MOD 8 PT

The nurse is caring for a child who is diagnosed with autism spectrum disorder (ASD). The child's parents ask the nurse, "What is the cause of ASD in our child?" Which response by the nurse is accurate? "ASD is most likely caused due a problem with the neurons in the frontal and temporal lobes of your child's brain." "ASD is caused by problems in the parietal and frontal lobes of your child's brain." "ASD is caused by trauma that happened at birth." "ASD is caused by arrested development of the brain in the uterus."

"ASD is most likely caused due a problem with the neurons in the frontal and temporal lobes of your child's brain." While the exact cause of ASD is unknown, it is thought to result from genetic abnormalities of the neurons in the frontal and temporal lobes. The construction of the brain is atypical in comparison to those without autism. MRIs and other imaging have shown there are abnormalities of neurons of the cerebral cortex. The frontal and temporal lobes are particularly susceptible to these abnormal neuron patches. The frontal lobe is responsible for social behaviors, motor function, problem solving, and other higher functions. The temporal lobe is responsible for language and sensory input. It is not caused by issues in the parietal lobe, by trauma at birth, or arrested development in utero.

A nurse in a pediatric clinic is caring for a preschool-age child who has a new diagnosis of ADHD. When teaching the guardian about this disorder, which of the following statements should the nurse include in the teaching? A) "Behaviors associated with ADHD are present prior to age 3." B) "This disorder is characterized by argumentativeness." C) "Below-average intellectual functioning is associated with ADHD." D) "Because of this disorder, your child is at an increased risk for injury."

"Because of this disorder, your child is at an increased risk for injury."

The nurse is discussing the need for early diagnosis and treatment of autism spectrum disorder (ASD) with parents of children suspected of having the condition. Which statement should the nurse include? "Early diagnosis and treatment gives your child the best chance of becoming a fully functioning adult." "Early diagnosis and treatment provides the only means for a cure of ASD." "Early diagnosis and treatment provides the best way to ensure that your child can be admitted to an assisted living facility as an adult." "Early diagnosis and treatment prevents your child from developing any other mental condition."

"Early diagnosis and treatment gives your child the best chance of becoming a fully functioning adult." Early diagnosis and treatment of ASD provides access to treatments and therapies that give patients the best chance to become fully functioning adults. Undiagnosed or untreated ASD decreases quality of life and the likelihood that comorbid conditions such as depression will be identified. ASD is a lifelong condition and is not "cured." Early detection and treatment does not prevent the development of any other mental condition but allows for the early diagnosis and treatment of depression or anxiety. It does not help the adult with ASD enter into an assistive living facility. Additional Learning

The nurse is discussing medications that are used in treatment of autism spectrum disorder (ASD) with a parent of a child who was recently diagnosed with the condition. Which statement by the parent indicates the need for further teaching? "I will give my child aspirin to help with the symptoms of ASD. "I will monitor my child closely with any new medications." "I will note if my child has any increase in negative behaviors from medication. "I will watch to see if my child has any suicidal thoughts."

"I will give my child aspirin to help with the symptoms of ASD. Antipyretic agents are used to decrease body temperature and would not be appropriate for use in the treatment of a patient diagnosed with ASD. Children with autism might not respond to medications as other children do. Some negative behaviors might increase with medications. Other medications may cause severe depression and suicidal thoughts. Children with autism should be monitored closely when starting new medications. Previous

The nurse is assessing a 2-year-old toddler who is diagnosed with autism spectrum disorder. Which comment by the mother should lead the nurse to question the diagnosis? "My child loves to play with others." "My child engages in mostly solitary activity." "My child does not enjoy cuddling." "My child does not respond to conversations in the room."

"My child loves to play with others." The fact that the toddler enjoys playing with others would not support a diagnosis of ASD, while preferring solitary activity would support an ASD diagnosis. Many, but not all, children with ASD would not like to play with siblings, enjoy cuddling, or respond to conversation in the room.

An adolescent client states, "My mother doesn't believe that I'm really in pain. She thinks it's all in my head, but I know I feel the pain." The child/adolescent psychiatric and mental health clinical nurse specialist responds: "Pain is real, whatever the cause. Many physical diseases are partially related to stress." "You never know what is real pain and what is psychological pain until you explore the source." "Your mother may be right. Let's try to figure out if that is the problem in your case." "Your mother thinks that I can help you; that is why you were sent to me."

"Pain is real, whatever the cause. Many physical diseases are partially related to stress."

A 9-year-old client with attention deficit hyperactivity disorder (ADHD) has been placed on the stimulant methylphenidate. The nurse knows that the teaching has been effective when the client's parents state what? A) "The client knows that the client only needs to take this medication once every 12 hours." B) "The client may have some side effects, like insomnia, loss of appetite, or weight loss, but they are rare." C) "The client will have an effect from this drug in about 2 weeks." D) "We'll bring the client in every week to get blood levels drawn."

"The client may have some side effects, like insomnia, loss of appetite, or weight loss, but they are rare."

The nurse is presenting to a group of parents whose children are suspected of having autism spectrum disorder (ASD). Which statement by the nurse should be included? "The features of autism are typically apparent by the time a child is 3 years of age." "You should notice deficits in your child by the age of 5." "A feature of ASD is the ability to understand nonverbal behavior." "A child with ASD should be able to successfully engage in imaginative play."

"The features of autism are typically apparent by the time a child is 3 years of age." The essential features of ASD (social deficits, language impairment, and repetitive behaviors) typically become apparent by the time a child is 3 years of age, not 5. The child with ASD is unable to read nonverbal behavior or engage in imaginative play.

The nurse is caring for a child who is diagnosed with autism spectrum disorder (ASD). The child's parents tell the nurse, "All tests were negative, so how did they diagnose our child with ASD?" Which response by the nurse is correct? "The presence of certain criteria outlined in the DSM-5 is the basis for your child's diagnosis." "Since all the tests are negative, ASD is the only answer left." "Your child's ASD was diagnosed by a special test that you were not aware of." "Your child has a positive electroencephalogram, which points to the presence of ASD."

"The presence of certain criteria outlined in the DSM-5 is the basis for your child's diagnosis." There is no diagnostic test or imaging that can diagnose autism. The presence of certain criteria, as outlined in the DSM-5, is the basis for diagnosis. The fact that all tests are negative does not necessarily point to ASD; certain criteria must also be present. A positive electroencephalogram (EEG) is used to rule out ASD.

The nurse is discussing nonpharmacologic interventions with the parents of a young child who was recently diagnosed with autism spectrum disorder (ASD). Which statement by the parents indicates that teaching was successful? "We are going to investigate applied behavior analysis as treatment." "I'm contacting my doctor to request starting chelation therapy." "I'm going to begin to give my child mineral solutions." "We will start encouraging echolalia in our child's speech."

"We are going to investigate applied behavior analysis as treatment." Applied behavior analysis is a form of behavior modification therapy that rewards the patient with ASD for positive behaviors like making eye contact or completing a sentence. Chelation therapy and mineral solutions are unproven and dangerous therapies. Echolalia is a compulsive parroting of a word or phrase that has just been spoken by another.

The nurse is teaching parents how to communicate with their child who is diagnosed with autism spectrum disorder (ASD). Which statement by the parents indicates that further teaching is necessary? "We will use more complete sentences in talking with our child." "We will use pictures in talking with our child." "We will take our child to speech and language therapy." "We will try using sign language with our child."

"We will use more complete sentences in talking with our child." Patients with ASD have difficulties communicating. To improve communication, parents should use short, direct sentences. Pictures or other visual aids or sign language may also be used to enhance communication. The patient should benefit from speech and language therapy.

The nurse is planning care for a young, nonverbal patient with autism spectrum disorder. In order to plan the best care for the child, which question is most important for the nurse to ask the child's parents? "What are some of your child's rituals that we can incorporate into daily care?" "How do you supervise your child to prevent infection?" "Which one method of communication is best to use with your child?" "How do you complete the activities for daily living for your child?"

"What are some of your child's rituals that we can incorporate into daily care?" An appropriate intervention for a patient with ASD is to incorporate the patient's rituals into daily care. The nurse would supervise the patient closely to enhance safety, not to prevent infection. The nurse would adapt communication style to meet the needs of the patient. The nurse would encourage the patient to participate fully in care. Therefore, the nurse would not complete all activities of daily living for the patient.

The nurse is conducting a teaching session for parents of children who have been diagnosed with autism spectrum disorder (ASD). A parent asks, "My child is high functioning. What should I expect of him as an adult?" Which response by the nurse is best? "Your child will most likely continue to struggle with communication skills." "Your child will comprehend nonverbal cues." "Your child will function normally with social interaction." Unselected "Your child will most likely function independently."

"Your child will most likely continue to struggle with communication skills." Even high-functioning adults with ASD continue to struggle with communication skills, especially understanding nonverbal communication and socialization. Many adults with ASD cannot function independently.

The parents of an autistic child ask the nurse, "Will my child ever be normal?" Which would be the most appropriate response by the nurse? A) B) C) D) A) "You seem worried about your child's future." B) "Autistic children can fully recover with the right treatment and education." C) "Your child should outgrow autistic traits by adolescence." D) "Your child will probably always have some autistic traits."

"Your child will probably always have some autistic traits."

A child diagnosed with severe mental retardation becomes aggressive with staff members when faced with the inability to complete simple tasks. Which nursing diagnosis would reflect this client's problem? 1. Ineffective coping R/T inability to deal with frustration. 2. Anxiety R/T feelings of powerlessness and threat to self-esteem. 3. Social isolation R/T unconventional social behavior. 4. Risk for injury R/T altered physical mobility.

1. A child diagnosed with severe mental retardation (IQ level 20 to 34) who strikes out at staff members when not being able to complete simple tasks is using aggres- sion to deal with frustration. Ineffective coping related to inability to deal with frustration is the appropriate nursing diagnosis for this child.

Which is a DSM-IV-TR criterion for the diagnosis of attention-deficit/hyperactivity disorder? 1. Inattention. 2. Recurrent and persistent thoughts. 3. Physical aggression. 4. Anxiety and panic attacks.

1. According to the DSM-IV-TR, inatten- tion, along with hyperactivity and impul- sivity, describes the essential criteria of ADHD. Children with this disorder are highly distractible and have extremely limited attention spans.

Which is a description of the etiology of autism from a genetic perspective? 1. Parents who have one child diagnosed with autism are at higher risk for having other children with the disorder. 2. Amygdala abnormality in the anterior portion of the temporal lobe is associated with the diagnosis of autism. 3. Decreased levels of serotonin have been found in individuals diagnosed with autism. 4. Congenital rubella is implicated in the predisposition to autistic disorders.

1. Research has revealed strong evidence that genetic factors may play a significant role in the etiology of autism. Studies show that parents who have one child with autism are at an increased risk for having more than one child with the dis- order. Also, monozygotic and dizygotic twin studies have provided evidence of genetic involvement.

A client diagnosed with oppositional defiant disorder has an outcome of learning new coping skills through behavior modification. Which client statement indicates that behavioral modification has occurred? 1. "I didn't hit Johnny. Can I have my Tootsie Roll?" 2. "I want to wear a helmet like Jane wears." 3. "Can I watch television after supper?" 4. "I want a puppy right now."

1. The question infers that the client defen- sively copes with frustration by lashing out and hitting people. New coping skills have been achieved through behavior modification when the client's states, "I didn't hit Johnny. Can I have my Tootsie Roll?" The intervention used to achieve this outcome is a reward system that rec- ognizes and appreciates appropriate behavior, modifying that which was previ- ously unacceptable.

A client diagnosed with moderate mental retardation suddenly refuses to participate in supervised hygiene care. Which short-term outcome would be appropriate for this individual? 1. The client will comply with supervised hygiene by day 3. 2. The client will be able to complete hygiene without supervision by day 3. 3. The client will be able to maintain anxiety at a manageable level by day 2. 4. The client will accept assistance with hygiene by day 2.

1. With appropriately implemented inter- ventions that direct the client back to previously supervised hygiene perform- ance, the short-term outcome of client compliance and participation by day 2 can be a reasonable expectation. To achieve this outcome, interventions might include exploring reasons for non- compliance; maintaining consistency of staff members; or providing the client with familiar objects, such as an old ver- sus new toothbrush.

A child diagnosed with an autistic disorder withdraws into self and, when spoken to, makes inappropriate nonverbal expressions. The nursing diagnosis impaired verbal communication is documented. Which intervention would address this problem? 1. Assist the child to recognize separateness during self-care activities. 2. Use a face-to-face and eye-to-eye approach when communicating. 3. Provide the child with a familiar toy or blanket to increase feelings of security. 4. Offer self to the child during times of increasing anxiety.

2. A child diagnosed with an autistic disorder has impairment in communication affect- ing verbal and nonverbal skills. Nonverbal communication, such as facial expression, eye contact, or gestures, is often absent or socially inappropriate. Eye-to-eye and face-to-face contact expresses genuine interest in, and respect for, the individual. Using an "en face" approach role-models correct nonverbal expressions.

Which is associated with the etiology of Tourette's disorder from a biochemical per- spective? 1. An inheritable component, as suggested by monozygotic and dizygotic twin studies. 2. Abnormal levels of several neurotransmitters. 3. Prenatal complications, including low birth weight. 4. Enlargement of the caudate nucleus of the brain.

2. Abnormalities in levels of dopamine, sero- tonin, dynorphin, gamma-aminobutyric acid, acetylcholine, and norepinephrine have been associated with Tourette's dis- order. This etiology is from a biochemical perspective.

A child diagnosed with oppositional defiant disorder begins yelling at staff members when asked to leave group therapy because of inappropriate language. Which nursing intervention would be appropriate? 1. Administer PRN medication to decrease acting-out behaviors. 2. Accompany the child to a quiet area to decrease external stimuli. 3. Institute seclusion following agency protocol. 4. Allow the child to stay in group therapy to monitor the situation further.

2. Accompanying the child to a quiet area to decrease external stimuli is the most ben- eficial action for this child. This action would aid in decreasing anger and hostility expressed by the child's outburst and inappropriate language. Later, the nurse may sit with the child and develop a system of rewards for compliance with therapy and consequences for noncompliance. This can be accomplished by starting with minimal expectations and increasing these expectations as the child begins to mani- fest evidence of control and compliance.

A child diagnosed with an autistic disorder has a nursing diagnosis of impaired social interaction. The child is currently making eye contact and allowing physical touch. Which of the following statements addresses the evaluation of this child's behavior? 1. The nurse is unable to evaluate this child's ability to interact socially based on the observed behaviors. 2. The child is experiencing improved social interaction as evidenced by making eye contact and allowing physical touch. 3. The nurse is unable to evaluate this child's ability to interact socially because the child has not experienced these behaviors for an extended period. 4. The child's making eye contact and allowing physical touch are indications of improved personal identity, not improved social interaction.

2. By making eye contact and allowing phys- ical touch, this child is experiencing improved social interaction, making this an accurate evaluative statement.

Which is a predisposing factor in the diagnosis of autism? 1. Having a sibling diagnosed with mental retardation. 2. Congenital rubella. 3. Dysfunctional family systems. 4. Inadequate ego development.

2. Children diagnosed with congenital rubella, postnatal neurological infections, phenylke- tonuria, or fragile X syndrome are predis- posed to being diagnosed with autism.

A client diagnosed with Tourette's disorder has a nursing diagnosis of social isolation. Which charting entry documents a successful outcome related to this client's problem? 1. "Compliant with instructions to use bathroom before bedtime." 2. "Made potholder at activity therapy session." 3. "Able to distinguish right hand from left hand." 4. "Able to focus on TV cartoons for 30 minutes."

2. During activity therapy, clients interact with peers and staff. This participation in a social activity reflects a successful out- come for the nursing diagnosis of social isolation.

A child admitted to an in-patient psychiatric unit is diagnosed with separation anxiety disorder. This child is continually refusing to go to bed at the designated time. Which nursing diagnosis best documents this child's problem? 1. Noncompliance with rules R/T low self-esteem. 2. Ineffective coping R/T hospitalization and absence of major attachment figure. 3. Powerlessness R/T confusion and disorientation. 4. Risk for injury R/T sleep deprivation.

2. Ineffective coping is defined as the inability to form a valid appraisal of the stressors, ineffective choices of practice responses, or inability to use available resources. A child diagnosed with separation anxiety often refuses to go to school or bed because of fears of separation from home or from individuals to whom the child is attached. The child in the question is refusing to go to bed as a way to cope with fear and anxiety. The nursing diagnosis of ineffective coping would be an appropriate documentation of this client's problem.

Which short-term outcome would be considered a priority for a hospitalized child diagnosed with a chronic autistic disorder who bites self when care is attempted? 1. The child will initiate social interactions with one caregiver by discharge. 2. The child will demonstrate trust in one caregiver by day 3. 3. The child will not inflict harm on self during the next 24-hour period. 4. The child will establish a means of communicating needs by discharge.

3. A child diagnosed with a chronic autistic disorder who bites self when care is attempted is at risk for injury R/T self- mutilation. Self-injurious behaviors, such as head banging and hand and arm biting, are used as a means to relieve tension. Considering that the nurse's primary responsibility is client safety, expecting the child to refrain from inflicting self-harm during a 24-hour period is the short-term outcome that should take priority.

Which charting entry would document an appropriate nursing intervention for a client diagnosed with profound mental retardation? 1. "Rewarded client with lollipop after independent completion of self-care." 2. "Encouraged client to tie own shoelaces." 3. "Kept client in line of sight continually during shift." 4. "Taught the client to sing the alphabet 'ABC' song."

3. A client diagnosed with profound mental retardation requires constant care and supervision. Keeping this client in line of sight continually during the shift is an appropriate intervention for a child with an IQ level 20.

When admitting a child diagnosed with a conduct disorder, which symptom would the nurse expect to assess? 1. Excessive distress about separation from home and family. 2. Repeated complaints of physical symptoms such as headaches and stomachaches. 3. History of cruelty toward people and animals. 4. Confabulation when confronted with wrongdoing.

3. A history of physical cruelty toward peo- ple and animals is commonly associated with conduct disorder. These children may bury animals alive and set fires intending to cause harm and damage.

A child diagnosed with a conduct disorder is disruptive and noncompliant with rules in the milieu. Which outcome, related to this client's problem, should the nurse expect the client to achieve? 1. The child will maintain anxiety at a reasonable level by day 2. 2. The child will interact with others in a socially appropriate manner by day 2. 3. The child will accept direction without becoming defensive by discharge. 4. The child will contract not to harm self during this shift.

3. Accepting direction without becoming defensive by discharge is a specific, meas- urable, positive, realistic, client-centered outcome for this child. The disruption and noncompliance with rules on the milieu is this child's defensive coping mechanism. Helping the child to see the correlation between this defensiveness and the child's low self-esteem, anger, and frustration would assist in meeting this outcome.

A child diagnosed with an autistic disorder makes no eye contact; is unresponsive to staff members; and continuously twists, spins, and head bangs. Which nursing diagnosis would take priority? 1. Personal identity disorder R/T poor ego differentiation. 2. Impaired verbal communication R/T withdrawal into self. 3. Risk for injury R/T head banging. 4. Impaired social interaction R/T delay in accomplishing developmental tasks.

3. Children diagnosed with an autistic disorder frequently head bang because of neurologi- cal alterations, increased anxiety, or catastrophic reactions to changes in the envi- ronment. Because the nurse is responsible for ensuring client safety, the nursing diag- nosis risk for injury takes priority.

A child diagnosed with mild to moderate mental retardation is admitted to the medical/ surgical floor for an appendectomy. The nurse observes that the child is having difficulty making desires known. Which nursing diagnosis reflects this client's problem? 1. Ineffective coping R/T developmental delay. 2. Anxiety R/T hospitalization and absence of familiar surroundings. 3. Impaired verbal communication R/T developmental alteration. 4. Impaired adjustment R/T recent admission to hospital.

3. Impaired verbal communication R/T developmental alteration is the appropri- ate nursing diagnosis for a child diagnosed with mild to moderate mental retardation who is having difficulties making needs and desires understood to staff members. Clients diagnosed with mild to moderate retardation often have deficits in commu- nication.

A child newly admitted to an in-patient psychiatric unit with a diagnosis of major depressive disorder has a nursing diagnosis of high risk for suicide R/T depressed mood. Which nursing intervention would be most appropriate at this time? 1. Encourage the child to participate in group therapy activities daily. 2. Engage in one-on-one interactions to assist in building a trusting relationship. 3. Monitor the child continuously while no longer than an arm's length away. 4. Maintain open lines of communication for expression of feelings.

3. Keeping a child who is at high risk for suicide safe from self-harm would take immediate priority over any other inter- vention. Monitoring the child continu- ously while no longer than an arm's length away would be an appropriate nursing intervention. This observation would allow the nurse to note self-harm behaviors and intervene immediately if necessary.

Which factors does Mahler attribute to the etiology of attention-deficit/hyperactivity disorder? 1. Genetic factors. 2. Psychodynamic factors. 3. Neurochemical factors. 4. Family dynamic factors.

3. Mahler's theory suggests that a child with ADHD has psychodynamic problems. Mahler describes these children as fixed in the symbiotic phase of development. They have not differentiated self from mother. Ego development is retarded, and impul- sive behavior, dictated by the id, is mani- fested.

A foster child diagnosed with oppositional defiant disorder is spiteful, vindictive, and argumentative, and has a history of aggression toward others. Which nursing diagno- sis would take priority? 1. Impaired social interaction R/T refusal to adhere to conventional social behavior. 2. Defensive coping R/T unsatisfactory child-parent relationship. 3. Risk for violence: directed at others R/T poor impulse control. 4. Noncompliance R/T a negativistic attitude.

3. Risk for violence: directed at others is defined as behaviors in which an individ- ual demonstrates that he or she can be physically, emotionally, or sexually harm- ful to others. Children diagnosed with ODD have a pattern of negativistic, spite- ful, and vindictive behaviors. The foster child described in the question also has a history of aggression toward others. Because maintaining safety is a critical responsibility of the nurse, risk for vio- lence: directed at others would be the priority nursing diagnosis.

A child diagnosed with severe mental retardation displays failure to thrive related to neglect and abuse. Which nursing diagnosis would best reflect this situation? 1. Altered role performance R/T failure to complete kindergarten. 2. Risk for injury: self-directed R/T poor self esteem. 3. Altered growth and development R/T inadequate environmental stimulation. 4. Anxiety R/T ineffective coping skills.

3. The nursing diagnosis of altered growth and development related to inadequate environmental stimulation would best address this child's problem of failure to thrive. Failure to thrive frequently results from neglect and abuse.

The nursing instructor is preparing to teach nursing students about oppositional defiant disorder (ODD). Which fact should be included in the lesson plan? 1. Prevalence of ODD is higher in girls than in boys. 2. The diagnosis of ODD occurs before the age of 3. 3. The diagnosis of ODD occurs no later than early adolescence. 4. The diagnosis of ODD is not a developmental antecedent to conduct disorder.

3. The symptoms of ODD usually appear no later than early adolescence. A child diag- nosed with ODD presents with a pattern of negativity, disobedience, and hostile behavior toward authority figures. This pattern of behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

Which short-term outcome would take priority for a client who is diagnosed with moderate mental retardation, and who resorts to self-mutilation during times of peer and staff conflict? 1. The client will form peer relationships by end of shift. 2. The client will demonstrate adaptive coping skills in response to conflicts. 3. The client will take direction without becoming defensive by discharge. 4. The client will experience no physical harm during this shift.

4. A child diagnosed with moderate mental retardation who resorts to self-mutilation during times of peer and staff conflict must be protected from self-harm. A real- istic, measurable outcome would be that the client would experience no physical harm during this shift.

A client has been diagnosed with an IQ level of 60. Which client social/communication capability would the nurse expect to observe? 1. The client has almost no speech development and no socialization skills. 2. The client may experience some limitation in speech and social convention. 3. The client may have minimal verbal skills, with acting-out behavior. 4. The client is capable of developing social and communication skills.

4. A client with mild mental retardation (IQ level 50 to 70) would be capable of developing social and communication skills. The client would function well in a struc- tured, sheltered setting.

Which developmental characteristic would be expected of an individual with an IQ level of 40? 1. Independent living with assistance during times of stress. 2. Academic skill to 6th grade level. 3. Little, if any, speech development. 4. Academic skill to 2nd grade level.

4. An IQ level of 40 is within the range of moderate mental retardation (IQ level 35 to 49). Academic skill to 2nd grade level would be a developmental characteristic expected of an individual in this IQ range.

The nurse on an in-patient pediatric psychiatric unit is admitting a client diagnosed with an autistic disorder. Which would the nurse expect to assess? 1. A strong connection with siblings. 2. An active imagination. 3. Abnormalities in physical appearance. 4. Absence of language.

4. One of the first characteristics that the nurse would note is the client's abnormal language patterning or total absence of language. Children diagnosed with autism display an uneven development of intellec- tual skills. Impairments are noted in verbal and nonverbal communication. These chil- dren cannot use or understand abstract language, and they may make unintelligible sounds or say the same word repeatedly.

A child diagnosed with autism spectrum disorder has the nursing diagnosis of disturbed personal identity. Which outcome would best address this clients diagnosis? A. The client will name own body parts as separate from others by day 5. B. The client will establish a means of communicating personal needs by discharge. C. The client will initiate social interactions with caregivers by day 4. D. The client will not harm self or others by discharge.

A

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

A

A nurse is providing teaching to an adolescent client who has a new prescription for clomipramine for OCD. Which of the following information should the nurse provide? A. Eat a diet high in fiber B. Check temp daily C. Take medication first thing in the morning before eating D. Add extra calories to the diet as between meal snacks

A

A nursing instructor presents a case study in which a 3-year-old child is in constant motion and is unable to sit still during story time. The instructor asks a student to evaluate this childs behavior. Which student response indicates an appropriate evaluation of the situation? A. This childs behavior must be evaluated according to developmental norms. B. This child has symptoms of attention deficit hyperactivity disorder. C. This child has symptoms of the early stages of autistic disorder. D. This childs behavior indicates possible symptoms of oppositional defiant disorder.

A

A parent is concerned that his child might suffer from attention deficit hyperactivity disorder (ADHD). Which of the following behaviors reported by the parent would be consistent with this diagnosis? A) The child interrupts others. B) The child has been hoarding objects. C) The child has lots of friends. D) The child is excelling academically in school.

A

After an adolescent diagnosed with attention deficit-hyperactivity disorder (ADHD) begins methylphenidate (Ritalin) therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. What is the best explanation for this weight loss? A. The pharmacological action of Ritalin causes a decrease in appetite. B. Hyperactivity seen in ADHD causes increased caloric expenditure. C. Side effects of Ritalin cause nausea; therefore, caloric intake is decreased. D. Increased ability to concentrate allows the client to focus on activities rather than food.

A

An adolescent client who was diagnosed with conduct disorder at the age of 8 is sentenced to juvenile detention after bringing a gun to school. How should the nurse apply knowledge of conduct disorder to this clients situation? A. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood. B. Childhood-onset conduct disorder is caused by a difficult temperament, and the child is likely to outgrow these behaviors by adulthood. C. Childhood-onset conduct disorder is diagnosed only when behaviors emerge before the age of 5, and therefore improvement is likely. D. Childhood-onset conduct disorder has no treatment or cure, and children diagnosed with this disorder are likely to develop progressive oppositional defiant disorder.

A

For which reason is it crucial for nurses to advocate for children and adolescents regarding psychiatric disorders? A) It is much more difficult to diagnose psychiatric disorders in children and adolescents. B) It is not necessary because psychiatric disorders do not occur in children and adolescents. C) Children and adolescents experience some of the same mental health problems as adults. D) Psychiatric disorders in children manifest themselves very quickly.

A

The mother of a 15-year-old boy tells the nurse that her son is becoming more assertive in conflict situations and wants to get a job. She asks if it is healthy for a 15-year-old to be so independent. Which is valid information for the nurse to offer the mother? A) his behaviors reflect normal growth and development B) he is overly independent C) it sounds like he's trying to avoid her D) she should observe for signs of substance abuse

A

The nurse is assisting a child with ADHD to complete his ADLs. Which is the best approach for nurse to use with this child? A) Break tasks into small steps. B) Let the child complete tasks at his own pace. C) Offer rewards when all tasks are completed. D) Set a time limit to complete all tasks.

A

When planning care for a client, which medication classification should a nurse recognize as effective in the treatment of Tourettes disorder? A. Antipsychotic medications B. Antimanic medications C. Tricyclic antidepressant medications D. Monoamine oxidase inhibitor medications

A

When teaching the parents of a child with attention deficit hyperactivity disorder (ADHD), which statement by the parents would indicate the need for further teaching? A) ìWe'll have him do his homework at the kitchen table with his brothers and sisters.î B) ìWe'll make sure he completes one task before going on to another.î C) ìWe'll set up rules with specific times for eating, sleeping, and playing.î D) ìWe'll use simple, clear directions and instructions.î

A

Which of the following disorders involves problems with forming sounds associated with speech? A) Phonologic disorder B) Mixed receptiveñexpressive language disorder C) Expressive language disorder D) Stuttering

A

A nurse is assessing a 2-year-old child in a pediatric facility. The parents tell the nurse that the child is aggressive and occasionally smacks older people at home. The child doesn't seem to listen to anyone. What is the most appropriate response of the nurse to the parents? a) "I realize that this behavior is quite challenging, but it is quite normal for a child this age." b) "We need to assess your child. He may require behavioral modification." c) "Your child will require some antidepressant medication." d) "You should punish the child for behaving like this."

A A certain level of disruptive behavior is expected in a 2-year-old child. Not listening to elders and hitting them occasionally is a normal behavior at this age. The nurse should tell the parents not to worry and that this behavior is normal. The nurse should never ask the parents to punish a young child. The child should not be prescribed any medications or therapy for such behaviors

A nurse is caring for a client with conduct disorder. The nurse needs to help the client understand the relationship between aberrant behavior and the consequences when the behavior is problematic. Which nursing intervention is most appropriate to help this client? a) Teach the client about limit setting and the need for limits. b) Teach appropriate conversation and social skills. c) Encourage the client to discuss his thoughts and feelings. d) Teach the client the problem-solving process.

A Clients with conduct disorder may have no knowledge of the concept of limits and how they can be beneficial. The nurse should teach about limit setting and the need for limits, to help clients understand the relationship between aberant behavior and the consequences when the behavior is problematic. The problem-solving process should be taught to clients, as they may not know how to solve problems constructively. Appropriate conversation and social skills should be taught to clients to assist them in socializing with others. Clients should be encouraged to discuss their thoughts and feelings, as this is the first step in dealing with clients with conduct disorder.

Which of the following childhood disorders is characterized by serious violations of social norms, such as destruction of property? a) Conduct disorder b) Oppositional defiant disorder (ODD) c) Obsessive-compulsive disorder (OCD) d) Attention deficit hyperactivity disorder (ADHD)

A Conduct disorder is characterized by serious violations of social norms, including aggressive behavior, destruction of property, and cruelty of animals. ODD is characterized by a persistent pattern of disobedience, argumentativeness, angry outbursts, low frustration tolerance, and tendency to blame others for misfortunes. OCD is characterized by intrusive thoughts that are difficult to dislodge (obsessions) or ritualized behaviors that the child feels driven to perform (compulsions). ADHD is a persistent pattern of inattention, hyperactivity, and impulsiveness that is pervasive and inappropriate for developmental level.

While interviewing a client with conduct disorder, the nurse asks the client about having friends in school. What is the most likely response of the client? a) "I don't want to interact or be friends with dumb and meek people in school." b) "I prefer doing useful productive work instead of making friends." c) "I am not a social person. It is difficult for me to make friends." d) "I am such an awful person. Who will be friends with me?"

A In clients with conduct disorder, good peer relationships are often not seen. These clients view their peers who follow rules as dumb or afraid. Clients with conduct disorders are not likely to get involved in 'productive' work such as studies. In this disorder, the client does not accept his negative qualities such as not being a social person. These clients have a low self esteem but they do not show this externally. Depressive, guilt laden behavior is not seen in this client.

Which of the following would be the most appropriate intervention for an adolescent who is manipulative and exhibiting aggressive behaviors? a) Limit setting b) Self-esteem enhancement c) Time out d) Social skills training

A Limit setting involves three steps: informing the client of the rule or limit, explaining the consequences if the client exceeds the limit, and stating the expected behavior.

A group of nursing students is reviewing information about disruptive behavior disorders. The students demonstrate understanding of the topic when they identify which of the following as an externalizing disorder? a) Conduct disorder b) Depression c) Anxiety d) Schizophrenia

A The disruptive behavior disorders, which include oppositional defiant disorder and conduct disorder, are a group of syndromes marked by significant problems of conduct. Because these disorders are characterized by "acting out" behaviors, they are sometimes referred to as externalizing disorders. In contrast, disorders of mood (e.g., anxiety, depression) are classified as internalizing disorders because the symptoms tend to be within the child. Schizophrenia is not characterized by acting out behaviors.

A nurse is caring for a client with conduct disorder. The nurse tells the client, "It is not appropriate for you to break things in this center every time you get angry. You should inform me when you get angry. If you break anything else in the facility, you will not be allowed to play video games for a week." What is the statement indicative of? a) The nurse is trying to teach limit setting. b) The nurse is trying to teach social skills. c) The nurse is trying to teach problem-solving skills. d) The nurse is trying to teach coping skills.

A The nurse tells the client that his behavior is inappropriate and that there will be consequences if the same behavior is continued. The nurse is trying to teach the client limit setting. This sentence does not indicate that the nurse is teaching social skills, problem solving, or coping strategies

A nurse is caring for a client with conduct disorder who injures people around him when he is angry. Which is the primary goal for intervention in this case? a) To ensure safety of others. b) To help the client develop good peer relationships. c) To reduce the aggression of the client. d) To help the client express his/her feelings.

A With a physically aggressive client, the nurse should first ensure the safety of others. Reducing the aggression of the client, helping the client express his feelings, and helping the client to develop good peer relationships are all goals of treatment. These outcomes are of a comparatively lesser priority than safety

An adolescent client with conduct disorder does not have extreme aggressive behavior and mood disturbances. What treatment is most effective for this client to eliminate this disorder? a) Individualized behavior therapy b) Family therapy c) Group therapy d) Medication

A Adolescents rely less on their parents than younger children do. So adolescents with conduct disorder would benefit most from individualized behavior therapy. These adolescents are usually not attached to their parents, thus family therapy is not useful for them. Group therapy will also not be beneficial for these clients, as they are uncomfortable socializing. The client here does not have extreme aggressive behavior and mood disturbances; therefore, the client need not be prescribed psychotropic drugs or mood stabilizers.

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

A Atomoxetine (Strattera), a noradrenergic reuptake inhibitor, is not classified as a stimulant and is effective in the treatment of ADHD. Bupropion is an antidepressant. Methylphenidate is a stimulant. Alpha agonists include guanfacine and clonidine.

A nurse is studying the medical records of a client with conduct disorder. The nurse finds that the client was prescribed carbamazepine (Tegretol). What would be the most likely reason for prescribing this drug for this client? a) The presence of a labile mood b) A tendency to injure others c) Risk of developing seizures d) Difficulty with decision-making skills

A Clients with conduct disorder who have a labile mood are prescribed medications such as carbamazepine (Tegretol) or valproic acid (Depakote). Carbamazepine is an antiseizure drug. Occurrence of seizures in clients with conduct disorder is less likely. For clients with conduct disorder who have a tendency to injure others, a psychotropic drug such as risperdone (Risperdol) may be prescribed. Behavioral therapy and psychotherapy are required to improve decision-making abilities

Which of the following children is most likely to be diagnosed with oppositional defiant disorder or conduct disorder? a) An 11-year-old boy who was caught breaking into a home to steal money b) A 14-year-old girl who admits to having had four different sex partners in the past several months c) A 13-year-old boy who experiences tics and has occasional outbursts of obscenities for no apparent reason d) A 6-year-old boy who finds school profoundly stressful due to his inability to relate to others

A Crime is a common manifestation of oppositional defiant disorder and conduct disorder. High-risk sexual behavior may accompany the disorders but is not diagnostic. Tics and verbal outbursts are characteristic of Tourette's syndrome. Difficulty in relating to others is characteristic of autism spectrum disorders.

A nurse is caring for a female adolescent with conduct disorder. The nurse tries to involve the client in discussions on age-related topics such as fashion, beauty tips, and movies. What is the nurse trying to accomplish by doing this? a) Help the client develop peer relationships. b) Teach the client to deal with problems. c) Teach about the relationship between behavior and its consequences. d) Encourage the client to verbalize feelings.

A Engaging clients with conduct disorder in conversation on age-related topics helps them practice how to interact as other adolescents do. This should help the client to develop peer relationships. This intervention is not useful for teaching clients to deal with problems, verbalize feelings, or understand the relationship between behavior and its consequences.

Which of the following treatment modalities is especially helpful for adolescents? a) Group therapy b) Family therapy c) Play therapy d) Individual therapy

A Group therapy is especially helpful for adolescents for whom the influence of peers is strong; adolescents are more likely to accept feedback and suggestions from their peers than from adults. Group therapy is less threatening than individual therapy and allows the adolescent to identify with others who have similar problems

The parents of a child with autism spectrum disorder (ASD) tell the nurse that they have decided to try nutrition therapy. Which diet should the nurse expect will be suggested for the child? A gluten-free, casein-free diet A low-fat, low-sodium diet The Paleo diet The Atkins diet

A gluten-free, casein-free diet A popular option for treating ASD is a gluten-free, casein-free diet. Since there is anecdotal evidence that the behavior of some children improves on this diet, many parents opt to try it with their children. A low-fat, low-sodium diet and the Paleo diet are used to treat heart disease. The Atkins diet is a reduced-carbohydrate diet.

A child with ADHD is being placed on the Restricted Elimination Diet. When teaching the mother about this diet, which of the following food choices would the nurse include? a) Water b) Beans c) Cheese d) Beef e) Gluten-free grains

A, B, E The Restricted Elimination Diet has been shown to improve behavior in some children and can be used as an instrument to determine whether ADHD behaviors are induced by food. In this diet, all-natural, chemical-free foods are eaten, and most of the foods that are regularly eaten are removed (Lomangino, 2011). Fruits, vegetables, nuts, nut butters, beans, seeds, gluten-free grains such as rice and quinoa, fish, lamb, wild game meats, organic turkey and large amounts of water are consumed

The director of psychiatric services asks a child/adolescent psychiatric and mental health clinical nurse specialist to define and coordinate the standard of nursing care for psychiatric patients in the emergency department. The clinical nurse specialist is serving in the role of a change: Agent. Investigator. Recipient. Strategist.

Agent.

While assessing a 5-year-old boy with autism spectrum disorder (ASD), the nurse notices that the boy is standing near his mother playing with a teddy bear and does not respond to the nurse's greeting. Which approach is most appropriate for the nurse to use? Allowing the patient to stay next to his mother with the teddy bear and speaking to him calmly and concisely Explaining that this is not at all unusual and that there is not much that can be done, because this is the normal progression of the disorder Engaging as little as possible with the patient, so as not to upset him more, and keeping to the task at hand Telling the mother that her son is too old to play with teddy bears

Allowing the patient to stay next to his mother with the teddy bear and speaking to him calmly and concisely It is best to allow the patient to stay near his mother and keep the teddy bear, which will help him accept the new environment and activities that will be taking place. Using the patient's name before saying hello will help him recognize that he is being spoken to. The other answers would not be helpful to the patient.

The nurse is teaching a new colleague about medications that are used to treat autism spectrum disorder (ASD). When the nurse asks the colleague to list the medications that may be used, which response indicates a need for further teaching? Antipyretic agents Stimulant agents Selective serotonin reuptake inhibitors (SSRIs) Mood stabilizers

Antipyretic agents Medications that are used in the treatment of ASD include stimulant agents, SSRIs, and mood stabilizers. Antipyretic agents are used to decrease body temperature and would not be appropriate for use in the treatment of a patient who is diagnosed with ASD.

Dysregulation of gamma-aminobutyric acid is associated with a diagnosis of: Anxiety disorder. Delirium. Huntington disease. Schizophrenia.

Anxiety disorder.

A child/adolescent psychiatric and mental health clinical nurse specialist conducts a community meeting for children and adolescent patients. Several adolescent patients complain about the intrusive behavior of the younger children. The clinical nurse specialist maintains the therapeutic milieu by: Asking both the adolescents and the younger patients to provide solutions. Giving the younger patients room restrictions. Reviewing with the group the rules and consequences of intrusive behaviors. Scheduling a meeting with the adolescent patients and nurse manager for later in the day.

Asking both the adolescents and the younger patients to provide solutions.

Two child/adolescent psychiatric and mental health clinical nurse specialists are conducting a continuing education class for nurses, psychiatric technicians, and aides who have varying levels of experience and education. The clinical nurse specialists begin the class by introducing themselves and relating their backgrounds and experience. The class is then asked to do the same and tell why they are there. This method reflects which principle of adult learning theory? Assessment of group dynamics Assessment of knowledge and learning needs of participants Establishment of group cohesiveness and rapport with participants Establishment of the clinical nurse specialists' role as experts

Assessment of knowledge and learning needs of participants

A child has been diagnosed with autism spectrum disorder. The distraught mother cries out, Im such a terrible mother. What did I do to cause this? Which nursing reply is most appropriate? A. Researchers really don't know what causes autistic disorder, but the relationship between autistic disorder and fetal alcohol syndrome is being explored. B. Poor parenting doesn't cause autism. Research has shown that abnormalities in brain structure and/or function are to blame. This is beyond your control. C. Research has shown that the mother appears to play a greater role in the development of this disorder than the father. D. Lack of early infant bonding with the mother has shown to be a cause of autistic disorder. Did you breastfeed or bottle-feed?

B

A child has been recently diagnosed with mild intellectual disability (ID). What information about this diagnosis should the nurse include when teaching the child's mother? A. Children with mild ID need constant supervision. B. Children with mild ID develop academic skills up to a sixth-grade level. C. Children with mild ID appear different from their peers. D. Children with mild ID have significant sensory-motor impairment.

B

A child with ADHD complains to his parents that he does not like the side effects of his medicine, Adderall. The parents ask the nurse for suggestions to reduce the medication's negative side effects. The nurse can best help the parents by offering which advice? A) Give the child his medicine at night. B) Have the child eat a good breakfast and snacks late in the day and at bedtime. C) Limit the number of calories the child eats each day. D) Let the child take daytime naps.

B

A client has an IQ of 47. Which nursing diagnosis best addresses a client problem associated with this degree of intellectual disability? A. Risk for injury R/T self-mutilation B. Altered social interaction R/T nonadherence to social convention C. Altered verbal communication R/T delusional thinking D. Social isolation R/T severely decreased gross motor skills

B

A nurse has taken report for the evening shift on an adolescent inpatient unit. Which client should the nurse address first? A. A client diagnosed with oppositional defiant disorder being sexually inappropriate with staff B. A client diagnosed with conduct disorder who is verbally abusing a peer in the milieu C. A client diagnosed with conduct disorder who is demanding special attention from staff D. A client diagnosed with attention deficit disorder who has a history of self-mutilation

B

A nurse is assessing a 4 year old child for indications of autism spectrum disorder. For which of the following manifestations should the nurse assess? A. Impulsive behavior B. Repetitive counting C. Destructiveness D. Somatic problems

B

A physician orders methylphenidate (Ritalin) for a child diagnosed with attention deficit-hyperactivity disorder (ADHD). Which information about this medication should the nurse provide to the parents? A. If one dose of Ritalin is missed, double the next dose. B. Administer Ritalin to the child after breakfast. C. Administer Ritalin to the child just prior to bedtime. D. A side effect of Ritalin is decreased ability to learn.

B

A preschool child is admitted to a psychiatric unit with a diagnosis of autism spectrum disorder. To help the child feel more secure on the unit, which intervention should a nurse include in this clients plan of care? A. Encourage and reward peer contact. B. Provide consistent caregivers. C. Provide a variety of safe daily activities. D. Maintain close physical contact throughout the day.

B

An 8-year-old with attention deficit hyperactivity disorder is jumping off the bed onto a chair. Which should be the nurse's first step? A) ìI need to talk to you.î B) ìStop that right now.î C) ìYou are going to hurt yourself.î D) ìWhy are you jumping off the bed?î

B

The mother of a 6-year-old boy with attention deficit hyperactivity disorder asks to speak to the nurse about her son's disruptive behavior. The nurse would be most therapeutic by saying which of the following? A) ìYour son is a cute child, but he needs to calm down.î B) ìIt must be difficult to handle your son at home.î C) ìYou need to take a firmer approach with your son.î D) ìYour son sure is active.î

B

The nurse understands that when working with a child with a mental health problem, the family must be included in the care. Which is one of the best ways the nurse can advocate for the child? A) Support transferring the child to a healthy living environment. B) Teach the parents age-appropriate expectations of the child. C) Reinforce the parents' expectations of the child's behavior. D) Interpret the child's thoughts and feelings to the parent.

B

Which behavioral approach should a nurse utilize when caring for children diagnosed with disruptive behavior disorders? A. Involving parents in designing and implementing the treatment process B. Reinforcing positive actions to encourage repetition of desired behaviors C. Providing opportunities to learn appropriate peer interactions D. Administering psychotropic medications to improve quality of life

B

Which finding would be most likely in a child diagnosed with separation anxiety disorder? A. The child has a history of antisocial behaviors. B. The childs mother is diagnosed with an anxiety disorder. C. The child previously had an extroverted temperament. D. The childs mother and father have an inconsistent parenting style.

B

Which nursing intervention related to self-care would be most appropriate for a teenager diagnosed with moderate intellectual disability? A. Meeting all of the clients self-care needs to avoid injury B. Providing simple directions and praising clients independent self-care efforts C. Avoiding interference with the clients self-care efforts in order to promote autonomy D. Encouraging family to meet the clients self-care needs to promote bonding

B

Which nursing intervention should be prioritized when caring for a child diagnosed with intellectual disability? A. Encourage the parents to always prioritize the needs of the child. B. Modify the childs environment to promote independence and encourage impulse control. C. Delay extensive diagnostic studies until the child is developmentally mature. D. Provide one-on-one tutorial education in a private setting to decrease overstimulation.

B

Which of the following terms describes the repeating of one's own words or sounds? A) Coprolalia B) Palilalia C) Echolalia D) None of the above

B

Which one of the following nursing interventions should take priority for a child with ADHD? A) Structured daily routine B) Ensuring the child's safety and that of others C) Simplifying instructions and directions D) Improved role performance

B

Which one of the following statements about educating parents of a child with ADHD is true? A) It is unimportant to educate the family members about ADHD as they already know the problem too well. B) Parents feel empowered and relieved to have specific strategies that can help them and their child be more successful. C) It is important for the nurse to spend the majority of his or her time with parents of children with ADHD in talking to the parents. D) If the child receives special school services under the Individuals with Disabilities Education Act, there is no need for further services.

B

A nurse is assessing a 9-year-old child diagnosed with conduct disorder. Which advice should the nurse give the child's parents regarding treatment of the disorder? a) "Your child requires individualized behavioral therapy." b) "Your child requires your support and motivation." c) "Your child needs to be incarcerated." d) "Your child should be sent to boot camp."

B Family therapy is most desirable to treat a 9 year old child with conduct disorder. Interventions like sending the child to boot camp or incarceration can worsen the symptoms in the child. Unlike adolescents, school-aged children with conduct disorder do not usually require individualized behavioral therapy.

The nurse uses the technique of timeout for a client with conduct disorder. Which problem demonstrated by the client would have led the nurse to use this technique? a) Unwillingness to talk to the nurse b) Threatening the nurse c) Unwillingness to build social relationships d) Refusing to perform a dialy chore

B Timeout is used to prevent aggression when the client's behavior starts to escalate, such as yelling or threatening someone. This technique helps the client with conduct disorder to gain control of emotions and outbursts. This technique may not be useful for helping the client interact with the nurse, to build better social relationships, or to perform daily chores.

A client is diagnosed with oppositional defiant disorder (ODD). Which assessment finding would indicate that the client needs medications? a) Extreme hostile behavior toward the parents b) Presence of comorbid psychiatric disorders c) Less than 3 years of age d) Use of abusive language by the client

B Clients with ODD are likely to have comorbid psychiatric symptoms related to conditions like attention deficit hyperactivity disorder (ADHD). Pharmacological therapy for these comorbid conditions can be helpful in reducing the severity of ODD symptoms. Children less than 3 years of age are expected to exhibit behavior similar to ODD, but this is considered normal and does not require any therapy. Use of abusive language and hostile behavior toward parents are signs consistent with ODD and do not require pharmacological therapy.

In clients with conduct disorder, reactivity of the autonomic nervous system is reduced. Which sign related to this physiological abnormality can be seen in clients with conduct disorder? a) Unemotional behavior b) Decreased social inhibitions c) Disturbed peer relationships d) Decreased interest in social activities

B In clients with conduct disorder, there is a lack ofreactivity of the autonomic nervous system, which results in decreased normal avoidance or social inhibitions. Decreased interest in social activities, disturbed peer relationships, and unemotional behavior may be secondary effects of such decreased levels of avoidance and social inhibition

A nurse is caring for a 10-year-old child with conduct disorder. The child starts throwing stones at the staff. What statement made by the nurse to control the child's behavior is most appropriate? a) "You are a hopeless child. Your behavior will make you a criminal one day." b) "You may injure people around you. If you feel angry, you could always come and talk to me or another nurse." c) "You should be ashamed of what you've done." d) "Are you out of your mind? You could hurt people."

B Through the statements "You may injure people around you. If you feel angry, you could always come and talk to me," the nurse is explaining the consequence of the child's behavior and suggesting a more socially acceptable intervention to deal with the anger. Telling the child that he is out of his mind and may hurt people conveys is judmental and will reinforce the client's self-image of a "bad person." Telling the child that he is hopeless and that he may become a criminal also would reinforce the child's low self-esteem. Telling the child to be ashamed of his behavior does not foucs on the specific behavior.

A child/adolescent psychiatric and mental health clinical nurse specialist counsels the parent of a preschool-aged child who has fetal alcohol syndrome. When asked how to manage the child's excitability, the clinical nurse specialist advises the parent to: Avoid games with repetition of ideas and behaviors. Begin and end each play activity with less action. Increase interactions with other children. Play soft music in the background during play activities.

Begin and end each play activity with less action.

The graduate nurse is caring for a family with a child who was recently diagnosed with autism spectrum disorder (ASD) and is discussing treatment options for the child. Which goal of collaborative therapy would require correction from the preceptor? Behavior modification through electroconvulsive therapy Advocating for parent support and coping groups Use of focusing techniques and behavior management Implementing treatments that decrease maladaptive behaviors such as rigidity and stereotypy

Behavior modification through electroconvulsive therapy The goals of therapy for a child with ASD and their family include advocating for parent support and coping groups, using focused techniques and behavior management, and implementing treatments that decrease maladaptive behaviors. While behavior modification may be a goal of treatment, electroconvulsive therapy is not a treatment option for children with ASD.

According to the Diagnostic and Statistical Manual of Mental Disorders, to diagnose attention-deficit hyperactivity disorder, a child/adolescent psychiatric and mental health clinical nurse specialist assesses a child's: Ability to listen when directly addressed. Ability to remain seated in a classroom. Behavioral functioning, both at home and at school. Intellectual functioning based on psychometric testing.

Behavioral functioning, both at home and at school.

The parents of a child who is diagnosed with autism spectrum disorder (ASD) tell the nurse that they wish to put their child on a gluten-free, casein-free diet. Which foods should the nurse instruct the parents to avoid feeding their child? Bread and milk Fish and fruit Red meat and green, leafy vegetables Rice and eggs

Bread and milk A gluten-free, casein-free diet eliminates the proteins found in wheat and dairy products. The child should avoid bread, milk, and cheese because they are made from grains or dairy. All other foods can be consumed.

A 6-year-old client is prescribed methylphenidate (Ritalin) for a diagnosis of attention deficit-hyperactivity disorder (ADHD). When teaching the parents about this medication, which nursing statement explains how Ritalin works? A. Ritalins sedation side effect assists children by decreasing their energy level. B. How Ritalin works is unknown. Although it is a stimulant, it does combat the symptoms of ADHD. C. Ritalin helps the child focus by decreasing the amount of dopamine in the basal ganglia and neuron synapse. D. Ritalin decreases hyperactivity by increasing serotonin levels.

C

A child diagnosed with attention deficit-hyperactivity disorder (ADHD) is having difficulty completing homework assignments. What information should the nurse include when teaching the parents about task performance improvement? A. The parents should isolate the child when completing homework to improve focus. B. The parents should withhold privileges if homework is not completed within a 2-hour period. C. The parents should divide the homework task into smaller steps and provide an activity break. D. The parents should administer an extra dose of methylphenidate (Ritalin) prior to homework.

C

A mother expresses concern to the nurse that the child's regularly scheduled vaccines may not be safe. The mother states that she has heard reports that they cause autism. The most appropriate response by the nurse is, A) ìIt is recommended that you wait until the child is older to vaccinate.î B) ìThere are safer alternative immunizations available now.î C) ìThere has been no research to establish a relationship between vaccines and autism.î D) ìThe risks do not outweigh the benefits of immunization against childhood diseases.î

C

A mother questions the decreased effectiveness of methylphenidate (Ritalin), prescribed for her childs attention deficit-hyperactivity disorder (ADHD). Which nursing reply best addresses the mothers concern? A. The physician will probably switch from Ritalin to a central nervous system stimulant. B. The physician may prescribe an antihistamine with the Ritalin to improve effectiveness. C. Your child has probably developed a tolerance to Ritalin and may need a higher dosage. D. Your child has developed sensitivity to Ritalin and may be exhibiting an allergy.

C

A preschool child diagnosed with autism spectrum disorder has been engaging in constant head-banging behavior. Which nursing intervention is appropriate? A. Place client in restraints until the aggression subsides. B. Sedate the client with neuroleptic medications. C. Hold clients head steady and apply a helmet. D. Distract the client with a variety of games and puzzles.

C

In planning care for a child diagnosed with autistic spectrum disorder, which would be a realistic client outcome? A. The client will communicate all needs verbally by discharge. B. The client will participate with peers in a team sport by day 4. C. The client will establish trust with at least one caregiver by day 5. D. The client will perform most self-care tasks independently.

C

The nurse has been working with the family of a small child with a psychiatric disorder. The nurse is feeling very frustrated because the parents refuse to implement effective parenting skills that the nurse has taught. What is the best action for the nurse at this time? A) Review effective disciplinary practices with the parents again. B) Refer the parents to a family therapist. C) Try to remember that the parents are trying to the best of their ability to carry out the suggestions. D) Explore alternative living arrangements for the child.

C

When the prognosis of improvement in a child with psychiatric disorders is poor, what can the nurse do to positively influence children and adolescents and their parents? A) Continue to remind the child and parents that the prognosis for improvement is very poor. B) Encourage the parents to believe that the child will recover spontaneously. C) Assist the child and the parents to develop coping mechanisms. D) Focus on their problems instead of their strengths and assets.

C

Which should be the priority nursing intervention when caring for a child diagnosed with conduct disorder? A. Modify the environment to decrease stimulation and provide opportunities for quiet reflection. B. Convey unconditional acceptance and positive regard. C. Recognize escalating aggressive behaviors and intervene before violence occurs. D. Provide immediate positive feedback for appropriate behaviors.

C

After teaching a group of nursing students about the diagnostic criteria for attention deficit hyperactivity disorder, the instructor determines a need for additional education when the students identify which of the following as a criterion? a) Hyperactivity b) Impulsivity c) Distractibility d) Inattention

C A persistent pattern of inattention, hyperactivity, and impulsiveness that interferes with functioning characterizes ADHD. Distractibility is a component associated with inattention

A child is suspected of having obsessive-compulsive disorder. Which of the following would be the first step in assessing the child? a) The severity of the family's response to the child's behavior b) The amount of interference the rituals have on the child's functioning c) Distinguishing between normal childhood rituals and worries and those that are pathologic d) The frequency of which the child engages in the compulsions

C Although frequency, amount of interference and severity of the family's response would be important, the first step in the assessment of OCD in children is to distinguish between normal childhood rituals and worries, and pathologic rituals and obsessional thoughts

Children with conduct disorder may be diagnosed with which of the following disorders as adults? a) Schizophrenia b) Depression c) Antisocial personality disorder d) Bipolar disorder

C As many as 30% to 50% of children diagnosed with conduct disorder are diagnosed with antisocial personality disorder as adults.

A 13-year-old child is constantly involved in breaking tables and chairs at school. On further assessment, the nurse finds that the child has conduct disorder. Which condition is the child most likely to develop in the future if not treated properly for this condition? a) Schizophrenia b) Depression c) Antisocial personality disorder d) Anxiety disorder

C As many as 30% to 50% of children diagnosed with conduct disorder are later diagnosed with antisocial personality disorder as adults. Proper treatment could prevent the onset of antisocial personality disorder in this client. Depression, schizophrenia, and anxiety are not known to be consequences of conduct disorder

A 15-year-old client with intermittent explosive disorder gives no history of childhood abuse, neglect, or maltreatment. What could be the cause of the disorder in this client? a) Presence of coronary artery disease b) Dysfunction of the parietal lobe c) Imbalance in the production of serotonin d) Depleted levels of glucose in the blood

C Childhood abuse, neglect, or maltreatment is often the cause of intermittent explosive disorder (IED). As the client does not have a history of any of these, the client likely has the disorder because of other factors. Other etiologic factors include imbalance in the production of serotonin and dysfunction of the frontal lobe. Parietal lobe dysfunction and depleted blood glucose levels are not associated with IED. Presence of coronary artery disease is not a known etiologic factor in IED but is strongly correlated with the disease.

The nurse is teaching the parents of a child with conduct disorder about methods to deal with their child's detention from school for breaking science equipment. What advice should the nurse give the parents to deal with the situation? a) "You should punish your child so that he never repeats the same mistake at school." b) "You should be supportive of your child as she might be very depressed after receiving detention." c) "You should be supportive of the school for taking this step regarding your child's inappropriate behavior." d) "You should file a case against the school for punishing your child so severely."

C The nurse should explain to the parents that the child has received detention for behaving inappropriately in school and that they should support the school for this instead of blaming it. Using severe punishment is not a recommended treatment strategy for conduct disorder. The child with conduct disorder is unlikely to be depressed or guilty for receiving detention from school.

Which of the following would be an appropriate intervention for a child diagnosed with conduct disorder? a) Avoid limiting setting to decrease confrontation b) Allow the child increased control over situations c) Have the child accept responsibility for his own behavior d) Allow self-monitoring of the child's own behavior

C The child diagnosed with conduct disorder needs to accept responsibility for his or her own actions. The nurse must protect others from the manipulative or aggressive behaviors with these clients.

The nurse is assessing a child who is suspected of having Tourette's disorder. The nurse is reviewing the child's history, keeping in mind that for the diagnosis to be made, the tics must be present for at least which time frame? a) 1 month b) 6 months c) 1 year d) 2 years

C Tourette's disorder, the most severe tic disorder, is defined by multiple motor and phonic tics for at least one year.

A nurse is providing care to a child with Tourette's disorder. Which of the following medications would the nurse expect to be prescribed as treatment? a) Haloperidol b) Pimozide c) Aripiprazole d) Clonidine

C Although, haloperidol, pimozide and clonidine may be prescribed, the use of atypical antipsychotics such as risperidone and aripiprazole is replacing the use of older antipsychotics, haloperidol and pimozide. The level of improvement with clonidine is generally less than that with the antipsychotics

The nurse is assessing an adolescent with conduct disorder. The nurse finds that the adolescent is not interested in seeking summer employment. What is the most likely reason for the client's disinterest in getting a job? a) The client feels that his depression and anxiety would interfere with working. b) The client feels that he is too disturbed to work. c) The client prefers stealing money over working for it. d) The client feels that he will not be efficient in the workplace.

C The adolescent with conduct disorder is most likely to steal money for survival instead of earning it through employment. Feeling too disturbed to be able to work and feeling that he would be inefficient at work are not behaviors related to clients with conduct disorder. Depression and anxiety are not present in clients with conduct disorder.

A nurse is counseling the parents of a 5-year-old child with oppositional defiant disorder (ODD). What type of management does the nurse suggest to help the parents deal with the disorder? a) The child can be managed if given proper psychotherapy. b) The child can be managed if given psychotropic drugs. c) The child can be managed if the parents modify their own behavior. d) The child can be managed if admitted to a juvenile home.

C Treatment of oppositional defiant disorder (ODD) is based on parent management training models of behavioral interventions. It requires that the parents modify their behavior in such a way that they ignore maladaptive behavior and reward positive behavior. ODD need not be treated with psychotherapy or psychotropic drugs or by admittance to a juvenile home. These may be required if the client has developed a more severe form of the condition, such as conduct disorder.

he nurse is reviewing the medical record of a​ 6-year-old client diagnosed with autism spectrum disorder​ (ASD). Which item in the health history should the nurse consider may have been a factor in the client developing​ ASD? A. Appropriate adaptation to new environments B. Postterm birth C. Fetal alcohol syndrome D. Childhood vaccinations

C. Fetal alcohol syndrome Rationale: The ingestion of​ alcohol, tobacco, and toxic substances has been known to cause birth defects.​ Therefore, fetal alcohol syndrome could possibly be a factor in the development of ASD. Childhood vaccinations have not been proven to cause ASD. Appropriate adaptation to new environments and postterm birth have no link to ASD.

The nurse is developing a plan of care for a client diagnosed with autism spectrum disorder​ (ASD). Which nursing diagnosis is most appropriate for the nurse to​ include? A. ​Macrocephaly, Risk for B. ​Infection, Risk for C. ​Communication: Verbal, Impaired D. Airway​ Clearance, Ineffective

C. ​Communication: Verbal, Impaired ​Rationale: ​Communication: Verbal, Impaired is an appropriate nursing diagnosis for a client with ASD. ​Macrocephaly, Risk for is not a nursing diagnosis. The client with ASD is not at risk for infection or ineffective airway clearance.​ (NANDA-I ©2014)

After climbing on the trees that surround a six-year-old female child's home, the child reports that the "angry trees" made her fall. This animistic thinking is: A coping mechanism to allay the child's guilt feelings. An abnormal thought process for a child of this age. Characteristic of preoperational thought. Indicative of childhood schizophrenia.

Characteristic of preoperational thought.

The parent or legal guardian of a seven-year-old child must approve any medication orders, because a child of this age fails to meet which two of the four elements of informed consent? Autonomy and veracity. Competence and comprehension. Confidentiality and beneficence. Disclosure of information and voluntariness.

Competence and comprehension.

The nurse is assessing a 3-year-old child for symptoms of autism spectrum disorder (ASD). Which assessment finding should lead the nurse to question the diagnosis? Comprehends language well beyond the complexity of age Inability to react accordingly to social clues Engages in repetitive behaviors Displays self-destructive behavior

Comprehends language well beyond the complexity of age While children with autism may have high IQs, they do not understand the nuances of language and therefore do not comprehend well beyond the complexity of their age, so this is not a clinical manifestation that supports the diagnosis. Clinical manifestations that support the diagnosis of ASD include the inability to react accordingly to social cues, engaging in repetitive behaviors, and displaying self-destructive behavior.

An eight-year-old female child is referred to the child/adolescent psychiatric and mental health clinical nurse specialist for verbalizing fears that her immigrant grandmother will die. The widowed grandmother wears heavy black clothes, prays throughout the day, and secludes herself from everyone except the child. Although the grandmother is physically healthly, she discusses her impending death with the child. The clinical nurse specialist recognizes that: Cultural factors may negate the significance of seemingly obvious symptoms. Religious fixations are common in delusional systems. The grandmother and the child communicate only in the grandmother's native language. The grandmother is exhibiting classic signs of endogenous depression.

Cultural factors may negate the significance of seemingly obvious symptoms.

A nurse asks an assigned client, ìHow are you doing today?î The client responds with ìdoing today, doing today, doing today.î Which speech pattern disturbance is this an example of? A) Reactive attachment disorder B) Stereotypic movement disorder C) Selective mutism D) Echolalia

D

A nurse in a pediatric clinic is caring for a preschool-age child who has a new diagnosis of ADHD. Wine teaching the guardian about the disorder, which of the following statements should the nurse include in the teaching? A. "Behaviors associated with ADHD are present prior to age 3." B. "This disorder is characterized by argumentativeness" C. "Below-average intellectual functioning is associated with ADHD" D. Because of this disorder, your child is at increased risk for injury"

D

A nurse is caring for a school age child who has conduct disorder and a new prescription for methylphenidate transdermal patches. Which of the following information should the nurse provide about the medication? A. Apply the patch once daily at bed time B. Place the patch carefully in a trash can after removal C. Apply the transdermal patch to the anterior waist area D. Remove the patch each day after 9 hr

D

A nursing instructor is teaching about pharmacological treatments for attention deficit-hyperactivity disorder (ADHD). Which information about atomoxetine (Strattera) should be included in the lesson plan? A. Strattera, unlike methylphenidate (Ritalin), is a central nervous system depressant. B. When taking Strattera, a client should eliminate all red food coloring from the diet. C. Strattera will be a life-long intervention for clients diagnosed with this disorder. D. Strattera, unlike methylphenidate (Ritalin), is a selective norepinephrine reuptake inhibitor.

D

A nursing instructor is teaching about the developmental characteristics of clients diagnosed with moderate intellectual disability (ID). Which student statement indicates that further instruction is needed? A. These clients can work in a sheltered workshop setting. B. These clients can perform some personal care activities. C. These clients may have difficulties relating to peers. D. These clients can successfully complete elementary school.

D

A parent of a child with autism spectrum disorder asks the nurse if there is anything that can be done to control the child's tantrums. Which option should the nurse inform the parents that may be appropriate? A) Give the child rewards for resisting tantrums. B) Reason with the child why tantrums are not effective. C) Place the child in a time-out when tantrums occur. D) Explore the use of antipsychotic medications to control tantrums.

D

An 8-year-old client diagnosed with attention deficit-hyperactivity disorder (ADHD) was admitted 5 days ago for management of temper tantrums. What would be a priority nursing intervention during the termination phase of the nurseclient relationship? A. Set a contract with the client to limit acting-out behaviors while hospitalized. B. Teach the importance of taking fluoxetine (Prozac) consistently, even when feeling better. C. Discuss behaviors that are and are not acceptable on the unit. D. Ask the client to demonstrate learned coping skills without direction from the nurse.

D

The parents of an autistic child ask the nurse, ìWill my child ever be normal?î Which would be the most appropriate response by the nurse? A) ìYou seem worried about your child's future.î B) ìAutistic children can fully recover with the right treatment and education.î C) ìYour child should outgrow autistic traits by adolescence.î D) ìYour child will probably always have some autistic traits.î

D

Which developmental characteristic should a nurse identify as typical of a client diagnosed with severe intellectual disability? A. The client can perform some self-care activities independently. B. The client has advanced speech development. C. Other than possible coordination problems, the clients psychomotor skills are not affected. D. The client communicates wants and needs by acting out behaviors.

D

Which statement would indicate that medication teaching for the parents of a 6-year-old child with attention deficit hyperactivity disorder (ADHD) has been effective? A) ìWe'll teach him the proper way to take the medication, so he can manage it independently.î B) ìWe'll be sure he takes Ritalin at the same time every day, just before bedtime.î C) ìWe're so glad that Ritalin will eliminate the problems of ADHD.î D) ìWe'll be sure to record his weight on a weekly basis.î

D

The nurse is counseling a family with a child who has been abused by an adult family friend in the past. When explaining the child's needs to the family, which of the following would be most important for the nurse to stress? a) Long-term psychotherapy b) Antidepressant medications c) Short-term separation from the parents d) A supportive relationship with an adult

D A major protective factor against psychopathology stemming from abuse and neglect is the establishment of a supportive relationship with at least one adult who can provide empathy, consistency, and possibly a corrective experience. Long-term psychotherapy and antidepressant medication may or may not be appropriate. Short-term parental separation would be unlikely because the abuser was a family friend, not a parent

When assessing children, the nurse needs to ask more of which type of question compared with assessment of adults? a) Abstract b) Nonspecific c) Open ended d) Closed ended

D Children think in more concrete terms; thus, the nurse needs to ask more specific and fewer open-ended questions than would typically be asked of adults.

Why would a nurse ask a female adolescent client with conduct disorder to maintain a diary? a) To help reduce the chances of having outbursts of anger. b) To improve problem solving skills. c) To help learn socially acceptable behavior. d) To help identify her feelings.

D Clients with conduct disorder are tough on the exterior but have difficulty expressing their feelings and emotions. Keeping a diary can be very useful to help these clients to identify and express their emotions and feelings. Keeping a diary would not improve problem solving or teach socially acceptable behavior. It also does not reduce the chances of an angry outburst. The nurse should teach problem-solving skills, continually involve the client in age-appropriate discussions, and use techniques such as timeout to address these challenges.

Which of the following children is most likely to be diagnosed with oppositional defiant disorder or conduct disorder? a) A 6-year-old boy who finds school profoundly stressful due to his inability to relate to others b) A 13-year-old boy who experiences tics and has occasional outbursts of obscenities for no apparent reason c) A 14-year-old girl who admits to having had four different sex partners in the past several months d) An 11-year-old boy who was caught breaking into a home to steal money

D Crime is a common manifestation of oppositional defiant disorder and conduct disorder. High-risk sexual behavior may accompany the disorders but is not diagnostic. Tics and verbal outbursts are characteristic of Tourette's syndrome. Difficulty in relating to others is characteristic of autism spectrum disorders.

The nurse who provides care under the auspices of a group home is planning the care of a 12-year-old boy who has been referred to the home by the court system. Knowing that the boy has a documented history of conduct disorder, which of the following nursing diagnoses should the nurse prioritize during the boy's transition into the group home? a) Risk for Injury related to poor safety awareness b) Hopelessness related to separation from family c) Impaired Social Interaction due to withdrawal d) Impaired Social Interaction due to alienation from others secondary to aggressive acts

D The aggression, acting out, and antisocial behavior associated with conduct disorder create the potential for social alienation in a group setting. Such individuals are less likely to withdraw, injure themselves, or experience hopelessness.

Which of the following statements reflects accurately the effects of biologic influences on the development of mental illness in children? a) Development of the prefrontal cortex of the brain, which plays a role in the inhibition of impulses, is usually complete by 15 years of age in girls and 18 years of age in boys. b) The likelihood of a child developing a mood disorder when one parent suffers from depression is greater than 50%. c) No demonstrable brain abnormalities are evident in children with attention deficit hyperactivity disorder (ADHD). d) An infant with a difficult temperament is thought to be at risk for later maladjustment.

D The child's temperament, which is thought to be at least partly determined genetically, plays a role in whether he or she is at risk for maladjustment. An infant with a difficult temperament may be at risk for future maladjustment. It is important to remember, however, that responses from caregivers and others to the infant can modify the risk. Negative responses to an infant with a difficult temperament increase the risk for maladjustment

The nurse is assessing a child diagnosed with conduct disorder. Based on which behavior would this client be described as exhibiting a moderate intensity form of the disorder? a) Cruelty to animals b) Attempted robbery c) Truancy d) Verbal bullying

D Verbal bullying is an example of a behavior seen clients exhibiting a moderate intensity form of conduct disorder. Truancy is described as a behavior seen in a mild intensity form of the disorder. Cruelty to animals and attempted robbery are described as a behavior seen in a severe intensity form of conduct disorder.

A 13-year-old boy who has been diagnosed with oppositional defiant disorder has taunted the nurse when she bent over to pick something up and mocked her weight. How should then nurse respond? a) Say, "How would you like it if someone said that to you?" b) Pretend not to hear the boy and leave the room. c) Say, "That makes me feel embarrassed and I don't appreciate it." d) Say, "That's not an acceptable thing to say."

D A direct, matter-of-fact approach to hostile or inappropriate behavior is beneficial when engaging with adolescents.

A nurse is a speaking to parents of a child at school. The parents tell the nurse that their child is not very irritable or frustrated but has a calm temperament. If emotionally upset, the child prefers to be left alone undisturbed in the bedroom. What psychiatric disorder is this child likely to develop in the future? a) Antisocial personality disorder b) Oppositional defiant disorder c) Conduct disorder d) Depression

D According to the parents, the child prefers to be left alone when disturbed emotionally. This behavior indicates that the child has the tendency to internalize emotions. Such children are likely to develop anxiety and depression. Conduct disorder, oppositional defiant disorder, and antisocial personality disorder are more common in children who tend to externalize their emotional issues by directing anger and frustration into aggressive behavior.

In a discussion with a group of high school teachers about oppositional defiant disorder (ODD), the nurse says that behavior modification of the parents and teachers toward such children forms the basis of therapy. What is the most appropriate rationale that the nurse gives when asked about this strategy? a) Adolescents with ODD are less aggressive toward parents and teachers. b) Adolescents with ODD are closest to their parents and teachers. c) Adolescents with ODD only fear their parents and teachers. d) Adolescents with ODD learn maladaptive behavior at home and school.

D The treatment of ODD is based on parental behavioral interventions. It is believed that problem behaviors in ODD are learned and reinforced in the home and at school, hence the approach of the parents and teachers toward the child may help to eliminate this disorder at earlier ages. In adolescents, behavioral therapy may also be required along with parental management. It may not be true that these children are closest to their parents. Such clients are usually very aggressive and lack a sense of fear of anybody

The nurse is caring for an elderly patient with a history of autism spectrum disorder (ASD). For which condition should the nurse screen the patient? Depression Schizophrenia Diabetes mellitus Unselected Gout

Depression The elderly patient with ASD has an increased likelihood of developing depression. Schizophrenia does not develop as a result of ASD. There is no evidence that patients with ASD are more likely to develop gout or diabetes mellitus than the normal population.

A primary goal of a practice guideline is to: Document preferred practice patterns. Enhance subjective judgments. Expand access to care. Support expert opinion.

Document preferred practice patterns.

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? A) Early in the afternoon B) At noon C) At 6 p.m. D) At 9 p.m.

Early in the afternoon

The nurse is preparing discharge teaching for the parents of a child who is diagnosed with autism spectrum disorder (ASD). Which instruction should the nurse include? Encouraging repetition of treatments at home Emphasizing that the patient will never be normal Avoiding childhood vaccinations until adulthood Teaching the patient to consume foods that are rich in gluten

Encouraging repetition of treatments at home The nurse would encourage repetition of treatments for a patient at home in order to enhance effective treatment. It is not appropriate for the nurse to emphasize that the patient will never be normal. It is not necessary to avoid childhood vaccinations. The nurse would teach the patient not to consume foods that are rich in gluten.

Which one of the following nursing interventions should take priority for a child with ADHD? A) Structured daily routine B) Ensuring the child's safety and that of others C) Simplifying instructions and directions D) Improved role performance

Ensuring the child's safety and that of others

When conducting a longitudinal non-experimental study about various modalities to treat bipolar disorder in children and adolescents, a child/adolescent psychiatric and mental health clinical nurse specialist: Chooses two types of randomly assigned treatment. Evaluates each child and adolescent research participant every six months for five years. Initiates several clinical trials under strict criteria. Sets up a comparison group of patients who will not receive any treatment for a two-year period.

Evaluates each child and adolescent research participant every six months for five years.

A mother and father who have recently separated are in family therapy with their six-year-old child, who is experiencing behavioral problems. The father is now involved in a homosexual relationship. During this session, the mother initiates a heated discussion of her fears that the child is being exposed to age-inappropraite sexual behavior in the father's home. The child/adolescent psychiatric and mental health clinical nurse specialist's action is to: Exclude the child from future sessions because of the child's age and cognitive ability. Exclude the child from future sessions because of the sexual content being discussed. Exclude the child from this session because the issues being discussed are inappropriate for the child to hear. Include the child in this session because his or her presence provides useful data for clinical assessment.

Exclude the child from this session because the issues being discussed are inappropriate for the child to hear.

A parent of a child with autism spectrum disorder asks the nurse if there is anything that can be done to control the child's tantrums. Which option should the nurse inform the parents that may be appropriate? A) Give the child rewards for resisting tantrums. B) Reason with the child why tantrums are not effective. C) Place the child in a time-out when tantrums occur. D) Explore the use of antipsychotic medications to control tantrums.

Explore the use of antipsychotic medications to control tantrums.

A child is receiving mental health care in a managed care setting. The child's father questions the confidentiality of the treatment records, fearing that the information could negatively impact his employment or future insurance coverage. In responding, a child/adolescent psychiatric and mental health clinical nurse specialist recognizes that the father is: Demonstrating resistance to therapy. Expressing a major concern for patients of managed care systems. Focused on personal, rather than treatment, issues. Having difficulty building a trusting, therapeutic relationship.

Expressing a major concern for patients of managed care systems.

The nurse is reviewing the medical record of a 6-year-old patient who is diagnosed with autism spectrum disorder (ASD). Which item in the health history should the nurse consider may have been a factor in the patient's development of ASD? Fetal alcohol syndrome Appropriate adaptation to new environments Childhood vaccinations Cystic fibrosis

Fetal alcohol syndrome History of maternal alcohol use during pregnancy may have contributed to the development of ASD. Childhood vaccinations and cystic fibrosis are not linked to ASD. The ability to adapt to new environments is an appropriate goal, not a cause, for a patient who is diagnosed with ASD.

The parents of a child diagnosed with autism spectrum disorder (ASD) are trying to determine why their child has the disorder. In response, the nurse should include which etiology? Genetic factors Chemical factors Psychological factors Toxins

Genetic factors Genetic factors are seen as being one of the associated causes of autism spectrum disorder. Those with autism have defects in the genes and gene expression in the areas of cell-cycle expression. The other responses are not thought to cause ASD.

Teaching for methylphenidate (Ritalin) should include which information? A) Give the medication after meals B) Give the medication when the Childs becomes overactive. C) Increase the child's fluid intake when he or she is taking the medication D) Check the child's temperature daily

Give the medication after meals

A child/adolescent psychiatric and mental health clinical nurse specialist on the adolescent unit observes a group of three patients ostracizing a fourth patient. The members of the group use a special walk and wear similar outfits to define themselves. The clinical nurse specialist realizes that the: Group members must be separated from one another. Group's intolerance serves as a defense against their sense of identity confusion. Ostracized adolescent may not have reached the developmental stage of the others. Ostracized adolescent should be transferred to another unit or discharged.

Group's intolerance serves as a defense against their sense of identity confusion.

A child with ADHD reports to his parents that he does not like the side effects of his medicine, Adderall. The parents ask the nurse for suggestions to reduce the medication's negative side effects. The nurse can best help the parents by offering which advice? A) Give the child his medicine at night. B) Have the child eat a good breakfast and snacks late in the day and at bedtime. C) Limit the number of calories the child eats each day. D) Let the child take daytime naps.

Have the child eat a good breakfast and snacks late in the day and at bedtime.

he nurse admits a child suspected of having autism spectrum disorder (ASD). Which test to aid in the diagnosis should the nurse question? Head x-ray Electrocardiogram (EEG) Computerized tomography (CT) scan Lead screening

Head x-ray

The nurse takes a team approach to help a middle-age patient who is diagnosed with autism spectrum disorder (ASD) achieve their full potential. The nurse uses a community center to help find a job for the patient. Which strategy should the nurse engage to allow this patient to have the best opportunity for success? Helping the patient find a position that will allow them to use their strongest talents Making sure the job is an easy one Partnering the patient with someone else at work so that they can keep an eye on them at all times None, as those with ASD generally cannot work because the disorder is too debilitating to allow them to be productive community members

Helping the patient find a position that will allow them to use their strongest talents Individuals with ASD have the greatest chance of success with training and finding opportunities that use their strengths. Many are active members of the community, while others need more support.

The nurse is caring for a patient who is diagnosed with autism spectrum disorder (ASD). Which nursing intervention is most appropriate for the nurse to use? Incorporating the patient's rituals into daily care Supervising the patient closely to prevent infection Using one method of communication with the patient Completing activities of daily living for the patient

Incorporating the patient's rituals into daily care An appropriate intervention for a patient with ASD is to incorporate the patient's rituals into daily care. The nurse would supervise the patient closely to enhance safety, not to prevent infection. The nurse would adapt communication style to meet the needs of the patient. The nurse would encourage the patient to participate fully in care. Therefore, the nurse would not complete all activities of daily living for the patient.

The nurse recognizes which as a common behavioral sign of autism? A) Clinging behavior toward parents B) Creative imaginative play with peers C) Early language development D) Indifference to being hugged or held

Indifference to being hugged or held

he nurse is assessing a high-functioning adult patient who is diagnosed with autism spectrum disorder (ASD). The nurse will most likely observe which characteristic in this patient? Language skills and sentence formation Comprehending nonverbal clues Social interaction Flexibility of thought

Language skills and sentence formation A high-functioning adult with ASD will most likely have language skills and be able to form full sentences, however, they may still have difficulty comprehending nonverbal cues, difficulty in social interactions, and difficulty in flexibility of thought.

The nurse is teaching about autism spectrum disorder to a group of community members. Which risk factor should the nurse include? Maternal age over 40 Female gender Paternal age less than 20 Parents who are close in age

Maternal age over 40 Risk factors for autism spectrum disorder (ASD) include advanced maternal age (greater than 40), paternal age greater than 50, male gender, and having parents with an age disparity of greater than 10 years.

Which medication is effective in 70% to 80% of children with attention deficit hyperactivity disorder (ADHD)? Amphetamine Methylphenidate Pemoline Dextroamphetamine

Methylphenidate

The nurse would expect to see all the following symptoms in a child with ADHD, except: A) distractibility and forgetfulness B) excessive running, climbing, and fidgeting C) moody, sullen, and pouting behavior D) Interrupting others and inability to take turns

Moody, sullen, and pouting behavior

When beginning therapy with a six-year-old child with autism, the child/adolescent psychiatric and mental health clinical nurse specialist initially communicates with the child: Nonverbally, through facial expressions and simple gestures. Nonverbally, through tactile stimulation. Verbally, by giving full, detailed explanations. Verbally, by using humor and popular children's language.

Nonverbally, through facial expressions and simple gestures.

A mother brings her four-year-old son in for evaluation because he "does not get along with his step-siblings." The mother reports that her son refuses to play a game with his step-siblings unless they play by his rules. According to cognitive development theory, the explanation for the child's behavior is that he is in the: Developmental stage of industry versus inferiority and he may feel inadequate when competing with older children. Preconventional stage of thinking and his behavior is motivated by egocentrism. Preoperational stage of thinking and it is difficult for him to accept differing viewpoints. Stage of concrete operations.

Preoperational stage of thinking and it is difficult for him to accept differing viewpoints.

A child/adolecent psychiatric and mental health clinical nurse specialist meets regularly with the staff nurses of an adolescent inpatient psychiatric unit to improve the nurses' therapeutic interactions with the patients. Each nurse keeps a journal describing clinical interactions with an adolescent and examines the factors that hinder the nurse's ability to interact therapeutically with the patient. The clinical specialist reviews the entries and provides written feedback. This teaching strategy is known as: Concept mapping. Discovery learning. Problem-based learning. Reflective practice.

Reflective practice.

A nurse is assessing a 4-year-old child for indications of autism spectrum disorder. For which of the following manifestation should the nurse assess? A) Impulsive behavior B) Repetitive counting C) Destructiveness D) Somatic problems

Repetitive counting

A preschool-age patient was recently diagnosed with autism spectrum disorder (ASD). The nurse should consider which observation of the patient to be supportive of the diagnosis? Rocking on the exam table Sitting quietly during the assessment Wanting to be held by the parent during the assessment Actively participating with the nurse during the assessment

Rocking on the exam table Performing a physical assessment of patients with ASD can present many challenges. Patients diagnosed with ASD may not sit still for the assessment and can display flapping, rocking or head-banging as a way to self-soothe during the assessment process. Patients who have sensory deficits or behaviors often do not like being touched and show a disinterest in being cuddled. These patients also do not like quick transitions and generally will not actively participate in the assessment process.

The adolescent parents of a three-year-old child attend an alternate high school that houses an onsite daycare center. The school nurse refers the parents to a child/adolescent psychiatric and mental health clinical nurse specialist to help them manage their child's temper tantrums. The focus of the treatment plan is a: Behavior modification program for the child that the parents will implement at home. Parenting class at a local mental health clinic for the parents to attend weekly during the evening. Play therapy session for the child, which the clinical nurse specialist conducts weekly. School-based intervention with the parents to convey that behavior is motivated by thoughts and feelings.

School-based intervention with the parents to convey that behavior is motivated by thoughts and feelings.

A 17-year-old patient arrives at the emergency department with nonspecific complaints. The patient's temperature is 100.8°F (38.2°C), pulse rate and blood pressure are elevated, and pupils are dilated with decreased reaction to light. Two days ago, the patient began taking sertraline (Zoloft) 50 mg daily for treatment of depression. The patient has a history of substance use and smoked marijuana one week ago. The diagnosis is: Alcohol withdrawal. Infection affecting the central nervous system. Neuroleptic malignant syndrome. Serotonin syndrome.

Serotonin syndrome.

A child/adolescent psychiatric and mental health clinical nurse specialist learns that a patient with bipolar affective disorder is moving out of state. The clinical nurse specialist refers the patient to a new provider for a followup appointment and prescribes enough medication to last until the appointment with the new clinical nurse specialist. These actions demonstrate the clinical nurse specialist's understanding of the: Disease process of bipolar affective disorder. Laws related to patient abandonment. Length of time needed to schedule a new appointment. Standards of practice.

Standards of practice.

A parent is concerned that his child might suffer from attention deficit hyperactivity disorder (ADHD). She brings the child in to be evaluated. Which of the following behaviors reported by the parent would be consistent with this diagnosis? A) The child interrupts others. B) The child has been hoarding objects. C) The child has lots of friends. D) The child is excelling academically in school.

The child interrupts others.

The nurse is planning the care for a patient who is admitted to the hospital for a tonsillectomy. The patient is also diagnosed with autism spectrum disorder (ASD). Which goal is appropriate for the nurse to include in the plan of care for the patient? The patient will demonstrate behavior that is not self-destructive. The patient will try new foods during hospitalization. The patient will allow the nurse to perform all activities of daily living. The patient will not socialize with other children in the same age group.

The patient will demonstrate behavior that is not self-destructive. An appropriate goal for this patient is to demonstrate behaviors that are not self-destructive. It is important for the child who is diagnosed with ASD to maintain home rituals. Therefore, it is not appropriate for the patient to try new foods during hospitalization. The patient should have a goal of independently performing activities of daily living during hospitalization. The nurse would encourage socialization with other children in the same age group, not discourage it.

For the past 18 months, an eight-year-old child has exhibited involuntary, purposeless, rapid recurrent movements of the arms and face as well as spontaneous unintelligible vocalizations. When receiving verbal cues, the child can decrease and sometimes extinguish the erratic movements for several minutes. The diagnosis is: Atypical tic disorder. Chronic motor tic disorder. Stereotypic movement disorder. Tourette disorder.

Tourette disorder.

Which of Yalom's curative factors in group therapy applies to female adolescents who have sustained incest? Altruism. Group cohesiveness. Imitative behaviors. Universality.

Universality.

A mother who has paranoid delusions has been isolating her seven-year-old child. The child is developing disruptive behavior and the family has come to the attention of several community agencies. The most effective means of addressing the family's needs is to: Allow the mother and child to determine their desired level of involvement with the community agencies. Encourage the mother and child to interact with representatives from the various agencies. Focus on a single need and service agency to help manage the anxiety level of the mother and child. Use multiple agencies with a primary clinician to clarify the roles and boundaries and coordinate interventions.

Use multiple agencies with a primary clinician to clarify the roles and boundaries and coordinate interventions.

The nurse is teaching a 12-year-old with intellectual disability about medications. Which intervention is essential? A) Speak slowly and distinctly B) Teach the information to the parents only C) Use pictures rather than printed words D) Validate client understanding of teaching

Validate client understanding of teaching

Several months ago, a 12-year-old male client was involved in an exploitative homosexual relationship with an older adolescent. Now in therapy, the client expresses feelings of helplessness and fantasizes about "getting even" with the older youth. The child/adolescent psychiatric and mental health clinical nurse specialist encourages the client to: Engage in activities with boys who are his age. Take karate lessons to learn the skills needed to defend himself. Work out with a punching bag to displace his hostility. Write a letter to the perpetrator, expressing his rage at being exploited.

Write a letter to the perpetrator, expressing his rage at being exploited.

Which intervention is most appropriate for the nurse to include in the plan of care for a child with autism spectrum disorder​ (ASD)? A. Scheduling procedures for different times each day B. Encouraging the​ client's family to bring in familiar objects from home C. Putting the television on loud to provide stimulation for the client D. Rearranging the hospital room until a comfortable arrangement is found

​ B. Encouraging the​ client's family to bring in familiar objects from home Rationale: Clients with ASD need structure and a predictable course of action. Bringing in familiar objects from home provides comfort for the client. It is important for the nurse to be oriented to the room and care should be taken not to relocate objects in the environment. Clients with ASD are sensitive to loud noises and bright​ lights, so the television should be turned off to minimize stimuli that may distress the client. Procedures should be scheduled for the same time to maintain predictability.

Which teaching point is important for the nurse to include in the plan of care for a client who is diagnosed with autism spectrum disorder​ (ASD)? A. Establishing a routine B. Focusing on limitations in order to see progress in care C. Keeping the same pediatric healthcare provider for all children in the family D. Maintaining the home as a​ treatment-free zone

​A. Establishing a routine Rationale: Clients who are diagnosed with ASD thrive when routines are established and followed. The family should consider seeking a healthcare provider who has experience in treating a child with ASD. Therapies must be practiced and implemented in the home environment in order to be effective. The family would focus on the​ child's strengths, not the​ child's limitations.

The nurse is planning care for a client who is diagnosed with autism spectrum disorder​ (ASD). Which goal is appropriate for the nurse to​ include? A. The client will engage in private activities to stimulate learning. B. The client will demonstrate negative communication skills. C. The client will display developmental progress. D. The client will remain free from infection.

​C. The client will display developmental progress. Rationale: An appropriate goal when providing care to a client diagnosed with ASD is for the client to display developmental progress. Other appropriate goals include the client remaining free of​ injury, the client demonstrating positive communication​ skills, and the client participating in activities with family members or small groups of peers.

Which resource should the nurse expect the healthcare provider to use to confirm the diagnosis of autism spectrum disorder​ (ASD)? A. The Mental Health Rights Manual B. The Autism Handbook C. Teaching Social Communication to Families with Autism D. Diagnostic and Statistical Manual of Mental Disorders

​D. Diagnostic and Statistical Manual of Mental Disorders Rationale: Criteria for diagnosis can be found in the American Psychiatric​ Association's Diagnostic and Statistical Manual of Mental Disorders​, 5th edition​ (DSM-5), which includes screening tests to identify tendencies consistent with ASD. Although the other resources may be helpful in teaching the client and the family about​ ASD, they are not used as a diagnostic tool.

The nurse is assessing a toddler client for an upper respiratory infection. The nurse suspects the child may have autism spectrum disorder​ (ASD). Which behavior caused the​ nurse's suspicion? A. Crying after the administration of immunizations B. Playing with the other children and toys while awaiting the nurse C. Speaking to the nurse in sentences D. Having a tantrum when touched by the nurse

​D. Having a tantrum when touched by the nurse Rationale: An assessment finding that supports the diagnosis of ASD is having a tantrum when touched by the healthcare provider. It is not uncommon for the child with ASD to display an inability to attend and systematize situational reactions. Playing with other​ children, speaking to the nurse in​ sentences, and crying after the administration of immunizations are not findings that support ASD. These assessment findings are age appropriate for the client.

The home care nurse is visiting a child diagnosed with autism spectrum disorder​ (ASD). Which intervention is appropriate for the nurse to include in the treatment plan for this​ family? A. Focusing on the​ child's limitations B. Recommending that the home be a​ therapy-free zone C. Encouraging the family to get over negative feelings regarding the diagnosis D. Providing appropriate education regarding what to expect for the child

​D. Providing appropriate education regarding what to expect for the child Rationale: An appropriate intervention for the family of a child diagnosed with ASD is for the nurse to provide education about what to expect. The nurse would encourage the family to grieve the loss of the​ "perfect child" and encourage the parents to focus on the​ child's strengths and talents. In order for therapy to be​ effective, the nurse would recommend that treatments be continued at home.