Chapter 11

Question 1

1. Which nursing diagnosis is universally applicable for children diagnosed with autism spectrum disorders?
   a.
   Impaired social interaction related to difficulty maintaining relationships
   b.
   Chronic low self-esteem related to excessive negative feedback
   c.
   Deficient fluid volume related to abnormal eating habits
   d.
   Anxiety related to nightmares and repetitive activities

Answer 1

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.

Question 2

2.	Which behavior indicates that the treatment plan for a child diagnosed with an autism spectrum disorder was effective? The child
a.
plays with one toy for 30 minutes.
b.
repeats words spoken by a parent.
c.
holds the parent’s hand while walking.
d.
spins around and claps hands while walking.

Answer 2

ANS: C
Holding the hand of another person suggests relatedness. Usually, a child diagnosed 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.

Question 3

3. 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
   a.
   promote integration of self-concept.
   b.
   provide inpatient treatment for the child.
   c.
   reduce loneliness and increase self-esteem.
   d.
   improve language and communication skills.

Answer 3

ANS: C
Because of their disruptive behaviors, children diagnosed with attention deficit hyperactivity disorder (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.

Question 4

4.	A nurse will prepare teaching materials for the parents of a child newly diagnosed with ADHD. Information will focus on which medication likely to be prescribed?
a.
Paroxetine
b.
Imipramine
c.
Methylphenidate
d.
Carbamazepine

Answer 4

ANS: C
Central nervous system (CNS) stimulants are the drugs of choice for treating children diagnosed with ADHD. Methylphenidate and mixed amphetamine salts are most commonly used. None of the other drugs are psychostimulants used to treat ADHD.

Question 5

5.	What is the nurse’s priority focused assessment for side effects in a child taking methylphenidate for ADHD?
a.
Dystonia, akinesia, and extrapyramidal symptoms
b.
Bradycardia and hypotensive episodes
c.
Sleep disturbances and weight loss
d.
Neuroleptic malignant syndrome

Answer 5

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 antipsychotic medications.

Question 6

6.	A desired outcome for a 12-year-old diagnosed with ADHD is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care?
a.
Reality therapy
b.
Simple restitution
c.
Social skills group
d.
Insight-oriented group therapy

Answer 6

ANS: C
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.

Question 7

7.	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
a.
communication disorder.
b.
stereotypic movement disorder.
c.
intellectual development disorder.
d.
ADHD.

Answer 7

ANS: D
Excessive motion, distractibility, and excessive talkativeness are seen in ADHD. The behaviors presented in the scenario do not suggest intellectual development, stereotypic, or communication disorder.

Question 8

8. A child diagnosed with ADHD 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 child
   a.
   has an improved ability to identify anxiety and use self-control strategies.
   b.
   has increased expressiveness in communication with others.
   c.
   shows increased responsiveness to authority figures.
   d.
   engages in cooperative play with other children.

Answer 8

ANS: D
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.

Question 9

9. When a 5-year-old diagnosed with 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.

Answer 9

ANS: 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.

Question 10

10.	A child diagnosed with ADHD will begin medication therapy. The nurse should prepare a plan to teach the family about which classification of medications?
a.
CNS stimulants
c.
Antipsychotics
b.
Tricyclic antidepressants
d.
Anxiolytics

Answer 10

ANS: A
CNS 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 ADHD. The other medication categories listed would not be appropriate.

Question 11

11.	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?
a.
Social isolation
b.
Decisional conflict
c.
Chronic low self-esteem
d.
Disturbed personal identity

Answer 11

ANS: A
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.

Question 12

12. 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.

Answer 12

ANS: C
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.

Question 13

13.	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
a.
has occasional toileting accidents.
b.
interrupts or intrudes on others.
c.
cries when separated from a parent.
d.
continuously rocks in place for 30 minutes.

Answer 13

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. Occasional toileting accidents and crying when separated from a parents are expected findings for a 3-year-old. Interrupting or intruding on others are assessment findings associated with ADHD.

Question 14

14. 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.
    a.
    “Ask the teacher to let the child call you at play time.”
    b.
    “Withdraw the child from preschool until maturity increases.”
    c.
    “Remain with your child for the first hour of preschool time.”
    d.
    “Give your child a kiss before you leave the preschool program.”

Answer 14

ANS: D
The child demonstrates age-appropriate behavior for a 4-year-old. The nurse should reassure the parents. The distracters are over-reactions.

Question 15

15. 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 recurring major depressive disorder.
    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.

Answer 15

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.

Question 16

16.	The child prescribed an antipsychotic medication to manage violent behavior is one most likely diagnosed with
a.
ADHD.
b.
posttraumatic stress disorder (PTSD).
c.
communication disorder.
d.
an anxiety disorder.

Answer 16

ANS: A
Antipsychotic medication is useful for managing aggressive or violent behavior in some children diagnosed with ADHD. 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.

Question 17

17. A child reports to the school nurse of being verbally bullied by an aggressive classmate. What is the nurse’s best first action?
    a.
    Give notice to the chief administrator at the school regarding the events.
    b.
    Encourage the victimized child to share feelings about the experience.
    c.
    Encourage the victimized child to ignore the bullying behavior.
    d.
    Discuss the events with the aggressive classmate.

Answer 17

ANS: B
The behaviors by the bullying child create emotional pain and present the risk for physical pain. Encouraging the victimized child to share feelings about the experience provides the nurse an opportunity to further assess the situation as well as provide support to the child. The nurse should 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.

Question 18

18.	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?
a.
Disobedience
b.
Hyperactivity
c.
Impulsivity
d.
Anxiety

Answer 18

ANS: C
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.

Question 19

19. A child diagnosed with ADHD shows hyperactivity, aggression, and impaired play. The health care provider prescribed amphetamine salts (Adderall). The nurse should monitor for which desired behavior?
    a.
    Increased expressiveness in communication with others
    b.
    Abilities to identify anxiety and implement self-control strategies
    c.
    Improved abilities to participate in cooperative play with other children
    d.
    Tolerates social interactions for short periods without disruption or frustration

Answer 19

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 disorder.

Question 20

20.	When group therapy is prescribed as a treatment modality, the nurse would suggest placement of a 9-year-old in a group that uses
a.
guided imagery.
b.
talk focused on a specific issue.
c.
play and talk about a play activity.
d.
group discussion about selected topics.

Answer 20

ANS: C
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.

Question 21

21. Which child demonstrates behaviors indicative of a neurodevelopmental disorder?
    a.
    A 4-year-old who stuttered for 3 weeks after the birth of a sibling
    b.
    A 9-month-old who does not eat vegetables and likes to be rocked
    c.
    A 3-month-old who cries after feeding until burped and sucks a thumb
    d.
    A 3-year-old who is mute, passive toward adults, and twirls while walking

Answer 21

ANS: D
Symptoms consistent with autistic spectrum disorders (ASD) are evident in the correct answer. ASD is one type of neurodevelopmental disorder. The behaviors of the other children are within normal ranges.

Question 22

22. 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?
    a.
    “Perhaps your child was misdiagnosed.”
    b.
    “Your observation indicates the medication is effective.”
    c.
    “Tics often change frequency or severity. That doesn’t mean they aren’t real.”
    d.
    “This finding is unexpected. How have you been administering your child’s medication?”

Answer 22

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 sleep.

Question 23

23. When a 5-year-old is disruptive, the nurse says, “You must take a time-out.” The expectation is that the child will
    a.
    go to a quiet room until called for the next activity.
    b.
    slowly count to 20 before returning to the group activity.
    c.
    sit on the edge of the activity until able to regain self-control.
    d.
    sit quietly on the lap of a staff member until able to apologize for the behavior.

Answer 23

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 self-control 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 not sufficient.

Question 24

24.	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
a.
displays resiliency.
b.
has a passive temperament.
c.
is at risk for PTSD.
d.
uses intellectualization to deal with problems.

Answer 24

ANS: A
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.

Question 25

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

Answer 25

ANS: B, D, E
Some dated terminology contributes to the stigma of mental illness and misconceptions about mental illness. It is important for the nurse to use current terminology.

Question 26

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.

Answer 26

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.

Question 27

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 potential safety risks in online environments.
   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.

Answer 27

ANS: B, C, D
The nurse’s focus is safety, including online environments. Education and awareness-based approaches are indicated to reduce the risks of potentially harmful 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.

Question 28

4.	Which assessment findings present familial risks for a child to develop a psychiatric disorder? (Select all that apply.)
a.
Having a mother diagnosed with schizophrenia
b.
Being the oldest child in a family
c.
Living with an alcoholic parent
d.
Being an only child
e.
Living in an urban community

Answer 28

ANS: A, C
Familial risk factors that correlate with child psychiatric disorders include severe marital discord, low socioeconomic status, large families and overcrowding, parental criminality, maternal psychiatric disorders, and foster-care placement. Having a parent with a substance abuse problem increases the risk of marital discord. A family history of schizophrenia presents a genetic risk. Being in a middle-income family, living in an urban community, and being an only or oldest child do not represent adversity.