NURSING CARE OF CLIENTS WITH DISORDERS USUALLY FIRST EVIDENT IN INFANCY, CHILDHOOD, OR ADOLESCENCE

The mother of a boy with a tentative diagnosis of attention deficit hyperactivity disorder (ADHD) arrives at the pediatric clinic insisting that the doctor give her a prescription for medication that will control his behavior. The nurse's best response is: 1. "It must be so frustrating to deal with your son's behaviors." 2. "Have you considered any alternative to using medication?" 3. "Perhaps you are looking for an easy solution to the problem." 4. "Are you aware of the side effects of medications used for ADHD?"

1. "It must be so frustrating to deal with your son's behaviors." This response acknowledges the mother's distress and encourages her to verbalize her feelings.

The nurse teaches that the signs of autism initially may be evident when the child is about: 1. 2 years of age 2. 6 years of age 3. 6 months of age 4. 1 to 3 months of age

1. 2 years of age By 2 years of age the child should demonstrate an interest in others, communicate verbally, and possess the ability to learn from the environment. Before these skills develop, autism is difficult to diagnose. Usually by 3 years the signs of autism become more profound.

A 6-year-old girl with autism is nonverbal and has limited eye contact. What should the nurse do initially to promote social interaction? 1. Engage in parallel play while sitting next to the child 2. Encourage the chid to vocalize through sound games and songs 3. Provide play opportunities for the child to play with other children 4. Use therapeutic holding when the child does not respond to verbal interactions

1. Engage in parallel play while sitting next to the child Entering the child's world in a nonthreatening way helps to promote trust and eventual interaction with the nurse.

A 4-year-old is diagnosed with attention deficit hyperactivity disorder. when obtaining a history from the parents, what information about the child should the nurse expect? Select all that apply. 1. Is impulsive 2. Talks excessively 3. Is spiteful and vindictive 4. Annoys others deliberately 5. Plays video games for hours 6. Does not follow through or finish tasks

1. Is impulsive Impulsivity, the inability to limit or control words or actions, results in spontaneous, irresponsible verbalizations or behaviors. 2. Talks excessively Hyperactivity occurs with both words and actions. 5. Plays video games for hours Games that are fun, engaging, and interactive often maintain the four of the child with attention deficit hyperactivity disorder. 6. Does not follow through or finish tasks Inattention and distractibility results in an inability to focus long enough to complete tasks.

For which clinical indication should the nurse observe the child suspected of being autistic? 1. Not wanting to eat 2. Crying for attention 3. Catatonic-like rigidity 4. Enjoying being with people

1. Not wanting to eat From infancy the child is non responsive. Not wanting to eat demonstrates a further withdrawal.

The nurse understands that one of the major behaviors characteristics of children with attention deficit disorder is their: 1. Overreaction to stimuli 2. Continued use of rituals 3. Delayed speech development 4. Inability to use abstract thoughts

1. Overreaction to stimuli A practically universal characteristic of these children is distractibility. They are highly reactive to any extraneous stimuli, such as noise and movement, and are unable to inhibit their responses to such stimuli.

The nurse is caring for a preschool-age child with a history of physical and sexual abuse. What is the most advantageous therapy for this child? 1. Play 2. Group 3. Family 4. Psychodrama

1. Play It is the most effective method for the child to play out feelings; when feelings are allowed to surface, the child can then learn to face them by controlling, accepting, or abandoning them.

A 16-year-old male adolescent, with the diagnosis of conduct disorder since the age of 10, is place in a residential facility because the parents can no longer manage his behavior. He has a history of fighting, stealing, vandalizing property, and running away from home. He is aggressive, has no friends, and has been suspended form school repeatedly. When developing a plan of care for this client, what should be the nurse's priority? 1. Preventing violence 2. Supporting self-esteem 3. Limiting defensive coping 4. Promoting social interaction

1. Preventing violence Clients with conduct disorder are at risk for physically, emotionally, or sexually harming themselves or others; safety of the client and others is the priority.

The nurse understands that the childhood problem that has legal as well as emotional aspects and cannot be ignored is: 1. School phobias 2. Fear of animals 3. Fear of monsters 4. Sleep disturbances

1. School phobias School phobias is a symptom that cannot legally be ignored for long because children must attend school. It requires intervention to alleviate the separation anxiety and/or to promote the child's increasing independence.

The nurse is working with school-age children who have the diagnosis of conduct disorder, childhood-onset type. The nurse understands that these children are at risk for having their conduct disorder progress to an additional disorder during adolescence; therefore in the future the nurse should assess these clients for signs of: 1. Oppositional defiant disorder 2. Antisocial personality disorder 3. Pervasive developmental disorder 4. Attention deficit hyperactivity disorder

2. Antisocial personality disorder Children who exhibit behaviors associated with conduct disorder before the age of 10, rather than during adolescence, have a higher incidence of developing antisocial personality disorder during adolescence.

An 8-year-old body is diagnosed with oppositional defiant disorder. When the nurse assesses the child, the behavior that support this diagnosis is the fact that the boy: 1. Is easily distracted 2. Argues with adults 3. Lies to obtain favors 4. Initiates physical fights

2. Argues with adults Oppositional defiant isorder is a repeated pattern of negativistic, disobedient, hostile, defiant behavior toward authority figures usually exhibited before 8 years of age.

A client with the diagnosis of Tourette's syndrome has demonstrated a combination of motor tics and involuntary vocal utterances. When the client engages in verbal utterances that are often obscene, the nurse understands that this behavior is known as: 1. Palilalia 2. Coprolalia 3. Echokinesis 4. Agoraphobia

2. Coprolalia Coprolalia is the use of involuntary vocalizations that are often obscene, socially unacceptable, or profane.

The nurse teaches that autism is a form of a pervasive developmental disorder (PDD) that can be differentiated from other forms of PDD in that autism: 1. Has less severe linguistic handicaps 2. Has an early onset before 36 months of age 3. Is the only form that does not include seizures 4. Is the only form that does not include mental retardation

2. Has an early onset before 36 months of age Autism impairs bonding and communication and therefore becomes apparent early in life.

The physician orders methylphenidate (Ritalin) once a day for a child with attention deficit hyperactivity disorder. The nurse should teach the parents to administer the daily dose: 1. Before breakfast 2. Just after breakfast 3. Immediately before lunch 4. As soon as the child awakens

2. Just after breakfast Ritalin is an appetite suppressant; it should be given after meals.

The nurse is caring or a child with school phobia. The nurse teaches the parents that the best treatment is to: 1. Accompany the child to the classroom 2. Return the child to school immediately 3. Explain why attendance at school is necessary 4. Allow the child to enter the classroom before other children

2. Return the child to school immediately The longer these children stay out, the more difficult it is to get them to return to school because more fantasies and fears develop.

A child is diagnosed with attention deficit hyperactivity disorder (ADHD). The nurse teaches the parents strategies to assist their child to cope with this disorder. These strategies should include: 1. Orienting the child to reality 2. Rewarding appropriate conduct 3. Suppressing feelings of frustration 4. Using restraint when behavior is out of control

2. Rewarding appropriate conduct External rewards can motivate as well as increase self-esteem.

When planning care fora group of children, the nurse understands that the problem of separation anxiety becomes most problematic for children hospitalized during the age of: 1. 5 to 11 1/2 years 2. 12 to 18 years 3. 6 to 30 months 4. 36 to 59 months

3. 6 to 30 months Infants and toddlers 6 to 30 months of age experience separation anxiety; it is this age-group's major stressor and is most traumatic to the child and parent.

A 3-year-old child is diagnosed with autism. Which should the nurse expect when assessing this child? Select all that apply. 1. Imitates others 2. Seeks physical contact 3. Avoids eye-to-eye contact 4. Engages in cooperative play 5. Performs repetitive activities 6. Displays interest in children rather than adults

3. Avoids eye-to-eye contact Impairments in social interaction are manifested by a lack of eye contact, a lack of facial responses, and a lack of responsiveness to and interest in others. 5. Performs repetitive activities Children with autism display obsessive ritualistic behaviors, such as rocking, spinning, dipping, swaying, walking on toes, head banging, or hand biting, because of their self-absorption and need to stimulate themselves.

The nurse is caring for an adolescent with the diagnosis of conduct disorder who is receiving behavioral therapy to attempt to limit activities that violate societal norms. A specific outcome criterion unique for adolescents with this problem is, "The client will: 1. Exhibit increased impulse control." 2. Identify two positive personal attributes." 3. Demonstrate respect for the rights of others." 4. Use age-appropriate play activities with at least one peer."

3. Demonstrate respect for the rights of others." This outcome is specific for children with a risk for violence directed at others; children with the diagnosis of conduct disorder typical present with a repetitive and persistent pattern of behavior that violates the basic rights of others or major age-appropriate societal norms or rules.

The nurse understands that children with attention deficit hyperactivity disorder may be learning-disabled. This means that these children: 1. Will probably not be self-sufficient as adults 2. Have intellectual deficits that interfere with learning 3. Experience perceptual difficulties that interfere with learning 4. Are performing usually two grade levels below their age norm

3. Experience perceptual difficulties that interfere with learning This disorder interferes with the ability to perceive and respond to sensory stimuli, which causes a deficit in interpreting new sensory data, makes learning difficult, and results in learning disabilities.

The nurse uses behavior modification to foster toilet training efforts in a cognitively impaired child. What reward should the nurse provide to reinforce appropriate use of the toilet by the child? 1. Candy bar 2. Piece of fruit 3. Hug with praise 4. Choice of reward

3. Hug with praise Secondary reinforcers involve the use of social approval; behaviors such as a hug meet this requirement.

The nurse teaches parents of a child with attention deficit hyperactivity disorder (ADHD) that ADHD usually is treated with: 1. Lorazepam (Ativan) 2. Haloperidol (Haldol) 3. Methylphenidate (Ritalin) 4. Methocarbamol (Robaxin)

3. Methylphenidate (Ritalin) Ritalin appears to act by stimulating release of norepinephrine from nerve endings in the brainstem.

A 10-year-old boy, who was diagnosed with autism at the age of 3, attends a school for developmentally disable children and lives with his parents. He has frequent episodes of biting his arms and banging his head and needs help with feeding and toileting. The priority nursing goal for this child is, "The child will: 1. Be able feed himself." 2. Control repetitive behaviors." 3. Remain safe from self-inflicted injury." 4. Develop control of urinary elimination."

3. Remain safe from self-inflicted injury." The priority is safety; the child must be protected form self-harm.

The nurse knows that most common characteristic of autistic children is that they: 1. Respond to any stimulus 2. Respond to physical contact 3. Seem unresponsive to the environment 4. Are totally involved with the environment

3. Seem unresponsive to the environment Poor interpersonal relationships, inappropriate behavior, and learning disabilities prevent the children from emotionally adapting or responding to the environment despite a possible high level of intelligence.

A hyperactive 9-year-old child, with a history of attention deficit hyperactivity disorder, is admitted for observation after a motor vehicle accident. What should be the focus of nursing actions to meet the goal of personal safety? 1. Requesting the child write at least three safety rules 2. Asking the child to verbalize as many safety rules a possible 3. Talking with the child about the importance of using a seat belt 4. Encouraging the child to talk with other children about their opinions of the safety rules

3. Talking with the child about the importance of using a seat belt Focusing on specifics is important for children who are easily distracted.

A child with the diagnosis of attention deficit hyperactivity disorder often becomes frustrated and loses control. The nurse should use a variety of graduated techniques to manage disruptive behaviors. List the numbers of the following interventions in order from the lest invasive technique to the most invasive technique. 1. Place the child in time-out 2. Monitor behavior for use of rising anxiety 3. Use a signal to remind the child to use self-control 4. Avoid situations that usually precipitate frustration

4,2,3,1

When planning activities for a child with autism, the nurse must remember that autistic children respond best to: 1. Large-group activity 2. Loud, cheerful music 3. Individuals in small groups 4. Their own self-stimulating acts

4. Their own self-stimulating acts Autistic behavior turns inwards. These children do not respond to the environment but attempt to maintain emotional equilibrium by rubbing and manipulating themselves and displaying a compulsive need for behavioral repetition.

What is the prognosis for a normal productive life for a child diagnosed with autism? 1. Dependent on an early diagnosis 2. Often related to the child's overall temperament 3. Emphasized with the parents regardless of child's level of functioning 4. Unlikely because of interference with so many parameters of functioning

4. Unlikely because of interference with so many parameters of functioning Research studies have show that the prognosis for normal productive functioning in autistic people is guarded, particularly if there are delays in language development.