Chapter 34

11. A child diagnosed with attention-deficit hyperactivity disorder (ADHD) will begin medication therapy. The nurse should prepare a plan to teach the family about which classification of medications prescribed to help manage the associated behaviors? a. Central nervous system stimulants b. Tricyclic antidepressants c. Antipsychotics d. Anxiolytics

ANS: A Central nervous system stimulants, such as methylphenidate and pemoline, increase blood flow to the brain and have proved helpful in reducing hyperactivity in children and adolescents with A

14. Which assessment finding would cause the nurse to consider a child to be most at risk for the development of mental illness? a. The child has been raised by a parent with chronic major depression. b. The child's best friend has developed a chronic illness c. The child was not promoted to the next grade one year. d. The child moved to three new homes over a 2-year period.

ANS: A Statistics indicate that children raised by a depressed parent have an increased risk of developing an emotional disorder. The chronicity of the parent's depression means it has been a consistent stressor. The other factors are not as risk enhancing.

7. A child being treated for which medication has a high risk for suicide and should be monitored closely? a. Depression with fluoxetine b. ADHD with methylphenidate c. Bipolar disorder with aripiprazole d. Asperger disorder with social skills training

ANS: A The child being treated for depression with fluoxetine is at risk for behavioral activation, a drug side effect. Increased suicide risk is part of the behavioral activation complex. The drugs mentioned in the other options do not place the individual in the same risk category as fluoxetine. D

1. Which behaviors are indicative of bullying by a child? (Select all that apply.) a. Recruits other children to avoid a child who wears glasses. b. Consistently calls another child "fat" and "stupid." c. Trips another children, because "it's fun." d. Repeatedly steals another child's lunch money. e. Plays a practical joke on another child.

ANS: A, B, C, D Bullying can be verbal, relational, or physical. It is repetitive and intentionally produces harm or pain in another person. Playful teasing, one-time aggression, and joking do not meet the criteria for bullying.

4. A nurse will prepare teaching materials regarding which drug for the parents of a child diagnosed with ADHD? a. Paroxetine b. Imipramine c. Methylphenidate d. Carbamazepine

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

3. A kindergartener is disruptive to the class. This child is unable to sit for expected lengths of time, inattentive to the teacher, and aggressive toward others, bursting out talking while the teacher is talking. Other children shun this child. The nurse plans interventions designed to address which of the child's needs? a. Provide inpatient treatment for the child. b. Reduce loneliness and increase self-esteem. c. Improve language and communication skills. d. Promote individuation and integration of self-concept.

ANS: B Because of their disruptive behaviors, children with attention-deficit hyperactivity disorder (ADHD) often receive negative feedback from parents, teachers, and peers, leading to self-esteem disturbance. These same behaviors lead peers to avoid the child with ADHD, who seems reckless and impulsive, and can rarely finish games, leaving the child with ADHD vulnerable to loneliness. The other options might or might not be relevant but are not the priority. The child does not need inpatient treatment at this time.

6. Which finding necessitates immediate nursing action for a child being treated for depression with a selective serotonin reuptake inhibitor (SSRI)? a. A weight gain of 10 lb in 4 weeks b. Repeatedly hitting a younger sibling c. Frequently reports being tired and just wanting to sleep d. Has fallen three times as a result of "being dizzy"

ANS: B Selective serotonin reuptake inhibitors (SSRIs) are frequently used in children and adolescents. Some aggressive and out of control behaviors, and even suicidality have been linked to these serotonin-enhancing drugs. The other drug side effects are associated with tricyclic antidepressants.

17. An adolescent in a residential program threatens to throw a pool ball at another adolescent. Which comment by the nurse would effectively set limits? a. "You will be taken to seclusion if you throw that ball." b. "Do not throw the ball. Put it back on the pool table." c. "Attention everyone: We're all going to the gym." d. "Please do not lose control of your behavior."

ANS: B Setting limits uses clear, sharp statements about which behavior is not allowed and guidance for performing a behavior that is expected. The distracters represent a threat, use of restructuring (which would be inappropriate in this instance), and a direct appeal to the child's developing self-control that may be ineffective.

5. A desired outcome for a 12-year-old diagnosed with autism spectrum disorder (ASD) is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care? a. Reality therapy b. Social skills group c. Response prevention d. Insight-oriented group therapy

ANS: B 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 to no impact on peer relationships.

16. A child shares with the school nurse about painful verbal bullying by an aggressive classmate. What should be the nurse's initial action? a. Give notice to the chief administrator at the school regarding the events. b. Support the victimized child to share feelings about the experience. c. Encourage the victimized child to ignore the bullying behavior. d. Discuss the events with the aggressive classmate.

ANS: B The behaviors by the bullying child create emotional pain and present the risk for physical pain. The nurse should first listen to the child's complaints and validate the child for reporting the events. Later, school authorities should be notified. School administrators are the most appropriate personnel to deal with the bullying child. The behavior should not be ignored; it will only get worse.

2. Which behavior indicates that the treatment plan for a 5-year-old child diagnosed with autistic disorder has been effective? a. Is content to play with one toy for hours. b. Repeats words spoken by a parent. c. Holds the parent's hand while walking. d. Finds enjoyment in clapping his or her hands while walking.

ANS: C Holding the hand of another person suggests relatedness. Usually, a child with autism would resist holding someone's hand and stand or walk alone, perhaps flapping arms or moving in a stereotyped pattern. The other options reflect behaviors that are consistent with autistic disorder.

9. A child diagnosed with attention-deficit hyperactivity disorder (ADHD) had this nursing diagnosis—impaired social interaction, related to excessive neuronal activity, as evidenced by aggressiveness and dysfunctional play with others. Which finding indicates the plan of care was effective? a. Improved ability to identify anxiety and use self-control strategies. b. Increased expressiveness in communication with others. c. Engages in cooperative play with other children. d. Increased responsiveness to authority figures.

ANS: C 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 pervasive developmental disorder or anxiety disorder.

13. A 14-year-old is sent to a residential program after arrests for truancy and assault. At the program, the teen refused to participate in scheduled activities and pushed a staff member, causing a fall. Which statement made by the nurse demonstrates an effective strategy to manage the client effectively? a. "I've enrolled you in the unit's social skills training group to help you interact with others better." b. "What will it take to get you to obey unit rules?" c. "If you don't want to go to movie night you don't have too." d. "There is a loss of privileges following any refusal to comply with unit rules."

ANS: D Firm limits are necessary to ensure physical safety and emotional security. Limit-setting will also protect other patients from the teen's thoughtless or aggressive behavior. Permitting refusals to participate in the treatment plan, coaxing, and bargaining are strategies that do not help the patient learn to abide by rules or structure.

1. Which factor presents the most imminent risk for the development of a childhood psychiatric disorder? a.Having an uncle diagnosed with schizophrenia b. Living in a low-income family c. Being the oldest child in a family d. Living with an alcoholic parent

ANS: D Having a parent with a substance abuse problem has been designated an adverse psychosocial condition that increases the risk of a child developing a psychiatric condition. Neither being in a low-income family nor being the oldest child are considered psychosocial adversity situations. While having an extended family history of schizophrenia presents a risk, the negative childhood events associated with having an alcoholic parent present a higher level of risk.

15. The child most likely to receive risperidone to manage symptoms is one diagnosed with what mental health disorder? a. Attention-deficit hyperactivity disorder (ADHD) b. Posttraumatic stress disorder (PTSD) c. Anxiety d. Autism

ANS: D Risperidone is useful for relieving irritability and labile affect demonstrated by some autistic children. It is not indicated in any of the other disorders.

8. The parent of an 8-year-old says, "My child is in constant motion, talking all the time but is out of bed every morning before I am and into trouble." This description supports which mental health diagnosis? a. Bipolar disorder (BPD) b. Disruptive mood dysregulation disorder (DMDD) c. Oppositional defiant disorder (ODD) d. Attention-deficit hyperactivity disorder (ADHD)

ANS: D The excessive motion, distractibility, and excessive talkativeness are seen in ADHD. The behaviors presented in the scenario do not suggest the other possible choices. oppositional defiant disorder (ODD) in children and adolescents is defined as a pattern of angry/irritable mood symptoms. Bipolar disorder (BPD) in children differs from the adult type in that irritability is a more prominent symptom, and there are often high rates of co-occurring attention problems and anxiety. The diagnosis of disruptive mood dysregulation disorder (DMDD) was established in DSM-5 to help account for youngsters who are very irritable or angry much of the day, nearly every day, and who have severe recurrent temper outbursts.

10. In the waiting room a 5-year-old child diagnosed with attention-deficit hyperactivity disorder (ADHD) bounces out of a chair, runs over to another child, and slaps the other child. What action implemented by the nurse would be most effective in therapeutically managing the situation? a. Direct the aggressive child to stop immediately. b. Call for emergency assistance from other staff. c. Instruct the parents to take the child home. d. Take the child to another waiting area.

ANS: D The nurse should manage the milieu with structure and limit-setting. Removing the aggressive child to another waiting area is an appropriate consequence for the aggressiveness. Directing the child to stop will not be effective. This is not an emergency situation. Intervention is needed rather than sending the child away.

12. A nurse assesses a 3-year-old child diagnosed with autism spectrum disorder (ASD). Which finding is most associated with the child's disorder? a. Cries when frustrated. b. Inability to identify colors. c. Shows no interest in playing with other children. d. Anxiety when separated from a parent.

NS: C Autistic disorder involves distortions in development of social skills and language that include perception, motor movement, attention, and reality testing. Caretakers nearly always mention the child's failure to develop interpersonal skills. The distracters are expected behaviors for a 3-year-old child.