Development: Childhood Disorders

The nurse is caring for a child who is diagnosed with autism spectrum disorder (ASD). The child's parents ask the nurse, "What is the cause of ASD in our child?" Which response by the nurse is accurate? "ASD is caused by problems in the parietal and frontal lobes of your child's brain." "ASD is caused by trauma that happened at birth." "ASD is most likely caused due to a problem with the neurons in the frontal and temporal lobes of your child's brain." "ASD is caused by the arrested development of the brain in the uterus."

"ASD is most likely caused due a problem with the neurons in the frontal and temporal lobes of your child's brain." While the exact cause of ASD is unknown, it is thought to result from genetic abnormalities of the neurons in the frontal and temporal lobes. The construction of the brain is atypical in comparison to those without autism. MRIs and other imaging have shown there are abnormalities of neurons of the cerebral cortex. The frontal and temporal lobes are particularly susceptible to these abnormal neuron patches. The frontal lobe is responsible for social behaviors, motor function, problem solving, and other higher functions. The temporal lobe is responsible for language and sensory input. It is not caused by issues in the parietal lobe, by trauma at birth, or arrested development in utero.

The nurse is discussing clinical manifestations with a group of parents of children who have been diagnosed with autism spectrum disorder (ASD). Which statement by a parent should lead the nurse to question the diagnosis of their child? "My child is not able to react to social cues." "My child engages in repetitive behaviors." "My child understands the language of older children." "My child displays self-destructive behavior."

"My child understands the language of older children." While children with autism may have high IQs, they do not understand the nuances of language and therefore do not comprehend well beyond the complexity of their age, so this is not a clinical manifestation that supports the diagnosis. Clinical manifestations that support the diagnosis of ASD include the inability to react accordingly to social cues, engaging in repetitive behaviors, and displaying self-destructive behavior.

The nurse is performing discharge teaching for a child who is diagnosed with autism spectrum disorder (ASD) with the child's parents. Which statement by the parents indicates that the teaching was successful? "We will remind our child that he will never be normal." "We will avoid all childhood vaccinations until our child reaches adulthood." "We will repeat treatments performed at the clinic and hospital at home." "We will feed our child a diet that is rich in gluten.

"We will repeat treatments performed at the clinic and hospital at home." The nurse would encourage repetition of treatments for the patient at home in order to enhance effective treatment. It is not appropriate for the nurse to emphasize that the patient will never be normal. It is not necessary to avoid childhood vaccinations. The nurse would educate the patient not to consume foods rich in gluten.

The nurse is teaching parents how to communicate with their child who is diagnosed with autism spectrum disorder (ASD). Which statement by the parents indicates that further teaching is necessary? "We will use more complete sentences in talking with our child." "We will use pictures in talking with our child." "We will take our child to speech and language therapy." "We will try using sign language with our child."

"We will use more complete sentences in talking with our child." Patients with ASD have difficulties communicating. To improve communication, parents should use short, direct sentences. Pictures or other visual aids or sign language may also be used to enhance communication. The patient should benefit from speech and language therapy.

The nurse is planning care for a young, nonverbal patient with an autism spectrum disorder. In order to plan the best care for the child, which question is most important for the nurse to ask the child's parents? "What are some of your child's rituals that we can incorporate into daily care?" "How do you supervise your child to prevent infection?" "Which one method of communication is best to use with your child?" "How do you complete the activities for daily living for your child?"

"What are some of your child's rituals that we can incorporate into daily care?" An appropriate intervention for a patient with ASD is to incorporate the patient's rituals into daily care. The nurse would supervise the patient closely to enhance safety, not to prevent infection. The nurse would adapt communication style to meet the needs of the patient. The nurse would encourage the patient to participate fully in care. Therefore, the nurse would not complete all activities of daily living for the patient.

The nurse is conducting a teaching session for parents of children who have been diagnosed with autism spectrum disorder (ASD). A parent asks, "My child is high functioning. What should I expect of him as an adult?" Which response by the nurse is best? "Your child will comprehend nonverbal cues." "Your child will most likely continue to struggle with communication skills." "Your child will function normally with social interaction." "Your child will most likely function independently."

"Your child will most likely continue to struggle with communication skills." n high-functioning adults with ASD continue to struggle with communication skills, especially understanding nonverbal communication and socialization. Many adults with ASD cannot function independently.

CNS Stimulants (Amphetamines)

1st line therapy Remember children are not just small adults, meds get absorbed faster

The parents of a child with autism spectrum disorder (ASD) tell the nurse that they have decided to try nutrition therapy. Which diet should the nurse expect will be suggested for the child? A gluten-free, casein-free diet A low-fat, low-sodium diet The Paleo diet The Atkins diet

A gluten-free, casein-free diet A popular option for treating ASD is a gluten-free, casein-free diet. Since there is anecdotal evidence that the behavior of some children improves on this diet, many parents opt to try it with their children. A low-fat, low-sodium diet and the Paleo diet are used to treat heart disease. The Atkins diet is a reduced-carbohydrate diet.

Which instruction should the nurse include when teaching the parents of a​ 3-year-old child with autism spectrum disorder​ (ASD)? (Select all that​ apply.) A. Teaching problem solving regarding client issues B. Providing for play with other children of the same age C. Providing methods to decrease the incidence of head banging D. Administering stimulants to calm repetitive motions E. Establishing therapies to assist with building play skills

A,B,C,E ​Rationale: Clients with ASD have behaviors that interfere with functioning and can be harmful to​ them, such as banging their head or hitting solid objects. Provide clients who have ASD with early physical and occupational therapy that may be beneficial in developing some play and social skills. Clients with ASD may keep themselves in​ isolation, and assisting the clients to be able to be in the presence of others is a focus of treatment. The client with autism spectrum disorder may not progress to living​ independently; therefore, parents need to learn​ problem-solving skills to assist them and the client throughout life. Stimulants are a​ pharmacologic, not​ nonpharmacologic, treatment for autism spectrum disorder.

Which intervention is an appropriate nonpharmacologic treatment for the nurse to include in the plan of care for a client with autism spectrum disorder​ (ASD)? (Select all that​ apply.) A. Teaching the family about studies on complementary care B. Creating an environment that is conducive to positive behavior management C. Establishing support for the parents and family D. Encouraging parents not to vaccinate their children E. Promoting enhanced communication

A,B,C,E Rationale: Children with ASD will benefit from the following nonpharmacologic treatment​ options: establishing support for the parents and​ family; creating an environment that is conducive to positive behavior​ management; promoting enhanced​ communication; and educating the family about studies on the use of complementary care. Discouraging parents from vaccinating their children is not an appropriate treatment option for children with ASD.

Which instruction should the nurse include when teaching parents strategies to enhance communication with a child diagnosed with autism spectrum disorder​ (ASD)? (Select all that​ apply.) A. Using​ pictures, computers, or other visual aids B. Considering using sign language C. Using complex words to stimulate the​ child's vocabulary D. Using​ short, direct sentences E. Speaking loudly

A,B,D ​Rationale: Clients with ASD have impaired communication skills. Strategies to improve communication include using​ short, direct sentences that are easy to​ understand, supplementing verbal communication with the use of​ pictures, computers, or other visual​ aids, and using sign language. Deafness is not a clinical manifestation of​ ASD, so speaking loudly will not improve communication and will distress the client.​ Simple, not​ complex, words and sentences are best for communication with the client with ASD.

The parents of a child diagnosed with autism spectrum disorder (ASD) are trying to determine why their child has the disorder. In response, the nurse should include which etiology? A. Genetic factors B. Chemical factors C. Psychological factors D. Toxins

A. Genetic factors Genetic factors are seen as being one of the associated causes of autism spectrum disorder. Those with autism have defects in the genes and gene expression in the areas of cell-cycle expression. The other responses are not thought to cause ASD.

The nurse is assessing a toddler client for an upper respiratory infection. The nurse suspects the child may have autism spectrum disorder​ (ASD). Which behavior caused the​ nurse's suspicion? A. Having a tantrum when touched by the nurse B. Playing with the other children and toys while awaiting the nurse C. Crying after the administration of immunizations D. Speaking to the nurse in sentences

A. Having a tantrum when touched by the nurse ​Rationale: An assessment finding that supports the diagnosis of ASD is having a tantrum when touched by the healthcare provider. It is not uncommon for a child with ASD to display an inability to attend and systematize situational reactions. Playing with other​ children, speaking to the nurse in​ sentences, and crying after the administration of immunizations are not findings that support ASD. These assessment findings are age appropriate for the client.

The nurse is presenting to a group of parents whose children are suspected of having autism spectrum disorder (ASD). Which statement by the nurse should be included? A.) "The features of autism are typically apparent by the time a child is 3 years of age." B.) "You should notice deficits in your child by the age of 5." C.) "A feature of ASD is the ability to understand nonverbal behavior." D.) "A child with ASD should be able to successfully engage in imaginative play."

A.) "The features of autism are typically apparent by the time a child is 3 years of age." The essential features of ASD (social deficits, language impairment, and repetitive behaviors) typically become apparent by the time a child is 3 years of age, not 5. The child with ASD is unable to read nonverbal behavior or engage in imaginative play.

The child prescribed an antipsychotic medication to manage violent behavior is one most likely diagnosed with: a. attention deficit hyperactivity disorder. b. posttraumatic stress disorder. c. communication disorder. d. an anxiety disorder.

ANS: A Antipsychotic medication is useful for managing aggressive or violent behavior in some children diagnosed with attention deficit hyperactivity disorder. If medication were prescribed for a child with an anxiety disorder, it would be a benzodiazepine. Medications are generally not needed for children with communication disorder. Treatment of PTSD is more often associated with SSRI medications.

*A child diagnosed with attention deficit hyperactivity disorder will begin medication therapy. The nurse should prepare a plan to teach the family about which classification of medications?* a. Central nervous system stimulants b. Tricyclic antidepressants c. Antipsychotics d. Anxiolytics

ANS: A Central nervous system stimulants, such as methylphenidate and pemoline (Cylert), increase blood flow to the brain and have proved helpful in reducing hyperactivity in children and adolescents with attention deficit hyperactivity disorder. The other medication categories listed would not be appropriate.

Which nursing diagnosis is universally applicable for children diagnosed with autism spectrum disorders? a. Impaired social interaction related to difficulty relating to others b. Chronic low self-esteem related to excessive negative feedback c. Deficient fluid volume related to abnormal eating habits d. Anxiety related to nightmares and repetitive activities

ANS: A Children diagnosed with autism spectrum disorders display profoundly disturbed social relatedness. They seem aloof and indifferent to others, often preferring inanimate objects to human interaction. Language is often delayed and deviant, further complicating relationship issues. The other nursing diagnoses might not be appropriate in all cases.

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 was absent from the child's birthday party. 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 Children raised by a depressed parent have an increased risk of developing an emotional disorder. Familial risk factors correlate with child psychiatric disorders, including severe marital discord, low socioeconomic status, large families and overcrowding, parental criminality, maternal psychiatric disorders, and foster-care placement. The chronicity of the parent's depression means it has been a consistent stressor. The other factors are not as risk- enhancing.

A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. The child 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: a. displays resiliency. b. has a passive temperament. c. is at risk for posttraumatic stress disorder. d. uses intellectualization to deal with problems.

ANS: A Resiliency 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.

Soon after parents announced they were divorcing, a child stopped participating in sports, sat alone at lunch, and avoided former friends. The child told the school nurse, "If my parents loved me, they would work out their problems." Which nursing diagnosis has the highest priority? a. Social isolation b. Decisional conflict c. Chronic low self-esteem d. Disturbed personal identity

ANS: A This child shows difficulty coping with problems associated with the family. Social isolation refers to aloneness that the patient perceives negatively, even when self-imposed. The other options are not supported by data in the scenario.

A child reports to the school nurse of being verbally bullied by an aggressive classmate. What is the nurse's best first action? a. Give notice to the chief administrator at the school regarding the events. b. Encourage 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.

At the time of a home visit, the nurse notices that each parent and child in a family has his or her own personal online communication device. Each member of the family is in a different area of the home. Which nursing actions are appropriate? Select all that apply. a. Report the finding to the official child protection social services agency. b. Educate all members of the family about risks associated with cyberbullying. c. Talk with the parents about parental controls on the children's communication devices. d. Encourage the family to schedule daily time together without communication devices. e. Obtain the family's network password and examine online sites family members have visited.

ANS: B, C, D Education and awareness-based approaches have a chance of effectively reducing harmful online behavior, including risks associated with cyberbullying. Parental controls on the children's devices will support safe Internet use. Family time together will promote healthy bonding and a sense of security among members. There is no evidence of danger to the children, so a report to child protective agency is unnecessary. It would be inappropriate to seek the family's network password and an invasion of privacy to inspect sites family members have visited.

A nurse prepares to lead a discussion at a community health center regarding children's health problems. The nurse wants to use current terminology when discussing these issues. Which terms are appropriate for the nurse to use? Select all that apply. a. Autism b. Bullying c. Mental retardation d. Autism spectrum disorder e. Intellectual development disorder

ANS: B, D, E Some dated terminology contributes to the stigma of mental illness and misconceptions about mental illness. It's important for the nurse to use current terminology.

*A kindergartener is disruptive in class. This child is unable to sit for expected lengths of time, inattentive to the teacher, screams while the teacher is talking, and is aggressive toward other children. The nurse plans interventions designed to:* a. promote integration of self-concept. b. provide inpatient treatment for the child. c. reduce loneliness and increase self-esteem. d. improve language and communication skills.

ANS: C Because of their disruptive behaviors, children with ADHD often receive negative feedback from parents, teachers, and peers, leading to self-esteem disturbance. These behaviors also cause peers to avoid the child with ADHD, leaving the child with ADHD vulnerable to loneliness. The child does not need inpatient treatment at this time. The incorrect options might or might not be relevant.

*A nurse will prepare teaching materials for the parents of a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which medication will the information focus on?* a. Paroxetine (Paxil) b. Imipramine (Tofranil) c. Methyphenidate (Ritalin) d. Carbamazepine (Tegretol)

ANS: C CNS stimulants are the drugs of choice for treating children with ADHD: Ritalin and dexedrine are commonly used. None of the other drugs are psychostimulants used to treat ADHD.

When group therapy is prescribed as a treatment modality, the nurse would suggest placement of a 9-year-old in a group that uses: a. guided imagery. b. talk focused on a specific issue. c. play and talk about a play activity. d. group discussion about selected topics.

ANS: C Group therapy for young children takes the form of play. For elementary school children, therapy combines play and talk about the activity. For adolescents, group therapy involves more talking.

Which factor presents the highest risk for a child to develop a psychiatric disorder? a. Having an uncle with schizophrenia b. Being the oldest child in a family c. Living with an alcoholic parent d. Being an only child

ANS: C 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. Being in a middle-income family and being the oldest child do not represent psychosocial adversity. Having a family history of schizophrenia presents a risk, but an alcoholic parent in the family offers a greater risk.

*Which behavior indicates that the treatment plan for a child diagnosed with an autism spectrum disorder was effective? The child:* a. plays with one toy for 30 minutes. b. repeats words spoken by a parent. c. holds the parent's hand while walking. d. spins around and claps hands while walking.

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

A desired outcome for a 12-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care? a. Reality therapy b. Simple restitution c. Social skills group d. Insight-oriented group therapy

ANS: C 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 or no impact on peer relationships.

A child diagnosed with attention deficit hyperactivity disorder (ADHD) shows hyperactivity, aggression, and impaired play. The health care provider prescribed amphetamine salts (Adderall). The nurse should monitor for which desired behavior? a. Increased expressiveness in communication with others b. Abilities to identify anxiety and implement self-control strategies c. Improved abilities to participate in cooperative play with other children d. Tolerates social interactions for short periods without disruption or frustration

ANS: C The goal is improvement in the child's hyperactivity, aggression, and play. The remaining options are more relevant for a child with intellectual development disorder or an anxiety disorder.

*What is the nurse's priority focused assessment for side effects in a child taking methylphenidate (Ritalin) for attention deficit hyperactivity disorder (ADHD)?* a. Dystonia, akinesia, and extrapyramidal symptoms b. Bradycardia and hypotensive episodes c. Sleep disturbances and weight loss d. Neuroleptic malignant syndrome

ANS: C The most common side effects are gastrointestinal disturbances, reduced appetite, weight loss, urinary retention, dizziness, fatigue, and insomnia. Weight loss has the potential to interfere with the child's growth and development. The distracters relate to side effects of conventional antipsychotic medications.

Assessment data for a 7-year-old reveals an inability to take turns, blurting out answers to questions before a question is complete, and frequently interrupting others' conversations. How should the nurse document these behaviors? a. Disobedience b. Hyperactivity c. Impulsivity d. Anxiety

ANS: C These behaviors are most directly related to impulsivity. Hyperactive behaviors are more physical in nature, such as running, pushing, and the inability to sit. Inattention is demonstrated by failure to listen. Defiance is demonstrated by willfully doing what an authority figure has said not to do.

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? a. "Perhaps your child was misdiagnosed." b. "Your observation indicates the medication is effective." c. "Tics often change frequency or severity. That doesn't mean they aren't real." d. "This finding is unexpected. How have you been administering your child's medication?"

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

When a 5-year-old is disruptive, the nurse says, "You must take a time-out." The expectation is that the child will: a. go to a quiet room until called for the next activity. b. slowly count to 20 before returning to the group activity. c. sit on the edge of the activity until able to regain self-control. d. sit quietly on the lap of a staff member until able to apologize for the behavior.

ANS: C Time-out is designed so that staff can be consistent in their interventions. Time-out may require going to a designated room or sitting on the periphery of an activity until the child gains self-control and reviews the episode with a staff member. Time-out may not require going to a designated room and does not involve special attention such as holding. Counting to 10 or 20 is not sufficient.

A nurse works with a child who is sad and irritable because the child's parents are divorcing. Why is establishing a therapeutic alliance with this child a priority? a. Therapeutic relationships provide an outlet for tension. b. Focusing on the strengths increases a person's self-esteem. c. Acceptance and trust convey feelings of security to the child. d. The child should express feelings rather than internalize them.

ANS: C Trust is frequently an issue because the child may question their trusting relationship with the parents. In this situation, the trust the child once had in parents has been disrupted, reducing feelings of security. The correct answer is the most global response.

A nurse prepares the plan of care for a 15-year-old diagnosed with moderate intellectual developmental disorder. What are the highest outcomes that are realistic for this patient? Within 5 years, the patient will: (select all that apply) a. graduate from high school. b. live independently in an apartment. c. independently perform own personal hygiene. d. obtain employment in a local sheltered workshop. e. correctly use public buses to travel in the community.

ANS: C, D, E Individuals with moderate intellectual developmental disorder progress academically to about the second grade. These people can learn to travel in familiar areas and perform unskilled or semiskilled work. With supervision, the person can function in the community, but independent living is not likely.

*A nurse assesses a 3-year-old diagnosed with an autism spectrum disorder. Which finding is most associated with the child's disorder? The child:* a. has occasional toileting accidents. b. is unable to read children's books. c. cries when separated from a parent. d. continuously rocks in place for 30 minutes.

ANS: D Autism spectrum 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 autism spectrum disorder. The distracters are expected findings for a 3-year-old.

The parent of a 6-year-old says, "My child is in constant motion and talks all the time. My child isn't interested in toys but is out of bed every morning before me." The child's behavior is most consistent with diagnostic criteria for: a. communication disorder. b. stereotypic movement disorder. c. intellectual development disorder. d. attention deficit hyperactivity disorder.

ANS: D Excessive motion, distractibility, and excessive talkativeness are seen in attention deficit hyperactivity disorder (ADHD). The behaviors presented in the scenario do not suggest intellectual development, stereotypic, or communication disorder.

Which child demonstrates behaviors indicative of a neurodevelopmental disorder? a. A 4-year-old who stuttered for 3 weeks after the birth of a sibling b. A 9-month-old who does not eat vegetables and likes to be rocked c. A 3-month-old who cries after feeding until burped and sucks a thumb d. A 3-year-old who is mute, passive toward adults, and twirls while walking

ANS: D Symptoms consistent with autistic spectrum disorders (ASD) are evident in the correct answer. Autistic spectrum disorder is one type of neurodevelopmental disorder. The behaviors of the other children are within normal ranges.

A 4-year-old cries for 5 minutes when the parents leave the child at preschool. The parents ask the nurse, "What should we do?" Select the nurse's best response. a. "Ask the teacher to let the child call you at play time." b. "Withdraw the child from preschool until maturity increases." c. "Remain with your child for the first hour of preschool time." d. "Give your child a kiss before you leave the preschool program."

ANS: D The child demonstrates age-appropriate behavior for a 4-year-old. The nurse should reassure the parents. The distracters are over-reactions.

A child diagnosed with attention deficit hyperactivity disorder had this nursing diagnosis: impaired social interaction related to excessive neuronal activity as evidenced by aggression and demanding behavior with others. Which finding indicates the plan of care was effective? The child: a. has an improved ability to identify anxiety and use self-control strategies. b. has increased expressiveness in communication with others. c. shows increased responsiveness to authority figures. d. engages in cooperative play with other children.

ANS: D 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 autism spectrum or anxiety disorder.

*When a 5-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) bounces out of a chair and runs over and slaps another child, what is the nurse's best action?* a. Instruct the parents to take the aggressive child home. b. Direct the aggressive child to stop immediately. c. Call for emergency assistance from other staff. d. Take the aggressive child to another room.

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

Childhood Depression Ages 3-5

Accident proneness, phobias, excessive self-approach, clumsy, does not show at risk and does not step risk and behavior.

Depressive Disorders in Pediatrics

Adjustment Disorder: most common Major Depressive Disorder

Childhood Depression Focus or therapy

Alleviate symptoms and strengthen coping skills Observe first to see what the child's point is Parent and family therapy to build the support.

While assessing a 5-year-old boy with autism spectrum disorder (ASD), the nurse notices that the boy is standing near his mother playing with a teddy bear and does not respond to the nurse's greeting. Which approach is most appropriate for the nurse to use? Explaining that this is not at all unusual and that there is not much that can be done, because this is the normal progression of the disorder Allowing the patient to stay next to his mother with the teddy bear and speaking to him calmly and concisely Engaging as little as possible with the patient, so as not to upset him more, and keeping to the task at hand Telling the mother that her son is too old to play with teddy bears

Allowing the patient to stay next to his mother with the teddy bear and speaking to him calmly and concisely It is best to allow the patient to stay near his mother and keep the teddy bear, which will help him accept the new environment and activities that will be taking place. Using the patient's name before saying hello will help him recognize that he is being spoken to. The other answers would not be helpful to the patient.

Oppositional Defiant Disorder (ODD) Spiteful or indictive at least 2x in the last six months begins by age 8, early teens

Angry, Negative, irritable mood, argumentative, defiant, disobedient Hostile towards authority Resistant to directions Blames others for misfortunes Unwilling to compromise or negotiate with adults Environmental/genetic compound ,k

The nurse is discussing medications that are used in the treatment of autism spectrum disorder (ASD) with a parent of a child who was recently diagnosed with the condition. Which statement by the parent indicates the need for further teaching? "I will monitor my child closely with any new medications." I will note if my child has an increase in negative behaviors from medication." "I will give my child aspirin to help with the symptoms of ASD." "I will watch to see if my child has any suicidal thoughts."

Antipyretic agents are used to decrease body temperature and would not be appropriate for use in the treatment of a patient diagnosed with ASD. Children with autism might not respond to medications as other children do. Some negative behaviors might increase with medications. Other medications may cause severe depression and suicidal thoughts. Children with autism should be monitored closely when starting new medications.

The nurse is teaching the parents of a young child who was recently diagnosed with autism spectrum disorder (ASD). Which nonpharmacologic intervention should the nurse include? Applied behavior analysis Chelation therapy Mineral solutions Echolalia

Applied behavior analysis Applied behavior analysis is a form of behavior modification therapy that rewards the patient with ASD for positive behaviors like making eye contact or completing a sentence. Chelation therapy and mineral solutions are unproven and dangerous therapies. Echolalia is a compulsive parroting of a word or phrase just spoken by another.

The nurse is discussing nonpharmacologic interventions with the parents of a young child who was recently diagnosed with autism spectrum disorder (ASD). Which statement by the parents indicates that teaching was successful? "I'm contacting my doctor to request starting chelation therapy." "We are going to investigate applied behavior analysis as treatment." "I'm going to begin to give my child mineral solutions." "We will start encouraging echolalia in our child's speech."

Applied behavior analysis is a form of behavior modification therapy that rewards the patient with ASD for positive behaviors like making eye contact or completing a sentence. Chelation therapy and mineral solutions are unproven and dangerous therapies. Echolalia is a compulsive parroting of a word or phrase that has just been spoken by another.

The nurse assesses a child suspected of having autism spectrum disorder​ (ASD). Which behavior noted in the assessment supports the​ diagnosis? (Select all that​ apply.) A. Deep set eyes B. Echolalia C. Emotional calm D. Stereotypy E. An aversion to being touched

B,D,E ​Rationale: Behaviors indicative of ASD include stereotypy​ (rigid and obsessive​ behavior), echolalia​ (the compulsive parroting of a word or phrase just stated by​ another), and an aversion to being touched. Emotional lability​ (rapid, significant mood​ changes), not emotional​ calm, is a clinical manifestation of ASD. ASD does not manifest in any physical signs.

The nurse is addressing a group of parents whose children are suspected of having autism spectrum disorder (ASD). Which statement by the parents indicates that additional teaching is necessary? A. "The essential features of autism are typically noticed by 3 years of age." B. "We should notice deficits in our children by the age of 5." C. "A feature of ASD is the inability to understand nonverbal behavior." D. "A child with ASD should not engage in imaginative play."

B. "We should notice deficits in our children by the age of 5." The essential features of ASD (social deficits, language impairment, and repetitive behaviors) typically become apparent by the time a child is 3 years of age, not 5. The child with ASD is unable to read nonverbal behavior or engage in imaginative play.

The nurse is discussing the need for early diagnosis and treatment of autism spectrum disorder (ASD) with parents of children suspected of having the condition. Which statement should the nurse include? A.) "Early diagnosis and treatment provides the only means for a cure of ASD." B.) "Early diagnosis and treatment give your child the best chance of becoming a fully functioning adult." C.) "Early diagnosis and treatment provide the best way to ensure that your child can be admitted to an assisted living facility as an adult." E.) "Early diagnosis and treatment prevent your child from developing any other mental condition."

B.) "Early diagnosis and treatment give your child the best chance of becoming a fully functioning adult." Early diagnosis and treatment of ASD provide access to treatments and therapies that give patients the best chance to become fully functioning adults. Undiagnosed or untreated ASD decreases the quality of life and the likelihood that comorbid conditions such as depression will be identified. ASD is a lifelong condition and is not "cured." Early detection and treatment do not prevent the development of any other mental condition but allows for the early diagnosis and treatment of depression or anxiety. It does not help the adult with ASD enter into an assistive living facility.

The graduate nurse is caring for a family with a child who was recently diagnosed with autism spectrum disorder (ASD) and is discussing treatment options for the child. Which goal of collaborative therapy would require correction from the preceptor? Advocating for parent support and coping groups Use of focusing techniques and behavior management Implementing treatments that decrease maladaptive behaviors such as rigidity and stereotype Behavior modification through electroconvulsive therapy

Behavior modification through electroconvculsive therapy The goals of therapy for a child with ASD and their family include advocating for parent support and coping groups, using focused techniques and behavior management, and implementing treatments that decrease maladaptive behaviors. While behavior modification may be a goal of treatment, electroconvulsive therapy is not a treatment option for children with ASD.

ADHD Impulsivity

Blurts out answers before question has been completely asked. Difficulty waiting turn ( cannot hold on) Interrupts or intrudes on others. Acting urges, notions, or desires without considering other or consequences. Finds a reason to get in front of the line. Often interrupting No guidelines

The parents of a child who is diagnosed with autism spectrum disorder (ASD) tell the nurse that they wish to put their child on a gluten-free, casein-free diet. Which foods should the nurse instruct the parents to avoid feeding their child? Bread and milk Fish and fruit Red meat and green, leafy vegetables Rice and eggs

Bread and milk A gluten-free, casein-free diet eliminates the proteins found in wheat and dairy products. The child should avoid bread, milk, and cheese because they are made from grains or dairy. All other foods can be consumed.

The home care nurse is visiting a child diagnosed with autism spectrum disorder​ (ASD). Which intervention is appropriate for the nurse to include in the treatment plan for this​ family? A. Focusing on the​ child's limitations B. Recommending that the home be a​ therapy-free zone C. Providing appropriate education regarding what to expect for the child D. Encouraging the family to get over negative feelings regarding the diagnosis

C Rationale: An appropriate intervention for the family of a child diagnosed with ASD is for the nurse to provide education about what to expect. The nurse would encourage the family to grieve the loss of the​ "perfect child" and encourage the parents to focus on the​ child's strengths and talents. In order for therapy to be​ effective, the nurse would recommend that treatments be continued at home.

Which medication should the nurse expect to find on the medication administration record​ (MAR) for a child with autism spectrum disorder​ (ASD)? (Select all that​ apply.) A. Beta-blocker B. Angiotensin-converting enzyme​ (ACE) inhibitor C. Mood stabilizer D. Selective serotonin reuptake inhibitor​ (SSRI) E. Stimulant

C,D,E Rationale: While there is no medication to cure​ ASD, medications are prescribed to manage behaviors and symptoms. These medications include​ stimulants, SSRIs, and mood stabilizers. ACE inhibitors and beta blockers are used to treat hypertension.

The nurse is assessing a 3-year-old child for symptoms of autism spectrum disorder (ASD). Which assessment finding should lead the nurse to question the diagnosis? A.) Inability to react accordingly to social clues B.) Engages in repetitive behaviors C.) Comprehends language well beyond the complexity of age D.) Displays self-destructive behavior

C.) Comprehends language well beyond the complexity of age While children with autism may have high IQs, they do not understand the nuances of language and therefore do not comprehend well beyond the complexity of their age, so this is not a clinical manifestation that supports the diagnosis. Clinical manifestations that support the diagnosis of ASD include the inability to react accordingly to social cues, engaging in repetitive behaviors, and displaying self-destructive behavior.

ADHD Pharmacotherapy

Concentra Adderall Ritalin Strattera

ADHD Intervention Successful treatment requires combination of behavioral management and medication.

Create safe, constant environment with limits. Behavior modifications and contracts Social skills Training (play therapy, cyclotherapy) Family/school education Medication assist with anxiety and behavioral syst.

Which intervention is most appropriate for the nurse to include in the plan of care for a child with autism spectrum disorder​ (ASD)? A. Putting the television on loud to provide stimulation for the client B. Rearranging the hospital room until a comfortable arrangement is found C. Scheduling procedures for different times each day D. Encouraging the​ client's family to bring in familiar objects from home

D. Encouraging the​ client's family to bring in familiar objects from home

Nonselective reuptake inhibitor (non stimulant) Wellbutrin Mechanism of Action

Decreases the reuptake of dopamine, serotonin, prepi

Depression Tx

Developmentally appropriate psychotherapy Family therapy Consultation with child's school Antidepressants Monitor for suicidal risk and ideation

Tourette's Disorder intervention

Education and supportive intervention Individual and family therapy.

Childhood Depression Symptoms: <Age 3

Feeding problems, tantrums lack of playfulness, and emotional expressiveness, depression

The nurse is reviewing the medical record of a 6-year-old patient who is diagnosed with autism spectrum disorder (ASD). Which item in the health history should the nurse consider may have been a factor in the patient's development of ASD? Appropriate adaptation to new environments Fetal alcohol syndrome Childhood vaccinations Cystic fibrosis

Fetal alcohol syndrome History of maternal alcohol use during pregnancy may have contributed to the development of ASD. Childhood vaccinations and cystic fibrosis are not linked to ASD. The ability to adapt to new environments is an appropriate goal, not a cause, for a patient who is diagnosed with ASD.

SSRI S/E in Children and Teens Seretonin syndrome

Fever, tachycardia, BP, delirum, tremors, motor activity, seizures, hyperpyrexia, shock, death Esp. with concurrent use of MAO inhibitors

ADHD Hyperactivity

Fidgets with hands/feet or squirms in seat Leaves seat (classroom) Runs about or climbs excessively in settings that is inappropriate. Difficulty with leisure activities such as reading a book or quiet time. "on the go " or "the energizer bunny" Talks excessively. Involve the child to allow them to move in classroom. transmission are firing to fast.

SNRI's Strattera ( 6 years and older) Side effects

HA, N?V, upper abd pain, dry mouth, decreased appetite, weight loss, constipation, insomnia, increased blood pressure, and heart rate, sexual dysfunction.

Tic Disorders TOURETTE'S DISORDERS Psychopharmacology

Haloperidaol (haldo) S/E: COGNITIVE BLUNTING, aggression or sedation

The nurse admits a child suspected of having autism spectrum disorder (ASD). Which test to aid in the diagnosis should the nurse question? Electrocardiogram (EEG) Computerized tomography (CT) scan Lead screening Head x-ray

Head x-ray There is no laboratory test or imaging that can diagnose autism. Diagnosis is based on the presence of certain criteria contained in the DSM-5. However, testing should be completed first to rule out a medical cause of the child's behavior. Tests may include neuroimaging (CT scan or MRI), lead screening, DNA analysis, and electroencephalography. CT or MRI would be of more value in ruling out medical causes than a head x-ray.

Tourette"s Disorder MULTIPLE MOTOR TIES

Head, torso, and lower limbs eye blinking, neck jerking, shoulder shrugging, grimacing. hopping n squinting

The nurse takes a team approach to help a middle-aged patient who is diagnosed with autism spectrum disorder (ASD) achieve their full potential. The nurse uses a community center to help find a job for the patient. Which strategy should the nurse engage to allow this patient to have the best opportunity for success? Making sure the job is an easy one Helping the patient find a position that will allow them to use their strongest talents Partnering the patient with someone else at work so that they can keep an eye on them at all times None, as those with ASD generally cannot work because the disorder is too debilitating to allow them to be productive community members

Helping the patient find a position that will allow them to use their strongest talents Individuals with ASD have the greatest chance of success with training and finding opportunities that use their strengths. Many are active members of the community, while others need more support.

Nonselective reuptake inhibitor (non stimulant) Wellbutrin Contraindicated

If history of seizures, an eating disorder, or concurrent MAOI therapy

The nurse is caring for a patient who is diagnosed with autism spectrum disorder (ASD). Which nursing intervention is most appropriate for the nurse to use? Supervising the patient closely to prevent infection Incorporating the patient's rituals into daily care Using one method of communication with the patient Completing activities of daily living for the patient

Incorporating the patient's rituals into daily care An appropriate intervention for a patient with ASD is to incorporate the patient's rituals into daily care. The nurse would supervise the patient closely to enhance safety, not to prevent infection. The nurse would adapt communication style to meet the needs of the patient. The nurse would encourage the patient to participate fully in care. Therefore, the nurse would not complete all activities of daily living for the patient.

separation Anxiety Disorder tx

Individual psychotherapy (play therapy) Family therapy Does not use behavioral therapy

CNS Stimulants (Amphetamines) Adverse Effects

Insomnia, agitation, tachycardia, syncope, hypertension, allergic reaction. Hypertensive crisis may occur with concomitant use of MAOIs (do not take Caffeine)

School Age Depression Clinical Presentation

Irritability, aggression boys negativism, more aggressive girls withdrawal Somatic complaints, often do not want to go to school feel unloved eat/sleep problems lethargy Suicidal ideation

Preschooler Depression Clinical Presentation

Irritability, anger, sad facial expression, with Playing with other kids. Crying, anhedonia Seep/eating problems Spending much time rocking/crying Somatic complaints; HA, stomach aches Regressive behavio

Autism Spectrum Disorder: clinical presentation Mannerism

Lack of gestures failure to make eye contact poor name orientation stereotyped body movements don't like being held or hugged prefer to play alone hyperactive abnormal eating/sleeping patterns echolalia intolerable to change mood/affect abnormalities impulsive/aggressive self-injurious behaviors temper tantrums

Risk Factors for Adolescent Suicide

Loss of significant relationship Multiple losses/changes Suicide of friend, relative, or public figure Divorce of parents Break up with boyfriend or girlfriend Dropped out of school Only child in family Abut to self/others Homophobic response to sexual preference Chronic illness/disabilities Ask who/what they are/were exposed to:

ODD & CD Intervention

MAINTAIN SAFETY SET LIMITS & BE CONSISTENT ON MANIPULATIVE/IMPULSIVE BEHAVIOR Assist to develop internal limits, problem solving skills & self responsibility Mulidisciplinary behavior modification

The nurse is teaching about autism spectrum disorder to a group of community members. Which risk factor should the nurse include? Maternal age over 40 Female gender Paternal age less than 20 Parents who are close in age

Maternal age over 40 Risk factors for autism spectrum disorder (ASD) include advanced maternal age (greater than 40), paternal age greater than 50, male gender, and having parents with an age disparity of greater than 10 years.

Etiology for ASD perinatal influences

Maternal asthma or alergies

Childhood Depression Ages 9-12

Morbid thoughts excessive worry about bad things, and thinks it will happen to them. Will show in the art work.

SSRI S/E in Children and Teens Same S/E as adults

Nausea, depressed appetite, sexual dysfunction

ODD & CD Outcomes The client will:

Not harm self or others (CP will be done every 24o Interact whit others in a socially appropriate manner Accept directions without becoming defensive Demostrate increased sef-esteem as evidence by manipulating others

One or more vocal tics (words or sounds)

Obscenities, coughs, clicks, grunts, barks, sniffs, palilalia, echolalia.

Co-morbidity As many as 2/3 of children with ADHD have co-morbid conditions.

Oppositional defiant disorder Conduct Disorder learning disorders Anxiety Depression Bipolar disorder Substance use/abuse

Disruptive Disorders

Oppositional defiant disorder conduct disorder

Adolescent Depression Most common precipitant to adolescent suicide Perception of abandonment/loss by parents or close peer relationship

Parent or close friend dies/leaves/moves Move to a new town/school

Tic Disorders TOURETTE'S DISORDERS MOTOR TIES:

Persistent ( Chronic) Motor or Vocal Tie Diisorders Provisional Tie Disorder onset is at 2 yrs of age

Conduct Disorder (cd) essencial feature:

Persistent pattern of conductl that VIOLATES OTHER'S RIGHTS and major age appropriate societal norms and/ or rules Cruel to people and animals (Bully) Deceitfulness, theft (steal, lie, con) Destroy property (Sea) Pattern of disruptive willfully disobedient behavior - serius violation of rules skip school Demonstrates little empathy or guilt More serious violations than ODD

Childhood Depression Ages 6-8

Physical complaints, aggressive behavior, clinging behavior, blames self, does not want to go to school

Childhood Depression

Precipitated by a loss (actual/perceived)

Interventions for Autism Spectrum disorder

Provide a safe and consistent environmental determine a mode of communication speak calmly,in short phrases, simple, direct behavioral modification techniques parental support and education caregiver respite Transfer child to a private room to stimulation

Potenctal Nurcsng Dx for ODD & CD

RISK FOR SELF/OTHER DIRECTED VIOLENCE Noncompliance with therapy Defensive coping Low self esteem impaired social interaction

ADHD Nursing Dx.

Risk for injury Disturbed sleep patterns Impaired social interaction Low self esteem

Potential Nursing Dx for autismSpectrum Disorder

Risk for self-directed injury impaired social interaction Impaired berbal communications Disturbed personal identity

A preschool-age patient was recently diagnosed with autism spectrum disorder (ASD). The nurse should consider which observation of the patient to be supportive of the diagnosis? Sitting quietly during the assessment Wanting to be held by the parent during the assessment Actively participating with the nurse during the assessment Rocking on the exam table

Rocking on the exam table Performing a physical assessment of patients with ASD can present many challenges. Patients diagnosed with ASD may not sit still for the assessment and can display flapping, rocking or head-banging as a way to self-soothe during the assessment process. Patients who have sensory deficits or behaviors often do not like being touched and show a disinterest in being cuddled. These patients also do not like quick transitions and generally will not actively participate in the assessment process.

Psychopharmacotherapy

SSRI Fluvoxamine (luvox) old standard imipramine

Suicide Intervention

Same as with adults assess plan & lethality Obtain no suicide contract (do not understand) Secure lethal agents Increase family support, reduce discord, treat parental illness Educate parents and caregivers

Disinhibited Social Engagement Disorder

Seeks comfort and attention from anyone Overly friendly and solicitous May be highly anxious d/t repeated changes in caregivers Approaches adults but not in an appropriate behavior does not bond weil

Impairments in Attachment

Severe abuse and/or neglect Sexualization of child through abuse Learning to manipulate adults as survival skill Limited bonding at critical times in development Neurological damage

Separation Anxiety Disorder EXCESSIVE ANXIETY AT SEPARATION FROM PARENTS or major attachment figures

Shadow parents and not let him/her out of sight Frequent NIGHTMARES about separation school refusal extreme stress at anticipation of separation Onset as early as preschool before 18 yrs old Do not like things that are unfamiliar

Autism Spectrum Disorders Has markedly abnormal or impaired development in?

Socialization Communication Restrictive & repetitive behaviors Abnormal impairedder

Adolescent Depression Symptoms::

Somatic complains Loss of appetite, sleep problems Social withdrawal Anger aggressiveness Running away (will say they have been abandoned) Delinquency/Truancy Sexual acting out Substance abuse (get medication to feel better} Restlessness, apathy Many s/s similar to adults Dysphoria without stating feelings Reports feeling stupid, down, bored, worthless, apathy Intense self consciousness fear of rejection Somatic complains Decreased performance in school Irritability which can lead to aggression behaviors Suicidal thoughts (ask is they have a plan, make sure they are safe.) :

SSRI S/E in Children and Teens

Suicidal ideation Behavioral activation or sedation

Nonselective reuptake inhibitor (non stimulant) Wellbutrin Side effects

Tachycardia, dizziness, shakiness, insomnia, nausea, anorexia, weight loss.

The nurse is caring for an elderly patient with a history of autism spectrum disorder (ASD). For which condition should the nurse screen the patient? Depression Schizophrenia Diabetes mellitus Gout

The elderly patient with ASD has an increased likelihood of developing depression. Schizophrenia does not develop as a result of ASD. There is no evidence that patients with ASD are more likely to develop gout or diabetes mellitus than the normal population.

The nurse is planning the care for a patient who is admitted to the hospital for a tonsillectomy. The patient is also diagnosed with autism spectrum disorder (ASD). Which goal is appropriate for the nurse to include in the plan of care for the patient? The patient will try new foods during hospitalization. The patient will allow the nurse to perform all activities of daily living. The patient will not socialize with other children in the same age group. The patient will demonstrate behavior that is not self-destructive.

The patient will demonstrate behavior that is not self-destructive. An appropriate goal for this patient is to demonstrate behaviors that are not self-destructive. It is important for the child who is diagnosed with ASD to maintain home rituals. Therefore, it is not appropriate for the patient to try new foods during hospitalization. The patient should have a goal of independently performing activities of daily living during hospitalization. The nurse would encourage socialization with other children in the same age group, not discourage it.

Attachment Disorder in early Childhood

Trauma- and stressor-related disorder Reactive attachment disorder Disinhibited social engagement disorder`

Adolescent Depression Best clue that differentiates depression from normal stormy adolescent behavior

Visible manifestation of behavioral change that lasts for several weeks..

SNRI's Strattera ( 6 years and older) Mechanism of Action

boosts norepinephrine and noradrenline and may increase dopamine at prefrontal cortex.

SNRI's Strattera ( 6 years and older) WARNINGS

careful monitoring of cardiovascular and liver function during treatment is necessary d/t HTN crisis

Autism Spectrum Disorders

characterized by withdrawal of the child into the self and into fantasy world of his or her own creation

Autism Spectrum disorder

chronic disorder onset prior to 3 years of age 18-24 month period,if caught early, interventions have a better outcome

ADHD inattention

easily distracted (hard to read lengtny material long tough) poor follow through or fails to complete task does not listen when spoken to Disorganized (always loses things) loses things necessary for tasks forgetful in daily activities avoids,dislike, or is reluctant to engage in activities that require sustained mental effort ( schoolwork) homework mind is somewhere else hard to concentrate too much stimuli (easiley distracted).

etiology for ADHD

fetal lead poisoning

Depressive Disorders in Pediatrics Prevalence in 1 to 5 % with children at the lower end and adolescents at the higher end

higher likelihood if parent is depressed Exposure to trauma may precipitate SUICIDE ALERT: CHILDREN CAN ATTEMPT SUICIDE when they come out of the depressive disorder Moving can cause the disorder if it was traumatic

ADHD Pharmacotherapy CNS stimulants

increase levels of norepinephines, dopamine, and secrotonin in the CNS Therapeutic effects, increased attention span, control of hyperactive behavior and improvement in learning ability

pharmacotherapy : for ASD

no med can control core dificits but Risperdal and ability help| stereotypic behavior,hyperactivity & emotional lability temperaments

ADHD clinical presentation

onset by age 3 and before age 7 need 6+ symptoms

Reactive attachment disorder (RAD)

overly shy and wary Extremely withdrawn Emotionally detached towards caregiver Resistant to comforting May act out in aggression, irritability "frozen watchfulness" does not bond well

Anxiety disorder in children

separation anxiety disorder Reactive attachment disorder Disinhibited social engagement disorder

Which teaching point is important for the nurse to include in the plan of care for a client who is diagnosed with autism spectrum disorder​ (ASD)? A. Establishing a routine B. Maintaining the home as a​ treatment-free zone C. Keeping the same pediatric healthcare provider for all children in the family D. Focusing on limitations in order to see progress in care

​A Rationale: Clients who are diagnosed with ASD thrive when routines are established and followed. The family should consider seeking a healthcare provider who has experience in treating a child with ASD. Therapies must be practiced and implemented in the home environment in order to be effective. The family would focus on the​ child's strengths, not the​ child's limitations.

The nurse is developing a plan of care for a client diagnosed with autism spectrum disorder​ (ASD). Which nursing diagnosis is most appropriate for the nurse to​ include? A. ​Communication: Verbal, Impaired B. Airway​ Clearance, Ineffective C. ​Macrocephaly, Risk for D. ​Infection, Risk for

​A Rationale: ​Communication: Verbal, Impaired is an appropriate nursing diagnosis for a client with ASD. ​Macrocephaly, Risk for is not a nursing diagnosis. The client with ASD is not at risk for infection or ineffective airway clearance.

The nurse admitting a child who is suspected of having autism spectrum disorder​ (ASD) knows that it is necessary to rule out medical causes for the​ child's behavior before diagnosing ASD. Which diagnostic test should the nurse anticipate will be ordered for the​ client? (Select all that​ apply.) A. Electroencephalography B. CT scan C. KUB​ x-ray D. DNA analysis E. ABG

​A,B,D Rationale: To rule out medical causes for behavior in a suspected ASD​ client, the healthcare provider should order a CT scan or​ MRI, DNA​ analysis, lead​ screening, and electroencephalography. A KUB​ x-ray is a radiograph of the​ kidneys, ureters, and bladder. ABGs are arterial blood gases and are used to measure the amounts of oxygen and carbon dioxide in the blood. They are not used to rule out ASD.

Which assessment finding should the nurse expect in a child with autism spectrum disorder​ (ASD)? (Select all that​ apply.) A. Reiteration of questions as opposed to answering them B. Use of the word you to represent I C. Stuttering D. Echolalia E. Enchantment with the rhythmic repetition of verse or song

​A,B,D,E Rationale: Echolalia​ (parroting a particular word or​ phrase), repetition of inquiries rather than responding to​ them, using you to represent ​I, and fascination with things that are lyrical in nature such as a song or verse are typical speech pattern abnormalities for children diagnosed with ASD. Stuttering is not a clinical manifestation associated with ASD.

The nurse is assessing a​ high-functioning adult client who is diagnosed with autism spectrum disorder​ (ASD). Which characteristic of ASD should the nurse anticipate this client will demonstrate during the nursing​ assessment? (Select all that​ apply.) A. Understanding body language B. Displaying problems with sentence structure C. Having trouble with double meanings D. Choosing inappropriate topics to discuss E. Lacking the ability to participate in small talk

​A,C,D,E Rationale: Socialization and​ communication, especially understanding nonverbal​ communication, are lifelong struggles for the adult with ASD. Behaviors that the nurse will anticipate during the assessment include choosing inappropriate topics to​ discuss, not engaging in small​ talk, understanding body​ language, and having trouble with double meanings. The nurse would not expect the adult client with ASD to display problems with sentence structure.

The nurse is reviewing the medical record of a​ 6-year-old client diagnosed with autism spectrum disorder​ (ASD). Which item in the health history should the nurse consider may have been a factor in the client developing​ ASD? A. Fetal alcohol syndrome B. Appropriate adaptation to new environments C. Childhood vaccinations D. Postterm birth

​A. Rationale: The ingestion of​ alcohol, tobacco, and toxic substances has been known to cause birth defects.​ Therefore, fetal alcohol syndrome could possibly be a factor in the development of ASD. Childhood vaccinations have not been proven to cause ASD. Appropriate adaptation to new environments and postterm birth have no link to ASD

Which resource should the nurse expect the healthcare provider to use to confirm the diagnosis of autism spectrum disorder​ (ASD)? A. Diagnostic and Statistical Manual of Mental Disorders B. The Mental Health Rights Manual C. The Autism Handbook D. Teaching Social Communication to Families with Autism

​A. Rationale: Criteria for diagnosis can be found in the American Psychiatric​ Association's Diagnostic and Statistical Manual of Mental Disorders​, 5th edition​ (DSM-5), which includes screening tests to identify tendencies consistent with ASD. Although the other resources may be helpful in teaching the client and the family about​ ASD, they are not used as a diagnostic tool.

The nurse is planning care for a client who is diagnosed with autism spectrum disorder​ (ASD). Which goal is appropriate for the nurse to​ include? A. The client will remain free from infection. B. The client will display developmental progress. C. The client will demonstrate negative communication skills. D. The client will engage in private activities to stimulate learning.

​B Rationale: An appropriate goal when providing care to a client diagnosed with ASD is for the client to display developmental progress. Other appropriate goals include the client remaining free of​ injury, the client demonstrating positive communication​ skills, and the client participating in activities with family members or small groups of peers.

The nurse is teaching the family of a client diagnosed with autism spectrum disorder​ (ASD) about a​ gluten-free and​ casein-free diet. Which food should the nurse​ include? (Select all that​ apply.) A. Yogurt B. Cheese C. Cornmeal D. Grilled salmon E. Soy milk

​C,D,E Rationale: A​ gluten-free and​ casein-free diet eliminates wheat and dairy products. Foods that support a​ gluten-free and​ casein-free diet include​ cornmeal, grilled​ salmon, and soy milk. Cheese and yogurt are​ casein-rich foods.​ Therefore, they should be avoided.

The nurse is teaching the parents of a child recently diagnosed with autism spectrum disorder​ (ASD). Which etiologies should the nurse​ include? (Select all that​ apply.) A. Neurotransmitters B. Environmental factors C. ​Mercury-containing vaccinations D. Genetics E. Immunologic factors

​a,b,d,e Rationale: The etiology of ASD is​ uncertain, but it is believed to be the result of an intricate​ co-action between​ genetic, immunologic, and environmental circumstances. There is research being conducted on the role of​ neurotransmitters, such as dopamine and serotonin. There is no evidence that​ mercury-containing vaccinations cause autism.

The nurse is assessing a​ 3-year-old child with autism spectrum disorder​ (ASD). In which area should the nurse expect to find​ impairments? (Select all that​ apply.) A. Ability to engage in complex thought process B. Communication C. Social adaptability D. Ability to organize responses to situations E. Social interactions

​b,c,d,e Rationale: Impairments are noted in the social interactions and ability to adapt socially at the appropriate age level. The young child with ASD will have a decreased ability to communicate as well as an inability to organize situational responses.​ Developmentally, the​ 3-year-old is not old enough for complex thought.