Psych nursing chapter 34 children and adolescent

2. Which nursing diagnosis is universally applicable for children with autism? a. Impaired social interaction related to inability to relate to others. 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.

ANS: A Autistic children display profoundly disturbed social relatedness. They seem aloof and indifferent to others, often preferring inanimate objects to human interaction. Language is often delayed and deviant, further complicating relationship issues. The other nursing diagnoses listed as options might not be appropriate in all cases.

6. What is the priority focused assessment for side effects in a child taking methylphenidate (Ritalin) for ADHD? a. Anorexia and weight loss. b. Dystonia and GI symptoms. c. Bradycardia and weight gain. d. Growth retardation and urinary retention.

ANS: A CNS stimulant therapy might produce side effects such as anorexia, weight loss, mood lability, and agitation. The other options are unrelated to this drug.

13. A child with ADHD will begin medication therapy. The nurse should prepare a plan to teach the family about which classification of medications? a. Central nervous system stimulants b. Tricyclic antidepressants c. Antipsychotics d. Anxiolytics

ANS: A Central nervous system stimulants, such as methylphenidate and pemoline (Cylert), increase blood flow to the brain and have proved helpful in reducing hyperactivity in children and adolescents with attention deficit hyperactivity disorder. The other medication categories listed would not be appropriate.

21. 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 chronic major depression. 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 3 new homes over a 2-year period.

ANS: A Statistics indicate that children raised by a depressed parent have an increased risk of developing an emotional disorder. The chronicity of the parent's depression means it has been a consistent stressor. The other factors are not as risk enhancing

9. Which child has a high risk for suicide and should be monitored closely? A child being treated for: a. depression with fluoxetine (Prozac) b. ADHD with methylphenidate (Ritalin) c. bipolar disorder with aripiprazole (Abilify) d. Asperger's disorder with social skills training

ANS: A The child being treated for depression with Prozac is at risk for behavioral activation, a drug side effect. Increased suicide risk is part of the behavioral activation complex. The drugs mentioned in the other options do not place the individual in the same risk category as Prozac.

14. Soon after parents announced they were divorcing, an adolescent stopped participating in sports, sat alone at lunch, and avoided former friends. The adolescent 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

ANS: A This diagnosis refers to aloneness that the patient perceives negatively, even when self-imposed. Defining characteristics that the teen displays include expressing feelings of being different from others and self-imposed isolation from peers. The other options are not supported by data in the scenario.

1. Which interventions would be therapeutic for a child with ADHD? (Select all that apply.) a. Maintain environmental safety. b. Focus on positive accomplishments. c. Provide a low-stimulus environment. d. Minimize interactive play with peers. e. Reinforce desired behavior with long-term rewards.

ANS: A, B, C Providing a safe environment to minimize injury associated with hyperactivity, reducing stimuli to limit distractibility, and focusing on accomplishments to bolster self-esteem would be appropriate interventions. Peer play should not be discouraged, but rather monitored. Because the attention span of a child with ADHD is short, long-term rewards are less useful than immediate reinforcement.

2. Which behaviors are indicative of bullying? A child: Select all that apply. a. recruits other children to avoid a child who wears glasses. b. consistently calls another child "fat" and "stupid." c. accidentally trips another child, resulting in a fall. d. repeatedly steals another child's lunch money. e. plays a practical joke on another child.

ANS: A, B, D Bullying can be verbal, relational, or physical. It is repetitive and intentionally produces harm or pain on another person. Playful teasing, one-time aggression, and joking do not meet the criteria for bullying.

4. A kindergartener is disruptive to the class. This child is unable to sit for expected lengths of time, inattentive to the teacher, aggressive toward others, and bursts out talking while the teacher is talking. Other children shun this child. The nurse plans interventions designed to: a. provide inpatient treatment for the child. b. reduce loneliness and increase self-esteem. c.improve language and communication skills. d. promote individuation and integration of self-concept.

ANS: B Because of their disruptive behaviors, children with ADHD often receive negative feedback from parents, teachers, and peers, leading to self-esteem disturbance. These same behaviors lead peers to avoid the child with ADHD, who seems reckless and impulsive and can rarely finish games, leaving the child with ADHD vulnerable to loneliness. The other options might or might not be relevant, but are not the priority. The child does not need inpatient treatment at this time.

8. Which finding necessitates immediate nursing action for a child being treated for depression with a selective serotonin reuptake inhibitor (SSRI)? a. Oversedation b. behavioral activation c. Anticholinergic effects d. Extrapyramidal symptoms

ANS: B Behavioral activation, a common side effect of SSRI therapy, is demonstrated by motor restlessness, insomnia, hypomania, and disinhibition. Suicidal thoughts and planning are thought to be associated with behavioral activation, so individuals should be monitored closely as depression lifts. The other drug side effects are associated with typical antipsychotics and TCAs.

20. A 15-year-old is referred to the mental health clinic by juvenile court after multiple instances of running away. The teen tells the nurse, "I hate my parents. They focus all their attention on my sister, who is perfect in their eyes." Which therapy might promote the greatest change in the teen's behavior? a. Cognitive behavioral therapy b. Family therapy c. Play therapy d. Art therapy

ANS: B Family therapy would focus on problematic family relationships and interactions. The patient has identified problems within the family. The teen is too old for play therapy. Art therapy and CBT would not directly address the problem.

24. An adolescent in a residential program threatens to throw a pool ball at another adolescent. Which comment by the nurse would set limits? a. "You will be taken to seclusion if you throw that ball." b. "Do not throw the ball. Put it back on the pool table." c. "Attention everyone: We're all going to the gym." d. "Please do not lose control of your behavior."

ANS: B Setting limits uses clear, sharp statements about which behavior is not allowed and guidance for performing a behavior that is expected. The distracters represent a threat, use of restructuring (which would be inappropriate in this instance), and a direct appeal to the child's developing self-control that may be ineffective.

7. A desired outcome for a 12-year-old with ADHD is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care? a. Reality therapy b. Social skills group c. Response prevention d.insight-oriented group therapy

ANS: B Social skills training teaches the child to recognize the impact of his or her behavior on others. It uses instruction, role playing, and positive reinforcement to enhance social outcomes. The other therapies would have lesser to no impact on peer relationships.

23. A child complains to the school nurse about painful verbal bullying 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. Support 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.

ANS: B The behaviors by the bullying child create emotional pain and present the risk for physical pain. The nurse should first listen to the child's complaints and validate the child for reporting the events. Later, school authorities should be notified. School administrators are the most appropriate personnel to deal with the bullying child. The behavior should not be ignored; it will only get worse.

17. A nurse assesses a 3-year-old child with autistic disorder. Which finding is most associated with the child's disorder? a.Toilet training is complete. b. Inability to identify colors. c. Failure to develop interpersonal skills. d. Anxiety when separated from a parent.

ANS: C Autistic disorder involves distortions in development of social skills and language that include perception, motor movement, attention, and reality testing. Caretakers nearly always mention the child's failure to develop interpersonal skills. The distracters are expected behaviors for a 3-year-old child.

A nurse will prepare teaching materials regarding which drug for the parents of a child with ADHD? a. Paroxetine (Paxil) b. Imipramine (Tofranil) c. Methyphenidate (Ritalin) d. Carbamazepine (Tegretol)

ANS: C CNS stimulants are the drugs of choice for treating children with ADHD. Ritalin and dexedrine are commonly used. None of the other drugs are psychostimulants used to treat ADHD.

3. Which behavior indicates that the treatment plan for a child with autistic disorder has been effective? The child: 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.

ANS: C Holding the hand of another person suggests relatedness. Usually, a child with autism would resist holding someone's hand and stand or walk alone, perhaps flapping arms or moving in a stereotyped pattern. The other options reflect behaviors that are consistent with autistic disorder.

11. A child with ADHD had this nursing diagnosis: impaired social interaction, related to excessive neuronal activity, as evidenced by aggressiveness and dysfunctional play with others. Which finding indicates the plan of care was effective? a. Improved ability to identify anxiety and use self-control strategies b. Increased expressiveness in communication with others c. Engages in cooperative play with other children d. Increased responsiveness to authority figures

ANS: C The goal should be directly related to the defining characteristics of the nursing diagnosis; in this case, improvement in the child's aggressiveness and play. The distracters are more relevant for a child with pervasive developmental disorder or anxiety disorder.

25. Assessment data for a 7-year-old child 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

ANS: C These behaviors are most directly related to impulsivity. Hyperactive behaviors are more physical in nature, such as running, pushing, and the inability to sit. The child's behaviors are broader than simply disobedience. The child does not show evidence of anxiety.

16. A nurse works with a child who is depressed 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 and not keep them internalized.

ANS: C Trust is frequently an issue because the child may question his or her trusting relationship with the parents. In this situation, the trust she once had in her parents has been disrupted, reducing feelings of security. Only the key relates to the therapeutic alliance.

19. A 14-year-old is sent to a residential program after arrests for truancy and assault. At the program, the teen refused to participate in scheduled activities and pushed a staff member, causing a fall. Which strategy by nursing staff is indicated? a. Begin social skills training. b. Coax to gain compliance. c. Neutrally allow refusals. d. Establish firm limits.

ANS: D Firm limits are necessary to ensure physical safety and emotional security. Limit setting will also protect other patients from the teen's thoughtless or aggressive behavior. Permitting refusals to participate in the treatment plan, coaxing, and bargaining are strategies that do not help the patient learn to abide by rules or structure.

1. Which factor presents the most imminent risk for a child to develop a psychiatric disorder? a. Having an uncle with schizophrenia b. Living in a middle-income family c. Being the oldest child in a family d. Living with an alcoholic parent

ANS: D Having a parent with a substance abuse problem has been designated an adverse psychosocial condition that increases the risk of a child developing a psychiatric condition. Being in a middle-income family and being the oldest child are not considered psychosocial adversity. Having a family history of schizophrenia presents a risk, but an alcoholic parent in the family is more imminent.

22. The child most likely to receive risperidone (Risperdal) to manage symptoms is one diagnosed with: a. attention-deficit/hyperactivity disorder. b. posttraumatic stress disorder. c. anxiety disorder. d. autistic disorder.

ANS: D Risperidone (Risperdal) is useful for relieving irritability and labile affect of some autistic children. It is not indicated in any of the other disorders.

15. Soon after parents announced they were divorcing, an adolescent stopped participating in sports, sat alone at lunch, and avoided former friends. The adolescent tells the school nurse, "If my parents loved me, they would work out their problems." Which nursing intervention is most appropriate? a. Develop a plan for new sports activities. b. Monitor the adolescent's academic performance. c. Communicate disbelief relative to the adolescent's feelings. d. Assist the adolescent to realize the parents' love remains intact.

ANS: D The adolescent's perception that love must be proven is unrealistic. The adolescent needs help to acknowledge and realize that the parents love remains intact. Including the parents in the dialogue with the adolescent would be helpful.

18. 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?" Select 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. "Perhaps you should take your child to the mental health center." d. "That's normal. Give your child a kiss before you leave the preschool program."

ANS: D The child demonstrates age-appropriate behavior for a 4-year-old child. The nurse should reassure the parents. The distracters are overreactions.

10. The parent of an 8-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 I am and into trouble." The child's problem is most consistent with DSM-IV-TR criteria for: a. anxiety disorder. b. Asperger's disorder. c. pervasive developmental disorder. d. attention-deficit/hyperactivity disorder.

ANS: D The excessive motion, distractibility, and excessive talkativeness are seen in attention-deficit/hyperactivity disorder (ADHD). The behaviors presented in the scenario do not suggest the other possible choices. Developmental delays would be seen if pervasive developmental disorder or Asperger's disorder were present.

12. In the waiting room, a 5-year-old child with ADHD bounces out of a chair, runs over to another child, and slaps the other child. What is the nurse's best action? a. Direct the aggressive child to stop immediately. b. Call for emergency assistance from other staff. c.Instruct the parents to take the child home. d. Take the child to another waiting area.

ANS: D The nurse should manage the milieu with structure and limit setting. Removing the aggressive child to another waiting area is an appropriate consequence for the aggressiveness. Directing the child to stop will not be effective. This is not an emergency situation. Intervention is needed rather than sending the child away.