Ch. 36 Childhood/Adolescence Mental Health DOs

A nurse is assessing a child diagnosed with attention deficit hyperactivity disorder. Which of the following would the nurse expect the parents to report? "He is very methodical when he is working on something." "He likes to focus his attention on one thing at a time." "He just doesn't seem to want to sit still, ever!" "He is always so sad all of the time."

"He just doesn't seem to want to sit still, ever!"

A nurse is seeing an adolescent with a diagnosis of conduct disorder for the first time to establish goals for treatment. During the first meeting, the adolescent yells a profanity at the nurse and states, "This is pointless." What is the nurse's best response? "We can't begin this work until you feel invested in it." "Now is not a good time. Maybe we can meet another day?" "I want to continue to work with you but I don't accept the language you have chosen." "I am concerned that you are going to act out right now."

"I want to continue to work with you but I don't accept the language you have chosen."

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

"It must be difficult to handle your son at home."

A 14-year-old client is being treated for conduct disorder. The client refuses to attend class today, stating that yesterday the other nurse told the client that the client did not have to go to class if the client did not want to. Which would be the best response by the nurse? "Fine, but you're confined to your room." "Why do you keep fighting the system?" "You and I both know you're lying." "Missing class is against the rules."

"Missing class is against the rules."

After completing a series of parent training sessions with parents of an 8-year-old client with oppositional defiant disorder, the child's mother calls the nurse with concerns. The mother states, "What you taught us isn't working. Can you please talk to my child about his behavior?" Which is the nurse's most effective response? "Tell me how you have been using negotiation when limit setting with your child." "Please tell me more about what you are having difficulty with." "Please bring your child to my office for another session." "I can meet with your child individually at the school counseling office."

"Please tell me more about what you are having difficulty with."

A 10-year-old child with Tourette's disorder is receiving haloperidol as part of his treatment plan. When assessing the child at a follow up visit, which statement by the child would lead the nurse to suspect that he is experiencing a side effect of the drug? "I'm eating about the same amount as before." "My muscles seem pretty flexible lately." "Sometimes I feel like I'm so sleepy." "I think I'm much more alert with this drug."

"Sometimes I feel like I'm so sleepy."

The nurse is using limit setting with a child diagnosed with conduct disorder. Which statement reflects the most effective way for the nurse to set limits with the child? "Why do you do these things?' "That is not allowed here. You will lose a privilege. You need to stop." "I would appreciate if you would not do that." "Stop what you are doing. Go to your room."

"That is not allowed here. You will lose a privilege. You need to stop."

After educating the parents of a child diagnosed with ADHD on the disorder and its treatment, the nurse determines that the education has been effective when the parents state which of the following? "We should set up regular routines for him, but not worry if he violates the limits once in a while." "We need to be careful so he doesn't develop a substance abuse problem as he grows older." "We need to remember that our son is not a bad kid; he just has difficulty with impulse control and attention." "We should stop the medication after two months to see how effective it is in really controlling his symptoms."

"We need to remember that our son is not a bad kid; he just has difficulty with impulse control and attention."

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

"We'll have him do his homework at the kitchen table with his brothers and sisters."

A child with attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate. The parent reports that the child is having trouble sleeping. When assessing this report, which question would be most appropriate for the nurse to ask? "Is the child taking any over-the-counter medications?" "When does the child take the last dose of medication?" "Are you crushing the sustained release tablet?" "Is the child having any other complaints?"

"When does the child take the last dose of medication?"

Assessment of an 8-year-old client reveals communication difficulties and an inability to manage age-appropriate tasks. The child undergoes standardized testing. An intelligent quotient (IQ) of which would support a diagnosis of intellectual disability? 85 95 75 65

65

Which of the following should be included in the education plan for a client receiving methylphenidate? There is no risk of dependence. Adverse effects include hypertension and nervousness. The medication is usually taken after 5 p.m. Alcohol may be used in moderation.

Adverse effects include hypertension and nervousness.

Which of the following statements is true regarding the use of pharmacologic agents in children with anxiety disorders? Behavioral therapy, including imagery, self-talk, and cognitive techniques, is ineffective without the adjunctive use of pharmacologic agents. Anxiolytics and selective serotonin reuptake inhibitors (SSRIs) have been shown to help reduce anxiety. Mood-stabilizing medications, including lithium, divalproex (Depakote), and carbamazepine (Tegretol), are used for their calming and antiaggressive effects. The use of pharmacologic agents is discouraged in children because of addictive or suicidal potential.

Anxiolytics and selective serotonin reuptake inhibitors (SSRIs) have been shown to help reduce anxiety.

A nurse is providing care to a child with Tourette's disorder. Which medication would the nurse expect to be prescribed as treatment? Aripiprazole Haloperidol Clonidine Pimozide

Aripiprazole

Which is an effective way for parents to deal with problem behaviors in children and to prevent later development of conduct disorders? Attending group-based parenting classes Administering medications Avoiding setting limits Being overprotective of the child

Attending group-based parenting classes

A 14-year-old is diagnosed with depression. Which finding would the nurse most likely assess? Select all that apply. Talking openly about feelings of sadness Being verbally abusive to the staff Using a plastic knife to draw blood Consistently reacting to any criticism by withdrawing Having difficulty falling and staying sleeping

Being verbally abusive to the staff Using a plastic knife to draw blood Consistently reacting to any criticism by withdrawing Having difficulty falling and staying sleeping

When working with children with neurodevelopmental disorders, which would be appropriate? Building on the child's strength Criticizing the child's behavior Avoiding the use of visual cues Maintaining an unstructured environment

Building on the child's strength

A nurse is developing a presentation for an adolescent community group on mental health and illness, focusing on mood disorders. Which of the following would the nurse most likely include as a major mental health issue in adolescents? Dysthymia Bipolar II Depression Bipolar I

Depression

Which of the following are parental disorders associated with the development of separation anxiety in the child? Select all that apply. Attention deficit hyperactivity disorder (ADHD) Anxiety Schizophrenia Depression

Depression

Which is likely to be most effective for adolescents with conduct disorder? Focusing on the parenting education Involvement with the legal system Incarceration Early intervention

Early intervention

A nurse asks an assigned client, "How are you doing today?" The client responds with "doing today, doing today, doing today." This is an example of which of the following speech pattern disturbances? Selective mutism Stereotypic movement disorder Echolalia Reactive attachment disorder

Echolalia

A health care provider in an outpatient clinic has prescribed fluoxetine (Prozac) to a client with intermittent explosive disorder. What should the nurse include in teaching about this medication? Inform the client appetite loss is a side effect that will persist throughout treatment. Tell the client to stop taking the medication if the client experiences drowsiness. Emphasize the need to seek medical help if suicidal thoughts arise. Remind the client it is uncommon to experience sleep changes with this medication.

Emphasize the need to seek medical help if suicidal thoughts arise.

When developing the plan of care for the family of a child with a neurodevelopmental disorder, which of the following would be least appropriate to include? Modeling appropriate behavior modification techniques Excluding the parents from being included in the plan of care Assisting the family in resolving their sense of loss Helping to coordinate support systems for the family.

Excluding the parents from being included in the plan of care

Which steps are involved in limit setting? Select all that apply. Explain the consequences if clients exceed the limit. State expected behavior. Threaten incarceration. Occasionally limit enforcement. Inform clients or the rule or limit.

Explain the consequences if clients exceed the limit. State expected behavior. Inform clients or the rule or limit.

The parents of a toddler are distraught that he has been diagnosed with autism spectrum disorder. When providing teaching for the child's parents, which of the following would the nurse need to bear in mind about the etiology of this disorder? Higher levels of antioxidants have been found in individuals with this disorder Expression of multiple genes involved with neurogenesis seem to play a role. Lower levels of mercury are associated with this disorder. Lower levels of lead have been found to be linked to autism spectrum disorder

Expression of multiple genes involved with neurogenesis seem to play a role.

Brain images of people with ADHD have suggested decreased metabolism in which of the following cerebral lobes? Temporal Frontal Occipital Parietal

Frontal

When attention deficit hyperactivity disorder (ADHD) is present, the child will most likely exhibit which core symptoms? Overly friendly, able to follow directions, impulsive, and active Affective disturbances, autism, psychosis, and excessive talkativeness Quiet, impulsive, excessively attentive, and psychotic Highly distractible, excitable, impulsive, and excessively active

Highly distractible, excitable, impulsive, and excessively active

A nurse is conducting a presentation about autism spectrum disorder for a group of parents. When describing this condition, the nurse would identify that approximately 50% of those with this condition also experience which of the following? Motor decline Seizure disorder Hypertension Intellectual disability

Intellectual disability

Which is true of the time-out strategy that may be used for persons with conduct disorder? It should only be used as a last resort. It is a punishment. It is not a permanent solution; eventually, the goal is for the client to avoid time-out. It is retreat to a neutral place, so clients can regain self-control.

It is retreat to a neutral place, so clients can regain self-control.

After educating a group of students on attention deficit hyperactivity disorder (ADHD), the instructor determines that additional education is required when the group identifies which as a typical characteristic? Hyperactivity Inattention Language difficulty Impulsiveness

Language difficulty

ADHD is characterized by inattentiveness, overactivity, and impulsiveness. Which of the following would the nurse identify related to inattentiveness? Fidgeting Interrupting Missing details Talking excessively

Missing details

When teaching a child with ADHD and parents about the prescribed psychostimulant therapy, the nurse integrates understanding about the drug's action. Which neurotransmitter would the nurse identify as being enhanced? Select all that apply. GABA Norepinephrine Epinephrine Serotonin Dopamine

Norepinephrine Dopamine

The nurse is counseling a family whose child has autism. When describing this condition, which would the nurse most likely include? Connection to ineffective parental practices Onset before child is 2.5 years old Girls are more frequently affected than boys Detection after the child enters school

Onset before child is 2.5 years old

The nurse is meeting with a family of a client with conduct disorder. The nurse discusses changes the parents can make to help their child change problematic behaviors. Which parenting technique would the nurse encourage the parents to use? Provide consistent consequences for behaviors. Release the child from household responsibilities until the child can demonstrate dependable behavior. Set earlier curfews than the child's peers adhere to. Avoid discussing feelings and expectations with the child.

Provide consistent consequences for behaviors.

An 8-year-old boy has been diagnosed with ADHD. His mother is shocked that he will be prescribed a psychostimulant, stating, "His whole problem is that he's too stimulated, not understimulated!" Which of the following facts should underlie the nurse's response to the mother? Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior. Psychostimulants are a form of aversion therapy in which the child becomes uncomfortable with overstimulation. Brain stimulation is inversely proportionate to motor stimulation. Controlled, medication-induced stimulation helps children become more comfortable and functional during times of high stimulation.

Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior.

A child with an existing diagnosis of attention deficit hyperactivity disorder shows signs and symptoms of depression. Which would most likely be prescribed? Tricylic antidepressant Monoamine oxidase inhibitor Mood stabilizer Selective serotonin and norepinephrine reuptake inhibitor (SSNRI)

Selective serotonin and norepinephrine reuptake inhibitor (SSNRI)

A 15-year-old boy being treated for depression will most likely be given which of the following first-line pharmacologic treatments? Tricyclic antidepressants Benzodiazepines Serotonin reuptake inhibitors Monoamine oxidase inhibitors

Serotonin reuptake inhibitors

When assisting the parents of a child diagnosed with ADHD, which of the following would the nurse suggest? Select all that apply. Set clear limits with consequences Keep to regular routines Provide extensive explanations Let him work on several things at once Maintain a calm environment

Set clear limits with consequences Keep to regular routines Maintain a calm environment

The parents of a child with attention deficit hyperactivity disorder (ADHD) bring the child for a follow-up visit. During the visit, they tell the nurse that the child receives the first dose of methylphenidate at about 7:30 a.m. every morning before leaving for school. The teacher and school nurse have noticed a return in the child's overactivity and distractibility just before lunch. The child's second dose is scheduled for about 12 p.m. Which might the nurse suggest as a possible solution to control the child's symptoms a bit more effectively? Switch to another class of medication. Split the early morning dose in half. Switch to a longer-acting preparation. Give the second dose at 1 p.m. or later.

Switch to a longer-acting preparation.

The mother of a 6-year-old boy reports that the child has had increasing somatic complaints that have no physical basis and disappear when he is allowed to remain home from school. The nurse should suspect what? The child has a school phobia. The child has ADHD. The child has a developmental disorder. The child has oppositional defiant disorder.

The child has a school phobia.

The client is 6-year-old who has been diagnosed with autism spectrum disorder. Which symptom would the client display? The client becomes overly attached to those around the client. The client spends time alone with little interest in making friends. The client has an irresistible urge to pull out the client's own hair. The client has multiple motor tics and several vocal tics.

The client spends time alone with little interest in making friends.

The nurse is assessing an adolescent client. The father is in the room and answers most of the questions, even though the questions are directed at the client. Which actions from the parents of a child with conduct disorders may contribute to the problems of the child? Select all that apply. The parents may not behave appropriately themselves because of a lack of knowledge. The parents make reasonable curfews that are appropriate for the age of the client. The parents engage in yelling at, hitting, or simply ignoring the behavior of their child. The parents establish household responsibilities that are appropriate for the age of the client. The parents blame the school when the child causes a disturbance in school and receives detention.

The parents may not behave appropriately themselves because of a lack of knowledge. The parents engage in yelling at, hitting, or simply ignoring the behavior of their child. The parents blame the school when the child causes a disturbance in school and receives detention.

Which of the following conditions is characterized by multiple motor tics and one or more vocal tics many times throughout the day for 1 year or more? Intellectual disability Autism spectrum disorder Tourette's syndrome Attention deficit hyperactivity disorder

Tourette's syndrome

Which of the following statements reflects accurately the effects of childhood mental illness? A child with mental illness may have a difficult time in adulthood, but siblings without mental illness typically are unaffected. Children with depression frequently outgrow their mood disorder after the trials of adolescence and young adulthood are over. Approximately 20% of children with conduct disorder become antisocial adults. Untreated mental illness in childhood often results in long-term mental illness in adults.

Untreated mental illness in childhood often results in long-term mental illness in adults.

A child with ADHD is being placed on the Restricted Elimination Diet. After teaching the mother about this diet, which food choice if selected by the mother would indicate that the teaching was successful? Water Cheese Gluten-free grains Beans Beef

Water Gluten-free grains Beans

A client has been referred to a mental health center by a juvenile court after being arrested for vandalism. At the mental health center, the client refuses to participate in scheduled activities. The client was seen pushing another client, causing the person to fall. Which approach by nursing staff would be most therapeutic? offering rewards in advance coaxing to gain compliance neutrally permitting refusals establishing firm limits

establishing firm limits

A nurse is working with an adolescent client with a diagnosis of conduct disorder. The nurse is helping the client reflect on a situation in which the client became aggressive and asks how the client could have handled it differently. The nurse is employing which intervention? improving coping skills and self-esteem promoting social interaction providing client education increasing treatment compliance

improving coping skills and self-esteem

The nurse is conducting a health history of a 35-year-old male client with a history of intermittent explosive disorder, diagnosed in adolescence. The nurse should include an assessment of which health issue? hearing loss obesity blood disorders increased blood pressure

increased blood pressure

When providing education to a client with intermittent explosive disorder, the nurse explains that antidepressant medications can be effective in the treatment of the condition because they: can replace the need for cognitive behavioral therapy. promote balancing of serotonin. provide sedation during explosive episodes. help to improve loss of appetite.

promote balancing of serotonin.

When a young client is disruptive, the nurse responds, "You must take a time-out." What is the expectation of a client during a time-out? to go to his or her room until called for the next meal to sit quietly on the lap of one of the staff members to sit in a designated place until able to regain self-control and review the episode to slowly count to 20 before returning to the group

to sit in a designated place until able to regain self-control and review the episode