ADHD
a,b,d,e (Rationale The three required findings for a diagnosis of ADHD are limited attention span, an inability to stay on an assigned task, and excessive motor activity with the inability to sit still for more than a few minutes. Clients with ADHD are frequently labeled as poor achievers with difficulty learning. Conduct disorder would be suspected in a client who deliberately destroys other people's property.)
A parents group asks the nurse what they would look for if they suspected their child has attention-deficit/hyperactivity disorder (ADHD). Which observations would the nurse have the parents report for further assessment? Select all that apply. a Having difficulty with learning at school b Inability to stay on an assigned task to completion c Deliberately destroys other people's property d Limited attention span when speaking with parent e Excessive motor activity
b,e (Rationale: Studies have linked smoking and alcohol consumption during pregnancy to the development of ADHD in the child. Pre-term delivery is associated with ADHD. A lack of folic acid intake puts the fetus at risk for neural tube disorders. A delivery by caesarean section does not put the child at risk for ADHD.)
A pregnant client asks the nurse about risk factors for her baby developing attention deficit hyperactivity disorder (ADHD). The nurse responds: (Select all that apply.) a "Caesarean section delivery" b "Mother smokes while pregnant." c "Lack of folic acid in pregnancy" d "Post-term delivery" e "Mother drinks alcohol during pregnancy."
d (Rationale Fatigue is common among parents of children with ADHD because of the high energy and needs of their children. The priority nursing diagnosis is alterations in family processes, as the parents appear to need more emotional support. Increased risk for injury is less of a problem, since the parents understand proper administration and management of the client's medication. Impaired socialization and low self-esteem are also lower priorities because the client seems happy about school and friends.)
An 8-year-old boy with attention-deficit/hyperactivity disorder (ADHD) arrives at the clinic for a well visit with his parents. The client's parents appear fatigued and argue with each other when answering questions about the client's home and school routine. The client talks happily about school and new friends he has made this year. The client has been taking methylphenidate (Ritalin) for the past year, and his parents verbalize proper administration and management of the medication. Which is the priority nursing diagnosis for this client? a Increased risk for injury b Potential for enhanced self-esteem c Impaired socialization d Alterations in family processes
c (Girls with ADHD typically show less aggression and impulsiveness than boys. Girls tend to show more anxiety, mood swings, social withdrawal, rejection, and cognitive and language problems.)
As compared with boys, girls with attention-deficit/hyperactivity disorder (ADHD) typically show less of which characteristic? a Mood swings b Cognitive problems c Impulsiveness d Anxiety
a (Rationale To date, there is no consistent evidence that elimination diets, dietary supplements, or herbs are effective in treating ADHD. Telling the client this in a factual, nonjudgmental manner is the best response. The nurse does not have the authority to change the client's treatment regimen without approval from the healthcare provider, even if the nurse tells the client to tell the provider about the change. Neither suggesting a new medication nor minimizing the client's concerns addresses the client's interest in alternative therapies and does not acknowledge the client's concerns.)
A 22-year-old client with attention-deficit/hyperactivity disorder (ADHD) is currently taking atomoxetine (Strattera).The client states, "I don't want to be dependent on medication my entire life. I've heard that cutting out sugar from my diet and taking ginkgo biloba might help my ADHD symptoms." Which is the best response by the nurse about complementary and alternative therapies for ADHD? a "These are popular alternative treatments, but scientific evidence does not consistently support their effectiveness." b "Why don't we ask your healthcare provider to prescribe a different medication instead of the one you're taking, if you're worried about it?" c "Taking medication isn't really that bad, especially since it is the only effective way to control your symptoms and let you live a normal life." d"You can replace your medication with these alternative treatments if you like, but be sure to tell your healthcare provider about them."
b,c,d (Rationale The nonstimulant medication Strattera is approved for use in adults. Stimulant medications such as Focalin are not approved for use in adults. Environmental modifications that decrease stimulation, such as maintaining a quiet environment and having an orderly work area, are beneficial to clients with ADHD. Having a structured routine is more helpful to clients with ADHD than a loose, flexible schedule.)
A 34-year-old client recently diagnosed with attention-deficit/hyperactivity disorder (ADHD) asks the nurse about treatment options. Which treatment options should the nurse describe? Select all that apply. a Allowing for a flexible schedule b Maintaining a quiet environment c Having an orderly work area d Prescribing nonstimulant medication atomoxetine (Strattera) e Prescribing stimulant medications such as dexmethylphenidate (Focalin)
b (To help Cole focus, his teachers should minimize environmental distractions and provide him with an orderly, uncluttered workspace. They should encourage therapeutic play for him to express his feelings. They should consistently reward all positive behaviors, not just one per day. The teachers should set a structured daily routine, and not allow Cole to set his own routine.)
Cole Greene is a 7-year-old boy with ADHD who is doing poorly in school. While his medication regimen is helping control his symptoms, he still has difficulty concentrating. Which intervention would the nurse suggest to Cole's teachers to help him focus in school? a Rewarding one positive behavior per day b Minimizing environmental distractions c Avoiding therapeutic play d Allowing Cole to set his own routine
a (Ms. Chiappe is likely to participate in high-risk activities because of the impulsivity associated with ADHD. She is also likely to have a limited attention span, engage in excessive talking, and be an underachiever at work.)
During a routine examination, Paola Chiappe, a 41-year-old woman, mentions that she has always had difficulty concentrating at work and asks whether there are any strategies to help her focus. While taking Ms. Chiappe's health history, the nurse suspects that the client has previously undiagnosed attention-deficit/hyperactivity disorder (ADHD). Which finding would the nurse most likely assess in Ms. Chiappe? a Participation in high-risk activities b Highly accomplished at work c Quiet demeanor d Good listening skills
d (Explaining that stimulants paradoxically improve focus and attention and do not increase hyperactivity most directly addresses Mrs. Fuller's concerns. Explaining the side effects of Strattera and Ritalin does not answer Mrs. Fuller's question. In addition, Lainey is being prescribed Ritalin because Strattera has been ineffective, not because it carries a greater suicide risk.)
Lainey Fuller, a 10-year-old girl with attention-deficit/hyperactivity disorder (ADHD), has been taking atomoxetine (Strattera) for the past 4 months. It has not improved her symptoms, so her healthcare provider is changing her prescription to methylphenidate (Ritalin). Lainey's mother asks, "Isn't Ritalin a stimulant? That doesn't make any sense. How is a stimulant going to help Lainey get better?" What is the nurse's best response? a "We will have to watch Lainey's growth carefully when she is taking Ritalin because stimulants can decrease the amount of height and weight she gains." b "Side effects with Strattera are less serious than with stimulants, but there is an increased risk of suicide in children taking Strattera, which is why we are making the switch." c "Stimulants like Ritalin will cause side effects like headache, increased heart rate, loss of appetite, and insomnia even when they are successful in treating ADHD." d "It does seem like the opposite of what should happen, but stimulants help improve focus and attention in children with ADHD and do not increase hyperactivity."
c (Rationale: Having family routines helps the child to know what to expect and to build a trusting relationship. The child should not be outside without supervision, and running around is likely to increase the child's level of excitation. Inviting other children over to play may provide too much stimulation and cause the child to be more hyperactive. Punishment for unwanted behavior may decrease the child's self-esteem. The family should concentrate on positive reinforcement when the child shows desired behaviors.)
The family of a child with attention deficit hyperactivity disorder tells the nurse the child's behavior at home is difficult to manage. The nurse teaches the family which technique to help manage the child at home? a Invite the neighborhood children over to play. b Put the child in the yard to exercise and run to tire the child. c Have routines for eating, sleeping, and recreation. d Punish unwanted behaviors.
a (Rationale: The child with ADHD has difficulty controlling impulses. A goal of treatment would be that the child's behavior is less impulsive. High energy is not necessarily a sign of ADHD or improving behavior. Sleeping on and off and fast speech are symptomatic of ADHD.)
The home health nurse is planning care for a child with attention deficit hyperactivity disorder (ADHD). Which child behavior would indicate progress toward the goal of increased self-esteem? a The child is able to control impulse behavior. b The child has high energy. c The child sleeps off and on at night. d The child speaks very quickly.
c (Rationale: Children with ADHD have difficulty completing tasks, fidget constantly, and often interrupt others. These symptoms are not seen in the other disorders mentioned.)
The nurse evaluates a child who demonstrates daydreaming, poor school performance, constant fidgeting, interrupting others, and mood swings. The child's speech development is age-appropriate. Which disorder would the nurse suspect? a Mental retardation b Depression c Attention deficit hyperactivity disorder (ADHD) d Autism
b,c,d,e (Rationale Risk factors for ADHD in children include improper parenting, exposure to high levels of lead, prenatal exposure to alcohol, and poor nutrition. Daily television exposure at ages 1-3 years, not limited exposure, is another risk factor of ADHD.)
The nurse is addressing a group of high-risk teen mothers. Which risk factors that can lead to attention-deficit/hyperactivity disorder (ADHD) in children would the nurse describe to the teen mothers? Select all that apply. a Limited television exposure at ages 1 -3 years b Lack of proper parenting c Poor nutrition d Exposure to high levels of lead in childhood e Drinking alcohol during pregnancy
b (Rationale As clients with ADHD age, physical hyperactivity tends to turn into verbal hyperactivity, which can manifest as excessive talking or constant interruptions. Physical hyperactivity such as constant fidgeting and squirming, and standing up in the middle of the health history interview is more commonly seen in children.)
The nurse is assessing an adult client with suspected attention-deficit/hyperactivity disorder (ADHD). Which finding would the nurse most likely observe? a Squirming in chair b Excessive talking c Stands up mid-interview d Fidgeting with hands or feet
b (Rationale Girls with ADHD tend to show less aggression and impulsiveness than boys with ADHD. However, girls show more anxiety, mood swings, social withdrawal, rejection, and cognitive and language problems. Girls are usually older, not younger, than boys at the time of diagnosis.)
The nurse is discussing a 13-year-old female client's recent diagnosis of attention-deficit/hyperactivity disorder (ADHD) with her parents. The client's mother states, "Our daughter has a male cousin who also has ADHD, but he doesn't act anything like her." How would the nurse best explain this difference to the client's parents? a "Girls with ADHD tend to show fewer language problems than boys with ADHD." b "Girls with ADHD tend to show less impulsiveness than boys with ADHD." c "Girls are usually younger than boys at the time of diagnosis." d "Girls with ADHD tend to show more aggression than boys with ADHD."
a (Rationale The nonstimulant medication atomoxetine (Strattera) is used in children over age 6, adolescents, and adults to control the symptoms of ADHD. Stimulants like dextroamphetamine and methylphenidate are approved for use in adults; however, there is a higher risk of adverse effects on the cardiovascular system. Guanfacine does not appear to be beneficial for adults with ADHD.)
The nurse is educating a 27-year-old client with attention-deficit/hyperactivity disorder (ADHD) who is taking ADHD medications. About which medication would the nurse most likely educate the client? a Atomoxetine (Strattera) b Dextroamphetamine (Adderall) c Guanfacine (Intuniv) d Methylphenidate (Ritalin)
c (Rationale Sleep disturbances are common in clients with ADHD, and a decrease in their frequency indicates successful treatment of the condition. Stating that ADHD is a "childish disease" displays a lack of understanding about the condition, which often persists into adulthood. Finishing the nurse's sentences indicates remaining problems with impulse control. Asking for a higher dosage of medication indicates ineffective pharmacologic treatment or medication abuse.)
The nurse is evaluating an adult client with attention-deficit/hyperactivity disorder (ADHD). Which observation indicates to the nurse that treatment has been successful? a The client confides that it is embarrassing to have a childish disease. b The client often finishes the nurse's sentences. c The client reports fewer sleep disturbances. d The client asks for a higher dosage of ADHD medication.
b (Rationale Text messaging is an age-appropriate social interaction for the client. While they can be distracting and cause the client to lose focus, the client did ask permission before responding, which indicates that the client is controlling impulsivity and inattentiveness. An inability to complete tasks and follow directions indicates that client goals have not been met. Excessive talking is another sign that client goals have not been met.)
The nurse is observing a 17-year-old client with attention-deficit/hyperactivity disorder (ADHD) at home. Which observation indicates to the nurse that client outcomes have been met? a The client talks incessantly, jumping from one topic to another. b The client receives several text messages from friends and does not respond until after asking permission to do so. c The client receives poor grades on homework for not completing assignments as requested. d The client folds half a basket of laundry and leaves the rest to read a magazine.
a (Rationale: A 4-year-old who is climbing trees is at risk for injury. While the other behaviors described by the mother are common symptoms of ADHD, they do not necessarily put the child at risk for injury.)
The nurse is planning care for a 4-year-old child with attention deficit hyperactivity disorder (ADHD). The nurse selects risk for injury as a nursing diagnosis based on which statement made by the client's parent? a "I found my child up at the top of a tree this week." b "My child seems to daydream a lot." c "My child doesn't listen very well to me." d "My child just never sits down anymore."
c,e (Rationale Many adult clients with ADHD have inattentiveness as their primary manifestation and do not have problems with hyperactivity or impulsivity. Appropriate goals for the client include achieving maximum work performance potential and completing tasks. The client does not have impulsivity problems, so remaining free from injury is not a priority. This client has a strong social network, so the client likely respects boundaries and interacts well with peers and family, rendering these goals unnecessary.)
The nurse is planning care for an adult client diagnosed with attention-deficit/hyperactivity disorder (ADHD). The client has a strong social network and does not display much impulsivity but has problems with inattentiveness. Which goal is the priority for the nurse to include in the plan of care? Select all that apply. a The client will demonstrate age-appropriate social interactions with peers and family. b The client will remain free of injury. c The client will be able to complete tasks. d The client will respect the boundaries of others. e The client will achieve work performance to maximum potential.
d (Rationale: Television has been shown to be over stimulating for the child with ADHD and should be limited and monitored. The other activities are typically helpful for a child with ADHD)
The nurse teaches a family about reducing stimulation for their child with attention deficit hyperactivity disorder (ADHD). Which activity will the nurse teach the family to limit? a Eating with the family b Playing with a sibling c Reading books d Watching television
a (Rationale: The child being evaluated for attention deficit hyperactivity disorder (ADHD) will have a history taken from pregnancy to current age, behavior history, and social and environmental conditions. A mental health specialist administers tests to the child. Laboratory studies, MRI imaging, and intelligence testing are not necessarily associated with the diagnostic process for ADHD.)
The parent of a 3-year-old child asks the nurse how attention deficit hyperactivity disorder would be made. The nurse tells the parent that a diagnosis is made by: a History and physical assessment b An MRI c An IQ test d Laboratory studies
c (Rationale: Atomoxetine is one of the first nonstimulant treatments for ADHD that decreases hyperactivity and impulsivity. Side effects are uncommon and transient. Methylphenidate and amphetamines are stimulants, and opioids are narcotics, which are central nervous system depressants.)
The physician is discussing medication administration with the family of a child diagnosed with attention deficit hyperactivity disorder (ADHD). Which nonstimulant drug does the nurse expect the physician to order? a Methylphenidate b Amphetamines c Atomoxetine d Opioids
c (Rationale A physical examination will rule out neurological diseases and other health problems that may mimic ADHD or affect its treatment. There are no physical characteristics of ADHD that can be found with a physical exam. ADHD is diagnosed from a careful psychosocial history and questionnaires. The nurse is equally as qualified as the healthcare provider to provide strategies to help the client focus. Other mental health issues are diagnosed by a mental health specialist using interviews and questionnaires, not a physical exam.)
The school nurse is arranging an appointment for a physical examination of an 11-year-old client recently diagnosed with attention-deficit/hyperactivity disorder (ADHD). The client's parent states, "Our child was evaluated at home and here at school, and now we have to make another appointment for a physical? Why?" Which is the best response by the nurse? a "We need to see whether your child has the physical characteristics that go along with the behaviors of ADHD to correctly diagnose ADHD." b "The healthcare provider will be able to give you better strategies for helping your child focus at home and at school." c "We need to rule out neurological diseases and other health problems in your child that may affect treatment of ADHD." d "The physical exam will find out whether your child has other mental health issues, such as depression, anxiety, learning disorder, or conduct disorder."
a (Rationale An appropriate behavioral goal for the client with ADHD is for the client to respect the boundaries of others. Because the client is a child, it is not appropriate to expect the client to manage medication administration. The client should demonstrate an increase, not decrease, in attentiveness. An appropriate goal is for the client to achieve school performance to maximum potential, not merely minimum competency.)
The school nurse is helping to create an individualized education plan (IEP) for a 12-year-old client with attention-deficit/hyperactivity disorder (ADHD). Which behavioral goal is appropriate to include in the plan of care? The client will respect the boundaries of others. The client will demonstrate a decrease in attentiveness. The client will achieve school performance to minimum competency. The client will accurately manage medication administration.
a (Rationale An appropriate behavioral goal for the client with ADHD is for the client to respect the boundaries of others. Because the client is a child, it is not appropriate to expect the client to manage medication administration. The client should demonstrate an increase, not decrease, in attentiveness. An appropriate goal is for the client to achieve school performance to maximum potential, not merely minimum competency.)
The school nurse is helping to create an individualized education plan (IEP) for a 12-year-old client with attention-deficit/hyperactivity disorder (ADHD). Which behavioral goal is appropriate to include in the plan of care? a The client will respect the boundaries of others. b The client will demonstrate a decrease in attentiveness. c The client will achieve school performance to minimum competency. d The client will accurately manage medication administration.
a (Clients with ADHD do best when they experience consistent limits and expectations. Decreasing stimulation, having a structured routine, and close classroom supervision can also help clients with ADHD concentrate and focus their attention.)
Which behavioral therapy can help improve quality of life for the client with ADHD? a Setting consistent limits b Loose classroom supervision c Having a flexible routine d Increasing stimulation
a,c,e (Encouraging therapeutic play, using time-outs, and promoting self-esteem are all appropriate nursing interventions for the young client with ADHD. Environmental stimulation should be minimized, not increased, and consequences for negative behaviors should be consistent, not varied.)
Which intervention is appropriate to include in the plan of care for a young client with attention-deficit/hyperactivity disorder (ADHD)? Select all that apply. a Encouraging therapeutic play b Increasing environmental stimulation c Using time-outs d Varying consequences for negative behaviors e Promoting self-esteem
a,c,e (Rationale Children with ADHD do best with structured and consistent routines, which include maintaining a consistent time and routine for bedtime and praising all positive behaviors. Reducing environmental stimuli by turning off the television will also help the child with ADHD. To reduce stimulant abuse, "drug holidays" during weekends and school breaks, when the child does not take medication, can be discussed with the healthcare provider. Like positive behaviors, all negative behaviors should have consistent consequences, not just the worst ones.)
Which interventions should the nurse teach to the parents of a school-age child with attention-deficit/hyperactivity disorder (ADHD)? Select all that apply. a Turning off the television when client is doing homework b Not asking the healthcare provider to provide "drug holidays" c Maintaining a consistent bedtime routine and time d Giving time-outs only for the worst negative behaviors e Praising all positive behaviors
a,c,d (Attention-deficit hyperactivity disorder (ADHD) is characterized by inattention, hyperactivity, and impulsivity. Exposure to excess lead can contribute to the development of ADHD. There is a strong link between heredity and the development of ADHD. Thirty to seventy percent of ADHD cases persist into adulthood. Hyperactivity and impulsivity often improve as the client gets older, with inattentiveness becoming the most persistent characteristic in adults. Some children with ADHD have a deficit in dopamine and norepinephrine, not acetylcholine.)
Which is a characteristic of attention-deficit/hyperactivity disorder (ADHD)? Select all that apply. a Linked to heredity b Impulsivity is a persistent characteristic in adults c Linked to exposure to excess lead d Often persists into adulthood e Some children have a deficit in acetylcholine in the brain
b (Insomnia is a side effect of stimulants used as medication for children with ADHD. Irritability, stomach pain, and constipation are common side effects of guanfacine extended release (Intuniv), a nonstimulant medication that helps control attention and impulsivity in children with ADHD.)
Which is a side effect of stimulants used as medication for children with ADHD? a Constipation b Insomnia c Stomach pain d Irritability
a (Rationale Teenagers may have problems with their self-esteem, due to the difficulties with academics and relationships caused by ADHD. There should be consequences for low grades, but the nurse's effort should go toward assisting the client to be successful. Parents need to be supported by healthcare providers as they identify problems and seek assistance to define the best solutions for the client. Clients with ADHD perform best when in an environment with the fewest distractions.)
Which is the best intervention for the nurse to implement when caring for a 16-year-old client with attention-deficit/hyperactivity disorder (ADHD)? a Provide opportunities to increase self-esteem. b Allow the client to study in a family room with the television on. c Initiate negative consequences for low academic scores. d Allow the parents to work out problems on their own.
a (The client with ADHD is at increased risk for injury, because the impulsivity and inattentiveness seen with this disorder are risk factors for antisocial behavior, substance abuse, and serious accidents. Alterations in physical mobility, increased risk for chronic pain, and alterations in growth and development are not appropriate nursing diagnoses for clients with ADHD.)
Which is the priority nursing diagnosis for a client with ADHD? a Increased risk for injury b Alterations in physical mobility c Increased risk for chronic pain d Alterations in growth and development
d (The client best demonstrates improved socialization by respecting the boundaries of others. The other observations indicate that some potential safety problem has been addressed.)
Which observation by the nurse best indicates that a client with attention-deficit/hyperactivity disorder (ADHD) has addressed the potential problem of impaired socialization? a The client demonstrates a decrease in sleep disturbance. b The client is free of injury. c The client accurately manages medication administration. d The client respects the boundaries of others.
a,d,e (Hyperactivity, impulsivity, and inattentiveness in the client with ADHD often manifest as excessive talking and interruption of others. Because of these disruptive behaviors, clients with ADHD are also often ostracized by their peer group and have low self-esteem. ADHD can cause difficulty at school and work, so clients are often viewed as underachievers, not overachievers.)
Which psychosocial history consideration is relevant to a client with ADHD? Select all that apply. a Ostracized by peer group b Viewed as overachiever c High self-esteem d Excessive talking e Interrupts others
a (Sleep disturbances are common in children with ADHD. Arthur is likely to have difficulty completing tasks and maintaining friendships with other children. His social isolation and poor performance in school are likely to lead to poor, not high, self-esteem.)
While taking an assessment of Arthur Kim, a 12-year-old boy, Arthur tells the nurse that he is getting bad grades at school, and he repeatedly interrupts to talk about his favorite character from a new movie. The nurse suspects that Arthur might have attention-deficit/hyperactivity disorder (ADHD). Which other finding would the nurse expect when questioning the father about Arthur's behavior? a Sleep disturbances b Ease in completing tasks c High self-esteem d Strong friendships with other children