Chapter 11: Childhood and Neurodevelopmental Disorders

The child prescribed an antipsychotic medication to manage violent behavior is one most likely diagnosed with what disorder? A. attention deficit hyperactivity disorder (ADHD). B. posttraumatic stress disorder (PTSD). C. communication disorder. D. an anxiety disorder.

ANS: A Antipsychotic medication is useful for managing aggressive or violent behavior in some children diagnosed with ADHD. 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.

A child diagnosed with attention deficit hyperactivity disorder (ADHD) will begin medication therapy. thenurse should prepare a plan to teach thefamily about which classification of medications? A. CNS stimulants B. Tricyclic antidepressants C. Antipsychotics D. Anxiolytics

ANS: A CNS stimulants, such as methylphenidate and pemoline, increase blood flow to thebrain and have proved helpful in reducing hyperactivity in children and adolescents with ADHD. theother medication categories listed would not be appropriate.

Which nursing diagnosis is universally applicable for children diagnosed with autism spectrum disorders? a. Impaired social interaction related to difficulty maintaining relationships 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

ANS: A 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.

Which assessment finding would cause thenurse to consider a child to be most at risk for thedevelopment of mental illness? A. The child has been raised by a parent with recurring major depressive disorder. B. The child's best friend was absent from thechild's birthday party. C. The child was not promoted to thenext grade one year. D. The child moved to three new homes over a 2-year period.

ANS: A 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. thechronicity of theparent's depression means it has been a consistent stressor. theother factors are not as risk-enhancing.

A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. thechild formed a trusting relationship with a shelter volunteer. thechild says, ―My three friends and I got an A on our school science project.‖ thenurse can assess that thechild demonstrating what? a.resiliency. b.a passive temperament. c.at risk for post-traumatic stress disorder (PTSD). d.intellectualization to deal with problems.

ANS: A Resiliency enables a child to handle thestresses of a difficult childhood. Resilient children can adapt to changes in theenvironment, take advantage of nurturing relationships with adults other than parents, distance themselves from emotional chaos occurring within thefamily, learn, and use problem-solving skills.

Soon after parents announced they were divorcing, a child stopped participating in sports, sat alone at lunch, and avoided former friends. thechild told theschool nurse, ―If my parents loved me, they would work out their problems.‖ Which nursing diagnosis has thehighest priority? A. Social isolation B. Decisional conflict C. Chronic low self-esteem D. Disturbed personal identity

ANS: A This child shows difficulty coping with problems associated with thefamily. Social isolation refers to aloneness that thepatient perceives negatively, even when self-imposed. theother options are not supported by data in thescenario.

Which assessment findings present familial risks for a child to develop a psychiatric disorder? (Select all that apply.) a.Having a mother diagnosed with schizophrenia b.Being theoldest child in a family c.Living with an alcoholic parent d.Being an only child e.Living in an urban community

ANS: A, C Familial risk factors that correlate with child psychiatric disorders include severe marital discord, low socioeconomic status, large families and overcrowding, parental criminality, maternal psychiatric disorders, and foster-care placement. Having a parent with a substance abuse problem increases therisk of marital discord. A family history of schizophrenia presents a genetic risk. Being in a middle-income family, living in an urban community, and being an only or oldest child do not represent adversity.

A child reports to theschool nurse of being verbally bullied by an aggressive classmate. What is thenurse's best first action? Give notice to the chief administrator at the school regarding the events. A. Encourage the victimized child to share feelings about the experience. B. Encourage the victimized child to ignore the bullying behavior. C. Discuss theevents with the aggressive classmate.

ANS: B The behaviors by thebullying child create emotional pain and present therisk for physical pain. Encouraging thevictimized child to share feelings about theexperience provides thenurse an opportunity to further assess thesituation as well as provide support to thechild. thenurse should validate thechild for reporting theevents. Later, school authorities should be notified.School administrators are themost appropriate personnel to deal with thebullying child. thebehavior should not be ignored; it will only get worse.

At thetime of a home visit, thenurse notices that each parent and child in a family has his or her own personal online communication device. Each member of thefamily is in a different area of thehome. Which nursing actions are appropriate? (Select all that apply.) a.Report thefinding to theofficial child protection social services agency. b.Educate all members of thefamily about potential safety risks in online environments. c.Talk with theparents about parental controls on thechildren's communication devices. d.Encourage thefamily to schedule daily time together without communication devices. e.Obtain thefamily's network password and examine online sites family members have visited.

ANS: B, C, D The nurse's focus is safety, including online environments. Education and awareness-based approaches are indicated to reduce therisks of potentially harmful behavior, including risks associated with cyberbullying. Parental controls on thechildren's 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 thechildren, so a report to child protective agency is unnecessary. It would be inappropriate to seek thefamily's network password and an invasion of privacy to inspect sites family members have visited.

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

ANS: B, D, E Some dated terminology contributes to thestigma of mental illness and misconceptions about mental illness. It is important for thenurse to use current terminology.

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 achieve what? A. integration of self-concept. B. inpatient treatment for the child. C. loneliness and increase self-esteem. D. language and communication skills.

ANS: C Because of their disruptive behaviors, children diagnosed with attention deficit hyperactivity disorder (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.

A nurse will prepare teaching materials for the parents of a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Information will focus on which medication likely to be prescribed?a. Paroxetine b. Imipraminec. Methylphenidate d. Carbamazepine

ANS: C Central nervous system (CNS) stimulants are the drugs of choice for treating children diagnosed with ADHD. Methylphenidate and mixed amphetamine salts are most commonly used. None of the other drugs are psychostimulants used to treat ADHD.

When group therapy is prescribed as a treatment modality, thenurse would suggest placement of a 9-year-old in a group that uses what strategy? A. guided imagery. B. talk focused on a specific issue. C. play and talk about a play activity. D. group discussion about selected topics.

ANS: C Group therapy for young children takes theform of play. For elementary school children, therapy combines play and talk about theactivity. For adolescents, group therapy involves more talking.

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

ANS: C Holding the hand of another person suggests relatedness. Usually, a child diagnosed with an autism spectrum disorder would resist holding someone's 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 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 B. Simple restitution C. Social skills group D. Insight-oriented group therapy

ANS: C 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.

A child diagnosed with attention deficit hyperactivity disorder (ADHD) shows hyperactivity, aggression, and impaired play. thehealth care provider prescribed amphetamine salts. thenurse 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

ANS: C The goal is improvement in thechild's hyperactivity, aggression, and play. theremaining options are more relevant for a child with intellectual development disorder or an anxiety disorder.

What is the nurse's priority focused assessment for side effects in a child taking methylphenidate 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

ANS: C 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 child's growth and development. The distracters relate to side effects of conventional antipsychotic medications.

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 thenurse document these behaviors? a. Disobedience b. Hyperactivity c. Impulsivity d. Anxiety

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

The parent of a child diagnosed with Tourette's disorder says to thenurse, ―I think my child is faking thetics because they come and go.‖ Which response by thenurse is accurate? ―Perhaps your child was misdiagnosed.‖ ―Your observation indicates themedication is effective.‖ ―Tics often change frequency or severity. That doesn't mean they aren't real.‖ ―This finding is unexpected. How have you been administering your child'smedication?‖

ANS: C Tics are sudden, rapid, involuntary, repetitive movements or vocalizations characteristic of Tourette's disorder. They often fluctuate in frequency, severity, and are reduced or absent during sleep

When a 5-year-old is disruptive, thenurse says, ―You must take a time-out.‖ theexpectation is that thechild will do what? A.go to a quiet room until called for thenext activity. B. slowly count to 20 before returning to thegroup activity. C. sit on theedge of theactivity until able to regain self-control. D. sit quietly on thelap of a staff member until able to apologize for thebehavior.

ANS: C 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 theperiphery of an activity until thechild gains self- control and reviews theepisode 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.

A nurse works with a child who is sad and irritable because thechild's 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 thestrengths increases a person's self-esteem. C. Acceptance and trust convey feelings of security to thechild. D. The child should express feelings rather than internalize them.

ANS: C Trust is frequently an issue because thechild may question their trusting relationship with theparents. In this situation, thetrust thechild once had in parents has been disrupted, reducing feelings of security. thecorrect answer is themost global response.

A nurse prepares theplan of care for a 15-year-old diagnosed with moderate intellectual developmental disorder. What are thehighest outcomes that are realistic for this patient? Within 5 years, thepatient 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 thecommunity.

ANS: C, D, E Individuals with moderate intellectual developmental disorder progress academically to about thesecond grade. These people can learn to travel in familiar areas and perform unskilled or semiskilled work. With supervision, theperson can function in thecommunity, but independent living is not likely.

A nurse assesses a 3-year-old diagnosed with an autism spectrum disorder. Which finding is most associated with thechild's disorder? A. has occasional toileting accidents. B. interrupts or intrudes on others. C. cries when separated from a parent. D. continuously rocks in place for 30 minutes.

ANS: D 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. Occasional toileting accidents and crying when separated from a parents are expected findings for a 3-year-old. Interrupting or intruding on others are assessment findings associated with ADHD.

The parent of a 6-year-old says, ―My child is in constant motion and talks all the time. My child isn't interested in toys but is out of bed every morning before me.‖ The child's behavior is most consistent with diagnostic criteria for which disorder? A. communication disorder. B. stereotypic movement disorder. C. intellectual development disorder. D. attention deficit hyperactivity disorder (ADHD).

ANS: D Excessive motion, distractibility, and excessive talkativeness are seen in ADHD. The behaviors presented in the scenario do not suggest intellectual development, stereotypic, or communication disorder.

Which child demonstrates behaviors indicative of a neurodevelopmental disorder? A. A 4-year-old who stuttered for 3 weeks after thebirth 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

ANS: D Symptoms consistent with autistic spectrum disorders (ASD) are evident in thecorrect answer. ASD is one type of neurodevelopmental disorder. thebehaviors of theother children are within normal ranges.

A 4-year-old cries for 5 minutes when theparents leave thechild at preschool. theparents ask thenurse, ―What should we do?‖ What is thenurse's best response? ―Ask theteacher to let thechild call you at play time.‖ ―Withdraw thechild from preschool until maturity increases.‖ ―Remain with your child for thefirst hour of preschool time.‖ ―Give your child a kiss before you leave thepreschool program.‖

ANS: D The child demonstrates age-appropriate behavior for a 4-year-old. thenurse should reassure theparents. thedistracters are over-reactions.

A child diagnosed with attention deficit hyperactivity disorder (ADHD) 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? 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.

ANS: D The goal should be directly related to the defining characteristics of the nursing diagnosis, in this case, improvement in the child's aggressiveness and play. The distracters are more relevant for a child with autism spectrum or anxiety disorder.

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 nurse's 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.

ANS: D 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.