Chapter 11 - Childhood Neurodevelopmental Disorders (Psych) EAQ's

The nurse instructs the parent of a child with attention-deficit/hyperactivity disorder (ADHD) to administer methylphenidate before 4 PM. Which side effect is the nurse addressing by giving this instruction? 1 Nausea 2 Insomnia 3 Lethargy 4 Anorexia

2 - Insomnia Insomnia is a side effect associated with methylphenidate. Administering the drug during nighttime hours would not allow the child to sleep at night. Therefore, the drug should be administered when the child is usually awake, in the morning or afternoon hours. Nausea is not associated with methylphenidate. Lethargy and appetite suppression are also side effects associated with methylphenidate. Taking the drug before 4 PM will not prevent these side effects. Text Reference - p. 186

Which medication would the nurse most likely include when educating the parents of a child diagnosed with attention-deficit/hyperactivity disorder? 1 Buspirone 2 Haloperidol 3 Clomipramine 4 Methylphenidate

4 - Methylphenidate Central nervous system stimulants, such as methylphenidate, are used to treat attention-deficit/hyperactivity disorder. Text Reference - pp. 185-186

An assessment that is focused on a child's developmental status will focus on which area? Select all that apply. 1 Reflexes 2 Social skills 3 Energy level 4 Impulse control 5 School performance

2 - Social skills 3 - Energy level 4 - Impulse control 5 - School performance A developmental assessment includes academic achievement and coping skills such as impulse control, social skills, and typical energy levels. Reflexes would be included in a neurologic assessment. Text Reference - p. 179

What should the nurse ask a 3-year-old child while assessing the child's relationship with his or her parents? 1 "Do you go on family vacations?" 2 "Who in the family helps you in studies?" 3 "Would you draw me a picture of your family?" 4 "On whom do you rely the most in your family?"

3 - "Would you draw me a picture of your family?" The nurse is performing an assessment of a 3-year-old child so the nurse should ask the child to interact using play activities, drawings, and puppets. The child may be too young to give verbal answers to the nurse's questions. Thus, the nurse should ask the child to draw a picture of the family. This picture would help the nurse to understand the child's perception of the family. Asking the child about who helps in studies, about family vacations, and whom the child relies on the most would not be appropriate for a child of this age. The child lacks the maturity to answer these questions. Text Reference - p. 176

A pediatric patient is being discharged. The parents have asked how and when to address angry outbursts from their child at home. Which technique can be replicated outside of the hospital setting? 1 Restraint 2 Seclusion 3 Quiet room 4 Parenteral medication

3 - Quiet room A quiet room or area can be replicated in most home environments. This is distinctly different from seclusion, which is not psychologically beneficial. Restraints can be physically harming, and parenteral medication requires medical personnel. Text Reference - p. 178

Which areas of the brain undergo dramatic changes in childhood and adolescence? Select all that apply. 1 Pons 2 Medulla 3 Synapses 4 Cerebellum 5 Prefrontal cortex

3 - Synapses 4 - Cerebellum 5 - Prefrontal cortex The synapses dramatically decline after age 5. The prefrontal and frontal cortex regions, as well as the cerebellum, change and mature in adolescents. The medulla and pons do not undergo significant changes in childhood and adolescence Text Reference - p. 173

A nurse talks with the parents of a child diagnosed with attention-deficit/hyperactivity disorder. Amphetamine salts have been prescribed for the child. The nurse should teach the parents to monitor for which side effects? Select all that apply. 1 Insomnia 2 Headache 3 Tachycardia 4 Hypotension 5 Appetite stimulation

1 - Insomnia 2 - Headache 3 - Tachycardia Insomnia is a common side effect, as well as appetite suppression, headache, tachycardia, abdominal pain, and lethargy. Hypertension, rather than hypotension, may occur. Text Reference - p. 186

A patient with attention-deficit/hyperactivity disorder (ADHD) is prescribed methylphenidate transdermal patch. How often should the nurse change the patch? 1 Once a day 2 Once a week 3 Three times a day 4 Three times a week

1 - Once a day Methylphenidate is available as a transdermal patch. It is prescribed for patients of the age group 6 to 12. Changing the patch should be scheduled for once a day because its duration of action is for 10 to 12 hours and up to 3 hours after removal of the patch. Text Reference - p. 187, Table 11.2

A school nurse observes a child in one of the classes who often slaps his own face, bangs his head against the wall, and uses repetitive language patterns. What appropriate suggestion should the nurse give to the parents and caregivers of the patient? 1 The nurse should suggest hospitalizing the child briefly. 2 The nurse should suggest removing the child from school. 3 The nurse should prevent the child from playing with peers. 4 The nurse should suggest administering anxiolytics to the child.

1 - The nurse should suggest hospitalizing the child briefly. A child who often slaps his own face, bangs his head, and uses repetitive language is likely suffering from intellectual development disorder. The nurse should suggest that the child be hospitalized for a short-term evaluation. The education provided should be supportive to the child and match his or her cognitive level and nature of illness, but that does not always mean the child must be removed from school permanently. A nurse cannot suggest medications because they can only be prescribed by a primary health care provider. The child should be encouraged to mingle with his or her peer group and play. Playing helps children express thoughts and emotions. Text Reference - p. 181

The family of a child diagnosed with attention-deficient/hyperactivity disorder (ADHD), inattentive type, is told the evaluation of their child's care will focus on symptom patterns and severity. What will the focus of evaluation be? Select all that apply. 1 Physical growth 2 Social relationships 3 Personal perception 4 Activities of daily living 5 Academic performance

2 - Social relationships 3 - Personal perception 4 - Activities of daily living 5 - Academic performance For the family and child with ADHD, evaluation will focus on the symptom patterns and severity. For those with ADHD, inattentive type, the focus of evaluation will be academic performance, activities of daily living, social relationships, and personal perception. For those with ADHD, hyperactive-impulsive type or combined type, the focus will be on both academic and behavioral responses. Text Reference - p. 186

A social behavior that is often a result of a child having been abused is 1 Eating disorders 2 Speech disorders 3 Bullying of others 4 Delayed motor skills

3 - Bullying of others Children who have experienced abuse are at risk for identifying with their aggressor and may act out, bully others, become abusers, or develop dysfunctional interpersonal relationships in adulthood. Text Reference - p. 174

When a nurse assesses the style of behavior a child habitually uses to cope with the demands and expectations of the environment, he or she is assessing 1 Resilience 2 Vulnerability 3 Temperament 4 Cultural assimilation

3 - Temperament Temperament is the behavior the child habitually uses to cope with the environment. It is a constitutional factor thought to be determined genetically. It may be modified by the parent-child relationship. Text Reference - p. 173

A child diagnosed with attention-deficit/hyperactivity disorder is reprimanded for taking the nurse's pen without asking first. The child responds by shouting, "You don't like me! You won't let me have anything, even a pen!" The nurse is most therapeutic when responding, 1 "I do like you, but I don't like it when you grab my pen." 2 "It sounds as though you are feeling helpless and insecure." 3 "Liking you has nothing to do with whether I will loan you my pen." 4 "You must ask for permission before taking someone else's things."

1 - "I do like you, but I don't like it when you grab my pen." This reply shows positive regard for the child while describing the behavior as undesirable. Feedback such as this helps the child feel accepted while making him or her aware of the effect his or her behavior has on others. Text Reference - p. 185

A 9-year-old patient has deficits in social and intellectual functioning and cannot manage practical aspects of daily life and functioning. These symptoms/signs support which diagnosis? 1 Specific learning disorder 2 Intellectual development disorder (IDD) 3 Autism spectrum disorder (ASD) 4 Attention-deficit/hyperactivity disorder (ADHD)

2 - Intellectual development disorder (IDD) IDD is characterized by severe deficits in three major areas of functioning: intellectual, social, and managing daily life. Specific learning disorder is diagnosed when a child demonstrates persistent difficulty in the acquisition of reading (dyslexia), mathematics (dyscalculia), or written expression (dysgraphia), and his or her performance is well below the expected performance of peers. Autism is characterized by severe problems in communication skills and social interaction. ADHD is characterized by inattention, impulsivity, and hyperactivity. Text Reference - p. 180

A nursing diagnosis that should be considered for a child with attention-deficit/hyperactivity disorder is 1 Anxiety 2 Risk for injury 3 Defensive coping 4 Impaired verbal communication

2 - Risk for injury The child's marked hyperactivity puts him or her at risk for injury from falls, bumping into objects, impulsively operating equipment, pulling heavy objects off shelves, and so forth. Text Reference - p. 181, Table 11.1

The nurse is caring for a child with autism spectrum disorder. The nurse identifies that the child has high levels of anxiety and has depression. Which measure taken by the nurse is most appropriate for treating the condition? 1 Administer anticonvulsants to the child. 2 Administer adrenolytic drugs to the child. 3 Administer a selective serotonin reuptake inhibitor (SSRI). 4 Administer a nonstimulant selective norepinephrine reuptake inhibitor (SNRI).

3 - Administer a selective serotonin reuptake inhibitor (SSRI). The goal of administering pharmacologic agents is to reduce the level of anxiety and agitation. SSRIs are the most common choice of drug used for treating autism spectrum disorders. These drugs promote tolerance in patients to minimize further complications of the disorder. Anticonvulsants, adrenolytic drugs, and nonstimulant SNRIs are not used for treating anxiety in autism disorders. Anticonvulsants are used to treat aggressive behavior in children with attention-deficit/hyperactivity disorder. Adrenolytic drugs are used for treating agitation in attention-deficit/hyperactive patients. Nonstimulant SNRIs are used to treat side effects caused by antistimulants. Text Reference - p. 183

Which factor can help explain why one child in a family might develop a mental disorder while another does not? 1 Culture 2 Genetics 3 Resilience 4 Environment

3 - Resilience Resilience is considered to be an inborn trait that is shaped by both internal and external factors. Genetics would be an explanation of similarities in mental health history, not differences. Environment and culture would also affect both siblings in equal measure. Text Reference - p. 173

A child in a pediatric mental health facility has depression and occasionally gets violent. The nurse decides to design a seclusion room where the child would be transferred next time he or she becomes violent. The nurse keeps few soft toys in the room. What is the reason for the nurse to keep these soft toys? 1 The child will feel relaxed on seeing the toys. 2 The child will get good sleep and become calm. 3 The child will express anger by punching the toys. 4 The child will play with the toys and become happy.

3 - The child will express anger by punching the toys. The nurse is designing a seclusion room where children can be kept when they get violent. Ideally, the room should be nonstimulating. A child should be able to regain self-control in this room. The purpose for keeping soft toys is that children can throw or punch the soft toy to release anger. This would help the child to express anger in a nondestructive manner. The soft toys are not necessarily helpful in inducing sleep in the child. The child is aggressive and violent and it is unlikely that the child plays with the toys in such a state. Seeing the toys would not calm down the child directly. Text Reference - p. 178

A nurse counsels the parents of a 5-year-old child diagnosed with severe autism spectrum disorder (ASD). When suggesting activities, which activity is most likely to engage this child? 1 Singing with a choir of young children 2 Playing video games with an older child 3 Riding bicycles with a small group of children 4 Assembling and disassembling a simple toy alone

4 - Assembling and disassembling a simple toy alone A child with ASD has severe impairments in social interactions and communication skills, often accompanied by stereotypical behavior, interests, and activities. Assembling and disassembling a simple toy alone would be an engaging activity for this child because of its repetitive nature. Play with other children will be difficult, especially for this young child with a severe disorder; solitary activities are better suited to this child. Text Reference - p. 182

A 7-year-old who is described as impulsive and hyperactive tells the nurse, "I am a dummy, because I don't pay attention, and I can't read like the other kids." The nurse notes that these behaviors are most consistent with the Diagnostic and Statistical Manual of Mental Disorders (DSM), fifth edition, diagnosis of 1 Autism 2 Conduct disorder 3 Attention deficit disorder 4 Attention-deficit/hyperactivity disorder

4 - Attention-deficit/hyperactivity disorder The data are most consistent with attention-deficit/hyperactivity disorder as described in the DSM-5. Text Reference - p. 184

A patient with attention-deficit/hyperactivity disorder (ADHD) also has depression and anxiety. Prescription of which drug should be avoided in the patient to treat ADHD? 1 Atomoxetine 2 Risperidone 3 Methylphenidate 4 Amphetamine salts

1 - Atomoxetine Use of atomoxetine is associated with increased incidence of suicidal ideation in patients with depression and anxiety. Therefore, a patient with ADHD who also has depression should not be prescribed atomoxetine. Risperidone, methylphenidate, and amphetamine salts are not known to cause such side effects and thus can be prescribed to a patient with ADHD and depression. Text Reference - p. 186

The diagnosis of impaired intellectual functioning is supported when a child diagnosed with intellectual development disorders (IDD) 1 Cannot put together a five-piece jigsaw puzzle 2 Has difficulty with the concept of social boundaries 3 Cries uncontrollably when a toy is temporarily missing 4 Can neither brush the teeth nor comb the hair effectively

1 - Cannot put together a five-piece jigsaw puzzle IDD, previously called mental retardation, are characterized by deficits in reasoning, problem solving, planning, judgment, abstract thinking, and academic ability compared with same-age peers. Text Reference - p. 180

What statement is true regarding children diagnosed with specific learning disorders? Select all that apply. 1 Diagnosis generally is made during the school years. 2 Diagnosis involves a series of assessment evaluations. 3 Such a diagnosis requires the confirmed existence of another mental illness. 4 Learning disabilities are associated with poor reading, writing, or math skills. 5 Poor self-esteem is a common long-term outcome associated with learning disorders.

1 - Diagnosis generally is made during the school years. 2 - Diagnosis involves a series of assessment evaluations. 4 - Learning disabilities are associated with poor reading, writing, or math skills. 5 - Poor self-esteem is a common long-term outcome associated with learning disorders. Children with specific learning disorders are identified during the school years. A learning disorder is diagnosed when a child demonstrates persistent difficulty in the acquisition of reading (dyslexia), mathematics (dyscalculia), or written expression (dysgraphia), and the child's performance is well below the expected performance of his or her peers. Diagnosis of a learning disorder is made through the evaluation of multiple assessments, including formal psychological evaluations, and is not explained better in the context of another mental illness. Long-term outcomes for children with learning disorders include low self-esteem, poor social skills, higher rates of school dropout, difficulties with attaining and maintaining employment, and poorer social adjustment. Such a diagnosis is not dependent on a comorbid mental health condition. Text Reference - p. 180

A 3-year-old has been diagnosed with autism. Although there is an absence of language, the child does babble but is indifferent to contact with people. The nurse's initial intervention will be to 1 Give one-to-one attention in nonverbal parallel play 2 Sit next to the child while looking at a picture book 3 Feed the child snacks while talking softly 4 Sit across from the child at the play table and introduce new toys

1 - Give one-to-one attention in nonverbal parallel play The nurse should enter the child's world in a nonthreatening manner to establish trust before beginning to verbalize or engage in more intrusive attempts at play. Text Reference - p. 182

Multiple family therapy focuses on which goal? Select all that apply. 1 Identifying family strengths 2 Learning how other families problem solve 3 Improving interfamily communication skills 4 Developing insight regarding their own family 5 Determining which members are natural leaders

1 - Identifying family strengths 2 - Learning how other families problem solve 3 - Improving interfamily communication skills 4 - Developing insight regarding their own family Multiple family therapy may prove useful for learning how other families solve problems and build on strengths, developing insight and improved judgment about their own family, learning and sharing new information, and developing lasting and satisfying relationships with other families. Identifying problematic members is not a goal of such therapy. Text Reference - p. 185

A nurse is caring for a patient with specific learning disorders. Which behavioral aspects can the nurse find in the patient? Select all that apply. 1 Inability of the patient to read 2 Inability of the patient to communicate 3 Inability of the patient to solve a math problem 4 Inability to control hand movements like hand waving 5 Unwillingness of the patient to participate in a new task

1 - Inability of the patient to read 3 - Inability of the patient to solve a math problem Learning disorders are characterized by difficulty in learning, reading, and solving mathematics. An inability to solve a mathematical problem or inability to read indicates learning disorder. In motor disorder, the patient doesn't have the ability to perform new skills because of reduced coordination. A patient is diagnosed with communication disorder when the patient has trouble with making sounds and is unable to communicate. Continuous hand waving by the patient is seen in motor disorder as a result of poor coordination. Text Reference - p. 180

A nurse prepares to assess an adolescent with recent reports of serious behavioral problems at school. Which resources should the nurse use to complete the assessment? Select all that apply. 1 Interview the adolescent. 2 Interview the adolescent's closest friends. 3 Gather information from the adolescent's family. 4 Obtain information from the adolescent's teachers and school. 5 View the adolescent's recent activity on social networking sites.

1 - Interview the adolescent. 3 - Gather information from the adolescent's family. 4 - Obtain information from the adolescent's teachers and school. Methods of collecting data include interviewing, screening, testing (neurologic, psychological, intelligence), observing, and interacting with the child or adolescent. Histories are taken from multiple sources, including parents, teachers, other caregivers, and the child or adolescent when possible. Parents and teachers can complete structured questionnaires and behavior checklists. Interviewing the adolescent's friends would violate confidentiality. Viewing the adolescent's recent activity on social networking sites violates rights to privacy. Text Reference - p. 175

A nurse prepares the plan of care for an adolescent with a moderate intellectual development disorder. When determining outcomes for this patient, what should the nurse do? Select all that apply. 1 Involve family members and community resources. 2 Anticipate needs for custodial care as the adolescent ages. 3 Individualize the plan based on the needs and abilities of the patient and family. 4 Focus on the physical needs of the adolescent rather than psychosocial needs. 5 Consider continuing care needs as this patient ages and matures into adulthood.

1 - Involve family members and community resources. 3 - Individualize the plan based on the needs and abilities of the patient and family. 5 - Consider continuing care needs as this patient ages and matures into adulthood. Treatment plans should be individualized and realistic, using interventions designed to assist the patient to achieve his or her potential. Although the care plan is developed for the adolescent, family members or caregivers as well as community resources should be included. It is important for all members of the multidisciplinary team and the family to include long-term planning, with a goal of transitioning the child to a level of supervised or assisted care as he or she ages into adulthood; therefore, custodial care should not be the focus. The plan of care should focus on both physical and psychosocial needs of the adolescent and the family. Text Reference - p. 181

A primary health care provider has prescribed atomoxetine to a patient with impaired attention. The nurse administered the drug as prescribed. On the 40th day while monitoring the patient, which possible side effect could the nurse find in the patient? Select all that apply. 1 Liver injury 2 Weight gain 3 Urinary retention 4 Increased appetite 5 Reduced blood pressure

1 - Liver injury 3 - Urinary retention Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor used in attention-deficit/hyperactivity disorder. The common side effects associated with atomoxetine are urinary retention, liver injury, weight loss, increased blood pressure and heart rate, reduced appetite, dizziness, fatigue, and insomnia. Text Reference - p. 186

The nurse is caring for a toddler with a mental disorder. The nurse identifies that the toddler finds it difficult to communicate with the staff. What action does the nurse take next during the assessment? 1 Make use of play therapy. 2 Make use of bibliotherapy. 3 Make use of journaling therapy. 4 Make use of therapeutic drawing.

1 - Make use of play therapy. Play therapy is an effective medium for children with difficulties in verbal communication. Children are provided with toys, art supplies, molding clay, blocks, and puppets. Toddlers with mental disorders communicate with help of these toys as models. Bibliotherapy, journaling therapy, and therapeutic drawing are not used for assessing toddlers with mental disorders because these children may not have adequate cognitive development to perform these tasks. Bibliotherapy is used for older patients who are able to read and understand the materials provided. Journaling therapy is effective when designing treatment protocols for adolescents. Therapeutic drawing is used for younger patients who are able to express their views in the form of pictographic representation. Text Reference - p. 177

The nurse is assessing a child in the pediatric facility. While answering the nurse's questions, the child provides information with no context to the nurse's questions. What is the best nursing action? 1 Refer the child to an audiologist. 2 Refer the child to a speech therapist. 3 Refer the child to a child psychologist. 4 Refer the child to an occupational therapist.

1 - Refer the child to an audiologist. The child uses words that are not in context with the nurse's question. This indicates that the child has a communication disorder. In this situation, the first step taken by the nurse should be to eliminate the possibility of a hearing loss. Therefore, the child should be first referred to an audiologist. If the child has an intact sense of hearing, then the nurse should refer the child to a speech therapist. The child does not show any psychological disorder, thus the child need not be referred to a child psychologist. If the child has any learning disorder, then the nurse should refer the child to an occupational therapist. Text Reference - p. 179

What statement regarding the implementation of play therapy is true? Select all that apply. 1 The child learns coping mechanisms through playing with toys. 2 Limits are set only to promote security and provide a sense of reality. 3 The expression of feelings is supported through the use of a variety of toys. 4 Therapists direct the focus of the child's play toward identified problem areas. 5 The acting out of situations with dolls and puppets substitutes for verbal discussions.

1 - The child learns coping mechanisms through playing with toys. 2 - Limits are set only to promote security and provide a sense of reality. 3 - The expression of feelings is supported through the use of a variety of toys. 5 - The acting out of situations with dolls and puppets substitutes for verbal discussions. The guiding principles of play therapy are to accept the child as he or she is and follow his or her lead; establish a warm, friendly relationship that fosters the expression of feelings completely; and set limits only to provide reality and security. Through the use of an appropriate medium, a child can express thoughts or emotions that he or she may not be able to express verbally. The dolls, puppets, and dollhouse provide the child with opportunities to act out conflicts and situations involving the family, work through feelings, and develop more adaptive ways of coping. Text Reference - p. 177

The nurse is assessing a 10-year-old child who is performing poorly in school. On assessment, the nurse finds that the child has a learning disability. Which observation has led the nurse to come to this conclusion? Select all that apply. 1 The child was unable to read a storybook. 2 The child was not paying attention in class. 3 The child was unable to write properly on paper. 4 The child was not answering the nurse's questions. 5 The child was unable to perform basic calculations.

1 - The child was unable to read a storybook. 3 - The child was unable to write properly on paper. 5 - The child was unable to perform basic calculations. Inability to read is referred to as dyslexia, inability to perform simple calculations is called dyscalculia, and inability to write properly is called dysgraphia. These are the criteria for diagnosing a learning disorder. If the child does not answer the nurse's question, the nurse cannot conclude that the child has a learning disorder. There can be many causes that can prevent the child from talking to the nurse, such as depression or fear. Similarly, there can be many reasons why the child is not able to pay attention in class, such as depression or preoccupation with thoughts. A nurse cannot infer that the child has a learning disorder with this information. Text Reference - pp. 180-181

What are the interventions that focus on the recognized barriers to the identification and treatment of children and adolescents demonstrating symptoms of mental health disorders? Select all that apply. 1 Working with the local school board to identify screening opportunities for adolescents. 2 Researching policies regarding interdisciplinary coordination of mental health services. 3 Fundraising for a mental health clinic that focuses on providing services to children. 4 Identifying cultural groups that are at high risk for mental health issues among their children. 5 Lobbying the state regarding the revising of the reimbursement process for mental health services.

1 - Working with the local school board to identify screening opportunities for adolescents. 2 - Researching policies regarding interdisciplinary coordination of mental health services. 3 - Fundraising for a mental health clinic that focuses on providing services to children 5 - Lobbying the state regarding the revising of the reimbursement process for mental health services. The barriers to assessment and treatment of this population include lack of consensus and clarity about conditions for screening children; lack of coordination among multiple systems; lack of community-based resources and long waiting lists for services; lack of mental health providers; and cost and inadequate reimbursement. Identifying cultural groups at risk for mental illness would not be recognized as a barrier. Text Reference - p. 172

A nurse considers actions after a child throws a toy at another child. Sequence the following interventions in the order the nurse would apply them in response to the child's behavior, beginning with the first intervention (1) and progressing to the fourth intervention (4). 1. Place the child in physical restraints. 2. Place the child in a locked seclusion room. 3. Relocate the child to an unlocked sensory room. 4. Discuss the event and appropriate behaviors with the child.

1.Discuss the event and appropriate behaviors with the child. 2.Relocate the child to an unlocked sensory room. 3.Place the child in a locked seclusion room. 4.Place the child in physical restraints. Interventions should progress from the least to the most restrictive. First, the nurse should discuss the event and appropriate behaviors with the child. If that intervention is not effective, the child should be relocated to an unlocked sensory room where the child is encouraged to express freely and work through feelings in private and with staff support. This intervention also provides decreased stimulation for regaining and maintaining self-control. If that intervention is not effective, place the child in a locked seclusion room. If that intervention is not effective, lastly the child would be physically restrained. In general, seclusion is viewed as less restrictive than restraint, where all movement is constrained. Text Reference - pp. 177-178

A nurse counsels parents of a child diagnosed with moderate autism spectrum disorder (ASD). The parents say, "We are going to move our child to a different bedroom in our home. We think the change will be intellectually stimulating." Select the nurse's therapeutic response. 1 "Include bright colors and music for additional stimulation of your child." 2 "Children with autism spectrum disorder usually prefer for things to stay the same." 3 "Can you arrange for your other child to share a room with your special needs child?" 4 "Be sure to select a bedroom close to your bedroom so you can supervise your child adequately."

2 - "Children with autism spectrum disorder usually prefer for things to stay the same." The child with ASD usually has stereotypical behavior, interests, and activities along with overadherence to routines or rituals and fixations with particular objects. Changing the child's room will be disruptive. The nurse should offer other ideas for intellectually engaging the child but avoid overstimulation, which may result in agitation. Sharing a bedroom could be disruptive to other children in the family. Parents have an ongoing responsibility to supervise the child, regardless of where the child's bedroom is located. Text Reference - p. 183

The nurse is administering methylphenidate to a child. After medication administration, the nurse observes a disturbance in the child's regular sleep pattern. The nurse reports this to the primary health care provider. What instruction is the nurse most likely to receive from the primary health care provider? 1 "Administer lithium as prescribed." 2 "Reduce the dose of methylphenidate." 3 "Administer atomoxetine to the patient." 4 "Make the patient's room environment conducive for sleep."

2 - "Reduce the dose of methylphenidate." Insomnia is a common side effect observed in patients receiving methylphenidate. When the patient has insomnia, the dose of methylphenidate should be reduced. This drug should be administered no later than 4:00 PM because the extended-release formula of the drug causes disturbances in regular sleep pattern. Administering lithium, using physical restraints, or administering atomoxetine may not be helpful. Lithium is used as an antidepressant to control aggressive behavior. Making the room conducive for sleep will not help to curb insomnia caused by methylphenidate. Atomoxetine is a nonstimulant selective norepinephrine reuptake inhibitor used for gastrointestinal disorders related to attention-deficit/hyperactivity disorder. Text Reference - pp. 185-186

A study was conducted at a school to study mental development in children. The nurse reported that 70% of the study group is mentally healthy. Which characteristics could the nurse find in the mentally healthy children? Select all that apply. 1 Ability to trust no one 2 Ability to respond spontaneously 3 Ability to make accurate perception 4 Ability to have realistic self-concept 5 Ability to behave more maturely than their age

2 - Ability to respond spontaneously 3 - Ability to make accurate perception 4 - Ability to have realistic self-concept Mentally healthy children respond spontaneously and have the ability to express themselves in creative ways. They have the ability to make accurate perceptions and can interpret their surroundings. Healthy children have a positive, realistic self-concept and developing identity. The healthy child trusts others and can judge whether the surroundings are safe and supportive. The healthy child behaves appropriately according to age and does not violate social norms. Text Reference - p. 176, Box 11.2

A nurse is taking the clinical interview of a patient with autism spectrum disorder. Which assessment technique can the nurse follow to effectively diagnose the patient's condition? 1 Assess the level of depression in the patient. 2 Assess the developmental delays in the patient. 3 Assess the independent functioning in the patient. 4 Assess the level of frustration tolerance in the patient.

2 - Assess the developmental delays in the patient. Autism spectrum disorder (ASD) is characterized by developmental disabilities. It affects the normal development of the brain. It hinders social interaction and communication skills. Therefore, the nurse should check for the development delays in a patient with ASD. Frustration is usually seen in patients with attention-deficit/hyperactivity disorder. Patients with intellectual development disorder cannot perform daily activities independently without help. Patients with ASDs experience anxiety rather than depression. Text Reference - p. 182

A nurse develops a plan of care for a teenager newly admitted to a residential care program who is diagnosed with attention-deficit/ hyperactivity disorder. The teenager has poor judgment, high risk-taking behaviors, and impulsivity. Which intervention has the highest priority? 1 Develop and sign a "no self-harm" contract with the teenager. 2 Assign a staff member to one-to-one observation until the treatment team determines the teenager is no longer at risk for harm. 3 Schedule frequent discussions between the nurse and teenager to explore stressors, coping skills, and behavioral alternatives. 4 Implement locked seclusion until the teenager is able to identify examples of good judgment and control impulsive reactions.

2 - Assign a staff member to one-to-one observation until the treatment team determines the teenager is no longer at risk for harm. Safety is the priority. This teenager needs constant supervision until the team determines the risk for harm has dissipated. No-harm contracts have variable success and do not ensure supervision of this patient. It is important for the nurse to engage in dialogue with the teenager, but safety has a higher priority. Locked seclusion is inappropriate and presents additional risks for injury. Text Reference - p. 185, Box 11.3

Which characteristic supports that the patient is a mentally healthy adolescent? Select all that apply. 1 Proudly states, "I'm tall and strong and like playing sports." 2 Child names four "really good friends" when asked to do so. 3 Volunteers that, "I've only had one lesson but I really like horseback riding." 4 Reports that, "I don't like sharing a room with my little brother but I make do." 5 Shares, "If I make good grades, I'll be able to take advanced math in school."

2 - Child names four "really good friends" when asked to do so. 3 - Volunteers that, "I've only had one lesson but I really like horseback riding." 4 - Reports that, "I don't like sharing a room with my little brother but I make do." 5 - Shares, "If I make good grades, I'll be able to take advanced math in school." Characteristics of a mentally healthy adolescent include the following: develops and maintains satisfying relationships, can learn and master developmental tasks and new situations, adapts to and copes with anxiety and stress using age-appropriate behavior, and correctly interprets reality and makes accurate perceptions of the environment and one's ability to influence it through actions (e.g., self-determination). Comments that focus on physical traits are not as relevant to determining mental health. Text Reference - p. 176, Box 11.2

A 5-year-old who consistently omits the sound for "r" and "s" when speaking is demonstrating a 1 Language disorder 2 Communication disorder 3 Specific learning disorder 4 Social communication disorder

2 - Communication disorder Communication disorders are marked by problems in making sounds. Children may have trouble making certain sounds, saying "no" for snow or "wabbit" for rabbit; they may distort, add, or omit sounds. Text Reference - p. 179

Which intervention by the nurse helps to introduce ideas and work through issues with children? 1 Play therapy 2 Group therapy 3 Family therapy 4 Behavioral therapy

2 - Group therapy Group therapy is an intervention that introduces ideas to children and helps them work through their issues. Group therapy includes learning social skills and interacting with peers. Play therapy, family therapy, and behavioral therapy do not help introduce ideas or work through issues. Play therapy is a mode of communication for the assessment of the developmental and emotional status of those children with whom verbal interaction is not possible. Family therapy includes counseling the parents and siblings of a child and motivating all family members to participate in the child's caregiving process. Behavioral therapy includes motivating changes from maladaptive behaviors to desired behaviors. Text Reference - p. 178

An adjustment in the medication dosage prescribed for a child diagnosed with attention-deficit/hyperactivity disorder (ADHD) is appropriate when the child 1 Experiences a loss 2 Has a growth spurt 3 Engages in strenuous exercise 4 Is challenged to learn new cognitive material

2 - Has a growth spurt Medication adjustments may be required once the child has stabilized on a pharmacotherapy regimen; however, they tend to be infrequent and often are associated with the child's physical growth and development. Text Reference - p. 186

A nurse observed that during play therapy, a patient is unable to follow the rules of the game and has conflict with peers. Which of these drugs would you anticipate would be administered to the patient? 1 Naltrexone 2 Methylphenidate 3 Diphenhydramine 4 Botulinum toxin type A

2 - Methylphenidate A patient with attention-deficit/hyperactivity disorder does not follow rules in a game and has conflicts with peers. Methylphenidate is a physicostimulant drug used in attention-deficit/hyperactivity disorder. Botulinum toxin type A is given in Tourette syndrome to calm the muscles. Naltrexone is an opioid antagonist that is usually given in Tourette syndrome to block the euphoric responses. Diphenhydramine is an antihistaminic drug prescribed for allergies. Text Reference - pp. 185-186

An 8-year-old diagnosed with attention-deficient/hyperactivity disorder (ADHD) is prescribed an extended-release medication to help manage symptoms. The child attends after-school activities 4 days a week, causing the parents to be concerned about appropriate administration of the medication, especially because the child has stated, "I don't like swallowing pills." According to the following table regarding medications, which medication will best address their concerns? 1 Methylphenidate 2 Methylphenidate HCL 3 Dexmethylphenidate (Focalin XR) 4 Amphetamine/dextroamphetamine

2 - Methylphenidate HCL Methylphenidate HCL is an extended- or sustained-release form of medication for children ages 6 to 12 that can be administered by transdermal patch once daily. Amphetamine/dextroamphetamine, methylphenidate, and dexmethylphenidate are all administered in the oral form. Text Reference - p. 187, Table 11.2

The nurse is assessing a child with tic disorder. The child repeatedly bites his or her own forearm. What is the nursing diagnosis for this patient? 1 Stress overload 2 Risk for trauma 3 Ineffective coping 4 Activity intolerance

2 - Risk for trauma If a child repeatedly bites his or her own forearm, the nursing diagnosis for this abnormal behavior would likely be at risk for trauma. If a child demonstrates lack of cooperation with peers during play, then the most likely nursing diagnosis would be activity intolerance. If the child is extremely depressed, then the nursing diagnosis would be stress overload. If the child fails to follow age-appropriate social norms, then the nursing diagnosis would be ineffective coping. Text Reference - p. 181, Table 11.1

Which neurodevelopmental disorder is characterized by difficulty in written expressions? 1 Communication disorder 2 Specific learning disorder 3 Autism spectrum disorder 4 Intellectual developmental disorder

2 - Specific learning disorder Specific learning disorders are observed mostly in preschoolers and school-aged children. Patients with specific learning disorders may have conditions such as dysgraphia (difficulty writing). Disabilities such as dysgraphia are not associated with communication, autism spectrum, and intellectual developmental disorders. Communication disorders are characterized by difficulty with language and speech. Autism spectrum disorders are characterized by impaired memory status. Intellectual developmental disorders are characterized by difficulty with reasoning, problem solving, planning, and judgment. Text Reference - p. 180

A nurse counsels the parents of a child with autism spectrum disorder. The parents say, "We are going to completely redecorate our child's room. We think that will help." Select the nurse's best response. 1 "Bright colors are often stimulating for children with autistic disorder." 2 "Remember to not use rugs so that your child will not slip and fall." 3 "Children with autistic disorder usually prefer that things stay the same." 4 "New toys and games will help develop your child's intellectual abilities."

3 - "Children with autistic disorder usually prefer that things stay the same." Children with autism spectrum disorder are usually inflexible and preoccupied with orderliness and sameness. Redecorating the child's room is likely to upset the child. Text Reference - p. 182

When a child demonstrates a temperament that prompts the mother to say, "She is just so different from me; I just can't seem to connect with her," the nurse will 1 Suggest that the child's father become her primary caregiver 2 Encourage the mother to consider attending parenting classes 3 Counsel the mother regarding ways to better bond with her child 4 Educate the father regarding signs that the child is being physically abused

3 - Counsel the mother regarding ways to better bond with her child All people have temperaments, and the fit between the child and parent's temperament is critical to the child's development. The caregiver's role in shaping that relationship is of primary importance, and the nurse can intervene to teach parents ways to modify their behaviors to improve the interaction. Text Reference - p. 173

What are the familial risk factors associated with child psychiatric disorders? Select all that apply. 1 Nuclear family 2 Single-child family 3 Severe marital discord 4 Foster care placement 5 Low socioeconomic status

3 - Severe marital discord 4 - Foster care placement 5 - Low socioeconomic status The familial risk factors associated with child psychiatric illness include severe marital discord, low socioeconomic status, and foster care placement. Such children are more likely to develop psychiatric disorders because they have ineffective coping skills. Children belonging to a single-child family tend to be well looked after and thus are unlikely to develop psychiatric problems. A child belonging to a nuclear family would be given more attention compared with a child who belongs to a large family. Thus these children are less susceptible to developing psychiatric illnesses. Text Reference - p. 173

A 6-year-old boy without any other diagnosed problems has bitten his nails repetitively and engaged in body rocking for the past 2 months. There are no other diagnosed health problems. Which condition should the nurse predict? 1 Speech disorder 2 Autism spectrum disorder 3 Stereotypic movement disorder 4 Intellectual development disorder

3 - Stereotypic movement disorder Repetitive, purposeless movements (e.g., hand waving, rocking, head banging, nail biting, and teeth grinding) for 4 weeks or more occur in stereotypic movement disorder. This disorder is more common in boys. Speech disorders are characterized by problems making sounds or the child may distort, add, or omit sounds, such as stuttering. Autism spectrum disorder typically appears during a child's first 3 years of life. Intellectual development disorders are characterized by deficits in intellectual and social function, as well as deficits in managing age-appropriate activities of daily living, functioning at school or work, and performing self-care. Text Reference - p. 179

To confirm the diagnosis of attention-deficit/hyperactivity disorder (ADHD), a child's symptoms of hyperactivity, inattention, and impulsivity must meet which criteria? 1 They worsen in times of severe stress. 2 They are confirmed by supervised clinical observations. 3 They occur both at home and at school. 4 They are confirmed by a diagnostic testing tool.

3 - They occur both at home and at school. For ADHD to be diagnosed, the symptoms have to be present in two settings, such as home and school, with onset occurring before the age of 7 years. Worsening symptoms in times of severe stress and confirmation by supervised clinical observations and a diagnostic testing tool do not describe two settings. Text Reference - p. 193

A 10-year-old who is often disruptive in the classroom begins to fidget in the chair and then moves on to unruly behavior. A possible technique for managing this sort of disruptive behavior is 1 Seclusion 2 Quiet room 3 Touch control 4 Therapeutic holding

3 - Touch control The appropriate adult can move closer to the child and place a hand on the arm or an arm around the shoulder for a calming effect when the fidgeting first is noted. The closeness signals the child to use self-control. It is the least restrictive treatment approach and should be tried initially Text Reference - p. 185, Box 11.3

What does the nurse know is true about childhood trauma? 1 Boys are more commonly the victims of sexual abuse. 2 Sexual assault is the most common form of child abuse. 3 Witnessing violence can be a damaging form of childhood trauma. 4 Only doctors can report suspected abuse of a minor to child protective services (CPS).

3 - Witnessing violence can be a damaging form of childhood trauma. Witnessing violence can be a damaging form of childhood trauma, putting the child at risk for a number of mental health problems. Neglect is the most common form of child abuse. Girls are more often the victims of sexual abuse than are boys. Nurses are required to report suspected abuse of minors to CPS. Text Reference - p. 174

A parent tells the nurse, "I am worried about my child. When anxious, my child becomes aggressive and starts slapping himself." Which statement made by the nurse is appropriate about the child's condition? 1 "Your child may have a communication disorder." 2 "Your child may have a specific learning disorder." 3 "Your child may have intellectual development disorder." 4 "Your child may have attention-deficit/hyperactivity disorder."

4 - "Your child may have attention-deficit/hyperactivity disorder." Children with attention-deficit/hyperactivity disorder (ADHD) experience a peak level of impulsiveness and hyperactivity. Observation for disruptive behaviors such as anger, hyperaggressiveness, and harming others are the parameters for the detection of this disorder in patients. Such patients do not maintain peer relationships or participate in age-appropriate activities. A hyperaggressive nature is associated with self-harm or harming others and does not indicate a communication disorder, a specific learning disorder, or an intellectual development disorder. Communication disorders are characterized by difficulty in making and differentiating sounds. Specific learning disorders are characterized by dyslexia, dyscalculia, and dysgraphia. Intellectual development disorders are characterized by an inability in thinking, abstracting, and reasoning. Text Reference - p. 183

A preschool-age child has been referred for evaluation for symptoms that resemble attention-deficit/hyperactivity disorder (ADHD). The child has been acting impulsively at school and at home and having trouble with peers and staying on task. The nurse knows that there can be other disorders that the child may have. Which disorder is most commonly mistaken for ADHD? 1 Anxiety 2 Depression 3 Bipolar disorder 4 Conduct disorder

4 - Conduct disorder Conduct disorder has symptoms similar to ADHD, and even though it is a distinctly different diagnosis, it is often seen as a comorbid condition. Depression is not likely to be confused for ADHD, although it could develop as a result of poor peer interactions. This is also true of anxiety. Bipolar disorder is rarely diagnosed in children. Text Reference - p. 184

A nurse is caring for a patient with Tourette syndrome. Which possible symptom can the nurse find in the patient? 1 Inattentive behavior 2 Sleeping for long hours 3 Reduced listening skills 4 Frequent tongue protrusion

4 - Frequent tongue protrusion Tourette syndrome is associated with motor tics and verbal tics. The motor tics usually found in patients are tongue protrusion, touching, squatting, hopping, and so on. Sleeping for long hours is not a symptom of Tourette syndrome. Inattentive behavior is seen in patients with attention-deficit/hyperactivity disorder. Reduced listening skills is the symptom of autism spectrum disorder that affects communication. Text Reference - p. 179

A nurse has to prepare a treatment plan for a patient with reduced nonverbal communication and reduced social relatedness. Which appropriate strategy should the nurse include in the treatment plan? 1 Change the patient's schedule frequently. 2 Avoid structured activities with the patient. 3 Avoid nonverbal communication with the patient. 4 Give a star to the patient when he or she learns a new skill.

4 - Give a star to the patient when he or she learns a new skill. Autism spectrum disorder is characterized by reduced nonverbal communication and social relatedness. The treatment plan should aim for behavior management. The patient should be rewarded. A nurse can give a star or sticker to encourage when the patient learns a new activity. Consistency should be maintained in the daily routines of the patient. The patient's schedule should not be changed frequently as it can confuse the patient. The patient should be encouraged to improve nonverbal communication skills by providing speech therapy. The patient should also be involved in structured activities with the help of parents. These activities should have a definite process and not require frequent changes. Text Reference - p. 182

The nurse's concern about a 12-year-old living in a poor inner city neighborhood becoming involved in gang activity is based on the understanding that this age group 1 Is often the target of bullies and sexual predators 2 Is considered at high risk for drug and alcohol use and abuse 3 Lacks intellectual and social skills to select appropriate friends 4 Has limited decision-making skills and often looks up to older peers

4 - Has limited decision-making skills and often looks up to older peers The targeted age group for gang initiation seems to be 11 to 13, a time of particular developmental vulnerability. Decision-making capacities are not fully formed at this stage, and children in this age group may look up to older peers for status and belonging. Text Reference - p. 175

An elementary school-age child is impulsive and has a difficult time staying on task. This has begun to affect the child's schoolwork as well as his or her social relationships. When the child does play, it is not characteristic of the anticipated level of development. Which form of assessment would need to be made to explain the behaviors? 1 Family history 2 Medical history 3 Physical assessment 4 Mental status assessment

4 - Mental status assessment A mental status assessment includes areas such as manner of relating, thought processes and content, and characteristics of play. Physical assessment includes observable physical signs/symptoms. Family history may include the child's siblings, but in this scenario, the issue extends to friends as well. Medical history includes such things as allergies, review of systems, illness, and traumas. Text Reference - p. 176

Which communication disorder is the latest to be identified and accepted? 1 Fluency disorder 2 Receptive language disorder 3 Expressive language disorder 4 Social communication disorder

4 - Social communication disorder Social communication disorder was not identified until 2013. It was first considered on the autism spectrum. Receptive language disorders are characterized by the child's inability to understand language and follow directions. Expressive language disorder occurs when the child cannot form clear sentences and find the right words to convey their message. Fluency disorder is more commonly known as stuttering. Receptive language, expressive language, and fluency disorders were all established prior to social communication disorder. Text Reference - p. 179

A nurse taking care of an adolescent patient with appendicitis identifies that the patient is unable to eat and take a bath. What appropriate diagnosis can the nurse make about the patient's neurodevelopmental status? 1 The patient has reduced self-care. 2 The patient has situational low self-esteem. 3 The patient has impaired social interaction. 4 The patient has delayed growth and development.

4 - The patient has delayed growth and development. A patient with intellectual development disorder has reduced intellectual functioning, social functioning, and ability to perform daily life activities when compared with peers. The nurse can diagnose this condition by observing the patient's symptoms. Inability of the patient to feed and bathe himself indicates that the patient has delayed growth and development. A patient who lacks responsiveness or interest has an impaired social interaction. A patient who does not cooperate and play with peers has activity intolerance and situational low self-esteem. A patient who intentionally ignores body needs may have reduced self-care. Text Reference - p. 181, Table 11.1

A workshop was conducted by the American Psychiatric Nurses Association (APNA). The nurses explained different psychoanalytical therapeutic tools to the teachers to analyze a child's behavior. Which method followed by the teacher in the class shows effective learning? 1 The teacher should stop the child from playing. 2 The teacher should force the child to read a book. 3 The teacher should stop playing music in the class. 4 The teacher should encourage the child to theme draw.

4 - The teacher should encourage the child to theme draw. Drawing is a nonverbal means of expressing emotions. Children should be encouraged to draw themes that reflect their surroundings and mental condition. When reading a book, the child unconsciously identifies with the characters. It helps in cognitive development. A child should never be forced to read a book. Playing helps a child express the thoughts and emotions that the child cannot express verbally. Music can be helpful in treating psychological and physical disorders. Music helps to provide an insight into the child's emotions and thoughts, so the teacher should play music daily in the class. Text Reference - pp. 176, 177

Which drug is effective in treating attention-deficit/hyperactive patients within the age group of 6 to 65 years? 1 Atomoxetine 2 Methylphenidate 3 Dextroamphetamine 4 Lisdexamfetamine dimesylate

1 - Atomoxetine The pharmacologic approach for attention-deficit/hyperactivity disorder includes a wide range of drugs such as antidepressants, antipsychotics, and anticonvulsants. Atomoxetine is the drug used for treating the disorder in all patients aged 6 to 65 years. It is a nonstimulant selective norepinephrine reuptake inhibitor and prescribed for once-a-day use. Methylphenidate, dextroamphetamine, and lisdexamfetamine dimesylate are not used for all patients within the age group of 6 to 65 years. Methylphenidate and lisdexamfetamine dimesylate are used for patients of between the ages of 6 and 12 years. Dextroamphetamine is used for patients between the ages of 3 and 16 years. Text Reference - p. 186