chapter 11: childhood and neurodevelpment disorders

A 3-year-old has been diagnosed with autism. While there is an absence of language, the child does babble but is indifferent to contact with people. The nurse's initial intervention will be to 1. Give one-to-one attention in nonverbal parallel play 2. Sit next to the child while looking at a picture book 3. Feed the child snacks while talking softly 4. Sit across from the child at the play table and introduce new toys

1

A nurse is caring for a patient with Tourette's syndrome. Which possible symptom can the nurse find in the patient? 1. Frequent tongue protrusion 2. Sleeping for long hours 3. Inattentive behavior 4. Reduced listening skill

1

A nurse needs to use group therapy for very young children. What activity should be included in the group therapy for maximum benefit of the children? 1. Playing 2. Learning skill 3. Talking about an activity 4. Using popular media events

1

The primary health care provider has prescribed that the nurse administer an injectable drug to a five-year-old child. How does the nurse administer the drug if the child is uncooperative? 1. The nurse demonstrates injection administration on dolls or toys. 2. The nurse administers the drug through the oral route of administration. 3. The nurse explains to the child the importance of administering the injection. 4. The nurse asks the parents to hold the child's arm and administers the injection.

1

Which factor can reduce the vulnerability of a child to etiological influences predisposing to the development of psychopathology? 1. resilience 2. malnutrition 3. child abuse 4. having depressed parent

1

A nurse counsels the parents of a child with autistic disorder. The parents say, "We are going to completely redecorate our child's room. We think that will help." Select the nurse's best response. 1. "Children with autistic disorder usually prefer that things stay the same." 2. "Bright colors are often stimulating for children with autistic disorder." 3. "Remember to not use rugs so that your child will not slip and fall." 4. "New toys and games will help develop your child's intellectual abilities."

1 Children with autistic disorder are usually inflexible and preoccupied with orderliness and sameness. Redecorating the child's room is likely to upset the child.

the nurse is caring for a preschooler w. mental disorder. the nurse ID's that the preschooler refuses to attend school and feels isolated. what does the nurse report to the primary health care provider about this preschooler? 1. child has ineffective coping skills 2. child has impaired verbal communication 3. child has delayed growth and development 4. child is at risk for developing suicidal ideation

1 Children with intellectual developmental disorders have decreased ability in social, conceptual, and practical functioning. Ineffective coping skills are a sign of intellectual development disorders. Preschoolers with ineffective coping abilities find difficulty with peer interaction and lack interest in attending school. These conditions do not indicate impaired verbal communication, delayed growth and development, or risk of suicidal ideation. Impaired verbal communication is characterized by repetitive usage of language. Delayed growth and development is characterized by an inability to perform activities such as feeding, bathing, and dressing. Risk of suicidal ideation is characterized by signs such as difficulty in concentration and depression.

a 5 year old who consistently omits the sounds 'r' and 's' when speaking in demonstrating a 1. communication disorder 2. language disorder 3. social communication disorder 4. specific learning disorder

1 Communication disorders are marked by problems in making sounds. Children may have trouble making certain sounds, saying "no" for "snow" or "wabbit" for rabbit; they may distort, add, or omit sounds.

A 9-year-old patient has deficits in social and intellectual functioning, and cannot manage practical aspects of daily life and functioning. These symptoms/signs support which diagnosis? 1. Intellectual development disorder (IDD) 2. Specific learning disorder 3. Autism spectrum disorder (ASD) 4. Attention deficit hyperactivity disorder (ADHD)

1 IDD is characterized by severe deficits in three major areas of functioning: intellectual, social, and managing daily life. Specific learning disorder is diagnosed when a child demonstrates persistent difficulty in the acquisition of reading (dyslexia), mathematics (dyscalculia), or written expression (dysgraphia), and his or her performance is well below the expected performance of peers. Autism is characterized by severe problems in communication skills and social interaction. ADHD is characterized by inattention, impulsivity, and hyperactivity.

nurse is assessing a child in pediatric facility. while answering the nurse's questions, the child provides information with no context to nurse's questions. what is best nursing action? 1. refer child to audiologist 2. refer child to psychologist 3. refer to child to speech therapist 4. refer child to occupation therapist.

1 The child uses words that are not in context with the nurse's question. This indicates that the child has a communication disorder. In this situation, the first step taken by the nurse should be to eliminate the possibility of a hearing loss. Therefore, the child should be first referred to an audiologist. If the child has an intact sense of hearing, then the nurse should refer the child to a speech therapist. The child does not show any psychological disorder, thus the child need not be referred to a child psychologist. If the child has any learning disorder, then the nurse should refer the child to an occupational therapist.

A 3-year-old has been diagnosed with autism. While there is an absence of language, the child does babble but is indifferent to contact with people. The nurse's initial intervention will be to 1. give 1-1 attention in nonverbal parallel play 2. sit next to the child while looking at a picture book 3. feed the child snacks while talking softly 4. sit across from child at play and introduce new toys

1 The nurse should enter the child's world in a nonthreatening manner to establish trust before beginning to verbalize or engage in more intrusive attempts at play.

A nurse prepares to assess an adolescent with recent reports of serious behavioral problems at school. Which resources should the nurse use to complete the assessment? Select all that apply. 1. Interview the adolescent. 2. Interview the adolescent's closest friends. 3. Gather information from the adolescent's family. 4. Obtain information from the adolescent's teachers and school. 5. View the adolescent's recent activity on social networking sites.

1, 3, 4 Methods of collecting data include interviewing, screening, testing (neurological, psychological, intelligence), observing, and interacting with the child or adolescent. Histories are taken from multiple sources, including parents, teachers, other caregivers, and the child or adolescent when possible. Parents and teachers can complete structured questionnaires and behavior checklists. Interviewing the adolescent's friends would violate confidentiality. Viewing the adolescent's recent activity on social networking sites violates rights to privacy.

A nurse prepares the plan of care for an adolescent with a moderate intellectual development disorder. When determining outcomes for this patient, what should the nurse do? Select all that apply. 1. Involve family members and community resources. 2. Anticipate needs for custodial care as the adolescent ages. 3. Individualize the plan based on the needs and abilities of the patient and family. 4. Focus on the physical needs of the adolescent rather than psychosocial needs. 5. Consider continuing care needs as this patient ages and matures into adulthood.

1, 3, 5

he nurse is assessing a 10-year-old child who is performing poorly in school. On assessment, the nurse finds that the child has a learning disability. Which observation has led the nurse to come to this conclusion? Select all that apply. 1. The child was unable to read a story book. 2. The child was not answering the nurse's questions. 3. The child was unable to perform basic calculations. 4. The child was not paying attention in class. 5. The child was unable to write properly on paper.

1, 3, 5

A nurse is caring for a child with separation anxiety. The child does not interact with anybody and stays in one corner of the room. The nurse decides to give bibliotherapy to this child. What is the primary aim of the nurse to give this intervention? 1. The child would be relaxed and peaceful. 2. the child would be able to gain insight into feelings. 3. The child would not exhibit self-destructive behaviors. 4. The child would develop better communication skills.

2

A patient with attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate (Daytrana) transdermal patch. How frequently should the nurse change the patch? 1. Once a week 2. Once a day 3. Three times a week 4. Three times a day

2

The nurse is assessing a child with a tic disorder with no history of brain injury. The child repeatedly bangs his or her head on the wall. Which advice given to the parents by the nurse is of most priority? 1. "You should consult a behavioral therapist." 2. "You should make the child wear a helmet." 3. "You should get a scan of your child's brain." 4. "You should stop your child from banging his or her head."

2

Which neurodevelopmental disorder is characterized by difficulty in written expressions? 1. Communication disorder 2. Specific learning disorder 3. Autism spectrum disorder 4. Intellectual developmental disorder

2

then nurse instructs the parent of a child with ADHD to administer methylphenidate (ritalin) before 4 pm. which side effect is the nurse addressing by giving this instruction? 1. nausea 2. insomnia 3. lethargy 4. anorexia

2

A nurse observed that during play therapy, a patient is unable to follow the rules of the game and has conflict with peers. Which of these drugs would you anticipate would be administered to the patient? 1. Botulinum Toxin type A (Botox) 2. Methylphenidate (Ritalin) 3. Naltrexone (Revia) 4. Diphenhydramine (Benadryl)

2 A patient with attention deficit hyperactivity disorder does not follow rules in a game and has conflicts with peers. Methylphenidate (Ritalin) is a physicostimulant drug used in attention deficit hyperactivity disorder. Botulinum toxin type A (Botox) is given in Tourette's syndrome to calm the muscles. Naltrexone (Revia) is an opioid antagonist which is usually given in Tourette's syndrome to block the euphoric responses. Diphenhydramine (Benadryl) is an antihistaminic drug prescribed for allergies.

An appropriate intervention of a 12-year-old child demonstrating faulty personality development associated with attention deficit hyperactivity disorder (ADHD) would include 1. Regular entries into a personal sleep hygiene journal 2. Enrollment in family and individual group therapies 3. Involvement in family menu planning and food shopping 4. After school tutoring to help maintain passing grades

2 Interventions for patients with ADHD focus on correcting the faulty personality (ego and superego) development. Treatment may include hospitalization for those who present an imminent danger to self or others, but is predominantly on an outpatient basis, using individual, group, and family therapy, with an emphasis on parenting issues.

A nurse develops a plan of care for a teenager newly admitted to a residential care program who is diagnosed with attention deficit hyperactivity disorder. The teenager has poor judgment, high risk-taking behaviors, and impulsivity. Which intervention has the highest priority? 1. Develop and sign a "no self-harm" contract with the teenager. 2. Assign a staff member to one-to-one observation until the treatment team determines the teenager is no longer at risk for harm. 3. Schedule frequent discussions between the nurse and teenager to explore stressors, coping skills, and behavioral alternatives. 4. Implement locked seclusion until the teenager is able to identify examples of good judgment and control impulsive reactions.

2 Safety is the priority. This teenager needs constant supervision until the team determines the risk for harm has dissipated. No-harm contracts have variable success and do not ensure supervision of this patient. It is important for the nurse to dialogue with the teenager, but safety has a higher priority. Locked seclusion is inappropriate and presents additional risks for injury.

A nursing diagnosis that should be considered for a child with attention deficit hyperactivity disorder is 1. Anxiety 2. Risk for injury 3. Defensive coping 4. Impaired verbal communication

2 The child's marked hyperactivity puts him or her at risk for injury from falls, bumping into objects, impulsively operating equipment, pulling heavy objects off shelves, and so forth.

A study was conducted at a school to study the mental development in children. The nurse reported that 70% of the study group is mentally healthy. Which characteristics could the nurse find in the mentally healthy children? Select all that apply. 1. Ability to trust no one 2. Ability to respond spontaneously 3. Ability to behave more maturely than their age 4. Ability to make accurate perception 5. Ability to have realistic self-concept

2, 4, 5 Mentally healthy children respond spontaneously and have the ability to express themselves in creative ways. They have the ability to make accurate perception and can interpret their surroundings. Healthy children have a positive, realistic self-concept and developing identity. The healthy child trusts others and can judge whether the surroundings are safe and supportive. The healthy child behaves appropriately according to age and does not violate social norms.

The nurse is administering methylphenidate (Ritalin) to a child. Following medication administration, the nurse observes a disturbance in the child's regular sleep pattern. The nurse reports this to the primary health care provider. What instruction is the nurse most likely to receive from the primary health care provider? 1. "Administer lithium (Lithium) as prescribed." 2. "Make the patient's room environment conducive for sleep." 3. "Reduce the dose of methylpenidate (Ritalin)." 4. "Administer atomoxetine (Strattera) to the patient."

3

The nurse is assessing a five-year-old child. After completing the general assessment, the nurse reassesses the child using the Denver II developmental scale. What is the reason for the nurse to use this assessment tool? 1. The child is demonstrating abnormal behaviors related to stress. 2. The child is susceptible to engaging in risk-taking behaviors. 3. The child's behavior is inappropriate for their chronological age. 4. The child's physical disability is interfering with their functional abilities.

3

What is the primary reason that the use of restraint and seclusion are controversial in children? 1. Parents may initiate a lawsuit. 2. Nursing staff have conflicted feelings, leading to ineffectiveness. 3. Restraint and seclusion are psychologically harmful and may be physically harmful. 4. Staff are untrained in use of restraints in children.

3

nurse is taking the clinical interview of a patient with autism spectrum disorder. Which assessment technique can the nurse follow to effectively diagnose the patient's condition? 1. Assess the level of frustration tolerance in the patient. 2. Assess the independent functioning in the patient. 3. Assess the developmental delays in the patient. 4. Assess the level of depression in the patient.

3

When a child demonstrates a temperament that prompts the mother to say, "She is just so different from me; I just can't seem to connect with her," the nurse will 1. Suggest that the child's father become her primary caregiver 2. Encourage the mother to consider attending parenting classes 3. Counsel the mother regarding ways to better bond with her child 4. Educate the father regarding signs that the child is being physically abused

3 All people have temperaments, and the fit between the child and parent's temperament is critical to the child's development. The caregiver's role in shaping that relationship is of primary importance, and the nurse can intervene to teach parents ways to modify their behaviors to improve the interaction.

Which data should be documented by the nurse while taking the medical history of a patient? 1. Intellectual functions 2. Attachment behaviors 3. Review of body systems 4. Social skills and friendships

3 Data recorded during the assessment of the patient helps in designing interventions for effective management of illness. Assessment of a patient's medical history includes a review of body systems. This helps with identifying the effect of an illness on the patient's physical and mental status. This information is needed to develop an appropriate plan of treatment. Intellectual functions, attachment behaviors, social skills, and friendships are not documented under medical history. Intellectual functions are assessed to gather information about the mental status of a patient. Attachment behaviors and social skills and friendships are assessed under developmental history.

to confirm diagnosis of ADHD, a child's symptoms of hyperactivity, inattention, and impulsivity must meet which criteria? 1. they worsen in times of severe stress 2. they are confirmed by supervised clinical observations 3. they occur both at home and school 4. they are confirmed by a diagnostic testing tool

3 For ADHD to be diagnosed, the symptoms have to be present in two settings, such as home and school, with onset occurring before the age of 7 years. Worsening symptoms in times of severe stress and confirmation by supervised clinical observations and a diagnostic testing tool do not describe two settings.

Which behavior is most indicative of a 4-year-old child diagnosed with Tourette's syndrome? 1. Difficulty in social relationships 2. Humming when concentrating 3. Frequently blinking eyes 4. Difficulty in completing tasks on time

3 Frequent eye blinking is an example of an involuntary action associated with Tourette's syndrome. Difficulty with social relationships is an inconclusive symptom, especially for a 4-year-old. Humming can be a normal response to a child at play. Poor task completion usually is associated with a child who demonstrates ADHD.

the diagnosis of impaired intellectual functioning is supported when child diagnosed with intellectual development disorder? 1. can neither brush the teeth or comb the hair effectively 2. cries uncontrollably when toy is temporarily missing 3. cannot put together a 5 piece jigsaw puzzle 4. has diff. with conceptual of social boundaries

3 IDD, previously called mental retardation, are characterized by deficits in reasoning, problem solving, planning, judgment, abstract thinking, and academic ability compared with same-age peers.

What are the familial risk factors associated with child psychiatric disorders? Select all that apply. 1. Single-child family 2. Nuclear family 3. Severe marital discord 4. Low socioeconomic status 5. Foster care placement

3, 4, 5

A nurse counsels the parents of a five-year-old child diagnosed with severe autism spectrum disorder (ASD). When suggesting activities, which activity is most likely to engage this child? 1. Singing with a choir of young children 2. Playing video games with an older child 3. Riding bicycles with a small group of children 4. Assembling and disassembling a simple toy, alone

4

Which medication would the nurse most likely include when educating the parents of a child diagnosed with attention deficit hyperactivity disorder? 1. Buspirone (Buspar) 2. Haloperidol (Haldol) 3. Clomipramine (Anafranil) 4. Methylphenidate (Ritalin)

4

When preparing to assess a 4-year-old child to help rule out a neurodevelopmental disorder, the nurse bases interventions on the understanding that 1. Children of that age are very resilient 2. Age makes these children poor interviewees 3. Poor cooperation is typical at that age 4. Language skills are limited at that age

4 Younger children are more difficult to diagnose than older children because of their limited language skills and cognitive and emotional development.