Question 1

A nurse will prepare teaching materials regarding which drug for the parents of a child diagnosed with ADHD?

Accepted Answer

Central nervous system (CNS) stimulants are the drugs of choice for treating children with ADHD. Methylphenidate and dexedrine are commonly used. None of the other drugs are psychostimulants used to treat ADHD.

Question 2

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

Accepted Answer

CNS stimulants, such as methylphenidate (Ritalin) and pemoline (Cylert), increase blood flow to the brain and have proved helpful in reducing hyperactivity in children and adolescents with ADHD. The other medication categories listed would not be appropriate.

Question 3

Which finding necessitates immediate nursing action for a child being treated for depression with a selective serotonin reuptake inhibitor (SSRI)?

Accepted Answer

Behavioral activation, a common side effect of SSRI therapy, is demonstrated by motor restlessness, insomnia, hypomania, and disinhibition. Suicidal thoughts and planning are thought to be associated with behavioral activation, so individuals should be monitored closely as depression lifts. The other drug side effects are associated with typical antipsychotics and tricyclic antidepressants.

Question 4

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

Accepted Answer

Risperidone (Risperdal) is useful for relieving irritability and labile affect demonstrated by some autistic children. It is not indicated in any of the other disorders.

Question 5

In the waiting room a 5-year-old child diagnosed with ADHD bounces out of a chair, runs over to another child, and slaps the other child. What is the nurse's best action?

Accepted Answer

The nurse should manage the milieu with structure and limit-setting. Removing the aggressive child to another waiting area is an appropriate consequence for the aggressiveness. Directing the child to stop will not be effective. This is not an emergency situation. Intervention is needed rather than sending the child away.

Question 6

Which behaviors are indicative of bullying by a child? Select all that apply.

Accepted Answer

Bullying can be verbal, relational, or physical. It is repetitive and intentionally produces harm or pain in another person. Playful teasing, one-time aggression, and joking do not meet the criteria for bullying.

Question 7

Which behavior indicates that the treatment plan for a child diagnosed with autistic disorder has been effective? The child:

Accepted Answer

Holding the hand of another person suggests relatedness. Usually, a child with autism would resist holding someone's hand and stand or walk alone, perhaps flapping arms or moving in a stereotyped pattern. The other options reflect behaviors that are consistent with autistic disorder.

Question 8

A child with ADHD had this nursing diagnosis: impaired social interaction, related to excessive neuronal activity, as evidenced by aggressiveness and dysfunctional play with others. Which finding indicates the plan of care was effective?

Accepted Answer

The goal should be directly related to the defining characteristics of the nursing diagnosis; in this case improvement in the child's aggressiveness and play. The distracters are more relevant for a child with pervasive developmental disorder or anxiety disorder.

Question 9

Which factor presents the most imminent risk for a child to develop a psychiatric disorder?

Accepted Answer

Having a parent with a substance abuse problem has been designated an adverse psychosocial condition that increases the risk of a child developing a psychiatric condition. Being in a middle-income family and being the oldest child are not considered psychosocial adversity. Having a family history of schizophrenia presents a risk, but an alcoholic parent in the family is more imminent.

Question 10

Which assessment finding would cause the nurse to consider a child to be most at risk for the development of mental illness?

Accepted Answer

Statistics indicate that children raised by a depressed parent have an increased risk of developing an emotional disorder. The chronicity of the parent's depression means it has been a consistent stressor. The other factors are not as risk enhancing.

Question 11

A nurse assesses a 3-year-old child diagnosed with autistic disorder. Which finding is most associated with the child's disorder?

Accepted Answer

Autistic disorder involves distortions in development of social skills and language that include perception, motor movement, attention, and reality testing. Caretakers nearly always mention the child's failure to develop interpersonal skills. The distracters are expected behaviors for a 3-year-old child.

Question 12

A kindergartener is disruptive to the class. This child is unable to sit for expected lengths of time, inattentive to the teacher, and aggressive toward others, bursting out talking while the teacher is talking. Other children shun this child. The nurse plans interventions designed to:

Accepted Answer

Because of their disruptive behaviors, children with attention deficit-hyperactivity disorder (ADHD) often receive negative feedback from parents, teachers, and peers, leading to self-esteem disturbance. These same behaviors lead peers to avoid the child with ADHD, who seems reckless and impulsive, and can rarely finish games, leaving the child with ADHD vulnerable to loneliness. The other options might or might not be relevant but are not the priority. The child does not need inpatient treatment at this time.

Question 13

A child being treated for which of the following has a high risk for suicide and should be monitored closely?

Accepted Answer

The child being treated for depression with fluoxetine is at risk for behavioral activation, a drug side effect. Increased suicide risk is part of the behavioral activation complex. The drugs mentioned in the other options do not place the individual in the same risk category as fluoxetine.

Question 14

A 14-year-old is sent to a residential program after arrests for truancy and assault. At the program, the teen refused to participate in scheduled activities and pushed a staff member, causing a fall. Which strategy by nursing staff is indicated?

Accepted Answer

Firm limits are necessary to ensure physical safety and emotional security. Limit-setting will also protect other patients from the teen'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 15

The parent of an 8-year-old says, "My child is in constant motion and talks all the time. My child isn't interested in toys, but is out of bed every morning before I am and into trouble." The child's problem is most consistent with:

Accepted Answer

The excessive motion, distractibility, and excessive talkativeness are seen in ADHD. The behaviors presented in the scenario do not suggest the other possible choices. Developmental delays would be seen if pervasive developmental disorder or Asperger's disorder were present.

Question 16

An adolescent in a residential program threatens to throw a pool ball at another adolescent. Which comment by the nurse would set limits?

Accepted Answer

Setting limits uses clear, sharp statements about which behavior is not allowed and guidance for performing a behavior that is expected. The distracters represent a threat, use of restructuring (which would be inappropriate in this instance), and a direct appeal to the child's developing self-control that may be ineffective.

Question 17

A child complains to the school nurse about painful verbal bullying by an aggressive classmate. What is the nurse's best first action?

Accepted Answer

The behaviors by the bullying child create emotional pain and present the risk for physical pain. The nurse should first listen to the child's complaints and validate the child for reporting the events. Later, school authorities should be notified. School administrators are the most appropriate personnel to deal with the bullying child. The behavior should not be ignored; it will only get worse.

Question 18

A desired outcome for a 12-year-old diagnosed with autism is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care?

Accepted Answer

Social skills training teaches the child to recognize the impact of his or her behavior on others. It uses instruction, role-playing, and positive reinforcement to enhance social outcomes. The other therapies would have lesser to no impact on peer relationships.

Quiz 34: Children and Adolescents