Prep U Ch 37

Abnormal transmission of which neurotransmitter is thought to play a part in tic disorders? Dopamine Noradrenaline Acetylcholine Serotonin

Dopamine

A child is diagnosed with attention deficit hyperactivity disorder and is to receive pharmacologic therapy. Which of the following would the nurse expect to be prescribed as a first line agent? Clonidine Bupropion Guanfacine Atomoxetine

Atomoxetine

A psychiatric-mental health nurse is teaching a parent of a child diagnosed with conduct disorder. Which statement made by the parent indicates a need for further teaching? "I will suppress my problems and not burden others with what I am going through." "I will not try to rescue my child." "I will enforce effective limit-setting techniques." "I will implement age-appropriate activities and expectations."

"I will suppress my problems and not burden others with what I am going through."

The nurse is educating a pregnant client about prenatal care and the potential for decreasing the risk for conduct disorder. The client presently has a child with a conduct disorder and is concerned that this will happen again. Which statement made by the client indicates further education is required? "As long as I only have a beer or two a couple of times a week, my unborn child will be ok." "Prenatal care is important and I will attend all of my visits routinely." "I should be sure to be adherent to my prescribed prenatal vitamins and folic acid." "There are several factors that are involved for a child to develop a conduct disorder."

"As long as I only have a beer or two a couple of times a week, my unborn child will be ok."

Parents of a child are concerned about the child being completely obsessed with action figures to the point that it interferes with all activities of daily living. Which is the best response by the nurse? "The child is just mimicking what is seen by other siblings." "Can you clarify for me what your concern regarding this behavior is?" "This is normal behavior that will soon be outgrown." "Have there been any recent changes affecting the family?"

"Can you clarify for me what your concern regarding this behavior is?" (the nurse needs to obtain specific information to be able to quantify the reported issue)

A 10-year-old client diagnosed with conduct disorder is currently in the stabilization phase of care. Which client outcome would be appropriate in the stabilization phase? "Learn problem-solving process within 2 to 3 days." "Verbalize feelings within 2 to 3 days." "Demonstrate development of relationships with peers." "Demonstrate effective problem-solving and coping skills."

"Demonstrate effective problem-solving and coping skills."

The nurse is talking with an adolescent client who has been externalizing behaviors indicating a conduct disorder. Which client statement(s) indicate that externalizing behaviors are being experienced? "I set fire to a trash can on school property when I threw my cigarette in it." "My stomach hurts and I feel nauseated all of the time." "I'm always tired and sleepy. Just don't feel like going anywhere or doing things." "When I get dropped off at school, I skip and go drink with my friends." "I got caught cheating on an exam. I cheat all of the time, why should I study?"

"I set fire to a trash can on school property when I threw my cigarette in it." "When I get dropped off at school, I skip and go drink with my friends." "I got caught cheating on an exam. I cheat all of the time, why should I study?" (Externalizing behavior is demonstrated by an outward show of abnormal actions by the adolescent.)

The parent of an adolescent diagnosed with Tourette disorder shares with the nurse that the tics have gotten more frequent with longer duration since the child has started elementary school. The parent asks that the dose of the prescribed antipsychotic medication be increased to help manage the tics more effectively. What response should the nurse provide to address the parent's concern? "Increasing the dose will most likely result in the lessening of the therapeutic effectiveness." "Increasing the medication will trigger some very serious cardiac focused side effects." "Maybe it is time to discontinue the original medication and prescribe something new." "It sounds as if we need to introduce some form of stress management techniques."

"Increasing the dose will most likely result in the lessening of the therapeutic effectiveness."

The nurse is performing a family assessment to determine why an adolescent is engaging in risky behaviors. The parent states, "I just don't understand why my child would want to drink alcohol when my spouse is an alcoholic and has had several DUI's as well as being abusive to the children and I." Which is the best response by the nurse? -"You never know what type of things children will pick up. You have to be the best parent for you and your spouse." -"I realize this is unusual behavior because you would think the child would not want to repeat those behaviors." -"Parents that engage in risky behaviors are more likely to have children that engage in these behaviors." -"If the spouse doesn't know right from wrong, how can you expect the child to behave any differently?"

"Parents that engage in risky behaviors are more likely to have children that engage in these behaviors."

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? -"I can meet with your child individually at the school counseling office." -"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."

"Please tell me more about what you are having difficulty with."

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? -"Sometimes I feel like I'm so sleepy." -"I'm eating about the same amount as before." -"My muscles seem pretty flexible lately." -"I think I'm much more alert with this drug."

"Sometimes I feel like I'm so sleepy."

When teaching the parents of a child with attention deficit hyperactivity disorder (ADHD), which of the following statements by the parents would indicate the need for further teaching? -"We'll have him do his homework at the kitchen table with his brothers and sisters." -"We'll make sure he completes one task before going on to another." -"We'll set up rules with specific times for eating, sleeping, and playing." -"We'll use simple, clear directions and instructions."

"We'll have him do his homework at the kitchen table with his brothers and sisters."

Which statement, made by the parent of a teen diagnosed with conduct disorder, demonstrates effective parenting? "When are you going to learn that bullying is not acceptable behavior?" "Do you understand that you hurt your sister's feelings when you call her names?" "You will lose your driving privileges for a week if you don't clean your room today." "A person your age knows better than to skip school."

"You will lose your driving privileges for a week if you don't clean your room today." (While the other options express appropriate parental emotions, they do not address parenting strategies that will effectively address the teen's behavior.)

Assessment of an 8-year-old client reveals communication difficulties and an inability to manage age-appropriate tasks. The child undergoes standardized testing. An intelligent quotient (IQ) of which would support a diagnosis of intellectual disability? -65 -85 -95 -75

-65

A nurse working with an adolescent client diagnosed with disruptive behavior disorder is developing a plan of care to improve outcomes. Which nursing action best supports the use of problem-solving therapy? -Focus on the written understanding of words and their meanings. -Consider alternative approaches based on their individual merits. -Provide the client with a checklist for comparison of decisions. -Tell the client that one should wait 24 hours before making any choice.

-Consider alternative approaches based on their individual merits.

The parents of a toddler are distraught that he has been diagnosed with autism spectrum disorder. When providing teaching for the child's parents, which of the following would the nurse need to bear in mind about the etiology of this disorder? -Lower levels of mercury are associated with this disorder. -Lower levels of lead have been found to be linked to autism spectrum disorder -Higher levels of antioxidants have been found in individuals with this disorder -Expression of multiple genes involved with neurogenesis seem to play a role.

-Expression of multiple genes involved with neurogenesis seem to play a role.

Which of the following disorders involves problems with forming sounds associated with speech? -Stuttering -Expressive language disorder -Phonologic disorder -Mixed receptive-expressive language disorder

-Phonologic disorder (Phonologic disorder involves problems with articulation)

The nurse is assessing an adolescent client. The parent is in the room and answers most of the questions, even though the questions are directed at the client. Which action(s) from the parents of a child with conduct disorders does the nurse identify may be a contributing factor to the behaviors? Select all that apply. -The parents make reasonable curfews that are age appropriate. -The parents establish household responsibilities that are age appropriate. -The parents may not behave appropriately because of a lack of knowledge. -The parents engage in yelling at, hitting, or simply ignoring the behavior of the child. -The parents blame the school when the child causes a disturbance in school.

-The parents may not behave appropriately because of a lack of knowledge. -The parents engage in yelling at, hitting, or simply ignoring the behavior of the child. -The parents blame the school when the child causes a disturbance in school.

A 13-year-old client is being assessed by the psychiatric-mental health nurse. Upon assessment, the client reveals that they believe that the world is aggressive and threatening and they respond likewise. Which aspect of the assessment would the nurse document the findings in the medical record? -general appearance and motor behavior -mood and affect -self-concept -thought process and content

-thought process and content

The nurse is caring for a child with a neurodevelopmental disorder. Which action will the nurse perform to assist the child with achieving developemental stages? Encouraging strict disciplinary actions for temper tantrums Building on the child's strengths instead of focusing on areas for improvement Avoiding the use of visual cues Maintaining an environment that allows for free expression

Building on the child's strengths instead of focusing on areas for improvement (building on their strengths and using positive reinforcement are very important. If they feel that they are constantly criticized or need "fixing," their self-esteem will be eroded, and they will be unlikely to cooperate and learn)

Brain images of people with ADHD have suggested decreased metabolism in which of the following cerebral lobes? · Temporal · Occipital · Parietal · Frontal

Frontal (Brain images of people with ADHD have suggested decreased metabolism in the frontal lobes, which are essential for attention, impulse control, organization, and sustained goal-directed activity.)

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? -Genetic syndromes -Exposure to hazardous chemicals -Environment -Perinatal complications

Genetic syndromes

The parents of a child with attention-deficit/hyperactivity disorder (ADHD) express to the nurse, "We get so frustrated when our child never listens to us." Which parenting strategies will the nurse discuss with the parents? Select all that apply. -Give verbal reprimands for negative behavior. -Use appropriate time-out strategies for behavior control. -Provide occasional rewards and consequences for behavior. -Resist giving praise until fully compliant with requests. -Use a point system for positive and negative behavior.

Give verbal reprimands for negative behavior. Use appropriate time-out strategies for behavior control. Use a point system for positive and negative behavior.

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 Inattention Hyperactivity

Language difficulty

Parents bring their child to the clinic and state to the nurse, "We just don't know what to do anymore. It must be a medical disorder because our child has never been in trouble or acted this way. They are lying, stealing, and destroying property." Which is likely to be the most effective intervention for this adolescent? Prevention and early intervention Parenteral education about discipline Placing the child in a "boot camp" Incarceration into the penal system

Prevention and early intervention

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 are a form of aversion therapy in which the child becomes uncomfortable with overstimulation. Brain stimulation is inversely proportionate to motor stimulation. Controlled, medication-induced stimulation helps children become more comfortable and functional during times of high stimulation. Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior.

Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior.

The nurse is working with clients who have disruptive behavior disorders. Which are important point(s) for the nurse to consider when working with these clients and their families? Select all that apply. Remember to focus on the client's strengths and assets, as well as their problems. Most behavior disorders are caused by being raised by parents who had behavior disorders in their own childhoods. Transient conduct disorders are common in all children. Avoid a "blaming" attitude toward clients and/or families. Focus on positive actions to improve situations and/or behaviors.

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.

A child with an existing diagnosis of attention deficit hyperactivity disorder shows signs and symptoms of depression. Which would most likely be prescribed? Monoamine oxidase inhibitor Tricylic antidepressant Mood stabilizer Selective serotonin and norepinephrine reuptake inhibitor (SSNRI)

Selective serotonin and norepinephrine reuptake inhibitor (SSNRI) (Selective serotonin and norepinephrine reuptake inhibitor (SSNRI))

A 15-year-old boy being treated for depression will most likely be given which of the following first-line pharmacologic treatments? -Benzodiazepines -Serotonin reuptake inhibitors -Monoamine oxidase inhibitors -Tricyclic antidepressants

Serotonin reuptake inhibitors

A 7-year-old client experiences tics, which have become increasingly frequent in recent months. How should the nurse educate the client's teacher to respond to the tics? Place the client in a private, low-stimulation environment whenever possible to prevent the client's tics. Set firm limits about where, when, and how the client exhibits the tics. Teach the client's classmates that the tics are not something that the client can control. Provide rewards when the client goes long periods without having any tics.

Teach the client's classmates that the tics are not something that the client can control.

A child has been prescribed methylphenidate for treatment of attention deficit hyperactivity disorder (ADHD). Which observation is indicative to the nurse that a potential problem exists? -The child experiences weight gain of 2 pounds (0.9 kg) in one month. -The child is taking the medication three times a day in divided dosages. -The child reports eyes feeling tired. -The child reports dry mouth.

The child reports eyes feeling tired (The child reporting eyes feel tired is a concern because glaucoma can be a contraindication to therapy)

The client is 6-year-old who has been diagnosed with autism spectrum disorder. Which symptom would the client display? 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 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.

A nurse is developing the plan of care for a 6-year-old child diagnosed with attention deficit hyperactive disorder (ADHD). The nurse identifies interventions to address which behavior issues? Select all that apply. Throws a temper tantrum when asked to clean up toys Has a habit of not waiting for a turn Does not acknowledge others' right to select group activities Gently asks a peer to share a particular toy Frequently acts out during class "quiet time"

Throws a temper tantrum when asked to clean up toys Has a habit of not waiting for a turn Does not acknowledge others' right to select group activities Frequently acts out during class "quiet time"

When a client repeatedly vocalizes an obscene phrase and imitates the motions of a staff member, the nurse documents that the client is most likely exhibiting symptoms of what disorder? Autism spectrum disorder Mixed receptive-expressive language disorder Phonological disorder Tourette's syndrome

Tourette's syndrome

Genetics can play a role in the development of a childhood psychiatric disorder. When assessing a child, which disorder would the nurse identify as having a genetic component? bulimia sociopathy depression attention-deficit hyperactivity disorder

attention-deficit hyperactivity disorder

A nurse is assessing a child with a communication disorder. The nurse would anticipate a problem involving: a head injury. overprotective parents. lack of play therapy opportunities. decreased social interaction.

decreased social interaction.

A school nurse is caring for a child who has demonstrated a significantly lower-than-average score for mental age on standardized tests in reading. However, the child's IQ scores were within the average range. The nurse interprets this information as suggesting which condition(s)? Select all that apply. dyslexia Tourette syndrome Asperger syndrome communication disorder attention deficit hyperactivity disorder

dyslexia

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? -providing client education -improving coping skills and self-esteem -increasing treatment compliance -promoting social interaction

improving coping skills and self-esteem

A child with attention deficit hyperactivity disorder is taking methylphenidate in divided doses. If the child takes the first dose at 0800. Which behavior might the school nurse expect to see at noon? sleepiness or drowsiness lack of appetite for lunch social isolation from peers increased impulsivity or hyperactive behavior

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.)

A pediatric client has a history of repeated, intentional fire-setting behaviors. Which diagnosis should the client be assessed for? pyromania kleptomania intermittent explosive disorder (IED) oppositional defiant disorder (ODD)

pyromania

Which of the following statements 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 Ritalin will eliminate the problems of ADHD." · "We'll be sure to record his weight on a weekly basis." · "We'll be sure he takes the Ritalin at the same time every day, just before bedtime." · "We'll teach him the proper way to take the medication so he can manage it independently."

· "We'll be sure to record his weight on a weekly basis."

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. · Appetite suppression · Weight gain · Weight loss · Insomnia · Hypotension

· Appetite suppression · Weight loss · Insomnia

Parents of a child who has behavioral problems ask the nurse which is the most effective way to deal with these behaviors and prevent them in their other children. Which is the best response by the nurse? · Being overprotective of the child · Adopting more of a relaxed limit setting strategy · Attending group-based parenting classes · Administering medications

· Attending group-based parenting classes

A child is diagnosed with autism spectrum disorder and is experiencing significant irritability. Which medication would the nurse expect to be prescribed to address this issue? · Atypical antipsychotics · Mood stabilizers · Antidepressants · Anticonvulsants

· Atypical antipsychotics

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? · Attention-deficit/hyperactivity disorder · Asperger syndrome · Conduct disorder · Oppositional defiant disorder

· Conduct disorder

Which aspect of managing a child with attention deficit hyperactivity disorder (ADHD) may often be overlooked in the treatment plan? · Effects on parents' coping styles · Effects on school performance · Effects on siblings · Effects on the marriage

· Effects on siblings

When developing the plan of care for the family of a child with a neurodevelopmental disorder, which of the following would be least appropriate to include? · Assisting the family in resolving their sense of loss · Helping to coordinate support systems for the family. · Excluding the parents from being included in the plan of care · Modeling appropriate behavior modification techniques

· Excluding the parents from being included in the plan of care

After completing the assessment of a boy age 9 years with attention-deficit hyperactivity disorder (ADHD), the nurse documents the findings. Which finding would the nurse document as reflecting the child's hyperactivity? Select all that apply. · Fidgeting · Hyperalertness · Inability to wait his turn · Restlessness · Easy distractibility

· Fidgeting · Hyperalertness · Restlessness

When assisting the parents of a child diagnosed with ADHD, which of the following would the nurse suggest? Select all that apply. · Let him work on several things at once · Maintain a calm environment · Provide extensive explanations · Keep to regular routines · Set clear limits with consequences

· Keep to regular routines · Set clear limits with consequences · Maintain a calm environment

A nurse is providing care to a child with a reading disability. When explaining to the parents about the underlying issue involved, which structure would the nurse integrate into the explanation? · Left hemisphere of the brain · Optic nerve · Cerebellum · Medulla

· Left hemisphere of the brain

ADHD is characterized by inattentiveness, overactivity, and impulsiveness. Which of the following would the nurse identify related to inattentiveness? · Missing details · Talking excessively · Fidgeting · Interrupting

· Missing details

After teaching a group of students about medications used to treat ADHD, the instructor determines that the education was successful when the group identifies atomoxetine as which of the following? · Alpha-agonist · Stimulant · Noradrenergic reuptake inhibitor · Antipsychotic

· Noradrenergic reuptake inhibitor

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 · Girls are more frequently affected than boys · Connection to ineffective parental practices · Detection after the child enters school

· Onset before child is 2.5 years old

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 · Listen to the parents feelings and frustrations · Having a playroom with climbing structures and rolling chairs

· Providing a structured, routine environment

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 oppositional defiant disorder. · The child has a school phobia. · The child has a developmental disorder. · The child has ADHD.

· The child has a school phobia.

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. · Approximately 20% of children with conduct disorder become antisocial adults. · Untreated mental illness in childhood often results in long-term mental illness in adults.

· Untreated mental illness in childhood often results in long-term mental illness in adults.