Unit 6 - Development (Autism/ADD/ADHD) - NCO
A nurse is assessing a child with suspected autism. At what age does the nurse determine that the signs of autism initially may be evident? 1 2 years 2 6 years 3 6 months 4 1 to 3 months
1 2 years By 2 years of age the child should demonstrate an interest in others, communicate verbally, and possess the ability to learn from the environment. Before the age when these skills develop, autism is difficult to diagnose. Usually by 3 years the signs of autism become more profound. Autism can be diagnosed long before a child is 6 years old. Infantile autism may occur in an infant of 1 to 3 months, but at this age it is difficult to diagnose.
A 4-year-old child is found to have attention deficit-hyperactivity disorder (ADHD). What information about the child's behavior should the nurse expect when obtaining a health history from the parents? Select all that apply. 1 Impulsiveness 2 Excessive talking 3 Spitefulness and vindictiveness 4 Deliberate annoyance of others 5 Playing video games for hours on end 6 Failure to follow through or finish tasks
1 Impulsiveness 2 Excessive talking 5 Playing video games for hours on end 6 Failure to follow through or finish tasks Impulsivity, the inability to limit or control words or actions, results in spontaneous, irresponsible verbalizations or behaviors. Hyperactivity occurs with both words and actions. Games that are fun, engaging, and interactive often maintain the focus of a child with ADHD. Inattention and distractibility result in inability to focus long enough to complete tasks. Being spiteful and vindictive toward others is characteristic of oppositional defiant disorder. Annoying others deliberately is associated with oppositional defiant disorder; children with ADHD may be annoying, but their behavior is not deliberate.
A nurse is interviewing a child with attention deficit disorder. For which major characteristic should the nurse assess this child? 1 Overreaction to stimuli 2 Continued use of rituals 3 Delayed speech development 4 Inability to use abstract thought
1 Overreaction to stimuli A universal characteristic of children with attention deficit disorder is distractibility. They are highly reactive to any extraneous stimuli, such as noise and movement, and are unable to inhibit their responses to such stimuli. Rituals are uncommon, although these children do use repetition in language and movement. Delayed development of language skills is not the major problem, but children with attention deficit disorder may exhibit dyslexia (reading difficulty), dysgrammatism (speaking difficulty), dysgraphia (writing difficulty), or delayed speech. Loss of abstract thought is not a universal characteristic associated with children with attention deficit disorder.
The nurse is caring for a child who has attention deficit-hyperactivity disorder (ADHD). Which changes in the child's classroom will be beneficial? Select all that apply. 1 Providing breaks frequently at regular intervals 2 Writing instructions on the blackboard after verbalization 3 Increasing the number of classroom assignments and homework 4 Improving the writing skills of the child compared with computer skills 5 Scheduling academic subjects for times when the child is under the effect of medication
1 Providing breaks frequently at regular intervals 2 Writing instructions on the blackboard after verbalization 5 Scheduling academic subjects for times when the child is under the effect of medication A child with ADHD will not be able to concentrate properly and experiences difficulty sitting in one place for a prolonged time. Therefore frequent breaks are helpful to improve the child's concentration. Visual representations also help attract attention and improve concentration. Therefore it is appropriate to write instructions after saying them. The child will have increased concentration under the effect of medication, which is generally in the morning. Therefore academic subjects should be scheduled for the morning. A child with ADHD will have dysgraphia, or poor handwriting. Therefore it is appropriate to concentrate on improving the child's computer skills, instead of improving handwriting. It is appropriate to allot more time to take tests and help the child complete tasks rather than giving homework and assignments.`
Methylphenidate has been prescribed for a 7-year-old child with attention deficit-hyperactivity disorder (ADHD) and is to be taken with meals. What rationale does the nurse provide for the parents about the timing of medication administration? 1 Ritalin depresses the appetite. 2 This will ensure proper absorption. 3 It is an oral mucous membrane irritant. 4 Children tend to forget to take it before meals.
1 Ritalin depresses the appetite. A side effect of methylphenidate is anorexia; it should be given during or immediately after breakfast. The absorption rate is not affected by the timing of when it is given. Oral mucous membrane irritation is not a side effect of methylphenidate. In a child of this age the parents are responsible for administering medications.
A mother of a 6-year-old boy with the diagnosis of attention deficit-hyperactivity disorder (ADHD) tells the nurse that when she is reading storybooks to her son, about halfway through the story he becomes distracted, fidgets, and stops paying attention. What should the nurse suggest to the mother? 1 "Talk with a louder voice." 2 "Shorten the rest of the story." 3 "Encourage your son to pay attention." 4 "Use therapeutic holding for the rest of the story."
2 "Shorten the rest of the story." Shortening the story nonjudgmentally limits the activity while supporting the child's self-esteem; the child with ADHD cannot control his inattention and hyperactivity. The mother should select activities that are more interactive or interesting for the child to engage his attention. The child does not have a hearing problem, and speaking louder will not change the behavior. Inattention and hyperactivity cannot be controlled; encouraging the child to pay attention may precipitate feelings of doubt, shame, or guilt and reinforce low self-esteem. Using therapeutic holding for the rest of the story is unnecessary in this situation; therapeutic holding is used when a child is out of control and at risk for self-harm or violence toward others; it reassures the child that the adult is in control and promotes feelings of security and comfort.
A nurse understands that autism is a form of a pervasive developmental disorder (PDD). Which factor unique to autism differentiates it from other forms of PDD? 1 Less severe linguistic handicaps 2 Early onset, before 36 months of age 3 The only form that does not include seizures 4The only form that does not include cognitive impairment
2 Early onset, before 36 months of age Autism impairs bonding and communication and therefore becomes apparent early in life. Autism involves both delayed and deviant linguistic problems. About 25% of children with autism have a seizure disorder. Autism may, and often does, include cognitive impairment.
A 6-year-old child with autism is nonverbal and makes limited eye contact. What should the nurse do initially to promote social interaction? 1 Encourage the child to sing songs with the nurse. 2 Engage in parallel play while sitting next to the child. 3 Provide opportunities for the child to play with other children. 4 Use therapeutic holding when the child does not respond to verbal interactions.
2 Engage in parallel play while sitting next to the child. Entering the child's world in a nonthreatening way helps promote trust and eventual interaction with the nurse. Using therapeutic holding may be necessary when a child initiates self-mutilating behaviors. Singing songs with the child participating or providing opportunities for the child to play with other children is unrealistic at this time; playing with others is a long-term objective.
A second-grade teacher discusses the behavior of one of the students with the school nurse. The school nurse suspects that the child has attention deficit-hyperactivity disorder (ADHD). Which finding often is associated with ADHD? 1 Hostility 2 Impulsivity 3 Excellent testing ability 4 Positive peer relationships
2 Impulsivity Criteria for diagnosis of ADHD include maladaptive behavior lasting at least 6 months and characterized by inattention, impulsiveness, and overactivity. Impulsivity often results in unsafe behaviors. Hostility is more characteristic of oppositional defiant disorder. Excellent testing ability is unexpected in ADHD. Inattention to detail, careless mistakes, and difficulty organizing work, which are associated with ADHD, hinder the affected child's test-taking ability. Peer relationships are usually strained and of short duration.
A 3-year-old client has been admitted to the pediatric unit for dehydration resulting from nausea and vomiting. The parents tell the nurse the child has autism and resists being held, acts as if deaf, frequently mimics words or phrases, and is not toilet trained. What is most important for the nurse to do when planning care for this child? 1 Provide a structured routine for the child to follow while in the hospital 2 Involve the parents in the plan of care and encourage their being with the child as much as possible 3 Place the child in a semiprivate room near the nurses' station where activities can be seen and heard 4 Assign different personnel to the child until it is determined which staff members the child relates to best, and then use them to enhance the nurse-child relationship
2 Involve the parents in the plan of care and encourage their being with the child as much as possible The parents should stay with the child during hospitalization to preserve stability and consistency for the child. Although providing a structured routine is important, it is not the priority. Ensuring parental support is the priority. Decreased stimulation is essential; using a private room and avoiding extraneous auditory and visual distraction may decrease the disruptiveness of hospitalization. Assigning different personnel will increase the irritability and frustration of the child; consistency and stability are essential for the child's well-being, and the same staff members should be assigned to care for the child.
The nurse is planning care for a school-aged child with autism spectrum disorder (ASD) who has been hospitalized for some tests. Which intervention should the nurse plan to implement? 1 Providing adequate stimulation through play 2 Placing the child in a private room 3 Encouraging staff to visit the child frequently 4Giving detailed explanations about the upcoming tests
2 Placing the child in a private room The child with ASD should be placed in a private room. Decreasing stimulation by placing the child in a private room may lessen the disruptiveness of hospitalization. Play should be carefully planned; overstimulation can precipitate behavioral outbursts. Children with ASD need to be introduced slowly to new situations, with visits from staff caregivers kept short whenever possible. Because these children have difficulty organizing their behavior and redirecting their energy, they need to be told directly what to do. Explanations about tests should be at the child's developmental level, brief, and concrete.
A child is found to have attention deficit-hyperactivity disorder (ADHD). What strategy should the nurse teach the parents to help them cope with this disorder? 1 Orient the child to reality. 2 Reward appropriate conduct. 3 Suppress feelings of frustration. 4 Use restraints when behavior is out of control
2 Reward appropriate conduct. External rewards can motivate as well as increase self-esteem in the child with ADHD. Orienting the child to reality is unnecessary, because children with ADHD are alert and oriented. Feelings of frustration should not be suppressed; rather, the child should learn how to cope with these feelings in an acceptable manner. The use of restraints is contraindicated, because they are restrictive and punitive.
When assessing a toddler with autism, what characteristic findings or behaviors should the nurse expect? Select all that apply. 1 The desire to hug the nurse 2 Sad, blank facial expression 3 Laughing when pulse is taken 4 Inability to maintain eye contact 5 Inappropriate smiling and flat emotions
2 Sad, blank facial expression 4 Inability to maintain eye contact The inability to maintain eye contact reflects withdrawal. Children with autism are unable to or find it difficult to form meaningful human relationships. Therefore emotion is rarely expressed (for example, through hugging). The facial expression is blank; sadness is a response to the external world from which the child has withdrawn. The child with autism tends to overrespond to stimuli in the environment. Many children with autism rarely, if ever, smile or laugh.
What strategy should the nurse employ to be effective when using play therapy with a 6-year-old child with autism? 1 Play music and dance with the child. 2 Use mechanical and inanimate objects for play. 3 Employing positive reinforcements such as hugging. 4 Provide brightly colored toys and blocks that can be held.
2 Use mechanical and inanimate objects for play. Self-isolation and disinterest in interpersonal relationships lead the autistic child to find security in nonthreatening, impersonal objects. Dancing with the child is too threatening for a child with autism because of the close personal contact it requires. Close interaction, such as hugging, with others is too threatening for a child with autism. These children do not respond to brightly colored toys and blocks as other children do unless movement is involved.
A 3-year-old child is found to have autism. Which behaviors should the nurse expect when assessing this child? Select all that apply. 1 Imitates others 2 Seeks physical contact 3 Avoids eye-to-eye contact 4 Engages in cooperative play 5 Performs repetitive activities 6 Displays interest in children rather than adults
3 Avoids eye-to-eye contact 5 Performs repetitive activities Impairment of social interaction manifests as a lack of eye contact, a lack of facial responses, and a lack of responsiveness to and interest in others. Children with autism display obsessive ritualistic behaviors such as rocking, spinning, dipping, swaying, toe-walking, head-banging, and hand-biting because of their self-absorption and need to stimulate themselves. The impairments in communication and imaginative activity result in a failure to imitate others. Children with autism are indifferent to or have an aversion to affection and physical contact. Impairments in social interaction and imaginative activity manifest as failure to engage in cooperative or imaginative play with others. They are unable to establish meaningful relationships with adults or children because of their lack of responsiveness to others.
Methylphenidate is prescribed to treat a 7-year-old child's attention deficit-hyperactivity disorder (ADHD). The nurse understands that methylphenidate is used in the treatment of this disorder in children because it has what effect? 1 Diuretic effect 2 Synergistic effect 3 Paradoxical effect 4 Hypotensive effect
3 Paradoxical effect Methylphenidate, a stimulant, has an opposite effect on hyperactive children; the reason for this action is as yet totally unexplained. Although methylphenidate has a hypotensive effect, this is not why it is given to hyperactive children. Methylphenidate does not induce diuretic or synergistic effects. Paradoxical -is the opposite effect which would normally be expected.
A 10-year-old child in whom autism was diagnosed at the age of 3 years attends a school for developmentally disabled children and lives with parents. The child has frequent episodes of self-biting and head-banging and needs help with feeding and toileting. What is the priority nursing goal for this child? 1 Controlling repetitive behaviors 2 Being able to feed independently 3 Remaining safe from self-inflicted injury 4 Developing control of urinary elimination
3 Remaining safe from self-inflicted injury The priority is safety; the child must be protected from self-harm. Repetitive behaviors are comforting, and unless they are harmful their limitation is not a priority. Although feeding independently is a basic need that may be achieved, it is not the priority. Children who need help with toileting are not necessarily incontinent, and it is not the priority.
A nurse is caring for a group of children with the diagnosis of autism. Which signs and symptoms are associated with this disorder? Select all that apply. 1 Lack of appetite 2 Depressed mood 3 Repetitive activities 4 Self-injurious behaviors 5 Lack of communication with others
3 Repetitive activities 4 Self-injurious behaviors 5 Lack of communication with others Perseveration (repetition of a behavior pattern) is commonly demonstrated by children with autism; this behavior provides comfort. Self-stimulation through injurious behavior is associated with autism. Children with autism have difficulty communicating or do not communicate at all with others. There may be unusual eating habits and food preferences, but lack of appetite is not associated with autism. Mood disorders are usually not associated with autism.
While walking to the examination room with the nurse, a toddler with autism suddenly runs to the wall and starts banging the head on it. What should the nurse's initial action be? 1 Allowing the toddler to act out feelings 2 Asking the toddler to stop this behavior 3 Restraining the toddler to prevent head injury 4 Telling the toddler that the behavior is unacceptable
3 Restraining the toddler to prevent head injury The child with autism needs protection from self-injury. Permitting the child to act out is possible only if the acting out does not place the child in jeopardy. The child with autism has difficulty following directions, especially when out of control. The child with autism cannot separate self from behavior; a punitive approach will decrease the child's self-esteem.
A child who has attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate hydrochloride. Which behavior indicates that the child needs further treatment? 1 The child remains attentive during long classes while seated at a desk. 2 The child follows instructions given by teachers on a regular basis. 3 The child experiences difficulty keeping school assignments organized. 4 When instructed to wait, the child sits in one place without complaint.
3 The child experiences difficulty keeping school assignments organized. A child with ADHD will have difficulty organizing belongings and tasks. Therefore, the child who has difficulty organizing school assignments even after treatment with methylphenidate hydrochloride will require further treatment. After successful treatment of ADHD, the child will be able to remain attentive for prolonged periods of time. Successful treatment with methylphenidate hydrochloride makes the child more attentive to instructions. The child with ADHD is hyperactive, so he or she does not stay quiet. If the child is obedient and stays quiet, the treatment has been effective.
For what most common characteristic of autism should a nurse assess a child in whom the disorder is suspected? 1 Responds to any stimulus 2 Responds to physical contact 3 Unresponsiveness to the environment 4 Interacts with children rather than adults
3 Unresponsiveness to the environment Poor interpersonal relationships, inappropriate behavior, and learning disabilities prevent autistic children from emotionally adapting or responding to the environment even when the intelligence level is high. It is the lack of response to stimuli that is the clue that the child may have autism. Children with autism have an aversion to physical contact; they also have impaired interpersonal relationships regardless of the age of the other person.
A 6-year-old child who has autism exhibits frequent spinning and hand-flapping behaviors. What should the nurse teach the parents to do to limit these actions? 1 Hold the child. 2 Place the child in time-out. 3 Use another activity to distract the child. 4 Determine the reason for the child's behavior.
3 Use another activity to distract the child. Providing a constructive distraction will help redirect the autistic child's behavior. Physical contact provokes anxiety for the autistic child. A time-out is punitive and is not constructive. The reason for this repetitive behavior is unknown.
A team approach is used to help a 6-year-old boy with attention deficit-hyperactivity disorder (ADHD). What behaviors indicate that the interventions have been effective? Select all that apply. 1 Is not inhibited by rules or routines 2 Has fun playing with toys by himself 3 Is no longer enuretic during the night 4 Has an increased attention span in school 5 Is able to wait his turn when in line with others
4 Has an increased attention span in school 5 Is able to wait his turn when in line with others One characteristic of children with ADHD is the inability to remain focused on any activity; an increased attention span in school indicates that the child has improved. Other characteristics of children with ADHD are impulsivity, impatience, and the inability to delay gratification; the ability to wait for one's turn in line indicates that the child has improved. A lack of inhibition by rules or routines indicates that the child has not made sufficient progress and his behavior is still impulsive. Having fun playing with toys by himself indicates that the child has not made progress because children should enjoy playing with peers at this age. A 6-year-old child usually does not experience nocturnal enuresis; there are no data to indicate that the child had enuresis.
A nurse is caring for a child with autism. Which intervention is most appropriate in an attempt to promote socialization for this child? 1 Encouraging participation in group activities 2 Providing minimal environmental stimulation 3 Holding and cuddling the child for short periods 4 Imitating and participating in the child's activities
4 Imitating and participating in the child's activities The nurse should begin by attempting to enter the world where the child's attention is currently focused; this is a way of establishing human contact, because the child's usual contacts are inanimate objects. Children with autism have deficits in social development, and relationships are difficult to establish. Autistic children are generally unable to participate in group activities. Providing minimal environmental stimulation will have no effect on the nurse's ability to reach the child; rather, it will reinforce withdrawal. Autistic children generally cannot tolerate body contact and will become rigid when anyone attempts to initiate it.
When the nurse is planning care for a school-aged child with autism, what play activity is the best choice to suggest to the parents? 1 Holding a cuddly toy 2 Climbing a jungle gym 3 Building with small blocks 4 Riding on a playground merry-go-round
4 Riding on a playground merry-go-round The rhythmic movement of the merry-go-round provides an opportunity for the child to practice spatial and sensory orientation. This is important in helping the child increase interaction with the environment. The autistic child rejects cuddling and anything that feels cuddly. Jungle gyms and blocks do not provide rhythmic movements that will engage the child.
When planning activities for a child with autism, what does the nurse remember that autistic children respond best to? 1 Loud, cheerful music 2 Large-group activities 3 Individuals in small groups 4 Their own self-stimulating acts
4 Their own self-stimulating acts Autistic behavior turns inward. Autistic children do not respond to the environment; instead, they attempt to maintain emotional equilibrium by rubbing and manipulating themselves, and they display a compulsive need for behavioral repetition. Autistic children do seem to respond to music, but not necessarily loud, cheerful music. Large-group (or small-group) activities have little effect on the autistic child's response. Part of the autistic pattern is the inability to interact with others in the environment, regardless of the size of the group.
What is the prognosis for a normal, productive life for a child with autism? 1 Dependent on an early diagnosis 2 Often related to the child's overall temperament 3 Ensured as long as the child attends a school tailored to meet needs 4 Unlikely because of interference with so many parameters of function
4 Unlikely because of interference with so many parameters of function Research studies have shown that the prognosis for normal productive function in autistic people is guarded, particularly if there are delays in language development. Accurate diagnosis and early interventions have not been shown to promote a normal, productive life; however, early intervention may help individuals maximize their abilities. Although temperament may affect the child's response to treatment, it does not affect prognosis to any extent. Stating that success is ensured as long as the child attends a school tailored to meet needs is false reassurance and is not helpful.
For which clinical indication should a nurse observe a child in whom autism is suspected? 1 Lack of eye contact 2 Crying for attention 3 Catatonia-like rigidity 4 Engaging in parallel play
1 Lack of eye contact Children with autism usually have a pervasive impairment of reciprocal social interaction. Lack of eye contact is a typical behavior associated with autism. Crying for attention, rigidity, and parallel play are not indicative of autism.
A nurse is teaching the parents of a child with attention deficit hyperactivity disorder. What does the nurse include as the most frequently prescribed medication for this disorder? 1 Lorazepam 2 Haloperidol 3 Methylphenidate 4 Methocarbamol
3 Methylphenidate Methylphenidate appears to act by stimulating release of norepinephrine from nerve endings in the brainstem. Lorazepam is a benzodiazepine used to treat anxiety and insomnia. Haloperidol is an antipsychotic medication. Methocarbamol is a muscle relaxant.
A school nurse is formulating a plan of care for a 6-year-old client with attention deficit-hyperactivity disorder (ADHD). What is an appropriate outcome for this child? 1 Developing language skills 2 Avoiding regressive behavior 3 Attending regular classes in school 4 Self-image as an independent person of worth
4 Self-image as an independent person of worth Academic deficits, an inability to function within constraints required in certain settings, and negative peer attitudes often lead to low self-esteem. Children with ADHD are usually quite verbal; children with autism need assistance with language development. When the child receives therapy, regressive behavior is expected, because it is a strategy for reducing anxiety. There is no evidence that this child is on a special education track.
A healthcare provider diagnoses attention deficit hyperactivity disorder (ADHD) in a 7-year-old child and prescribes methylphenidate. The nurse discusses the child's treatment with the parents. What does the nurse emphasize as important for the parents to do? 1 Monitor the effect of the medication on their child's behavior. 2 Increase or decrease the dosage, depending on the child's behavior. 3 Avoid imposing too many rules, because this will frustrate the child. 4 Point out to their child that behavior can be controlled.
1 Monitor the effect of the medication on their child's behavior. By monitoring and reporting changes in the child's behavior, the healthcare provider can determine the effectiveness of the medication. Dosage changes are the responsibility of the healthcare provider. Children need structure and rules; they provide a sense of security. Behavior is not deliberate or controllable; this statement may diminish the child's self-esteem if he or she cannot exert control.
The school nurse knows that many children with attention deficit problems are also learning disabled. What should the nurse teach the parents about children with learning deficits? 1 Will probably not be as self-sufficient when they are adults 2 Will have cognitive deficits that interfere with learning 3 Usually perform two grade levels below the age norm 4 Experience perceptual difficulties that make learning problematic
4 Experience perceptual difficulties that make learning problematic This disorder interferes with the ability to perceive and respond to sensory stimuli, which in turn results in a deficit in interpreting new sensory data and makes learning difficult. That a child will probably not be a self-sufficient adult or will perform two grade levels below the age norm is not necessarily true. It is not an intellectual deficit that prevents learning but rather a perceptual difficulty; these children may have superior intelligence.
