Question 1

A child reports to the school nurse that he was verbally bullied by an aggressive classmate. What is the nurse's best first action?

Accepted Answer

The behaviours 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 behaviour should not be ignored; it will only get worse.

Question 2

The parent of a 6-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 me." The child's behaviour is most consistent with diagnostic criteria for which of the following?

Accepted Answer

Excessive motion, distractibility, and excessive talkativeness are seen in attention deficit-hyperactivity disorder (ADHD). The behaviours presented in the scenario do not suggest intellectual development, stereotypic, or communication disorder.

Question 3

What is the nurse's priority focused assessment for adverse effects in a child taking methylphenidate (Ritalin) for attention deficit-hyperactivity disorder (ADHD)?

Accepted Answer

The most common side effects are gastrointestinal disturbances, reduced appetite, weight loss, urinary retention, dizziness, fatigue, and insomnia. Weight loss has the potential to interfere with the child's growth and development. The distracters relate to adverse effects of conventional antipsychotic medications.

Question 4

A child diagnosed with attention deficit-hyperactivity disorder had this nursing diagnosis: Impaired social interaction related to excessive neuronal activity as evidenced by aggression and demanding behaviour 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 autism spectrum or anxiety disorder.

Question 5

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

Accepted Answer

Children raised by a depressed parent have an increased risk of developing an emotional disorder. Familial risk factors correlate with child psychiatric disorders, including severe marital discord, low socioeconomic status, large families and overcrowding, parental criminality, maternal psychiatric disorders, and foster-care placement. The chronicity of the parent's depression means it has been a consistent stressor. The other factors are not as risk- enhancing.

Question 6

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

Accepted Answer

Autism spectrum disorder (ASD) involves distortions in development of social skills and language that include perception, motor movement, attention, and reality testing. Body rocking for extended periods suggests ASD. The distracters are expected findings for a 3-year-old.

Question 7

A kindergartener is disruptive in class. This child is unable to sit for expected lengths of time, inattentive to the teacher, screams while the teacher is talking, and is aggressive toward other children. The nurse plans interventions designed to do which of the following?

Accepted Answer

Because of their disruptive behaviours, children with attention deficit-hyperactivity disorder (ADHD) often receive negative feedback from parents, teachers, and peers, leading to self-esteem disturbance. These behaviours also cause peers to avoid the child with ADHD, leaving the child with ADHD vulnerable to loneliness. The child does not need inpatient treatment at this time. The incorrect options may or may not be relevant.

Question 8

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

Accepted Answer

Psychostimulants, such as methylphenidate and pemoline (Cylert), increase blood flow to the brain and have proved helpful in reducing hyperactivity in children and adolescents with attention deficit-hyperactivity disorder. The other medication categories listed would not be appropriate.

Question 9

Which nursing diagnosis is universally applicable for children diagnosed with autism spectrum disorders?

Accepted Answer

This disorder affects the normal development of the brain in social interaction and communication skills. People with autism spectrum disorder (ASD) typically have difficulties in verbal and nonverbal communication, social interactions, and leisure or play activities. Language is often delayed and deviant, further complicating relationship issues. The other nursing diagnoses might not be appropriate in all cases.

Question 10

A nurse will prepare teaching materials for the parents of a child newly diagnosed with attention deficit-hyperactivity disorder. Which medication will the information focus on?

Accepted Answer

CNS stimulants are the drugs of choice for treating children with attention deficit-hyperactivity disorder (ADHD): Ritalin and Dexedrine are commonly used. None of the other drugs are psychostimulants used to treat ADHD.

Question 11

Soon after parents announced they were divorcing, a child stopped participating in sports, sat alone at lunch, and avoided former friends. The child told the school nurse, "If my parents loved me, they would work out their problems." Which nursing diagnosis has the highest priority?

Accepted Answer

This child shows difficulty coping with problems associated with the family. Social isolation refers to aloneness that the patient perceives negatively, even when self-imposed. The other options are not supported by data in the scenario.

Question 12

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

Accepted Answer

Development of problem solving, conflict resolution, empathy, and social skills are important treatment modalities for the nurse to consider when planning care.Social skills training teaches the child to recognize the impact of his or her behaviour on others. It uses instruction, role-playing, and positive reinforcement to enhance social outcomes. The other therapies would have lesser or no impact on peer relationships.

Question 13

A 4-year-old cries for 5 minutes when the parents leave the child at preschool. The parents ask the nurse, "What should we do?" Select the nurse's best response.

Accepted Answer

The child demonstrates age-appropriate behaviour for a 4-year-old. The nurse should reassure the parents. The distracters are over-reactions.

Question 14

Assessment data for a 7-year-old reveals an inability to take turns, blurting out answers to questions before a question is complete, and frequently interrupting others' conversations. How should the nurse document these behaviours?

Accepted Answer

These behaviours are most directly related to impulsivity. Hyperactive behaviours are more physical in nature, such as running, pushing, and the inability to sit. Defiance is demonstrated by willfully doing what an authority figure has said not to do. Anxiety behaviours in children are typically more withdrawn and avoidant than expressive.

Question 15

A nurse works with a child who is sad and irritable because the child's parents are divorcing. Why is establishing a therapeutic alliance with this child a priority?

Accepted Answer

The initial interview is key to building trust and rapport. Trust is frequently an issue because the child may question his or her trusting relationship with the parents. In this situation, the trust the child once had in the parents has been disrupted, reducing feelings of security. The correct answer is the most global response.

Question 16

When a 5-year-old diagnosed with attention deficit-hyperactivity disorder bounces out of a chair and runs over and slaps another 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 room is an appropriate consequence for the aggressiveness. Directing the child to stop will not be effective. This is not an emergency. Intervention is needed rather than sending the child home.

Question 17

A child diagnosed with attention deficit-hyperactivity disorder (ADHD) shows hyperactivity, aggression, and impaired play. The health care provider prescribed amphetamine (Adderall XR). For which desired behaviour should the nurse monitor?

Accepted Answer

The goal is improvement in the child's symptoms of ADHD, for example, hyperactivity, aggression, and play. The remaining options are more relevant for a child with intellectual development disorder or an anxiety disorder.

Question 18

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

Accepted Answer

A child with a parent with depression is at risk for developing an anxiety disorder, mood disorder, conduct disorder, or substance use. The parent's inability to model effective coping strategies can lead to learned helplessness, the creation of anxiety or apathy, and an inability to master the environment. Being in a middle-income family and being the oldest child do not represent psychosocial adversity. Having a family history of schizophrenia presents a risk, but an alcoholic parent in the family offers a greater risk.

Question 19

The child who has been prescribed an antipsychotic medication to manage violent behaviour was most likely diagnosed with which of the following?

Accepted Answer

Antipsychotic medication is useful for managing aggressive or violent behaviour in some children diagnosed with attention deficit-hyperactivity disorder. If medication were prescribed for a child with an anxiety disorder, it would be a benzodiazepine. Medications are generally not needed for children with communication disorder. Treatment of post-traumatic stress disorder is more often associated with SSRI medications.

Question 20

Which behaviour indicates that the treatment plan for a child diagnosed with an autism spectrum disorder was effective?

Accepted Answer

A characteristic of a child with autism spectrum disorder (ASD) is an indifference or aversion to affection and physical contact. Holding the hand of another person suggests relatedness. Usually, a child with ASD would resist holding someone's hand and stand or walk alone, perhaps flapping arms or moving in a stereotyped pattern. The incorrect options reflect behaviours that are consistent with ASDs.

Quiz 29: Disorders of Children and Adolescents