Week 4: Boyd Questions
A 14-year-old client is being treated for conduct disorder. The client refuses to attend class today, stating that yesterday the other nurse told the client that the client did not have to go to class if the client did not want to. Which would be the best response by the nurse? "Missing class is against the rules." "You and I both know you're lying." "Why do you keep fighting the system?" "Fine, but you're confined to your room."
"Missing class is against the rules." *Reinforcing rules avoids a power struggle; the nurse must set limits on the unacceptable behavior of missing class. The nurse can negotiate with a client a behavioral contract outlining expected behaviors, limits, and rewards to increase treatment compliance. The nurse must avoid responses that will exacerbate conflict, like "Why do you keep fighting the system?" and "You and I both know you're lying." It would be inappropriate to comply with the adolescent's desire to miss school because this contravenes the rules.
After completing a series of parent training sessions with parents of an 8-year-old client with oppositional defiant disorder, the child's mother calls the nurse with concerns. The mother states, "What you taught us isn't working. Can you please talk to my child about his behavior?" Which is the nurse's most effective response? "Please tell me more about what you are having difficulty with." "Tell me how you have been using negotiation when limit setting with your child." "Please bring your child to my office for another session." "I can meet with your child individually at the school counseling office."
"Please tell me more about what you are having difficulty with." *Exploring in depth what the client's mother is having difficulty with can help the nurse build the parental capacity to address the behavioral difficulties they are having on their own. Identifying specific pitfalls can promote problem solving. Meeting with the child individually at the school counseling office takes the child out of the environment where the behavior is most problematic (in the home). Working with the child individually is ineffective as the best treatment for oppositional defiant disorder is to work with the parents in building their capacity for behavior management. Telling the mother to bring the client to the nurse's office for another session communicates that the parents do not already have the tools to manage the child's behaviors independently
A 10-year-old child with Tourette's disorder is receiving haloperidol as part of his treatment plan. When assessing the child at a follow up visit, which statement by the child would lead the nurse to suspect that he is experiencing a side effect of the drug? "I think I'm much more alert with this drug." "I'm eating about the same amount as before." "My muscles seem pretty flexible lately." "Sometimes I feel like I'm so sleepy."
"Sometimes I feel like I'm so sleepy." *The most frequently encountered side effects associated with medication therapy such as haloperidol include drowsiness, dulled thinking, muscle stiffness, akathisia, increased appetite and weight gain, and acute dystonic reactions.
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? "We're so glad that methylphenidate will eliminate the problems of ADHD." "We'll be sure the child takes methylphenidate at the same time every day, just before bedtime." "We'll teach the child the proper way to take the medication, so the child can manage it independently." "We'll be sure to record the child's weight on a weekly basis."
"We'll be sure to record the child's weight on a weekly basis." *Stimulant medications used to treat ADHD can suppress appetite, and the child may lose or fail to gain weight properly. The client is too young to manage his medications independently. Ritalin should be given in divided doses and taking it at bedtime can cause insomnia. Ritalin reduces hyperactivity, impulsivity, and mood lability and helps the child to pay attention more appropriately. However, it does not wholly eliminate the challenges of the disorder.
The child psychiatric assessment differs from that of adults in which of the following ways? Attention to feelings Attention to signs and symptoms Attention to developmental milestones Attention to the family history
Attention to developmental milestones
The nurse is assisting a child with attention deficit hyperactivity disorder (ADHD) to complete the child's activities of daily living. Which is the best approach for nurse to use with this child? Set a time limit to complete all tasks. Let the child complete tasks at the child's own pace. Break tasks into small steps. Offer rewards when all tasks are completed.
Break tasks into small steps. *Before beginning any task, adults must gain the child's full attention. The adult should tell the child what needs to be done and break the task into smaller steps if necessary. This approach prevents overwhelming the child and provides the opportunity for feedback about each set of problems he or she completes. Self-pacing would give the child freedom but make it unlikely that the child will complete the task independently; these children benefit from redirection and smaller, achievable tasks. Similarly, offering a reward will not provide the child with the continued focus necessary to complete a large task independently. Setting a time limit would be likely to frustrate the child by increasing pressure and further decreasing focus.
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 gain Appetite suppression Weight loss Insomnia Hypotension
Insomnia Weight loss Appetite suppression
A nurse is conducting a presentation about autism spectrum disorder for a group of parents. When describing this condition, the nurse would identify that approximately 50% of those with this condition also experience which of the following? Hypertension Motor decline Seizure disorder Intellectual disability
Intellectual disability
During a mental status examination of a child, the nurse observes the child's sentence structure and vocabulary for a general sense of ... Ability to respond accurately to questions asked Intellectual functioning Ability to focus on the conversation Listening skills without interrupting
Intellectual functioning
For which reason is it crucial for nurses to advocate for children and adolescents regarding psychiatric disorders? Children and adolescents experience some of the same mental health problems as adults. It is not necessary because psychiatric disorders do not occur in children and adolescents. It is much more difficult to diagnose psychiatric disorders in children and adolescents. Psychiatric disorders in children manifest themselves very quickly.
It is much more difficult to diagnose psychiatric disorders in children and adolescents.
Which is true of the time-out strategy that may be used for persons with conduct disorder? It is not a permanent solution; eventually, the goal is for the client to avoid time-out. It should only be used as a last resort. It is retreat to a neutral place, so clients can regain self-control. It is a punishment.
It is not a permanent solution; eventually, the goal is for the client to avoid time-out.
When working with a hospitalized preschooler, the nurse knows that the best way to achieve rapport is by doing what? Being friendly with the child when the parents are around Talking to the child one-on-one Providing multiple rewards for acceptable behavior Joining in play
Joining in play
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? Impulsiveness Language difficulty Hyperactivity Inattention
Language difficulty
Which of the following approaches is included in milieu management for the child with autism spectrum disorder? Scheduling a group in which the children talk about school Providing a structured, routine environment Having a playroom with climbing structures and rolling chairs Listen to the parents feelings and frustrations
Providing a structured, routine environment *Milieu management—a consistent, structured environment with predictable routines for activities, mealtimes, and bedtimes—is necessary for successful treatment. Changes in routine may provoke disorganization in the child, leading to emotional disequilibrium and explosive behavior. Children with autism spectrum disorder often have social deficits, therefore a group talk or activites that promote interpersonal interaction would be inappropriate. Climbing structures and rolling chairs would be problematic and impose a safety risk. Listening to the parents feelings and frustrations would fall in the psychosocial domain of treatment for a child with ASD.
An 8-year-old boy has been diagnosed with ADHD. His mother is shocked that he will be prescribed a psychostimulant, stating, "His whole problem is that he's too stimulated, not understimulated!" Which of the following facts should underlie the nurse's response to the mother? Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior. Psychostimulants are a form of aversion therapy in which the child becomes uncomfortable with overstimulation. Controlled, medication-induced stimulation helps children become more comfortable and functional during times of high stimulation. Brain stimulation is inversely proportionate to motor stimulation.
Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior.
Which are important points for the nurse to consider when working with clients with disruptive behavior disorders and their families? Select all that apply. Remember to focus on the client's strengths and assets, as well as their problems. Transient conduct disorders are common in all children. Focus on positive actions to improve situations and/or behaviors. Most behavior disorders are caused by being raised by parents who had behavior disorders in their own childhoods. Avoid a "blaming" attitude toward clients and/or families.
Remember to focus on the client's strengths and assets, as well as their problems. Avoid a "blaming" attitude toward clients and/or families. Focus on positive actions to improve situations and/or behaviors.
When presenting information about conduct disorders to a community group, the nurse is asked, "Which is the best setting for care of a client with conduct disorders when parents cannot provide safe, structured environments and adequate supervision for the client?" Which would be the most appropriate reply by the nurse? School Jail-diversion program The acute care setting Residential treatment settings
Residential treatment settings *Group homes, halfway houses, and residential treatment settings are designed to provide safe, structured environments and adequate supervision if that cannot be provided at home. Clients with conduct disorder are seen in acute care settings only when their behavior is severe and only for short periods of stabilization. Clients with legal issues may be placed in detention facilities, jails, or jail-diversion programs but this option is reserved for clients with legal issues, not for treatment purposes.
A child with an existing diagnosis of attention deficit hyperactivity disorder shows signs and symptoms of depression. Which would most likely be prescribed? Tricylic antidepressant Mood stabilizer Monoamine oxidase inhibitor Selective serotonin and norepinephrine reuptake inhibitor (SSNRI)
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 assisting the parents of a child diagnosed with ADHD, which of the following would the nurse suggest? Select all that apply. Keep to regular routines Let him work on several things at once Maintain a calm environment Set clear limits with consequences Provide extensive explanations
Set clear limits with consequences Keep to regular routines Maintain a calm environment
Ground rules for nurses to follow when establishing rapport with children include what? Letting the child know that you are in charge by setting the rules quickly Showing acceptance and giving clear directions about unacceptable behavior Tailoring your speech to fit the child by using child-like language Imitating the child's nonverbal behavior to establish rapport
Showing acceptance and giving clear directions about unacceptable behavior Showing the child acceptance and clearly defining unacceptable behavior are important to ensure the child feels unconditional positive regard for building self esteem, but has a firm understanding of the limits for safety and social appropriateness. The nurse should not tailor speech to fit the child, exhibit controlling behaviors, or imitate the child's nonverbal behaviors.
A nurse is conducting an assessment of a child. Which technique would be most effective for the nurse to use to establish rapport with family members? Select all that apply. Showing acceptance. Speaking slowly. Maintaining eye contact. Reacting subjectively. Making the interview nurse centered.
Showing acceptance. Speaking slowly. Maintaining eye contact. *Establishing rapport can be facilitated by maintaining appropriate eye contact; speaking slowly, clearly, and calmly with friendliness and acceptance; using a warm and expressive tone; reacting to communications from interviewees objectively; showing interest in what the interviewees are saying; and making the interview a joint undertaking.
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? Explore alternative living arrangements for the child. Review effective disciplinary practices with the parents again. Try to remember that the parents are trying to the best of their ability to carry out the suggestions. Refer the parents to a family therapist.
Try to remember that the parents are trying to the best of their ability to carry out the suggestions. *The nurse's beliefs and values about raising children affect how he or she deals with children and parents. The nurse must not be overly critical about how parents handle their children's problems until the situation is fully understood: Given their own skills and problems, parents often give their best efforts. Given the opportunity, resources, support, and education, many parents can improve their parenting. It is premature to refer to family therapy or remove the child from the home. Emotional barriers to effective parenting should be explored first.
A nurse is assessing a 10-year-old child who is displaying behaviors that are consistent with oppositional defiance disorder. When conducting the assessment, the nurse should also assess for which co-morbidity? schizophrenia kleptomania attention deficit hyperactivity disorder cognitive impairment
attention deficit hyperactivity disorder
A pre-teen client has been considered a neighborhood bully for several years. Peers avoid him, and the mother says she cannot believe a thing he tells her. Recently, the client was observed shooting at several dogs with a pellet gun and setting fire to a vacant lot for the first time. A nurse would assess these behaviors as being most consistent with which disorder? pyromania oppositional defiant disorder conduct disorder defiance of authority
conduct disorder
After being arrested for prostitution, an adolescent client has been referred to a mental health clinic by a juvenile officer. The client has a history of truancy and being physically abusive to siblings. From the history gathered during assessment, the nurse might anticipate which diagnosis? conduct disorder intermittent explosive disorder childhood depressive disorder oppositional disorder
conduct disorder
Which is considered a hyperactive/impulsive behavior seen in attention deficit hyperactivity disorder (ADHD)? Avoiding tasks requiring mental effort Inability to play quietly Frequent forgetfulness in daily activities Making careless mistakes
Inability to play quietly
An 11-year-old has been diagnosed with depression. When interviewing the child for the first time, which question would be most appropriate to ask? "Do you ever feel anxious?" "Are you feeling sad?" "Have you ever had delusions?" "Have you ever heard of thorazine?"
"Are you feeling sad?" Children have a narrower vocabulary and are more concrete in their thinking. The nurse should use the terms "sad" or "nervous" rather than depressed or anxious. The nurse must adapt communication to the child's age level. The challenge is to avoid using overly complex vocabulary or talking down to children.
When interviewing children or adolescents, which of the following frames the assessment and management of the plan of care? Developmental level Educational level Assessment tools Social skills
Developmental level
ADHD is characterized by inattentiveness, overactivity, and impulsiveness. Which of the following would the nurse identify related to inattentiveness? Talking excessively Missing details Fidgeting Interrupting
Missing details
Which would be important circumstances to gather assessment data for a child with attention deficit hyperactivity disorder (ADHD)? Select all that apply. Assessing the client in a group of peers Directly observing the child Interviewing the client's teachers Reviewing the client's record Interviewing the client's parents
Directly observing the child Interviewing the client's parents Interviewing the client's teachers Assessing the client in a group of peers
In a preschool child assessment to clarify the child's body image difficulties, the nurse will use ... Direct questions Playing checkers Drawings Playing cards
Drawings
Brain images of people with ADHD have suggested decreased metabolism in which of the following cerebral lobes? Temporal Occipital Parietal Frontal
Frontal
The nurse is counseling a family whose child has autism. When describing this condition, which would the nurse most likely include? Detection after the child enters school Connection to ineffective parental practices Girls are more frequently affected than boys Onset before child is 2.5 years old
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.
The parent of a 6-year-old child with attention deficit hyperactivity disorder asks to speak to the nurse about the child's disruptive behavior. The nurse would be most therapeutic by saying what? "Your child is cute but needs to calm down." "You need to take a firmer approach with your child." "It must be difficult to handle your child at home." "Your child sure is active."
"It must be difficult to handle your child at home." *Parents find themselves chronically exhausted mentally and physically. Parents need support and reassurance, and making a statement about the difficulties of handling the child at home validates the mother's feelings. It is not appropriate to say, "Your son is a cute child, but he needs to calm down" because this suggests a simplistic solution to the child's problem.." It may make the parents defensive to say, "You need to take a firmer approach with your son." "Your son sure is active" is not a therapeutic response because it downplays the significance of the child's disorder and its effect on the family.
The nurse is using limit setting with a child diagnosed with conduct disorder. Which statement reflects the most effective way for the nurse to set limits with the child? "Stop what you are doing. Go to your room." "That is not allowed here. You will lose a privilege. You need to stop." "I would appreciate if you would not do that." "Why do you do these things?'
"That is not allowed here. You will lose a privilege. You need to stop." *The nurse must set limits on unacceptable behavior at the beginning of treatment. Limit setting involves three steps: (1) informing clients of the rule or limit; (2) explaining the consequences if clients exceed the limit; and (3) stating expected behavior. Saying "Stop what you are doing. Go to your room" does not explain the expected behavior. Saying "I would appreciate if you would not do that" does not provide a consequence. Asking, "Why do you do these things" provides none of the three steps.
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? "We'll have the child do homework at the kitchen table with the child's siblings." "We'll set up rules with specific times for eating, sleeping, and playing." "We'll use simple, clear directions and instructions." "We'll make sure the child completes one task before going on to another."
"We'll have the child do homework at the kitchen table with the child's siblings."
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? "You seem worried about your child's future." "Your child will probably always have some autistic traits." "Your child should outgrow autistic traits by adolescence." "Autistic children can fully recover with the right treatment and education."
"Your child will probably always have some autistic traits." *Autistic traits persist into adulthood, and most people with autism remain dependent to some degree on others. Manifestations vary from little speech and poor daily living skills throughout life to adequate social skills that allow relatively independent functioning. Social skills rarely improve enough to permit marriage and child rearing. Stating, "You seem worried about your child's future" is empathic but does not address the parent's specific question.
The nurse is assessing a child who is suspected of having Tourette's disorder. The nurse is reviewing the child's history, keeping in mind that for the diagnosis to be made, the tics must be present for at least which time frame? 1 month 2 years 1 year 6 months
1 year
Which of the following should be included in the education plan for a client receiving methylphenidate? Adverse effects include hypertension and nervousness. Alcohol may be used in moderation. The medication is usually taken after 5 p.m. There is no risk of dependence.
Adverse effects include hypertension and nervousness. *Methylphenidate has several adverse reactions, including hypertension, psychological dependence, and nervousness. The medication is usually not taken after 5 p.m. because of a risk of insomnia. Alcohol and over-the-counter products should be avoided.
Changes in behavior at school may be evidenced by which of the following? Select all that apply. Decreased concentration Withdrawal from peers Physical disability Aggression towards peers Falling grades
Aggression towards peers Falling grades Decreased concentration Withdrawal from peers
A nurse is providing education to a group of parents who have children with attention deficit hyperactivity disorder (ADHD). Which statement would be accurate and should be included in the education? Select all that apply. It is important for parents of children with ADHD to learn how to rebuild their child's self-esteem. Medication alone will adequately treat children with ADHD. Children with ADHD do not qualify for special school services under the Individuals With Disabilities Education Act. Because raising a child with ADHD can be frustrating and exhausting, it often helps parents to attend support groups that can provide information and encouragement from other parents with the same problems. ADHD is not the fault of the parents or the child and techniques and school programs are available to help.
Because raising a child with ADHD can be frustrating and exhausting, it often helps parents to attend support groups that can provide information and encouragement from other parents with the same problems. It is important for parents of children with ADHD to learn how to rebuild their child's self-esteem. ADHD is not the fault of the parents or the child and techniques and school programs are available to help.
A nurse is providing community education regarding adolescents with oppositional defiance disorder (ODD). Which point should the nurse include in the educational session? Parental roles do not influence the development of ODD It is ideal if parents can wait until adolescence to seek treatment Rewarding positive behaviors consistently can lead to ODD Behavior problems can develop when parental figures pay attention to a child's maladaptive behaviors
Behavior problems can develop when parental figures pay attention to a child's maladaptive behaviors **The disruptive, defiant behaviors associated with ODD usually begin at home with parents or parental figures and are more intense in this setting than in settings outside the home. Consistently giving attention to maladaptive behaviors and ignoring any positive ones can lead to the development of ODD. With ODD, the problem develops as a result of the parents or parental figures to miss opportunities to reward the child for demonstrating positive behaviors but attention, whether it is positive or negative, is typically given when the child is engaging in maladaptive behavior. Parents/parental figures play a key role in preventing or perpetuating ODD. The problem behaviors are learned and inadvertently reinforced in the home. The most effective treatment for ODD begins when the child is young, preferably elementary school-aged. Waiting until adolescence to seek treatment can render the client more treatment resistant.
Adolescents receiving treatment for psychiatric disorders can be suspicious and guarded. The nurse understands what as a major reason for this type of behavior? Belief that everybody hates them Belief that their feelings are normal Belief that they will be blamed for their problems Belief that adults will understand their problems better than they understand them
Belief that they will be blamed for their problems
For which reasons is it more difficult to diagnose psychiatric disorders in children than in adults? Select all that apply. Sometimes, children "outgrow" psychiatric disorders. Because they are constantly changing and developing, children are unable to discriminate unusual or unwanted symptoms from normal feelings and sensations. Children and adolescents experience some of the same mental health problems as adults and are diagnosed using the same criteria as for adults. Behaviors that are appropriate for a child of one developmental level may be inappropriate for a child of a different developmental level. Children usually lack the abstract cognitive abilities and verbal skills to describe what is happening.
Children usually lack the abstract cognitive abilities and verbal skills to describe what is happening. Because they are constantly changing and developing, children are unable to discriminate unusual or unwanted symptoms from normal feelings and sensations. Behaviors that are appropriate for a child of one developmental level may be inappropriate for a child of a different developmental level.
A child is expelled from school for repeated fighting and vandalizing school property. The school nurse and counselor meet with the parents to explain that the child may benefit from counseling and are formulating a collaborative plan. The child is experiencing signs of which disorder? Conduct disorder Oppositional defiant disorder Attention deficit hyperactivity disorder Asperger's syndrome
Conduct disorder *Conduct disorder is characterized by persistent antisocial behavior in children and adolescents that significantly impairs their ability to function in social, academic, or occupational areas. Behavioral symptoms include physical fights, destruction of property, vandalism, and serious violation of rules among others. Oppositional defiant disorder consists of an enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures without major antisocial violations. Asperger's disorder is a pervasive developmental disorder characterized by the same impairments of social interaction and restricted stereotyped behaviors seen in autistic disorder, but there are no language or cognitive delays. Attention deficit hyperactivity disorder is characterized by inattentiveness, overactivity, and impulsiveness.
The nurse caring for a child with a mental health disorder knows the importance of assessing for psychosocial development as well assessing the biologic and psychological domains. Which model is the most commonly used to assess the psychosocial development of a child? Erikson's Piaget's Baker Miller's Freud's
Erikson's
A nurse is meeting the parents of an 8-year-old child with oppositional defiant disorder. Which strategies can the nurse offer the parents to promote the use of positive reinforcement? (Select all that apply.) Provide hugs and cuddles when the child and throwing objects during a tantrum. Take the child out for ice cream after a weekend free of arguing or questioning. Give high-fives for following through on a request the first time. Engage in discussion with the child when the child is arguing. Offer the child a toy or a game after a week of good behavior at school.
Give high-fives for following through on a request the first time. Offer the child a toy or a game after a week of good behavior at school. Take the child out for ice cream after a weekend free of arguing or questioning.
A child with attention deficit hyperactivity disorder is taking methylphenidate in divided doses. If the child takes the first dose at 8 a.m., which behavior might the school nurse expect to see at noon? Sleepiness or drowsiness Lack of appetite for lunch Increased impulsivity or hyperactive behavior Social isolation from peers
Increased impulsivity or hyperactive behavior *Ritalin has a short half-life, so doses are needed about every 4 hours during the day to maintain symptom control. The child's symptoms may worsen four hours after a dose. Giving stimulants during daytime hours usually effectively combats insomnia. Social isolation is likely to be an ongoing, long term problem that is unrelated to the precise timing of doses. A loss of appetite is more likely when serum levels of the drug are higher.
The nurse caring for a young child knows the importance of interviewing both child and parent. When it comes time to speak with the child alone, however, some children fear separation from their parents. What could the nurse do to ease this separation? Offer a transitional object for the child to hold. Extend the time the child is away from the parents to promote desensitization Tell the child there is nothing to be afraid of. Speak to the child as if he or she was an adult.
Offer a transitional object for the child to hold. *Young children may fear separating from their parents. The nurse can reassure children by showing them where the waiting room is and telling them that they can check on their parents when they wish. Other comfort measures include introducing a game or toy or allowing the child to hold a transitional object.
The parent of a child with attention deficit hyperactivity disorder (ADHD) tells the school nurse that the child's teacher has called a conference. Which statement is true regarding evaluation of treatments for the child with ADHD? Often the child notices the change in treatment before anyone else Often it is the siblings that notice the change in behavior first Often the parents or teacher notice positive outcomes of treatment Often the change is subtle and gets noticed at the follow-up visit
Often the parents or teacher notice positive outcomes of treatment
Given that the child's primary environment is most often with the parent, the assessment of the child and parent interaction commences when ... Parent is asked to leave the room noting attachment issues and then commence interview of child Child and parent get each other's attention Parent and child are in the waiting area noting behaviors expressed toward each other Both child and parent are interviewed
Parent and child are in the waiting area noting behaviors expressed toward each other *Because the child's primary environment is most often with the parent, child-parent interactions provide important data about the child-parent attachment and parenting practices. The nurse's observations focus on both the child alone and the child within the family. The nurse can actually make some of these observations while the family is in the waiting area, noting their behaviors.
A nurse is preparing to assess a school-aged child. Which method would be most effective for the nurse to use to establish rapport with this child? Playing with dolls Wearing dress-up clothes Playing cards Painting a picture
Playing cards *The nurse can establish rapport with school-aged children by using competitive board games, such as checkers and playing cards. Nurses can establish rapport with a preschool-aged child by playing with dolls, having the child wear dress-up clothes, and painting pictures.
The nurse understands the importance of developing rapport with family members before the evaluation when caring for children with psychiatric disorders. The main reason for doing this is what? Reducing fear of rejection Reducing anxiety Reducing cost of stay Reducing length of stay
Reducing anxiety
The nurse asking to speak to the child alone can provide reassurance to the child by ... Speaking to the child in an assertive voice and telling the child that you will not hurt him or he Telling the child that we will only be together for a short time Showing the child that the waiting area is close by, where the parents will wait for the child Allowing the parent to stay if the child requests
Showing the child that the waiting area is close by, where the parents will wait for the child *After talking with the parent and child together, the nurse should ask to speak with the child alone for a while. Young children may fear separating from their parents. The nurse can reassure children by showing the child where the waiting area is and telling him or her, "Mommy and Daddy are going to be waiting right here for you. You and I are going to be in a room close by."
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
The nurse is working with a child with a mental health problem and the family must be included in the care. Which is one of the best ways the nurse can advocate for the child? Interpret the child's thoughts and feelings to the parent. Teach the parents age-appropriate expectations of the child. Reinforce the parents' expectations of the child's behavior. Support transferring the child to a healthy living environment.
Teach the parents age-appropriate expectations of the child. *Working with parents is a crucial aspect of dealing with children with these disorders. Parents often have the most influence on how these children learn to cope with their disorders. The nurse can teach parents age-appropriate activities and expectations for clients.
A nurse working with an adolescent understands the importance of using a straightforward approach and making the teenager feel in control. The nurse can best do this by which of the following? Telling the teenager that he or she does not have to talk about anything that he or she is not ready to reveal Stopping any hostile behavior from the very beginning Not mentioning what information the nurse will share with others Sugarcoating everything so that the client does not feel bad
Telling the teenager that he or she does not have to talk about anything that he or she is not ready to reveal *The nurse should clearly convey from the very beginning what information will and will not be shared. Adolescents appreciate a straightforward approach. Mentioning that the teen does not have to discuss anything until ready will help the adolescent feel in control. The nurse should be patient and not jump to conclusions when a client is hostile.
The mother of a 6-year-old boy reports that the child has had increasing somatic complaints that have no physical basis and disappear when he is allowed to remain home from school. The nurse should suspect what? The child has a school phobia. The child has ADHD. The child has a developmental disorder. The child has oppositional defiant disorder.
The child has a school phobia. *The child's wanting to remain home from school may be an example of parents' explanations for some behaviors. The data in the question indicate an ongoing and progressive problem. Some aspects of the school experience are feared by the child. Separation anxiety is thought to play a role in this disorder. The data neither indicate ADHD nor suggest childhood developmental disorder.
A parent is concerned that the parent's child might suffer from attention deficit hyperactivity disorder (ADHD). The parent brings the child in to be evaluated. Which behavior reported by the parent would be consistent with this diagnosis? The child has been hoarding objects. The child has lots of friends. The child interrupts others. The child is excelling academically in school.
The child interrupts others. By the time the child starts school, symptoms of ADHD begin to interfere significantly with behavior and performance. He or she cannot listen to directions or complete tasks. The child interrupts and blurts out answers before questions are completed. Academic performance suffers because the child makes hurried, careless mistakes in schoolwork, often loses or forgets homework assignments, and fails to follow directions. Socially, peers may ostracize or even ridicule the child for his or her behavior. The child often loses necessary things, rather than hoarding items.
Which of the following statements reflects accurately the effects of childhood mental illness? Children with depression frequently outgrow their mood disorder after the trials of adolescence and young adulthood are over. A child with mental illness may have a difficult time in adulthood, but siblings without mental illness typically are unaffected. Untreated mental illness in childhood often results in long-term mental illness in adults. Approximately 20% of children with conduct disorder become antisocial adults.
Untreated mental illness in childhood often results in long-term mental illness in adults.
When providing education to the parents of a client with conduct disorder, which is a valid teaching point? Act as the adolescent's advocate at school when the client is disruptive. Tell the adolescent to go to their room as a consequence for using profanity. Use 'I' language and express an emotion when setting limits. Provide reassurance that frequent sexual activity is normal in adolescence.
Use 'I' language and express an emotion when setting limits. *With clients diagnosed with conduct disorder, parents need to replace old patterns of communicating such as yelling, hitting, or simply ignoring with more effective communication strategies such as assertive limit setting. Using 'I' language and identifying an emotion can help the parents set limits in a healthy way. Consequences will only be effective if something of value is taken from the client. Many adolescents prefer time alone in their rooms. This would not be the most effective information to provide to the parents. Some parents need to let the client experience the consequences of their actions rather than rescuing them. Advocating for the adolescent when the client is disruptive in school will only perpetuate the negative behavior. Adolescents with conduct disorder are prone to thrill-seeking, risky behavior including frequent sexual activity. This should not be normalized as part of the education provided to the parents.
The parents of a child with attention deficit hyperactivity disorder (ADHD) express to the nurse, "We get so frustrated when our child never minds us." Which parenting strategies should the nurse discuss with the parents? Select all that apply. Give verbal reprimands for negative behavior. Use time-out for behavior control. Provide occasional rewards and consequences for behavior. Use a point system for positive and negative behavior. Resist giving praise until fully compliant with requests.
Use time-out for behavior control. Give verbal reprimands for negative behavior. Use a point system for positive and negative behavior.
When interviewing a 12-year-old child in an outpatient psychiatric setting, the nurse can establish a high degree of credibility by ... asking the child to describe his or her parents. giving the child a transitional object to hold. asking about things that are important to the child. providing advice to the child about his or her parents.
asking about things that are important to the child.
A nurse is working with an adolescent client with a diagnosis of conduct disorder. The nurse is helping the client reflect on a situation in which the client became aggressive and asks how the client could have handled it differently. The nurse is employing which intervention? improving coping skills and self-esteem providing client education promoting social interaction increasing treatment compliance
improving coping skills and self-esteem
A nurse is discussing a client's condition with the client's family. A family member states that the client has a long history of mental retardation. The nurse corrects the family member by explaining that which is the correct term for this condition? mental incapacity intellectual retardation mental delay intellectual disability
intellectual disability
To establish rapport with a 10-year-old child who is hospitalized in a psychiatric setting, the nurse should ... play a competitive board game. use the DECA tool. use sports to bond with the child. analyze a fairy tale.
play a competitive board game.
The nurse is preparing to interview a 6-year-old child and her mother in an outpatient psychiatric setting. To establish a treatment alliance with the child, the nurse should ... sit in a chair next to the child. ask the parent if the child can be interviewed alone. act in a professional manner. recognize the child's individuality.
recognize the child's individuality.
