Chapter 32. Children and Adolescents

The nurse is visiting with a child with suspected ADHD. Which statement by the parent supports the nurse's suspicion? 1. "My child has been doing poorly in his schoolwork because he can't stay in his seat." 2. "My son never takes responsibility for his actions. It is always someone else's fault." 3. "My daughter told me she saw my son kick our neighbor's dog." 4. "I wish I could get my son to eat other foods. All he will eat are chips because they are crunchy."

1. "My child has been doing poorly in his schoolwork because he can't stay in his seat." This statement describes the difficulty associated with completing schoolwork and struggling to stay in one's seat associated with ADHD.

A nursing instructor presents a case study in which a 3-year-old is in constant motion and is unable to sit still during story time. The instructor asks a student to evaluate this child's behavior. Which response indicates that the student has evaluated the situation appropriately? 1. "This child's behavior must be evaluated according to developmental norms." 2. "This child has symptoms of attention deficit-hyperactivity disorder (ADHD)." 3. "This child has symptoms of the early stages of ASD." 4. "This child's behavior indicates possible symptoms of ODD."

1. "This child's behavior must be evaluated according to developmental norms." An evaluation of the child's behavior should be based on developmental norms. Guidelines for determining whether emotional problems exist in a child should consider if the behavioral manifestations are not age appropriate, deviate from cultural norms, or create deficits or impairments in adaptive functioning.

Which risk factors noted during a family history assessment would the nurse associate with the potential development of ID? Select all that apply. 1. A family history of Tay-Sachs disease 2. Childhood meningococcal infection 3. Deprivation of nurturance and social contact 4. History of maternal multiple motor and verbal tics 5. A diagnosis of maternal major depressive disorder

1. A family history of Tay-Sachs disease 2. Childhood meningococcal infection 3. Deprivation of nurturance and social contact All are risk factors for ID

When planning care for a client, which medication classification would the nurse recognize as effective in the treatment of Tourette's disorder? 1. Antipsychotic medications 2. Antimanic medications 3. Tricyclic antidepressant medications 4. Monoamine oxidase inhibitor (MAOI) medications

1. Antipsychotic medications Antipsychotic medications and alpha 2- adrenergic agonists are effective in reducing the severity of tics. The medications are most effective when combined with psychosocial therapy.

Which interventions would the nurse anticipate implementing when planning care for children diagnosed with ADHD? Select all that apply. 1. Behavior modification 2. Antianxiety medications 3. Competitive group sports 4. Group therapy 5. Family therapy

1. Behavior modification 4. Group therapy 5. Family therapy

An adolescent client who was diagnosed with conduct disorder at the age of 8 years is sentenced to juvenile detention after bringing a gun to school. Which statement indicates the nurse's understanding of conduct disorder related to this client's situation? 1. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood. 2. Childhood-onset conduct disorder is caused by a difficult temperament, and the child is likely to outgrow these behaviors by adulthood. 3. Childhood-onset conduct disorder is diagnosed only when behaviors emerge before the age of 5 years; therefore, improvement is likely. 4. Childhood-onset conduct disorder has no treatment or cure, and children diagnosed with this disorder are likely to develop progressive ODD.

1. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood. Childhood-onset conduct disorder is more severe than the adolescent-onset type. These individuals are likely to develop antisocial personality disorder in adulthood. Individuals with this subtype are usually boys, frequently display psychical aggression, and have disturbed peer relationship.

Why would a nurse establish goals for a client diagnosed with ADHD presenting with low frustration tolerance and short attention span that allow the client to complete part of the task, rewarding each step completion with a break for physical activity? 1. Short-term goals are not so overwhelming for clients with a short attention span. 2. Repetition of instructions helps to determine the client's level of comprehension. 3. This encourages the client to perform independently while providing a feeling of security. 4. The client lacks the ability to assimilate information that is complicated or has abstract meaning.

1. Short-term goals are not so overwhelming for clients with a short attention span. Breaking tasks up into smaller parts and rewarding each step completion will increase self-esteem and provide incentive for the client to pursue the task to completion. This supports the long-term goal of completing assigned tasks independently or with minimal assistance.

A child diagnosed with ASD has the nursing diagnosis of disturbed personal identity. Which outcome best addresses this client's diagnosis? 1. The client will name own body parts as separate from others by day 5. 2. The client will establish a means of communicating personal needs by discharge. 3. The client will initiate social interactions with caregivers by day 4. 4. The client will not harm self or others by discharge.

1. The client will name own body parts as separate from others by day 5. The appropriate outcome is for the client to name own body parts as separate from others. The nurse should assist the client in the recognition of separateness during self-care activities such as dressing and feeding. The long-term goal for disturbed personal identity is for the client to develop an ego identity.

A 6-year-old client is prescribed methylphenidate for a diagnosis of ADHD. When teaching the parents about this medication, which nursing statement explains how methylphenidate works? 1. "Methylphenidate's sedation side effect assists children by decreasing their energy level." 2. "How methylphenidate works is unknown. Although it is a stimulant, it does combat the symptoms of ADHD." 3. "Methylphenidate helps the child focus by decreasing the amount of dopamine in the basal ganglia and neuron synapses." 4. "Methylphenidate decreases hyperactivity by increasing serotonin levels."

2. "How methylphenidate works is unknown. Although it is a stimulant, it does combat the symptoms of ADHD." Methylphenidate is a central nervous system (CNS) stimulant that serves to increase attention span, control hyperactive behaviors, and improve learning ability for clients diagnosed with ADHD. It's mechanism of action is unknown. It has been hypothesized that its effectiveness is in response to neurotransmitter dysregulation.

A child has been diagnosed with autism spectrum disorder (ASD). The distraught mother cries out, "I'm such a terrible mother. What did I do to cause this?" Which nursing reply is most appropriate? 1. "Researchers really don't know what causes autistic disorder, but the relationship between autistic disorder and fetal alcohol syndrome is being explored." 2. "Poor parenting doesn't cause autism. Research has shown that abnormalities in brain structure and/or function are to blame. This is beyond your control." 3. "Research has shown that the mother appears to play a greater role in the development of this disorder than does the father." 4. "Lack of early infant bonding with the mother has shown to be a cause of autistic disorder. Did you breastfeed or bottle feed?"

2. "Poor parenting doesn't cause autism. Research has shown that abnormalities in brain structure and/or function are to blame. This is beyond your control." ASD is believed to be caused by abnormalities in brain structure and/or function, not poor parenting. ASD occurs in approximately 6 per 1000 children and is about four times more likely in boys.

The nurse has taken report for the evening shift on an adolescent inpatient unit. Which client would the nurse address first? 1. A client diagnosed with ODD being sexually inappropriate with staff 2. A client diagnosed with conduct disorder who is verbally abusing a peer in the milieu 3. A client diagnosed with conduct disorder who is demanding special attention from staff 4. A client diagnosed with ADHD who has a history of self-mutilation

2. A client diagnosed with conduct disorder who is verbally abusing a peer in the milieu A client diagnosed with conduct disorder who is verbally abusing a peer in the milieu creates a risk for injury to others.

A child has been recently diagnosed with mild ID. Which information about this diagnosis would the nurse include when teaching the child's mother? 1. Children with mild ID need constant supervision. 2. Children with mild ID develop academic skills up to a sixth-grade level. 3. Children with mild ID appear different from their peers. 4. Children with mild ID have significant sensory-motor impairment.

2. Children with mild ID develop academic skills up to a sixth-grade level. Child with mild ID develop academic skills up to a sixth grade level. Individuals with mild ID are capable of independent living, capable of developing social skills, and having normal psychomotor skills.

A preschool child diagnosed with ASD has been engaging in constant head-banging behavior. Which nursing intervention is most appropriate? 1. Place client in restraints until the aggression subsides. 2. Sedate the client with neuroleptic medications. 3. Hold client's head steady and apply a helmet. 4. Distract the client with a variety of games and puzzles

3. Hold client's head steady and apply a helmet. The nurse should initiate the least-restrictive interventions and maintain client safety. Holding the child's head steady and applying a helmet is the least-restrictive intervention and will protect the client's head from injury.

A client has an IQ of 47. Which nursing diagnosis best addresses a client problem associated with this degree of ID? 1. Risk for injury related to (R/T) self-mutilation 2. Impaired social interaction R/T nonadherence to social convention 3. Altered verbal communication R/T delusional thinking 4. Social isolation R/T severely decreased gross motor skills

2. Impaired social interaction R/T nonadherence to social convention The appropriate nursing diagnosis is altered social interaction R/T non adherence to social convention. Moderate ID is associated with an IQ of 47. The client would demonstrate limitations in speech communications and may have difficulty adhering to social conventions that would interfere with peer relationships.

Which nursing intervention would be prioritized when caring for a child diagnosed with ID? 1. Encourage the parents to always prioritize the needs of the child. 2. Modify the child's environment to promote independence and encourage impulse control. 3. Delay extensive diagnostic studies until the child is developmentally mature. 4. Provide one-on-one tutorial education in a private setting to decrease overstimulation

2. Modify the child's environment to promote independence and encourage impulse control. The nursing priority is to focus on each client's strengths and individual abilities. Positive reinforcement can serve to increase self-esteem and encourage repetition of behaviors. This intervention is related to the nursing diagnosis "self-care deficit".

A preschool child is admitted to a psychiatric unit with a diagnosis of ASD. To help the child feel more secure on the unit, which intervention would the nurse include in this client's plan of care? 1. Encourage and reward peer contact. 2. Provide consistent caregivers. 3. Provide a variety of safe daily activities. 4. Maintain close physical contact throughout the day.

2. Provide consistent caregivers. Children with ASD have an inability to trust, show little interest in people, and often do not respond to others' attempts at interaction. Providing consistent caregivers allows the client to develop trust and a sense of security.

Which nursing intervention related to self-care is most appropriate for a teenager diagnosed with moderate ID? 1. Meet all of the client's self-care needs to avoid injury. 2. Provide simple directions and praise client's independent self-care efforts. 3. Avoid interference with the client's self-care efforts to promote autonomy. 4. Encourage family to meet the client's self-care needs to promote bonding.

2. Provide simple directions and praise client's independent self-care efforts. Individuals with moderate ID can perform some activities independently and may be capable of academic skill to a second-grade level.

Which behavioral approach would the nurse utilize when caring for children diagnosed with a disruptive behavior disorder? 1. Involving parents in designing and implementing the treatment process. 2. Reinforcing positive actions to encourage repetition of desired behaviors. 3. Providing opportunities to learn appropriate peer interactions. 4. Administering psychotropic medications to improve quality of life.

2. Reinforcing positive actions to encourage repetition of desired behaviors. The nurse should reinforce positive actions to encourage repetition of desired behaviors when caring for children diagnosis end with a disruptive behavior disorder. Behavior therapy is based on the concepts of classical conditioning and operant conditioning.

Which finding is the nurse most likely to assess in a child diagnosed with separation anxiety disorder? 1. The child has a history of antisocial behaviors. 2. The child's mother is diagnosed with an anxiety disorder. 3. The child previously had an extroverted temperament. 4. The child's parents have inconsistent parenting styles.

2. The child's mother is diagnosed with an anxiety disorder. A child whose mother is diagnosed with an anxiety disorder has a greater risk of developing and anxiety disorder. Research indicates that there is a hereditary influence in the development of separation anxiety disorder. More children with relatives who manifest anxiety problems develop anxiety disorders than those without.

The nurse would recognize which of the following as contributing factors to a client's development of ADHD? Select all that apply. 1. The client's parent was a smoker. 2. The client was born 7 weeks premature. 3. The client is lactose intolerant. 4. The client has a sibling diagnosed with ADHD. 5. The client has been diagnosed with dyslexia.

4. The client has a sibling diagnosed with ADHD. Siblings of a child with ADHD have an increased risk of developing ADHD.

The nurse is assessing a 14-year-old client who is receiving aripiprazole. Which side effect would be of most concern to the nurse? 1. Dizziness 2. Headache 3. Nausea 4. Tremor

4. Tremor The nurse would be conspired if the client experienced tremor. This could be indicative of extrapyramidal disorder, and the client may need to stop taking the medications.

A care plan for the child with ID states that the child "will attempt to interact with others in the presence of trusted caregiver." This is an example of an outcome criterion for which nursing diagnosis? 1. Impaired verbal communication; short-term goal 2. Impaired verbal communication; long-term goal 3. Impaired social interaction; short-term goal 4. Impaired social interaction; long-term goal

3. Impaired social interaction; short-term goal This is an example of a short-term goal for a client with a nursing diagnosis of impaired social interaction.

Which nursing intervention is the priority when caring for a child diagnosed with conduct disorder? 1. Modify the environment to decrease stimulation and provide opportunities for quiet reflection. 2. Convey unconditional acceptance and positive regard. 3. Recognize escalating aggressive behaviors and intervene before violence occurs. 4. Provide immediate positive feedback for appropriate behaviors

3. Recognize escalating aggressive behaviors and intervene before violence occurs. The client's behaviors create risk of other-directed violence. The nurse's priority is safety.

In planning care for a child diagnosed with ASD, which is a realistic client outcome? 1. The client will communicate all needs verbally by discharge. 2. The client will participate with peers in a team sport by day 4. 3. The client will establish trust with at least one caregiver by day 5. 4. The client will perform most self-care tasks independently.

3. The client will establish trust with at least one caregiver by day 5. The most realistic client outcome is related to the nursing diagnosis "impaired social interaction for a child diagnosed with ASD" is for the client to establish trust with at least one caregiver. Children with ASD hav difficulty forming interpersonal relationships with others. They show little interest in people and often do not respond to others' attempts at interaction.

A child diagnosed with ADHD is having difficulty completing homework assignments. Which information would the nurse include when teaching the parents about task performance improvement? 1. The parents should isolate the child when completing homework to improve focus. 2. The parents should withhold privileges if homework is not completed within a 2-hour period. 3. The parents should divide the homework task into smaller steps and provide an activity break. 4. The parents should administer an extra dose of methylphenidate prior to homework

3. The parents should divide the homework task into smaller steps and provide an activity break. Children diagnosed with ADHD have a limited attention span and shift from one uncompleted activity to another. Dividing homework takes into smaller steps helps achieve completion. Physical activity provides an outlet for motor activity, restlessness, and fidgeting.

The nurse is caring for a client who blinks when the nurse asks a question and coughs when the nurse looks at him. Which condition does the nurse suspect? 1. Oppositional defiant disorder (ODD) 2. ASD 3. Tourette's disorder 4. Conduct disorder

3. Tourette's disorder The blinking is an example of a motor tic, and the coughing is a type of vocal tic, both of which are exhibited by individuals with Tourette's disorder

The nurse is caring for a 16-year-old client with ASD who is receiving risperidone for agitation. For which effects would the nurse monitor the client? Select all that apply. 1. Signs of bruising 2. Improved mood 3. Weight gain of 20 lb in 1 month 4. Elevated blood glucose level 5. Uncontrolled jaw movements

3. Weight gain of 20 lb in 1 month 4. Elevated blood glucose level 5. Uncontrolled jaw movements

Which student statement indicates further instruction is needed regarding developmental characteristics of clients diagnosed with moderate intellectual developmental disorder? 1. "These clients can work in a sheltered workshop setting." 2. "These clients can perform some personal care activities." 3. "These clients may have difficulty relating to peers." 4. "These clients can successfully complete elementary school."

4. "These clients can successfully complete elementary school." Individuals diagnosed with moderate ID are capable of academic skill up to only a second grade level. Moderate ID reflect and IQ range of 35 to 49.

A pregnant client is being treated for uncontrolled diabetes and reports to the nurse, "I have two other children, and my diabetes hasn't affected them. I'm sure this baby will be fine too." What percentage of ID cases result in early alterations in embryonic development? 1. 5% 2. 10% 3. 20% 4. 30%

4. 30% Conditions that result in early alterations in embryonic development account for approximately 30% of ID cases. Damages may occur in response to toxicity associated with maternal ingestion of alcohol or other drugs.

Which child is most likely to be diagnosed with ASD? 1. A 5-year-old girl 2. A 6-year-old girl 3. A 7-year-old girl 4. An 8-year-old boy

4. An 8-year-old boy ASD occurs 4 times more often in boys than in girls

A nursing instructor is teaching about pharmacological treatments for ADHD. Which information about atomoxetine should be included in the lesson plan? 1. Atomoxetine, unlike methylphenidate, is a CNS depressant. 2. When taking atomoxetine, a client should eliminate all red food coloring from the diet. 3. Atomoxetine will be a lifelong intervention for clients diagnosed with this disorder. 4. Atomoxetine, unlike methylphenidate, is a selective norepinephrine reuptake inhibitor (SNRI).

4. Atomoxetine, unlike methylphenidate, is a selective norepinephrine reuptake inhibitor (SNRI). Atomoxetine is an SNRI. Methylphenidate is a CNS stimulant. Both medications increase attention span, control hyperactive behaviors, and improve learning ability for clients diagnosed ADHD.

Sophie is 11 years old and has a diagnosis of ADHD. Her parents report and provide documentation from her teachers that Sophie is distracted easily and is unable to complete classroom activities, even in the presence of minimal stimulation. A nursing diagnosis of noncompliance with task expectations has been determined, with a shortterm goal that Sophie will participate in and cooperate during therapeutic activities. Which nursing intervention is most appropriate? 1. Establish goals that allow Sophie to complete part of the task, rewarding each step completion with a break for physical activity. 2. Ask Sophie to repeat instructions to you. 3. Provide assistance on a one-to-one basis, beginning with simple, concrete instructions. 4. Provide an environment for task efforts that is as free of distractions as possible.

4. Provide an environment for task efforts that is as free of distractions as possible. A distraction-free environment is essential for successful task efforts with this client.

Which developmental characteristic should the nurse identify as typical of a client diagnosed with severe intellectual disability (ID)? 1. The client can perform some self-care activities independently. 2. The client has advanced speech development. 3. Other than possible coordination problems, the client's psychomotor skills are not affected. 4. The client communicates wants and needs by "acting out" behaviors

4. The client communicates wants and needs by "acting out" behaviors A client diagnosed with severe ID may communicate wants and needs by "acting out" behaviors. Severe ID indicates an IQ between 20 to 34. Individuals with severe ID require complete supervision and have minimal verbal skills and poor psychomotor development.