Question 1

The child most likely to receive propranolol (Inderal)to control aggression,deliberate self-injury,and temper tantrums is one diagnosed with:

Accepted Answer

Propranolol is useful for controlling aggression,deliberate self-injury,and temper tantrums of some autistic children.It is not indicated in any of the other disorders.

Question 2

A 4-year-old child cries and screams from the time the parents leave the child at preschool until the child is picked up 4 hours later.The child is calm and relaxed when the parents are present.The parents ask,"What should we do?" What is the nurse's best recommendation?

Accepted Answer

Separation anxiety disorder becomes apparent when the child is separated from the attachment figure.Often,the first time separation occurs is when the child goes to kindergarten or nursery school.Separation anxiety may be based on the child's fear that something will happen to the attachment figure.The child needs professional help.

Question 3

A child with attention deficit hyperactivity disorder (ADHD)is going to begin medication therapy.The nurse should plan to teach the family about which classification of medications?

Accepted Answer

Central nervous system stimulants increase blood flow to the brain and have proven helpful in reducing hyperactivity in children and adolescents with ADHD.The other medication categories listed would not be appropriate.

Question 4

Shortly after an adolescent's parents announce a plan to divorce,the teen stops participating in sports,sits alone at lunch,and avoids former friends.The adolescent says,"If my parents loved me,then they would work out their problems." What nursing diagnosis is most applicable?

Accepted Answer

Ineffective coping is evident in the adolescent's response to family stress and discord.Adolescents value peer interactions,and yet this child has eliminated that source of support.The distracters are not supported by the data in this scenario.

Question 5

A 5-year-old child moves and talks constantly,is easily distracted,and does not listen to the parents.The child awakens before the parents every morning.The child attended kindergarten,but the teacher could not handle the behavior.What is this child's most likely problem?

Accepted Answer

The excessive motion,distractibility,and excessive talkativeness suggest ADHD.Developmental delays would be observed if either a pervasive developmental disorder or mental retardation were present.ODD includes serious violations of the rights of others.

Question 6

A 15-year-old adolescent is referred to a residential program after an arrest for theft and running away from home.At the program,the adolescent refuses to participate in scheduled activities and pushes a staff member,causing a fall.Which approach by the nursing staff would be most therapeutic?

Accepted Answer

Firm limits are necessary to ensure physical safety and emotional security.Limit setting will also protect other patients from the teenager's thoughtless or aggressive behavior.Permitting refusals to participate in the treatment plan,coaxing,and bargaining are strategies that do not help the patient learn to abide by rules or structure.

Question 7

Which assessment finding would cause the nurse to consider an 8-year-old child to be most at risk for the development of a psychiatric disorder?

Accepted Answer

Statistics tell us that children raised by a depressed parent have a 30% to 50% chance of developing an emotional disorder.The chronicity of the parent's depression means it has been a consistent stressor.The other factors do not create ongoing stress.

Question 8

When assessing a 2-year-old toddler with suspected autistic disorder,a nurse expects:

Accepted Answer

Autistic disorder involves distortions in the development of social skills and language that include perception,motor movement,attention,and reality testing.Caretakers frequently mention the child's failure to develop interpersonal skills.The distracters are more relevant to ADHD,separation anxiety,and CD.

Question 9

A 5-year-old child with attention deficit hyperactivity disorder (ADHD)bounces out of a chair in the waiting room,runs across the room,and begins to slap another child.What is the nurse's best action?

Accepted Answer

The use of play to express feelings is appropriate;the cognitive and language abilities of the child may require the acting out of feelings if verbal expression is limited.The remaining options provide no outlet for feelings or opportunity to develop coping skills.

Question 10

A 15-year-old adolescent has run away from home six times.After the adolescent was arrested for prostitution,the parents told the court,"We can't manage our teenager." The adolescent is physically abusive to the mother and defiant with the father.The adolescent's problem is most consistent with criteria for:

Accepted Answer

CDs are manifested by a persistent pattern of behavior in which the rights of others and age-appropriate societal norms are violated.The Diagnostic and Statistical Manual of Mental Disorders (fourth edition,text revision)(DSM-IV-TR)identifies CDs as: serious violations of rules.The patient's clinical manifestations do not coincide with the other disorders listed.

Question 11

The parent of a child 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?

Accepted Answer

Tics are sudden,rapid,involuntary,repetitive movements or vocalizations characteristic of Tourette's disorder.They often fluctuate in frequency and severity and are reduced or absent during sleep.

Question 12

An adolescent is arrested for prostitution and assault on a parent.The adolescent says,"I hate my parents.They focus all their attention on my brother,who's perfect in their eyes." Which nursing diagnosis is most applicable?

Accepted Answer

The patient demonstrates an inability to problem solve by using adaptive behaviors to meet life's demands and roles.The defining characteristics are not present for the other nursing diagnoses.The patient has never mentioned hopelessness,low self-esteem,or disturbed personal identity.

Question 13

When group therapy is to be used as a treatment modality,the nurse should suggest placing a 9-year-old in a group that uses:

Accepted Answer

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 14

Shortly after a 15-year-old's parents announce a plan to divorce,the adolescent stops participating in sports,sits alone at lunch,and avoids former friends.The adolescent says,"All the other kids have families.If my parents loved me,then they would stay together." Which nursing intervention is most appropriate?

Accepted Answer

The patient's perceptions that all the other kids are from two-parent households and that he or she is different are not based in reality.Assisting the patient to test the accuracy of the perceptions is helpful.

Question 15

Which child shows behaviors indicative of mental illness?

Accepted Answer

Symptoms consistent with an autistic spectrum disorder (ASD)are evident in the correct answer.The behaviors of the other children are within normal ranges.

Question 16

An adolescent was arrested for prostitution and assault on a parent.The adolescent says,"I hate my parents.They focus all their attention on my brother,who's perfect in their eyes." Which type of therapy might promote the greatest change in this adolescent's behavior?

Accepted Answer

Family therapy focuses on problematic family relationships and interactions.The patient has already identified problems within the family.

Question 17

A child with attention deficit hyperactivity disorder (ADHD)has hyperactivity,distractibility,and impaired play.The health care provider prescribed methylphenidate (Concerta).The desired behavior for which the nurse should monitor is:

Accepted Answer

The goal is improvement in the child's hyperactivity,distractibility,and play.The remaining options are more relevant for a child with a pervasive developmental or anxiety disorder.

Question 18

A 16-year-old adolescent with a conduct disorder (CD)has been in a residential program for 3 months.Which outcome should occur before discharge?

Accepted Answer

The patient and the parents must agree on a behavioral contract that clearly outlines rules,expected behaviors,and consequences for misbehavior.It must also include rewards for following the rules.The patient will continue to experience anger and frustration.The patient and parents must continue with family therapy to work on boundary and communication issues.Separating the patient from the family to work on these issues is not necessary,and separation is detrimental to the healing process.

Question 19

An 11-year-old child,who has been diagnosed with oppositional defiant disorder ODD,becomes angry over the rules at a residential treatment program and begins shouting at the nurse.Select the best method to defuse the situation.

Accepted Answer

Redirecting the expression of feelings into nondestructive age-appropriate behaviors such as a physical activity helps the child learn how to modulate the expression of feelings and exert self-control.This method is the least restrictive alternative of those listed and should be tried before resorting to more restrictive measures.

Question 20

A 12-year-old child has been the neighborhood bully for several years.The parents say,"We can't believe anything our child says." Recently,the child shot a dog with a pellet gun and set fire to a trash bin outside a store.The child's behaviors are most consistent with:

Accepted Answer

The behaviors mentioned are most consistent with the DSM-IV-TR criteria for CD: aggression against people and animals;destruction of property;deceitfulness;rule violations;and impairment in social,academic,or occupational functioning.The behaviors are not consistent with ADHD and separation anxiety and are more pervasive than defiance of authority.

Quiz 26: Children and Adolescents

The child most likely to receive propranolol (Inderal) to control aggression,deliberate self-injury,and temper tantrums is one diagnosed with: