Exam 4 4415 Ch 11-21

An 11-year-old diagnosed with oppositional defiant disorder becomes angry over the rules at a residential treatment program and begins shouting at the nurse. What is the nurses initial action to defuse the situation? a. Say to the child, Tell me how youre feeling right now. b. Take the child swimming at the programs pool. c. Establish a behavioral contract with the child. d. Administer an anxiolytic medication.

b. Take the child swimming at the programs pool.

What are the primary distinguishing factors between the behavior of persons diagnosed with oppositional defiant disorder (ODD) and those with conduct disorder (CD)? Select all that apply. The person diagnosed with: a. ODD relives traumatic events by acting them out. b. ODD tests limits and disobeys authority figures. c. ODD has difficulty separating from loved ones. d. CD uses stereotypical or repetitive language. e. CD often violates the rights of others.

b. ODD tests limits and disobeys authority figures. e. CD often violates the rights of others.

A 15-year-old was placed in a residential program after truancy, running away, and an arrest for theft. At the program, the adolescent refused to join in planned activities and pushed a staff member, causing a fall. Which approach by nursing staff will be most therapeutic? a. Planned ignoring b. Establish firm limits c. Neutrally permit refusals d. Coaxing to gain compliance

b. Establish firm limits

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

a. Central nervous system stimulants

A nurse on an adolescent psychiatric unit assesses a newly admitted 14-year-old. An impulse control disorder is suspected. Which aspects of the patients history support the suspected diagnosis? Select all that apply. a. Family history of mental illness b. Allergies to multiple antibiotics c. Long history of severe facial acne d. Father with history of alcohol abuse e. History of an abusive relationship with one parent

a. Family history of mental illness d. Father with history of alcohol abuse e. History of an abusive relationship with one parent

An adolescent was arrested for prostitution and assault on a parent. The adolescent says, I hate my parents. They focus all attention on my brother, whos perfect in their eyes. Which type of therapy might promote the greatest change in the adolescents behavior? a. Family therapy b. Bibliotherapy c. Play therapy d. Art therapy

a. Family therapy

Which nursing diagnosis is universally applicable for children diagnosed with autism spectrum disorders? a. Impaired social interaction related to difficulty relating to others b. Chronic low self-esteem related to excessive negative feedback c. Deficient fluid volume related to abnormal eating habits d. Anxiety related to nightmares and repetitive activities

a. Impaired social interaction related to difficulty relating to others

Which assessment findings support a diagnosis of oppositional defiant disorder? a. Negative, hostile, and spiteful toward parents. Blames others for misbehavior. b. Exhibits involuntary facial twitching and blinking; makes barking sounds. c. Violates others rights; cruelty toward people or animals; steals; truancy. d. Displays poor academic performance and reports frequent nightmares.

a. Negative, hostile, and spiteful toward parents. Blames others for misbehavior.

Parents of an adolescent diagnosed with a conduct disorder say, We dont know how to respond when our child breaks the rules in our house. Is there any treatment that might help us? Which therapy is likely to be helpful for these parents? a. Parent-child interaction therapy (PCIT) b. Behavior modification therapy c. Multi-systemic therapy (MST) d. Pharmacotherapy

a. Parent-child interaction therapy (PCIT)

An adolescent diagnosed with conduct disorder has aggression, impulsivity, hyperactivity, and mood symptoms. The treatment team believes this adolescent may benefit from medication. The nurse anticipates the health care provider will prescribe which type of medication? a. Second-generation antipsychotic b. Anti-anxiety medication c. Calcium channel blocker d. Beta-blocker

a. Second-generation antipsychotic

Soon after parents announced they were divorcing, a child stopped participating in sports, sat alone at lunch, and avoided former friends. The child told the school nurse, If my parents loved me, they would work out their problems. Which nursing diagnosis has the highest priority? a. Social isolation b. Decisional conflict c. Chronic low self-esteem d. Disturbed personal identity

a. Social isolation

A 16-year-old diagnosed with a conduct disorder has been in a residential program for 3 months. Which outcome should occur before discharge? a. The adolescent and parents create and agree to a behavioral contract with rules, rewards, and consequences. b. The adolescent identifies friends in the home community who are a positive influence. c. Temporary placement is arranged with a foster family until the parents complete a parenting skills class. d. The adolescent experiences no anger and frustration for 1 week.

a. The adolescent and parents create and agree to a behavioral contract with rules, rewards, and consequences.

Which assessment finding would cause the nurse to consider a child to be most at risk for the development of mental illness? a. The child has been raised by a parent with chronic major depression. b. The childs best friend was absent from the childs birthday party. c. The child was not promoted to the next grade one year. d. The child moved to three new homes over a 2-year period.

a. The child has been raised by a parent with chronic major depression.

The child prescribed an antipsychotic medication to manage violent behavior is one most likely diagnosed with: a. attention deficit hyperactivity disorder. b. posttraumatic stress disorder. c. communication disorder. d. an anxiety disorder.

a. attention deficit hyperactivity disorder.

A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. The child formed a trusting relationship with a shelter volunteer. The child says, My three friends and I got an A on our school science project. The nurse can assess that the child: a. displays resiliency. b. has a passive temperament. c. is at risk for posttraumatic stress disorder. d. uses intellectualization to deal with problems.

a. displays resiliency.

A child reports to the school nurse of being verbally bullied by an aggressive classmate. What is the nurses best first action? a. Give notice to the chief administrator at the school regarding the events. b. Encourage the victimized child to share feelings about the experience. c. Encourage the victimized child to ignore the bullying behavior. d. Discuss the events with the aggressive classmate.

b. Encourage the victimized child to share feelings about the experience.

A nurse prepares to lead a discussion at a community health center regarding childrens health problems. The nurse wants to use current terminology when discussing these issues. Which terms are appropriate for the nurse to use? Select all that apply. a. Autism b. Bullying c. Mental retardation d. Autism spectrum disorder e. Intellectual development disorder

b. Bullying d. Autism spectrum disorder e. Intellectual development disorder

At the time of a home visit, the nurse notices that each parent and child in a family has his or her own personal online communication device. Each member of the family is in a different area of the home. Which nursing actions are appropriate? Select all that apply. a. Report the finding to the official child protection social services agency. b. Educate all members of the family about risks associated with cyberbullying. c. Talk with the parents about parental controls on the childrens communication devices. d. Encourage the family to schedule daily time together without communication devices. e. Obtain the familys network password and examine online sites family members have visited.

b. Educate all members of the family about risks associated with cyberbullying. c. Talk with the parents about parental controls on the childrens communication devices. d. Encourage the family to schedule daily time together without communication devices.

A nurse works with an adolescent who was placed in a residential program after multiple episodes of violence at school. Establishing rapport with this adolescent is a priority because: (select all that apply) a. it is a vital component of implementing a behavior modification program. b. a therapeutic alliance is the first step in a nurses therapeutic use of self. c. the adolescent has demonstrated resistance to other authority figures. d. acceptance and trust convey feelings of security for the adolescent. e. adolescents usually relate better to authority figures than peers.

b. a therapeutic alliance is the first step in a nurses therapeutic use of self. d. acceptance and trust convey feelings of security for the adolescent.

A child known as the neighborhood bully says, Nobody can tell me what to do. After receiving a poor grade on a science project, this child secretly loaded a virus on the teachers computer. These behaviors support a diagnosis of: a. conduct disorder. b. oppositional defiant disorder. c. intermittent explosive disorder. d. attention deficit hyperactivity disorder.

b. oppositional defiant disorder.

An adolescent was arrested for prostitution and assault on a parent. The adolescent says, I hate my parents. They focus all attention on my brother, whos perfect in their eyes. Which nursing diagnosis is most applicable? a. Disturbed personal identity related to acting out as evidenced by prostitution b. Hopelessness related to achievement of role identity as evidenced by feeling unloved by parents c. Ineffective coping related to inappropriate methods of seeking parental attention as evidenced by acting out d. Impaired parenting related to inequitable feelings toward children as evidenced by showing preference for one child over another

c. Ineffective coping related to inappropriate methods of seeking parental attention as evidenced by acting out

A nurse works with a child who is sad and irritable because the childs parents are divorcing. Why is establishing a therapeutic alliance with this child a priority? a. Therapeutic relationships provide an outlet for tension. b. Focusing on the strengths increases a persons self-esteem. c. Acceptance and trust convey feelings of security to the child. d. The child should express feelings rather than internalize them.

c. Acceptance and trust convey feelings of security to the child.

An 11-year-old diagnosed with oppositional defiant disorder becomes angry over the rules at a residential treatment program and begins cursing at the nurse. Select the best method for the nurse to defuse the situation. a. Ignore the childs behavior. b. Send the child to time-out. c. Accompany the child to the gym and shoot baskets. d. Role-play a more appropriate behavior with the child.

c. Accompany the child to the gym and shoot baskets.

An adolescent acts out in disruptive ways. When this adolescent threatens to throw a pool ball at another adolescent, which comment by the nurse would set appropriate limits? a. Attention everyone: we are all going to the craft room. b. You will be taken to seclusion if you throw that ball. c. Do not throw the ball. Put it back on the pool table. d. Please do not lose control of your emotions.

c. Do not throw the ball. Put it back on the pool table.

A child diagnosed with attention deficit hyperactivity disorder (ADHD) shows hyperactivity, aggression, and impaired play. The health care provider prescribed amphetamine salts (Adderall). The nurse should monitor for which desired behavior? a. Increased expressiveness in communication with others b. Abilities to identify anxiety and implement self-control strategies c. Improved abilities to participate in cooperative play with other children d. Tolerates social interactions for short periods without disruption or frustration

c. Improved abilities to participate in cooperative play with other children

Assessment data for a 7-year-old reveals an inability to take turns, blurting out answers to questions before a question is complete, and frequently interrupting others conversations. How should the nurse document these behaviors? a. Disobedience b. Hyperactivity c. Impulsivity d. Anxiety

c. Impulsivity

Shortly after the parents announced that they were divorcing, a 15-year-old became truant from school and assaulted a friend. The adolescent told the school nurse, Id rather stay in my room and listen to music. Its easie than thinking about what is happening in my family. Which nursing diagnosis is most applicable? a. Chronic low self-esteem related to role within the family b. Decisional conflict related to compliance with school requirements c. Ineffective coping related to adjustment to changes in family relationships d. Disturbed personal identity related to self-perceptions of changing family dynamics

c. Ineffective coping related to adjustment to changes in family relationships

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

c. Living with an alcoholic parent

An adolescent was recently diagnosed with oppositional defiant disorder. The parents say to the nurse, Isnt there some medication that will help with this problem? Select the nurses best response. a. There are no medications to treat this problem. This diagnosis is behavioral in nature. b. Its a common misconception that there is a medication available to treat every health problem. c. Medication is usually not prescribed for this problem. Lets discuss some behavioral strategies you can use. d. There are many medications that will help your child manage aggression and destructiveness. The health care provider will discuss them with you.

c. Medication is usually not prescribed for this problem. Lets discuss some behavioral strategies you can use.

A nurse will prepare teaching materials for the parents of a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which medication will the information focus on? a. Paroxetine (Paxil) b. Imipramine (Tofranil) c. Methyphenidate (Ritalin) d. Carbamazepine (Tegretol)

c. Methyphenidate (Ritalin)

An adolescent diagnosed with a conduct disorder stole and wrecked a neighbors motorcycle. Afterward, the adolescent was confronted about the behavior but expressed no remorse. Which variation in the central nervous system best explains the adolescents reaction? a. Serotonin dysregulation and increased testosterone activity impair ones capacity for remorse. b. Increased neuron destruction in the hippocampus results in decreased abilities to conform to social rules. c. Reduced gray matter in the cortex and dysfunction of the amygdala results in decreased feelings of empathy. d. Disturbances in the occipital lobe reduce sensations that help an individual clearly visualize the consequences of behavior.

c. Reduced gray matter in the cortex and dysfunction of the amygdala results in decreased feelings of empathy.

What is the nurses priority focused assessment for side effects in a child taking methylphenidate (Ritalin) for attention deficit hyperactivity disorder (ADHD)? a. Dystonia, akinesia, and extrapyramidal symptoms b. Bradycardia and hypotensive episodes c. Sleep disturbances and weight loss d. Neuroleptic malignant syndrome

c. Sleep disturbances and weight loss

A desired outcome for a 12-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care? a. Reality therapy b. Simple restitution c. Social skills group d. Insight-oriented group therapy

c. Social skills group

The parent of a child diagnosed with Tourettes disorder says to the nurse, I think my child is faking the tics because they come and go. Which response by the nurse is accurate? a. Perhaps your child was misdiagnosed. b. Your observation indicates the medication is effective. c. Tics often change frequency or severity. That doesnt mean they arent real. d. This finding is unexpected. How have you been administering your childs medication?

c. Tics often change frequency or severity. That doesnt mean they arent real.

Which behavior indicates that the treatment plan for a child diagnosed with an autism spectrum disorder was effective? The child: a. plays with one toy for 30 minutes. b. repeats words spoken by a parent. c. holds the parents hand while walking. d. spins around and claps hands while walking.

c. holds the parents hand while walking.

A nurse prepares the plan of care for a 15-year-old diagnosed with moderate intellectual developmental disorder. What are the highest outcomes that are realistic for this patient? Within 5 years, the patient will: (select all that apply) a. graduate from high school. b. live independently in an apartment. c. independently perform own personal hygiene. d. obtain employment in a local sheltered workshop. e. correctly use public buses to travel in the community.

c. independently perform own personal hygiene. d. obtain employment in a local sheltered workshop. e. correctly use public buses to travel in the community.

When group therapy is prescribed as a treatment modality, the nurse would suggest placement of a 9-yearold in a group that uses: a. guided imagery. b. talk focused on a specific issue. c. play and talk about a play activity. d. group discussion about selected topics.

c. play and talk about a play activity.

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

c. reduce loneliness and increase self-esteem.

When a 5-year-old is disruptive, the nurse says, You must take a time-out. The expectation is that the child will: a. go to a quiet room until called for the next activity. b. slowly count to 20 before returning to the group activity. c. sit on the edge of the activity until able to regain self-control. d. sit quietly on the lap of a staff member until able to apologize for the behavior.

c. sit on the edge of the activity until able to regain self-control.

Which child demonstrates behaviors indicative of a neurodevelopmental disorder? a. A 4-year-old who stuttered for 3 weeks after the birth of a sibling b. A 9-month-old who does not eat vegetables and likes to be rocked c. A 3-month-old who cries after feeding until burped and sucks a thumb d. A 3-year-old who is mute, passive toward adults, and twirls while walking

d. A 3-year-old who is mute, passive toward adults, and twirls while walking

A 15-year-old ran away from home six times and was arrested for shoplifting. The parents told the court, We cant manage our teenager. The adolescent is physically abusive to the mother and defiant with the father. Which diagnosis is supported by this adolescents behavior? a. Attention deficit hyperactivity disorder (ADHD) b. Posttraumatic stress disorder (PTSD) c. Intermittent explosive disorder d. Conduct disorder

d. Conduct disorder

The family of a child diagnosed with an impulse control disorder needs help to function more adaptively. Which aspect of the childs plan of care will be provided by an advanced practice nurse rather than a staff nurse? a. Leading an activity group b. Providing positive feedback c. Formulating nursing diagnoses d. Dialectical behavioral therapy (DBT)

d. Dialectical behavioral therapy (DBT)

A 4-year-old cries for 5 minutes when the parents leave the child at preschool. The parents ask the nurse, What should we do? Select the nurses best response. a. Ask the teacher to let the child call you at play time. b. Withdraw the child from preschool until maturity increases. c. Remain with your child for the first hour of preschool time. d. Give your child a kiss before you leave the preschool program.

d. Give your child a kiss before you leave the preschool program.

An adolescent diagnosed with an impulse control disorder said, I just want to die. I spend all my time getting even with people who have done wrong to me. When asked about a suicide plan, the adolescent replied Ill jump from the bridge near my home. My father threw kittens off that bridge, and they died because they couldnt swim. Rate the suicide risk. a. Absent b. Low c. Moderate d. High

d. High

When a 5-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) bounces out of a chair and runs over and slaps another child, what is the nurses best action? a. Instruct the parents to take the aggressive child home. b. Direct the aggressive child to stop immediately. c. Call for emergency assistance from other staff. d. Take the aggressive child to another room.

d. Take the aggressive child to another room.

The parent of a 6-year-old says, My child is in constant motion and talks all the time. My child isnt interested in toys but is out of bed every morning before me. The childs behavior is most consistent with diagnostic criteria for: a. communication disorder. b. stereotypic movement disorder. c. intellectual development disorder. d. attention deficit hyperactivity disorder.

d. attention deficit hyperactivity disorder.

A 12-year-old has engaged in bullying for several years. The parents say, We cant believe anything our child says. Recently this child shot a dog with a pellet gun and set fire to a neighbors trash bin. The childs behaviors support the diagnosis of: a. attention deficit hyperactivity disorder. b. intermittent explosive disorder. c. defiance of authority. d. conduct disorder.

d. conduct disorder.

A nurse assesses a 3-year-old diagnosed with an autism spectrum disorder. Which finding is most associated with the childs disorder? The child: a. has occasional toileting accidents. b. is unable to read childrens books. c. cries when separated from a parent. d. continuously rocks in place for 30 minutes.

d. continuously rocks in place for 30 minutes.

A child diagnosed with attention deficit hyperactivity disorder had this nursing diagnosis: impaired social interaction related to excessive neuronal activity as evidenced by aggression and demanding behavior with others. Which finding indicates the plan of care was effective? The child: a. has an improved ability to identify anxiety and use self-control strategies. b. has increased expressiveness in communication with others. c. shows increased responsiveness to authority figures. d. engages in cooperative play with other children.

d. engages in cooperative play with other children.