Attention-Deficit/Hyperactivity Disorder, Mod 25a

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Which intervention should the nurse include in the plan of care for a young client with​ attention-deficit/hyperactivity disorder​ (ADHD)? (Select all that​ apply.) A. Encouraging therapeutic play B. Using​ time-outs C. Promoting​ self-esteem D. Varying consequences for negative behaviors E. Increasing environmental stimulation

Encouraging therapeutic play Using​ time-outs Promoting​ self-esteem Rationale: Encouraging therapeutic​ play, using​ time-outs, and promoting​ self-esteem are all appropriate nursing interventions for the young client with ADHD. Environmental stimulation should be​ minimized, not​ increased, and consequences for negative behaviors should be​ consistent, not varied.

The nurse is teaching a group of parents about​ attention-deficit/hyperactivity disorder​ (ADHD). Which psychosocial history consideration should the nurse include when addressing this​ group? (Select all that​ apply.) A. Excessive talking B. Viewed as overachiever C. High​ self-esteem D. Interrupts others E. Ostracized by peer group

Excessive talking Interrupts others Ostracized by peer group ​Rationale: Hyperactivity,​ impulsivity, and inattentiveness in the client with ADHD often manifest as excessive talking and interruption of others. Because of these disruptive​ behaviors, clients with ADHD are also often ostracized by their peer group and have low​ self-esteem. ADHD can cause difficulty at school and​ work, so clients are often viewed as​ underachievers, not overachievers.

The parents of a young client newly diagnosed with​ attention-deficit/hyperactivity disorder​ (ADHD) are concerned about the school environment and the​ child's grades. Which suggestion should the nurse encourage the parents to discuss with the​ child's teacher?​ (Select all that​ apply.) A. Provide a quiet area for examinations and extra time if necessary. B. ​Don't allow the child to do special tasks or run errands without supervision. C. Place the child in the front of the classroom close to the teacher. D. Place the child in the back of the classroom. E. Remind the child to pay attention in front of the class.

Provide a quiet area for examinations and extra time if necessary. Place the child in the front of the classroom close to the teacher. Rationale: The child should be placed in the front of the​ classroom, not in the back of the classroom. A quiet area to take examinations and additional time if necessary would be encouraged. The child should not be called out in front of the class. The child should be allowed to do special tasks or run​ errands, within​ reason, to provide additional opportunities for movement.

The school nurse is helping to create an individualized education plan​ (IEP) for a young client with​ attention-deficit/hyperactivity disorder​ (ADHD). Which behavioral goal should the nurse include in the plan of​ care? A. The client will accurately manage medication administration. B. The client will respect the boundaries of others. C. The client will demonstrate a decrease in attentiveness. D. The client will achieve school performance to minimum competency.

The client will respect the boundaries of others. ​Rationale: An appropriate behavioral goal for the client with ADHD is respecting the boundaries of others. Because the client is a​ child, it is not appropriate to expect the client to manage medication administration. The client should demonstrate an​ increase, not​ decrease, in attentiveness. An appropriate goal is for the client to achieve school performance to maximum​ potential, not merely minimum competency.

Which characteristic is typically seen less in​ girls, when compared with​ boys, having​ attention-deficit/hyperactivity disorder​ (ADHD)? A. Impulsiveness B. Cognitive problems C. Anxiety D. Mood swings

impulsiveness ​Rationale: Girls with ADHD typically show less aggression and impulsiveness than boys. Girls tend to show more​ anxiety, mood​ swings, social​ withdrawal, rejection, and cognitive and language problems.

The parents of a​ school-age child newly diagnosed with​ attention-deficit/hyperactivity disorder​ (ADHD) ask why the child needs a physical in addition to examinations made at home and at school. Which response should the nurse​ make? A. ​"We need to rule out neurologic diseases and other health problems in your child that may affect treatment of​ ADHD." B. ​"We need to see whether your child has the physical characteristics that go along with the behaviors of ADHD to correctly diagnose​ ADHD." C. ​"The healthcare provider will be able to give you better strategies for helping your child focus at home and at​ school." D. ​"The physical exam will allow the healthcare provider to explore the possibility of other mental health​ issues, such as​ depression, anxiety, learning​ disorder, or conduct disorder your child may​ have."

​"We need to rule out neurologic diseases and other health problems in your child that may affect treatment of​ ADHD." Rationale: A physical examination will rule out neurologic diseases and other health problems that may mimic ADHD or affect its treatment. There are no physical characteristics of ADHD that can be found with a physical exam. ADHD is diagnosed from a careful psychosocial history and questionnaires. The nurse is equally as qualified as the healthcare provider to provide strategies to help the client focus. A mental health specialist diagnoses other mental health issues using interviews and​ questionnaires, not a physical exam.

An adult client with​ attention-deficit/hyperactivity disorder​ (ADHD) is being prescribed medication. About which medication should the nurse prepare teaching for this​ client? A. Guanfacine​ (Intuniv) B. Atomoxetine​ (Strattera) C. Dextroamphetamine​ (Adderall) D. Methylphenidate​ (Ritalin)

​Atomoxetine​ (Strattera) Rationale: The nonstimulant medication atomoxetine​ (Strattera) is used for children over age 6​ years, adolescents, and adults to control the symptoms of ADHD. Stimulants like dextroamphetamine and methylphenidate are approved for use in​ adults; however, there is a higher risk of adverse effects on the cardiovascular system. There is no information about guanfacine use in adults.

A parents group asks the nurse what they should look for if they suspect their​ school-age child has ​ attention-deficit/hyperactivity disorder​ (ADHD). Which observation should the nurse instruct the parents to report to their​ child's healthcare provider​ (HCP) for further​ assessment? (Select all that​ apply.) A. Excessive motor activity B. Deliberately destroying other​ people's property C. Inability to stay on an assigned task to completion D. Having difficulty with learning at school E. Limited attention span when speaking with parent

​Excessive motor activity Inability to stay on an assigned task to completion Having difficulty with learning at school Limited attention span when speaking with parent Rationale: The required findings for a diagnosis of ADHD are limited attention​ span, an inability to stay on an assigned​ task, and excessive motor activity with the inability to sit still for more than a few minutes. Clients with ADHD are frequently labeled as poor achievers with difficulty learning. While many of the behaviors of ADHD in adolescence and adulthood could be considered​ antisocial, such as destruction of​ property, this type of behavior would be less likely to occur in a younger child. Both children and adolescents with ADHD sometimes struggle with making and maintaining friends.

The nurse is teaching the parents of a very young client newly diagnosed with​ attention-deficit/hyperactivity disorder​ (ADHD) about the newly prescribed medication methylphenidate​ (Ritalin). Which instruction should the nurse​ include? A. Give the medication first thing in the morning. B. Observe the child for excessive sleepiness. C. Give the medication prior to going to bed at night. D. Restrict the amount of calories that the client eats each day.

​Give the medication first thing in the morning. Rationale: The parents should give the medication first thing in the morning to ensure attentiveness and alertness during the day at school. This medication should not be given at bedtime because it can cause insomnia. The client should be observed for​ insomnia, rather than excessive sleepiness.​ Lastly, the client should be encouraged to consume an adequate amount of calories because this medication can also cause anorexia.

The nurse is addressing a group of​ high-risk teen mothers. Which risk factor that can lead to​ attention-deficit/hyperactivity disorder​ (ADHD) in teens should the nurse include in the​ discussion? (Select all that​ apply.) A. Lack of proper parenting B. Affluence C. Poor nutrition D. Drinking alcohol during pregnancy E. Exposure to high levels of lead in childhood

​Lack of proper parenting Poor nutrition Drinking alcohol during pregnancy Exposure to high levels of lead in childhood Rationale: Risk factors for ADHD in teens include improper​ parenting, exposure to high levels of​ lead, prenatal exposure to​ alcohol, and poor nutrition. Poverty is an environmental risk​ factor, not affluence.

Which is characteristic of​ attention-deficit/hyperactivity disorder​ (ADHD)? (Select all that​ apply.) A. Often persists into adulthood B. Linked to heredity C. Linked to exposure to excess lead D. Impulsivity persists in adults E. Acetylcholine deficit in some children

​Often persists into adulthood Linked to heredity Linked to exposure to excess lead Rationale: Attention-deficit/hyperactivity disorder​ (ADHD) is characterized by​ inattention, hyperactivity, and impulsivity. Exposure to excess lead can contribute to the development of ADHD. There is a strong link between heredity and the development of ADHD. Thirty to seventy percent of ADHD cases persist into adulthood. Hyperactivity and impulsivity often improve as the client gets​ older, with inattentiveness becoming the most persistent characteristic in adults. Some children with ADHD have a deficit in dopamine and​ norepinephrine, not acetylcholine.

The nurse is teaching the parents of a very young client newly diagnosed with​ attention-deficit/hyperactivity disorder​ (ADHD) regarding therapeutic interventions. Which intervention should the nurse encourage the parents to implement during study time at​ home? (Select all that​ apply.) A. Administer stimulant medication at least 30 minutes prior to studying. B. Reduce environmental stimuli such as music and television. C. Provide a​ clutter-free area to study. D. Give the child a snack to eat during study time. E. Allow the child as much screen time as he desires.

​Reduce environmental stimuli such as music and television. Provide a​ clutter-free area to study. Rationale: During study​ time, the client should have a​ quiet, clutter-free area to study and complete homework assignments. Giving the child a snack would provide a distraction during study​ time, so this should happen either before or after study time. Minimizing screen time is an important environmental control that should be implemented. Stimulant medications are administered first thing in the​ morning, not prior to tasks.

An adult client recently diagnosed with​ attention-deficit/hyperactivity disorder​ (ADHD) asks about treatment options. Which treatment option should the nurse​ recommend? A. Minimizing all changes in the home and work environment B. Requesting a nonstimulant medication from the healthcare provider C. Having a​ loose, flexible schedule so that activities can be adjusted quickly D. Requesting a stimulant medication from the healthcare provider

​Requesting a nonstimulant medication from the healthcare provider Rationale: The nonstimulant medication atomoxetine​ (Strattera) is approved for use in adults. Stimulant medications such as dexmethylphenidate​ (Focalin) are not approved for use in adults. Environmental modifications that decrease​ stimulation, such as maintaining a quiet environment and having an orderly work​ area, are beneficial to clients with ADHD. Having a structured routine is more helpful to clients with ADHD than a​ loose, flexible schedule.

The parents state that the behavior of a child with​ attention-deficit/hyperactivity disorder​ (ADHD) is creating stress for the environment in their home. Which suggestion should the nurse encourage the parents to consider to minimize this​ stress? (Select all that​ apply.) A. Set boundaries and consequences. B. Make a schedule for​ bedtime, meals, and recreational activities. C. Allow the child as many choices as possible to decrease conflict in the home. D. Provide appropriate rewards when the child meets expected behavior. E. Allow the child to listen to music during study time.

​Set boundaries and consequences. Make a schedule for​ bedtime, meals, and recreational activities. Provide appropriate rewards when the child meets expected behavior. Rationale: Boundaries and consequences should be set for the child. When the child meets expected​ behaviors, appropriate rewards such as playing outside or riding a bike for 30 minutes should be allowed to continue to reinforce positive behaviors.​ Additionally, providing a schedule of​ activities, meals, and bedtime will provide structure within the home. The child should not listen to music during study time. And the child should not be allowed as many choices as possible because the child needs specific boundaries and expectations.

The nurse is observing a teen client with​ attention-deficit/hyperactivity disorder​ (ADHD) at home. Which observation should indicate to the nurse that client outcomes have been​ met? A. The client receives poor grades on homework for not completing assignments as requested. B. The client receives several text messages from friends and does not respond until after asking permission to do so. C. The client talks​ incessantly, jumping from one topic to another. D. The client folds half a basket of laundry and leaves the rest to read a magazine

​The client receives several text messages from friends and does not respond until after asking permission to do so. Rationale: Text messaging is an​ age-appropriate social interaction for the client. While they can be distracting and can cause the client to lose​ focus, the client did ask permission before​ responding, which indicates that the client is controlling impulsivity and inattentiveness. An inability to complete tasks and follow directions indicates that client goals have not been met. Excessive talking is another sign that client goals have not been met.

A client with​ attention-deficit/hyperactivity disorder​ (ADHD) taking atomoxetine​ (Strattera) asks about eliminating sugar from the diet and taking ginkgo biloba to control symptoms. Which response should the nurse make about complementary and alternative therapies for​ ADHD? A. ​"Taking medication​ isn't really that​ bad, especially since it is the only effective way to control your symptoms and let you live a normal​ life." B. ​"Why don't we ask your healthcare provider to prescribe a different medication instead of the one​ you're taking, if​ you're worried about​ it?" C. ​"You can replace your medication with these alternative treatments if you​ like, but be sure to tell your healthcare provider about​ them." D. ​"These are popular alternative​ treatments, but scientific evidence does not consistently support their​ effectiveness."

​These are popular alternative​ treatments, but scientific evidence does not consistently support their​ effectiveness." Rationale: To​ date, there is no consistent evidence that elimination​ diets, dietary​ supplements, or herbs are effective in treating ADHD. Telling this to the client in a​ factual, nonjudgmental manner is the best response. The nurse does not have the authority to change the​ client's treatment regimen without approval from the healthcare​ provider, even if the nurse tells the client to tell the provider about the change. Neither suggesting a new medication nor minimizing the​ client's concerns addresses the​ client's interest in alternative​ therapies, and they do not acknowledge the​ client's concerns.

Which intervention should the nurse teach the parents of a​ school-age client with​ attention-deficit/hyperactivity disorder​ (ADHD)? (Select all that​ apply.) A. Giving​ time-outs only for the worst negative behaviors B. Turning off the television when the client is doing homework C. Praising all positive behaviors D. Asking the healthcare provider to provide drug holidays every other week E. Maintaining a consistent bedtime routine and time

​Turning off the television when the client is doing homework Praising all positive behaviors Maintaining a consistent bedtime routine and time Rationale: Children with ADHD do best with structured and consistent​ routines, which include maintaining a consistent time and routine for bedtime and praising all positive behaviors. Reducing environmental stimuli by turning off the television will also help the child with ADHD. To reduce stimulant​ abuse, drug holidays during weekends and school​ breaks, when the child does not take​ medication, can be discussed with the healthcare provider. Like positive​ behaviors, all negative behaviors should have consistent​ consequences, not just the worst ones.

The mother of a teenage female client recently diagnosed with​ attention-deficit/hyperactivity disorder​ (ADHD) tells the​ nurse, "Our daughter has a male cousin who has​ ADHD, but he​ doesn't act anything like​ her." Which response should the nurse make to explain the​ difference? A. ​"Girls with ADHD tend to be diagnosed earlier than​ boys." B. ​"Girls with ADHD tend to show fewer language problems than boys with​ ADHD." C. ​"Girls with ADHD tend to show more aggression than boys with​ ADHD." D. ​"Girls with ADHD tend to show less impulsiveness than boys with​ ADHD."

​​"Girls with ADHD tend to show less impulsiveness than boys with​ ADHD." Rationale: Girls with ADHD tend to show less aggression and impulsiveness than boys with ADHD.​ However, girls show more​ anxiety, mood​ swings, social​ withdrawal, rejection, and cognitive and language problems. Girls are usually​ older, not​ younger, than boys at the time of diagnosis.

The nurse is teaching the parents of a client with​ attention-deficit/hyperactivity disorder​ (ADHD) about the prescribed medication methylphenidate​ (Ritalin). Which statement from the parents reflects an understanding of the medication​ regimen? A. ​"We should restrict calories due to possible weight​ gain." B. ​"We can stop giving the medication during the​ summer." C. ​"We should observe for excessive sleepiness during the​ day." D. ​"The medication can be given any time of the​ day."

​​"We can stop giving the medication during the​ summer." Rationale: Clients on stimulant medications go on a drug holiday during the summer breaks. Clients who are on stimulant medications can experience insomnia and​ anorexia; thus, calories would not be restricted. Excessive sleepiness is generally not observed.

The nurse is caring for an adolescent client newly diagnosed with​ attention-deficit/hyperactivity disorder​ (ADHD). Which nursing diagnosis should the nurse prioritize for this​ client? A. ​Injury, Risk for B. ​Pain, Chronic C. ​Development: Delayed, Risk for D. ​Mobility: Physical, Impaired

​​Injury, Risk for Rationale: The client with ADHD is at increased risk for injury because the impulsivity and inattentiveness seen with this disorder are risk factors for antisocial​ behavior, substance​ abuse, and serious accidents. ​Mobility: Physical,​ Impaired; ​Pain, Chronic; and ​Development: Delayed, Risk for are not appropriate nursing diagnoses for clients with ADHD.​ (NANDA-I ©2014)


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