Chapter 22 VIDE (ADHD), ch 22 NCLEX questions, Chapter 22, Chapter 22: Neurodevelopmental Disorders, Psych CH 22

During a comprehensive assessment of a child, which person does the nurse interview first? child parent caregiver grandparents

child Explanation: The child should be interviewed first during a comprehensive assessment, then the parents or other caregivers. The grandparents are not interviewed unless the child lives with them.

A nurse is using limit setting with a child hospitalized for a psychiatric disorder. Which statement made by the nurse would reflect appropriate limit setting? Select all that apply. "Swearing is a sign of disrespect." "Swearing is not allowed here on the unit." "When you feel like swearing come and talk to me." "You will lose television privileges for 24 hours if you ignore a unit rule." "Unit rules are made to keep everyone safe."

"Swearing is not allowed here on the unit." "When you feel like swearing come and talk to me." "You will lose television privileges for 24 hours if you ignore a unit rule." Rationale:Limit setting involves three steps: 1. Inform clients of the rule or limit. 2. Explain the consequences if clients exceed the limit. 3. State expected behavior. The remaining options are explanations as to why swearing is not allowed.

A nurse is using limit setting with a child hospitalized for a psychiatric disorder. Which statement made by the nurse would reflect appropriate limit setting? Select all that apply. "Swearing is not allowed here on the unit." "When you feel like swearing come and talk to me." "Swearing is a sign of disrespect." "Unit rules are made to keep everyone safe." "You will lose television privileges for 24 hours if you ignore a unit rule."

"Swearing is not allowed here on the unit." "You will lose television privileges for 24 hours if you ignore a unit rule." "When you feel like swearing come and talk to me." Explanation: Limit setting involves three steps:1. Inform clients of the rule or limit.2. Explain the consequences if clients exceed the limit.3. State expected behavior.The remaining options are explanations as to why swearing is not allowed.

A 9-year-old client with attention deficit hyperactivity disorder (ADHD) has been placed on the stimulant methylphenidate. The nurse knows that the teaching has been effective when the client's parents state what? "The client will have an effect from this drug in about 2 weeks." "The client knows that the client only needs to take this medication once every 12 hours." "The client may have some side effects, like insomnia, loss of appetite, or weight loss, but they are rare." "We'll bring the client in every week to get blood levels drawn."

"The client may have some side effects, like insomnia, loss of appetite, or weight loss, but they are rare." Rationale:The most common side effects of common medications used to treat ADHD, such as methylphenidate, include insomnia, loss of appetite, and weight loss or failure to gain weight.

Which question is an appropriate question that provides information regarding a child's self-concept? "Do you have friends at school?" "Do you get along with your parents about food?" "If you were stranded on an island, what three things would you want to have?" "What do you want to do when you grow up?"

"What do you want to do when you grow up?" Explanation: Other ways to assess a child's self-concept include asking the child what the child wants to do when they grow up, what their best subjects are in school, what things they are really good at, and how well liked they are at school.

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 95 75 85

65 Explanation: The usual threshold for intellectual disability is an IQ of 70 or less (i.e., two standard deviations below the population mean).

Below average intellectual functioning is initially diagnosed when an intelligence quotient (IQ) is below which level? 20 50 35 70

70 Explanation: The essential feature of intellectual disability is below-average intellectual functioning (IQ less than 70) accompanied by significant limitations in areas of adaptive functioning such as communication skills, self-care, home living, social or interpersonal skills, use of community resources, self-direction, academic skills, work, leisure, and health and safety.

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.

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.

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.

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.

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 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.

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

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.

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

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.

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: 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.

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."

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.

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, 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.

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

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.

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.

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.

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

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.

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.

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.

After teaching a group of nursing students about pharmacotherapy and attention deficit hyperactivity disorder (ADHD), the instructor determines that the education was successful when they identify which agent as one of the first-line choices for treatment? A. Atomoxetine B. Clonidine C. Guanfacine D. Bupropion

A. Atomoxetine

A nurse is assessing a child who had an episode of passing feces in the classroom. The child has no other disabilities. The nurse concludes that the child had intentional encopresis. Which other condition is the child likely to have? A. Conduct disorder B. Expressive language disorder C. Tourette's disorder D. Rett's disorder

A. Conduct disorder

A nurse is caring for a child with enuresis. The child does not have any abnormalities associated with development or behavior. Which drug would the child be prescribed to treat the condition? A. Imipramine B. Atomoxetine C. Risperidone D. Dextroamphetamine

A. Imipramine

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. A. Insomnia B. Hypotension C. Weight loss D. Appetite suppression E. Weight gain

A. Insomnia C. Weight loss D. Appetite suppression

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

A. Selective serotonin and norepinephrine reuptake inhibitor (SSNRI)

Which is a disturbance of the normal fluency and time patterning of speech? A. Stuttering B. Expressive language disorder C. Phonologic disorder D. Mixed receptive-expressive language disorder

A. Stuttering

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? A. Tourette's syndrome B. Autism spectrum disorder C. Mixed receptive-expressive language disorder D. Phonological disorder

A. Tourette's syndrome

Which are nursing actions that support active listening? Select all that apply. A. Use appropriate vocabulary B. Use reflective comments C. Use a computer to write out observations D. Sit with arms and legs crossed E. Interrupt conversations to ask more questions

A. Use appropriate vocabulary B. Use reflective comments

Which medication classification is used in the treatment of tic disorders? Antidepressants Antimanics Anxiolytics Antipsychotics

Antipsychotics Rationale:Tic disorders are usually treated with risperidone or olanzapine.

Which action provides first-hand information about the issue and reinforces interest in the child's viewpoint during the assessment? Inquire about the school report card. Solicit information regarding after school activities the child is involved in. Request that the child interpret the parent's concerns. Ask about the history of the current problem.

Ask about the history of the current problem. Explanation: Directly asking the child as many questions as possible is generally the best way to get accurate, first-hand information and reinforces interest in the child's viewpoint. Some areas to ask about include the history of the current problem, previous psychiatric experiences, family psychiatric history, medical problems, peer relationship, and family functioning.

Which is an antidepressant used to treat attention deficit hyperactivity disorder (ADHD)? Atomoxetine Amphetamine Dextreamphetamine Pemoline

Atomoxetine Rationale:Atomexetine is an antidepressant used for the treatment of ADHD. All of the other options are stimulants.

Which common disorder of childhood accounts for the most referrals in children? Autism Intellectual disability Conduct disorder Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) Rationale:ADHD, a common disorder of childhood, accounts for most referrals in children. A child who suffers from ADHD often exhibits poor academic performance, strain family relations, and is rejected by peers.

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.

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.

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?"

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.

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

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.

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.

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.

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."

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.

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: 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.

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.

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.

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.

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.

4. Which of the following symptoms are characteristic of ADHD? Select all that apply. A) Enuresis B) Inattentiveness C) Encopresis D) Overactivity E) Impulsiveness

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.

Which term describes the use of socially unacceptable words, which are frequently obscene? A. Palilalia B. Coprolalia C. Echolalia D. None of the above

B. Coprolalia

Which medication is effective in 70% to 80% of children with attention deficit hyperactivity disorder (ADHD)? A. Pemoline B. Methylphenidate C. Dextroamphetamine D. Amphetamine

B. Methylphenidate

Which type of intervention may be helpful for children who are bullies? A. Art therapy B. Social skills training C. Bibliotherapy D. Play therapy

B. Social skills training

During a comprehensive assessment of a child, which person does the nurse interview first? A. grandparents B. child C. parent D. caregiver

B. child

A variety of areas are assessed during the mental status examination. Which are sections of the mental status examination? Select all that apply. A. religious background B. cognition C. gross and fine motor movement D. academic interests E. intellectual functioning

B. cognition C. gross and fine motor movement E. intellectual functioning

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."

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.

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: 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.

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.

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.

Which medication classification is used in the treatment of tic disorders? A. Antimanics B. Anxiolytics C. Antipsychotics D. Antidepressants

C. Antipsychotics

Nurses who work in a pediatric psychiatric-mental health facility should do what? A. Ensure that their own physical and mental health needs are placed above those of the clients. B. Use self-disclosure of personal struggles with problems of childhood and adolescence with clients. C. Develop self-awareness of issues that remind them of their own childhood and adolescence. D. Ensure that their professional life is a higher priority than their personal life.

C. Develop self-awareness of issues that remind them of their own childhood and adolescence.

Which is considered a hyperactive/impulsive behavior seen in attention deficit hyperactivity disorder (ADHD)? A. Frequent forgetfulness in daily activities B. Avoiding tasks requiring mental effort C. Inability to play quietly D. Making careless mistakes

C. Inability to play quietly

A nurse is assessing a child who is suspected of having attention deficit hyperactivity disorder. Which would the nurse identify as reflecting impulsiveness in the child? A. Restlessness B. Inability to wait the child's turn C. Risk-taking behavior D. Difficulty completing a task

C. Risk-taking behavior

A nurse is assessing a child who had an episode of passing feces in the classroom. The child has no other disabilities. The nurse concludes that the child had intentional encopresis. Which other condition is the child likely to have? Expressive language disorder Conduct disorder Tourette's disorder Rett's disorder

Conduct disorder Explanation: Intentional passing of feces in inappropriate places like the classroom is referred to as intentional encopresis. This condition is mostly associated with conduct disorder or oppositional defiant disorder. The child does not show any impairment in normal functioning. Rett's disorder is a type of pervasive developmental disorder characterized by the development of multiple deficits over a period of normal functioning. In Tourette's disorder, the child engages in multiple motor and vocal stereotypical behaviors. In expressive language disorder, the child has difficulty communicating through verbal or sign language. Such behavior is not evident in the assessment.

A nurse is assessing a child who had an episode of passing feces in the classroom. The child has no other disabilities. The nurse concludes that the child had intentional encopresis. Which other condition is the child likely to have? Conduct disorder Tourette's disorder Expressive language disorder Rett's disorder

Conduct disorder Rationale:Intentional passing of feces in inappropriate places like the classroom is referred to as intentional encopresis. This condition is mostly associated with conduct disorder or oppositional defiant disorder. The child does not show any impairment in normal functioning. Rett's disorder is a type of pervasive developmental disorder characterized by the development of multiple deficits over a period of normal functioning. In Tourette's disorder, the child engages in multiple motor and vocal stereotypical behaviors. In expressive language disorder, the child has difficulty communicating through verbal or sign language. Such behavior is not evident in the assessment.

Which term describes the use of socially unacceptable words, which are frequently obscene? None of the above Palilalia Coprolalia Echolalia

Coprolalia Rationale:Coprolalia is the use of socially unacceptable words, which are frequently obscene. Palilalia is the repeating of one's own words or sounds. Echolalia is the repeating of the last heard sound, word, or phrase.

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."

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.

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

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.

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.

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.

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."

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.

The mental health nurse assesses for the most common mental health disorder found in children when asking which question? A. "Do you ever hear voices in your head telling you what to do?" B. "What makes you afraid or nervous?" C. "Are you sad often?" D. "Do you ever get scolded at school for not sitting still?

D. "Do you ever get scolded at school for not sitting still?

A nurse is speaking to the parents of a child with attention deficit hyperactivity disorder (ADHD). The parents ask the nurse about the reason for the child's underachievement in academics. What explanation given by the nurse is most appropriate? A. "Your child does not attend classes." B. "Your child has impaired cognitive abilities." C. "Your child has difficulty with reading and writing." D. "Your child has trouble following the teacher's directions."

D. "Your child has trouble following the teacher's directions."

The nurse is assessing a child diagnosed with expressive language disorder. During the assessment, the parents tell the nurse the child had normal speech development until around 3 years of age when the child was involved in a serious car accident. Which part of the body may be affected in the child? A. Tongue B. Vocal cords C. Auditory canal D. Brain

D. Brain

The nurse is teaching a client's parents about managing the child's tic disorder. The nurse explains that it is extremely important for the child to get plenty of rest. What is the primary reason for the nurse to provide this education? Choose the best answer. A. Mental stress from the disorder could make the child depressed. B. Good sleep may normalize the transmission of dopamine. C. Repetitive motor movements cause fatigue, and the child needs rest. D. Physical stress and fatigue can increase symptoms in tic disorder.

D. Physical stress and fatigue can increase symptoms in tic disorder.

The nurse understands the importance of developing rapport with family members before the evaluation when caring for children with psychiatric disorders. The main reason for doing this is what? A. Reducing cost of stay B. Reducing fear of rejection C. Reducing length of stay D. Reducing anxiety

D. Reducing anxiety

Which condition is characterized by multiple motor tics and one or more vocal tics many times throughout the day for 1 year or more? A. Attention deficit hyperactivity disorder B. Asperger's syndrome C. Trichotillomania D. Tourette syndrome

D. Tourette syndrome

The nurse working with pediatric clients knows the importance of checking for developmental delays, which not only slow the child's progress but also are often associated with what? Bullying Normalization Resilience Development of poor self-esteem

Development of poor self-esteem Explanation: Developmental delays not only slow a child's progress but also can interfere with the development of positive self-esteem.

A nurse is assessing an 8-year-old child. The child is unable to dress the self and is not able to manipulate toys, such as building blocks. The child stutters while talking. The child does not have impaired motor coordination. What is the most likely diagnosis of the child? Developmental coordination disorder Tic disorder Cerebral palsy Learning disorder

Developmental coordination disorder Explanation: Developmental coordination disorder is characterized by impaired coordination, which interferes with activities such as dressing and manipulating toys. A communication disorder, such as stuttering, often coexists with the condition. The child does not show any stereotypical motor or vocal behavior, thus the child does not have tic disorder. An inability to read, write, and do math is not found in this child; thus the child does not have a learning disorder. Motor coordination is not impaired; this indicates that the child does not have a motor disorder, such as cerebral palsy or muscular dystrophy.

The nurse is developing a care plan for a client diagnosed with attention deficit hyperactivity disorder (ADHD). The nurse teaches the client to take the last dose of dextroamphetamine when? At 6 p.m. At noon At 9 p.m. Early in the afternoon

Early in the afternoon Rationale:Giving stimulants during daytime hours usually effectively combats insomnia, which is a side effect of stimulants.

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

Effects on siblings Explanation: Family members of children with ADHD may experience disrupted routines and the strain of caretaking. The client may victimize siblings, who may feel unprotected because the parents are too emotionally overwhelmed to deal successfully with the situation.

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? Perinatal complications Environment Genetic syndromes Exposure to hazardous chemicals

Genetic syndromes Explanation: Although exposure to toxins, perinatal complications, and environmental effects are associated with intellectual disability, the most common etiology is related to genetic syndromes.

Which intervention assists the nurse to gain rapport with the child and parent? Greet the child in friendly, personal way. Give paperwork to caregiver to complete. Discuss the history with the caregiver. Introduce child and caregiver to staff.

Greet the child in friendly, personal way. Explanation: The assessment interview is the initial contact between the child and parent or caregiver and the nurse. The first step is to establish rapport by greeting the child or adolescent in a friendly, polite, open manner and putting him or her at ease.

A child is taking methylphenidate for treatment of attention deficit hyperactivity disorder (ADHD). Which side effect must be monitored in this child? Growth delays Increased appetite Weight gain Polyuria

Growth delays Rationale:Nursing considerations when administering methylphenidate include monitoring appetite suppression or growth delays.

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

Has a habit of not waiting for a turn Frequently acts out during class "quiet time" Does not acknowledge others' right to select group activities Throws a temper tantrum when asked to clean up toys Rationale:The care plan of a 6-year-old child diagnosed with ADHD includes interventions to help manage the client's temper tantrums and acting out, refusal to acknowledge others' right to select group activities, and habit of not waiting for their turn, and to prevent physically intrusive behavior while playing.

A nurse is caring for a child with enuresis. The child does not have any abnormalities associated with development or behavior. Which drug would the child be prescribed to treat the condition? Imipramine Atomoxetine Dextroamphetamine Risperidone

Imipramine Rationale:Imipramine is an antidepressant drug with a side effect of urinary retention. This drug is commonly used to treat enuresis. The child has no abnormalities associate with behavior, thus the child will not be prescribed psychotropic drug like risperidone. Atomoxetine is an antidepressant drug used to treat attention deficit hyperactivity disorder; this drug is not prescribed for a child with enuresis. Dextroamphetamine is also an antidepressant drug used to treat hyperactivity, impulsivity, and mood lability in children with attention deficit hyperactivity disorder.

A nurse is assessing a child with attention deficit hyperactivity disorder. Which assessment finding is the nurse likely to see in this child? Select all that apply. Impulsiveness Overactivity Stuttering Attentiveness Stereotypical movements

Impulsiveness Overactivity Rationale:Attention deficit hyperactivity disorder is characterized by behaviors like overactivity, impulsiveness, and inattentiveness. Stuttering is a language disorder; it is not associated with attention deficit hyperactivity disorder. The child has attention deficit. Unlike in tic disorder, stereotypical movements are not seen in children with attention deficit hyperactivity disorder.

Which is considered a hyperactive/impulsive behavior seen in attention deficit hyperactivity disorder (ADHD)? Avoiding tasks requiring mental effort Making careless mistakes Frequent forgetfulness in daily activities Inability to play quietly

Inability to play quietly Rationale:Inability to play quietly is a hyperactive/impulsive behavior seen in ADHD. Inattentive behaviors include avoiding tasks that require mental effort, making careless mistakes, and being forgetful in daily activities.

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? Hyperactivity Inattention Impulsiveness Language difficulty

Language difficulty Explanation: A persistent pattern of inattention, hyperactivity, and impulsiveness that interferes with functioning characterizes ADHD. Language difficulties are not associated with ADHD.

An adolescent client says the client has become bored with the video game that has been used as a reward for positive behavior. Which is the most effective intervention for this client? Tell the client that the client no longer has to clean the client's room in order to play. Reinforce to the client that the client selected the video game and the client needs to stick with it. Tell the client that the client has to use this video game to ensure understanding of value. Let the client choose another reward that would be more fun.

Let the client choose another reward that would be more fun. Explanation: Positive rewards need to be viewed as desirable to motivate desired behavior changes.

Which medication is effective in 70% to 80% of children with attention deficit hyperactivity disorder (ADHD)? Amphetamine Pemoline Dextroamphetamine Methylphenidate

Methylphenidate Explanation: Methylphenidate, a common medication for treating ADHD, is effective in 70% to 80% of children who have ADHD. The other stimulants dextroamphetamine and pemoline, and the amphetamine compound Adderall are used to treat ADHD, but they are not as effective as methylphenidate.

Which medication is effective in 70% to 80% of children with attention deficit hyperactivity disorder (ADHD)? Pemoline Dextroamphetamine Amphetamine Methylphenidate

Methylphenidate Rationale:Methylphenidate, a common medication for treating ADHD, is effective in 70% to 80% of children who have ADHD. The other stimulants dextroamphetamine and pemoline, and the amphetamine compound Adderall are used to treat ADHD, but they are not as effective as methylphenidate.

Which is an inattentive behavior seen in attention deficit hyperactivity disorder (ADHD)? Missing details Interrupting Talking excessively Fidgeting

Missing details Rationale:Missing details is an inattentive behavior seen in ADHD. Hyperactive/impulsive behaviors include fidgeting, interrupting, and talking excessively.

What materials would assist the preschool age child to develop rapport with the nurse? Select all that apply. Paint and an easel Puppets Video games Puzzles Dress up clothes

Paint and an easel Puppets Dress up clothes Explanation: When interviewing preschool-aged children, the nurse should understand that these children may have difficulty putting their feelings into works and their thinking is very concrete. The nurse can achieve rapport with preschool-aged children by joining their world by play using paper, pencils, crayons, paints, paint brushes, easels, clay, blocks, balls, dolls, doll houses, puppets, animals, dress-up clothes, and water.

The nurse understands the importance of developing rapport with family members before the evaluation when caring for children with psychiatric disorders. The main reason for doing this is what? Reducing cost of stay Reducing length of stay Reducing anxiety Reducing fear of rejection

Reducing anxiety Explanation: To reduce anxiety about the evaluation, the nurse must develop rapport with the family members. The other options do not reflect the right reasons for developing rapport.

Assessment of a child with autism spectrum disorder reveals stereotypic behavior. Which behavior would the nurse most likely document being demonstrated by the child? Rocking Head banging Pronoun reversal Hand flapping Word repetition

Rocking Head banging Hand flapping Rationale:Stereotypic behavior incudes self-stimulating, nonfunctional, repetitive behaviors such as rocking, hand flapping, and head banging. Word repetition (echolalia) and pronoun reversal are communication difficulties.

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

Selective serotonin and norepinephrine reuptake inhibitor (SSNRI) Explanation: Antidepressant medications, most likely SSNRIs, are used for anxiety, depression, and primarily for ADHD. Mood stabilizers are prescribed primarily for bipolar disorder. These medications may be prescribed off-label. However, there is controversy surrounding the use of SSNRIs and selective serotonin reuptake inhibitors (SSRIs) in children. Nurses need to keep in mind that all medications involve a risk-benefit equation. Given the modest benefit of the SSNRIs and SSRIs and the potential for adverse behavioral effects, these medications merit careful monitoring in children and adolescents.

Which type of intervention may be helpful for children who are bullies? Social skills training Bibliotherapy Art therapy Play therapy

Social skills training Explanation: Social skills training may be particularly helpful for children who are bullies or rejected by their peers.

Which is a disturbance of the normal fluency and time patterning of speech? Phonologic disorder Stuttering Mixed receptive-expressive language disorder Expressive language disorder

Stuttering Explanation: Stuttering is a disturbance of the normal fluency and time patterning of speech. 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.

Which is a disturbance of the normal fluency and time patterning of speech? Phonologic disorder Mixed receptive-expressive language disorder Stuttering Expressive language disorder

Stuttering Rationale:Stuttering is a disturbance of the normal fluency and time patterning of speech. 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.

A nurse is assessing a 2-year-old child diagnosed with autism spectrum disorder. Which findings does the nurse expect to find on assessment? Select all that apply. The child becomes frightened when left alone. The child becomes upset with minor changes in routine. The child avoids eye contact. The child is extremely playful. The child does not relate to parents.

The child avoids eye contact. The child does not relate to parents. The child becomes upset with minor changes in routine. Explanation: Children with autism spectrum disorder tend to avoid eye contact with people. They do not identify or relate to their parents and remain detached. These children get upset with minor changes in routine. Children with autism spectrum disroder do not enjoy engaging in play or make-believe with toys. These children do not get frightened if left alone; in fact, they prefer being left alone.

A nurse is assessing a 2-year-old child diagnosed with autism spectrum disorder. Which findings does the nurse expect to find on assessment? Select all that apply. The child becomes upset with minor changes in routine. The child does not relate to parents. The child is extremely playful. The child avoids eye contact. The child becomes frightened when left alone.

The child becomes upset with minor changes in routine. The child does not relate to parents. The child avoids eye contact. Rationale:Children with autism spectrum disorder tend to avoid eye contact with people. They do not identify or relate to their parents and remain detached. These children get upset with minor changes in routine. Children with autism spectrum disroder do not enjoy engaging in play or make-believe with toys. These children do not get frightened if left alone; in fact, they prefer being left alone.

A nurse is working with a child undergoing behavioral modification therapy for attention deficit hyperactivity disorder (ADHD). The nurse finds that the child is thin. What could be the most likely reason for this observation? The child finds food distasteful. The child has decreased appetite. The child is genetically predisposed to being thin. The child cannot sit through meals.

The child cannot sit through meals. Explanation: Children with ADHD are not patient enough to sit through meals. This results in reduced dietary intake. This is the most likely reason for children with ADHD to be thin. Children with ADHD do not have impaired taste sensation. These children do not have loss of appetite unless they are on drugs like methylphenidate. It is not known whether children with ADHD are genetically predisposed to being thin.

A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The child is given medication and behavioral modification therapy to treat the condition. Which outcome achieved within 3 days would indicate successful therapy? The child is able to express positive statements about the self. The child is able to demonstrate successful interaction with family members over a long period of time. The child is able to interact and to develop successful peer relationships. The child is able to complete assignments or tasks with assistance.

The child is able to complete assignments or tasks with assistance. Explanation: If within 3 days of starting treatment the child with ADHD is able to complete work or assignments with assistance, then this indicates successful therapy. Being able to express positive statements about himself or herself cannot be expected of the child after only 3 days of therapy. The child's ability to develop peer relationships would also not be demonstrated within this time. After 3 days of therapy, the children with ADHD would be able to demonstrate changes like being able to listen to others. They would not be able to interact with family members for a long period of time.

A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The child is given medication and behavioral modification therapy to treat the condition. Which outcome achieved within 3 days would indicate successful therapy? The child is able to complete assignments or tasks with assistance. The child is able to demonstrate successful interaction with family members over a long period of time. The child is able to express positive statements about the self. The child is able to interact and to develop successful peer relationships.

The child is able to complete assignments or tasks with assistance. Rationale:If within 3 days of starting treatment the child with ADHD is able to complete work or assignments with assistance, then this indicates successful therapy. Being able to express positive statements about himself or herself cannot be expected of the child after only 3 days of therapy. The child's ability to develop peer relationships would also not be demonstrated within this time. After 3 days of therapy, the children with ADHD would be able to demonstrate changes like being able to listen to others. They would not be able to interact with family members for a long period of time.

A nurse is assessing a child with attention deficit hyperactivity disorder (ADHD). For every question asked by the nurse, the child answers, "I don't know." What is the most likely reason for the child to respond in this way? The child is not willing to answer the nurse. The child is not able to understand what the nurse is asking. The child does not like talking to the nurse. The child is not paying attention to the nurse's questions.

The child is not paying attention to the nurse's questions. Explanation: Children with ADHD are unable to pay attention and cannot stop their minds from racing. This is the reason for the child with ADHD responding "I don't know" to every question the nurse asks. It is not likely that the child dislikes the nurse. Unlike children with disruptive behavior, children with ADHD are not intentionally unwilling to respond to questions. Children with ADHD do not lack cognition. If they were able to be attentive, they would be able to understand the nurse's question easily.

The nurse is teaching the parents of a child with involuntary enuresis about methods to manage the condition. Which intervention does the nurse recommend to the parents? The child should use pads with a warning bell. The child should begin therapeutic play. The child needs to be taught special exercises. The child's dietary patterns should be changed.

The child should use pads with a warning bell. Rationale:The use of pads with a warning bell as well as positive reinforcement has been shown to help resolve the elimination disorder. This behavioral modification may help the child to void urine voluntarily over a period of time. The child does not pass urine voluntarily, so a change in diet will not help the child. Exercise does not help treat involuntary enuresis. Therapeutic play is used to promote communication in children.

The client is 6-year-old who has been diagnosed with autism spectrum disorder. Which symptom would the client display? The client has multiple motor tics and several vocal tics. 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 spends time alone with little interest in making friends.

The client spends time alone with little interest in making friends. Explanation: Children with autism spectrum disorder develop language slowly or not at all. They may use words without attaching meaning to them or communicate with only gestures or noises. They spend time alone and show little interest in making friends. Autism spectrum disorder is not associated with over attachment, pulling out hair, or tics.

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

Throws a temper tantrum when asked to clean up toys Does not acknowledge others' right to select group activities Frequently acts out during class "quiet time" Has a habit of not waiting for a turn Explanation: The care plan of a 6-year-old child diagnosed with ADHD includes interventions to help manage the client's temper tantrums and acting out, refusal to acknowledge others' right to select group activities, and habit of not waiting for their turn, and to prevent physically intrusive behavior while playing.

A psychiatric-mental health nurse is reviewing an article about genetics and the role in the development of a childhood psychiatric disorder. The nurse demonstrates understanding of this information by identifying which disorder as being genetically transmitted? Tourette's syndrome depression anxiety disorder bulimia

Tourette's syndrome Rationale:Many childhood psychiatric disorders, such as autism, intellectual disability, developmental learning disorders, some language disorders (e.g., dyslexia), attention deficit hyperactivity disorder (ADHD), and Tourette's syndrome, appear to be genetically transmitted. Research increasingly shows that major psychiatric disorders (e.g., depression, anxiety disorder, schizophrenia, bipolar disorder, substance abuse) run in families but are not necessarily identified as being genetically transmitted.

Which are nursing actions that support active listening? Select all that apply. Interrupt conversations to ask more questions Use a computer to write out observations Use appropriate vocabulary Use reflective comments Sit with arms and legs crossed

Use appropriate vocabulary Use reflective comments Explanation: During the comprehensive assessment, the nurse needs to be a good, active listener. Using appropriate vocabulary, tolerating a child's anxious, angry or sad behavior, and use of reflective comments are useful listening skills.

When describing intellectual disability to a group of parents, a nurse would identify which intelligent quotient (or less) as the usual threshold? A. 70 B. 50 C. 60 D. 80

A. 70