children and teens

Question 1

List 3 main childhood mental conditions.

Answer 1

• Attention Deficit Hyperactivity
  Disorder (ADHD)
• Autism
• conduct disorder

Question 2

Identify clinical manifestations of ADHD in children and adolescents

Answer 2

6 symptoms each (for inattention and hyperactivity-impulsivity) in DSM V appearing in 2 or more settings.

Six of the following inattention symptoms:
 Failure to give close attention to details or makes careless mistakes in school work, work, or other activities
 Difficulty sustaining attention in tasks
 Does not seem to listen
 Does not follow instructions and fails to finish schoolwork, chores or duties
 Difficulty organizing tasks and activities
 Often avoids tasks requiring mental effort
 Easily distracted by extraneous stimuli
 Often loses things and are forgetful

Six of the hyperactivity-impulsivity symptoms:
 Often fidgets with hands/feet or squirms in seat
 Often leaves seat in classroom
 Runs and climbs excessively (restlessness)
 Had difficulty playing and engaging in leisure or other activities quietly
 Often “on the go” or acts as if “driven by motor”
 Talks excessively
 Blurts out answers before questions
 Has difficulty awaiting turns
 Interrupts or intrudes on others

Question 3

Identify clinical manifestations of autism in children and adolescents

Answer 3

Six (or more items) from the below mentioned list
(1,2,3)
1. Qualitative impairment in social interaction
- Poor use of non-verbal behaviours (eye contact, facial expression, gesture)
- Failure to develop peer relationships appropriate to developmental level
- A lack of seeking to share enjoyment, interests, or
achievement with others
- A lack of social or emotional reciprocity
2. Qualitative impairment in communication
- Delay in, or lack of the development of spoken language
- In an individual with adequate speech, marked impairment
in the ability to initiate or sustain a conversation with others
- Stereotyped and repetitive use of language
- Lack of varied, spontaneous make – believe play or social
imitative play appropriate to developmental level
3. Restricted repetitive and stereotyped patterns of behaviour, interests, and activities
- Preoccupation with one or more interests such as dates, phone numbers and timetables (abnormal in intensity or
focus)
- Inflexible adherence to specific and non-functional routine or
rituals
- Stereotyped repetitive mannerisms such as clapping rocking or twisting
- Persistent preoccupation with parts of objects
 Delays or abnormal functioning in social interaction or imaginative play < 3 years old

Question 4

Identify clinical manifestations of conduct disorder in children and adolescents

Answer 4

Manifest at least 3 of the below mentioned
symptoms in the past 12 months
 Aggression to People and Animals
- bully, threaten or intimidate others
- Often initiate physical fights
- force someone into undesirable social activities
- Physically cruel to people and animals
- Commit crimes (mugging, purse snatching,
extortion, armed robbery)
- Force someone into sexual activities

Question 5

Develop a plan of care for children with ADHD
1. Pharmacotherapy
2. Psychological

Answer 5

1. NI for pharmacotherapy: Management of medication side effects
   - Insomnia: earlier dosing, co administer clonidine or trazodone at bedtime
   - Reduced appetite: morning dosing, use Focalin (result in less of this effect), ensuring that the child eats healthy meals
   - Stomachache: Give medication with food
   - Mild dysphoria: Switch medication or add
   antidepressants as ordered
   - Headache: Reduce dose
   - Lethargy, sedation, impaired concentration:
   Reduce dose
2. NI for Psychological
   - Behavioural modification – teaches the child self – monitoring (eg. STOP, THINK, DO)
   - Social Skills training groups
   - Attention training
   - Parent management training (Impt)
   - Parent support group
   - School interventions - academic support
   - Speech therapy if appropriate

NI:
* Establish and maintain good relationship with
the clients and parents
* Decrease risks for injury
- Assess frequency and severity of accidents
- Ensure safe environment
- Talk with the client about safe/unsafe behaviours
- Explain consequences directly related to undesirable behaviours
- Make corrective feedback as specific as possible (Don’t jump down the stairs. Walk one step at a time)
Enhance performance and social interactions
- Identify factors aggravating or alleviating the client’s performance
- Provide quiet environment with minimal distraction
- Give instructions slowly and use simple language
and concrete directions
- Let the client repeat instructions before doing the task
- Provide positive feedback after completion of the
task
- Allow time to move around
- Teach caregivers to use the same strategies

Question 6

Describe available treatment modalities for ADHD

Answer 6

1. Pharmacotherapy (mostly stimulants)
   - Ritalin (methylphenidate)
   - Dexedrine (dextroamphetamine)
   - Adderall (amphetamine)
   - Focalin (dexmethylphenidate)
   Goal of pharmacotherapy is to reduce
   core symptoms such as hyperactivity,
   inattentiveness and impulsiveness
2. Psychological interventions
    Behavioural modification – teaches the child
   self – monitoring (eg. STOP, THINK, DO)
    Social Skills training groups
    Attention training
    Parent management training (Impt)
    Parent support group
    School interventions - academic support
    Speech therapy if appropriate

Question 7

Describe available treatment modalities for Autism

Answer 7

 Language and academic interventions
 Behavioural modifications to reduce
disruptive behaviours
 Appropriate residential placement
 Insight – oriented individual psychotherapy
 Education programme for parents (esp concept of behavioural modification)
 Parent support group
 Medication for hyperactivity such as Ritalin and Lexapro

Question 8

Describe available treatment modalities for conduct disorder

Answer 8

 Treat comorbid substance abuse first
 Behavioural modification
 Structured children’s activities and curfew enforcement
 Social skill training
 Individual psychotherapy
 Family education and therapy
 Parental communication techniques
 Pharmacological interventions
- Dexedrine
- Ritalin
- Wellbutrin
- Prozac
 School – based prevention programme

Question 9

Develop a plan of care for children with Conduct disorder

Answer 9

 Establish and maintain good relationships with the client
and family
 Limit setting on undesirable behaviours
 Use a firm and consistent approach
 Contract with the client (ahead of time) for any special
requests or privileges
 Validate the client’s feelings of frustration but remain
firm
 Protect other clients from being manipulated by the
client afflicted with conduct disorder
 Structure a daily schedule such as getting up, going to
bed, etc
 Provide positive reinforcement after completion of
scheduled tasks
 Assess threats or suicidal risk seriously
 Institute “time – out” technique for a “cooling off” opportunity
 Encourage the client to keep a diary of his/her
feelings
 Encourage the client to verbalise his/her feelings
 Assist the client in exploring alternatives to acting out undesirable behaviours
 Teach a problem – solving strategy
 Role model appropriate communication and social skills
 Gradually introduce other clients into interaction with the client who has conduct disorder

Question 10

Teaching for methylphenidate (Ritalin) should include which
information?
a. Give the medication after meals.
b. Give the medication when the child becomes overactive.
c. Increase the child’s fluid intake when he or she is taking the
medication.
d. Check the child’s temperature daily.

Answer 10

a

Question 11

The nurse would expect to see all the following symptoms in a child
with ADHD, except
a. distractibility and forgetfulness.
b. excessive running, climbing, and fidgeting.
c. moody, sullen, and pouting behavior.
d. interrupting others and inability to take turns.

Answer 11

c

Question 12

The nurse is teaching a 12-year-old with intellectual disability about medications. Which intervention is essential?
a. Speak slowly and distinctly.
b. Teach the information to the parents only.
c. Use pictures rather than printed words.
d. Validate client understanding of teaching.

Answer 12

d

Question 13

The nurse recognizes which as a common behavioral sign of autism?
a. Clinging behavior toward parents
b. Creative imaginative play with peers
c. Early language development
d. Indifference to being hugged or held

Answer 13

d

Question 14

A 7-year-old child with ADHD is taking clonidine (Kapvay). Common
side effects include
a. appetite suppression.
b. dizziness.
c. dry mouth.
d. hypotension.
e. insomnia.
f. nausea.

Answer 14

b, c, d

Question 15

A teaching plan for the parents of a child with ADHD should include
a. allowing as much time as needed to complete any task.
b. allowing the child to decide when to do homework.
c. giving instructions in short simple steps.
d. keeping track of positive comments that the child is given.
e. providing a reward system for completion of daily tasks.
f. spending time at the end of the day reviewing the child’s behavior

Answer 15

c, d, e

Question 16

The nurse has completed teaching sessions for parents about conduct
disorder. Which statement indicates a need for further teaching?
a. “Being consistent with rules at home will probably be a real
challenge for me and my child.”
b. “It helps to know that these problems will get better as my child
gets older.”
c. “Real progress for our child is likely to take several weeks or even months.”
d. “We need to set up a system of rewards and consequences for our
child’s behaviors.

Answer 16

b

Question 17

Which behavior is normal adolescent behavior?
a. Being critical of self and others
b. Defiant, negative, and depressed behavior
c. Frequent hypochondriacal complaints
d. Unwillingness to assume greater autonomy

Answer 17

a

Question 18

An effective nursing intervention for the impulsive and aggressive
behaviors that accompany conduct disorder is
a. assertiveness training.
b. consistent limit setting.
c. negotiation of rules.
d. open expression of feelings.

Answer 18

b

Question 19

The nurse understands that effective limit setting for children includes
a. allowing the child to participate in defining limits.
b. consistent enforcement of limit by entire team.
c. explaining the consequences of exceeding limits.
d. informing the child of the rule or limit.
e. negotiation of reasonable requests for change in limits.
f. providing three or four cues or prompts to follow the established
limit

Answer 19

b, c, d