Childhood and neurodevelopmental disorders EAQ
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). a - Place the child in physical restraints. b - Place the child in a locked seclusion room. c - Relocate the child to an unlocked sensory room. d - Discuss the event and appropriate behaviors with the child.
d, c, b, a 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.
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 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.
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
1 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.
The nurse is caring for a preschooler with a mental disorder. The nurse identifies that the preschooler refuses to attend school and feels isolated. What does the nurse report to the primary health care provider about this preschooler? 1 - "The child has ineffective coping skills." 2 - "The child has impaired verbal communication." 3 - "The child has delayed growth and development." 4 - "The child is at a risk of developing suicidal ideation."
1 Children with intellectual developmental disorders have decreased ability in social, conceptual, and practical functioning. Ineffective coping skills are a sign of intellectual development disorders. Preschoolers with ineffective coping abilities find difficulty with peer interaction and lack interest in attending school. These conditions do not indicate impaired verbal communication, delayed growth and development, or risk of suicidal ideation. Impaired verbal communication is characterized by repetitive usage of language. Delayed growth and development is characterized by an inability to perform activities such as feeding, bathing, and dressing. Risk of suicidal ideation is characterized by signs such as difficulty in concentration and depression.
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 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.
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 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.
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 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.
Which question directed to the parents would focus on the broad categories addressed during a mental health assessment of their school-aged child? (SATA) 1 - "What are your child's favorite toys and activities?" 2 - "Has your child ever intentionally hurt himself or others?" 3 - "How would you describe your child's level of physical activity?" 4 - "What does the teacher say about your child's behavior in school?" 5 - "Which parent does your child go to when he or she wants comforting?"
1, 2, 3, 4 Assessment of mental status of children includes the following broad categories: safety, general appearance, socialization, activity level, speech, coordination and motor function, affect, manner of relating, intellectual function, thought processes and content, and characteristics of play. Parental preference is not as relevant.
Multiple family therapy focuses on which goal? (SATA) 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, 2, 3, 4 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.
Which facts about autism spectrum disorders are true? (SATA) 1 - Early intervention is crucial. 2 - They are partly genetic in origin. 3 - They always include intellectual disability. 4 - Antipsychotics and antidepressants may be prescribed. 5 - They are positively correlated with routine vaccinations.
1, 2, 4 There is at least some level of genetic component to autism, as evidenced by twin studies. Early intervention is critical, as is the family's role in these interventions. Second-generation antipsychotics as well as selective serotonin reuptake inhibitors may be prescribed. There is no correlation between childhood vaccinations and autism. Intellectual disabilities in patients with autism occur in about half of the cases, not all.
What statement is true regarding children diagnosed with specific learning disorders? (SATA) 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, 2, 4, 5 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.
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? (SATA) 1 - Liver injury 2 - Weight gain 3 - Urinary retention 4 - Increased appetite 5 - Reduced blood pressure
1, 3 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.
A nurse is caring for a patient with specific learning disorders. Which behavioral aspects can the nurse find in the patient? (SATA) 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, 3 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.
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? (SATA) 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, 3, 5 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.
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? (SATA) 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, 3, 5 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.
The nurse is identifying students in a school who are susceptible to substance use and abuse later in life. The nurse is planning to give behavioral therapy to such students. Which student does the nurse include in the program? (SATA) 1 - A student who is extremely shy 2 - A student who is extremely playful 3 - A student who is extremely talkative 4 - A student who has aggressive behavior 5 - A student whose behavior is rebellious
1, 4, 5 Behavioral traits in children are powerful predictors of substance use and abuse in the future. Shyness, aggressive behavior, or a rebellious nature make a child susceptible to develop a habit of substance abuse in the future. Children who engage in maladaptive behavior tend to repress feelings and do not socialize with others much. It has been found that talkative children do not usually experience substance abuse in the future. Interest in play activities is a normal behavior seen in a child. The nurse cannot predict that this child is susceptible to future substance abuse.
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 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.
The nurse is assessing a child with a tic disorder with no history of brain injury. The child repeatedly bangs his or her head on the wall. Which advice given to the parents by the nurse is the highest priority? 1 - "You should consult a behavioral therapist." 2 - "You should make the child wear a helmet." 3 - "You should get a scan of your child's brain." 4 - "You should stop your child from banging his or her head."
2 A tic disorder is a motor disorder in which a child displays involuntary, repetitive, and purposeless movements. The child is at risk of sustaining a head injury from this behavior. Therefore, the parents should make the child wear a helmet so that head injury is prevented. Behavioral therapy would be helpful in decreasing the severity of the disorder, but the primary priority of the nurse in this situation should be the safety of the child. The child does not have a history of brain injury, so the nurse does not need to refer the child for a brain scan. Banging of the head is an involuntary movement. The child cannot stop the behavior intentionally. Telling the child to stop banging his or her head would be of no use; therefore, the nurse should not advise this to the parents.
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 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.
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 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.
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 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.
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 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.
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 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.
A preschool-aged child who had a difficult birth and delayed developmental milestones is being assessed for potential intellectual disability diagnosis. Which sign would support the diagnosis? 1 - Subdued emotions 2 - Deficits in reasoning 3 - Ability to think abstractly 4 - Heightened need for self-care rituals
2 Intellectual disability includes deficits in three areas: intellectual functioning, social functioning, and daily functioning. Deficits in reasoning are considered intellectual functioning deficits. Inability to think in the abstract is also an intellectual function. Social functions include the inability to regulate emotions. Decrease in self-care is an example of daily functioning.
An appropriate intervention of a 12-year-old child demonstrating faulty personality development associated with attention-deficit/hyperactivity disorder (ADHD) would include 1 - Regular entries into a personal sleep hygiene journal 2 - Enrollment in family and individual group therapies 3 - Involvement in family menu planning and food shopping 4 - After-school tutoring to help maintain passing grades
2 Interventions for patients with ADHD focus on correcting the faulty personality (ego and superego) development. Treatment may include hospitalization for those who present an imminent danger to self or others but is predominantly on an outpatient basis, using individual, group, and family therapy, with an emphasis on parenting issues.
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 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.
The parent of a child diagnosed with Tourette syndrome says to the nurse, "I think my child is faking the tics because they occur in different places at different times." Select the correct response by the nurse. 1 - "Children diagnosed with Tourette syndrome often try to manipulate their caregivers by faking tics." 2 - "The movements are real. Tics can occur anywhere in the body and can change in frequency and severity." 3 - "Distract your child by planning activities with other children. That will help the tics stop permanently." 4 - "This finding indicates a worsening of your child's disorder. Let's discuss this change with the health care provider."
2 Motor tics usually involve the head but can involve the torso or limbs. They change in location, frequency, and severity over time. The nurse should provide accurate information to the parent. The child may be embarrassed if tics occur in the community.
During an assessment, the nurse finds that a patient says "wabbit" for "rabbit" and omits most of the sounds. Which neurodevelopmental disorder is the patient likely to have? 1 - Learning disorder 2 - Communication disorder 3 - Intellectual development disorder 4 - Attention-deficit/hyperactivity disorder
2 Patients having communication disorder often have problems with making sounds. They tend to distort, add, or omit some sounds. They often lack fluency while speaking and may repeat the words because of stammering. In intellectual development disorder, patients have problems in intellectual functioning and are unable to reason and judge in age-appropriate activities. In learning disorder, patients have reduced reading and writing skills. They have difficulty in doing mathematics and expressing their emotions. Patients suffering from attention-deficit/hyperactivity disorder have reduced attention and are often impulsive and hyperactive.
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 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.
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 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.
The nurse is assessing a 5-year-old child. After completing the general assessment, the nurse reassesses the child using the Denver II developmental scale. What is the reason for the nurse to use this assessment tool? 1 - The child is susceptible to engaging in risk-taking behaviors. 2 - The child's behavior is inappropriate for their chronological age. 3 - The child is demonstrating abnormal behaviors related to stress. 4 - The child's physical disability is interfering with their functional abilities.
2 The Denver II developmental scale is an assessment tool for identifying the developmental strengths or deficits of a child in relation to his or her chronologic age. The nurse would have suspected that the child's behavior is inappropriate for the child's chronologic age and thus would have used this assessment tool to assess the deficit. This scale is not helpful in assessing whether a child is stressed. The Youth Risk Behavior Survey for children and adolescents is used for assessment of risky behaviors in children. The Denver II developmental scale is not used to determine to what extent the child's physical disability is interfering with his or her functional abilities.
A nurse is caring for a child with separation anxiety. The child does not interact with anybody and stays in one corner of the room. The nurse decides to give bibliotherapy to this child. What is the primary aim of the nurse to give this intervention? 1 - The child will be relaxed and peaceful. 2 - The child will be able to gain insight into feelings. 3 - The child will not exhibit self-destructive behaviors. 4 - The child will develop better communication skills.
2 The child has separation anxiety. Bibliotherapy is a therapy in which literature is used to help the child to develop insight into his or her feelings and emotions. The child is made to read or listen to a story. While doing this, the child unconsciously relates to the characters of the story and this helps the child to develop an insight into his or her own feelings and behavior. Identifying with the story would help the child to express feelings. This would indirectly relax the child but does not have a direct relaxing effect. The child does not interact with anybody and stays in one corner of the room. This does not indicate that the child has destructive behavior. Listening to or reading stories will not be helpful for the child to develop good communication skills unless done on a long-term basis.
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 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.
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? (SATA) 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, 3, 4 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.
Which characteristic supports that the patient is a mentally healthy adolescent? (SATA) 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, 3, 4, 5 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.
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? (SATA) 1 - Physical growth 2 - Social relationships 3 - Personal perception 4 - Activities of daily living 5 - Academic performance
2, 3, 4, 5 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.
A registered nurse has decided to seclude a child. Which measure should the registered nurse take care of to ensure the patient's safety? (SATA) 1 - Use a sturdy and flexible restraint. 2 - Monitor the patient's vital signs every 15 minutes. 3 - Do not inform the patient's family about the seclusion. 4 - Release the patient immediately once there is no danger. 5 - Encourage discussion about the patient's behavior among the staff.
2, 4, 5 Seclusion can be an effective treatment for patients who display aggressive behavior and have become a danger to themselves or others. Patients in seclusion should be released as soon as they become calm. Staff members may talk with the secluded patient when the patient becomes calm. Seclusion helps in evaluating the emotional responses that made the patient aggressive. A new care plan can be made to enhance the patient's care. Vital signs must be monitored every 15 minutes while the patient is in seclusion. The nurse should take care that the restraint is prompt, firm, and nonretaliatory. The restrainer should not cause injury to the patient or staff. The patient's family must be informed about the seclusion. The nurse should discuss with the patient's family how to help reduce the recurrence of behavior that necessitated the seclusion. A new treatment plan can be bought into action.
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 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.
The primary health care provider has administered a botulinum toxin type A injection to a child with tic disorder. How will this drug benefit the child? 1 - By reducing the intensity of tics 2 - By reducing the anxiety that can cause tics 3 - By relaxing the muscles associated with tics 4 - By reducing euphoric responses associated with tics
3 Botulinum toxin type A injections are used to relax the muscles associated with tics. Naltrexone is used to block euphoric responses associated with the behaviors of those with stereotypic movement disorder. Conventional antipsychotics like haloperidol are used for reducing the intensity of tic disorder. Clonazepam is used to reduce the anxiety and therefore the resultant tics.
A family who has recently immigrated from Bangladesh is discussing their child's development with the pediatrician. The physician suggests that the child may be depressed or anxious. The parents strongly disagree, saying "This does not happen with our people." What is most important for the nurse to consider? 1 - Recognize this is a form of denial on the part of the parents. 2 - Accept that Bangladeshi patients do not experience depression. 3 - Recognize culture may play a role in stigmatizing patients with these disorders. 4 - The healthcare team must consult the vast array of data about mental illness in the patient's home country.
3 Due to the lack of child and adolescent mental health services in Bangladesh and a tendency toward somatization, the parents' response is most likely a fear of stigma. It is a form of denial, but more specifically, this is due to the potential for stigma. Bangladeshi patients do experience depression and anxiety, but it is not well documented or addressed. There is a limited amount of data to consult.
A 3-year-old boy recently has been diagnosed with autism spectrum disorder. His mom is tearful and states, "The doctor said we need to start therapy right away. I just don't understand how helpful it will be—he's so young!" What is the nurse's response? 1 - "If you have questions, it's best to ask your health care provider." 2 - "If your child starts therapy now, he will be able to stop therapy sooner." 3 - "Starting him on treatment now gives your child a much greater chance for a productive life." 4 - "You are right, 3 years old is very young to start therapy, but it will make you feel better to be doing something."
3 Early intervention for children with autism can enhance greatly their potential for a full, productive life. Three years old is not too young to start therapy because the sooner therapy is started the better the outcome. The patient most likely will not be able to stop therapy because interventions will continue indefinitely. Telling the mother to ask her health care provider about questions abdicates the nurse's responsibility to provide education to patients and families.
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 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.
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 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.
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 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.
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 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.
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 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.
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 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.
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, 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.
When preparing to assess a 4-year-old child to help rule out a neurodevelopmental disorder, the nurse bases interventions on the understanding that 1 - Children of that age are very resilient 2 - Poor cooperation is typical at that age 3 - Language skills are limited at that age 4 - Age makes these children poor interviewees
3 Younger children are more difficult to diagnose than older children because of their limited language skills and cognitive and emotional development.
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, 4, 5 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.
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 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.
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 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.
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 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.
A child diagnosed with an autism spectrum disorder (ASD) will demonstrate impaired development in: 1 - Adhering to routines 2 - Eye-hand coordination 3 - Swallowing and chewing 4 - Playing with other children
4 Autism affects the normal development of the brain in social interaction and communication skills. Symptoms associated with autism spectrum disorders include significant deficits in social relatedness, including communication, nonverbal behavior, and age-appropriate interaction.
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 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.
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 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.
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 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.
The parents of a child with attention-deficit/hyperactivity disorder (ADHD) have become concerned that the child is entering high school, and they have heard that the adolescent's medication is often abused. Which medication is most likely to be diverted? 1 - Clonidine 2 - Guanfacine 3 - Atomoxetine 4 - Methylphenidate
4 Methylphenidate is a stimulant and is a schedule II medication, meaning it is highly susceptible to abuse and diversion. Atomoxetine is a nonstimulant and is not controlled. Clonidine and guanfacine are alpha-2 agonists and are also not controlled substances.
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 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
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 he data are most consistent with attention-deficit/hyperactivity disorder as described in the DSM-5.
