Child and Adolescent Mental Health

Question 1

This is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains.

Answer 1

neurodevelopmental disorder

Question 2

Heterogenous group of neurodevelopmental syndromes
Wide range of communication impairments and restricted, repetitive behaviors
Withdrawal of child into self and into a fantasy world of his or her own creation
Onset in early childhood
Often chronic course

Answer 2

autism spectrum disorder

Question 3

predisposing factors for ASD

Answer 3

Neurological implications
Genetics
Prenatal and perinatal influences

Question 4

possible symptoms along spectrum of ASD

Answer 4

Impairment in social interaction
Impairment in communication and imaginative activity
Restricted activities and interests
Varied functionality

Question 5

possible nursing diagnosis for ASD

Answer 5

Risk for self-mutilation
Impaired social interaction
Impaired verbal communication

Question 6

ASD nursing outcomes
the client:

Answer 6

Exhibits no evidence of self-harm
Interacts appropriately with at least one staff member
Demonstrates trust in at least one staff member
Is able to communicate so that he or she can be understood by at least one staff member
Demonstrates behaviors that indicate he or she has begun the separation/individuation process

Question 7

ASD nursing planning/implementation

Answer 7

Protection of the child from self-harm
Improvement in social functioning
Improvement in verbal communication
Enhancement of personal identity

Question 8

ASD nursing evaluation

Answer 8

Has the child been able to establish trust with at least one caregiver?
Have the nursing actions directed toward preventing mutilative behaviors or other injury been effective in protecting the client from self-harm?
Has the child attempted to interact with others? Has he or she received positive reinforcement for these efforts?
Has eye contact improved?
Has the child established a means of communicating his or her needs and desires to others? Have all self-care needs been met?
Does the child demonstrate an awareness of self as separate from others? Can he or she name own body parts and body parts of caregiver?

Question 9

two medication FDA approved for ASD

Answer 9

Risperidone
Aripiprazole

Question 10

targeted symptoms for medications treating ASD

Answer 10

Aggression
Deliberate self-injury
Temper tantrums
Quickly changing moods

Question 11

Inattention and/or hyperactivity and impulsivity

Answer 11

Attention Deficit/Hyperactivity Disorder

Question 12

excessive psychomotor activity

Answer 12

Hyperactivity

Question 13

acting without reflection or thought of consequences

Answer 13

Impulsiveness

Question 14

ADHD subtypes

Answer 14

Combined type (meeting the criteria for both inattention and hyperactivity/impulsivity)
Predominantly inattentive presentation
Predominantly hyperactive/impulsive presentation

Question 15

ADHD predisposing factors

Answer 15

Genetics
Biochemical theory
Anatomical influences
Prenatal, perinatal, and postnatal factors

Question 16

environmental influences on ADHD

Answer 16

Environmental lead
Dietary factors (food dyes and additives)

Question 17

psychosocial influences on ADHD

Answer 17

Disorganized or chaotic family environments
Maternal mental disorder or paternal criminality
Low socioeconomic status
Unstable foster care

Question 18

ADHD nursing assessment

Answer 18

Difficulty in performing age-appropriate tasks
Highly distractible
Extremely limited attention span
Impulsive
Difficulty forming satisfactory interpersonal relationships
Demonstrates behaviors that inhibit acceptable social interaction
Disruptive and intrusive in group endeavors
Excessive levels of activity, restlessness, and fidgeting
Accident prone
Low frustration tolerance and temper outbursts

Question 19

ADHD comorbidities

Answer 19

Oppositional defiant disorder and conduct disorder: 50%
Anxiety: 30%
Depression: 30%
Bipolar disorder: 20%

Depression and anxiety may be treated concurrently with ADHD
Substance use disorder and bipolar disorder must be stabilized BEFORE beginning ADHD treatment

Question 20

possible nursing diagnosis for ADHD

Answer 20

Risk for injury
Impaired social interaction
Low self-esteem
Noncompliance with task expectations

Question 21

ADHD nursing outcomes
the client:

Answer 21

Has experienced no physical harm
Interacts with others appropriately
Verbalizes positive aspects about self
Demonstrates fewer demanding behaviors
Cooperates with staff in an effort to complete assigned tasks

Question 22

ADHD nursing planning/interventions

Answer 22

Ensuring that client remains free of injury
Encouraging appropriate interactions with others
Increasing feelings of self-worth
Fostering motivation for compliance with tasks

Question 23

ADHD nursing evaluation

Answer 23

Have the nursing actions directed at client safety been effective in protecting the child from injury?
Has the child been able to establish a trusting relationship with the primary caregiver?
Is the client responding to limits set on unacceptable behaviors?
Is the client able to interact appropriately with others?
Is the client able to verbalize positive statements about self?
Is the client able to complete tasks independently or with a minimum of assistance?
Can the client follow through after listening to simple instructions?

Question 24

CNS stimulants for ADHD med interventions

Answer 24

Dextroamphetamine, lisdexamfetamine, methylphenidate, dexmethylphenidate
Increase dopamine and norepinephrine levels
Side effects: Insomnia, anorexia, weight loss, tachycardia, decrease in rate of growth and development
Higher risk of injury-related hospital admissions

Question 25

Presence of vocal tics and multiple motor tics Onset may be as early as age 2 Occurs most commonly around age 6 or 7 More common in boys than in girls 3 to 8 per 1,000 in school-age children

Answer 25

tourette's disorder

Question 26

environmental predisposing factors for tourette's

Answer 26

Maternal alcohol use during pregnancy Low birth weight Complications during childbirth Infection

Question 27

tourette's nursing assessment

Answer 27

Simple motor tics Complex motor tics Vocal tics -Repeating certain words or phrases out of context -Palilalia -Echolalia

Question 28

possible nursing diagnosis for tourette's

Answer 28

Risk for self-directed or other-directed violence Impaired social interaction Low self-esteem

Question 29

tourette's nursing outcomes the client:

Answer 29

Has not harmed self or others Interacts with staff and peers in an appropriate manner Demonstrates self-control by managing tic behavior Follows rules without becoming defensive Verbalizes positive aspects about self

Question 30

Tourette’s Nursing Planning/Implementation

Answer 30

Safety of client and others Encouraging interpersonal interaction using appropriate behaviors Promoting increased feelings of self-worth

Question 31

Tourette’s Nursing Evaluation

Answer 31

Has the client refrained from causing harm to self or others during times of increased tension? Has the client developed adaptive coping strategies for dealing with frustration to prevent resorting to self-destruction or aggression to others? Is the client able to interact appropriately with staff and peers? Is the client able to suppress tic behaviors when he or she chooses? Does the client verbalize positive aspects about self, particularly as they relate to his or her ability to manage the illness?

Question 32

Tourette’s Pharmacological Intervention

Answer 32

Pharmacological intervention most effective when combined with other behavioral therapy Antipsychotics -Haloperidol (Haldol) and pimozide Alpha agonists (antihypertensives) -Clonidine (Catapres) and guanfacine (Tenex; Intuniv)

Question 33

Persistent pattern of angry mood and defiant behavior Interferes with social, educational, or vocational activities Typically begins by 8 years of age and usually not later than early adolescence

Answer 33

oppositional defiant disorder

Question 34

common comorbidities for ODD

Answer 34

ADHD, anxiety, MDD, conduct disorder, and substance use

Question 35

pathology of ODD

Answer 35

developmental phase is prolonged

Question 36

ODD Predisposing Factors

Answer 36

Biological influences -Role not determined Family influences -If power and control are issues for parents -If parents exercise authority for their own needs -Power struggle between the parents and the child

Question 37

ODD nursing assessment

Answer 37

Passive-aggressive behaviors Stubbornness, procrastination Disobedience, negativism Carelessness, testing of limits Resistance to directions Unwillingness to cooperate Running away School avoidance and underachievement Temper tantrums, fighting, and argumentativeness Impaired interpersonal relationships

Question 38

possible nursing diagnoses for ODD

Answer 38

Noncompliance with therapy Defensive coping Low self-esteem Impaired social interaction

Question 39

ODD nursing outcomes the client:

Answer 39

Complies with treatment by participating in therapies without negativism Accepts responsibility for his or her part in the problem Takes direction from staff without becoming defensive Does not manipulate other people Verbalizes positive aspects about self Interacts with others in an appropriate manner

Question 40

ODD nursing planning/implementation

Answer 40

Encouraging cooperation with therapy Helping client accept responsibility for own behaviors Promoting increased feelings of self-worth Assisting in the development of socially appropriate behaviors in interactions with others

Question 41

ODD nursing evaluation

Answer 41

Is the client cooperating with schedule of therapeutic activities? Is level of participation adequate? Is the client’s attitude toward therapy less negative? Is the client accepting responsibility for problem behavior? Is the client verbalizing the unacceptability of his or her passive-aggressive behavior? Is he or she able to identify which behaviors are unacceptable and substitute more adaptive behaviors? Is the client able to interact with staff and peers without defending behavior in an angry manner?

Question 42

Persistent pattern of behavior in which basic rights of others are violated Major age-appropriate societal norms or rules are violated -Childhood-onset type -Adolescent-onset type

Answer 42

conduct disorder

Question 43

predisposing factors for conduct disorder

Answer 43

Biological influences -Genetics -Irritable temperament -Biochemical factors Psychosocial influences -Peer relationships --Poor academic performance and social maladaptation --Affiliations with deviant peer group Family influences Parental rejection Inconsistent management with harsh discipline Early institutional living Frequent shifting of parental figures Large family size Absent father Parents with antisocial personality disorder, alcohol dependence Marital conflict and divorce Inadequate communication patterns Parental permissiveness

Question 44

assessment for conduct disorder

Answer 44

Use of physical aggression in violation of rights of others Use of drugs and alcohol Sexual permissiveness Low self-esteem manifested by a “tough-guy” image Problems with inattentiveness, impulsiveness, and hyperactivity Lack of feelings of guilt or remorse Use of projection as a defense mechanism Inability to control anger Low academic achievement

Question 45

possible nursing diagnoses for conduct disorder

Answer 45

Risk for other-directed violence Impaired social interaction Defensive coping Low self-esteem

Question 46

conduct disorder nursing outcomes the client:

Answer 46

Has not harmed self or others Interacts with others in a socially appropriate manner Accepts direction without becoming defensive Demonstrates evidence of increased self-esteem by discontinuing exploitative and demanding behaviors toward others

Question 47

Conduct Disorder Planning/Implementation

Answer 47

Ensuring safety of client and others Assisting in the development of socially appropriate behaviors in interactions with others Encouraging client to accept responsibility for own behaviors Promoting increased feelings of self-worth

Question 48

Conduct Disorder Evaluation

Answer 48

Have the nursing actions directed toward managing the client’s aggressive behavior been effective? Have interventions prevented harm to others or others’ property? Is the client able to express anger in an appropriate manner? Has the client developed more adaptive coping strategies to deal with anger and feelings of aggression? Does the client demonstrate the ability to trust others? Is he or she able to interact with staff and peers in an appropriate manner? Is the client able to accept responsibility for his or her own behavior? Is there less blaming of others?

Question 49

therapeutic approaches for conduct disorder

Answer 49

Behavior therapy Disruptive behavior disorders ADHD, ODD, and conduct disorder Group Therapy Parents should be involved in treatment process

Question 50

gender dysphoria shows distress with:

Answer 50

Gender identity Depression related to desire to be opposite gender Fear and anxiety related to others learning about their gender identity

Question 51

nurse role for gender dysphoria in children

Answer 51

emphasis is given to improvement in social interactions and enhancement of positive self-esteem

Question 52

treatment for gender dysphoria treatment should include:

Answer 52

Evaluation/management of concurrent mental health issues Social support systems Later childhood: nonjudgmental exploration of individual’s preferences Behavior modification: assist with acceptance of self-image without discomfort/distress Treatment is matter of personal choice Address depression, anxiety, social isolation, anger, self-esteem, and parental conflict Nursing role: educating families, identifying safe, supportive peer groups