Chapter 11 Pediatric Neurodevelopment Disorders

Which child would be most difficult to diagnose for a neurodevelopmental disorder? A. 3 years old B. 5 years old C. 8 years old D. 12 years old

A

Symptoms of autism cause impairments in everyday functioning and include:

•Stereotypical repetitive speech •Obsessive focus on specific objects •Over-adherence to routines or rituals •Hyperreactivity or hypo reactivity to sensory input •Resistance to change •Disturbances in social relatedness (developing and maintaining relationships)

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

D

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

D

Intellectual disability is characterized by 3 things:

Deficit in three areas of functioning : 1. Intellectual functioning 2. Social functioning 3. Daily functioning

Autism Assessment/Cues

•Development Delays •Communication and behavioral skills •Parent- or -caregiver-child relationship •Emotional and/or physical abuse, neglect •child, family, community resources

Treatment Modalities for ASD: Biological: Physchological therapies:

•Pharmacotherapy •Applied Behavior analysis Early Intensive Behavioral Intervention (EIBI) Early Start Denver Model (ESDM)

ADHD medications

•methylphenidate (Ritalin) •amphetamine/dextroamphetamine (Adderal) •lisdexamfetaminedimesylate (Vivanse) •atomextine (Strattera) •guanfacine(Tenex/Intuniv) •clonidine(Kapvay/Catapres)

disruptive behavior management includes:

•time out •quiet room •seclusion and restraint

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

C

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

C

A nurse assesses a 3-year-old diagnosed with an autism spectrum disorder. Which finding is most associated with the child's disorder? a. has occasional toileting accidents. b. interrupts or intrudes on others. c. cries when separated from a parent. d. continuously rocks in place for 30 minutes.

D

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

D

_____% the children and adolescents in the United States suffer from a major mental illness that causes significant impairment

20

Which of the following is most prevalent cause of child abuse? A.Physical abuse B. Sexual abuse C. Verbal abuse D. Neglect

D

ADHD sxs must be present in _____________

two settings

Autism Spectrum Disorder

a developmental disorder characterized by deficits in social interaction, by impaired communication, and by restricted interests

Therapeutic holds, seclusion, and restraints are limited to _______ (<9 years) and ________ (age 9-17 years)•

1 hour, 2 hours

The resilient child has the following characteristics:

1. adaptability to changes in the environment 2. ability to form nurturing relationships with other adults when the parent is not available 3. ability to distance self from emotional chaos 4. good social intelligence 5. good problem-solving skills 6. ability to perceive a long-term future

Synapses peak at age

5

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

A

A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. The child formed a trusting relationship with a shelter volunteer. The child says, "My three friends and I got an A on our school science project." The nurse can assess that the child demonstrating what? a. resiliency. b. a passive temperament. c. at risk for post-traumatic stress disorder (PTSD). d. intellectualization to deal with problems.

A

A patient is scheduled for DBS. Which of these disorders is most likely to improve from such treatment, if all else has failed? A.Tic disorder B.Autism spectrum disorder C.Social communication disorder D.Developmental coordination disorder

A

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

A

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

A

Which assessment finding would cause the nurse to consider a child to be most at risk for the development of mental illness? a. The child has been raised by a parent with recurring major depressive disorder. b. The child's best friend was absent from the child's birthday party. c. The child was not promoted to the next grade one year. d. The child moved to three new homes over a 2-year period.

A

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

A

Which assessment findings present familial risks for a child to develop a psychiatric disorder? (Select all that apply.) a. Having a mother diagnosed with schizophrenia b. Being the oldest child in a family c. Living with an alcoholic parent d. Being an only child e. Living in an urban community

A, C

__________ outcomes: •Reduction in: •Hyperactive behaviors •Impulsive behaviors •Inattentive behaviors •Development of self-identity and self-esteem •Freedom from injury •Improved social relationships •Positive coping skills •Increased family functioning

ADHD outcomes

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

C

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

C

A nurse will prepare teaching materials for the parents of a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Information will focus on which medication likely to be prescribed? a. Paroxetine b. Imipramine c. Methylphenidate d. Carbamazepine

C

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

C

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

C

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

C

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

C

The parent of a child diagnosed with Tourette's disorder says to the nurse, "I think my child is faking the tics because they come and go." Which response by the nurse is accurate? a. "Perhaps your child was misdiagnosed." b. "Your observation indicates the medication is effective." c. "Tics often change frequency or severity. That doesn't mean they aren't real." d. "This finding is unexpected. How have you been administering your child's medication?"

C

Area of decreased stimulation for regaining and maintaining control •Feelings room—carpeted and supplied with soft objects that canbe punched and thrown •Sensory room—contains items for relaxation and meditation

Quiet Room

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

C

Encourages positive behaviors and discourages negative behaviors

Applied Behavior analysis for ASD

Inappropriate degrees of inattention, impulsiveness, and/orhyperactivity

Attention Deficit Hyperactivity Disorder (ADHD)

A 4-year-old frequently lashes out in anger at adults and other children. This child's style of behavior is an aspect of A. neurobiology. B. temperament. C. resilience. D. culture.

B

A child reports to the school nurse of being verbally bullied by an aggressive classmate. What is the nurse's best first action? a. Give notice to the chief administrator at the school regarding the events. b. Encourage the victimized child to share feelings about the experience. c. Encourage the victimized child to ignore the bullying behavior. d. Discuss the events with the aggressive classmate.

B

At the time of a home visit, the nurse notices that each parent and child in a family has his or her own personal online communication device. Each member of the family is in a different area of the home. Which nursing actions are appropriate? (Select all that apply.) a. Report the finding to the official child protection social services agency. b. Educate all members of the family about potential safety risks in online environments. c. Talk with the parents about parental controls on the child

B, C, D

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

B, D, E

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

C, D, E

General Interventions for __________ and __________: •Behavioral interventions •Play therapy •Bibliotherapy •Expressive arts therapy •Journaling •Music therapy •Family interventions •Teamwork and safety •Disruptive behavior management

Children and Adolescents

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

D

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

D

Improves language and cognitive skills

Early Intensive Behavioral Intervention (EIBI) for ASD

One-to-one interactions, joint play, and activity routines with the adult and child

Early Start Denver Model (ESDM) for ASD

ADHD ____________ and _____________ •Safety promotion •Identification of symptom patterns and severity •Individualized Education Plan (IEP) or Section 504 •Recognize ineffective coping strategies and assist with developing positive strategies •Family therapy and education •Psychological therapies •Pharmacotherapy •Long-term planning

Interventions and Evaluations

What should you do every 15 minutes when a patient has restraints on?

Monitor vital signs, range of motion and document every 15 minutes

Behavior used to cope with the environment, begins in infancy

Temperament

Intended to promote self-reflection and self-control •May involve going to a designated area or sitting on the periphery ofan activity until self-control is regained •Less restrictive than the quiet room or seclusion •Loses effectiveness when used too ofte

Timeout

•Childhood neurodevelopment disorders can disrupt the normal pattern of childhood development resulting in consequences for _______, _________ and _________ functioning

academic, social, and psychological