Exam 5: Child and Adolescent Mental Health

b

In planning care for an autistic child, which positive and realistic client outcome would the nurse anticipate? A) Communicates all needs verbally. B) Has established trust with at least one caregiver. C) Performs all self-care tasks independently D) Participates with peers in a team sport.

a, b, c, d

A mother asks the school nurse about ways to manage her son's ADHD. She reports he has difficulty completing his homework, and she often finds him playing on the computer. Which teaching should the nurse provide? (Select all that apply.) A) Create an environment as free from distractions as possible. B) Provide immediate reinforcement for acceptable behaviors. C) Break larger projects into smaller, attainable tasks and have him take physical activity breaks in between. D) Reduce stimulation as much as possible. E) Expect the child to control his behavior.

b

A mother of a child newly diagnosed with autistic disorder is sobbing as the nurse enters the room. Upon inquiring, she cries, "I'm such a terrible mother. What did I do to cause this behavior in my son?" Which nursing response is appropriate? A) "Researchers really don't know what causes autism." B) "Research shows that abnormalities in brain structure or function are to blame for autism disorder" C) "Poor parenting is to blame with the mother greater role than the father in the development of the disorder" D) "Lack of early infant bonding with the mother may be a cause of autism. Did you breast-feed or bottle-feed?"

d

A nurse in a special education program is planning care for a child who has autistic disorder. Which of the following interventions is appropriate to include in the plan of care? a) Allow for adjustment of rules to correlate with the child's behavior. b) Provide a flexible schedule to adjust to the child's interests. c) Allow for imaginative play with peers without supervision. d) Establish a reward system for positive behavior.

a

A nurse is admitting a client who has experienced a weight loss of 25 lb (11 kg) in the past 3 months. The client weighs 88 lb (40 kg) and believes she is fat. Which of the following aspects of care should the nurse consider the first priority for this client? a) Identify the client's nutritional status. b) Request a mental health consult. c) Plan a therapeutic diet for the client. d) Talk to family members to find out more about the client's dietary habits.

c

A nurse is assessing an adolescent client who has anorexia nervosa. Which of the following client statements is a sign of cognitive distortion? a) "I like to cut my food into small pieces." b) "I really need to get into shape." c) "If I eat one piece of candy, I may as well eat ten." d) "I can't afford to gain weight."

d

A nurse is assessing an adolescent client who is newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which of the following manifestations should the nurse expect to find? a) Avoidance, emotional numbing, and withdrawal b) Elevated moods, hyperactivity, and insomnia c) Difficulty concentrating, anxiety, and inattention d) Inattention, hyperactivity, and impulsivity

d

A nurse is caring for an adolescent admitted with anorexia nervosa. Which of the following findings is associated with this diagnosis? a) Diarrhea b) Hypertension c) Tachycardia d) Bloating

d

A nurse is providing care for a client who has anorexia nervosa. Which of the following nursing interventions is appropriate? a) Complement the client for weight gain. b) Allow the client to eat at any time. c) Provide privacy when friends visit. d) Schedule regular weigh-in times.

d

A nurse is teaching the parents of a school-age child who has a new prescription for atomoxetine. Which of the following is appropriate to include in the teaching? a) Limit caloric intake to prevent excessive weight gain. b) Avoid crowds due to the increased risk for infection. c) Expect hyperactivity as a common side effect. d) Give the dose in the morning to help prevent insomnia.

d

A preschool child is admitted to the psychiatric unit with the diagnosis of autism. To help the child feel more secure on the unit, which should the nurse include in the plan of care? A) Encourage peer contact. B) Provide a variety of daily activities. C) Cuddle the child several times a day D) Schedule the same nurse to provide care.

c

A preschool child with autism is referred for evaluation. His mother reports he has begun head banging since she returned to full-time employment. She has had difficulty finding adequate and appropriate caregivers for her son. Which is the priority nursing diagnosis? A) Impaired social interaction B) Impaired verbal communication C) Risk for self-mutilation D) Dysfunctional grieving

a, b, c

A psychiatric nurse frequently visits a school-age child with autism and his family. Which behaviors are diagnostic of an autistic disorder? Select all that apply. A) Continuous rocking or swaying B) Intense fascination with moving objects C) Lack of eye contact D) Can parallel play with other children

c

A teenage female client is admitted to the adolescent unit of the psychiatric hospital for observation, diagnosis, and treatment of possible anorexia nervosa. She is 65 inches tall and weighs 85 pounds. On admission, she tells the nurse, "I don't know why my parents admitted me. I'm just trying to lose enough weight to stay on the gymnastic team." Which is the priority nursing diagnosis? A) Anxiety B) Altered growth and development C) Altered nutrition, less than body requirements D) Self-esteem disturbance

c

A young college woman who just discovered the body of her roommate who committed suicide is brought to the emergency department. She is lying on the gurney, curled up in a ball, shaking with anxiety and fear. The nurse interrupts the initial assessment to obtain a blanket and cover the client. Which reflects an appropriate rationale? A) Encouraging reality orientation and focusing on the present. B) Providing a concrete demonstration of caring that promotes trust. C) Providing for one's basic physiological needs. D) Modeling positive behaviors to the client.

a

An adolescent on medication for ADHD has lost 10 pounds in the past 2 months. Which Explanation would the nurse anticipate? A Medications used to treat people with ADHD causes decreased appetite B) Hyperactivity causes excess physical activity, and therefore, increased caloric expenditure. C) Side effects of the medications used to treat people with ADHD include nausea and vomiting. D) Excessive stimulation leads to decreased appetite.

a

Concerning meal times, which intervention is appropriate when the nurse is working with clients with eating disorders? A) Stay with the client during meals, allowing him or her to take as long as needed to consume 90% of the meal. B) Encourage the client to journal about types, consistencies and textures of foods, and nutritional information such as calories, fat grams, and carbohydrate amounts. C) Restrict the client's privileges if he or she does not consume at least 50% of the Meal within 20 minutes. D) Remaining with the client for at least 1 hour after the meal to prevent discarding of stashed food or self-induced vomiting.

c

The distraught parents of an adolescent escort their child to the emergency room because of disrespectful and bizarre behavior. The nurse expects that this behavior is due to a chemical imbalance. Which parts of the nervous system contribute to the alteration of chemicals in the brain? A) Dendrites B) Axons C) Neurotransmitters D) Synapses

a

The mother of an adolescent with conduct disorder says, "Oh, fighting and stealing yeah, he's always been this way. In fact, when he was 8 years old, he was already in trouble with the law." Which factor regarding the adolescent's behavior does the nurse recognize? A) Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood. B) Childhood-onset conduct disorder is caused by a difficult temperament, and the child is likely to outgrow these behaviors by adulthood. C) Childhood-onset conduct disorder is diagnosed only when behaviors emerge before the age of 8 years, so the client is likely to improve. D) Childhood-onset conduct disorder has no treatment or cure, and children with this diagnosis should be removed from society, because they are likely to develop antisocial personality disorder.

b

The physician orders methylphenidate (Ritalin) for a child with the diagnosis of attention deficit hyperactivity disorder. Which teaching should the nurse provide to the parent? A) Double the next dose if one dose is missed. B) Give the medication after the child has breakfast. C) Administer the medication just before going to bed. D) Crush the medication before putting it in applesauce.

b

The treatment team working with a teenage client with anorexia calls for a family meeting. The client's mother inquires of the nurse, "What is it that you want to ask us? My daughter's problem has now become this family's problem. We are tired of dealing with her issues." Which is the appropriate nursing response? A) "Don't be so defensive. Every client is required to participate in two family sessions." B) "Eating disorders have been correlated to certain familial patterns; without addressing these, her disorder is likely to continue." C) "Family dynamics are not at all linked to eating disorders. The meeting is to provide her with love and support." D) "Anorexic individuals cause disruptions in the family system that need to be addressed."

d

What is the purpose for behavioral modification programs designed for clients with eating disorders? A) Ignore the client's maladaptive behaviors B) Focus on adaptive behaviors. C) Provide control to the client D) Control the client's maladaptive behaviors.

c

What rationale explains why inspection of the teeth and gums of a client with bulimia will most likely reveal deterioration? A) Rapid ingestion of food without proper mastication B) Poor dental and oral hygiene C) The high acidity of emesis D) A lack of dietary calcium

a, b, c, d

Which are interventions used in the management of children with ADHD? (Select all that apply.) A) Behavior modification B) Family therapy C) Psychopharmacology D) Group therapy E) Antianxiety medications

a

Which class of medications does the nurse recognize that is effective in the treatment of Tourette's syndrome? A) Neuroleptics B) Antimanics C) Tricyclic antidepressants D) MAOI's (monoamine oxidase inhibitors)

b

Which nursing intervention is important when caring for a mildly retarded child? A) Encourage the parents to concentrate on the child rather than the rest of the family. B) Modify the child's environment to promote independence and impulse control. C) Delay extensive diagnostic studies until the child is older. D) Provide one-on-one tutorial education, and minimize peer interaction.

a

Which nursing intervention related to self-care would be appropriate for a moderately mentally retarded teenager? A) The nurse will provide simple directions and praise the client's efforts to independently perform self-care B) The nurse will perform all of client's self-care to avoid injury to the client. C) To promote autonomy, the nurse will not interfere with the client's self-care regimen. D) To promote bonding, the nurse will encourage family members to perform the client's self-care.