Unformatted text preview: Chapter 11: Childhood and Neurodevelopmental Disorders
1. Which factor presents the highest risk for a child to develop a psychiatric disorder?
Living with an alcoholic parent
Having a parent with a substance abuse problem has been designated an adverse psychosocial
condition that increases the risk of a child developing a psychiatric condition. Being in a middleincome family and being the oldest child do not represent psychosocial adversity. Having a
family history of schizophrenia presents a risk, but an alcoholic parent in the family offers a
2. Which nursing diagnosis is universally applicable for children diagnosed with autism spectrum
a. Impaired social interaction related to
difficulty relating to others ANS: A
Children diagnosed with autism spectrum disorders display profoundly disturbed social
relatedness. They seem aloof and indifferent to others, often preferring inanimate objects to
human interaction. Language is often delayed and deviant, further complicating relationship
issues. The other nursing diagnoses might not be appropriate in all cases.
3. Which behavior indicates that the treatment plan for a child diagnosed with an autism spectrum
disorder was effective? The child:
holds the parent’s hand while walking.
Holding the hand of another person suggests relatedness. Usually, a child with an autism
spectrum disorder would resist holding someone’s hand and stand or walk alone, perhaps
flapping arms or moving in a stereotyped pattern. The incorrect options reflect behaviors that are
consistent with autism spectrum disorders.
4. 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:
c. reduce loneliness and increase selfesteem. ANS: C
Because of their disruptive behaviors, children with ADHD often receive negative feedback from
parents, teachers, and peers, leading to self-esteem disturbance. These behaviors also cause peers
to avoid the child with ADHD, leaving the child with ADHD vulnerable to loneliness. The child
does not need inpatient treatment at this time. The incorrect options might or might not be
relevant. 5. 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?
(Ritalin) ANS: C
CNS stimulants are the drugs of choice for treating children with ADHD: Ritalin and dexedrine
are commonly used. None of the other drugs are psychostimulants used to treat ADHD.
6. What is the nurse’s priority focused assessment for side effects in a child taking methylphenidate
(Ritalin) for attention deficit hyperactivity disorder (ADHD)?
c. Sleep disturbances and weight loss ANS: C
The most common side effects are gastrointestinal disturbances, reduced appetite, weight loss,
urinary retention, dizziness, fatigue, and insomnia. Weight loss has the potential to interfere with
the child’s growth and development. The distracters relate to side effects of conventional
7. 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?
Social skills group
Social skills training teaches the child to recognize the impact of his or her behavior on others. It
uses instruction, role-playing, and positive reinforcement to enhance social outcomes. The other
therapies would have lesser or no impact on peer relationships.
8. The parent of a 6-year-old says, “My child is in constant motion and talks all the time. My child
isn’t interested in toys but is out of bed every morning before me.” The child’s behavior is most
consistent with diagnostic criteria for:
attention deficit hyperactivity disorder.
Excessive motion, distractibility, and excessive talkativeness are seen in attention deficit
hyperactivity disorder (ADHD). The behaviors presented in the scenario do not suggest
intellectual development, stereotypic, or communication disorder.
9. 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
d. engages in cooperative play with other children.
The goal should be directly related to the defining characteristics of the nursing diagnosis, in this
case, improvement in the child’s aggressiveness and play. The distracters are more relevant for a
child with autism spectrum or anxiety disorder.
10. 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?
Take the aggressive child to another room.
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.
11. 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?
Central nervous system stimulants
Central nervous system stimulants, such as methylphenidate and pemoline (Cylert), increase
blood flow to the brain and have proved helpful in reducing hyperactivity in children and
adolescents with attention deficit hyperactivity disorder. The other medication categories listed
would not be appropriate.
12. 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?
This child shows difficulty coping with problems associated with the family. Social isolation
refers to aloneness that the patient perceives negatively, even when self-imposed. The other
options are not supported by data in the scenario.
13. A nurse works with a child who is sad and irritable because the child’s 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
person’s self-esteem. c. Acceptance and trust convey feelings of
security to the child. d. The child should express feelings rather than internalize them.
Trust is frequently an issue because the child may question their trusting relationship with the
parents. In this situation, the trust the child once had in parents has been disrupted, reducing
feelings of security. The correct answer is the most global response.
14. A nurse assesses a 3-year-old diagnosed with an autism spectrum disorder. Which finding is most
associated with the child’s disorder? The child:
d. continuously rocks in place for 30
minutes. ANS: D
Autism spectrum disorder involves distortions in development of social skills and language that
include perception, motor movement, attention, and reality testing. Body rocking for extended
periods suggests autism spectrum disorder. The distracters are expected findings for a 3-year-old.
15. 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 nurse’s best response.
d. “Give your child a kiss before you leave
the preschool program.” ANS: D
The child demonstrates age-appropriate behavior for a 4-year-old. The nurse should reassure the
parents. The distracters are over-reactions.
16. 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. ANS: 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.
17. The child prescribed an antipsychotic medication to manage violent behavior is one most likely
attention deficit hyperactivity disorder.
Antipsychotic medication is useful for managing aggressive or violent behavior in some children
diagnosed with attention deficit hyperactivity disorder. If medication were prescribed for a child
with an anxiety disorder, it would be a benzodiazepine. Medications are generally not needed for
children with communication disorder. Treatment of PTSD is more often associated with SSRI
medications. 18. A child reports to the school nurse of being verbally bullied by an aggressive classmate. What is
the nurse’s best first action?
b. Encourage the victimized child to share
feelings about the experience. ANS: B
The behaviors by the bullying child create emotional pain and present the risk for physical pain.
The nurse should first listen to the child’s complaints and validate the child for reporting the
events. Later, school authorities should be notified. School administrators are the most
appropriate personnel to deal with the bullying child. The behavior should not be ignored; it will
only get worse.
19. 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?
These behaviors are most directly related to impulsivity. Hyperactive behaviors are more
physical in nature, such as running, pushing, and the inability to sit. Inattention is demonstrated
by failure to listen. Defiance is demonstrated by willfully doing what an authority figure has said
not to do.
20. 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?
c. Improved abilities to participate in
cooperative play with other children ANS: C
The goal is improvement in the child’s hyperactivity, aggression, and play. The remaining
options are more relevant for a child with intellectual development disorder or an anxiety
21. When group therapy is prescribed as a treatment modality, the nurse would suggest placement of
a 9-year-old in a group that uses:
play and talk about a play activity.
Group therapy for young children takes the form of play. For elementary school children, therapy
combines play and talk about the activity. For adolescents, group therapy involves more talking.
22. Which child demonstrates behaviors indicative of a neurodevelopmental disorder?
ANS: D A 3-year-old who is mute, passive toward
adults, and twirls while walking Symptoms consistent with autistic spectrum disorders (ASD) are evident in the correct answer.
Autistic spectrum disorder is one type of neurodevelopmental disorder. The behaviors of the
other children are within normal ranges.
23. The parent of a child diagnosed with Tourette’s 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?
c. “Tics often change frequency or severity.
That doesn’t mean they aren’t real.” ANS: C
Tics are sudden, rapid, involuntary, repetitive movements or vocalizations characteristic of
Tourette’s disorder. They often fluctuate in frequency, severity, and are reduced or absent during
24. When a 5-year-old is disruptive, the nurse says, “You must take a time-out.” The expectation is
that the child will:
c. sit on the edge of the activity until able to
regain self-control. ANS: C
Time-out is designed so that staff can be consistent in their interventions. Time-out may require
going to a designated room or sitting on the periphery of an activity until the child gains selfcontrol and reviews the episode with a staff member. Time-out may not require going to a
designated room and does not involve special attention such as holding. Counting to 10 or 20 is
25. 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:
Resiliency enables a child to handle the stresses of a difficult childhood. Resilient children can
adapt to changes in the environment, take advantage of nurturing relationships with adults other
than parents, distance themselves from emotional chaos occurring within the family, learn, and
use problem-solving skills.
1. 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
ANS: 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.
2. 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. ANS: C, D, E
Individuals with moderate intellectual developmental disorder progress academically to about the
second grade. These people can learn to travel in familiar areas and perform unskilled or
semiskilled work. With supervision, the person can function in the community, but independent
living is not likely.
3. 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 children’s communication
devices. d. Encourage the family to schedule daily
time together without communication
devices. e. Obtain the family’s network password and
examine online sites family members have
visited. ANS: B, C, D
Education and awareness-based approaches have a chance of effectively reducing harmful online
behavior, including risks associated with cyberbullying. Parental controls on the children’s devices will support safe Internet use. Family time together will promote healthy bonding and a
sense of security among members. There is no evidence of danger to the children, so a report to
child protective agency is unnecessary. It would be inappropriate to seek the family’s network
password and an invasion of privacy to inspect sites family members have visited.
Chapter 33. Children and Adolescents
1. Which developmental characteristic should a nurse identify as typical of a client diagnosed
with severe intellectual disability?
D. The client communicates wants and needs by acting out behaviors.
The nurse should identify that a client diagnosed with severe intellectual disability may
communicate wants and needs by acting out behaviors. Severe intellectual disability indicates an
IQ between 20 and 34. Individuals diagnosed with severe intellectual disability require complete
supervision and have minimal verbal skills and poor psychomotor development.
2. Which nursing intervention related to self-care would be most appropriate for a teenager
diagnosed with moderate intellectual disability?
B. Providing simple directions and praising clients independent self-care efforts
Providing simple directions and praise is an appropriate intervention for a teenager diagnosed
with moderate intellectual disability. Individuals with moderate intellectual disability can
perform some activities independently and may be capable of academic skill to a second-grade
3. A child has been diagnosed with autism spectrum disorder. The distraught mother cries out, Im
such a terrible mother. What did I do to cause this? Which nursing reply is most appropriate?
B. Poor parenting doesnt cause autism. Research has shown that abnormalities in brain structure
and/or function are to blame. This is beyond your control.
ANS: B The most appropriate reply by the nurse is to explain to the parent that autism spectrum disorder
is believed to be caused by abnormalities in brain structure and/or function, not poor parenting.
Autism spectrum disorder occurs in approximately 6 per 1,000 children and is about four times
more likely to occur in boys.
4. In planning care for a child diagnosed with autistic spectrum disorder, which would be a
realistic client outcome?
C. The client will establish trust with at least one caregiver by day 5.
The most realistic client outcome for a child diagnosed with autism spectrum disorder is for the
client to establish trust with at least one caregiver. Trust should be evidenced by facial
responsiveness and eye contact. This outcome relates to the nursing diagnosis impaired social
5. After an adolescent diagnosed with attention deficit-hyperactivity disorder (ADHD) begins
methylphenidate (Ritalin) therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month
period. What is the best explanation for this weight loss?
A. The pharmacological action of Ritalin causes a decrease in appetite.
The pharmacological action of Ritalin causes a decrease in appetite that often leads to weight
loss. Methylphenidate (Ritalin) is a central nervous symptom stimulant that serves to increase
attention span, control hyperactive behaviors, and improve learning ability for clients diagnosed
6. An adolescent client who was diagnosed with conduct disorder at the age of 8 is sentenced to
juvenile detention after bringing a gun to school. How should the nurse apply knowledge of
conduct disorder to this clients situation?
A. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these
individuals likely develop antisocial personality disorder in adulthood.
ANS: A The nurse should apply knowledge of conduct disorder to determine that childhood-onset
conduct disorder is more severe than adolescent-onset type. These individuals are likely to
develop antisocial personality disorder in adulthood. Individuals with this subtype are usually
boys and frequently display physical aggression and have disturbed peer relationships.
7. Which finding would be most likely in a child diagnosed with separation anxiety disorder?
B. The childs mother is diagnosed with an anxiety disorder.
The nurse should expect to find a ...
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