MODULE 8 PSYCH

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 most likely caused due a problem with the neurons in the frontal and temporal lobes of your child's brain." "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 caused by 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 presenting to a group of parents whose children are suspected of having autism spectrum disorder (ASD). Which statement by the nurse should be included? "The features of autism are typically apparent by the time a child is 3 years of age." "You should notice deficits in your child by the age of 5." "A feature of ASD is the ability to understand nonverbal behavior." "A child with ASD should be able to successfully engage in imaginative play."

"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 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 most likely continue to struggle with communication skills." "Your child will comprehend nonverbal cues." "Your child will function normally with social interaction." Unselected "Your child will most likely function independently."

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

The parents of an autistic child ask the nurse, "Will my child ever be normal?" Which would be the most appropriate response by the nurse? A) B) C) D) A) "You seem worried about your child's future." B) "Autistic children can fully recover with the right treatment and education." C) "Your child should outgrow autistic traits by adolescence." D) "Your child will probably always have some autistic traits."

"Your child will probably always have some autistic traits."

Which is a DSM-IV-TR criterion for the diagnosis of attention-deficit/hyperactivity disorder? 1. Inattention. 2. Recurrent and persistent thoughts. 3. Physical aggression. 4. Anxiety and panic attacks.

1. According to the DSM-IV-TR, inatten- tion, along with hyperactivity and impul- sivity, describes the essential criteria of ADHD. Children with this disorder are highly distractible and have extremely limited attention spans.

For which reason is it crucial for nurses to advocate for children and adolescents regarding psychiatric disorders? A) It is much more difficult to diagnose psychiatric disorders in children and adolescents. B) It is not necessary because psychiatric disorders do not occur in children and adolescents. C) Children and adolescents experience some of the same mental health problems as adults. D) Psychiatric disorders in children manifest themselves very quickly.

A

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.

An 8-year-old with attention deficit hyperactivity disorder is jumping off the bed onto a chair. Which should be the nurse's first step? A) ìI need to talk to you.î B) ìStop that right now.î C) ìYou are going to hurt yourself.î D) ìWhy are you jumping off the bed?î

B

The mother of a 6-year-old boy with attention deficit hyperactivity disorder asks to speak to the nurse about her son's disruptive behavior. The nurse would be most therapeutic by saying which of the following? A) ìYour son is a cute child, but he needs to calm down.î B) ìIt must be difficult to handle your son at home.î C) ìYou need to take a firmer approach with your son.î D) ìYour son sure is active.î

B

The nurse understands that when working with a child with a mental health problem, the family must be included in the care. Which is one of the best ways the nurse can advocate for the child? A) Support transferring the child to a healthy living environment. B) Teach the parents age-appropriate expectations of the child. C) Reinforce the parents' expectations of the child's behavior. D) Interpret the child's thoughts and feelings to the parent.

B

Which nursing intervention related to self-care would be most appropriate for a teenager diagnosed with moderate intellectual disability? A. Meeting all of the clients self-care needs to avoid injury B. Providing simple directions and praising clients independent self-care efforts C. Avoiding interference with the clients self-care efforts in order to promote autonomy D. Encouraging family to meet the clients self-care needs to promote bonding

B

Which of the following terms describes the repeating of one's own words or sounds? A) Coprolalia B) Palilalia C) Echolalia D) None of the above

B

Which one of the following nursing interventions should take priority for a child with ADHD? A) Structured daily routine B) Ensuring the child's safety and that of others C) Simplifying instructions and directions D) Improved role performance

B

A mother expresses concern to the nurse that the child's regularly scheduled vaccines may not be safe. The mother states that she has heard reports that they cause autism. The most appropriate response by the nurse is, A) ìIt is recommended that you wait until the child is older to vaccinate.î B) ìThere are safer alternative immunizations available now.î C) ìThere has been no research to establish a relationship between vaccines and autism.î D) ìThe risks do not outweigh the benefits of immunization against childhood diseases.î

C

The nurse has been working with the family of a small child with a psychiatric disorder. The nurse is feeling very frustrated because the parents refuse to implement effective parenting skills that the nurse has taught. What is the best action for the nurse at this time? A) Review effective disciplinary practices with the parents again. B) Refer the parents to a family therapist. C) Try to remember that the parents are trying to the best of their ability to carry out the suggestions. D) Explore alternative living arrangements for the child.

C

A parent of a child with autism spectrum disorder asks the nurse if there is anything that can be done to control the child's tantrums. Which option should the nurse inform the parents that may be appropriate? A) Give the child rewards for resisting tantrums. B) Reason with the child why tantrums are not effective. C) Place the child in a time-out when tantrums occur. D) Explore the use of antipsychotic medications to control tantrums.

D

The parents of an autistic child ask the nurse, ìWill my child ever be normal?î Which would be the most appropriate response by the nurse? A) ìYou seem worried about your child's future.î B) ìAutistic children can fully recover with the right treatment and education.î C) ìYour child should outgrow autistic traits by adolescence.î D) ìYour child will probably always have some autistic traits.î

D

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? Fetal alcohol syndrome Appropriate adaptation to new environments 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.

Teaching for methylphenidate (Ritalin) should include which information? A) Give the medication after meals B) Give the medication when the Childs becomes overactive. C) Increase the child's fluid intake when he or she is taking the medication D) Check the child's temperature daily

Give the medication after meals

he nurse is assessing a high-functioning adult patient who is diagnosed with autism spectrum disorder (ASD). The nurse will most likely observe which characteristic in this patient? Language skills and sentence formation Comprehending nonverbal clues Social interaction Flexibility of thought

Language skills and sentence formation A high-functioning adult with ASD will most likely have language skills and be able to form full sentences, however, they may still have difficulty comprehending nonverbal cues, difficulty in social interactions, and difficulty in flexibility of thought.

Which medication is effective in 70% to 80% of children with attention deficit hyperactivity disorder (ADHD)? Amphetamine Methylphenidate Pemoline Dextroamphetamine

Methylphenidate

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? Rocking on the exam table 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 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.

A parent is concerned that his child might suffer from attention deficit hyperactivity disorder (ADHD). She brings the child in to be evaluated. Which of the following behaviors reported by the parent would be consistent with this diagnosis? A) The child interrupts others. B) The child has been hoarding objects. C) The child has lots of friends. D) The child is excelling academically in school.

The child interrupts others.

The nurse is teaching a 12-year-old with intellectual disability about medications. Which intervention is essential? A) Speak slowly and distinctly B) Teach the information to the parents only C) Use pictures rather than printed words D) Validate client understanding of teaching

Validate client understanding of teaching

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

​ B. Encouraging the​ client's family to bring in familiar objects from home Rationale: Clients with ASD need structure and a predictable course of action. Bringing in familiar objects from home provides comfort for the client. It is important for the nurse to be oriented to the room and care should be taken not to relocate objects in the environment. Clients with ASD are sensitive to loud noises and bright​ lights, so the television should be turned off to minimize stimuli that may distress the client. Procedures should be scheduled for the same time to maintain predictability.

The nurse would expect to see all the following symptoms in a child with ADHD, except: A) distractibility and forgetfulness B) excessive running, climbing, and fidgeting C) moody, sullen, and pouting behavior D) Interrupting others and inability to take turns

Moody, sullen, and pouting behavior

A nurse in a pediatric clinic is caring for a preschool-age child who has a new diagnosis of ADHD. When teaching the guardian about this disorder, which of the following statements should the nurse include in the teaching? A) "Behaviors associated with ADHD are present prior to age 3." B) "This disorder is characterized by argumentativeness." C) "Below-average intellectual functioning is associated with ADHD." D) "Because of this disorder, your child is at an increased risk for injury."

"Because of this disorder, your child is at an increased risk for injury."

A child diagnosed with an autistic disorder has a nursing diagnosis of impaired social interaction. The child is currently making eye contact and allowing physical touch. Which of the following statements addresses the evaluation of this child's behavior? 1. The nurse is unable to evaluate this child's ability to interact socially based on the observed behaviors. 2. The child is experiencing improved social interaction as evidenced by making eye contact and allowing physical touch. 3. The nurse is unable to evaluate this child's ability to interact socially because the child has not experienced these behaviors for an extended period. 4. The child's making eye contact and allowing physical touch are indications of improved personal identity, not improved social interaction.

2. By making eye contact and allowing phys- ical touch, this child is experiencing improved social interaction, making this an accurate evaluative statement.

Which is a predisposing factor in the diagnosis of autism? 1. Having a sibling diagnosed with mental retardation. 2. Congenital rubella. 3. Dysfunctional family systems. 4. Inadequate ego development.

2. Children diagnosed with congenital rubella, postnatal neurological infections, phenylke- tonuria, or fragile X syndrome are predis- posed to being diagnosed with autism.

Which developmental characteristic should a nurse identify as typical of a client diagnosed with severe intellectual disability? A. The client can perform some self-care activities independently. B. The client has advanced speech development. C. Other than possible coordination problems, the clients psychomotor skills are not affected. D. The client communicates wants and needs by acting out behaviors.

D

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? "Early diagnosis and treatment gives your child the best chance of becoming a fully functioning adult." "Early diagnosis and treatment provides the only means for a cure of ASD." "Early diagnosis and treatment provides the best way to ensure that your child can be admitted to an assisted living facility as an adult." "Early diagnosis and treatment prevents your child from developing any other mental condition."

"Early diagnosis and treatment gives your child the best chance of becoming a fully functioning adult." Early diagnosis and treatment of ASD provides access to treatments and therapies that give patients the best chance to become fully functioning adults. Undiagnosed or untreated ASD decreases 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 does 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. Additional Learning

The nurse is discussing medications that are used in 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 give my child aspirin to help with the symptoms of ASD. "I will monitor my child closely with any new medications." "I will note if my child has any increase in negative behaviors from medication. "I will watch to see if my child has any suicidal thoughts."

"I will give my child aspirin to help with the symptoms of ASD. 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. Previous

The nurse is assessing a 2-year-old toddler who is diagnosed with autism spectrum disorder. Which comment by the mother should lead the nurse to question the diagnosis? "My child loves to play with others." "My child engages in mostly solitary activity." "My child does not enjoy cuddling." "My child does not respond to conversations in the room."

"My child loves to play with others." The fact that the toddler enjoys playing with others would not support a diagnosis of ASD, while preferring solitary activity would support an ASD diagnosis. Many, but not all, children with ASD would not like to play with siblings, enjoy cuddling, or respond to conversation in the room.

A 9-year-old client with attention deficit hyperactivity disorder (ADHD) has been placed on the stimulant methylphenidate. The nurse knows that the teaching has been effective when the client's parents state what? A) "The client knows that the client only needs to take this medication once every 12 hours." B) "The client may have some side effects, like insomnia, loss of appetite, or weight loss, but they are rare." C) "The client will have an effect from this drug in about 2 weeks." D) "We'll bring the client in every week to get blood levels drawn."

"The client may have some side effects, like insomnia, loss of appetite, or weight loss, but they are rare."

The nurse is caring for a child who is diagnosed with autism spectrum disorder (ASD). The child's parents tell the nurse, "All tests were negative, so how did they diagnose our child with ASD?" Which response by the nurse is correct? "The presence of certain criteria outlined in the DSM-5 is the basis for your child's diagnosis." "Since all the tests are negative, ASD is the only answer left." "Your child's ASD was diagnosed by a special test that you were not aware of." "Your child has a positive electroencephalogram, which points to the presence of ASD."

"The presence of certain criteria outlined in the DSM-5 is the basis for your child's diagnosis." There is no diagnostic test or imaging that can diagnose autism. The presence of certain criteria, as outlined in the DSM-5, is the basis for diagnosis. The fact that all tests are negative does not necessarily point to ASD; certain criteria must also be present. A positive electroencephalogram (EEG) is used to rule out ASD.

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? "We are going to investigate applied behavior analysis as treatment." "I'm contacting my doctor to request starting chelation therapy." "I'm going to begin to give my child mineral solutions." "We will start encouraging echolalia in our child's speech."

"We are going to investigate applied behavior analysis as treatment." 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 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 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.

A client diagnosed with Tourette's disorder has a nursing diagnosis of social isolation. Which charting entry documents a successful outcome related to this client's problem? 1. "Compliant with instructions to use bathroom before bedtime." 2. "Made potholder at activity therapy session." 3. "Able to distinguish right hand from left hand." 4. "Able to focus on TV cartoons for 30 minutes."

2. During activity therapy, clients interact with peers and staff. This participation in a social activity reflects a successful out- come for the nursing diagnosis of social isolation.

A child diagnosed with severe mental retardation becomes aggressive with staff members when faced with the inability to complete simple tasks. Which nursing diagnosis would reflect this client's problem? 1. Ineffective coping R/T inability to deal with frustration. 2. Anxiety R/T feelings of powerlessness and threat to self-esteem. 3. Social isolation R/T unconventional social behavior. 4. Risk for injury R/T altered physical mobility.

1. A child diagnosed with severe mental retardation (IQ level 20 to 34) who strikes out at staff members when not being able to complete simple tasks is using aggres- sion to deal with frustration. Ineffective coping related to inability to deal with frustration is the appropriate nursing diagnosis for this child.

Which is a description of the etiology of autism from a genetic perspective? 1. Parents who have one child diagnosed with autism are at higher risk for having other children with the disorder. 2. Amygdala abnormality in the anterior portion of the temporal lobe is associated with the diagnosis of autism. 3. Decreased levels of serotonin have been found in individuals diagnosed with autism. 4. Congenital rubella is implicated in the predisposition to autistic disorders.

1. Research has revealed strong evidence that genetic factors may play a significant role in the etiology of autism. Studies show that parents who have one child with autism are at an increased risk for having more than one child with the dis- order. Also, monozygotic and dizygotic twin studies have provided evidence of genetic involvement.

A client diagnosed with oppositional defiant disorder has an outcome of learning new coping skills through behavior modification. Which client statement indicates that behavioral modification has occurred? 1. "I didn't hit Johnny. Can I have my Tootsie Roll?" 2. "I want to wear a helmet like Jane wears." 3. "Can I watch television after supper?" 4. "I want a puppy right now."

1. The question infers that the client defen- sively copes with frustration by lashing out and hitting people. New coping skills have been achieved through behavior modification when the client's states, "I didn't hit Johnny. Can I have my Tootsie Roll?" The intervention used to achieve this outcome is a reward system that rec- ognizes and appreciates appropriate behavior, modifying that which was previ- ously unacceptable.

A client diagnosed with moderate mental retardation suddenly refuses to participate in supervised hygiene care. Which short-term outcome would be appropriate for this individual? 1. The client will comply with supervised hygiene by day 3. 2. The client will be able to complete hygiene without supervision by day 3. 3. The client will be able to maintain anxiety at a manageable level by day 2. 4. The client will accept assistance with hygiene by day 2.

1. With appropriately implemented inter- ventions that direct the client back to previously supervised hygiene perform- ance, the short-term outcome of client compliance and participation by day 2 can be a reasonable expectation. To achieve this outcome, interventions might include exploring reasons for non- compliance; maintaining consistency of staff members; or providing the client with familiar objects, such as an old ver- sus new toothbrush.

A child diagnosed with an autistic disorder withdraws into self and, when spoken to, makes inappropriate nonverbal expressions. The nursing diagnosis impaired verbal communication is documented. Which intervention would address this problem? 1. Assist the child to recognize separateness during self-care activities. 2. Use a face-to-face and eye-to-eye approach when communicating. 3. Provide the child with a familiar toy or blanket to increase feelings of security. 4. Offer self to the child during times of increasing anxiety.

2. A child diagnosed with an autistic disorder has impairment in communication affect- ing verbal and nonverbal skills. Nonverbal communication, such as facial expression, eye contact, or gestures, is often absent or socially inappropriate. Eye-to-eye and face-to-face contact expresses genuine interest in, and respect for, the individual. Using an "en face" approach role-models correct nonverbal expressions.

Which is associated with the etiology of Tourette's disorder from a biochemical per- spective? 1. An inheritable component, as suggested by monozygotic and dizygotic twin studies. 2. Abnormal levels of several neurotransmitters. 3. Prenatal complications, including low birth weight. 4. Enlargement of the caudate nucleus of the brain.

2. Abnormalities in levels of dopamine, sero- tonin, dynorphin, gamma-aminobutyric acid, acetylcholine, and norepinephrine have been associated with Tourette's dis- order. This etiology is from a biochemical perspective.

A child diagnosed with oppositional defiant disorder begins yelling at staff members when asked to leave group therapy because of inappropriate language. Which nursing intervention would be appropriate? 1. Administer PRN medication to decrease acting-out behaviors. 2. Accompany the child to a quiet area to decrease external stimuli. 3. Institute seclusion following agency protocol. 4. Allow the child to stay in group therapy to monitor the situation further.

2. Accompanying the child to a quiet area to decrease external stimuli is the most ben- eficial action for this child. This action would aid in decreasing anger and hostility expressed by the child's outburst and inappropriate language. Later, the nurse may sit with the child and develop a system of rewards for compliance with therapy and consequences for noncompliance. This can be accomplished by starting with minimal expectations and increasing these expectations as the child begins to mani- fest evidence of control and compliance.

A child admitted to an in-patient psychiatric unit is diagnosed with separation anxiety disorder. This child is continually refusing to go to bed at the designated time. Which nursing diagnosis best documents this child's problem? 1. Noncompliance with rules R/T low self-esteem. 2. Ineffective coping R/T hospitalization and absence of major attachment figure. 3. Powerlessness R/T confusion and disorientation. 4. Risk for injury R/T sleep deprivation.

2. Ineffective coping is defined as the inability to form a valid appraisal of the stressors, ineffective choices of practice responses, or inability to use available resources. A child diagnosed with separation anxiety often refuses to go to school or bed because of fears of separation from home or from individuals to whom the child is attached. The child in the question is refusing to go to bed as a way to cope with fear and anxiety. The nursing diagnosis of ineffective coping would be an appropriate documentation of this client's problem.

Which short-term outcome would be considered a priority for a hospitalized child diagnosed with a chronic autistic disorder who bites self when care is attempted? 1. The child will initiate social interactions with one caregiver by discharge. 2. The child will demonstrate trust in one caregiver by day 3. 3. The child will not inflict harm on self during the next 24-hour period. 4. The child will establish a means of communicating needs by discharge.

3. A child diagnosed with a chronic autistic disorder who bites self when care is attempted is at risk for injury R/T self- mutilation. Self-injurious behaviors, such as head banging and hand and arm biting, are used as a means to relieve tension. Considering that the nurse's primary responsibility is client safety, expecting the child to refrain from inflicting self-harm during a 24-hour period is the short-term outcome that should take priority.

Which charting entry would document an appropriate nursing intervention for a client diagnosed with profound mental retardation? 1. "Rewarded client with lollipop after independent completion of self-care." 2. "Encouraged client to tie own shoelaces." 3. "Kept client in line of sight continually during shift." 4. "Taught the client to sing the alphabet 'ABC' song."

3. A client diagnosed with profound mental retardation requires constant care and supervision. Keeping this client in line of sight continually during the shift is an appropriate intervention for a child with an IQ level 20.

When admitting a child diagnosed with a conduct disorder, which symptom would the nurse expect to assess? 1. Excessive distress about separation from home and family. 2. Repeated complaints of physical symptoms such as headaches and stomachaches. 3. History of cruelty toward people and animals. 4. Confabulation when confronted with wrongdoing.

3. A history of physical cruelty toward peo- ple and animals is commonly associated with conduct disorder. These children may bury animals alive and set fires intending to cause harm and damage.

A child diagnosed with a conduct disorder is disruptive and noncompliant with rules in the milieu. Which outcome, related to this client's problem, should the nurse expect the client to achieve? 1. The child will maintain anxiety at a reasonable level by day 2. 2. The child will interact with others in a socially appropriate manner by day 2. 3. The child will accept direction without becoming defensive by discharge. 4. The child will contract not to harm self during this shift.

3. Accepting direction without becoming defensive by discharge is a specific, meas- urable, positive, realistic, client-centered outcome for this child. The disruption and noncompliance with rules on the milieu is this child's defensive coping mechanism. Helping the child to see the correlation between this defensiveness and the child's low self-esteem, anger, and frustration would assist in meeting this outcome.

A child diagnosed with an autistic disorder makes no eye contact; is unresponsive to staff members; and continuously twists, spins, and head bangs. Which nursing diagnosis would take priority? 1. Personal identity disorder R/T poor ego differentiation. 2. Impaired verbal communication R/T withdrawal into self. 3. Risk for injury R/T head banging. 4. Impaired social interaction R/T delay in accomplishing developmental tasks.

3. Children diagnosed with an autistic disorder frequently head bang because of neurologi- cal alterations, increased anxiety, or catastrophic reactions to changes in the envi- ronment. Because the nurse is responsible for ensuring client safety, the nursing diag- nosis risk for injury takes priority.

A child diagnosed with mild to moderate mental retardation is admitted to the medical/ surgical floor for an appendectomy. The nurse observes that the child is having difficulty making desires known. Which nursing diagnosis reflects this client's problem? 1. Ineffective coping R/T developmental delay. 2. Anxiety R/T hospitalization and absence of familiar surroundings. 3. Impaired verbal communication R/T developmental alteration. 4. Impaired adjustment R/T recent admission to hospital.

3. Impaired verbal communication R/T developmental alteration is the appropri- ate nursing diagnosis for a child diagnosed with mild to moderate mental retardation who is having difficulties making needs and desires understood to staff members. Clients diagnosed with mild to moderate retardation often have deficits in commu- nication.

A child newly admitted to an in-patient psychiatric unit with a diagnosis of major depressive disorder has a nursing diagnosis of high risk for suicide R/T depressed mood. Which nursing intervention would be most appropriate at this time? 1. Encourage the child to participate in group therapy activities daily. 2. Engage in one-on-one interactions to assist in building a trusting relationship. 3. Monitor the child continuously while no longer than an arm's length away. 4. Maintain open lines of communication for expression of feelings.

3. Keeping a child who is at high risk for suicide safe from self-harm would take immediate priority over any other inter- vention. Monitoring the child continu- ously while no longer than an arm's length away would be an appropriate nursing intervention. This observation would allow the nurse to note self-harm behaviors and intervene immediately if necessary.

Which factors does Mahler attribute to the etiology of attention-deficit/hyperactivity disorder? 1. Genetic factors. 2. Psychodynamic factors. 3. Neurochemical factors. 4. Family dynamic factors.

3. Mahler's theory suggests that a child with ADHD has psychodynamic problems. Mahler describes these children as fixed in the symbiotic phase of development. They have not differentiated self from mother. Ego development is retarded, and impul- sive behavior, dictated by the id, is mani- fested.

Which of the following disorders involves problems with forming sounds associated with speech? A) Phonologic disorder B) Mixed receptiveñexpressive language disorder C) Expressive language disorder D) Stuttering

A

A foster child diagnosed with oppositional defiant disorder is spiteful, vindictive, and argumentative, and has a history of aggression toward others. Which nursing diagno- sis would take priority? 1. Impaired social interaction R/T refusal to adhere to conventional social behavior. 2. Defensive coping R/T unsatisfactory child-parent relationship. 3. Risk for violence: directed at others R/T poor impulse control. 4. Noncompliance R/T a negativistic attitude.

3. Risk for violence: directed at others is defined as behaviors in which an individ- ual demonstrates that he or she can be physically, emotionally, or sexually harm- ful to others. Children diagnosed with ODD have a pattern of negativistic, spite- ful, and vindictive behaviors. The foster child described in the question also has a history of aggression toward others. Because maintaining safety is a critical responsibility of the nurse, risk for vio- lence: directed at others would be the priority nursing diagnosis.

A child diagnosed with severe mental retardation displays failure to thrive related to neglect and abuse. Which nursing diagnosis would best reflect this situation? 1. Altered role performance R/T failure to complete kindergarten. 2. Risk for injury: self-directed R/T poor self esteem. 3. Altered growth and development R/T inadequate environmental stimulation. 4. Anxiety R/T ineffective coping skills.

3. The nursing diagnosis of altered growth and development related to inadequate environmental stimulation would best address this child's problem of failure to thrive. Failure to thrive frequently results from neglect and abuse.

The nursing instructor is preparing to teach nursing students about oppositional defiant disorder (ODD). Which fact should be included in the lesson plan? 1. Prevalence of ODD is higher in girls than in boys. 2. The diagnosis of ODD occurs before the age of 3. 3. The diagnosis of ODD occurs no later than early adolescence. 4. The diagnosis of ODD is not a developmental antecedent to conduct disorder.

3. The symptoms of ODD usually appear no later than early adolescence. A child diag- nosed with ODD presents with a pattern of negativity, disobedience, and hostile behavior toward authority figures. This pattern of behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

Which short-term outcome would take priority for a client who is diagnosed with moderate mental retardation, and who resorts to self-mutilation during times of peer and staff conflict? 1. The client will form peer relationships by end of shift. 2. The client will demonstrate adaptive coping skills in response to conflicts. 3. The client will take direction without becoming defensive by discharge. 4. The client will experience no physical harm during this shift.

4. A child diagnosed with moderate mental retardation who resorts to self-mutilation during times of peer and staff conflict must be protected from self-harm. A real- istic, measurable outcome would be that the client would experience no physical harm during this shift.

A client has been diagnosed with an IQ level of 60. Which client social/communication capability would the nurse expect to observe? 1. The client has almost no speech development and no socialization skills. 2. The client may experience some limitation in speech and social convention. 3. The client may have minimal verbal skills, with acting-out behavior. 4. The client is capable of developing social and communication skills.

4. A client with mild mental retardation (IQ level 50 to 70) would be capable of developing social and communication skills. The client would function well in a struc- tured, sheltered setting.

Which developmental characteristic would be expected of an individual with an IQ level of 40? 1. Independent living with assistance during times of stress. 2. Academic skill to 6th grade level. 3. Little, if any, speech development. 4. Academic skill to 2nd grade level.

4. An IQ level of 40 is within the range of moderate mental retardation (IQ level 35 to 49). Academic skill to 2nd grade level would be a developmental characteristic expected of an individual in this IQ range.

The nurse on an in-patient pediatric psychiatric unit is admitting a client diagnosed with an autistic disorder. Which would the nurse expect to assess? 1. A strong connection with siblings. 2. An active imagination. 3. Abnormalities in physical appearance. 4. Absence of language.

4. One of the first characteristics that the nurse would note is the client's abnormal language patterning or total absence of language. Children diagnosed with autism display an uneven development of intellec- tual skills. Impairments are noted in verbal and nonverbal communication. These chil- dren cannot use or understand abstract language, and they may make unintelligible sounds or say the same word repeatedly.

A child with attention deficit hyperactivity disorder is taking methylphenidate (Ritalin) in divided doses. If the child takes the first dose at 8 AM, which behavior might the school nurse expect to see at noon? A) Increased impulsivity or hyperactive behavior B) Lack of appetite for lunch C) Sleepiness or drowsiness D) Social isolation from peers

A

A parent is concerned that his child might suffer from attention deficit hyperactivity disorder (ADHD). Which of the following behaviors reported by the parent would be consistent with this diagnosis? A) The child interrupts others. B) The child has been hoarding objects. C) The child has lots of friends. D) The child is excelling academically in school.

A

The mother of a 15-year-old boy tells the nurse that her son is becoming more assertive in conflict situations and wants to get a job. She asks if it is healthy for a 15-year-old to be so independent. Which is valid information for the nurse to offer the mother? A) his behaviors reflect normal growth and development B) he is overly independent C) it sounds like he's trying to avoid her D) she should observe for signs of substance abuse

A

The nurse is assisting a child with ADHD to complete his ADLs. Which is the best approach for nurse to use with this child? A) Break tasks into small steps. B) Let the child complete tasks at his own pace. C) Offer rewards when all tasks are completed. D) Set a time limit to complete all tasks.

A

When teaching the parents of a child with attention deficit hyperactivity disorder (ADHD), which statement by the parents would indicate the need for further teaching? A) ìWe'll have him do his homework at the kitchen table with his brothers and sisters.î B) ìWe'll make sure he completes one task before going on to another.î C) ìWe'll set up rules with specific times for eating, sleeping, and playing.î D) ìWe'll use simple, clear directions and instructions.î

A

A nurse asks an assigned client, ìHow are you doing today?î The client responds with ìdoing today, doing today, doing today.î Which speech pattern disturbance is this an example of? A) Reactive attachment disorder B) Stereotypic movement disorder C) Selective mutism D) Echolalia

D

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? Allowing the patient to stay next to his mother with the teddy bear and speaking to him calmly and concisely 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 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.

Which statement would indicate that medication teaching for the parents of a 6-year-old child with attention deficit hyperactivity disorder (ADHD) has been effective? A) ìWe'll teach him the proper way to take the medication, so he can manage it independently.î B) ìWe'll be sure he takes Ritalin at the same time every day, just before bedtime.î C) ìWe're so glad that Ritalin will eliminate the problems of ADHD.î D) ìWe'll be sure to record his weight on a weekly basis.î

D

The nurse is teaching a new colleague about medications that are used to treat autism spectrum disorder (ASD). When the nurse asks the colleague to list the medications that may be used, which response indicates a need for further teaching? Antipyretic agents Stimulant agents Selective serotonin reuptake inhibitors (SSRIs) Mood stabilizers

Antipyretic agents Medications that are used in the treatment of ASD include stimulant agents, SSRIs, and mood stabilizers. Antipyretic agents are used to decrease body temperature and would not be appropriate for use in the treatment of a patient who is diagnosed with ASD.

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

B

A child with ADHD complains to his parents that he does not like the side effects of his medicine, Adderall. The parents ask the nurse for suggestions to reduce the medication's negative side effects. The nurse can best help the parents by offering which advice? A) Give the child his medicine at night. B) Have the child eat a good breakfast and snacks late in the day and at bedtime. C) Limit the number of calories the child eats each day. D) Let the child take daytime naps.

B

Which one of the following statements about educating parents of a child with ADHD is true? A) It is unimportant to educate the family members about ADHD as they already know the problem too well. B) Parents feel empowered and relieved to have specific strategies that can help them and their child be more successful. C) It is important for the nurse to spend the majority of his or her time with parents of children with ADHD in talking to the parents. D) If the child receives special school services under the Individuals with Disabilities Education Act, there is no need for further services.

B

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.

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? Behavior modification through electroconvulsive therapy Advocating for parent support and coping groups Use of focusing techniques and behavior management Implementing treatments that decrease maladaptive behaviors such as rigidity and stereotypy

Behavior modification through electroconvulsive 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.

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.

When the prognosis of improvement in a child with psychiatric disorders is poor, what can the nurse do to positively influence children and adolescents and their parents? A) Continue to remind the child and parents that the prognosis for improvement is very poor. B) Encourage the parents to believe that the child will recover spontaneously. C) Assist the child and the parents to develop coping mechanisms. D) Focus on their problems instead of their strengths and assets.

C

he 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. Appropriate adaptation to new environments B. Postterm birth C. Fetal alcohol syndrome D. Childhood vaccinations

C. Fetal alcohol syndrome 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.

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. ​Macrocephaly, Risk for B. ​Infection, Risk for C. ​Communication: Verbal, Impaired D. Airway​ Clearance, Ineffective

C. ​Communication: Verbal, Impaired ​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.​ (NANDA-I ©2014)

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? Comprehends language well beyond the complexity of age Inability to react accordingly to social clues Engages in repetitive behaviors Displays self-destructive behavior

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.

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 Unselected Gout

Depression 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 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? A) Early in the afternoon B) At noon C) At 6 p.m. D) At 9 p.m.

Early in the afternoon

The nurse is preparing discharge teaching for the parents of a child who is diagnosed with autism spectrum disorder (ASD). Which instruction should the nurse include? Encouraging repetition of treatments at home Emphasizing that the patient will never be normal Avoiding childhood vaccinations until adulthood Teaching the patient to consume foods that are rich in gluten

Encouraging repetition of treatments at home The nurse would encourage repetition of treatments for a 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 teach the patient not to consume foods that are rich in gluten.

Which one of the following nursing interventions should take priority for a child with ADHD? A) Structured daily routine B) Ensuring the child's safety and that of others C) Simplifying instructions and directions D) Improved role performance

Ensuring the child's safety and that of others

A parent of a child with autism spectrum disorder asks the nurse if there is anything that can be done to control the child's tantrums. Which option should the nurse inform the parents that may be appropriate? A) Give the child rewards for resisting tantrums. B) Reason with the child why tantrums are not effective. C) Place the child in a time-out when tantrums occur. D) Explore the use of antipsychotic medications to control tantrums.

Explore the use of antipsychotic medications to control tantrums.

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? Genetic factors Chemical factors Psychological factors Toxins

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.

A child with ADHD reports to his parents that he does not like the side effects of his medicine, Adderall. The parents ask the nurse for suggestions to reduce the medication's negative side effects. The nurse can best help the parents by offering which advice? A) Give the child his medicine at night. B) Have the child eat a good breakfast and snacks late in the day and at bedtime. C) Limit the number of calories the child eats each day. D) Let the child take daytime naps.

Have the child eat a good breakfast and snacks late in the day and at bedtime.

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

Head x-ray

The nurse takes a team approach to help a middle-age 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? Helping the patient find a position that will allow them to use their strongest talents Making sure the job is an easy one 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.

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? Incorporating the patient's rituals into daily care Supervising the patient closely to prevent infection 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.

The nurse recognizes which as a common behavioral sign of autism? A) Clinging behavior toward parents B) Creative imaginative play with peers C) Early language development D) Indifference to being hugged or held

Indifference to being hugged or held

A nurse is assessing a 4-year-old child for indications of autism spectrum disorder. For which of the following manifestation should the nurse assess? A) Impulsive behavior B) Repetitive counting C) Destructiveness D) Somatic problems

Repetitive counting

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 demonstrate behavior that is not self-destructive. 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. 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.

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. Focusing on limitations in order to see progress in care C. Keeping the same pediatric healthcare provider for all children in the family D. Maintaining the home as a​ treatment-free zone

​A. Establishing a routine 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 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 engage in private activities to stimulate learning. B. The client will demonstrate negative communication skills. C. The client will display developmental progress. D. The client will remain free from infection.

​C. The client will display developmental progress. 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.

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

​D. Diagnostic and Statistical Manual of Mental Disorders 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 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. Crying after the administration of immunizations B. Playing with the other children and toys while awaiting the nurse C. Speaking to the nurse in sentences D. Having a tantrum when touched by the nurse

​D. 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 the 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 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. Encouraging the family to get over negative feelings regarding the diagnosis D. Providing appropriate education regarding what to expect for the child

​D. Providing appropriate education regarding what to expect for the child 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.