Category 1
1. Bupropion is an antidepressant medication approved for treatment of ADHD in adults. Doses of bupropion should be administered at least 4 to 6 hours apart and never doubled when a dose is missed in order to prevent:
A. Orthostatic hypotension
B. Seizures
C. Hypertensive crisis
D. Extrapyramidal symptoms
B: Seizures
Rationale: The risk of seizures in patients receiving the maximum recommended dose of 450 mg/day or less is 5/1000. Increase the dose gradually.
2. What is the concern with children on a long-term CNS stimulant therapy for ADHD:
A. Addiction
B. Weight gain
C. Substance abuse
D. Growth suppression
A: Addiction
Rationale: CNS stimulants have potential for physical and psychological dependence. Tolerance develops quickly, and they should not be withdrawn abruptly because they can produce serious side effects like insomnia, anorexia, and restlessness.
3. What possible nursing diagnosis could be used for a child with ADHD?
Select all that apply.
A. Self-care deficit r/t physical disability
B. Risk for injury r/t impulsive behavior
C. Low self-esteem r/t dysfunctional family system and negative feedback
D. Impaired social interaction r/t intrusive and immature behavior
E. Risk for suicide r/t developmental delay
Answer: B, C & D
Rationale: Risk for injury-Children with ADHD experience a greater than average number of accidents, from minor mishaps to more serious accidents that may lead to physical injury or the destruction of property. Low self-esteem difficulties in performing age-appropriate tasks might lead to low self esteem. Impaired social interaction -hyperactive children with ADHD are disruptive and intrusive in group endeavors, and they may demonstrate behaviors that inhibit acceptable social interactions
4. Which of the following activities would be most appropriate for the child with attention-deficit/hyperactivity disorder (ADHD)?
a. Monopoly
b. Volleyball
c. Pool
d. Checkers
Answer: B volleyball
Rationale: Children with ADHD have boundless energy, exhibiting excessive levels of activity, restlessness, and fidgeting. They are highly distractible and have limited attention spans. Monopoly, pool, and checkers require certain level of focus and attention to detail. Volleyball would be the most appropriate activity.
5. Methylphenidate (Ritalin) is prescribed to an 8-year-old child for the treatment of attention deficit hyperactivity disorder (ADHD). The nurse will most likely monitor which of the following during the medication therapy?
A. Deep tendon reflex.
B. Intake and output.
C. Temperature and breath sound.
D. Height and weight.
Answer: D. Height and weight.
Rationale: Methylphenidate (Ritalin) may cause slow growth. The nurse will need to keep track of the client’s height and weight to make sure that there is a normal growth and development.
6. Nurse Daya, a school nurse is meeting with the school and health treatment team about a child who has been receiving methylphenidate (Ritalin) for two (2) months. The meeting is to evaluate the results of the child’s medication use. Which behavior change noted by the teacher will help determine the medication’s effectiveness.
A. Decrease repetitive behaviors
B. Decreased signs of anxiety
C. Increased depressed mood
D. Increased ability to concentrate on tasks
Answer: D. Increased ability to concentrate on tasks.
Rationale: Methylphenidate (Ritalin) is used as a method of treatment of ADHD. Evidence of increased ability to concentrate on tasks while taking this medication would establish the drug’s effectiveness.
7. The school nurse assesses Brook, a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which of the following symptoms are characteristic of the disorder? Select all that apply.
A. Constant fidgeting and squirming
B. Excessive fatigue and somatic complaints
C. Difficulty paying attention to details
D. Easily distracted
E. Running away
F. Talking constantly, even when inappropriate
Answer: A, C, D, and F. Constant fidgeting and squirming, difficulty paying attention to details, easily distracted, and talking constantly, even when inappropriate.
Rationale: A, C, D, and F; These behaviors are all characteristic of ADHD and indicate that the child is inattentive, hyperactive, and impulsive.
B and E: Options B and E are signs of emotional distress in a child and could be associated with a number of different psychiatric diagnoses.
8. The parents of Suzanne, a child with attention deficit hyperactivity disorder, tell the nurse they have tried everything to calm their child and nothing has worked. Which action by the nurse is most appropriate initially?
A. Actively listen to the parents’ concern before planning interventions.
B. Encourage the parents to discuss these issues with the mental health team.
C. Provide literature regarding the disorder and its management.
D. Tell the parents they are overacting to the problem.
Answer: A
The nurse would encourage parents to fully discuss and describe their perception of the problem in order to assess the family system before determining appropriate interventions. In option B, the nurse has not explored the problem and is deciding before adequately assessing the situation that the mental team should be consulted. Providing literature regarding the disorder and its management may be useful intervention; however, the initial action needs to involve a more thorough exploration of the parents’ concerns. Telling the parents they are overreacting to the problem is inappropriate because it dismisses the parents’ legitimate concerns and belittles their feelings.
9. A nurse may encounter children with mental disorders. Her knowledge of these various disorders is vital. When planning school interventions for a child with a diagnosis of attention deficit hyperactivity disorder, a guide to remember is to:
A. Provide as much structure as possible for the child.
B. Ignore the child’s overactivity.
C. Encourage the child to engage in any play activity to dissipate energy.
D. Remove the child from the classroom when disruptive behavior occurs.
Answer: A. provide as much structure as possible for the child.
Rationale: Decrease stimuli for behavior control thru an environment that is free of distractions, a calm non–confrontational approach and setting limit to time allotted for activities.
B: The child will not benefit from a lenient approach.
C: Dissipate energy through safe activities.
D: This indicates that the classroom environment lacks structure.
10. Martin Sanchez is a 9-year-old child admitted to a psychiatric treatment unit accompanied by Mr. and Mrs. Sanchez. To establish trust and position of neutrality, which action would the nurse take?
A. Encourage Mr. and Mrs. Sanchez to leave while Martin is being interviewed.
B. Interview Martin with his parents together, observing their interaction.
C. Provide diversion for Martin, and interview Mr. and Mrs. Sanchez alone.
D. Review the clinical record prior to interviewing Mr. and Mrs. Sanchez.
Answer: B
Rationale: It is important for nurse to be seen as a neutral person who is interested in the family as an adaptive functioning unit. By conducting the admission interview with the parents and child together, the nurse establishes this neutral role from the beginning. The responses on option A and C separate the parents and the child, and thus the nurse does not have an opportunity to establish a position of neutrality. Although the nurse would review the clinical record, this does not demonstrate to the family that she is an advocate for both parents and the child.