Ch. 37: Mental Health Disorders of Childhood and Adolescence

A child with attention deficit hyperactivity disorder is taking methylphenidate (Ritalin) in divided doses. If the child takes the first dose at 8 AM, the school nurse might expect to see which behavior occurring around noontime?

increased impulsivity or hyperactive behavior

The nurse is educating a pregnant client about prenatal care and the potential for decreasing the risk for conduct disorder. The client presently has a child with a conduct disorder and is concerned that this will happen again. Which statement made by the client indicates further education is required?

"As long as I only have a beer or two a couple of times a week, my unborn child will be ok."

Which of the following should be included in the education plan for a client receiving methylphenidate?

Adverse effects include hypertension and nervousness.

A psychiatric-mental health nurse is teaching a parent of a child diagnosed with conduct disorder. Which statement made by the parent indicates a need for further teaching?

"I will suppress my problems and not burden others with what I am going through."

The nurse is talking with an adolescent client who has been externalizing behaviors indicating a conduct disorder. Which client statement(s) indicate that externalizing behaviors are being experienced?

"I got caught cheating on an exam. I cheat all of the time, why should I study?" "I set fire to a trash can on school property when I threw my cigarette in it." "When I get dropped off at school, I skip and go drink with my friends."

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?

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

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?

"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?

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

Which statement by the nurse demonstrates an understanding of the importance of keeping negative emotions from interfering with care provided to aggressive clients?

"Talking with other staff helps."

A nurse is assessing a child who is suspected of having attention deficit hyperactivity disorder (ADHD). The parents ask about what actions the child may display. What statement(s) would the nurse provide? Select all that apply.

"The child is restless and can't sit still." "There is difficulty completing a task regardless of how simple." "The child has risk-taking behavior."

A nurse is providing care to a child with Tourette disorder. In teaching the parent about the disorder and treatment, what will the nurse teach about the medication?

"The condition is treated with atypical antipsychotic medication."

The nurse is having a group activity in the day room with adolescent clients with behavioral issues. One of the clients becomes angry and picks up someone else's project and throws it on the floor, breaking it. Which response by the nurse is most appropriate?

"Throwing things is unacceptable behavior. Tell me why you are upset and let's talk about it."

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

Which of the following statements would indicate that medication teaching for the parents of a 6-year-old child with attention deficit hyperactivity disorder (ADHD) has been effective?

"We'll be sure to record his weight on a weekly basis."

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?

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

Which statement, made by the parent of a teen diagnosed with conduct disorder, demonstrates effective parenting?

"You will lose your driving privileges for a week if you don't clean your room today."

When describing intellectual disability to a group of parents, a nurse would identify which intelligent quotient (or less) as the usual threshold?

70

A nurse is providing care to a group of preschool and school-aged children. Based on the nurse's understanding about separation anxiety disorder. the nurse would expect the condition to initially appear in children of which age?

7—9 years

Which of the following statements is true regarding the use of pharmacologic agents in children with anxiety disorders?

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

A child is diagnosed with attention deficit hyperactivity disorder and is to receive pharmacologic therapy. Which of the following would the nurse expect to be prescribed as a first line agent?

Atomoxetine The first-line recommended medications for ADHD symptoms are the psychostimulants and atomoxetine (Strattera). It is not unusual for two psychostimulants or a psychostimulant and atomoxetine to be prescribed together for maximum response. Second-line medications include bupropion (Wellbutrin) and other antidepressants (tricyclic antidepressants [TCAs]). Then, if symptoms are not improved, alpha agonists (guanfacine or clonidine) are usually used.

Parents of a child who has behavioral problems ask the nurse which is the most effective way to deal with these behaviors and prevent them in their other children. Which is the best response by the nurse?

Attending group-based parenting classes

The nurse is caring for a child with a neurodevelopmental disorder. Which action will the nurse perform to assist the child with achieving developemental stages?

Building on the child's strengths instead of focusing on areas for improvement

A child is expelled from school for repeated fighting and vandalizing school property. The school nurse and counselor meet with the parents to explain that the child may benefit from counseling and are formulating a collaborative plan. The child is experiencing signs of which disorder?

Conduct disorder

A nurse working with an adolescent client diagnosed with disruptive behavior disorder is developing a plan of care to improve outcomes. Which nursing action best supports the use of problem-solving therapy?

Consider alternative approaches based on their individual merits.

A 14-year-old is diagnosed with depression. Which finding would the nurse most likely assess? Select all that apply.

Consistently reacting to any criticism by withdrawing Having difficulty falling and staying sleeping Using a plastic knife to draw blood

A nurse is assessing a child suspected of having autism spectrum disorder. Which behavior(s) assessed by the nurse correlates with this diagnosis? Select all that apply.

Echolalia Delayed language skills

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 and was observed pushing another client. Which action by the nurse is the most therapeutic?

Establishing firm limits

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?

Excluding the parents from being included in the plan of care

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

Frontal

After teaching a group of nursing students about intellectual disability, the instructor determines that the teaching was successful when the students identify which as the most common etiology?

Genetic syndromes

A nurse is teaching a child with ADHD and his parents about the prescribed atomoxetine. The nurse determines that the education was successful when they identify which as an adverse effect of the drug? Select all that apply.

Headache Vomiting Somnolence

A child with attention deficit hyperactivity disorder (ADHD) has been prescribed dextroamphetamine. For what effects should the nurse tell the parents to monitor the child? Select all that apply.

Insomnia Weight loss Appetite suppression

A nurse is reviewing information about disruptive behavior disorders in children. Which finding best describes this clinical diagnosis?

It can lead to increased risk of other mental health disorders.

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?

Language difficulty

A nurse is providing care to a child with a reading disability. When explaining to the parents about the underlying issue involved, which structure would the nurse integrate into the explanation?

Left hemisphere of the brain

ADHD is characterized by inattentiveness, overactivity, and impulsiveness. Which of the following would the nurse identify related to inattentiveness?

Missing details

After teaching a group of students about medications used to treat ADHD, the instructor determines that the education was successful when the group identifies atomoxetine as which of the following?

Noradrenergic reuptake inhibitor

The nurse is counseling a family whose child has autism. When describing this condition, which would the nurse most likely include?

Onset before child is 2.5 years old

Parents bring their child to the clinic and state to the nurse, "We just don't know what to do anymore. It must be a medical disorder because our child has never been in trouble or acted this way. They are lying, stealing, and destroying property." Which is likely to be the most effective intervention for this adolescent?

Prevention and early intervention

Which of the following approaches is included in milieu management for the child with autism spectrum disorder?

Providing a structured, routine environment

The nurse is working with clients who have disruptive behavior disorders. Which are important point(s) for the nurse to consider when working with these clients and their families? Select all that apply.

Remember to focus on the client's strengths and assets, as well as their problems. Avoid a "blaming" attitude toward clients and/or families. Focus on positive actions to improve situations and/or behaviors.

A child with an existing diagnosis of attention deficit hyperactivity disorder shows signs and symptoms of depression. Which would most likely be prescribed?

Selective serotonin and norepinephrine reuptake inhibitor (SSNRI) Antidepressant medications, most likely SSNRIs, are used for anxiety, depression, and primarily for ADHD. Mood stabilizers are prescribed primarily for bipolar disorder. These medications may be prescribed off-label. However, there is controversy surrounding the use of SSNRIs and selective serotonin reuptake inhibitors (SSRIs) in children. Nurses need to keep in mind that all medications involve a risk-benefit equation. Given the modest benefit of the SSNRIs and SSRIs and the potential for adverse behavioral effects, these medications merit careful monitoring in children and adolescents.

A 15-year-old boy being treated for depression will most likely be given which of the following first-line pharmacologic treatments?

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 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 a longer-acting preparation.

A 7-year-old client experiences tics, which have become increasingly frequent in recent months. How should the nurse educate the client's teacher to respond to the tics?

Teach the client's classmates that the tics are not something that the client can control.

A child has been prescribed methylphenidate for treatment of attention deficit hyperactivity disorder (ADHD). Which observation is indicative to the nurse that a potential problem exists?

The child reports eyes feeling tired.

A child is diagnosed with obsessive-compulsive disorder (OCD). When reviewing the child's medical record, which of the following would the nurse most likely note as possibly being present? Select all that apply.

Tic disorder Mood disorder Anxiety disorder

The nurse is assessing an adolescent client. The parent is in the room and answers most of the questions, even though the questions are directed at the client. Which action(s) from the parents of a child with conduct disorders does the nurse identify may be a contributing factor to the behaviors? Select all that apply.

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

While interviewing a child, the nurse notes phonic tics. Which of the following might the nurse assess? Select all that apply.

Throat clearing Grunting Voicing of obscenities

Which of the following statements reflects accurately the effects of childhood mental illness?

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

A group of adolescent clients brought in by their parents are being screened for a possible disruptive disorder at a free community health fair. Which client would require a follow-up assessment from the nurse?

an adolescent who is unable to postpone gratification

Genetics can play a role in the development of a childhood psychiatric disorder. When assessing a child, which disorder would the nurse identify as having a genetic component?

attention-deficit hyperactivity disorder

A pediatric client has a history of repeated, intentional fire-setting behaviors. Which diagnosis should the client be assessed for?

pyromania

A 13-year-old client is being assessed by the psychiatric-mental health nurse. Upon assessment, the client reveals that they believe that the world is aggressive and threatening and they respond likewise. Which aspect of the assessment would the nurse document the findings in the medical record?

thought process and content