NCLEX Disorders of Infancy, Childhood & Adolescence

Question 1

Which complaint is representative of anxiety in a 6-year-old child?

a. “I worry that my dad will get hurt at work.”
b. “I get a stomach ache when it’s my weekend at my dad’s house.”
c. “I can’t sleep when I stay at Grandma’s because I worry about my mom.”
d. “I’m not going to sports camp because I don’t like being away from my friends.”

Answer 1

ANS: A
Developmental differences exist with regard to the symptoms of anxiety. Children between the ages of 5 and 8 years old most commonly report unrealistic worry about harm to their parents. Between the ages of 9 and 12 years, children report excessive distress during times of separation. Adolescents typically report somatic complaints.

Question 2

Which of the following meets the DSM-IV-TR criteria for moderate mental retardation?

a. Requires constant one-on-one supervision and total physical care
b. Advanced as far as the sixth grade and works at a warehouse every day and supports himself
c. Advanced as far as the second grade and provides her own personal care with supervision
d. Attends the local community college for developmental English and math courses

Answer 2

ANS: C
Individuals diagnosed as having moderate mental retardation acquire some communication skills, but rarely advance academically beyond the second grade. With supervision they can provide for their own personal care. Persons requiring constant supervision and total physical care would be considered profoundly retarded. Persons achieving elementary or above learning skills would be considered mildly retarded

Question 3

The nurse is assessing a child with autism. Which of the following behaviors would the nurse expect to observe?

a. Referring to their imaginary friend, Skipper
b. Asking to telephone ‘my friends’ on the weekends
c. Repeating, ‘milk, milk, milk, milk’ until given a drink
d. Is insistent that a dim light be left on in the bedroom at night

Answer 3

ANS: C
Stereotyped and repetitive use of language or idiosyncratic language is one of the characteristic behaviors seen in autism. The remaining options are normal characteristics of a child in various developmental stages.

Question 4

Which behavior best supports the diagnosis of attention-deficit/hyperactivity disorder in an 8-year-old child?

a. Cries when separated from his mother or father
b. Refuses to pick up toys as instructed by his parents
c. Is fascinated with spinning and moving toys and objects
d. Can concentrate on school work for only very short periods of time

Answer 4

ANS: D
Experiencing difficulty concentrating on tasks is a hallmark for ADHD. Crying is a characteristic of separation anxiety. Disobedience as described may represent oppositional behavior. Focusing on repetitious motion is characteristic of autism.

Question 5

Which behavior is most characteristic of a conduct disorder?

a. Frequently getting up and interrupting while being read to
b. Only apologizes for hitting a friend to avoid being punished
c. Finds it difficult to spend the night away from family members
d. Becomes extremely agitated when the television is turned off

Answer 5

ANS: B
Children or adolescents with conduct disorder generally do not empathize with other people’s feelings and are unconcerned with other’s situations or needs. They exhibit uncaring behavior, but they will often express words of guilt or remorse because they have learned that it reduces or prevents punishment. ADHD is often characterized by hyperactivity. Separation anxiety is often responsible for a child’s resistance to spending time away from home. Autism can be the cause of exaggerated responses

Question 6

Which assessment finding should be considered a high risk factor for adolescent suicide?

a. Being sexually abused
b. Having experienced panic attacks
c. Being mildly cognitively impaired
d. Having a diagnosis of type 1 diabetes

Answer 6

ANS: A
Suicide risk factors include a history of sexual abuse. There is no current research to support a strong relationship between suicide attempts and any of the other options

Question 7

Planning for a patient with Asperger’s disorder will be facilitated if the nurse understands that this disorder is different from autism. The nurse will base care on knowledge that Asperger’s disorder is characterized by:

a. Repetitive patterns of behavior
b. Age-appropriate language development
c. Stereotypic movements and speech patterns
d. Obsession with objects that move in a spinning motion

Answer 7

ANS: B
Communication will be facilitated knowing that a patient with Asperger’s disorder has no clinically significant delays in language or cognitive function. The remaining options are characteristics of both disorders

Question 8

Which behaviors would support a diagnosis of oppositional-defiant disorder?

a. Exhibits involuntary facial twitching and blinking and makes barking sounds
b. Negative, hostile, and spiteful toward parents and blames others for misbehavior
c. Displays high anxiety when away from parents, has nightmares, and fears being kidnapped
d. Violates others rights, is cruel to people or animals, lies and steals, and is truant from school

Answer 8

ANS: B
Children with oppositional defiant disorder argue with adults, actively defy adults’ requests, deliberately annoy adults, and refuse to take responsibility for their behaviors. Lying, stealing, and animal cruelty describes a child with conduct disorder. Being afraid of being kidnapped describes a child with separation anxiety. Facial twitching is associated with Tourette’s disorder.

Question 9

Which child’s history is a risk for developing a reactive attachment disorder?

a. Father is a chronic alcoholic
b. Was born with a congenital cardiac disorder
c. Experienced head trauma at age 7 months of age
d. Spent first 12 months of life in an Asian orphanage

Answer 9

ANS: D

Reactive attachment disorder is a disorder that occurs in some children who are institutionalized.

Question 10

Which intervention will best help a teenager manage aggressive behavior?

a. Administering prescribed medication as ordered
b. Supporting the patient’s interest in writing poetry
c. Reenacting situations that may trigger aggression
d. Providing information on anger management techniques

Answer 10

ANS: C
Role-play situations that trigger aggressiveness explore and reinforce alternative methods of coping. The other options although appropriate lack the opportunity to reflect on the triggers and practice the coping skills.

Question 11

Which intervention will best help a child manage hyperactive behavior?

a. Arranging for the child to play basketball 4 times a week
b. Allowing the child to play a favorite video game as a reward
c. Using a favorite food and beverage to distract the child
d. Placing the child in a low stimulation environment for 30-60 minutes

Answer 11

ANS: A
Redirect disruptive behavior with recreational activities to channel excess energy. The remaining options will have little positive effect on the child’s energy level.

Question 12

The nursing diagnosis that would be universally applicable for children with autistic disorder would be:

a. Risk for constipation related to odd eating habits
b. Chronic low self-esteem related to negative social feedback
c. Impaired social interaction related to inability to relate to others
d. Disturbed thought processes related a neurological dysfunction

Answer 12

ANS: C
Children with autistic disorder display profoundly disturbed social relationships. Essentially, they lack social reciprocity. They seem aloof and indifferent to others and prefer inanimate objects to people. The remaining options are not necessarily true of this mental illness.

Question 13

A child’s diagnosis of conduct disorder is supported by the fact that:

a. The child’s mother is a chronic alcoholic.
b. The child engages in ritualistic behaviors.
c. A brain scan shows structural abnormalities.
d. There is a family history of respiratory disorders.

Answer 13

ANS: B (book) A (rationale)
Conduct disorder occurs more frequently when a biologic parent has alcohol dependency. There is no research to support a connection between a conduct disorder and any of the remaining options.

Question 14

Which intervention will best help minimize parental guilt in the family of a child diagnosed with a psychiatric disorder?

a. Helping them to develop realistic expectations for their child
b. Educating them on the need to provide the child with boundaries
c. Providing them with information regarding locally available services
d. Encouraging them to use respite care periodically to allow for downtime

Answer 14

ANS: A
Teach the parents about the patient’s disorder to minimize their guilt related to causing or caring for the child. The remaining options although appropriate do not focus on the potential for self guilt.

Question 15

Which behavior demonstrates that a child is achieving appropriate management of separation anxiety?

a. Earned two As, three Bs, and one C this report card period
b. Falls asleep with a parent sitting outside the bedroom door
c. Sleeps on a chair in the parent’s bedroom rather than in their bed
d. Reports having only a ‘little stomach ache’ during breakfast on school days

Answer 15

ANS: A
Children with separation anxiety disorder demonstrate academic difficulties resulting from a refusal to attend school or frequent absences resulting from somatic illnesses. The other options show continued behaviors seen with this disorder.

Question 16

A 15-year-old has been diagnosed with major depression and admitted to the adolescent unit. Which behavior would the nurse expect to observe in this patient?

a. Discussing repeated “run-ins” with the law
b. Being manipulative and callous towards others
c. Blaming “adults” for his admission to the adolescent unit
d. Reporting decreased enjoyment of school-related activities

Answer 16

ANS: D
Anhedonia, the absence of pleasure, is a common manifestation of depression. Legal behavior and manipulative and uncaring behavior are characteristic of conduct disorder. Seeing adults as the root of their problems is common in conduct disorder and oppositional-defiant disorder.

Question 17

When discussing depression and suicide with parents of teenagers, the nurse is accurate in reporting that the most common method used in late adolescent suicide is:

a. Hanging
b. Firearms
c. Oral poisoning
d. Drug overdose

Answer 17

ANS: B
Statistics show the use of firearms is the most commonly used method of committing suicide among adolescents. With this in mind, the nurse could counsel parents about the importance of keeping firearms locked away from teens. The other options are less-often used methods for attempting suicide

Question 18

Planning safety interventions for a teenager with a history of self-injurious behavior is based on what research-based information?

a. Teenagers rarely entertain the idea of suicide.
b. Suicides can occur accidentally as a result of self-injurious behaviors.
c. Self-injury is always viewed as a risk factor for future suicidal attempts.
d. Assessment for suicidal ideations is a vital component of this child’s care.

Answer 18

ANS: B
Self-injurious behavior is not suicidal behavior and is not viewed as a risk factor for suicidal ideations or attempts, but some teenagers accidentally commit suicide in the process. Teenagers are acting on suicidal thoughts at an alarming rate

Question 19

Which statement made by a teenage male hospitalized after a failed suicide attempt is most concerning to the nurse?

a. “My uncle shot himself but he didn’t die.”
b. “I don’t know why I get so depressed and want to die.”
c. “The gun I got for my birthday is my most prized possession.”
d. “I hope I don’t ever get depressed enough to try and hurt myself again.”

Answer 19

ANS: C
Factors associated with suicidal behaviors include access to firearms providing the teenage patient with the opportunity and means to harm himself if he again becomes depressed. Although the remaining options represent possible risk factors, none provide insight into opportunity and means.

Question 20

The mother of a child describes her child’s “annoying behavior” as not being able to sit still or to stop jerking his arms when told to. Which disorder does the nurse suspect?

a. Tourette’s disorder
b. Oppositional-defiant disorder
c. Pervasive developmental disorder
d. Attention-deficit/hyperactivity disorder

Answer 20

ANS: A
The parent describes simple motor tics that are involuntary behaviors and characteristic of Tourette’s disorder. The child is not being defiant because he has no control of the tics. Although the child displays repeated motor behaviors, they are unrelated to hyperactivity because they are not generalized and occur only sporadically. These involuntary tics are not seen in pervasive developmental disorders such as autism.

Question 21

Which response is most therapeutic when a parent whose child is diagnosed with Tourette’s disorder voices concerns that their child’s facial contortions are merely acts of defiance?

a. “Your child isn’t defiant but rather mentally ill.”
b. “What makes you think he is doing that out of defiance?”
c. “I think with the use of some behavior modification techniques, he can learn to control the facial tics.”
d. “Your son’s behavior is likely due to a neurological dysfunction that causes those involuntary facial tics.”

Answer 21

ANS: D
Tourette’s disorder is most often thought to be a genetic neurologic disorder whose characteristic behaviors are involuntary in nature. Referring to the child as mentally ill is not a true description of the situation. Asking the parent to further discuss the idea that the tics are an act of defiance is inappropriate since that is not true. Behavioral modification is not effective on involuntary behaviors.

Question 22

Which description is characteristic of an impulsive child?

a. Pacing and speaking in a very loud, disruptive voice
b. Frequently talking about hearing voices telling him what to do
c. Running out into the street regardless of frequent instruction to look both ways first
d. Having a difficult time concentrating on reading since his attention is easily diverted

Answer 22

ANS: C
Running into the street is an example of impulsive behavior because it is clearly taking action before considering consequences. Hyperactivity refers to such things as increased pace and volume of activity. Thought disorders include such perceptual dysfunction as auditory hallucinations. Distractibility is characterized by poor concentration

Question 23

Which intervention would qualify as primary prevention of violent behaviors in children and adolescents?

a. Forbidding the child to continue friendships with violent peers
b. Limiting exposure to violence on TV, video, and computer games
c. Seeking counseling for a child who has been experimenting with drugs
d. Showing a unified approach to parenting when dealing with a violent child

Answer 23

ANS: B
Studies suggest that an obsession with violence in video games, movies, music, and writings increases aggressiveness in children and adolescents. The other options are relevant only after the risk for violence has been established

Question 24

A friend says to a nurse, “I am not going to get vaccines for my baby. I hear that vaccines cause autism.” The nurse’s best reply is:

a. “The exact cause of autism is not really known”
b. “It’s believed that autism is really a result of birth trauma.”
c. “There is no conclusive evidence to connect autism to vaccinations.”
d. “Please tell me more about where you got that information about autism?”

Answer 24

ANS: C
There is no research to connect autism to a reaction to vaccinations or to birth trauma. The exact cause of autism remains undetermined but that response doesn’t address the patient’s statement nor does asking the patient to give additional information regarding their original statement

Question 25

A 5-year-old girl on a behavior modification program is admitted to the unit. The nurse would expect to participate in which activity based on this approach?

a. Firmly challenging the child’s irrational thoughts
b. Including the child in the creation of a behavioral contract
c. Family therapy with every member present for each session
d. Play therapy with dolls representing every member of the family

Answer 25

ANS: B
Behavior modification includes constructing a contract that outlines behavioral changes that is a result of the input of therapists, family and the child. Family therapy, play therapy, and thought challenging are not generally used with a behavior modification program.

Question 26

A mother asks why the whole family needs to meet with the therapist because it is her teenage stepdaughter who has the substance abuse problem. The nurse replies with the knowledge that:

a. Mothers usually have insight into their children’s problem.
b. The parents are responsible for changing the teen’s behavior.
c. The family will probably use behavior modification with the teen.
d. Sometimes the teenaged patient is actually acting out family dynamics.

Answer 26

ANS: D
It is important to remember that children will often act out the underlying family dynamics or family psychopathology. Mothers may not have an understanding of the problems their children are experiencing. Behavior modification is not typically a treatment for teen substance abuse. The teen is responsible for changing personal behavior

Question 27

The parents of a child diagnosed with ADHD ask the nurse what current medications are available for their child. The nurse should list which of the following medications? (Select all that apply.)

a. Methylphenidate (Concerta)
b. Zolpidem (Ambien)
c. Dextroamphetamine (Adderall)
d. Atomoxetine (Strattera)
e. Haloperidol (Haldol)

Answer 27

ANS: A, C, D
Ambien is a sleeping medication and not typically used to treat ADHD. Haldol is an antipsychotic that is not specified for use for ADHD. The other medications are sometimes used for ADHD.