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Chapter 11: Childhood and Neurodevelopmental Disorders

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

Multiple Choice

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

a. Impaired social interaction related to difficulty maintaining relationships b. Chronic low self-esteem related to excessive negative feedback c. Deficient fluid volume related to abnormal eating habits d. Anxiety related to nightmares and repetitive activities

ANS: A

Children diagnosed with autism spectrum disorders display profoundly disturbed social relatedness. They seem aloof and indifferent to others, often preferring inanimate objects to human interaction. Language is often delayed and deviant, further complicating relationship issues. The other nursing diagnoses might not be appropriate in all cases.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 11-29, 30, 54 (Table 11-1) TOP: Nursing Process: Analysis/Diagnosis

MSC: Client Needs: Psychosocial Integrity

2. Which behavior indicates that the treatment plan for a child diagnosed with an autism spectrum disorder was effective? The child a. plays with one toy for 30 minutes. b. repeats words spoken by a parent. c. holds the parent’s hand while walking. d. spins around and claps hands while walking.

ANS: C

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

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 11-33 to 35 TOP: Nursing Process: Evaluation

MSC: Client Needs: Psychosocial Integrity

3. 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 a. promote integration of self-concept. b. provide inpatient treatment for the child. c. reduce loneliness and increase self-esteem. d. improve language and communication skills.

ANS: C

Because of their disruptive behaviors, children diagnosed with attention deficit hyperactivity disorder (ADHD) often receive negative feedback from parents, teachers, and peers, leading to self-esteem disturbance. These behaviors 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 might or might not be relevant.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 11-36, 40

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Planning a. Paroxetine b. Imipramine c. Methylphenidate d. Carbamazepine

4. A nurse will prepare teaching materials for the parents of a child newly diagnosed with ADHD. Information will focus on which medication likely to be prescribed?

ANS: C

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

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 11-41, 56 (Table 11-2) TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity a. Dystonia, akinesia, and extrapyramidal symptoms b. Bradycardia and hypotensive episodes c. Sleep disturbances and weight loss d. Neuroleptic malignant syndrome

5. What is the nurse’s priority focused assessment for side effects in a child taking methylphenidate for ADHD?

ANS: C

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 side effects of conventional antipsychotic medications.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 11-41 to 43, 56 (Table 11-2) TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity a. Reality therapy b. Simple restitution c. Social skills group d. Insight-oriented group therapy

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

ANS: C

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 or no impact on peer relationships.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 11-43 TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

7. 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 behavior is most consistent with diagnostic criteria for a. communication disorder. b. stereotypic movement disorder. c. intellectual development disorder. d. ADHD.

ANS: D

Excessive motion, distractibility, and excessive talkativeness are seen in ADHD. The behaviors presented in the scenario do not suggest intellectual development, stereotypic, or communication disorder.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 11-35 to 38 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

8. A child diagnosed with ADHD had this nursing diagnosis: impaired social interaction related to excessive neuronal activity as evidenced by aggression and demanding behavior with others. Which finding indicates the plan of care was effective? The child a. has an improved ability to identify anxiety and use self-control strategies. b. has increased expressiveness in communication with others. c. shows increased responsiveness to authority figures. d. engages in cooperative play with other children.

ANS: D

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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 11-39, 40, 43, 44

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Evaluation a. Instruct the parents to take the aggressive child home. b. Direct the aggressive child to stop immediately. c. Call for emergency assistance from other staff. d. Take the aggressive child to another room.

9. When a 5-year-old diagnosed with ADHD bounces out of a chair and runs over and slaps another child, what is the nurse’s best action?

ANS: D

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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 11-40, 41, 62 (Box 11-3)

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. CNS stimulants b. Tricyclic antidepressants

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

ANS: A c. Antipsychotics d. Anxiolytics

CNS stimulants, such as methylphenidate 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.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 11-41, 56 (Table 11-2)

MSC: Client Needs: Physiological Integrity

TOP: Nursing Process: Planning a. Social isolation b. Decisional conflict c. Chronic low self-esteem d. Disturbed personal identity

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?

ANS: A

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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 11-54 (Table 11-1), 61(Box 11-2)

TOP: Nursing Process: Analysis/Diagnosis

MSC: Client Needs: Psychosocial Integrity a. Therapeutic relationships provide an outlet for tension. b. Focusing on the strengths increases a person’s self-esteem. c. Acceptance and trust convey feelings of security to the child. d. The child should express feelings rather than internalize them.

12. 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?

ANS: C

Trust is frequently an issue because the child may question their trusting relationship with the parents. In this situation, the trust the child once had in parents has been disrupted, reducing feelings of security. The correct answer is the most global response.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 11-12, 16, 61 (Box 11-2) TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

13. A nurse assesses a 3-year-old diagnosed with an autism spectrum disorder. Which finding is most associated with the child’s disorder? The child a. has occasional toileting accidents. b. interrupts or intrudes on others. c. cries when separated from a parent. d. continuously rocks in place for 30 minutes.

ANS: D

Autism spectrum disorder involves distortions in development of social skills and language that include perception, motor movement, attention, and reality testing. Body rocking for extended periods suggests autism spectrum disorder. Occasional toileting accidents and crying when separated from a parents are expected findings for a 3-year-old. Interrupting or intruding on others are assessment findings associated with ADHD.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 11-30, 31 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. “Ask the teacher to let the child call you at play time.” b. “Withdraw the child from preschool until maturity increases.” c. “Remain with your child for the first hour of preschool time.” d. “Give your child a kiss before you leave the preschool program.”

14. 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.

ANS: D

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

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 11-12, 13, 61 (Box 11-2)

TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance a. The child has been raised by a parent with recurring major depressive disorder. b. The child’s best friend was absent from the child’s birthday party. c. The child was not promoted to the next grade one year. d. The child moved to three new homes over a 2-year period.

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

ANS: A

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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 11-6, 7 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

16. The child prescribed an antipsychotic medication to manage violent behavior is one most likely diagnosed with a. ADHD. b. posttraumatic stress disorder (PTSD). c. communication disorder. d. an anxiety disorder.

ANS: A

Antipsychotic medication is useful for managing aggressive or violent behavior in some children diagnosed with ADHD. 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 PTSD is more often associated with SSRI medications.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 11-43 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity a. Give notice to the chief administrator at the school regarding the events. b. Encourage the victimized child to share feelings about the experience. c. Encourage the victimized child to ignore the bullying behavior. d. Discuss the events with the aggressive classmate.

17. A child reports to the school nurse of being verbally bullied by an aggressive classmate. What is the nurse’s best first action?

ANS: B