Chapter 26 Children and Adolescents Mental Health

A 4-year-old child cries and screams from the time the parents leave the child at preschool until the child is picked up 4 hours later. The child is calm and relaxed when the parents are present. The parents ask, "What should we do?" What is the nurse's best recommendation?

"Talk with your health care provider about a referral to a mental health professional."

The parent of a child diagnosed with Tourette's 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?

"Tics often change frequency or severity. That does not mean they aren't real."

A nurse assesses the four children below. Which assessment findings should prompt the nurse to refer the child for further evaluation?

3-year-old who is mute, passive toward adults, and twirls while walking

Children with ______ frequently behave in ways that violate the rights of others and age-appropriate societal norms.

CD

A nurse will prepare teaching materials regarding which medication for the parents of a child diagnosed with enuresis?

Methylphenidate (Ritalin)

Children with _____ are negativistic, disobedient, and defiant toward authority figures without seriously violating the basic rights of others.

ODD

What are the primary distinguishing factors between the behavior of children diagnosed with oppositional defiant disorder (ODD) and those diagnosed with conduct disorder (CD)? (Select all that apply.) The child diagnosed with:

ODD tests limits and disobeys authority figures; CD often violates the rights of others.

What is the goal for a child with attention deficit hyperactivity disorder (ADHD)

The goal is improvement in the child's hyperactivity, distractibility, and play.

The child most likely to receive propranolol (Inderal) to manage tremors is one diagnosed with:

a motor disorder

An 11-year-old child, who has been diagnosed with oppositional defiant disorder (ODD), becomes angry over the rules at a residential treatment program and begins shouting at the nurse. Select the best method to defuse the situation.

assign the child to a short time-out

Shortly after a 15-year-old's parents announce a plan to divorce, the adolescent stops participating in sports, sits alone at lunch, and avoids former friends. The adolescent says, "All the other kids have families. If my parents loved me, then they would stay together." Which nursing intervention is most appropriate?

assist the adolescent to differentiate reality from perceptions

A 5-year-old child moves and talks constantly. The child awakens before the parents every morning. The child attends kindergarten, but the teacher reports difficulty handling the behavior. What is this child's most likely problem?

attention deficit hyperactivity disorder (ADHD)

The constant motion and excessive talkativeness suggest _____.

attention deficit hyperactivity disorder (ADHD)

Holding the hand of another person suggests relatedness. Usually, a child with _________ would resist holding someone's hand and stand or walk alone, perhaps flapping arms or moving in a stereotypical pattern.

autism

______________ 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 ______________ disorder.

autism spectrum disorder

_______________ disorder involves distortions in the development of social skills and language that include perception, motor movement, attention, and reality testing. Caretakers frequently mention the child's failure to develop interpersonal skills.

autism spectrum disorder

A nurse prepares to lead a discussion at a community health center regarding children's health. The nurse wants to use current terminology when teaching about these issues. Which terms are appropriate for the nurse to use? (Select all that apply.)

autism spectrum disorder; intellectual development disorder

Which finding would prompt the nurse to carefully assess an 8-year-old child for development of a psychiatric disorder?

being raised by a parent with chronic major depressive disorder

___________ and _________ therapy are appropriate for children

bibliotherapy and play therapy

A child diagnosed with attention deficit hyperactivity disorder (ADHD) is going to begin medication therapy. The nurse should plan to teach the family about which classification of medications?

central nervous system stimulants and non-stimulants

_____________ and ___________ INCREASE blood flow to the brain and have proven helpful in reducing hyperactivity in children and adolescents with ADHD.

central nervous system stimulants and non-stimulants

A 12-year-old child has been the neighborhood bully for several years. The parents say, "We can't believe anything our child says." Recently, the child shot a dog with a pellet gun and set fire to a trash bin outside a store. The child's behaviors are most consistent with:

conduct disorder (CD)

A 15-year-old adolescent has run away from home six times. After the adolescent was arrested for prostitution, the parents told the court, "We can't manage our teenager." The adolescent is physically abusive to the mother and defiant with the father. The adolescent's problem is most consistent with criteria for:

conduct disorder (CD)

The behaviors mentioned are most consistent with the DSM-5 criteria for ________: aggression against people and animals; destruction of property; deceitfulness; rule violations; and impairment in social, academic, or occupational functioning

conduct disorder (CD)

_________ is manifested by a persistent pattern of behavior in which the rights of others and age-appropriate societal norms are violated.

conduct disorder (CD)

A nurse assesses a 3-year-old diagnosed with autism spectrum disorder. Which finding is most associated with the child's disorder? The child:

continuously rocks in place for 30 minutes

A parent diagnosed with schizophrenia and her 13-year-old child live in a homeless shelter. The child has 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:

displays resiliency

A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. The child has formed a trusting relationship with a volunteer. The teen says, "I have three good friends at school. We talk and sit together at lunch." What is the nurse's best suggestion to the treatment team?

encourage healthy characteristics and existing environmental supports.

Pharmacological treatment of _______ commonly includes desmopressin (DDAVP), oxybutynin (Ditropan), various stimulants, indomethacin (Indocin), and SSRI antidepressants.

enuresis

A 15-year-old adolescent is referred to a residential program after an arrest for theft and running away from home. At the program, the adolescent refuses to participate in scheduled activities and pushes a staff member, causing a fall. Which approach by the nursing staff would be most therapeutic?

establish firm limits

When assessing a 2-year-old diagnosed with autism spectrum disorder, a nurse expects:

failure to develop interpersonal skills

An adolescent diagnosed with generalized anxiety disorder says, "My parents focus all their attention on my brother instead of me. He's perfect in their eyes." Which type of therapy might promote the greatest change in this adolescent's behavior?

family therapy

______ therapy focuses on problematic family relationships and interactions.

family therapy

_________ and ________ are necessary to ensure physical safety and emotional security. ________ and __________ will also protect other patients from the teenager's thoughtless or aggressive behavior.

firm limits and limit setting

______________ therapy for young children takes the form of play. For elementary school children, therapy combines play and talk about the activity. For adolescents, ________ therapy involves more talking.

group therapy

Which behavior indicates that the treatment plan for a child diagnosed with autism spectrum disorder was effective? The child:

holds the parent's hand while walking

The health care provider prescribes medication for a child diagnosed with attention deficit hyperactivity disorder (ADHD). The desired behavior for which the nurse should monitor is:

improved ability for cooperative play with other children

A nurse prepares the plan of care for a 15-year-old adolescent diagnosed with moderate intellectual developmental disorder (IDD). What are the highest outcomes realistic for this person? (Select all that apply.) Within 5 years, the person will:

obtain employment in a local sheltered workshop; correctly use public buses to travel in the community; independently perform his or her own personal hygiene

When group therapy is to be used as a treatment modality, the nurse should suggest placing a 9-year-old in a group that uses:

play and then talk about the play activity

____________ is useful for managing tremors associated with various motor disorders.

propranolol (Inderal)

____________ 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.

resiliency

_________________ disorder becomes apparent when the child is separated from the attachment figure. Often, the first time separation occurs is when the child goes to kindergarten or nursery school. _____________ can be based on the child's fear that something will happen to the attachment figure. The child needs professional help.

separation anxiety disorder

When a 5-year-old child is disruptive, the nurse says, "You must take a time-out." The expectation is that the child will:

sit on the edge of the activity until able to regain self-control

A desired outcome for a 12-year-old diagnosed with oppositional defiant disorder (ODD) is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care?

social skills groups

_________________ 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.

social skills training

A 5-year-old child diagnosed with attention deficit hyperactivity disorder (ADHD) bounces out of a chair in the waiting room, runs across the room, and begins to slap another child. What is the nurse's best action? Rationale: The use of play to express feelings is appropriate; the cognitive and language abilities of the child may require the acting out of feelings if verbal expression is limited.

take the child into another room with toys to act out feelings.

_____________ is associated with stereotypical, rapid, and involuntary motor movements.

tic disorder

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

tics

________ is designed so that staff can be consistent in their interventions. _________ may require having the child sit on the periphery of an activity until he or she gains self-control and reviews the episode with a staff member. ___________ may not require having the child go to a designated room and does not involve special attention such as holding.

time-out

___________ is a useful strategy for interrupting the angry expression of feelings and allows the child an opportunity to exert self-control. This method is the least restrictive alternative of those listed and should be tried before resorting to more restrictive measures.

time-out