Chapter 22 VIDE (ADHD)
A, C, D, E Feedback: During assessment, the nurse gathers information through direct observation and from the child's parents, day care providers (if any), and teachers. Assessing the child in a group of peers is likely to yield useful information because the child's behavior may be subdued or different in a focused one-to-one interaction with the nurse. Reviewing the client's record will not yield much assessment data.
12. Which of the following would be important circumstances to gather assessment data for a child with ADHD? Select all that apply. A) Direct observation of the child B) Reviewing the client's record C) Interviewing the client's parents D) Interviewing the client's teachers E) Assessing the client in a group of peers
B Feedback: Safety of the child and others is always a priority. The other nursing interventions are appropriate for a child with ADHD, but the priority is safety.
13. Which one of the following nursing interventions should take priority for a child with ADHD? A) Structured daily routine B) Ensuring the child's safety and that of others C) Simplifying instructions and directions D) Improved role performance
B Feedback: If the child is engaged in a potentially dangerous activity, the first step is to stop the behavior. Attempting to talk to or reason with a child engaged in a dangerous activity is unlikely to succeed because his or her ability to pay attention and to listen is limited.
14. An 8-year-old with attention deficit hyperactivity disorder is jumping off the bed onto a chair. Which should be the nurse's first step? A) "I need to talk to you." B) "Stop that right now." C) "You are going to hurt yourself." D) "Why are you jumping off the bed?"
D Feedback: Autistic traits persist into adulthood, and most people with autism remain dependent to some degree on others. Manifestations vary from little speech and poor daily living skills throughout life to adequate social skills that allow relatively independent functioning. Social skills rarely improve enough to permit marriage and child rearing.
17. The parents of an autistic child ask the nurse, "Will my child ever be normal?" Which would be the most appropriate response by the nurse? A) "You seem worried about your child's future." B) "Autistic children can fully recover with the right treatment and education." C) "Your child should outgrow autistic traits by adolescence." D) "Your child will probably always have some autistic traits."
A, C, E Feedback: Educating parents and helping them with parenting strategies are crucial components of effective treatment of ADHD. Effective approaches include providing consistent rewards and consequences for behavior, offering consistent praise, using time-out, and giving verbal reprimands. Additional strategies are issuing daily report cards for behavior and using point systems for positive and negative behavior.
18. The parents of a child with ADHD express to the nurse, "We get so frustrated when our son never minds us." Which parenting strategies should the nurse discuss with the parents? Select all that apply. A) Use time-out for behavior control. B) Provide occasional rewards and consequences for behavior. C) Give verbal reprimands for negative behavior. D) Resist giving praise until fully compliant with requests. E) Use a point system for positive and negative behavior.
B Feedback: Parents feel empowered and relieved to have specific strategies that can help them and their child be more successful. Including parents in planning and providing care for the child with ADHD is important. The nurse must listen to the parents' feelings. The education of a child with ADHD is important, but the child is only in school for part of their day. The parents must deal with the child and the other aspects of the child's life at all times.
19. Which one of the following statements about educating parents of a child with ADHD is true? A) It is unimportant to educate the family members about ADHD as they already know the problem too well. B) Parents feel empowered and relieved to have specific strategies that can help them and their child be more successful. C) It is important for the nurse to spend the majority of his or her time with parents of children with ADHD in talking to the parents. D) If the child receives special school services under the Individuals with Disabilities Education Act, there is no need for further services.
C Feedback: The National Institute of Child Health and Human Development, Centers for Disease control (CDC) and the Academy of Pediatrics have all conducted research studies for several years and have concluded that there is no relationship between vaccines and autism and that the MMR vaccine is safe.
2. A mother expresses concern to the nurse that the child's regularly scheduled vaccines may not be safe. The mother states that she has heard reports that they cause autism. The most appropriate response by the nurse is, A) "It is recommended that you wait until the child is older to vaccinate." B) "There are safer alternative immunizations available now." C) "There has been no research to establish a relationship between vaccines and autism." D) "The risks do not outweigh the benefits of immunization against childhood diseases."
B Feedback: Working with parents is a crucial aspect of dealing with children with these disorders. Parents often have the most influence on how these children learn to cope with their disorders. The nurse can teach parents age-appropriate activities and expectations for clients.
24. The nurse understands that when working with a child with a mental health problem, the family must be included in the care. Which is one of the best ways the nurse can advocate for the child? A) Support transferring the child to a healthy living environment. B) Teach the parents age-appropriate expectations of the child. C) Reinforce the parents' expectations of the child's behavior. D) Interpret the child's thoughts and feelings to the parent.
C Feedback: The nurse's beliefs and values about raising children affect how he or she deals with children and parents. The nurse must not be overly critical about how parents handle their children's problems until the situation is fully understood: Caring for a child as a nurse is very different from being responsible around the clock. The parents likely have other obstacles to carrying out effective discipline. Teaching again is not likely to effect change. Given their own skills and problems, parents often give their best efforts. Given the opportunity, resources, support, and education, many parents can improve their parenting. It is premature to refer to family therapy or remove the child from the home. Emotional barriers to effective parenting should be explored first.
27. The nurse has been working with the family of a small child with a psychiatric disorder. The nurse is feeling very frustrated because the parents refuse to implement effective parenting skills that the nurse has taught. What is the best action for the nurse at this time? A) Review effective disciplinary practices with the parents again. B) Refer the parents to a family therapist. C) Try to remember that the parents are trying to the best of their ability to carry out the suggestions. D) Explore alternative living arrangements for the child.
C Feedback: Working with children and adolescents can be both rewarding and difficult. Many disorders of childhood such as severe developmental disorders severely limit the child's abilities. It may be difficult for the nurse to remain positive with the child and parents when the prognosis for improvement is poor. Even in overwhelming and depressing situations, the nurse has an opportunity to positively influence children and adolescents, who are still in crucial phases of development. The nurse often can help these clients to develop coping mechanisms they will use through adulthood. It is important to remember to focus on the client's and parents' strengths and assets, not just their problems.
28. When the prognosis of improvement in a child with psychiatric disorders is poor, what can the nurse do to positively influence children and adolescents and their parents? A) Continue to remind the child and parents that the prognosis for improvement is very poor. B) Encourage the parents to believe that the child will recover spontaneously. C) Assist the child and the parents to develop coping mechanisms. D) Focus on their problems instead of their strengths and assets.
D Feedback: Pharmacologic treatment with antipsychotics, such as haloperidol (Haldol) or risperidone (Risperdal), may be effective for specific target symptoms such as temper tantrums, aggressiveness, self-injury, hyperactivity, and stereotyped behaviors.
9. A parent of a child with autism spectrum disorder asks the nurse if there is anything that can be done to control the child's tantrums. Which option should the nurse inform the parents that may be appropriate? A) Give the child rewards for resisting tantrums. B) Reason with the child why tantrums are not effective. C) Place the child in a time-out when tantrums occur. D) Explore the use of antipsychotic medications to control tantrums.
A, C, D Feedback: Children with autism display little eye contact with and make few facial expressions toward others; they use limited gestures to communicate. They have limited capacity to relate to peers or parents. They lack spontaneous enjoyment, express no moods or emotional affect, and cannot engage in play or make-believe with toys. There is little intelligible speech. These children engage in stereotyped motor behaviors such as hand flapping, body twisting, or head banging.
1. The nurse is assessing a 16-month-old child during a well-baby checkup. Which of the following behaviors would be consistent with autism spectrum disorder? Select all that apply. A) The child displays little eye contact with others. B) The child thrives on changes in routine. C) The child makes few facial expressions toward others. D) The child does not like repetition. E) The child answers questions verbally.
B Feedback: Giving stimulants during daytime hours usually effectively combats insomnia. Eating a good breakfast with the morning dose and substantial nutritious snacks late in the day and at bedtime helps the child to maintain an adequate dietary intake. Daytime napping for a child with ADHD is unrealistic and not developmentally necessary.
10. A child with ADHD complains to his parents that he does not like the side effects of his medicine, Adderall. The parents ask the nurse for suggestions to reduce the medication's negative side effects. The nurse can best help the parents by offering which advice? A) Give the child his medicine at night. B) Have the child eat a good breakfast and snacks late in the day and at bedtime. C) Limit the number of calories the child eats each day. D) Let the child take daytime naps.
A Feedback: Before beginning any task, adults must gain the child's full attention. The adult should tell the child what needs to be done and break the task into smaller steps if necessary. This approach prevents overwhelming the child and provides the opportunity for feedback about each set of problems he or she completes.
11. The nurse is assisting a child with ADHD to complete his ADLs. Which is the best approach for nurse to use with this child? A) Break tasks into small steps. B) Let the child complete tasks at his own pace. C) Offer rewards when all tasks are completed. D) Set a time limit to complete all tasks.
B Feedback: Parents find themselves chronically exhausted mentally and physically. Parents need support and reassurance, and making a statement about the difficulties of handling the child at home validates the mother's feelings. It is not appropriate to say, "Your son is a cute child, but he needs to calm down." It may make the parents defensive to say, "You need to take a firmer approach with your son." "Your son sure is active" is not a therapeutic response.
15. The mother of a 6-year-old boy with attention deficit hyperactivity disorder asks to speak to the nurse about her son's disruptive behavior. The nurse would be most therapeutic by saying which of the following? A) "Your son is a cute child, but he needs to calm down." B) "It must be difficult to handle your son at home." C) "You need to take a firmer approach with your son." D) "Your son sure is active."
A Feedback: Ritalin has a short half-life, so doses are needed about every 4 hours during the day to maintain symptom control. Giving stimulants during daytime hours usually effectively combats insomnia.
16. A child with attention deficit hyperactivity disorder is taking methylphenidate (Ritalin) in divided doses. If the child takes the first dose at 8 AM, which behavior might the school nurse expect to see at noon? A) Increased impulsivity or hyperactive behavior B) Lack of appetite for lunch C) Sleepiness or drowsiness D) Social isolation from peers
B, C, D Feedback: Although medication can help reduce hyperactivity and inattention and allow the child to focus during school, it is by no means a cure-all. The child needs strategies and practice to improve social skills and academic performance. Because these children are often not diagnosed until the second or third grade, they may have missed much basic learning for reading and math. Parents should know that it takes time for them to catch up with other children of the same age. Most of these children have low self-esteem because they have been labeled as having behavior problems and have been corrected continually by parents and teachers for not listening, not paying attention, and misbehaving. Parents must understand how to help rebuild their child's self-esteem. Parents should give positive comments as much as possible to encourage the child and acknowledge his or her strengths. One technique to help parents to achieve a good balance is to ask them to count the number of times they praise or criticize their child each day for several days. ADHD is not the fault of the parents or the child, and that techniques and school programs are available to help. Children with ADHD do qualify for special school services under the Individuals with Disabilities Education Act.
20. A nurse is providing education to a group of parents who have children with ADHD. Which of the following statements would be accurate and should be included in the education? Select all that apply. A) Medication alone will adequately treat children with ADHD. B) It is important for parents of children with ADHD to learn how to rebuild their child's self-esteem. C) Because raising a child with ADHD can be frustrating and exhausting, it often helps parents to attend support groups that can provide information and encouragement from other parents with the same problems. D) ADHD is not the fault of the parents or the child, and that techniques and school programs are available to help. E) Children with ADHD do not qualify for special school services under the Individuals with Disabilities Education Act.
A Feedback: The child with ADHD cannot accomplish complex tasks, such as homework, in a noisy or chaotic setting where there are a lot of distractions. The other choices do not indicate the need for further teaching.
21. When teaching the parents of a child with attention deficit hyperactivity disorder (ADHD), which statement by the parents would indicate the need for further teaching? A) "We'll have him do his homework at the kitchen table with his brothers and sisters." B) "We'll make sure he completes one task before going on to another." C) "We'll set up rules with specific times for eating, sleeping, and playing." D) "We'll use simple, clear directions and instructions."
D Feedback: Stimulant medications used to treat ADHD can suppress appetite, and the child may lose or fail to gain weight properly. The client is too young to manage his medications independently. Ritalin should be given in divided doses. Ritalin reduces hyperactivity, impulsivity, and mood lability and helps the child to pay attention more appropriately.
22. Which statement would indicate that medication teaching for the parents of a 6-year-old child with attention deficit hyperactivity disorder (ADHD) has been effective? A) "We'll teach him the proper way to take the medication, so he can manage it independently." B) "We'll be sure he takes Ritalin at the same time every day, just before bedtime." C) "We're so glad that Ritalin will eliminate the problems of ADHD." D) "We'll be sure to record his weight on a weekly basis."
A Feedback: The behaviors described by the mother are typical in terms of growth and development for a 15-year-old. The other choices are not found to give valid information to the mother regarding increased adolescent independence.
23. The mother of a 15-year-old boy tells the nurse that her son is becoming more assertive in conflict situations and wants to get a job. She asks if it is healthy for a 15-year-old to be so independent. Which is valid information for the nurse to offer the mother? A) His behaviors reflect normal growth and development. B) He is overly independent. C) It sounds like he is trying to avoid her. D) She should observe for signs of substance abuse.
A Feedback: It is much more difficult to diagnose psychiatric disorders in children and adolescents. Many of the same psychiatric disorders that affect adults also occur in children and adolescents, but because psychiatric disorders in children are difficult to diagnose, they do not manifest themselves very quickly.
25. For which reason is it crucial for nurses to advocate for children and adolescents regarding psychiatric disorders? A) It is much more difficult to diagnose psychiatric disorders in children and adolescents. B) It is not necessary because psychiatric disorders do not occur in children and adolescents. C) Children and adolescents experience some of the same mental health problems as adults. D) Psychiatric disorders in children manifest themselves very quickly.
A, B, C Feedback: Psychiatric disorders are not diagnosed as easily in children as they are in adults. Children usually lack the abstract cognitive abilities and verbal skills to describe what is happening. Because they are constantly changing and developing, children have limited sense of a stable, normal self to allow them to discriminate unusual or unwanted symptoms from normal feelings and sensations. Additionally, behaviors that are normal in a child of one age may indicate problems in a child of another age. Sometimes the manifestations of psychiatric disorders in adults are less of a problem than they were for the child at a younger age, but this does not make it more difficult to diagnose psychiatric disorders in children than in adults. Children and adolescents experience some of the same mental health problems as adults and are diagnosed using the same criteria as for adults, but this does not make it more difficult for children to be diagnosed.
26. For which reasons is it more difficult to diagnose psychiatric disorders in children than in adults? Select all that apply. A) Children usually lack the abstract cognitive abilities and verbal skills to describe what is happening. B) Because they are constantly changing and developing, children are unable to discriminate unusual or unwanted symptoms from normal feelings and sensations. C) Behaviors that are appropriate for a child of one developmental level may be inappropriate for a child of a different developmental level. D) Sometimes, children "outgrow" psychiatric disorders. E) Children and adolescents experience some of the same mental health problems as adults and are diagnosed using the same criteria as for adults.
A Feedback: By the time the child starts school, symptoms of ADHD begin to interfere significantly with behavior and performance. He or she cannot listen to directions or complete tasks. The child interrupts and blurts out answers before questions are completed. Academic performance suffers because the child makes hurried, careless mistakes in schoolwork, often loses or forgets homework assignments, and fails to follow directions. Socially, peers may ostracize or even ridicule the child for his or her behavior. The child often loses necessary things.
3. A parent is concerned that his child might suffer from attention deficit hyperactivity disorder (ADHD). Which of the following behaviors reported by the parent would be consistent with this diagnosis? A) The child interrupts others. B) The child has been hoarding objects. C) The child has lots of friends. D) The child is excelling academically in school.
B, D, E Feedback: ADHD is characterized by inattentiveness, overactivity, and impulsiveness. Encopresis is the repeated passage of feces into inappropriate places such as clothing or the floor by a child who is at least 4 years of age either chronologically or developmentally. Enuresis is the repeated voiding of urine during the day or at night into clothing or bed by a child at least 5 years of age either chronologically or developmentally. Encopresis and enuresis are elimination disorders that are unrelated to ADHD.
4. Which of the following symptoms are characteristic of ADHD? Select all that apply. A) Enuresis B) Inattentiveness C) Encopresis D) Overactivity E) Impulsiveness
A, B, D, E Feedback: Approximately 70% to 75% of adults with ADHD have at least one coexisting psychiatric diagnosis, with social phobia, bipolar disorder, major depression, and alcohol dependence being the most common.
5. Which of the following are common coexisting psychiatric disorders for adults with ADHD? Select all that apply. A) Social phobia B) Bipolar disorder C) Obsessive-compulsive disorder D) Major depression E) Alcohol dependence
D Feedback: Echolalia is repeating the last heard sound, word, or phrase. Stereotypic movement disorders include waving, rocking, twirling objects, biting fingernails, handing the head, biting or hitting oneself, or picking at the skin or body orifices. Selective mutism is characterized by persistent failure to speak in social situations where speaking is expected.
6. A nurse asks an assigned client, "How are you doing today?" The client responds with "doing today, doing today, doing today." Which speech pattern disturbance is this an example of? A) Reactive attachment disorder B) Stereotypic movement disorder C) Selective mutism D) Echolalia
B Feedback: Palilalia is the repeating of one's own words or sounds. Coprolalia is the use of socially unacceptable words, which are frequently obscene. Echolalia is the repeating of the last heard sound, word, or phrase.
7. Which of the following terms describes the repeating of one's own words or sounds? A) Coprolalia B) Palilalia C) Echolalia D) None of the above
A Feedback: Phonologic disorder involves problems with articulation. Mixed receptive-expressive language disorder includes problems of expressive language disorder along with difficulty understanding and determining the meaning of words and sentences. Expressive language disorder involves an impaired ability to communicate through verbal and sign language. Stuttering is a disturbance of the normal fluency and time patterning of speech.
8. Which of the following disorders involves problems with forming sounds associated with speech? A) Phonologic disorder B) Mixed receptive-expressive language disorder C) Expressive language disorder D) Stuttering
