Mental Health in Children
A mental health nurse is seeing a patient for the first time. It will be important for the nurse to assess:
1. The childs family, social, cultural and psychological aspects.
2. The childs psychological aspects.
3. The childs reasons for attending the therapy session.
4. All of the above
4. all of the above
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.
1. Has a habit of not waiting for a turn
2. Frequently acts out during class "quiet time"
3. Does not acknowledge others' right to select group activities
4. Throws a temper tantrum when asked to clean up toys
5. Gently asks a peer to share a particular toy
1. Has a habit of not waiting for a turn
2. Frequently acts out during class "quiet time"
3. Does not acknowledge others' right to select group activities
4. Throws a temper tantrum when asked to clean up toys
Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. She wears layered, loose clothing and now has amenorrhea. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely?
a. Binge eating disorder
b. Anorexia nervosa
c. Bulimia nervosa
d. Pica
B ~ Overly controlled eating behaviors, extreme weight loss, amenorrhea, preoccupation with food, and wearing several layers of loose clothing to appear larger are part of the clinical picture of an individual with anorexia nervosa. The individual with bulimia usually is near normal weight. The binge eater is often overweight. Pica refers to eating nonfood items.
The community nurse visits the home of George. a child recently diagnosed with autism. The parents express feelings of shame and guilt about having somehow caused this problem. Which statement by the nurse would best help alleviate parental guilt?
A. “Autism is a rare disorder. Your other children shouldn’t be affected.”
B. “The specific cause of autism is unknown. However. it is known to be associated with problems in the structure of and chemicals in the brain.”
C. “Sometimes a lack of prenatal care can be cause of autism.”
D. “Although autism is genetically inherited if you didn’t have testing you could not have known this would happen.”
B. “The specific cause of autism is unknown. However. it is known to be associated with problems in the structure of and chemicals in the brain.”
A mental health nurse has assessed a child and determined that the child exhibits behavioral challenges. When the school nurse explains this to a teacher, the best description would be:
1. The child may exhibit physical outbursts.
2. The child may exhibit violence toward others.
3. The child may be defiant or have tantrums.
4. The child will need special interventions for learning.
3. The child may be defiant or have tantrums.
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?
1. "The client will have an effect from this drug in about 2 weeks."
2. "The client knows that the client only needs to take this medication once every 12 hours."
3. "The client may have some side effects, like insomnia, loss of appetite, or weight loss, but they are rare."
4. "We'll bring the client in every week to get blood levels drawn."
3."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.
Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which statement regarding a client's home environment should a nurse associate with the development of anorexia nervosa?
1. The home environment maintains loose personal boundaries.
2. The home environment places an overemphasis on food.
3. The home environment is overprotective and demands perfection.
4. The home environment condones corporal punishment.
3 ~ The nurse should assess that a home environment that is overprotective and demands perfection may be a major influence in the development of anorexia nervosa. In adolescence, distorted eating patterns may represent a rebellion against the parents viewed by the child as a means of gaining and remaining in control.
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 nurse's 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
The nurse should manage the milieu with structure and limit setting. Removing the aggressive child to another room is an appropriate consequence for the aggressiveness. Directing the child to stop will not be effective. This is not an emergency. Intervention is needed rather than sending the child home.
A school nurse is giving an in-service to teachers to teach them how to deal with children with ADHD. The nurse should include all of the following topics for discussion except:
1. Giving shorter assignments.
2. Letting the child stand at the desk while working on projects.
3. Color coding folders for each subject.
4. Requiring 30 minutes of continuous reading each day during class.
4. Requiring 30 minutes of continuous reading each day during class.
Rationale: A classroom can have too much stimuli for a child with ADHD, and that length of time may cause the child to lose concentration.
A child is prescribed methylphenidate (Ritalin) to treat attention deficit hyperactivity disorder (ADHD). The parent expresses concern about using a controlled substance to treat ADHD and asks the burse about using a noncontrolled substance. The nurse knows ADHD can be treated with which noncontrolled substance?
A.) Atomoxetine (Strattera)
B.) Methylphenidate (Concerta)
C.) Amphetamine aspartate (Adderall)
D.) Dextroamphetamine sulfate (Dexedrine)
A.) Atomoxetine (Strattera)
A nurse is counseling a client diagnosed with bulimia nervosa about the symptom of tooth enamel deterioration. Which explanation for this complication of bulimia nervosa, should the nurse provide?
1. The emesis produced during purging is acidic and corrodes the tooth enamel.
2. Purging causes the depletion of dietary calcium.
3. Food is rapidly ingested without proper mastication.
4. Poor dental and oral hygiene leads to dental caries.
1 ~ The nurse should explain to the client diagnosed with bulimia nervosa that her teeth will eventually deteriorate, because the emesis produced during purging is acidic and corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance.
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 child's best friend was absent from the child's 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
Children raised by a depressed parent have an increased risk of developing an emotional disorder. Familial risk factors correlate with child psychiatric disorders, including severe marital discord, low socioeconomic status, large families and overcrowding, parental criminality, maternal psychiatric disorders, and foster-care placement. The chronicity of the parent's depression means it has been a consistent stressor. The other factors are not as risk- enhancing.
A teacher is working with a child with a known diagnosis of Oppositional Defiant Disorder. The teacher should include which of the following in her approach to the child?
1. Be consistent with consequences
2. Require the child to sit at the front of the classroom
3. Allow the child to play outside only when good behavior is present
4. Obtain a paraeducator to help with school activities
1. Be consistent with consequences
A child is taking methylphenidate for treatment of attention deficit hyperactivity disorder (ADHD). Which side effect must be monitored in this child?
1. Growth delays
2. Increased appetite
3. Weight gain
4. Polyuria
1. Growth delays
Rationale:Nursing considerations when administering methylphenidate include monitoring appetite suppression or growth delays.
A nurse is teaching a client diagnosed with an eating disorder about behavior-modification programs. Why is this intervention the treatment of choice?
1. It helps the client correct a distorted body image.
2. It addresses the underlying client anger.
3. It manages the client's uncontrollable behaviors.
4. It allows clients to maintain control.
4 ~ Behavior-modification programs are the treatment of choice for clients diagnosed with eating disorders, because these programs allow clients to maintain control. Issues of control are central to the etiology of these disorders. Behavior modification techniques function to restore healthy weight.
A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states, "My parents watch me like a hawk and never let me out of their sight." Which nursing diagnosis would take priority at this time?
1. Altered nutrition less than body requirements
2. Altered social interaction
3. Impaired verbal communication
4. Altered family processes
4 ~ The nurse should determine that once the client has been medically cleared, the diagnosis of altered family process should take priority. Clients diagnosed with anorexia nervosa have a need to control and feel in charge of their own treatment choices. Behavioral-modification therapy allows the client to maintain control of eating.
he nurse is explaining the difference of Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) to a parent. The best explanation is:
1. A child with CD is remorseful for bad behavior.
2. A child who has ADHD will have ODD too.
3. A child with ODD feels bad after breaking the rules, while a child with CD does not care if the rules are broken.
4. A child with CD requires constant intervention to be able to function in society
3. A child with ODD feels bad after breaking the rules, while a child with CD does not care if the rules are broken.
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.
A. Constant fidgeting and squirming.
C. Difficulty paying attention to details.
D. Easily distracted.
F. Talking constantly, even when inappropriate.
he family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing response?
1. Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions.
2. Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve.
3. Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support.
4. Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed.
2 ~ The nurse should educate the family on the correlation between certain familial patterns and anorexia nervosa. Families engaging in conflict avoidance and struggling with issues of power and control may contribute to the development of anorexia nervosa.
A nurse prepares to lead a discussion at a community health center regarding children's 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, D, E
Some dated terminology contributes to the stigma of mental illness and misconceptions about mental illness. It's important for the nurse to use current terminology.