DSM5 Neurodevelopmental Disorders

A nurse is assessing a 7-year-old child in a school. The nurse suspects that the child has insecure relationship with the parents. Which statement said by the child would have led the nurse to this conclusion? a) "If I speak to you, my mother would hit me with a stick." b) "I love playing with friends." c) "My mom and dad do not play with me." d) "I love my dad and mom very much."

A An insecure attachment forms when a child has learned fear and helplessness because of intimidation, abuse, or excessive control by parents. The child fears of getting hit by his or her mother on speaking with the nurse. This indicates that the child has an insecure relationship with parents. The statement that the child loves playing with friends doesn't indicate anything about the relationship of the child with the parents. The statement that the client loves their patients suggests that the child has a secure relationship with the parents. The statement that the client's parents do not play with the client indicates that the child feels neglected by the parents.

A nurse is assessing a child with attention deficit hyperactivity disorder (ADHD). For every question asked by the nurse, the child answers, "I don't know." What is the most likely reason for the child to respond in this way? a) The child is not paying attention to the nurse's questions. b) The child does not like talking to the nurse. c) The child is not able to understand what the nurse is asking. d) The child is not willing to answer the nurse.

A Children with ADHD are unable to pay attention and cannot stop their minds from racing. This is the reason for the child with ADHD responding "I don't know" to every question the nurse asks. It is not likely that the child dislikes the nurse. Unlike children with disruptive behavior, children with ADHD are not intentionally unwilling to respond to questions. Children with ADHD do not lack cognition. If they were able to be attentive, they would be able to understand the nurse's question easily.

Samuel is a 6-year-old boy who has been diagnosed with autism. Which of the following symptoms would you expect Samuel to display? a) He spends time alone and shows little interest in making friends. b) He has an irresistible urge to pull out his own hair. c) He has multiple motor tics and several vocal tics. d) He becomes overly attached to those around him.

A Children with autism develop language slowly or not at all. They may use words without attaching meaning to them or communicate with only gestures or noises. They spend time alone and show little interest in making friends. Approximately 80% of people with autism also are classified as mentally retarded. Their most distinctive feature, however, is their seeming isolation from the world around them. This detachment and aloofness help distinguish people with autism from those who are solely mentally retarded.

The nurse is assessing a child with tic disorder. The nurse documents in the assessment sheet that the child exhibits coprolalia. What might be be interpreted from this? a) The child continuously repeats socially unacceptable words. b) The child repeatedly shrugs the shoulders. c) The child continuously repeats the last heard phrase. d) The child grunts repeatedly.

A Coprolalia is a complex vocal tic in which a child with tic disorder continuously repeats socially unacceptable, often obscene, words. Grunting and shrugging of the shoulders are common simple vocal and motor tics, respectively. Repeating the last heard phrase is a type of vocal tic known as echolalia.

Which of the following, according to the DSM-IV-TR is considered a hyperactive/impulsive behavior seen in ADHD? a) Inability to play quietly b) Making careless mistakes c) Frequent forgetfulness in daily activities d) Avoiding tasks requiring mental effort

A Inability to play quietly is a hyperactive/impulsive behavior seen in ADHD. Inattentive behaviors include avoiding tasks that require mental effort, making careless mistakes, and being forgetful in daily activities.

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

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

After teaching a group of nursing students about learning disorders, the instructor determines that additional teaching is needed when the group identifies which of the following as a reflecting a reading disability? a) Reading disability appears to be familial. b) Discrimination and interpretation of speech sounds is the underlying issue c) Reading disability has only recently been identified in the literature. d) Genetics and environment play a role.

A Reading disability, also called dyslexia, has been recognized for more than 100 years. The underlying problem appears to be a deficit in phonologic processing, which involves the discrimination and interpretation of speech sounds. Both genetic and environmental factors have been implicated in the etiology of reading disability. Data from family studies show that reading disability is familial and that shared environmental factors alone cannot explain the high rate of recurrence in affected families.

The nurse is assessing a child with autism spectrum disorder. After reading the medical history, the nurse finds that the child engages in stereotypical motor behavior. Which observation of the child made by the nurse might be indicative of stereotypical motor behavior? a) Flapping hands repeatedly b) Not being able to engage in play activities c) Using limited gestures to communicate d) Unusual reactions to sounds, smells, and other sensory experiences

A Stereotypical motor behavior refers to repetitive or ritualistic movement of a body part, such as repeated flapping of the hands. Using limited gestures while communicating, an inability to engage in play activities, and having unusual reactions to sounds, smells, and other sensory experiences are behaviors typically seen in children with autism spectrum disorder. These behaviors, howerver, cannot be referred to as stereotypical motor behaviors

A nurse is performing an assessment interview of a boy age 14 years who is being admitted to an adolescent substance abuse unit. His parents are concerned about their son's repeated problems at school that they associate with his drug use. The boy stalks into the office, abruptly sits down, crosses his arms, and says, "Okay, ask your stupid questions, but don't expect me to cooperate!" Which response by the nurse would be most appropriate? a) "You seem pretty upset. Tell me about what is upsetting you." b) "Your attitude is offensive; I can see why your parents brought you here." c) "Why don't we wait until you've calmed down a bit to start the interview?" d) "Why are you so angry?"

A The nurse's ability to communicate respect, cooperation, honesty, and genuineness is important. Rejection by the adolescent, even outright hostility, during the first few interactions is common, especially if the teen is having behavior problems at home, at school, or in the community. The nurse should be patient and avoid jumping to conclusions. Hostility or defiance may be a test of how much the teen can trust the nurse, a defense against anxiety, or a transference phenomenon. Thus, the nurse needs to address the adolescent's behavior and statement in a nonjudgmental, accepting manner. Telling the adolescent his attitude is offensive or waiting until he calms down is nontherapeutic. Asking the adolescent why he is so angry also is inappropriate. The underlying feelings need to be addressed in a therapeutic manner

Nurses who work in a pediatric psychiatric-mental health facility should do which of the following? a) Acknowledge and deal with issues that remind them of their own childhood and adolescence. b) Ensure that their own physical and mental health needs are placed above those of the clients. c) Ensure that their professional life is a higher priority than their personal life. d) Avoid addressing their own childhood issues and focus solely on the clients.

A To care for themselves, nurses need to recognize and discuss their job-related stressors. They should acknowledge and deal with issues that remind them of their own childhood and adolescence. Equally important, they need to attend to their own physical and mental health. Proper nutrition, rest and sleep, exercise, healthcare, maturity, and balance in personal and professional lives maximize the energy available to work therapeutically with youth and their families.

When a client repeatedly vocalizes an obscene phrase and imitates the motions of a staff member, the nurse documents that he is exhibiting symptoms of ... a) Tourette's syndrome b) Echolalia c) Tics d) Palilalia

A Tourette's syndrome, or Gilles de la Tourette's syndrome, is described as a combination of motor tics and involuntary vocal and verbal utterances that often are obscene (coprolalia); imitating someone else's movements (echokinesis) may be present. A tic, repeating one's own sounds, and repeating the last-heard sound, word, or phrase (echolalia) are symptom

When designing a behavior modification program for a child with ADHD, the nurse should plan to include which of the following techniques to address aggression? a) Negative consequences b) Refocusing c) Positive reinforcement d) Social skills training

A While parents use positive reinforcement to encourage desirable behavior, they can use negative consequences to reduce misbehavior. Consistency is a key factor in success. If the undesired behavior is only sometimes met with negative consequences, the child will continue with the behavior. Parents can use typical child discipline measures, such as forfeiting a planned activity, initiating time-out, or taking away television or computer time as the consequences

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

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

Which of the following statements reflects accurately the effects of childhood mental illness? a) Untreated mental illness in childhood often results in long-term mental illness in adults. b) Approximately 20% of children with conduct disorder become antisocial adults. c) A child with mental illness may have a difficult time in adulthood, but siblings without mental illness typically are unaffected. d) Children with depression frequently outgrow their mood disorder after the trials of adolescence and young adulthood are over.

A Childhood mental illness has staggering effects. Untreated mental illness in childhood often results in long-term mental illness in adults.

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

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

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

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

According to which of the following is an inattentive behavior seen in ADHD? a) Missing details b) Interrupting c) Talking excessively d) Fidgeting

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

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

A The most effective treatment for ADHD is Ritalin.

A nurse has been asked to identify children with attention deficit hyperactivity disorder (ADHD) in a school. Which children should the nurse identify as having ADHD? Select all that apply. a) A child who does not follow instructions in class b) A child who makes excessive noise by tapping the desk c) A child who is not able to dress him- or herself independently d) A child who verbally abuses other children in the class e) A child who has difficulty reading or writing

A, B Children with ADHD exhibit hyperactive behaviors, like making excessive noise by tapping the desk. They are extremely impatient and inattentive; they cannot wait and listen for instructions before starting to work. Unlike children with a learning disorder, children with ADHD do not have difficulty with reading and writing. Motor skill development is not impaired in children with ADHD; therefore, they are able to dress themselves independently. Abusing other children in the class is indicative of disruptive behavior. A child with ADHD may not have disruptive behavior

The nurse is assessing the practical skills of a child diagnosed with intellectual disability. Which of the following would the nurse assess? Select all that apply. a) Occupational skills b) Use of money c) Activities of daily living d) Ability to follow rules e) Self-esteem

A, B, C Practical skills include activities of daily living, occupational skills, health care, travel and transportation, schedules and routines, safety, use of money, use of telephone. Self-esteem and ability to follow rules are social skills.

The nurse is assessing a 7-year-old child whose achievement in math is below that expected for his age, formatl education, and intelligence. The nurse suspects he may be at risk for: Select all that apply. a) Low self-esteem. b) Poor social skills. c) No interest in play. d) Dropping out of school. e) Difficulty speaking in correct sentences.

A, B, D A learning disorder is diagnosed when a child's achievement in reading, mathematics, or written expression is below that expected for age, formal education, and intelligence. Children with a learning disorder are at risk for low self-esteem and poor social skills. School dropout rates for these children is 1.5 times higher than average. Having a learning disability would not interfere with a child's desire to play. Difficulty speaking in correct sentences is found in expressive lanuguage disorder, a communication disorder.

A nurse is assessing a 2-year-old child diagnosed with autism spectrum disorder. Which findings does the nurse expect to find on assessment? Select all that apply. a) The child avoids eye contact. b) The child does not relate to parents. c) The child is extremely playful. d) The child becomes upset with minor changes in routine. e) The child becomes frightened when left alone.

A, B, D Children with autism spectrum disorder tend to avoid eye contact with people. They do not identify or relate to their parents and remain detached. These children get upset with minor changes in routine. Children with autism spectrum disroder do not enjoy engaging in play or make-believe with toys. These children do not get frightened if left alone; in fact, they prefer being left alone.

Assessment of a child with autism spectrum disorder reveals stereotypic behavior. Which of the following would the child demonstrate? a) Hand flapping b) Rocking c) Pronoun reversal d) Word repetition e) Head banging

A, B, E Stereotypic behavior incudes self-stimulating, nonfunctional, repetitive behaviors such as rocking, hand flapping and head banging. Word repetition (echolalia) and pronoun reversal are communication difficulties

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

A, C, E Although learning disability and attention deficit hyperactivity disorder occur in children, major depressive disorder, schizophrenia, and bipolar disorder are the main causes of disability worldwide among young people ages 10 to 24 years of age

A nurse is preparing a treatment plan for a child with attention deficit hyperactivity disorder (ADHD). What should be the treatment goals for the child? Select all that apply. a) The child should remain free of injury. b) The child should be able to perform fine motor activities. c) The child should be able to complete tasks. d) The child should not exhibit any stereotypical behavior. e) The child should follow directions.

A, C, E Children with ADHD tend to act too fast and in the process of doing things fail to perceive harm or danger. Thus, it is very important for the nurse to make sure that the child is not injured. These children lack the patience to listen and follow directions. The therapy should help the child be able to listen to directions. Children with ADHD are always hurried and thus tend not to complete tasks. Therefore, the nursing intervention should enable the child to complete tasks. Children with ADHD do not have impairment of fine motor skills, so it is not necessary to teach those skills. These children do not exhibit any stereotypical behavior.

When providing care for children with psychiatric disorders, which of the following are the priorities for care? Select all that apply. a) Safety b) Emotional support c) Nutrition d) Ability to function e) Self-esteem

A, E All of the psychiatric disorders of childhood and adolescence should be viewed within the context of growth and development models. Safety and self-esteem are priority considerations

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

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

The child psychiatric assessment differs from that of adults in which of the following ways? a) Attention to feelings b) Attention to developmental milestones c) Attention to signs and symptoms d) Attention to the family history

B Attention to feelings, signs and symptoms, and family history is common to both age groups. Attention to developmental milestones and stages is prioritized in the child psychiatric assessment.

A nurse is speaking to the parents of a child with attention deficit hyperactivity disorder (ADHD). The parents ask the nurse about the reason for the child's underachievement in academics. What explanation given by the nurse is most appropriate? a) "Your child has difficulty with reading and writing." b) "Your child makes careless mistakes in schoolwork." c) "Your child has impaired cognitive abilities." d) "Your child does not attend classes."

B Children with ADHD tend to be very hurried and make careless mistakes in schoolwork. This can cause underachievement in academics. Unlike children with conduct disorder, the child with ADHD does not have the tendency to miss classes. Cognition is not impaired in children with ADHD. Unlike children with a learning disorder, the child with ADHD does not have difficulty with reading and writing.

The mother of an 8-year-old girl was concerned that her daughter may have mental retardation. The mother states that her daughter has difficulty communicating. Which of the following would confirm a diagnosis of mental retardation? a) The diagnosis can be made based on communication difficulties b) An intelligence quotient (IQ) of 70 or below c) If in addition to communication difficulties, her daughter also has vision problems d) An IQ of approximately 100 or above

B DSM-IV-TR diagnostic criteria for mental retardation include the following: an IQ of approximately 70 or below; concurrent deficits or impairments in present adaptive functioning in at least two of the following areas—communication, self-care, home living, and social/interpersonal skills; and onset before 18 years.

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

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

The nurse is caring for a 3½-year-old child with autism who has been hospitalized. The child rocks continuously without any danger present to the child's safety. Which intervention by the nurse would be most appropriate? a) Place the child in a "time out" area until the rocking stops. b) Ignore the child's rocking behavior. c) Hold the child until the child stops rocking. d) Continue to monitor the child's behaviors.

B Managing the repetitive behaviors depends on the specific behavior and its effect on others and the environment. Because the rocking has no negative effects, ignoring it may be the best approach. If the behavior is unacceptable, redirecting the child and using positive reinforcement are recommended

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

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

Which of the following is a disturbance of the normal fluency and time patterning of speech? a) Mixed receptive-expressive language disorder b) Stuttering c) Expressive language disorder d) Phonologic disorder

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

A 7-year-old boy being treated for depression will most likely be given which of the following first-line pharmacologic treatments? a) Tricyclic antidepressants b) Serotonin reuptake inhibitors c) Monoamine oxidase inhibitors d) Benzodiazepines

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

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

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

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

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

An adolescent is being observed for ADHD. Which of the following would demonstrate that she suffers from that disorder? a) Is withdrawn in social contexts but energetic and engaging with her family. b) Forgets to turn in her homework, does not follow directions, cannot stay in her assigned seat in class, and is always talking excessively and inappropriately. c) Is stubborn, resistant to directions, and unwilling to negotiate. d) Shows cruelty to animals, callousness, and lack of guilt and remorse.

B ADHD is characterized by distractibility, lack of concentration, and excessive activity.

A nurse is assessing a child's adaptive behavior. Which of the following would the nurse assess when evaluating the child's conceptual skills? a) Activities of daily living b) Language c) Social responsibility d) Self-esteem

B Adaptive behavior is composed of three skill types: conceptual skills (language and literacy, money, time, number concepts, and self-direction), social skills (interpersonal skills, social responsibility, self-esteem, gullibility, social problem solving, and the ability to follow rules and obey laws and to avoid being victimized), and practical skills (activities of daily living, occupational skills, health care, travel and transportation, schedules and routines, safety, use of money, use of telephone).

Which of the following educational techniques is helpful in the special education classroom? a) Self-directed learning b) High degree of structure c) Individual rather than group activities d) Flexible routine

B An essential classroom technique for those with psychiatric challenges is to provide a high degree of structure. Clear expectations and defined limits diminish the youths' anxiety.

After teaching a group of nurses about assessing a child with autism spectrum disorders, the instructor determines that additional education is needed when the group identifies which of the following as a critical assessment area in the psychosocial domain? a) Behaviors b) Self-care c) Flexibility d) Communication

B Communication, behaviors, and flexibility are critical assessment areas in the psychosocial domain. Self-care is an assessment area in the biologic domain.

A nurse is assessing a child who had an episode of passing feces in the classroom. The child has no other disabilities. The nurse concludes that the child had intentional encopresis. Which other condition is the child likely to have? a) Rett's disorder b) Conduct disorder c) Expressive language disorder d) Tourette's disorder

B Intentional passing of feces in inappropriate places like the classroom is referred to as intentional encopresis. This condition is mostly associated with conduct disorder or oppositional defiant disorder. The child does not show any impairment in normal functioning. Rett's disorder is a type of pervasive developmental disorder characterized by the development of multiple deficits over a period of normal functioning. In Tourette's disorder, the child engages in multiple motor and vocal stereotypical behaviors. In expressive language disorder, the child has difficulty communicating through verbal or sign language. Such behavior is not evident in the assessment.

John has become bored with his PlayStation, which had been his positive reward for cleaning his room. The most effective intervention with John at this time would be to a) tell John that he has to use the PlayStation anyway because it was expensive. b) let John choose another reward that would be more fun. c) tell John that he no longer has to clean his room in order to play. d) reinforce to John that he selected the PlayStation and he needs to stick with it.

B Positive rewards need to be viewed as desirable to motivate desired behavior changes.

After reviewing information about separation anxiety disorder, a group of nursing students demonstrates understanding when they identify the typical age of onset as which of the following? a) 2-4 years b) 7-9 years c) 4-6 years d) 10-11 years

B The prevalence of separation anxiety disorder is estimated at 2% to 8% of school-aged children, with an onset usually between 7 and 9 years of age.

A nurse is assessing a child with attention deficit hyperactivity disorder. Which assessment finding is the nurse likely to see in this child? Select all that apply. a) Stuttering b) Impulsiveness c) Overactivity d) Stereotypical movements e) Attentiveness

B, C Attention deficit hyperactivity disorder is characterized by behaviors like overactivity, impulsiveness, and inattentiveness. Stuttering is a language disorder; it is not associated with attention deficit hyperactivity disorder. The child has attention deficit. Unlike in tic disorder, stereotypical movements are not seen in children with attention deficit hyperactivity disorder.

A nurse is speaking to the peers of a child with attention deficit hyperactivity disorder (ADHD). The nurse finds that these children do not like the child and do not want to include him during play. What are the likely reasons for the children feeling this way? Select all that apply. a) The child doesn't understand the rules of the games. b) The child constantly interrupts while playing. c) The child is not cooperative while playing. d) The child abuses other children. e) The child cannot move or play as quickly as the other children.

B, C Children with ADHD are often disliked by their peers and are usually not involved in play activities. The reasons for peers responding this way are that children with ADHD do not cooperate while playing and tend to constantly interrupt others during play. Children with ADHD do not lack the ability to play and are not too slow. Unlike children with disruptive disorder, children with ADHD are not abusive. Children with ADHD do not lack understanding; they lack attention and are too hurried to listen to the rules of play.

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

B, D, E Dextroamphetamine (Dexedrine) is a commonly prescribed drug to treat symptoms of ADHD. Insomnia, weight loss and appetite suppression are the common side effects associated with this drug. The nurse should educate the parents on monitoring these effects. Hypotension and weight gain are not common side effects of this drug.

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

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

When teaching a child with ADHD and his parents about the prescribed psychostimulant therapy, the nurse integrates understanding that the drug enhances which of the following? Select all that apply. a) Epinephrine b) Dopamine c) GABA d) Serotonin e) Norepinephrine

B, E Psychostimulants enhance dopamine and norepinephrine activity and thereby improve attention and focus, increase inhibition of impulsive actions, and quiet the "noise" associated with distractibility and shifting attention.

The nurse expects the child with expressive language disorder is likely to present with which nursing assessment finding? a) The child is mute. b) The child stutters while speaking. c) The child has difficulty forming complete sentences. d) The child has difficulty understanding the meaning of words.

C The child with expressive language disorder may have difficulty communicating through verbal or sign language. The child does not have impaired ability to produce sound. The child may not stutter while speaking, but would not be able to organize words to make sentences while speaking. The child does not have receptive language disorder, thus would not have difficulty understanding the meaning of words and sentences.

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

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

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

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

Which of the following would the nurse expect to implement first for a child diagnosed with encopresis? a) High-fiber diet b) Mineral oil administration c) Bowel catharsis d) Bowel retraining

C Cleaning out the bowel is necessary before initiating behavioral treatment. The bowel catharsis is usually followed by administration of mineral oil, which is often continued during the bowel retraining program. A high-fiber diet is often recommended.

Which of the following terms describes the use of socially unacceptable words, which are frequently obscene? a) None of the above b) Echolalia c) Coprolalia d) Palilalia

C Coprolalia is the use of socially unacceptable words, which are frequently obscene. Palilalia is the repeating of one's own words or sounds. Echolalia is the repeating of the last heard sound, word, or phrase.

A nurse is caring for a child with enuresis. The child does not have any abnormalities associated with development or behavior. Which drug would the child be prescribed to treat the condition? a) Atomoxetine (Strattera) b) Dextroamphetamine(Dexedrine) c) Imipramine (Tofranil) d) Risperidone(Risperdal)

C Imipramine is an antidepressant drug with a side effect of urinary retention. This drug is commonly used to treat enuresis. The child has no abnormalities associate with behavior, thus the child will not be prescribed psychotropic drug like Risperidone (Risperdal). Atomoxetine (Strattera) is an antidepressant drug used to treat attention deficit hyperactivity disorder; this drug is not prescribed for a child with enuresis. Dextroamphetamine (Dexedrine) is also an antidepressant drug used to treat hyperactivity, impulsivity, and mood lability in children with attention deficit hyperactivity disorder.

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

C One in five to ten children and adolescents surveyed exhibited symptomology of attention deficit/hyperactivity disorder, which can sometimes be evidenced by an inability to sit still in school.

Profound mental retardation is diagnosed as being which of the following IQs? a) 20 to 35 b) 35 to 50 c) Less than 20 d) 50 to 70

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

Which of the following conditions is characterized by multiple motor tics and one or more vocal tics many times throughout the day for 1 year or more? a) Asperger's syndrome b) Trichotillomania c) Tourette syndrome d) Attention deficit hyperactivity disorder

C Tourette syndrome, the most severe tic disorder, is characterized by multiple motor tics and one or more vocal tics many times throughout the day for 1 year or more.

Which of the following is the drug of choice for Tourette's disorder? a) Risperidone (Risperdal) b) Fluoxetione (Prozac) c) Haloperidol (Haldol) d) Lithium carbonate (Lithobid)

C Haldol is the drug of choice for Tourette's disorder.

A child is taking methylphenidate (Ritalin) for treatment of ADHD. Which of the following side effects much be monitored in this child? a) Weight gain b) Increased appetite c) Growth delays d) Polyuria

C Nursing considerations when administering Ritalin include monitoring appetite suppression or growth delays.

Which of the following is an antidepressants used to treat ADHD? a) Dextreamphetamine (Dexedrine) b) Pemoline (Cylert) c) Atomexetine (Strattera) d) Amphetamine (Adderral)

C Strattera is an antidepressant used for the treatment of ADHD. All of the other options are stimulants.

When working with children, the major consideration for framing assessment and all nursing interventions is which of the following? a) Chronological age b) Relationships with peers c) Developmental level d) Personal likes and dislikes

C Whenever assessing children or adolescents, development level will frame the assessment and implementation of the management plan.

A nurse is assessing a child diagnosed with autism spectrum disorder. When assessing the child's communication, which of the following would the nurse expect to find? Select all that apply. a) Language appropriate for age b) Abstract interpretation of words c) Echolalia d) Pronoun reversals e) Normal intonation

C, D The impairment in communication is severe and affects both verbal and nonverbal communication. Children with autism spectrum disorder may manifest delayed and deviant language development, as evidenced by echolalia (repetition of words or phrases spoken by others) and a tendency to be extremely concrete in interpretation of language. Pronoun reversals and abnormal intonation are also common.

For which of the following youth problems is social skills training useful? Select all that apply. a) Noncompliance with medication regimen b) Lack of assertiveness c) Aggressive behavior d) Low self-esteem e) High risk for substance abuse

C, D, E Social skills training is useful with youth who have low self-esteem or aggressive behavior or who are at high risk for substance abuse. Assertiveness training would assist with the lack of assertiveness. Medication education would be beneficial for those who are not compliant with their medication regimen.

Assessment of a child with autism spectrum disorder reveals stereotypic behavior. Which of the following would the child demonstrate? a) Pronoun reversal b) Word repetition c) Hand flapping d) Head banging e) Rocking

C, D, E Stereotypic behavior incudes self-stimulating, nonfunctional, repetitive behaviors such as rocking, hand flapping and head banging. Word repetition (echolalia) and pronoun reversal are communication difficulties.

A nurse is teaching a child with ADHD and his parents about the prescribed atomoxetine. The nurse determines that the education was successful when they identify which of the following as an adverse effect of the drug? Select all that apply. a) Increased appetite b) Chest pain c) Vomiting d) Headache e) Somnolence

C, D, E Common adverse events related to atomoxetine include headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea.

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

D Although exposure to toxins, perinatal complications, and environmental effects are associated with intellectual disability, the most common etiology is related to genetic syndromes

A nurse is working with a child undergoing behavioral modification therapy for his attention deficit hyperactivity disorder (ADHD). The nurse finds that the child is thin. What could be the most likely reason for this observation? a) He finds food distasteful. b) He has decreased appetite. c) He is genetically predisposed to being thin. d) He cannot sit through meals.

D Children with ADHD are not patient enough to sit through meals. This results in reduced dietary intake. This is the most likely reason for children with ADHD to be thin. Children with ADHD do not have impaired taste sensation. These children do not have loss of appetite unless they are on drugs like methylphenidate (Ritalin). It is not known whether children with ADHD are genetically predisposed to being thin

A nurse is assessing an 8-year-old child. The child is unable to dress herself and is not able to manipulate toys, such as building blocks. The child stutters while talking. The child does not have impaired motor coordination. What is the most likely diagnosis of the child? a) Cerebral palsy b) Learning disorder c) Tic disorder d) Developmental coordination disorder

D Developmental coordination disorder is characterized by impaired coordination, which interferes with activities such as dressing and manipulating toys. A communication disorder, such as stuttering, often coexists with the condition. The child here does not show any stereotypical motor or vocal behavior, thus the child does not have tic disorder. An inability to read, write, and do math is not found in this child; thus the child does not have a learning disorder. Motor coordination is not impaired; this indicates that the child does not have a motor disorder, such as cerebral palsy or muscular dystrophy.

The parents of a 2-year-old child complain to the nurse that their child is always dismantling toys, scribbling on the walls, and running all around the place and that it is very difficult to control his behavior. What is the most appropriate response from the nurse? a) "I will refer your child to the psychology clinic." b) "Your child may develop violent behavior in the future." c) "Therapy will help to calm your child" d) "Your child is perfectly normal."

D Dismantling toys, scribbling on the walls, and running around the entire place are all normal behaviors for a child 2 years of age. The nurse should tell the parents to not to worry and that their child is perfectly normal. On the basis of these behaviors, the nurse cannot predict whether the child will have to be referred to a psychology clinic. The behaviors of the child are not abnormal; hence no therapy is needed for the child. Future violent behavior cannot be predicted from the child's present behavior.

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

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

Which of the following aspects of managing a child with ADHD is often overlooked in the treatment plan? a) Effects on school performance b) Effects on the marriage c) Effects on parents' coping styles d) Effects on siblings

D Family members of children with ADHD may experience disrupted routines and the strain of caretaking. The client may victimize siblings, who may feel unprotected because the parents are too emotionally overwhelmed to deal successfully with the situation.

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

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

A child is diagnosed with autism spectrum disorder and is experiencing aggression and irritability. Which medication would the nurse expect to be prescribed to address these issues? a) Mood stabilizers b) Antidepressants c) Anticonvulsants d) Atypical antipsychotics

D No medication has proved effective at changing the core social and language deficits of autism. However, there are numerous psychiatric medications such as atypical antipsychotics for aggression and irritability, and antidepressants to treat anxiety and compulsions. There is minimal evidence that anticonvulsants and traditional mood stabilizers are useful in managing mood lability and aggression.

A nurse is studying the brain images of children with attention deficit hyperactivity disorder (ADHD). In these images, the nurse would find abnormalities related to which area of the brain? a) Parietal lobe b) Temporal lobe c) Occipital lobe d) Frontal lobe

D Studies have proven that ADHD is associated with malfunction of the frontal lobe. Decreased metabolism and decreased perfusion to the frontal lobe are the physiological alterations known to cause ADHD. Dysfunction of the parietal lobe would cause abnormalities in sensory perception. Dysfunction of the occipital lobe would cause abnormalities in vision. Dysfunction of the temporal lobe would cause dysfunction in communication

When ADHD is present, the child will most likely exhibit which core symptoms? a) Overly friendly, able to follow directions, impulsive, and active b) Affective disturbances, autism, psychosis, and excessive talkativeness c) Quiet, impulsive, excessively attentive, and psychotic d) Highly distractible, excitable, impulsive, and excessively active

D The correct answer provides the four core symptoms associated with this disorder. Although talking excessively is an associated behavior, the other choices are not accurate. Although impulsivity and being excessively active are core symptoms, the other choices are not accurate.

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

D Tics are largely involuntary, especially in younger children. Establishing a pattern of rewards or consequences would be ineffective and inappropriate. A calm environment may be of some benefit, but the priority would be teaching others that the boy's behavior is not deliberate

A child diagnosed with Tourette's syndrome is to be started on pharmacologic therapy. Which of the following would the nurse most likely expect to be prescribed? a) Haloperidol b) Clonidine c) Pimozide d) Risperdone

D Two classes of drugs are commonly used in the treatment of tics: antipsychotics and alpha-adrenergic receptor agonists. The use of atypical antipsychotics such as risperidone and aripiprazole is replacing the use of older antipsychotics, haloperidsol and pimozide.The alpha2-adrenergic receptor agonist clonidine (Catapres) has been used in treating Tourette's disorder for more than 30 years. Guanfacine (Tenex) is a newer alpha2-adrenergic receptor agonist that has only recently been studied in children with Tourette's disorder. However, the level of improvement in tic symptoms is generally less than that observed with the antipsychotics

Which of the following is the most common disorder of childhood? a) Mental retardation b) Conduct disorder c) Autism d) ADHD

D ADHD, the most common disorder of childhood, results in poor academic performance, strained family relations, and rejection of peers.

A nurse is caring for a child with attention deficit hyperactivity disorder. The nurse asks the child to draw pictures of himself and of his family members. What is the rationale for this intervention? a) To release excessive energy b) To improve concentration in the child c) To reduce hyperactivity in the child d) To help the child express himself

D Creative play techniques such as having children draw pictures of themselves and of their family are useful for children who are unwilling to express themselves verbally. Children's excess energy can be released and hyperactivity reduced by engaging them in activities such as pounding pegs and running. Drawing may not help improve the child's concentration.

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

D Giving stimulants during daytime hours usually effectively combats insomnia, which is a side effect of stimulants.

Which of the following medications has been found to be effective as a treatment in autism? a) Naltrexone (ReVia) b) Clonidine (Catapres) c) Clomipramine (Anafranil) d) Haloperidol (Haldol)

D Haldol may be effective for specific target symptoms such as temper tantrums, aggressiveness, self-injury, hyperactivity, and stereotyped behaviors seen in autism.

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

D Insomnia, headache, and stomach upset are common side effects of methylphenidate.

The nurse is assessing a child diagnosed with expressive language disorder. During the assessment, the parents tell the nurse the child had normal speech development until around 3 years of age when the child was involved in a serious car accident. Which part of the body may be affected in the child? a) Vocal cords b) Tongue c) Auditory canal d) Brain

D The child had normal language development until being involved in a car accident at the age of 3. Expressive language disorder usually occurs from an injury to the brain.. Expressive language doesn't mean that the child has problems with articulation, which may occur if tongue movements are impaired. If the vocal cords are damaged, the child will not be able to produce sounds. This finding is not seen in children with expressive language disorder. The child does not have any problems with hearing but does have problems with expressing words and sentences. This condition is not associated with problems in hearing (dysfunction of the auditory canal.