Neurodevelopment disorder Flashcards
The client is 6-year-old who has been diagnosed with autism spectrum disorder. Which symptom would the client display?
a. The client has multiple motor tics and several vocal tics.
b. The client spends time alone with little interest in making friends.
c. The client has an irresistible urge to pull out the client’s own hair.
d. The client becomes overly attached to those around the client.
b.
Children with autism spectrum disorder develop language slowly or not at all. They may use words without attaching meaning to them or communicate with only gestures or noises. They spend time alone and show little interest in making friends. Autism spectrum disorder is not associated with over attachment, pulling out hair, or tics.
After educating the parents of a child diagnosed with attention deficit hyperactivity disorder (ADHD) on the disorder and its treatment, the nurse determines that the education has been effective when the parents make which statement?
a. “We need to be careful so our child doesn’t develop a substance use disorder.”
b. “We should stop the medication after two months to see how effective it is in really controlling symptoms.”
c. “We need to remember that our child is not a bad kid but just has difficulty with impulse control and attention.”
d. “We should set up regular routines, but not worry if our child violates the limits once in a while.”
c.
Educating clients and families on the biological basis of ADHD helps parents understand that these children are not “bad” kids but that they have problems with impulse control and attention. It may be helpful to review the purposes of the medications and assure the parents that there is evidence that medications help most children. Studies show that treatment of ADHD is not associated with a risk of substance use disorders. The health care provider, not the parents, would determine when it would be appropriate to take a drug holiday to evaluate the need for continued medication therapy. Regular routines are important, but so are clear limits with clear consequences when these limits are violated.
An adolescent client diagnosed with attention-deficit/hyperactivity disorder (ADHD) is being counseled in the clinic for daily stressors. For which common comorbidity should the nurse assess regularly to identify and treat early within the client?
a. chronic obstructive pulmonary disease (COPD)
b. allergies
c. substance use disorder
d. hypertension
c. Substance use disorder
There is a high comorbidity between attention-deficit/hyperactivity disorder (ADHD) and other disorders, including substance use disorder, antisocial behavior, anxiety disorders, and mood disorders. To promote health through adulthood, individuals with ADHD could benefit from strategies to prevent other psychiatric disorders as well as early identification and treatment of coexisting disorders. Hypertension, allergies, and chronic obstructive pulmonary disease (COPD) are not correlated with ADHD. Therefore, the nurse should regularly assess substance use in order to treat it as early as possible.
Which medication is effective in 70% to 80% of children with attention deficit hyperactivity disorder (ADHD)?
a. Amphetamine
b. Dextroamphetamine
c. Pemoline
d. Methylphenidate
d. Methylphenidate
Methylphenidate, a common medication for treating ADHD, is effective in 70% to 80% of children who have ADHD. The other stimulants dextroamphetamine and pemoline, and the amphetamine compound Adderall are used to treat ADHD, but they are not as effective as methylphenidate.
An adolescent is being observed for attention deficit hyperactivity disorder (ADHD). Which circumstance would demonstrate evidence to support this diagnosis?
a. Is withdrawn in social contexts but energetic and engaging with family.
b. Shows cruelty to animals, callousness, and lack of guilt and remorse.
c. Is stubborn, resistant to directions, and unwilling to negotiate.
d. Forgets to turn in homework, does not follow directions, cannot stay in assigned seat in class, and is always talking excessively and inappropriately.
d.
ADHD is characterized by distractibility, lack of concentration, and excessive activity.
A child with attention deficit hyperactivity disorder is taking methylphenidate in divided doses. If the child takes the first dose at 0800. Which behavior might the school nurse expect to see at noon?
a. increased impulsivity or hyperactive behavior
b. social isolation from peers
c. lack of appetite for lunch
d. sleepiness or drowsiness
a. increased impulsivity or hyperactive behavior.
Ritalin has a short half-life, so doses are needed about every 4 hours during the day to maintain symptom control. The child’s symptoms may worsen four hours after a dose. Giving stimulants during daytime hours usually effectively combats insomnia. Social isolation is likely to be an ongoing, long term problem that is unrelated to the precise timing of doses. A loss of appetite is more likely when serum levels of the drug are higher.
A child is taking methylphenidate for treatment of attention deficit hyperactivity disorder (ADHD). Which side effect must be monitored in this child?
a. Weight gain
b. Polyuria
c. Increased appetite
d. Growth delays
d growth delays
Nursing considerations when administering methylphenidate include monitoring appetite suppression or growth delays.
The nurse is caring for a pediatric client diagnosed with attention-deficit/hyperactivity disorder (ADHD) who is having difficulty with school due to inattentiveness and hyperactivity. Which medication will the nurse anticipate most likely being prescribed for the client to help with these symptoms?
a. olanzapine
b. fluoxetine
c. methylphenidate
d. quetiapine
c. Methylphenidate
Medications are often effective in decreasing hyperactivity and impulsiveness and improving attention; this enables the child to participate in school and family life. The most common medications are methylphenidate and amphetamine compound. Methylphenidate is effective in 70% to 80% of children with ADHD; it reduces hyperactivity, impulsivity, and mood lability and helps the child pay attention more appropriately. Olanzapine, quetiapine, and fluoxetine are not prescribed for the symptoms of hyperactivity or inattentiveness associated with ADHD. Therefore, methylphenidate will most likely be prescribed for the client.
A 9-year-old client with attention deficit hyperactivity disorder (ADHD) has been placed on the stimulant methylphenidate. The nurse knows that the teaching has been effective when the client’s parents make which statement?
a. “Our child may have some side effects, like insomnia, loss of appetite, or weight loss.”
b. “We’ll bring our child in every week to get blood levels drawn.”
c. “Our child knows to take this medication once every 12 hours.”
d. “Our child will have an effect from this drug in about 2 weeks.”
a.
The most common side effects of common medications used to treat ADHD, such as methylphenidate, include insomnia, loss of appetite, and weight loss or failure to gain weight. Methylphenidate is not taken every 12 hours; it is available in a sustained-release form taken once daily or in a daily transdermal patch, or it is given in 3 or 4 divided doses a day. Methylphenidate begins to have an effect within about 30 minutes. The client does not need to have blood drawn weekly.
A child with attention deficit hyperactivity disorder (ADHD) has been prescribed dextroamphetamine. For what effects should the nurse tell the parents to monitor the child? Select all that apply.
a. Weight gain
b. Insomnia
c. Appetite suppression
d. Hypotension
e. Weight loss
b, c, e
Dextroamphetamine is a commonly prescribed drug to treat symptoms of ADHD. Insomnia, weight loss, and appetite suppression are the common side effects associated with this drug. The nurse should educate the parents on monitoring these effects. Hypotension and weight gain are not common side effects of this drug.
A pediatric client is being assessed in the clinic for a diagnosis of autism spectrum disorder (ASD). The client’s parent describes that the client bangs their head repeatedly at times. Which assessment finding should be documented by the nurse?
a. coprolalia
b. encopresis
c. enuresis
d. stereotyped motor behavior
d. stereotyped motor behavior.
Stereotyped motor behaviors, such as hand flapping, body twisting, and head banging, are common behaviors with autism spectrum disorder (ASD). The client in the scenario is exhibiting stereotyped motor behavior, which should be documented by the nurse. Coprolalia is the term for a complex vocal tic that includes using socially unacceptable words, frequently obscene words. Encopresis is the repeated passage of feces into inappropriate places such as clothing or the floor by a child who is at least 4 years of age either chronologically or developmentally. Enuresis is the repeated voiding of urine during the day or at night into clothing or bed by a child at least 5 years of age either chronologically or developmentally.
A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The child is given medication and behavioral modification therapy to treat the condition. Which outcome achieved within 3 days would indicate successful therapy?
a. The child is able to complete assignments or tasks with assistance.
b. The child is able to demonstrate successful interaction with family members over a long period of time.
c. The child is able to interact and to develop successful peer relationships.
d. The child is able to express positive statements about the self.
a.
If within 3 days of starting treatment the child with ADHD is able to complete work or assignments with assistance, then this indicates successful therapy. Being able to express positive statements about themself cannot be expected of the child after only 3 days of therapy. The child’s ability to develop peer relationships would also not be demonstrated within this time. After 3 days of therapy, the children with ADHD would be able to demonstrate changes like being able to listen to others. They would not be able to interact with family members for a long period of time.
An adult client diagnosed with social phobia is being treated in the clinic. Which screening question should the nurse ask the client to assess for the possible comorbidity of attention-deficit/hyperactivity disorder (ADHD)?
a. “Do you often find yourself resisting being around other people?”
b. “Do you perform tasks repeatedly or compulsively to avoid feeling anxious?”
c. “How often do you feel sad or depressed throughout the week?”
d. “How often do you have difficulty getting things in order when you have to do a task that requires organization?”
d
Approximately 70% to 75% of adults with attention-deficit/hyperactivity disorder (ADHD) have at least one coexisting psychiatric diagnosis, the most common being social phobia, bipolar disorder, major depression, and alcohol dependence. Usually ADHD is diagnosed in childhood, but if it was missed, the nurse should ask the client questions to determine if they possibly have the comorbidity of ADHD as well. Screening questions include: How often do you have trouble wrapping up the final details of a project once the challenging parts have been done? How often do you have difficulty getting things in order when you have to do a task that requires organization? How often do you have problems remembering appointments or obligations? When you have a task that requires a lot of thought, how often do you avoid or delay getting started? How often do you fidget or squirm with your hands or feet when you have to sit down for a long time? How often do you feel overly active and compelled to do things like you were driven by a motor? How often do you interrupt others when they are busy? How often do you finish sentences for others? How often do you have difficulty taking turns when that is required? The questions, “Do you perform tasks repeatedly or compulsively to avoid feeling anxious?”, “Do you often find yourself resisting being around other people?”, and “How often do you feel sad or depressed throughout the week?” do not screen for ADHD in adults.
A nurse is speaking to the parents of a child with attention deficit hyperactivity disorder (ADHD). The parents ask the nurse about the reason for the child’s underachievement in academics. What explanation given by the nurse is most appropriate?
a. “Your child has trouble following the teacher’s directions.”
b. “Your child does not attend classes.”
c. “Your child has difficulty with reading and writing.”
d. “Your child has impaired cognitive abilities.”
a
Children with ADHD tend to be have difficulty following directions in school and this leads to careless mistakes in their work. This can cause underachievement in academics. Unlike children with conduct disorder, the child with ADHD does not have the tendency to miss classes. Cognition is not impaired in children with ADHD. Unlike children with a learning disorder, the child with ADHD does not have difficulty with reading and writing.
A nurse is assessing a 2-year-old child diagnosed with autism spectrum disorder. Which findings does the nurse expect to find on assessment? Select all that apply.
a. The child becomes upset with minor changes in routine.
b. The child becomes frightened when left alone.
c. The child avoids eye contact.
d. The child is extremely playful.
e. The child does not relate to parents.
a, c, e
Children with autism spectrum disorder tend to avoid eye contact with people. They do not identify or relate to their parents and remain detached. These children get upset with minor changes in routine. Children with autism spectrum disroder do not enjoy engaging in play or make-believe with toys. These children do not get frightened if left alone; in fact, they prefer being left alone.
