1
A parent comes to the health clinic with their child. The parent states, “My child doesn't want to be held. They start rocking and banging their head when strangers come in the room.” Based on the parent's statements, the nurse suspects which neurodevelopmental disorder?
A. Intellectual/developmental disability
B. Psychosis
C. Autism spectrum disorder
D. Dyslexia
Answer: C
Rationale: Autism spectrum disorder refers to a range of complex neurodevelopmental disorders that involve differences in the development of various basic skills, including communication and socializing with others. The child with autism spectrum disorder has difficulty processing and understanding input from the world around them. The child may have specific areas in which problems exist and other areas of daily functioning. This disorder is characterized by differences in development of the ability to socially interact and communicate with others. Symptoms usually appear before 3 years of age. Children with this disorder often are withdrawn and inwardly focused with little interest in their environment, exhibit repetitive behaviors or interests, have magnified emotional responses, and are routine driven. Children with autism spectrum disorder often have accompanying intellectual disability ranging from mild to profound. Verbal skills and the ability to comprehend written words are usually below the level appropriate for the child’s age. Children diagnosed with psychosis characteristically exhibit symptoms of hallucinations, delusions, flat affect, disorganized speech, and stereotypical behaviors. Dyslexia is difficulty in the reading domain of learning. The scenario does not indicate the child is demonstrating any characteristics associated with an intellectual or developmental disability, a broad term that covers a variety of conditions that cause significant limitations in intellectual functioning, social interactions, and practical living skills.
The nurse is reviewing a plan of care for a child diagnosed with conduct disorder. When reviewing the care plan, the nurse should expect to see a focus on which problem?
A. Disturbance in personal identity
B. Sleep pattern disturbance
C. Risk for violence directed at others
D. Impaired verbal communication
Answer: C
Rationale: Children diagnosed with conduct disorder exhibit hostile and bullying-type behavior, using threats and fighting with or without weapons that can inflict serious injury. Risk for violence, directed at others would be the focus. The child is not experiencing a disturbance in personal identity or sleep pattern. Impaired verbal communication would involve an inability to form words or sentences, more commonly associated with an expressive language disorder.
A child diagnosed with oppositional-defiant disorder refuses to conform to curfew rules set by their parents. Which intervention would the nurse reinforce with the parents to do first?
A. Identifying triggers for defiant behaviors
B. Setting a reasonable limit with consequences
C. Identifying the child's strengths and weaknesses
D. Providing reinforcement for positive behavior
Answer: B
Rationale: Children diagnosed with oppositional-defiant disorder have the tendency to argue incessantly with adults, lose their temper, and actively defy or refuse to comply with rules and requests imposed upon them. Hence, limit setting is important. The other options are appropriate but do not have the priority of limit setting.
When providing nursing care for a child exhibiting suicidal ideations, which intervention should take priority for this client?
A. Establishing a trusting relationship
B. Maintaining consistency of caregivers
C. Maintaining a safe environment
D. Establishing a consistent pattern of reward for positive behavior
Answer: C
Rationale: It is very important to maintain a safe environment when a child is exhibiting suicidal ideation. Establishing a trusting relationship is the basis for the nurse–client relationship, but in this situation, safety takes priority. Maintaining consistency of caregivers and establishing a consistent pattern of reward for positive behavior may be in the treatment plan, but again safety takes priority for this child.
A nurse is assessing an adolescent for warning signs of suicide risk. Which behavior would the nurse identify as a cause for concern?
A. Improvement in schoolwork
B. Elevated mood
C. Giving away prized possessions
D. Increased energy level
Answer: C
Rationale: Warning signs for suicide risk in children and adolescents include giving away of prized possessions, decline in the quality of schoolwork, prolonged expression of sadness or uselessness, and excessive fatigue. The remaining options would not support the presence of a depressed, suicidal state of mind.
When obtaining data about a client diagnosed with Tourette disorder, which behavior would the nurse expect to find?
A. Inattention to detail
B. Verbal outbursts
C. Willful defiance of rules
D. Somatic concerns
Answer: B
Rationale: Children diagnosed with Tourette disorder exhibit vocal tics. Simple tics may involve such movements as blinking of the eye, wrinkling of the nose, jerking of the neck or shoulder, or grimacing. More complex movements may include hand gestures, contortions of the face, or physical actions such as jumping, retracing steps, hopping, and skipping over lines. Occasionally, the person may assume unusual positions or posturing. Vocal tics are meaningless recurrent sounds such as sniffing, snorting, and throat clearing. More complex behaviors include verbal outbursts of words or phrases, speech blocking, or meaningless changes in tone or volume of speech. These may be involuntary. Clinical manifestations of attention deficit/hyperactivity disorder (ADHD) include inattention to detail. Willful defiance of rules occurs in clients diagnosed with oppositional-defiant disorder. Children with separation anxiety disorder may note abdominal pain or nausea and vomiting.
An 8-year-old child has been prescribed medication to treat attention deficit/hyperactivity disorder (ADHD). The nurse would anticipate reinforcing teaching about which medication classification?
A. Stimulants
B. Antimanic agents
C. Anticonvulsants
D. Antipsychotics
Answer: A
Rationale: Attention deficit hyperactivity disorder (ADHD) can be successfully managed using a combination of medication and behavior therapy. Medication can be used to better control behavior challenges. While no one particular medication works successfully for every individual, it is important to find one that works best. Stimulants are the most commonly used treatment with most children responding favorably to their effects. The benefits of these medications result in improved attention, less disruptive behaviors, and improved peer relationships. Antimanic agents, anticonvulsants, and antipsychotics are not medications of choice for ADHD.
The nurse is reviewing a plan of care for a client diagnosed with attention deficit/hyperactivity disorder (ADHD). The child is prescribed atomoxetine. Which behavior if exhibited by the client would the nurse determine as indicative of medication effectiveness?
A. Increased attention on homework
B. Ability to tolerate overnight separation periods
C. Decreased somatic concerns
D. Absence of episodes of self-harm
Answer: A
Rationale: Atomoxetine is a nonstimulant medication used to treat ADHD. Medications used in the treatment aid the child in increasing the attention to detail. The benefits of these medications result in improved attention, less disruptive behaviors, and improved peer relationships. These benefits would contribute to increased attention on homework. The other outcomes are unrelated to the treatment of ADHD.
The plan of care for a child diagnosed with expressive language disorder focuses on impaired verbal communication. Which nursing intervention would be most appropriate for this child?
A. Maintaining consistency of caregivers
B. Allowing child ample time to express self
C. Identifying child’s capabilities for self-care
D. Establishing a consistent pattern of reward for positive behavior
Answer: B
Rationale: Children with an expressive language disorder have a difficult time expressing themselves through language and use gestures or verbal animation to express themselves. These children usually begin talking later than usual and progress at a slower rate than that which is considered age-appropriate. Allowing the child ample time to communicate would be the most appropriate nursing intervention for this child. The other nursing interventions may be appropriate but do not specifically address the focus of impaired verbal communication.
The nurse is managing the care of a child diagnosed with a moderate intellectual disability. Which intervention is the priority when attempting to impact the child's ultimate ability to function independently?
A. Facilitating early enrollment in a specialized educational program.
B. Counseling family to begin securing long-term financial assistance for the child.
C. Providing family with information regarding available social service providers.
D. Identifying risk factors for development of comorbid mental health issues.
Answer: A
Rationale: One of the purposes of establishing a diagnosis of intellectual disability is to assist the individuals with special education services, home- and community-based waiver services, and government Social Security Administration and health care benefits. Early intervention is necessary to assist both the child and family to develop the adaptive skills to encourage a functional level of existence. Financial and social needs must be addressed but these factors will be determined by the child's ultimate level of function. While individuals with intellectual disabilities are at risk for developing additional mental health disorders, the risk decreases with a higher level of function and these disorders are not always observable until adulthood.
A nurse practitioner is conducting an in-service education program to a group of clinic nurses. The topic is mental disorders in children. The nurse practitioner determines that the teaching was successful when the group identifies which factor as the most prevalent contributor for the incidence of childhood mental disorders?
A. Family income
B. Parental divorce
C. Exposure to violence
D. Family history
Answer: D
Rationale: While all the options may contribute to the incidence of a mental disorder in the child or adolescent, the most prevalent is the genetic component with a family history of mental disorders.
The nurse is gathering data from a child diagnosed with oppositional-defiant disorder. A history of which finding would the nurse interpret as supporting this diagnosis?
A. Stuttering
B. Poor interpersonal skills
C. Difficulty in written expression
D. Letter reversal
Answer: B
Rationale: Children with this disorder are usually vindictive, spiteful, and resentful in their interpersonal relationships and usually exhibit resistance to compromise or negotiation with peers or adults. Stuttering problems occur in those diagnosed with phonologic disorders. Dyslexia is characterized by difficulty in written expression and delayed language development. Letter reversal is also common in dyslexia.
An adolescent is placed in detention as a result of aggressive, physical behavior toward other students. The parents come to the clinic to ask for help. They tell the nurse that their adolescent is using threats and bullying often. “We even found him starting fires in the backyard.” The nurse interprets these findings as suggesting which mental health disorder?
A. Attention deficit/hyperactivity
B. Conduct
C. Oppositional-defiant
D. Separation anxiety
Answer: B
Rationale: Children with conduct disorder demonstrate aggressive actions that result in or threaten harm to other people or animals. They fight with or without weapons that can inflict serious physical injury. They may steal, rape, mug, assault other people, or seriously abuse animals. It is common for these children to lie and “con” by asking personal favors with no intention of repayment. Other behaviors may cause damage or loss of property, such as setting fires or vandalism. The manifestations in this situation do not correlate to ADHD, oppositional-defiant disorder, or separation anxiety disorder.
A nurse is preparing a presentation for a group of parents in the local school district about learning disabilities. The nurse would describe which disability as being the most common learning disability?
A. Dyslexia
B. Stuttering
C. Receptive language disorder
D. Mixed language disorder
Answer: A
Rationale: The most common type of learning disorder is dyslexia, or difficulty in the reading domain. In this disorder, there is a difference between the child's intellectual ability and their success in reading and spelling. Even though these children are of normal or higher intelligence, they may be behind in the level of reading expected for their grade level. The problem seems to stem from an inability to process incoming sensory stimuli with the correct interpretation. Stuttering is characterized by repetitive or prolonged sounds or syllables that include pauses and monosyllable broken words. It causes considerable discomfort for the child in both academic and social situations but may be absent when they are singing or reading aloud. Children with a receptive disorder have difficulty understanding the message that is being sent to them verbally. The child with a mixed language disorder also has a problem in understanding words and sentences and also difficulty expressing themselves.
A nurse is assisting with planning the care for a child with separation anxiety. Which intervention would be most appropriate to include?
A. Identifying the child's risk for self-injury
B. Intervening to prevent injury from aggression
C. Providing a familiar security object, such as a blanket
D. Using a slow deliberate approach when introducing tactile stimuli
Answer: C
Rationale: Providing familiar security objects such as a favorite toy, pillow, or blanket will help the child cope with separation anxiety. The other interventions are directed at issues associated with separation anxiety disorder.
Which assessment data support the nurse's evaluation that a 10-year-old diagnosed with attention deficit/hyperactivity disorder (ADHD) has demonstrated progress toward achieving a long-term goal specific to this disorder?
A. Child states, “I'm so proud of being on the baseball team.”
B. Child has expressed feelings consistent with a trusting parent–child relationship.
C. Parent reports child earned three Bs and one A on the report card.
D. Child's speech has showed significant improvement with therapy.
Answer: C
Rationale: Evaluation of the child with ADHD should show a consistent decrease in disruptive and dangerous behaviors along with the ability to function in a social or structured learning environment as evidenced by earning passing grades in school. The development of positive self-esteem, trust, or effective communication is not specific to ADHD.
A nurse is reviewing information with the parent of a child with enuresis. Which information if described by the parent would indicate to the nurse that the parent has a good understanding of the condition?
A. The child must be at least 5 years of age.
B. There is no family history of the disorder.
C. Symptoms generally worsen with age.
D. The child has control over urine incontinence.
Answer: A
Rationale: In the case of enuresis, the child must be at least 5 years of age or have control over urine continence. Males demonstrate the disorder most frequently and a family history is a predisposition to the problem. The symptoms generally improve with age.
A child is diagnosed with intermittent explosive disorder. When collecting data from the child, which behavior would the nurse expect to be reported?
A. Vandalism of neighbors' property
B. Stuttering
C. School truancy
D. Rapid-onset bursts of anger
Answer: D
Rationale: Intermittent explosive disorder is characterized by angry, aggressive outbursts that have a rapid onset, typically lasting less than 30 minutes. These outbursts are usually in response to a minor situation and may involve damage and/or physical aggression toward another person, animal, or property. Stuttering is characterized by repetitive or prolonged sounds or syllables that include pauses and monosyllable broken words. Vandalism and school truancy are associated with conduct disorder.
A child diagnosed with Tourette disorder demonstrates a sudden obscene gesture while the nurse is gathering data from the child. Which term would the nurse likely use to document this observation?
A. Echopraxia
B. Copropraxia
C. Dyslexia
D. Enuresis
Answer: B
Rationale: Copropraxia is a sudden tic-like obscene gesture. Echopraxia is repetitive tic-like movements. Dyslexia is a learning disorder in the reading domain. Enuresis is the involuntary passage of urine after the age of voluntary control has been established.
A child is diagnosed with ADHD. When working with the child and parents on long-term goals, which goal would be most important?
A. Child will demonstrate a consistent decrease in disruptive behaviors
B. Child will demonstrate a decrease in impulsive behaviors
C. Child will show improvement in satisfying relationships
D. Child will exhibit a decrease in harm toward others
Answer: A
Rationale: An evaluative outcome of a child diagnosed with ADHD would include a consistent decrease in disruptive and dangerous behaviors. A decrease in impulsive behaviors would be evaluative of conduct disorder. A decrease in impulsive behaviors, improvement in satisfying relationships, and a decrease in harm toward others are important but would not be the most important for the child diagnosed with ADHD.
The parents of a 13-year-old diagnosed with Tourette disorder is learning strategies to help manage their child’s tics. Which information should the nurse provide? Select all that apply.
A. Stress tends to trigger the behavior.
B. Tics typically increase during sleep.
C. Time of day rarely affects tic frequency.
D. Behavior is a result of a resistible urge.
E. Tics tend to decrease with concentrated activities.
Answer: A, E
Rationale: The incidence of tics may increase during periods of stress or demanding and competitive activities. Managing stress is vital to the management of the behaviors. Tics generally tend to decrease during sleep or during concentrated activity such as reading or playing the piano. The person with a tic disorder usually experiences an irresistible urge to perform the tic and feels relief once the behavior has occurred. Tics tend to occur in spells that may last from seconds to hours. The severity or frequency of the spells usually changes during the course of the day or as environmental location changes.
A child is diagnosed with a stuttering disorder. Which assessment finding(s) would the nurse most likely identify as supporting this diagnosis? Select all that apply.
A. Age under 6 years
B. Voice raspiness
C. Overall hyperactivity
D. Repetition of syllables
E. Increased symptoms when reading aloud
Answer: A, B, D
Rationale: Stuttering is characterized by repetitive or prolonged sounds or syllables that include pauses and monosyllable broken words. It causes considerable discomfort for the child in both academic and social situations but may be absent when they are singing or reading aloud. There may be accompanying motor movement such as jerking, twitching, or tremors. Increased levels of anxiety and stress will often initiate the problem, which leads to further anxiety, frustration, and low self-esteem. The development of stuttering is typically seen before 6 years of age and frequently resolves itself. Hyperactivity is a classic characteristic of attention deficit/hyperactivity disorder.
A child is exhibiting signs and symptoms of separation anxiety following the parents' divorce. Which behavior(s) should the nurse expect to assess in this child? Select all that apply.
A. Repetitive routines
B. Truancy
C. Somatic concerns
D. Willful defiance of rules
E. Refusal to attend school
Answer: C, E
Rationale: Children diagnosed with separation anxiety disorder may exhibit somatic concerns such as abdominal pain, nausea and vomiting, or headaches during or before the separation. They also may refuse to attend school or activities due to the fear of separation. Repetitive routines occur in children diagnosed with autism. Children diagnosed with conduct disorder exhibit repeated disruptive and destructive behaviors, willful defiance of family rules, and truancy from school or running away from home.
A nurse is reviewing the history of a child diagnosed with oppositional-defiant disorder. Which factor(s) would the nurse identify as increasing the child’s risk for this disorder? Select all that apply.
A. Overly involved, doting parents
B. Parental neglect
C. Sexual abuse
D. Physical abuse
E. Consistency in caregivers
Answer: B, C, D
Rationale: Parental rejection and neglect with harsh and abusive physical punishment or sexual abuse are often cited as predisposing factors for this disorder. The child may have been removed to a foster or group home situation with a frequent shift in caregivers. Rejection by peers may lead the child to an association with those who engage in delinquent antisocial behaviors, violence, and drug-related activity. Overly involved and doting parents and consistent caregivers are not associated risk factors for oppositional-defiant disorder.
A nurse is reviewing the history of a child diagnosed with conduct disorder. Which behavior(s) would the nurse identify as characteristic of this disorder? Select all that apply.
A. Truancy from school
B. Sexual promiscuity
C. Vandalism
D. Inattentiveness
E. Stuttering
Answer: A, B, C
Rationale: Truancy from school, vandalism, and sexual promiscuity are characteristics of conduct disorder that are a result of the child's aggressive and threatening tendencies. Inattentiveness occurs in those diagnosed with attention deficit/hyperactivity disorder. Stuttering is not associated with this disorder.