mental health ch 22

Assessment of an 8-year-old client reveals communication difficulties and an inability to manage age-appropriate tasks. The child undergoes standardized testing. An intelligent quotient (IQ) of which would support a diagnosis of intellectual disability? -65 -75 -85 -95

65 explanation: The usual threshold for intellectual disability is an IQ of 70 or less (i.e., two standard deviations below the population mean).

Below average intellectual functioning is initially diagnosed when an intelligence quotient (IQ) is below which level? 70 50 35 20

70 explanation: The essential feature of intellectual disability is below-average intellectual functioning (IQ less than 70) accompanied by significant limitations in areas of adaptive functioning such as communication skills, self-care, home living, social or interpersonal skills, use of community resources, self-direction, academic skills, work, leisure, and health and safety.

The nurse provides care to a child whose parents recently separated and are planning to divorce. The child's parents ask the nurse how they can help their child deal with the situation. Which response by the nurse is appropriate? - "Your child will likely require pharmacologic intervention." - "Your child will benefit from the introduction of new routines." - "It is best for your child to spend the majority of time with the custodial parent." - "It is important that you help your child by not speaking negatively about the other."

- "It is important that you help your child by not speaking negatively about the other." Explanation: Parents manage divorce better if they can remember that children naturally idealize and identify with both parents and need to view both positively; therefore, it is helpful for parents to guard against making negative statements about each other and focus on evidence of their former partner's love and respect for the child. Pharmacologic intervention is not supported by evidence-based practice in the absence of other psychological issues. Helpful interventions for children of divorce include education regarding children's reactions; promotion of regular and predictable visitation; reduction of conflict between the parents through counseling, mediation, and clear visitation policies; and continuance of usual routines.

A child with attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate. The parent reports that the child is having trouble sleeping. When assessing this report, which question would be most appropriate for the nurse to ask? - "When does the child take the last dose of medication?" - "Are you crushing the sustained release tablet?" - "Is the child taking any over-the-counter medications?" - "Is the child having any other complaints?"

- "When does the child take the last dose of medication?" Explanation: A report of trouble sleeping is a side effect of psychostimulants. The nurse should gather additional information about the child's sleep pattern and the schedule of medication, such as when the child takes the last dose. The drug is rarely taken after 5 p.m. Crushing the sustained release preparation would affect absorption and effectiveness. The use of over-the-counter medications could accentuate the side effects of the stimulant, but this information would be important if the nurse determines that the drug schedule is appropriate. Asking about any other complaints, although helpful to determine the effects of the drug, does not address the parent's concern.

The nurse is assessing a child with autism spectrum disorder. After reading the medical history, the nurse finds that the child engages in stereotypical motor behavior. Which observation of the child made by the nurse might be indicative of stereotypical motor behavior? - Flapping hands repeatedly - Using limited gestures to communicate - Not being able to engage in play activities - Unusual reactions to sounds, smells, and other sensory experiences

- Flapping hands repeatedly Explanation: Stereotypical motor behavior refers to repetitive or ritualistic movement of a body part, such as repeated flapping of the hands. Using limited gestures while communicating, an inability to engage in play activities, and having unusual reactions to sounds, smells, and other sensory experiences are behaviors typically seen in children with autism spectrum disorder. These behaviors, howerver, cannot be referred to as stereotypical motor behaviors.

A nurse is evaluating a child's attention span. Which finding indicates that the child's attention span is decreased? -Child is able to count back from 100 by 7s. -Child reads a book while in the waiting room. -Child is rocking in the chair continuously. -Child is engaged in a conversation.

-Child is rocking in the chair continuously. explanation Indications of decreased attention span include hyperactivity, inability to stay focused during an interview/conversation, and inability to perform simple tasks. The ability to count backwards, read a book, and be engaged in a conversation indicates an adequate attention span.

A nursing student is aware that which accounts for more deaths, illnesses, and disabilities across the life span than any other preventable condition? -Motor vehicle accidents -Substance abuse disorders -Falls -Mood disorders

-Substance abuse disorders

A nurse is assessing a child with attention deficit hyperactivity disorder (ADHD). For every question asked by the nurse, the child answers, "I don't know." What is the most likely reason for the child to respond in this way? -The child does not like talking to the nurse. -The child is not willing to answer the nurse. -The child is not paying attention to the nurse's questions. -The child is not able to understand what the nurse is asking.

-The child is not paying attention to the nurse's questions. explanation: Children with ADHD are unable to pay attention and cannot stop their minds from racing. This is the reason for the child with ADHD responding "I don't know" to every question the nurse asks. It is not likely that the child dislikes the nurse. Unlike children with disruptive behavior, children with ADHD are not intentionally unwilling to respond to questions. Children with ADHD do not lack cognition. If they were able to be attentive, they would be able to understand the nurse's question easily.

The parent of a child with attention deficit hyperactivity disorder (ADHD) is prescribed pemoline for treatment. When evaluating the laboratory studies of the child, which result will the nurse report to the health care provider? AST 65 U/L (1.1 μkat/L) Hemoglobin of 13.2 g/dL (132 g/L) Creatinine level of 0.9 mg/dL (79.6 μmol/L) Glucose level of 100 mg/dL (5.6 mmol/L)

AST 65 U/L (1.1 μkat/L) Explanation: The normal range for AST levels is 8 to 33 U/L (0.1 to 0.6 μkat/L) which may be a side effect of the pemoline. The health care provider should be alerted immediately and the medication may be discontinued and replaced with another that does not cause elevated liver enzymes. The hemoglobin is within normal range and would not correlate with a side effect of pemoline. The normal range of creatinine is 0.7 to 1.3 mg/dL (61.9 to 114.9 μmol/L) but is not a side effect determinant of pemoline. Glucose levels will not be altered from pemoline, and the level of 100 is within normal range for a child.

Which medication classification is used in the treatment of tic disorders? Antipsychotics Antidepressants Antimanics Anxiolytics

Antipsychotics Tic disorders are usually treated with risperidone or olanzapine.

Which term describes the use of socially unacceptable words, which are frequently obscene? -Coprolalia -Palilalia -Echolalia -None of the above

Coprolalia explanation: Coprolalia is the use of socially unacceptable words, which are frequently obscene. Palilalia is the repeating of one's own words or sounds. Echolalia is the repeating of the last heard sound, word, or phrase.

When attention deficit hyperactivity disorder (ADHD) is present, the child will most likely exhibit which core symptoms? Highly distractible, excitable, impulsive, and excessively active Affective disturbances, autism, psychosis, and excessive talkativeness Quiet, impulsive, excessively attentive, and psychotic Overly friendly, able to follow directions, impulsive, and active

Highly distractible, excitable, impulsive, and excessively active

The nurse working with pediatric clients knows the importance of checking for developmental delays, which not only slow the child's progress but also are often associated with what? Development of poor self-esteem Bullying Resilience Normalization

Development of poor self-esteem Explanation: Developmental delays not only slow a child's progress but also can interfere with the development of positive self-esteem.

A nurse is assessing an 8-year-old child. The child is unable to dress without assistance and is not able to manipulate toys, such as building blocks. The child stutters while talking. The difficulty with motor coordination was first noted after the child started to attend school, and it is not an aspect of a general underlying medical condition. What is the most likely diagnosis of the child? Tic disorder Learning disorder Cerebral palsy Developmental coordination disorder

Developmental coordination disorder explanation: Developmental coordination disorder is characterized by impaired coordination that interferes with activities such as dressing and manipulating toys. It may be diagnosed when the child begins to try to crawl or walk but is generally diagnosed after the child begins to participate in more structured activities at school. A communication disorder, such as stuttering, often coexists with the condition. The child does not show any stereotypical motor or vocal behavior; thus, the child does not have tic disorder. An inability to read, write, and do math is not found in this child; thus, the child does not have a learning disorder. Cerebral palsy is a neurological condition impacting movement; it has numerous symptoms and is usually diagnosed before the age of 2 years.

A nurse is assessing a child suspected of having autism spectrum disorder. Which behavior(s) assessed by the nurse correlates with this diagnosis? Select all that apply. Echolalia Delayed language skills Normal tone Inappropriate use of words Abstract thinking

Echolalia Delayed language skills explanation: The impairment in communication is severe and affects both verbal and nonverbal communication. Children with autism spectrum disorder may manifest delayed and deviant language development, as evidenced by echolalia (repetition of words or phrases spoken by others) and a tendency to be extremely concrete in interpretation of language and not abstract thinking. Pronoun reversals and abnormal intonation are also common.

The nurse is developing a care plan for a client diagnosed with attention deficit hyperactivity disorder (ADHD). The nurse teaches the client to take the last dose of dextroamphetamine when? -Midnight -Noon -At 6 p.m. -At 9 p.m.

Noon explanation: Giving stimulants during daytime hours usually effectively combats insomnia, which is a side effect of stimulants.

A nurse is caring for a child with enuresis. The child does not have any abnormalities associated with development or behavior. Which drug would the child be prescribed to treat the condition? Imipramine Risperidone Atomoxetine Dextroamphetamine

Imipramine Explanation: Imipramine is an antidepressant drug with a side effect of urinary retention. This drug is commonly used to treat enuresis. The child has no abnormalities associate with behavior, thus the child will not be prescribed psychotropic drug like risperidone. Atomoxetine is an antidepressant drug used to treat attention deficit hyperactivity disorder; this drug is not prescribed for a child with enuresis. Dextroamphetamine is also an antidepressant drug used to treat hyperactivity, impulsivity, and mood lability in children with attention deficit hyperactivity disorder.

An adolescent client says the client has become bored with the video game that has been used as a reward for positive behavior. Which is the most effective intervention for this client? Tell the client that the client no longer has to clean the client's room in order to play. Tell the client that the client has to use this video game to ensure understanding of value Let the client choose another reward that would be more fun. Reinforce to the client that the client selected the video game and the client needs to stick with it.

Let the client choose another reward that would be more fun.

The nurse is teaching a client's parents about managing the child's tic disorder. The nurse explains that it is extremely important for the child to get plenty of rest. What is the primary reason for the nurse to provide this education? Choose the best answer. - Physical stress and fatigue can increase symptoms in tic disorder. - Good sleep may normalize the transmission of dopamine. - Repetitive motor movements cause fatigue, and the child needs rest. - Mental stress from the disorder could make the child depressed.

Physical stress and fatigue can increase symptoms in tic disorder. Explanation: Physical fatigue and stress may exacerbate the symptoms of the tic disorder. As a result, children with this condition require a good amount of sleep. Sleeping would prevent physical fatigue and stress. Tic disorder is caused by abnormal transmission of dopamine. Good sleep does not normalize the transmission of dopamine. Repetitive motor movements may cause fatigue, but the requirement of sleep is not related to it. Mental stress from the disorder would make the child depressed. The depression may not be relieved by sleep.

A child with autistic spectrum disorder (ASD) is displaying temper tantrums. Which is the priority goal of treatment related to this issue? -Prevent inpatient treatment. -Reduce behavioral symptoms. -Attend a public school in regular classes. -Eliminate symptoms of ASD.

Reduce behavioral symptoms. Explanation: The goals of treatment of children with autism are to reduce behavioral symptoms (e.g., stereotyped motor behaviors) and to promote learning and development, particularly the acquisition of language skills. The symptoms of ASD will not be eliminated but may be controlled with a variety of behavioral therapies. It is likely that the child will require a class or a one-on-one teacher that can devote the time required to go at the child's pace. Inpatient treatment is not required.

Assessment of a child with autism spectrum disorder reveals stereotypic behavior. Which behavior would the nurse most likely document being demonstrated by the child? Select all that apply. Rocking Hand flapping Head banging Word repetition Pronoun reversal

Rocking Hand flapping Head banging Explanation: Stereotypic behavior incudes self-stimulating, nonfunctional, repetitive behaviors such as rocking, hand flapping, and head banging. Word repetition (echolalia) and pronoun reversal are communication difficulties.

A nurse is working with a child undergoing behavioral modification therapy for attention deficit hyperactivity disorder (ADHD). The nurse finds that the child is thin. What could be the most likely reason for this observation? - The child finds food distasteful. - The child cannot sit through meals. - The child has decreased appetite. - The child is genetically predisposed to being thin.

The child cannot sit through meals. Explanation: Children with ADHD are not patient enough to sit through meals. This results in reduced dietary intake. This is the most likely reason for children with ADHD to be thin. Children with ADHD do not have impaired taste sensation. These children do not have loss of appetite unless they are on drugs like methylphenidate. It is not known whether children with ADHD are genetically predisposed to being thin.

Echolalia

The uncontrollable and immediate repetition of words spoken by another person

Which condition is characterized by multiple motor tics and one or more vocal tics many times throughout the day for 1 year or more? Trichotillomania Tourette syndrome Asperger's syndrome Attention deficit hyperactivity disorder

Tourette syndrome Explanation: Tourette syndrome, the most severe tic disorder, is characterized by multiple motor tics and one or more vocal tics many times throughout the day for 1 year or more.

A psychiatric-mental health nurse is assessing a pediatric client. Upon assessment, the client repeats the last-heard sound from other people. Which observation would the nurse document in the client's medical record? Tourette disorder coprolalia palilalia echolalia

echolalia Explanation: Tourette disorder involves multiple motor tics and one or more vocal tics, which occur many times a day for more than 1 year. Complex vocal tics include repeating words or phrases out of context, coprolalia (use of socially unacceptable words, frequently obscene), palilalia (repeating one's own sounds or words), and echolalia (repeating the last-heard sound, word, or phrase). The client in the scenario repeats the last-heard sound from other people; therefore, echolalia would be documented in the medical record.

Coprolalia

is the use of socially unacceptable words, which are frequently obscene.

Palilalia

repeating words or sounds over and over

A pediatric client is being assessed in the clinic for a diagnosis of autism spectrum disorder (ASD). The client's parent describes that the client bangs their head repeatedly at times. Which assessment finding should be documented by the nurse? encopresis coprolalia stereotyped motor behavior enuresis

stereotyped motor behavior Explanation: Stereotyped motor behaviors, such as hand flapping, body twisting, and head banging, are common behaviors with autism spectrum disorder (ASD). The client in the scenario is exhibiting stereotyped motor behavior, which should be documented by the nurse. Coprolalia is the term for a complex vocal tic that includes using socially unacceptable words, frequently obscene words. Encopresis is the repeated passage of feces into inappropriate places such as clothing or the floor by a child who is at least 4 years of age either chronologically or developmentally. Enuresis is the repeated voiding of urine during the day or at night into clothing or bed by a child at least 5 years of age either chronologically or developmentally.

A pediatric client diagnosed with attention-deficit/hyperactivity disorder (ADHD) is participating in behavioral strategies to assist with daily functioning. In the session, the nurse is utilizing play techniques to understand the child's thoughts and feelings and to promote communication. Which type of play is the nurse utilizing with the client? dramatic play play therapy therapeutic play creative play

therapeutic play Explanation: Medications do not automatically improve the child's academic performance or ensure they make friends. Behavioral strategies are necessary to help the child master appropriate behaviors. In therapeutic play, play techniques are used to understand the child's thoughts and feelings and to promote communication. This should not be confused with play therapy, a psychoanalytic technique used by psychiatrists. Dramatic play is acting out an anxiety-producing situation such as allowing the child to be a doctor or use a stethoscope or other equipment to take care of a patient (a doll). Play techniques to release energy could include pounding pegs, running, or working with modeling clay. Creative play techniques can help children to express themselves, for example, by drawing pictures of themselves, their family, and peers. Therefore, the nurse is utilizing therapeutic play techniques with the client.