Psych CH 22
A nurse is assessing a 7-year-old child in a school. The nurse suspects that the child has an insecure relationship with the parents. Which statement said by the child would have led the nurse to this conclusion? "I love playing with friends." "My mom and dad do not play with me." "I love my dad and mom very much." "Please don't tell my mom anything we've talked about."
"Please don't tell my mom anything we've talked about." An insecure attachment forms when a child has learned fear and helplessness because of intimidation, abuse, or excessive control by parents. The child demonstrates having a fear-based relationship with the mother. This indicates that the child has an insecure relationship with parents. The statement that the child loves playing with friends doesn't indicate anything about the relationship of the child with the parents. The statement that the client loves their parents suggests that the child has a secure relationship with the parents. The statement that the client's parents do not play with the client indicates that the child feels neglected by the parents.
Below average intellectual functioning is initially diagnosed when an intelligence quotient (IQ) is below which level? 70 50 35 20
70 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.
Which term describes the use of socially unacceptable words, which are frequently obscene? Palilalia Coprolalia Echolalia None of the above
Coprolalia 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.
Nurses who work in a pediatric psychiatric-mental health facility should do what? Use self-disclosure of personal struggles with problems of childhood and adolescence with clients. Develop self-awareness of issues that remind them of their own childhood and adolescence. Ensure that their professional life is a higher priority than their personal life. Ensure that their own physical and mental health needs are placed above those of the clients.
Develop self-awareness of issues that remind them of their own childhood and adolescence. To care for themselves, nurses need to recognize and discuss their job-related stressors. They should acknowledge and deal with issues that remind them of their own childhood and adolescence. Equally important, they need to attend to their own physical and mental health. Proper nutrition, rest and sleep, exercise, health care, maturity, and balance in personal and professional lives maximize the energy available to work therapeutically with youth and their families.
The parents of a toddler are distraught that the toddler has been diagnosed with autism spectrum disorder. When providing care for the child and the parents, the nurse understands that autism spectrum disorder is thought to be caused by what? Genetic factors Immunizations containing mercury Perinatal hypoxia Impaired attachment in infancy
Genetic factors Approximately 70% of idiopathic autism spectrum disorder cases appear to be an inherited form of an affective disorder. Studies also suggest that autism spectrum disorder is caused by interactions of multiple genes. The disorder is not caused by immunizations. Neither impaired attachment nor perinatal hypoxia has been identified as an etiologic factor.
A child with attention deficit hyperactivity disorder (ADHD) has been prescribed dextroamphetamine. For what effects should the nurse tell the parents to monitor the child? Select all that apply. Weight loss Appetite suppression Insomnia Weight gain Hypotension
Insomnia Weight loss Appetite suppression Dextroamphetamine is a commonly prescribed drug to treat symptoms of ADHD. Insomnia, weight loss, and appetite suppression are the common side effects associated with this drug. The nurse should educate the parents on monitoring these effects. Hypotension and weight gain are not common side effects of this drug.
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? Reinforce to the client that the client selected the video game and the client needs to stick with it. Tell the client that the client no longer has to clean the client's room in order to play. Let the client choose another reward that would be more fun. 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. Positive rewards need to be viewed as desirable to motivate desired behavior changes.
The nurse is counseling a family whose child has autism. When describing this condition, which would the nurse most likely include? Onset before child is 2.5 years old Connection to ineffective parental practices Detection after the child enters school Girls are more frequently affected than boys
Onset before child is 2.5 years old Autism typically occurs before the age of 30 months. It is also marked by severe disturbances in social relatedness and occurs more often in boys than in girls.
Which is a disturbance of the normal fluency and time patterning of speech? Mixed receptive-expressive language disorder Phonologic disorder Stuttering Expressive language disorder
Stuttering Stuttering is a disturbance of the normal fluency and time patterning of speech. Phonologic disorder involves problems with articulation. Mixed receptive-expressive language disorder includes problems of expressive language disorder along with difficulty understanding and determining the meaning of words and sentences. Expressive language disorder involves an impaired ability to communicate through verbal and sign language.
A nursing student is aware that which accounts for more deaths, illnesses, and disabilities across the life span than any other preventable condition? Substance abuse disorders Falls Mood disorders Motor vehicle accidents
Substance abuse disorders Substance abuse disorders across the life span account for more deaths, illnesses, and disabilities than any other preventable health condition.
The parents of a child with attention deficit hyperactivity disorder (ADHD) bring the child for a follow-up visit. During the visit, they tell the nurse that the child receives the first dose of methylphenidate at about 7:30 a.m. every morning before leaving for school. The teacher and school nurse have noticed a return in the child's overactivity and distractibility just before lunch. The child's second dose is scheduled for about 12 p.m. Which might the nurse suggest as a possible solution to control the child's symptoms a bit more effectively? Switch to a longer-acting preparation. Switch to another class of medication. Give the second dose at 1 p.m. or later. Split the early morning dose in half.
Switch to a longer-acting preparation. Methylphenidate has a total duration of action of about 4 hours. Thus, parents or teachers often describe a return of overactivity and distractibility as the first dose of medication wears off. This "rebound effect" can often be managed by moving the second dose of the day slightly closer to the first dose. Longer-acting preparations of methylphenidate or amphetamine-dextroamphetamine do not require frequent dosing and may be a better fit with a school day schedule. Splitting the dose in half would affect the duration. Switching to another class of medication would be appropriate if the drug was ineffective in controlling the symptoms even with a change in the dosage schedule or after a switch to a longer acting preparation.
A 6-year-old client who has been diagnosed with autism spectrum disorder would be expected to display which behavior? The client has multiple motor tics and several vocal tics. The client has an irresistible urge to pull out the client's own hair. The client spends time alone and shows little interest in making friends. The client becomes overly attached to those around the client.
The client spends time alone and shows little interest in making friends. Children with autism develop language slowly or not at all. They may use words without attaching meaning to them or communicate with only gestures or noises. They spend time alone and show little interest in making friends. Approximately 80% of people with autism also are classified as intellectually disabled. Their most distinctive feature, however, is their seeming isolation from the world around them. This detachment and aloofness help distinguish people with autism from those who are solely diagnosed as intellectually disabled.
The client is 6-year-old who has been diagnosed with autism spectrum disorder. Which symptom would the client display? The client becomes overly attached to those around the client. The client has multiple motor tics and several vocal tics. The client spends time alone with little interest in making friends. The client has an irresistible urge to pull out the client's own hair.
The client spends time alone with little interest in making friends. Children with autism spectrum disorder develop language slowly or not at all. They may use words without attaching meaning to them or communicate with only gestures or noises. They spend time alone and show little interest in making friends. Autism spectrum disorder is not associated with over attachment, pulling out hair, or tics.
After teaching a group of nursing students about intellectual disability, the instructor determines that the teaching was successful when the students identify which as the most common etiology? Perinatal complications Genetic syndromes Exposure to hazardous chemicals Environment
Genetic syndromes Although exposure to toxins, perinatal complications, and environmental effects are associated with intellectual disability, the most common etiology is related to genetic syndromes.
A child is taking methylphenidate for treatment of attention deficit hyperactivity disorder (ADHD). Which side effect much be monitored in this child? Polyuria Weight gain Increased appetite Growth delays
Growth delays Nursing considerations when administering methylphenidate include monitoring appetite suppression or growth delays.
After educating a group of students on attention deficit hyperactivity disorder (ADHD), the instructor determines that additional education is required when the group identifies which as a typical characteristic? Language difficulty Inattention Impulsiveness Hyperactivity
Language difficulty A persistent pattern of inattention, hyperactivity, and impulsiveness that interferes with functioning characterizes ADHD. Language difficulties are not associated with ADHD.
The parents of a 2-year-old child complain to the nurse that their child is always dismantling toys, scribbling on the walls, and running all around the place and that it is very difficult to control the child's behavior. What is the most appropriate response from the nurse? "At this child's age, these behaviors are expected." "Your child may develop violent behavior in the future." "I will refer your child to the psychology clinic." "Therapy will help to calm your child."
"At this child's age, these behaviors are expected." Dismantling toys, scribbling on the walls, and running around the place are all normal behaviors for a child 2 years of age. The nurse should tell the parents to not to worry and that their child is perfectly normal. On the basis of these behaviors, the nurse cannot predict whether the child will have to be referred to a psychology clinic. The behaviors of the child are not abnormal; hence no therapy is needed for the child. Future violent behavior cannot be predicted from the child's present behavior.
A nurse tells the child and caregiver that the nurse will interview each of them separately. The caregiver questions why this needs to occur. What is the nurse's best response? "Both interviews provide unique and meaningful information." "Parents know best and I will determine this during the interview." "By interviewing separately I can validate all the information." "Research shows that information validates the child's feeling."
"Both interviews provide unique and meaningful information." To get an accurate picture of the child, the nurse should interview the child and parent individually because each can provide unique meaningful information. Research has shown that when parent and child are interviewed separately the children provide information about internalizing symptoms and the parents provide information about externalizing symptoms.
The mental health nurse assesses for the most common mental health disorder found in children when asking which question? "Do you ever get scolded at school for not sitting still? "Do you ever hear voices in your head telling you what to do?" "Are you sad often?" "What makes you afraid or nervous?"
"Do you ever get scolded at school for not sitting still? One in five to 10 children and adolescents surveyed exhibited symptoms of attention deficit hyperactivity disorder, which can sometimes be evidenced by an inability to sit still in school.
A nurse has been asked to identify children with attention deficit hyperactivity disorder (ADHD) in a school. Which children should the nurse identify as having ADHD? Select all that apply. A child who verbally abuses other children in the class A child who has limited facial expressions and poor eye contact A child who does not follow instructions in class A child who makes excessive noise by tapping the desk A child who is not able to dress himself or herself independently
A child who makes excessive noise by tapping the desk A child who does not follow instructions in class Children with ADHD exhibit hyperactive behaviors, like making excessive noise by tapping the desk. They are extremely impatient and inattentive; they cannot wait and listen for instructions before starting to work. Unlike children with a learning disorder, children with ADHD do not have difficulty with reading and writing. Motor skill development is not impaired in children with ADHD; therefore, they are able to dress themselves independently. Abusing other children in the class is indicative of disruptive behavior. A child with ADHD may not have disruptive behavior.
After teaching a group of nursing students about pharmacotherapy and attention deficit hyperactivity disorder (ADHD), the instructor determines that the education was successful when they identify which agent as the first line choice? Atomoxetine Bupropion Clonidine Guanfacine
Atomoxetine The first-line recommended medications for ADHD symptoms are the psychostimulants and atomoxetine. It is not unusual for two psychostimulants or a psychostimulant and atomoxetine to be prescribed together for maximum response. Second-line medications include bupropion and other antidepressants (tricyclic antidepressants). Then, if symptoms are not improved, alpha agonists (guanfacine or clonidine) are usually used.
Which is the most common disorder of childhood? Conduct disorder Attention deficit hyperactivity disorder (ADHD) Intellectual disability Autism
Attention deficit hyperactivity disorder (ADHD) ADHD, the most common disorder of childhood, results in poor academic performance, strained family relations, and rejection of peers.
A nurse is assessing a child who had an episode of passing feces in the classroom. The child has no other disabilities. The nurse concludes that the child had intentional encopresis. Which other condition is the child likely to have? Tourette's disorder Conduct disorder Rett's disorder Expressive language disorder
Conduct disorder Intentional passing of feces in inappropriate places like the classroom is referred to as intentional encopresis. This condition is mostly associated with conduct disorder or oppositional defiant disorder. The child does not show any impairment in normal functioning. Rett's disorder is a type of pervasive developmental disorder characterized by the development of multiple deficits over a period of normal functioning. In Tourette's disorder, the child engages in multiple motor and vocal stereotypical behaviors. In expressive language disorder, the child has difficulty communicating through verbal or sign language. Such behavior is not evident in the assessment.
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? Resilience Bullying Normalization Development of poor self-esteem
Development of poor self-esteem Developmental delays not only slow a child's progress but also can interfere with the development of positive self-esteem.
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? Not being able to engage in play activities Unusual reactions to sounds, smells, and other sensory experiences Using limited gestures to communicate Flapping hands repeatedly
Flapping hands repeatedly 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.
An adolescent is being observed for attention deficit hyperactivity disorder (ADHD). Which circumstance would demonstrate evidence to support this diagnosis? Is stubborn, resistant to directions, and unwilling to negotiate. Shows cruelty to animals, callousness, and lack of guilt and remorse. Forgets to turn in homework, does not follow directions, cannot stay in assigned seat in class, and is always talking excessively and inappropriately. Is withdrawn in social contexts but energetic and engaging with family.
Forgets to turn in homework, does not follow directions, cannot stay in assigned seat in class, and is always talking excessively and inappropriately. ADHD is characterized by distractibility, lack of concentration, and excessive activity.
A nurse is studying the brain images of children with attention deficit hyperactivity disorder (ADHD). In these images, the nurse would find abnormalities related to which area of the brain? Temporal lobe Frontal lobe Occipital lobe Parietal lobe
Frontal lobe Studies have proven that ADHD is associated with malfunction of the frontal lobe. Decreased metabolism and decreased perfusion to the frontal lobe are the physiological alterations known to cause ADHD. Dysfunction of the parietal lobe would cause abnormalities in sensory perception. Dysfunction of the occipital lobe would cause abnormalities in vision. Dysfunction of the temporal lobe would cause dysfunction in communication.
When attention deficit hyperactivity disorder (ADHD) is present, the child will most likely exhibit which core symptoms? Quiet, impulsive, excessively attentive, and psychotic Overly friendly, able to follow directions, impulsive, and active Highly distractible, excitable, impulsive, and excessively active Affective disturbances, autism, psychosis, and excessive talkativeness
Highly distractible, excitable, impulsive, and excessively active Highly distractible, excitable, impulsive, and excessively active are the four core symptoms associated with this disorder. Although talking excessively is an associated behavior, affective disturbances, autism, and psychosis are not accurate. Although impulsivity and being excessively active are core symptoms, being overly friendly and being able to follow directions are not accurate.
Which is considered a hyperactive/impulsive behavior seen in attention deficit hyperactivity disorder (ADHD)? Inability to play quietly Avoiding tasks requiring mental effort Frequent forgetfulness in daily activities Making careless mistakes
Inability to play quietly Inability to play quietly is a hyperactive/impulsive behavior seen in ADHD. Inattentive behaviors include avoiding tasks that require mental effort, making careless mistakes, and being forgetful in daily activities.
Which medication is the most effective treatment for attention deficit hyperactivity disorder (ADHD)? Amphetamine Methylphenidate Pemoline Dextroamphetamine
Methylphenidate The most effective treatment for ADHD is methylphenidate.
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. Mental stress from the disorder could make the child depressed. Good sleep may normalize the transmission of dopamine. Physical stress and fatigue can increase symptoms in tic disorder. Repetitive motor movements cause fatigue, and the child needs rest.
Physical stress and fatigue can increase symptoms in tic disorder. 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 an existing diagnosis of attention deficit hyperactivity disorder shows signs and symptoms of depression. Which would most likely be prescribed? Selective serotonin and norepinephrine reuptake inhibitor (SSNRI) Tricylic antidepressant Monoamine oxidase inhibitor Mood stabilizer
Selective serotonin and norepinephrine reuptake inhibitor (SSNRI) Antidepressant medications, most likely SSNRIs, are used for anxiety, depression, and primarily for ADHD. Mood stabilizers are prescribed primarily for bipolar disorder. These medications may be prescribed off-label. However, there is controversy surrounding the use of SSNRIs and selective serotonin reuptake inhibitors (SSRIs) in children. Nurses need to keep in mind that all medications involve a risk-benefit equation. Given the modest benefit of the SSNRIs and SSRIs and the potential for adverse behavioral effects, these medications merit careful monitoring in children and adolescents.
When performing a spiritual assessment on a child, the nurse and child discuss church attendance and practices that are most important to the child. Which domain is the nurse addressing when doing this assessment? Social All of the above Psychological Biologic
Social Spiritual assessment is an important part of a mental health assessment. It is part of the social domain. Growing research suggests that religious and spiritual practices may promote both physical and mental health.
Which type of intervention may be helpful for children who are bullies? Art therapy Play therapy Social skills training Bibliotherapy
Social skills training Social skills training may be particularly helpful for children who are bullies or rejected by their peers.
A nurse is assessing a 2-year-old child diagnosed with autism spectrum disorder. Which findings does the nurse expect to find on assessment? Select all that apply. The child is extremely playful. The child becomes upset with minor changes in routine. The child avoids eye contact. The child becomes frightened when left alone. The child does not relate to parents.
The child avoids eye contact. The child does not relate to parents. The child becomes upset with minor changes in routine. Children with autism spectrum disorder tend to avoid eye contact with people. They do not identify or relate to their parents and remain detached. These children get upset with minor changes in routine. Children with autism spectrum disroder do not enjoy engaging in play or make-believe with toys. These children do not get frightened if left alone; in fact, they prefer being left alone.
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 cannot sit through meals. The child is genetically predisposed to being thin. The child finds food distasteful. The child has decreased appetite.
The child cannot sit through meals. 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.
The nurse is assessing a child with tic disorder. The nurse documents in the assessment sheet that the child exhibits coprolalia. What might be be interpreted from this? The child continuously repeats socially unacceptable words. The child continuously repeats the last heard phrase. The child grunts repeatedly. The child repeatedly shrugs the shoulders.
The child continuously repeats socially unacceptable words. Coprolalia is a complex vocal tic in which a child with tic disorder continuously repeats socially unacceptable, often obscene, words. Grunting and shrugging of the shoulders are common simple vocal and motor tics, respectively. Repeating the last heard phrase is a type of vocal tic known as echolalia.
The nurse expects the child with expressive language disorder is likely to present with which nursing assessment finding? The child is mute. The child has difficulty understanding the meaning of words. The child stutters while speaking. The child has difficulty forming complete sentences.
The child has difficulty forming complete sentences. The child with expressive language disorder may have difficulty communicating through verbal or sign language. The child does not have impaired ability to produce sound. The child may not stutter while speaking but would not be able to organize words to make sentences while speaking. The child does not have receptive language disorder, thus the child would not have difficulty understanding the meaning of words and sentences.
A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The child is given medication and behavioral modification therapy to treat the condition. Which outcome achieved within 3 days would indicate successful therapy? The child is able to demonstrate successful interaction with family members over a long period of time. The child is able to express positive statements about the self. The child is able to complete assignments or tasks with assistance. The child is able to interact and to develop successful peer relationships.
The child is able to complete assignments or tasks with assistance. If within 3 days of starting treatment the child with ADHD is able to complete work or assignments with assistance, then this indicates successful therapy. Being able to express positive statements about himself or herself cannot be expected of the child after only 3 days of therapy. The child's ability to develop peer relationships would also not be demonstrated within this time. After 3 days of therapy, the children with ADHD would be able to demonstrate changes like being able to listen to others. They would not be able to interact with family members for a long period of time.
Which are nursing actions that support active listening? Select all that apply. Sit with arms and legs crossed Interrupt conversations to ask more questions Use reflective comments Use a computer to write out observations Use appropriate vocabulary
Use appropriate vocabulary Use reflective comments During the comprehensive assessment, the nurse needs to be a good, active listener. Using appropriate vocabulary, tolerating a child's anxious, angry or sad behavior, and use of reflective comments are useful listening skills.