J: Chapter 22- Neurodevelopmental Disorders
When assessing a child with encopresis, impairments will depend upon all of the following conditions except for what?
Intolerance to sedentary activity Explanation: Children with encopresis experience numerous impairments related to the elimination disorder. These impairments depend upon the limitations to the child's social activities, effects on self-esteem, degree of social ostracism by peers, anger, punishment and rejection reactions by the parents or caregivers. Intolerance of sedentary activity is commonly seen in children with attention deficit hyperactivity disorder and can impair functioning due to difficulty functioning in multiple life domains.
After teaching a group of nurses about assessing a child with autism spectrum disorders, the group leader determines that additional education is needed when the group identifies which as a critical assessment area in the psychosocial domain?
Self-care Explanation: Communication, behaviors, and flexibility are critical assessment areas in the psychosocial area. Self-care would be assessed with physical health.
When performing a spiritual assessment on a child, the nurse and child discuss church attendance and practices that are most important to the child. Which domain is the nurse addressing when doing this assessment?
Social Explanation: Spiritual assessment is an important part of a mental health assessment. It is part of the social domain. Growing research suggests that religious and spiritual practices may promote both physical and mental health.
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?
"Your child has trouble following the teacher's directions." Explanation: Children with ADHD tend to be have difficulty following directions in school and this leads to careless mistakes in their work. 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 nurse provides care to a school-age child whose sibling passed away after a motor vehicle accident. The child's parents ask what they should expect from their child because of the loss. Which response by the nurse is accurate?
"Your child may exhibit behavioral issues as a way of expressing grief." Explanation: School-age children understand the permanence of death more clearly than do younger children, but they may still struggle to articulate their feelings. Children in this age group may express their grief through somatic concerns, regression, behavior problems, withdrawal, and even anger toward their parents. The other statements reflect what is expected for an adolescent who experiences the loss of a sibling.
The nurse is assessing an adolescent client who was diagnosed with autism spectrum disorder as a child. On current assessment the nurse finds that the client's behavior has deteriorated. What may be the possible causes of this change? Select all that apply.
-Hormonal changes -Increased parental and peer pressure -Inability to perform well in school Explanation: Deterioration of autistic behavior during adolescence is due to hormonal changes and the difficulty in meeting excess social demands. Increased social demands may be due to pressure from peers and parents and to the inability to perform well in school and play. Persons with autism generally prefer solitude over social interaction. The need for more social interaction would not be a cause for deterioration in behavior. MMR vaccines are administered in childhood. Moreover, recent studies have found that autism is not related to MMR vaccinations.
Assessment of a child with autism spectrum disorder reveals stereotypic behavior. Which behavior would the nurse most likely document being demonstrated by the child? Select all that apply.
-Rocking -Hand flapping -Head banging Explanation: 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 describing intellectual disability to a group of parents, a nurse would identify which intelligent quotient (or less) as the usual threshold?
70 Explanation: The usual threshold for intellectual disability is an intelligence quotient of 70 or less (i.e., two standard deviations below the population mean).
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 the child during play. What are the likely reasons for the children feeling this way? Select all that apply.
-The child is not cooperative while playing. -The child constantly interrupts while playing. -The child doesn't follow the rules of the game. Explanation: 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 lack attention and are too hurried to listen to the rules of play. As a result, peers become frustrated because the child with ADHD does not follow the game rules. 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.
Which is an antidepressant used to treat attention deficit hyperactivity disorder (ADHD)?
Atomoxetine Explanation: Atomexetine is an antidepressant used for the treatment of ADHD. All of the other options are stimulants.
Which medication classification is used in the treatment of tic disorders?
Antipsychotics Explanation: Tic disorders are usually treated with risperidone or olanzapine.
A nurse is evaluating a child's attention span. Which finding indicates that the child's attention span is decreased?
Child is rocking in the chair continuously. Explanation: Indications of decreased attention span include hyperactivity, inability to stay focused during an interview/conversation, and inability to perform simple tasks. The ability to count backwards, read a book, and be engaged in a conversation indicates an adequate attention span.
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?
Conduct disorder Explanation: 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.
Which term describes the use of socially unacceptable words, which are frequently obscene?
Coprolalia Explanation: 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.
Nurses who work in a pediatric psychiatric-mental health facility should do what?
Develop self-awareness of issues that remind them of their own childhood and adolescence. Explanation: 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, health care, maturity, and balance in personal and professional lives maximize the energy available to work therapeutically with youth and their families.
The nurse working with pediatric clients knows the importance of checking for developmental delays, which not only slow the child's progress but also are often associated with what?
Development of poor self-esteem Explanation: Developmental delays not only slow a child's progress but also can interfere with the development of positive self-esteem.
The parents of a toddler are distraught that the toddler has been diagnosed with autism spectrum disorder. When providing care for the child and the parents, the nurse understands that autism spectrum disorder is thought to be caused by what?
Genetic factors Explanation: Approximately 70% of idiopathic autism spectrum disorder cases appear to be an inherited form of an affective disorder. Studies also suggest that autism spectrum disorder is caused by interactions of multiple genes. The disorder is not caused by immunizations. Neither impaired attachment nor perinatal hypoxia has been identified as an etiologic factor.
After teaching a group of nursing students about intellectual disability, the instructor determines that the teaching was successful when the students identify which as the most common etiology?
Genetic syndromes Explanation: Although exposure to toxins, perinatal complications, and environmental effects are associated with intellectual disability, the most common etiology is related to genetic syndromes.
A child is taking methylphenidate for treatment of attention deficit hyperactivity disorder (ADHD). Which side effect must be monitored in this child?
Growth delays Explanation: Nursing considerations when administering methylphenidate include monitoring appetite suppression or growth delays.
After educating a group of students on attention deficit hyperactivity disorder (ADHD), the instructor determines that additional education is required when the group identifies which as a typical characteristic?
Language difficulty Explanation: A persistent pattern of inattention, hyperactivity, and impulsiveness that interferes with functioning characterizes ADHD. Language difficulties are not associated with ADHD.
Which medication is effective in 70% to 80% of children with attention deficit hyperactivity disorder (ADHD)?
Methylphenidate Explanation: Methylphenidate, a common medication for treating ADHD, is effective in 70% to 80% of children who have ADHD. The other stimulants dextroamphetamine and pemoline, and the amphetamine compound Adderall are used to treat ADHD, but they are not as effective as methylphenidate.
The nurse is counseling a family whose child has autism. When describing this condition, which would the nurse most likely include?
Onset before child is 2.5 years old Explanation: Autism typically occurs before the age of 30 months. It is also marked by severe disturbances in social relatedness and occurs more often in boys than in girls.
A nurse is assessing a child with attention deficit hyperactivity disorder. Which assessment finding is the nurse likely to see in this child? Select all that apply.
Overactivity Impulsiveness Explanation: 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.
Which is a disturbance of the normal fluency and time patterning of speech?
Stuttering Explanation: 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 nursing student is aware that which accounts for more deaths, illnesses, and disabilities across the life span than any other preventable condition?
Substance abuse disorders Explanation: Substance abuse disorders across the life span account for more deaths, illnesses, and disabilities than any other preventable health condition.
The parents of a child with attention deficit hyperactivity disorder (ADHD) bring the child for a follow-up visit. During the visit, they tell the nurse that the child receives the first dose of methylphenidate at about 7:30 a.m. every morning before leaving for school. The teacher and school nurse have noticed a return in the child's overactivity and distractibility just before lunch. The child's second dose is scheduled for about 12 p.m. Which might the nurse suggest as a possible solution to control the child's symptoms a bit more effectively?
Switch to a longer-acting preparation. Explanation: Methylphenidate has a total duration of action of about 4 hours. Thus, parents or teachers often describe a return of overactivity and distractibility as the first dose of medication wears off. This "rebound effect" can often be managed by moving the second dose of the day slightly closer to the first dose. Longer-acting preparations of methylphenidate or amphetamine-dextroamphetamine do not require frequent dosing and may be a better fit with a school day schedule. Splitting the dose in half would affect the duration. Switching to another class of medication would be appropriate if the drug was ineffective in controlling the symptoms even with a change in the dosage schedule or after a switch to a longer acting preparation.
A 7-year-old client experiences tics, which have become increasingly frequent in recent months. How should the nurse educate the client's teacher to respond to the tics?
Teach the client's classmates that the tics are not something that the client can control. Explanation: Tics are largely involuntary, especially in younger children. Establishing a pattern of rewards or consequences would be ineffective and inappropriate. A calm environment may be of some benefit, but the priority would be teaching others that the client's behavior is not deliberate.
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.
The child avoids eye contact. The child does not relate to parents. The child becomes upset with minor changes in routine. Explanation: 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.
A nurse is working with a child undergoing behavioral modification therapy for attention deficit hyperactivity disorder (ADHD). The nurse finds that the child is thin. What could be the most likely reason for this observation?
The child cannot sit through meals. Explanation: 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. It is not known whether children with ADHD are genetically predisposed to being thin.
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?
The child continuously repeats socially unacceptable words. Explanation: Coprolalia is a complex vocal tic in which a child with tic disorder continuously repeats socially unacceptable, often obscene, words. Grunting and shrugging of the shoulders are common simple vocal and motor tics, respectively. Repeating the last heard phrase is a type of vocal tic known as echolalia.
The nurse expects the child with expressive language disorder is likely to present with which nursing assessment finding?
The child has difficulty forming complete sentences. Explanation: 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 the child would not have difficulty understanding the meaning of words and sentences.
A nurse is attempting to evaluate a child's insight and judgment. Which finding should be reported immediately to the health care provider?
The child states that it would be fun to crash a bicycle while riding. Explanation: Evaluation of insight and judgment refers to the ability of a client to state appropriate responses and reactions. The fact that the child thinks it would be fun to crash a bicycle while riding indicates a lack of concern for self and/or potentially danger to others. All of the other responses are appropriate.
The client is 6-year-old who has been diagnosed with autism spectrum disorder. Which symptom would the client display?
The client spends time alone with little interest in making friends. Explanation: Children with autism spectrum disorder develop language slowly or not at all. They may use words without attaching meaning to them or communicate with only gestures or noises. They spend time alone and show little interest in making friends. Autism spectrum disorder is not associated with over attachment, pulling out hair, or tics.
A nurse is developing the plan of care for a 6-year-old child diagnosed with attention deficit hyperactive disorder (ADHD). The nurse identifies interventions to address which behavior issues? Select all that apply.
Throws a temper tantrum when asked to clean up toys Does not acknowledge others' right to select group activities Frequently acts out during class "quiet time" Has a habit of not waiting for a turn Explanation: The care plan of a 6-year-old child diagnosed with ADHD includes interventions to help manage the client's temper tantrums and acting out, refusal to acknowledge others' right to select group activities, and habit of not waiting for their turn, and to prevent physically intrusive behavior while playing.
A psychiatric-mental health nurse is reviewing an article about genetics and the role in the development of a childhood psychiatric disorder. The nurse demonstrates understanding of this information by identifying which disorder as being genetically transmitted?
Tourette's syndrome Explanation: Many childhood psychiatric disorders, such as autism, intellectual disability, developmental learning disorders, some language disorders (e.g., dyslexia), attention deficit hyperactivity disorder (ADHD), and Tourette's syndrome, appear to be genetically transmitted. Research increasingly shows that major psychiatric disorders (e.g., depression, anxiety disorder, schizophrenia, bipolar disorder, substance abuse) run in families but are not necessarily identified as being genetically transmitted.
When a client repeatedly vocalizes an obscene phrase and imitates the motions of a staff member, the nurse documents that the client is most likely exhibiting symptoms of what disorder?
Tourette's syndrome Explanation: 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.
The nurse asks a child to have a seat on the examining table. The child responds to the nurse stating they cannot understand what the nurse is saying. The nurse has provided simple instructions to the child relative to having a seat on the examining table. What type of problem does the nurse identify?
receptive language Explanation: The fact that the child can respond to the nurse to make the statement that "they cannot understand what the nurse is saying" identifies an issue with receptive language. There is no specific information to suggest a problem with authority and/or a defense mechanism or that the dominant language is a second language because communication has been established.
A nurse is working with a pediatric client who appears shy but then warms up to the interaction and becomes engaged. How would the nurse best describe the client's temperament?
slow-to-warm-up and appropriate Explanation: A slow-to-warm-up temperament is characterized by a negative response that changes to a positive response over time. Temperaments are categorized as easy, difficult, and slow-to-warm-up. They can be construed as being positive or negative. There is no provided information relative to age and/or developmental delay, so the nurse cannot make that judgment.
A nurse is performing a health assessment for an adolescent who is undergoing counseling for psychological issues. Which part of the health assessment should the nurse identify as a priority?
spirituality Explanation: The inclusion of religion and spirituality has been identified by the Joint Commission as being a critical element of a psychiatric evaluation. The other parameters, although important, are not the priority assessment for this individual based on psychological counseling.
A child with attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate. The parent reports that the child is having trouble sleeping. When assessing this report, which question would be most appropriate for the nurse to ask?
"When does the child take the last dose of medication?" Explanation: A report of trouble sleeping is a side effect of psychostimulants. The nurse should gather additional information about the child's sleep pattern and the schedule of medication, such as when the child takes the last dose. The drug is rarely taken after 5 p.m. Crushing the sustained release preparation would affect absorption and effectiveness. The use of over-the-counter medications could accentuate the side effects of the stimulant, but this information would be important if the nurse determines that the drug schedule is appropriate. Asking about any other complaints, although helpful to determine the effects of the drug, does not address the parent's concern.
Approximately what percentage of children diagnosed with attention deficit hyperactivity disorder (ADHD) will continue to experience symptoms into adulthood?
60% Explanation: Previously, it was believed that children outgrew ADHD, but it is now known that ADHD can persist into adulthood. Estimates are that 60% of children with ADHD have symptoms that continue into adulthood.
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?
Imipramine Explanation: 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. Atomoxetine is an antidepressant drug used to treat attention deficit hyperactivity disorder; this drug is not prescribed for a child with enuresis. Dextroamphetamine is also an antidepressant drug used to treat hyperactivity, impulsivity, and mood lability in children with attention deficit hyperactivity disorder.
A child with attention deficit hyperactivity disorder (ADHD) has been prescribed dextroamphetamine. For what effects should the nurse tell the parents to monitor the child? Select all that apply.
Insomnia Weight loss Appetite suppression Explanation: Dextroamphetamine is a commonly prescribed drug to treat symptoms of ADHD. Insomnia, weight loss, and appetite suppression are the common side effects associated with this drug. The nurse should educate the parents on monitoring these effects. Hypotension and weight gain are not common side effects of this drug.
The nurse is developing a care plan for a client diagnosed with attention deficit hyperactivity disorder (ADHD). The nurse teaches the client to take the last dose of dextroamphetamine when?
Noon Explanation: Giving stimulants during daytime hours usually effectively combats insomnia, which is a side effect of stimulants.
A nurse observes a preschool-aged child refusing the efforts of the parents to provide comfort during a physical examination. The preschool-aged child displays aggressive behavior and begins to hit and flail. The parents just turn their back on the child, which only serves to make things worse. Based on this presentation, what is the best nursing response?
Provide a safe environment. Explanation: Based on the provided information, this may be a display of disruptive attachment manifesting as a reactive attachment disorder. However, there is insufficient information at this time for clinical diagnosis and best practice is to maintain a safe environment. There is no indication of child abuse. Asking the child to explain their behavior would not be warranted because it would only serve to escalate the situation. Referring the family and the child for counseling may be warranted, but it is not the priority at this time.
Which is the drug of choice for a tic disorder?
Risperidone Explanation: Risperidone is a drug of choice for tic disorders.
Which type of intervention may be helpful for children who are bullies?
Social skills training Explanation: Social skills training may be particularly helpful for children who are bullies or rejected by their peers.
A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The child is given medication and behavioral modification therapy to treat the condition. Which outcome achieved within 3 days would indicate successful therapy?
The child is able to complete assignments or tasks with assistance. Explanation: If within 3 days of starting treatment the child with ADHD is able to complete work or assignments with assistance, then this indicates successful therapy. Being able to express positive statements about himself or herself cannot be expected of the child after only 3 days of therapy. The child's ability to develop peer relationships would also not be demonstrated within this time. After 3 days of therapy, the children with ADHD would be able to demonstrate changes like being able to listen to others. They would not be able to interact with family members for a long period of time.
A nurse is caring for a child with attention deficit hyperactivity disorder. The nurse asks the child to draw pictures of the child and family members. What is the most likely rationale for this intervention?
To help the child self-express Explanation: 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. It is unlikely that the child will view sitting and drawing as a reward, therefore, using this intervention as a reward is not realistic.
Which child has the greatest risk for exhibiting bullying behaviors?
a school-age male who has divorced parents and a history of physical abuse Explanation: Children who have insecure attachments (e.g., divorced parents); who have distant or authoritarian parents; and who have been physically, sexually, or verbally abused are at risk for becoming bullies. In addition, males exhibit bullying behaviors more often than females. Based on this data, the child with the greatest risk for exhibiting bullying behavior has several risk factors, including male gender, parents who are divorced, and a history of physical abuse. The adolescent female has one risk factor for bullying behaviors, which is insecure attachment. The school-age male whose mother recently remarried has one risk factor: male gender. The adolescent female is likely the victim of bullying based on the clinical manifestations of low self-esteem and relationship difficulties.
A client tells the nurse that their significant other acts using non-supportive behavior, which is the same way that their parent, who also had a mental health issue, acted. How would the nurse best categorize this relationship?
assortative mating Explanation: Assortative mating is where one secures a relationship with someone who has similar characteristics to a family member who has a mental health trait/disorder. Genetic research has shown a vulnerability between nurture and nature whereby individuals look to maintain a consistent behavioral relationship. As the client indicates that there is non-supportive behavior, there is no way to assess that this is a realistic, potentially insignificant and/or mutually beneficial relationship.