Varcarolis Ch. 11 - Childhood and Neurodevelopmental Disorders - all

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

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

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

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

19. Assessment data for a 7-year-old reveals an inability to take turns, blurting out answers to questions before a question is complete, and frequently interrupting others conversations. How should the nurse document these behaviors? a. Disobedience c. Impulsivity b. Hyperactivity d. Anxiety

c. Impulsivity These behaviors are most directly related to impulsivity. Hyperactive behaviors are more physical in nature, such as running, pushing, and the inability to sit. Inattention is demonstrated by failure to listen. Defiance is demonstrated by willfully doing what an authority figure has said not to do.

1. Which factor presents the highest risk for a child to develop a psychiatric disorder? a. Having an uncle with schizophrenia c. Living with an alcoholic parent b. Being the oldest child in a family d. Being an only child

c. Living with an alcoholic parent Having a parent with a substance abuse problem has been designated an adverse psychosocial condition that increases the risk of a child developing a psychiatric condition. Being in a middle-income family and being the oldest child do not represent psychosocial adversity. Having a family history of schizophrenia presents a risk, but an alcoholic parent in the family offers a greater risk.

20. A child diagnosed with attention deficit hyperactivity disorder (ADHD) shows hyperactivity, aggression, and impaired play. The health care provider prescribed amphetamine salts (Adderall). The nurse should monitor for which desired behavior? a. Increased expressiveness in communication with others b. Abilities to identify anxiety and implement self-control strategies c. Improved abilities to participate in cooperative play with other children d. Tolerates social interactions for short periods without disruption or frustration

c. Improved abilities to participate in cooperative play with other children The goal is improvement in the childs hyperactivity, aggression, and play. The remaining options are more relevant for a child with intellectual development disorder or an anxiety disorder.

5. A nurse will prepare teaching materials for the parents of a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which medication will the information focus on? a. Paroxetine (Paxil) c. Methyphenidate (Ritalin) b. Imipramine (Tofranil) d. Carbamazepine (Tegretol)

c. Methyphenidate (Ritalin) CNS stimulants are the drugs of choice for treating children with ADHD: Ritalin and dexedrine are commonly used. None of the other drugs are psychostimulants used to treat ADHD.

6. What is the nurses priority focused assessment for side effects in a child taking methylphenidate (Ritalin) for attention deficit hyperactivity disorder (ADHD)? a. Dystonia, akinesia, and extrapyramidal symptoms b. Bradycardia and hypotensive episodes c. Sleep disturbances and weight loss d. Neuroleptic malignant syndrome

c. Sleep disturbances and weight loss The most common side effects are gastrointestinal disturbances, reduced appetite, weight loss, urinary retention, dizziness, fatigue, and insomnia. Weight loss has the potential to interfere with the childs growth and development. The distracters relate to side effects of conventional antipsychotic medications.

7. A desired outcome for a 12-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care? a. Reality therapy c. Social skills group b. Simple restitution d. Insight-oriented group therapy

c. Social skills group Social skills training teaches the child to recognize the impact of his or her behavior on others. It uses instruction, role-playing, and positive reinforcement to enhance social outcomes. The other therapies would have lesser or no impact on peer relationships.

23. The parent of a child diagnosed with Tourettes disorder says to the nurse, I think my child is faking the tics because they come and go. Which response by the nurse is accurate? a. Perhaps your child was misdiagnosed. b. Your observation indicates the medication is effective. c. Tics often change frequency or severity. That doesnt mean they arent real. d. This finding is unexpected. How have you been administering your childs medication?

c. Tics often change frequency or severity. That doesnt mean they arent real. Tics are sudden, rapid, involuntary, repetitive movements or vocalizations characteristic of Tourettes disorder. They often fluctuate in frequency, severity, and are reduced or absent during sleep.

3. Which behavior indicates that the treatment plan for a child diagnosed with an autism spectrum disorder was effective? The child: a. plays with one toy for 30 minutes. b. repeats words spoken by a parent. c. holds the parents hand while walking. d. spins around and claps hands while walking.,

c. holds the parents hand while walking. Holding the hand of another person suggests relatedness. Usually, a child with an autism spectrum disorder would resist holding someones hand and stand or walk alone, perhaps flapping arms or moving in a stereotyped pattern. The incorrect options reflect behaviors that are consistent with autism spectrum disorders.

A 10-year-old who is frequently disruptive in the classroom begins to fidget and then moves on to disruptive behavior. What is the most appropriate initial technique for managing this sort of disruptive behavior? A) Therapeutic holding B) Seclusion C) Quiet room D) Touch control

D) Touch Control The appropriate adult can move closer to the child and place a hand on his/her arm or an arm around his/her shoulder for a calming effect when the fidgeting is first noted. The closeness signals the child to use self-control. It is the least restrictive treatment approach and should be tried initially; before any of the other options.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A) "I do like you, but I don't like it when you grab my pen." This reply shows positive regard for the child while describing the behavior as undesirable. Feedback such as this helps the child feel accepted while making her aware of the effect her behavior has on others. None of the other options provide the necessary degree of positive regard.

The family of a child diagnosed with attention deficit hyperactivity disorder (ADHD), inattentive type, is told the evaluation of their child's care will focus on symptom patterns and severity. What is the focus of child's evaluation? Select all that apply. A) Academic performance B) Activities of daily living C) Physical growth D) Social relationships E) Personal perception

A) Academic performance B) Activities of daily living D) Social relationships E) Personal perception

An 8-year-old patient is newly diagnosed with attention deficit hyperactivity disorder (ADHD). It is important that the parents be educated to the fact that symptoms will take which form of inattention and impulsivity have to be apparent: Select all that apply. A) Low frustration tolerance B) Poor school performance C) Impulsive behaviors D) Easily intimidated E) Mood swings

A) Low frustration tolerance B) Poor school performance C) Impulsive behaviors E) Mood swings Individuals with ADHD show an inappropriate degree of inattention, impulsiveness, and hyperactivity. Attention problems and hyperactivity contribute to low frustration tolerance, temper outbursts, labile moods, poor school performance, peer rejection, and low self-esteem. ADHD is not generally characterized by meekness or by being easily intimidated.

Which factor can reduce the vulnerability of a child to etiological influences predisposing to the development of psychopathology? A) Resilience B) Malnutrition C) Child abuse D) Having a depressed parent

A) Resilience Resilience refers to developing and using certain characteristics that help a child to handle the stresses of a difficult childhood without developing mental problems. Resilient children can adapt to changes in the environment, form nurturing relationships with adults other than their parents, distance themselves from the emotional chaos of the family, and have social intelligence and the ability to use problem-solving skills.

When a nurse assesses the style of behavior a child habitually uses to cope with the demands and expectations of the environment, he or she is assessing characteristic? A) Temperament B) Resilience C) Vulnerability D) Cultural Assimilation

A) Temperament Temperament is the behavior the child habitually uses to cope with the environment. It is a constitutional factor thought to be genetically determined. It may be modified by the parent-child relationship. None of the other options would reflect this characteristic.

A 9-year-old patient has been diagnosed with an intellectual development disorder (IDD). Which assessment findings support this diagnosis? Select all that apply. A) Unable to explain the phrase, "Raining cats and dogs" B) Reads below age level C) Is capable of providing effective oral self care D) Enjoy interacting with developmentally similar peers E) Physically lashes out when frustrated

A) Unable to explain the phrase, "Raining cats and dogs" B) Reads below age level E) Physically lashes out when frustrated IDD is characterized by severe deficits in three major areas of functioning: intellectual, social, and managing daily life. These children demonstrate difficulty with self care and with almost any social interactions.

The mother of a 3-year-old boy just diagnosed with autism spectrum is tearful and states, "The doctor said we need to start therapy right away. I just don't understand how helpful it will be—he's only 3 years old!" What response should the nurse provide to the mother's statement? A) "You are right, 3 years old is very young to start therapy, but it will make you feel better to be doing something." B) "Starting him on treatment now gives Taylor a much greater chance for a productive life." C) "If your child starts therapy now, he will be able to stop therapy sooner." D) "If you have questions, its best to ask the doctor."

B) "Starting him on treatment now gives Taylor a much greater chance for a productive life." Early intervention for children with autism can greatly enhance their potential for a full, productive life. 3 years old is not too young to start therapy since the sooner therapy is started, the better the outcome. The patient will most likely not be able to stop therapy as interventions will continue indefinitely. Telling the mother to ask her provider abdicates the nurse's responsibility to provide education to patients and families.

A 12-year-old male patient diagnosed with Tourette's disorder is visiting his provider. The nurse will prepare medication teaching on which class of medication to help manage the tics associated with this disorder? Select all that apply. A) Mood stabilizers B) Antianxiety agents C) Anticholinesterase inhibitors D) First-generation antipsychotics E) Second-generation antipsychotics

B) Antianxiety agents D) First-generation antipsychotics E) Second-generation antipsychotics Drugs with Food and Drug Administration (FDA) approval for treating tics are the first-generation antipsychotics haloperidol and pimozide, and the second-generation antipsychotic aripiprazole.Clonidine hydrochloride, an alpha 2-adrenergic agonist, used to treat hypertension, is also prescribed for tics. While less effective and far slower acting than the antipsychotics, it has fewer side effects. The antianxiety drug clonazepam (Klonopin) is used as a supplement to other medications. It may work by reducing anxiety and resultant tics. The other options are not used or approved for the treatment of Tourette's disorder.

A 7-year-old, who is described as impulsive and hyperactive, tells the nurse, "I am a dummy, because I don't pay attention, and I can't read like the other kids." The nurse notes that these behaviors are most consistent with which diagnosis? A) Attention deficit disorder B) Attention deficit hyperactivity disorder C) Autism D) Conduct disorder

B) Attention deficit hyperactivity disorder The data are most consistent with attention deficit hyperactivity disorder (ADHD) as described in the DSM-5. The other options present with characteristics and behaviors that differ from those in the scenario.

Which social behavior is often a result of a child having been exposed to some form of abuse? A) Speech disorders B) Bullying others C) Eating disorders D) Delayed motor skills

B) Bullying others Children who have experienced abuse are at risk for identifying with their aggressor and may act out, bully others, become abusers, or develop dysfunctional interpersonal relationships in adulthood. None of the remaining options are as directly associated with abuse as bullying.

A child diagnosed with autism will demonstrate impaired development in which area? A) Adhering to routines B) Playing with other children C) Swallowing and chewing D) Eye-hand coordination

B) Playing with other children Autism affects the normal development of the brain in social interaction and communication skills. Symptoms associated with autism spectrum disorders include significant deficits in social relatedness, including communication, nonverbal behavior, and age-appropriate interaction. Other behaviors include stereotypical repetitive speech, obsessive focus on specific objects, over adherence to routines or rituals, hyper- or hypo-reactivity to sensory input, and extreme resistance to change. None of the other options are characteristically associated with autism.

Which nursing diagnosis should be considered for a child with attention deficit hyperactivity disorder ADHD? A) Anxiety B) Risk for Injury C) Defensive Coping D) Impaired Verbal Communication

B) Risk for Injury The child's marked hyperactivity puts him or her at risk for injury from falls, bumping into objects, impulsively operating equipment, pulling heavy objects off shelves, and so forth

When a child demonstrates a temperament that prompts the mother to say, "She is just so different from me; I just can't seem to connect with her." The nurse should plan to provide which intervention? A) Suggest that the child's father become her primary caregiver. B) Encourage the mother to consider attending parenting classes. C) Counsel the mother regarding ways to better bond with her child. D) Educate the father regarding signs that the child is being physically abused.

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

Which behavior is most indicative of a 4-year-old child diagnosed with Tourette's syndrome? A) Difficulty in social relationships B) Humming while performing activities that require concentration C) Frequent eye blinking D) Difficulty in completing tasks on time

C) Frequent eye blinking Persistent motor or vocal ticking is characteristic of Tourette's syndrome. Dysfunctional social relationship is an inconclusive symptom, especially for a 4-year-old. Humming can be a normal response of a child at play. Ineffective time management is usually associated with a child who demonstrates ADHD, not Tourette's syndrome.

What are the foundational concerns regarding the use of restraint and seclusion when providing care to children? Select all that apply. A) Parents may initiate a lawsuit if injury occurs. B) Staff have conflicted feelings leading to ineffectiveness. C) Research suggests both are psychologically and physically harmful. D) Staff tends to be under-trained in use of restraints in children. E) The principle of least restrictive intervention is a primary concern.

C) Research suggests both are psychologically and physically harmful. E) The principle of least restrictive intervention is a primary concern. Restraint and seclusion have been shown to be psychologically harmful and may also be physically harmful and result in injury or death. To ensure that the civil and legal rights of individuals are maintained, techniques are selected according to the principle of least restrictive intervention. This principle requires that you use more-restrictive interventions only after attempting less restrictive interventions to manage the behavior that have been unsuccessful. The other options are not correct reasons why restraint and seclusion are controversial in children.

11. A child diagnosed with attention deficit hyperactivity disorder will begin medication therapy. The nurse should prepare a plan to teach the family about which classification of medications? a. Central nervous system stimulants c. Antipsychotics b. Tricyclic antidepressants d. Anxiolytics

a. Central nervous system stimulants Central nervous system stimulants, such as methylphenidate and pemoline (Cylert), increase blood flow to the brain and have proved helpful in reducing hyperactivity in children and adolescents with attention deficit hyperactivity disorder. The other medication categories listed would not be appropriate.

2. Which nursing diagnosis is universally applicable for children diagnosed with autism spectrum disorders? a. Impaired social interaction related to difficulty relating to others b. Chronic low self-esteem related to excessive negative feedback c. Deficient fluid volume related to abnormal eating habits d. Anxiety related to nightmares and repetitive activities

a. Impaired social interaction related to difficulty relating to others Children diagnosed with autism spectrum disorders display profoundly disturbed social relatedness. They seem aloof and indifferent to others, often preferring inanimate objects to human interaction. Language is often delayed and deviant, further complicating relationship issues. The other nursing diagnoses might not be appropriate in all cases.

12. Soon after parents announced they were divorcing, a child stopped participating in sports, sat alone at lunch, and avoided former friends. The child told the school nurse, If my parents loved me, they would work out their problems. Which nursing diagnosis has the highest priority? a. Social isolation c. Chronic low self-esteem b. Decisional conflict d. Disturbed personal identity

a. Social isolation This child shows difficulty coping with problems associated with the family. Social isolation refers to aloneness that the patient perceives negatively, even when self-imposed. The other options are not supported by data in the scenario.

16. Which assessment finding would cause the nurse to consider a child to be most at risk for the development of mental illness? a. The child has been raised by a parent with chronic major depression. b. The childs best friend was absent from the childs birthday party. c. The child was not promoted to the next grade one year. d. The child moved to three new homes over a 2-year period.

a. The child has been raised by a parent with chronic major depression. Children raised by a depressed parent have an increased risk of developing an emotional disorder. Familial risk factors correlate with child psychiatric disorders, including severe marital discord, low socioeconomic status, large families and overcrowding, parental criminality, maternal psychiatric disorders, and foster-care placement. The chronicity of the parents depression means it has been a consistent stressor. The other factors are not as risk- enhancing.

17. The child prescribed an antipsychotic medication to manage violent behavior is one most likely diagnosed with: a. attention deficit hyperactivity disorder. b. posttraumatic stress disorder. c. communication disorder. d. an anxiety disorder.

a. attention deficit hyperactivity disorder. Antipsychotic medication is useful for managing aggressive or violent behavior in some children diagnosed with attention deficit hyperactivity disorder. If medication were prescribed for a child with an anxiety disorder, it would be a benzodiazepine. Medications are generally not needed for children with communication disorder. Treatment of PTSD is more often associated with SSRI medications.

25. A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. The child formed a trusting relationship with a shelter volunteer. The child says, My three friends and I got an A on our school science project. The nurse can assess that the child: a. displays resiliency. b. has a passive temperament. c. is at risk for posttraumatic stress disorder. d. uses intellectualization to deal with problems.

a. displays resiliency. Resiliency enables a child to handle the stresses of a difficult childhood. Resilient children can adapt to changes in the environment, take advantage of nurturing relationships with adults other than parents, distance themselves from emotional chaos occurring within the family, learn, and use problem-solving skills.

1. A nurse prepares to lead a discussion at a community health center regarding childrens health problems. The nurse wants to use current terminology when discussing these issues. Which terms are appropriate for the nurse to use? Select all that apply. a. Autism b. Bullying c. Mental retardation d. Autism spectrum disorder e. Intellectual development disorder

b. Bullying d. Autism spectrum disorder e. Intellectual development disorder Some dated terminology contributes to the stigma of mental illness and misconceptions about mental illness. Its important for the nurse to use current terminology.

3. At the time of a home visit, the nurse notices that each parent and child in a family has his or her own personal online communication device. Each member of the family is in a different area of the home. Which nursing actions are appropriate? Select all that apply. a. Report the finding to the official child protection social services agency. b. Educate all members of the family about risks associated with cyberbullying. c. Talk with the parents about parental controls on the childrens communication devices. d. Encourage the family to schedule daily time together without communication devices. e. Obtain the familys network password and examine online sites family members have visited.

b. Educate all members of the family about risks associated with cyberbullying. c. Talk with the parents about parental controls on the childrens communication devices. d. Encourage the family to schedule daily time together without communication devices. Education and awareness-based approaches have a chance of effectively reducing harmful online behavior, including risks associated with cyberbullying. Parental controls on the childrens devices will support safe Internet use. Family time together will promote healthy bonding and a sense of security among members. There is no evidence of danger to the children, so a report to child protective agency is unnecessary. It would be inappropriate to seek the familys network password and an invasion of privacy to inspect sites family members have visited.

18. A child reports to the school nurse of being verbally bullied by an aggressive classmate. What is the nurses best first action? a. Give notice to the chief administrator at the school regarding the events. b. Encourage the victimized child to share feelings about the experience. c. Encourage the victimized child to ignore the bullying behavior. d. Discuss the events with the aggressive classmate.

b. Encourage the victimized child to share feelings about the experience. The behaviors by the bullying child create emotional pain and present the risk for physical pain. The nurse should first listen to the childs complaints and validate the child for reporting the events. Later, school authorities should be notified. School administrators are the most appropriate personnel to deal with the bullying child. The behavior should not be ignored it will only get worse.

13. A nurse works with a child who is sad and irritable because the childs parents are divorcing. Why is establishing a therapeutic alliance with this child a priority? a. Therapeutic relationships provide an outlet for tension. b. Focusing on the strengths increases a persons self-esteem. c. Acceptance and trust convey feelings of security to the child. d. The child should express feelings rather than internalize them.

c. Acceptance and trust convey feelings of security to the child. Trust is frequently an issue because the child may question their trusting relationship with the parents. In this situation, the trust the child once had in parents has been disrupted, reducing feelings of security. The correct answer is the most global response.

2. A nurse prepares the plan of care for a 15-year-old diagnosed with moderate intellectual developmental disorder. What are the highest outcomes that are realistic for this patient? Within 5 years, the patient will: (select all that apply) a. graduate from high school. b. live independently in an apartment. c. independently perform own personal hygiene. d. obtain employment in a local sheltered workshop. e. correctly use public buses to travel in the community.

c. independently perform own personal hygiene. d. obtain employment in a local sheltered workshop. e. correctly use public buses to travel in the community. Individuals with moderate intellectual developmental disorder progress academically to about the second grade. These people can learn to travel in familiar areas and perform unskilled or semiskilled work. With supervision, the person can function in the community, but independent living is not likely.

21. When group therapy is prescribed as a treatment modality, the nurse would suggest placement of a 9-year-old in a group that uses: a. guided imagery. b. talk focused on a specific issue. c. play and talk about a play activity. d. group discussion about selected topics.

c. play and talk about a play activity. Group therapy for young children takes the form of play. For elementary school children, therapy combines play and talk about the activity. For adolescents, group therapy involves more talking.

4. A kindergartener is disruptive in class. This child is unable to sit for expected lengths of time, inattentive to the teacher, screams while the teacher is talking, and is aggressive toward other children. The nurse plans interventions designed to: a. promote integration of self-concept. b. provide inpatient treatment for the child. c. reduce loneliness and increase self-esteem. d. improve language and communication skills.

c. reduce loneliness and increase self-esteem. Because of their disruptive behaviors, children with ADHD often receive negative feedback from parents, teachers, and peers, leading to self-esteem disturbance. These behaviors also cause peers to avoid the child with ADHD, leaving the child with ADHD vulnerable to loneliness. The child does not need inpatient treatment at this time. The incorrect options might or might not be relevant.

24. When a 5-year-old is disruptive, the nurse says, You must take a time-out. The expectation is that the child will: a. go to a quiet room until called for the next activity. b. Slowly count to 20 before returning to the group activity. c. sit on the edge of the activity until able to regain self-control. d. sit quietly on the lap of a staff member until able to apologize for the behavior.

c. sit on the edge of the activity until able to regain self-control. Time-out is designed so that staff can be consistent in their interventions. Time-out may require going to a designated room or sitting on the periphery of an activity until the child gains self-control and reviews the episode with a staff member. Time-out may not require going to a designated room and does not involve special attention such as holding. Counting to 10 or 20 is not sufficient.

22. Which child demonstrates behaviors indicative of a neurodevelopmental disorder? a. 4-year-old who stuttered for 3 weeks after the birth of a sibling b. A 9-month-old who does not eat vegetables and likes to be rocked c. A 3-month-old who cries after feeding until burped and sucks a thumb d. A 3-year-old who is mute, passive toward adults, and twirls while walking

d. A 3-year-old who is mute, passive toward adults, and twirls while walking Symptoms consistent with autistic spectrum disorders (ASD) are evident in the correct answer. Autistic spectrum disorder is one type of neurodevelopmental disorder. The behaviors of the other children are within normal ranges.

15. A 4-year-old cries for 5 minutes when the parents leave the child at preschool. The parents ask the nurse, What should we do? Select the nurses best response. a. Ask the teacher to let the child call you at play time. b. Withdraw the child from preschool until maturity increases. c. Remain with your child for the first hour of preschool time. d. Give your child a kiss before you leave the preschool program.

d. Give your child a kiss before you leave the preschool program. The child demonstrates age-appropriate behavior for a 4-year-old. The nurse should reassure the parents. The distracters are over-reactions.

10. When a 5-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) bounces out of a chair and runs over and slaps another child, what is the nurses best action? a. Instruct the parents to take the aggressive child home. b. Direct the aggressive child to stop immediately. c. Call for emergency assistance from other staff. d. Take the aggressive child to another room.

d. Take the aggressive child to another room. The nurse should manage the milieu with structure and limit setting. Removing the aggressive child to another room is an appropriate consequence for the aggressiveness. Directing the child to stop will not be effective. This is not an emergency. Intervention is needed rather than sending the child home.

8. The parent of a 6-year-old says, My child is in constant motion and talks all the time. My child isnt interested in toys but is out of bed every morning before me. The childs behavior is most consistent with diagnostic criteria for: a. communication disorder. b. stereotypic movement disorder. c. intellectual development disorder. d. attention deficit hyperactivity disorder.

d. attention deficit hyperactivity disorder. Excessive motion, distractibility, and excessive talkativeness are seen in attention deficit hyperactivity disorder (ADHD). The behaviors presented in the scenario do not suggest intellectual development, stereotypic, or communication disorder.

14. A nurse assesses a 3-year-old diagnosed with an autism spectrum disorder. Which finding is most associated with the childs disorder? The child: a. has occasional toileting accidents. b. is unable to read childrens books. c. cries when separated from a parent. d. continuously rocks in place for 30 minutes.

d. continuously rocks in place for 30 minutes. Autism spectrum disorder involves distortions in development of social skills and language that include perception, motor movement, attention, and reality testing. Body rocking for extended periods suggests autism spectrum disorder. The distracters are expected findings for a 3-year-old.

9. A child diagnosed with attention deficit hyperactivity disorder had this nursing diagnosis: impaired social interaction related to excessive neuronal activity as evidenced by aggression and demanding behavior with others. Which finding indicates the plan of care was effective? The child: a. has an improved ability to identify anxiety and use self-control strategies. b. has increased expressiveness in communication with others. c. shows increased responsiveness to authority figures. d. engages in cooperative play with other children.

d. engages in cooperative play with other children. The goal should be directly related to the defining characteristics of the nursing diagnosis, in this case, improvement in the childs aggressiveness and play. The distracters are more relevant for a child with autism spectrum or anxiety disorder.