Deck 28: Disorders of Children and Adolescents

Question 1

A 16-year-old with a conduct disorder was placed in therapeutic foster care.Which outcome should be met before discharge?

A) The teen and parents create and consent to a behavioral contract with rules,rewards,and consequences.
B) The teen completes an application to enter a military academy for continued structure and discipline.
C) Placement with the foster family continues until the parents finish a parenting skills class.
D) The teen has an absence of anger and frustration for one week.

Answer 1

The teen and parents create and consent to a behavioral contract with rules,rewards,and consequences.

Question 2

A 15-year-old was referred to a residential program after an arrest for theft and multiple episodes of running away from home.At the program,the adolescent refused to participate in scheduled activities and pushed a staff member,causing a fall.Which approach by nursing staff will be most therapeutic?

A) Neutrally permit refusals.
B) Offer rewards in advance.
C) Plead for compliance.
D) Establish firm limits.

Answer 2

Establish firm limits.

Question 3

Shortly after the parents announced that they were divorcing,a 15-year-old stopped participating in sports,sat alone at lunch,and avoided friends.The adolescent told the school nurse,"I would rather stay in my room and listen to music.It's easier than talking to my friends about what is happening in my family." Which nursing diagnosis is most applicable?

A) Decisional conflict
B) Chronic low self-esteem
C) Disturbed personal identity
D) Impaired social interaction

Answer 3

Impaired social interaction

Question 4

A 5-year-old with ADHD bounces out of a chair in the waiting room and begins to slap another child.What is the nurse's best action?

A) Call for emergency assistance from other staff.
B) Direct the child to stop.Comfort the other child.
C) Instruct the parents to take the child home immediately.
D) Take the child to another room with toys to act out feelings.

Question 5

Shortly after the parents announced that they were divorcing,a 15-year-old stopped participating in cheerleading,sat alone at lunch,and avoided former friends.The adolescent told the school nurse,"All the other kids have families.If my parents loved me,they would work out their problems." Which nursing intervention would be most appropriate?

A) Develop a plan for activities of daily living.
B) Communicate disbelief relative to the patient's feelings.
C) Assist the patient to distinguish reality from perceptions.
D) Assess and document the patient's level of fatigue daily.

Question 6

A child known as the neighborhood bully recently set fire to a dumpster outside a supermarket.The parents report,"This event happened after our child was suspended from school for fighting." These behaviors are most consistent with:

A) conduct disorder.
B) Asperger's disorder.
C) attention deficit disorder.
D) pervasive developmental disorder.

Question 7

The parent of a 4-year-old says,"My child moves constantly.I try to get him interested in toys,but he is easily distracted.He talks all the time and is awake every morning before I am.I enrolled him in preschool,but the teacher could not handle him." The child's problem meets criteria for:

A) attention deficit hyperactivity disorder.
B) pervasive developmental disorder.
C) posttraumatic stress disorder.
D) oppositional defiant disorder.

Question 8

A 15-year-old is referred to the mental health clinic by juvenile court after an arrest for vandalism and running away from home six times.The teen has been physically abusive to the mother and defiant to the father.The adolescent's problem is most consistent with criteria for:

A) attention-deficit hyperactivity disorder.
B) adolescent depression.
C) conduct disorder.
D) autistic disorder.

Question 9

A 15-year-old was referred to the mental health clinic by juvenile court after an arrest for vandalism and assault on a teacher.The teen tells the nurse,"I hate my parents.They focus all attention on my brother,who is perfect in their eyes." Which nursing diagnosis applies?

A) Chronic low self-esteem related to feelings of guilt,as evidenced by believing a brother is the parental favorite
B) Hopelessness related to feeling unloved by parents,as evidenced by assaulting a teacher
C) Ineffective coping related to seeking parental attention,as evidenced by acting out
D) Disturbed personal identity related to acting out,as evidenced by vandalism

Question 10

A 15-year-old was referred to the mental health clinic by juvenile court after an arrest for prostitution and assault on the mother.The teen tells the nurse,"I hate my parents.They focus all attention on my brother.He's perfect in their eyes." Which type of therapy might promote the greatest change in the adolescent's behavior?

A) Family therapy
B) Bibliotherapy
C) Play therapy
D) Art therapy

Question 11

A 5-year-old cries and screams from the time the parents leave the child at kindergarten until picked up 6 hours later;however,this child is calm and relaxed when with the parents.The parents ask the nurse,"What should we do?" Select the nurse's best advice.

A) "Send a picture of yourself to school to keep with the child."
B) "Arrange with the teacher to let the child call home at play time."
C) "Talk with the school about withdrawing the child until maturity increases."
D) "Talk with your health care provider about a referral to a mental health clinic."

Question 12

A nurse works with an adolescent who is moody and withdrawn because the teen's parents are divorcing.Establishing a therapeutic alliance is a priority because:

A) focusing on the strengths of an individual increases the individual's self-esteem.
B) the adolescent should express feelings and not keep them internalized.
C) acceptance and trust convey feelings of security to the adolescent.
D) therapeutic activities provide an outlet for tension.

Question 13

When assessing a 2-year-old with suspected autistic disorder,a nurse would expect:

A) hyperactivity and attention deficits.
B) failure to develop interpersonal skills.
C) a history of disobedience and destructive acts.
D) high levels of anxiety when separated from the parent.

Question 14

Sustained release methylphenidate (Concerta)was administered to a child with ADHD.Which finding best indicates the medication was effective?

A) Increased expressiveness in communication with others.
B) Improved ability to participate in play with other children.
C) Ability to identify anxiety and implement self-control strategies.
D) Improved socialization skills with other children and authority figures.

Question 15

Which child shows behaviors indicative of mental illness?

A) Age 3 months: cries after feeding until burped;sucks thumb
B) Age 9 months: does not eat vegetables;likes to be rocked
C) Age 3 years: mute;passive toward adults;twirls when walking
D) Age 6 years: developed enuresis after the birth of a sibling

Question 16

The child most likely to receive risperidone (Risperdal)to manage symptoms is one diagnosed with:

A) attention deficit hyperactivity disorder.
B) pervasive developmental disorder.
C) obsessive-compulsive disorder.
D) posttraumatic stress disorder.

Question 17

Which factor places a child most at risk for development of a psychiatric disorder?

A) Moving to three new homes over a 2-year period
B) Not being promoted to the next grade at the completion of a school year
C) Developmental milestones achieved on schedule
D) Being raised by a mother with chronic major depression

Question 18

A child with ADHD will begin medication therapy.The nurse should prepare a plan to teach the family about which classification of medications?

A) Monoamine oxidase inhibitors
B) Antipsychotic medications
C) Anxiolytic medications
D) Psychostimulant drugs

Question 19

A child has excessive motor activity and talking that interfere with academic performance.Which aspect of the child's care and treatment would a clinical nurse specialist,but not a nurse generalist,perform?

A) Evaluating responses to nursing actions
B) Formulating nursing diagnoses
C) Planning nursing interventions
D) Providing psychotherapy

Question 20

A nurse assesses a 4-year-old with hyperactive,impulsive behavior.Which developmental task should the child have achieved?

A) Separation from parents and ability to socialize outside the family
B) Forming satisfactory relationships with peers
C) Ability to generate abstract ideas
D) A sense of autonomy

Question 21

An adolescent acts out in disruptive ways.When this patient threatens to throw a billiard ball at another adolescent,which comment by the nurse would set limits?

A) "Attention everyone: we are all going to the craft room."
B) "You will be taken to seclusion if you throw that ball."
C) "Do not throw the ball.Put it back on the pool table."
D) "Please do not lose control of your emotions."

Question 22

Parents of a child with ADHD tell the nurse,"We try to teach our child how to behave,but it doesn't help.We feel as though we are terrible parents." Select the nurse's most helpful response.

A) Refer the parents for pastoral counseling.
B) Discuss how traumatic life events precipitate ADHD.
C) Explain the correlation between ADHD and parental conflict.
D) Provide information about the relationship between ADHD and biochemical abnormalities.

Question 23

A nurse prepares to implement bibliotherapy in a pediatric psychiatric unit.Which resources will be most helpful? Select all that apply.

A) Children's books
B) Building blocks
C) Librarian
D) Games
E) Paint

Question 24

A child said,"I just want to die.No one likes me.Other kids laugh at me,but I do not know why.They will always laugh at me." When asked about a suicide plan,the child replied,"I'll jump from the bridge near my home.My father threw kittens off the bridge,and they died because they couldn't swim." Suicide risk is:

A) absent.
B) low.
C) moderate.
D) high.

Question 25

Which assessment findings indicate an adolescent is mentally healthy? Select all that apply.The adolescent:

A) is able to describe future career interests.
B) believes his/her community is a safe place to live.
C) frequently sends and receives text messages with friends.
D) states academic problems result from the father's harsh discipline.
E) shoplifts designer jeans when the parents say,"We cannot afford it."

Question 26

An 11-year-old has Asperger's disorder.Which assessment finding supports this diagnosis?

A) Mutism
B) Tics and twitching
C) Severe developmental delays
D) Restricted and repetitive patterns of behavior

Question 27

Assessment data for a 9-year-old shows blurting out answers before a question is complete,inability to take turns,and persistently interrupting conversations of others.These behaviors relate primarily to:

A) hyperactivity.
B) impulsivity.
C) inattention.
D) defiance.

Question 28

Which mental health problems for children and adolescents may respond favorably to atypical antipsychotic medications? Select all that apply.

A) ADHD
B) Tic disorders
C) Generalized anxiety disorder
D) Posttraumatic stress disorder
E) Pervasive developmental disorder

Question 29

An 11-year-old diagnosed with oppositional defiant disorder becomes angry over the rules at a residential treatment program and begins shouting at the nurse.What might be the best method to defuse the situation?

A) Say to the child,"Tell me how you're feeling right now."
B) Take the child swimming at the center's pool.
C) Administer an anxiolytic medication.
D) Call staff to seclude the child.

Question 30

A parent with schizophrenia and 10-year-old child live in a homeless shelter.The child has adapted to shelter life and formed a relationship with a supportive volunteer.The child says,"My three best friends and I got an A on our school science project." Which assessment applies?

A) The child displays resilience.
B) Risk factors for substance abuse are evident.
C) The child is at risk for posttraumatic stress disorder.
D) The child uses intellectualization to deal with problems.

Question 31

A parent with schizophrenia and 10-year-old child live in a homeless shelter.The child has adapted to shelter life.The child says,"I have three good friends at school.We talk about lots of things and sit together at lunch." Select the nurse's best action.

A) Recommend foster home placement of the child.
B) Refer the parent to the domestic violence program.
C) Refer the child for evaluation of emerging developmental problems.
D) Foster the child's healthy characteristics and existing environmental supports.

Question 32

The nurse on an adolescent psychiatric unit assesses a newly admitted 14-year-old.Which findings should the nurse document as aspects of the developmental history? Select all that apply.

A) Severe acne
B) Apgar score 10
C) Allergic to penicillin
D) Reports frequent nightmares
E) Had sexual intercourse one time with a childhood friend

Question 33

A 9-year-old has feelings of self-blame related to the parents' recent divorce.Which therapy is likely to be helpful for this child?

A) Cognitive behavioral therapy
B) Therapeutic drawing
C) Behavioral therapy
D) Pharmacotherapy

Question 34

Which health problems are likely to have familial patterns? Select all that apply.

A) Posttraumatic stress disorder
B) Separation anxiety disorder
C) Adjustment disorder
D) Asperger's disorder
E) Tourette's disorder

Question 35

The parent of a child with Tourette's disorder says,"My child's tics come and go.I think my child is faking them." Select the accurate response by the nurse.

A) "Perhaps your child was misdiagnosed."
B) "Your observation indicates the medication is effective."
C) "Tics often change frequency or severity.That does not mean they are not real."
D) "This finding indicates worsening of the condition.Let's review how you've been giving the child's medication."

Question 36

When a 5-year-old is disruptive,the nurse says,"You must take a time-out." The expectation is that the child will:

A) go to a quiet room until called for the next meal.
B) slowly count to 20 before returning to the milieu.
C) sit on the edge of the activity until able to regain self-control.
D) sit quietly with a staff member until able to apologize for the behavior.