agents in children with anxiety disorders? a) Mood-stabilizing medications, including lithium, divalproex (Depakote), and carbamazepine (Tegretol), are used for their calming and antiaggressive effects b) Anxiolytics and selective serotonin reuptake inhibitors (SSRIs) have been shown to help reduce anxiety c) The use of pharmacologic agents is discouraged in children because of addictive or suicidal potential d) Behavioral therapy, including imagery, self-talk, and cognitive techniques, is ineffective without the adjunctive use of pharmacologic agents

d) Left hemisphere of the brain Pg. 735-736 Although it is clear that no single cause will provide a sufficient explanation for reading disability, the underlying problem appears to be a deficit in phonologic processing, which involves the discrimination and interpretation of speech sounds. A disturbance in the development of the left hemisphere is believed to cause this deficit.

36. A nurse is providing care to a child with a reading disability. When explaining to the parents about the underlying issue involved, which structure would the nurse integrate into the explanation? a) Medulla b) Cerebellum c) Optic nerve d) Left hemisphere of the brain

c) SSRIs Pg. 737 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.

37. When working with the parents of child with severe separation anxiety disorder, the nurse may need to include teaching about which class of medications? a) Stimulants b) Antipsychotics c) SSRIs d) Benzodiazepines

b) Genetic syndromes Pg. 715-716 Although exposure to toxins, perinatal complications, and environmental effects are associated with intellectual disability, the most common etiology is related to genetic syndromes.

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

d) "We'll be sure to record his weight on a weekly basis" Pg. 721 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.

40. 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're so glad that Ritalin will eliminate the problems of ADHD" b) "We'll teach him the proper way to take the medication so he can manage it independently" c) "We'll be sure he takes the Ritalin at the same time every day, just before bedtime" d) "We'll be sure to record his weight on a weekly basis"

a) Attention-deficit hyperactivity disorder Pg. 714-715 Although other factors may be involved, genetic endowment is clearly a fundamental element in the etiology of ADHD. Genetics is not associated with depression, sociopathy, or bulimia.

46. Genetics can play a role in the development of a childhood psychiatric disorder. When assessing a child, which disorder would the nurse identify as having a genetic component? a) Attention-deficit hyperactivity disorder b) Sociopathy c) Depression d) Bulimia

b) Excluding the parents from being included in the plan of care Pg. 721 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.

5. 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

c) Intellectual disability Pg. 715 About half of children with autism spectrum disorder have intellectual disability, and about 25% have seizure disorders. Hypertension and motor decline are not associated with autism.

6. A nurse is conducting a presentation about autism spectrum disorder for a group of parents. When describing this condition, the nurse would identify that approximately 50% of those with this condition also experience which of the following? a) Hypertension b) Seizure disorder c) Intellectual disability d) Motor decline

d) 65 Pg. 720 The usual threshold for intellectual disability is an IQ of 70 or less (i.e., two standard deviations below the population mean).

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

c) Improving coping skills and self-esteem Pg. 715 Nursing interventions for conduct disorder include teaching and practicing problem-solving skills. In this scenario, the nurse is asking the client to reflect on the situation in order find healthier, adaptive solutions. Teaching and practicing problem-solving skills is aimed at the ultimate goal of improving coping skills and self-esteem for clients with conduct disorder.

8. A nurse is working with an adolescent client with a diagnosis of conduct disorder. The nurse is helping the client reflect on a situation in which the client became aggressive and asks how the client could have handled it differently. The nurse is employing which intervention? a) Increasing treatment compliance b) Promoting social interaction c) Improving coping skills and self-esteem d) Providing client education

a) Language difficulty Pg. 723 A persistent pattern of inattention, hyperactivity, and impulsiveness that interferes with functioning characterizes ADHD. Language difficulties are not associated with ADHD.

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

c) Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior Pg. 726 Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior, with the resulting effect of improved self-control.

23. 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) Psychostimulants are a form of aversion therapy in which the child becomes uncomfortable with overstimulation b) Controlled, medication-induced stimulation helps children become more comfortable and functional during times of high stimulation c) Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior d) Brain stimulation is inversely proportionate to motor stimulation

a) The child has a school phobia Pg. 733-734 The child's wanting to remain home from school may be an example of parents' explanations for some behaviors. The data in the question indicate an ongoing and progressive problem. Some aspects of the school experience are feared by the child. Separation anxiety is thought to play a role in this disorder. The data neither indicate ADHD nor suggest childhood developmental disorder.

24. The mother of a 6-year-old boy reports that the child has had increasing somatic complaints that have no physical basis and disappear when he is allowed to remain home from school. The nurse should suspect what? a) The child has a school phobia b) The child has oppositional defiant disorder c) The child has a developmental disorder d) The child has ADHD

d) The client spends time alone with little interest in making friends Pg. 716-719 Children with autism spectrum disorder develop language slowly or not at all. They may use words without attaching meaning to them or communicate with only gestures or noises. They spend time alone and show little interest in making friends. Autism spectrum disorder is not associated with over attachment, pulling out hair, or tics.

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

d) Phonologic disorder Pg. 735-736 Phonologic disorder involves problems with articulation. Mixed receptive-expressive language disorder includes problems of expressive language disorder along with difficulty understanding and determining the meaning of words and sentences. Expressive language disorder involves an impaired ability to communicate through verbal and sign language. Stuttering is a disturbance of the normal fluency and time patterning of speech.

38. Which of the following disorders involves problems with forming sounds associated with speech? a) Expressive language disorder b) Stuttering c) Mixed receptive-expressive language disorder d) Phonologic disorder

b) "Please tell me more about what you are having difficulty with" Pg. Exploring in depth what the client's mother is having difficulty with can help the nurse build the parental capacity to address the behavioral difficulties they are having on their own. Identifying specific pitfalls can promote problem solving. Meeting with the child individually at the school counseling office takes the child out of the environment where the behavior is most problematic (in the home). Working with the child individually is ineffective as the best treatment for oppositional defiant disorder is to work with the parents in building their capacity for behavior management. Telling the mother to bring the client to the nurse's office for another session communicates that the parents do not already have the tools to manage the child's behaviors independently.

4. After completing a series of parent training sessions with parents of an 8-year-old client with oppositional defiant disorder, the child's mother calls the nurse with concerns. The mother states, "What you taught us isn't working. Can you please talk to my child about his behavior?" Which is the nurse's most effective response? a) "Please bring your child to my office for another session" b) "Please tell me more about what you are having difficulty with" c) "Tell me how you have been using negotiation when limit setting with your child" d) "I can meet with your child individually at the school counseling office"

b) Anxiety c) Depression Pg. 733 Children of parents with at least one anxiety disorder are at increased risk of also having an anxiety disorder. The risk increases even more when two parents are affected. Parental depression is also associated with anxiety disorders in children. Schizophrenia, mania, and ADHD are not associated with separation anxiety in children.

41. Which of the following are parental disorders associated with the development of separation anxiety in the child? Select all that apply. a) Attention deficit hyperactivity disorder (ADHD) b) Anxiety c) Depression d) Schizophrenia

c) "You will lose your driving privileges for a week if you don't clean your room today" Pg. 724 The nurse should help parents identify appropriate discipline strategies. While the other options express appropriate parental emotions, they do not address parenting strategies that will effectively address the teen's behavior.

42. Which statement, made by the parent of a teen diagnosed with conduct disorder, demonstrates effective parenting? a) "When are you going to learn that bullying is not acceptable behavior?" b) "A person your age knows better than to skip school" c) "You will lose your driving privileges for a week if you don't clean your room today" d) "Do you understand that you hurt your sister's feelings when you call her names?"

c) Atomoxetine Pg. 726-727 The first-line recommended medications for ADHD symptoms are the psychostimulants and atomoxetine (Strattera). It is not unusual for two psychostimulants or a psychostimulant and atomoxetine to be prescribed together for maximum response. Second-line medications include bupropion (Wellbutrin) and other antidepressants (tricyclic antidepressants [TCAs]). Then, if symptoms are not improved, alpha agonists (guanfacine or clonidine) are usually used.

43. A child is diagnosed with attention deficit hyperactivity disorder and is to receive pharmacologic therapy. Which of the following would the nurse expect to be prescribed as a first line agent? a) Clonidine b) Guanfacine c) Atomoxetine d) Bupropion

a) Most children experience a spontaneous remission of the disorder Pg. 738 Enuresis is the involuntary excretion of urine after the age at which the child should have attained bladder control. It usually involves involuntary bedwetting at night, but repeated urination on clothing during waking hours can occur (diurnal enuresis). Enuresis is a self-limiting disorder, with most children experiencing a spontaneous remission. Nocturnal enuresis is most common in young boys. The frequency in girls is about half that of boys in each age group. Most children with nocturnal enuresis are urologically normal.

44. A nurse is preparing a presentation for a group of parents about enuresis. Which of the following would the nurse most likely include in the discussion? a) Most children experience a spontaneous remission of the disorder b) More girls than boys experience enuresis c) The disorder involves voluntary bedwetting at night d) Most children have a urologic abnormality