Deck 23: Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

Question 1

A preschool child is admitted to a psychiatric unit with a diagnosis of autistic disorder. To help the child feel more secure on the unit, which intervention should a nurse include in this client's plan of care?

A)Encourage and reward peer contact.
B)Provide consistent caregivers.
C)Provide a variety of safe daily activities.
D)Maintain close physical contact throughout the day.

Answer 1

Provide consistent caregivers.

Question 2

A child has been diagnosed with autistic disorder. The distraught mother cries out, "I'm such a terrible mother. What did I do to cause this?" Which nursing reply is most appropriate?

A)"Researchers really don't know what causes autistic disorder, but the relationship between autistic disorder and fetal alcohol syndrome is being explored."
B)"Poor parenting doesn't cause autistic disorder.Research has shown that abnormalities in brain structure and/or function are to blame.This is beyond your control."
C)"Research has shown that the mother appears to play a greater role in the development of this disorder than the father."
D)"Lack of early infant bonding with the mother has shown to be a cause of autistic disorder.Did you breastfeed or bottle-feed?"

Answer 2

"Poor parenting doesn't cause autistic disorder.Research has shown that abnormalities in brain structure and/or function are to blame.This is beyond your control."

Question 3

A child diagnosed with severe autistic disorder has the nursing diagnosis of disturbed personal identity. Which outcome would best address this client's diagnosis?

A)The client will name own body parts as separate from others by day 5.
B)The client will establish a means of communicating personal needs by discharge.
C)The client will initiate social interactions with caregivers by day 4.
D)The client will not harm self or others by discharge.

Answer 3

The client will name own body parts as separate from others by day 5.

Question 4

Which developmental characteristic should a nurse identify as typical of a client diagnosed with severe mental retardation?

A)The client can perform some self-care activities independently.
B)The client has advanced speech development.
C)Other than possible coordination problems, the client's psychomotor skills are not affected.
D)The client communicates wants and needs by "acting out" behaviors.

Question 5

An adolescent client who was diagnosed with conduct disorder at the age of 8 is sentenced to juvenile detention after bringing a gun to school. How should the nurse apply knowledge of conduct disorder to this client's situation?

A)Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood.
B)Childhood-onset conduct disorder is caused by a difficult temperament, and the child is likely to outgrow these behaviors by adulthood.
C)Childhood-onset conduct disorder is diagnosed only when behaviors emerge before the age of 5, and therefore improvement is likely.
D)Childhood-onset conduct disorder has no treatment or cure, and children diagnosed with this disorder are likely to develop progressive oppositional defiant disorder.

Question 6

Which nursing intervention should be prioritized when caring for a child diagnosed with mild mental retardation?

A)Encourage the parents to always prioritize the needs of the child.
B)Modify the child's environment to promote independence and encourage impulse control.
C)Delay extensive diagnostic studies until the child is developmentally mature.
D)Provide one-on-one tutorial education in a private setting to decrease overstimulation.

Question 7

When planning care for a client, which medication classification should a nurse recognize as effective in the treatment of Tourette's syndrome?

A)Neuroleptic medications
B)Antimanic medications
C)Tricyclic antidepressant medications
D)Monoamine oxidase inhibitor medications

Question 8

A nursing instructor presents a case study in which a 3-year-old child is in constant motion and is unable to sit still during story time. The instructor asks a student to evaluate this child's behavior. Which student response indicates an appropriate evaluation of the situation?

A)"This child's behavior must be evaluated according to developmental norms."
B)"This child has symptoms of attention deficit hyperactivity disorder."
C)"This child has symptoms of the early stages of autistic disorder."
D)"This child's behavior indicates possible symptoms of oppositional defiant disorder."

Question 9

Which nursing intervention related to self-care would be most appropriate for a teenager diagnosed with moderate mental retardation?

A)Meeting all of the client's self-care needs to avoid injury
B)Providing simple directions and praising client's independent self-care efforts
C)Avoiding interference with the client's self-care efforts in order to promote autonomy
D)Encouraging family to meet the client's self-care needs to promote bonding

Question 10

After an adolescent diagnosed with attention deficit-hyperactivity disorder (ADHD) begins methylphenidate (Ritalin) therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. What is the best explanation for this weight loss?

A)The pharmacological action of Ritalin causes a decrease in appetite.
B)Hyperactivity seen in ADHD causes increased caloric expenditure.
C)Side effects of Ritalin cause nausea; therefore, caloric intake is decreased.
D)Increased ability to concentrate allows the client to focus on activities rather than food.

Question 11

A physician orders methylphenidate (Ritalin) for a child diagnosed with attention deficit-hyperactivity disorder (ADHD). Which information about this medication should the nurse provide to the parents?

A)If one dose of Ritalin is missed, double the next dose.
B)Administer Ritalin to the child after breakfast.
C)Administer Ritalin to the child just prior to bedtime.
D)A side effect of Ritalin is decreased ability to learn.

Question 12

A preschool child diagnosed with autistic disorder has been engaging in constant head-banging behavior. Which nursing intervention is appropriate?

A)Place client in restraints until the aggression subsides.
B)Sedate the client with neuroleptic medications.
C)Hold client's head steady and apply a helmet.
D)Distract the client with a variety of games and puzzles.

Question 13

In planning care for a child diagnosed with autistic disorder, which would be a realistic client outcome?

A)The client will communicate all needs verbally by discharge.
B)The client will participate with peers in a team sport by day 4.
C)The client will establish trust with at least one caregiver by day 5.
D)The client will perform most self-care tasks independently.

Question 14

Which behavioral approach should a nurse utilize when caring for children diagnosed with disruptive behavior disorders?

A)Involving parents in designing and implementing the treatment process
B)Reinforcing positive actions to encourage repetition of desired behaviors
C)Providing opportunities to learn appropriate peer interactions
D)Administering psychotropic medications to improve quality of life

Question 15

A child has been recently diagnosed with mild mental retardation (MR). What information about this diagnosis should the nurse include when teaching the child's mother?

A)Children with mild MR need constant supervision.
B)Children with mild MR develop academic skills up to a sixth-grade level.
C)Children with mild MR appear different from their peers.
D)Children with mild MR have significant sensory-motor impairment.

Question 16

Which should be the priority nursing intervention when caring for a child diagnosed with conduct disorder?

A)Modify the environment to decrease stimulation and provide opportunities for quiet reflection.
B)Convey unconditional acceptance and positive regard.
C)Recognize escalating aggressive behaviors and intervene before violence occurs.
D)Provide immediate positive feedback for appropriate behaviors.

Question 17

A client has an IQ of 47. Which nursing diagnosis best addresses a client problem associated with this degree of mental retardation?

A)Risk for injury R/T self-mutilation
B)Altered social interaction R/T nonadherence to social convention
C)Altered verbal communication R/T delusional thinking
D)Social isolation R/T severely decreased gross motor skills

Question 18

A mother questions the decreased effectiveness of methylphenidate (Ritalin), prescribed for her child's attention deficit-hyperactivity disorder (ADHD). Which nursing reply best addresses the mother's concern?

A)"The physician will probably switch from Ritalin to a central nervous system stimulant."
B)"The physician may prescribe an antihistamine with the Ritalin to improve effectiveness."
C)"Your child has probably developed a tolerance to Ritalin and may need a higher dosage."
D)"Your child has developed sensitivity to Ritalin and may be exhibiting an allergy."

Question 19

A nursing instructor is teaching about the developmental characteristics of clients diagnosed with moderate mental retardation (MR). Which student statement indicates that further instruction is needed?

A)"These clients can work in a sheltered workshop setting."
B)"These clients can perform some personal care activities."
C)"These clients may have difficulties relating to peers."
D)"These clients can successfully complete elementary school."

Question 20

Which finding should a nurse expect when assessing a child diagnosed with separation anxiety disorder?

A)The child has a history of antisocial behaviors.
B)The child's mother is diagnosed with an anxiety disorder.
C)The child previously had an extroverted temperament.
D)The child's mother and father have an inconsistent parenting style.

Question 21

An 8-year-old client diagnosed with attention deficit-hyperactivity disorder (ADHD) was admitted 5 days ago for management of temper tantrums. What would be a priority nursing intervention during the termination phase of the nurse-client relationship?

A)Set a contract with the client to limit acting-out behaviors while hospitalized.
B)Teach the importance of taking fluoxetine (Prozac) consistently, even when feeling better.
C)Discuss behaviors that are and are not acceptable on the unit.
D)Ask the client to demonstrate learned coping skills without direction from the nurse.

Question 22

A child diagnosed with attention deficit-hyperactivity disorder (ADHD) is having difficulty completing homework assignments. What information should the nurse include when teaching the parents about task performance improvement?

A)The parents should isolate the child when completing homework to improve focus.
B)The parents should withhold privileges if homework is not completed within a 2-hour period.
C)The parents should divide the homework task into smaller steps and provide an activity break.
D)The parents should administer an extra dose of methylphenidate (Ritalin) prior to homework.

Question 23

A nurse has taken report for the evening shift on an adolescent inpatient unit. Which client should the nurse address first?

A)A client diagnosed with oppositional defiant disorder being sexually inappropriate with staff
B)A client diagnosed with conduct disorder who is verbally abusing a peer in the milieu
C)A client diagnosed with conduct disorder who is demanding special attention from staff
D)A client diagnosed with attention deficit disorder who has a history of self-mutilation

Question 24

Which of the following risk factors noted during a family history assessment should a nurse associate with the potential development of mental retardation? (Select all that apply.)

A)A family history of Tay-Sachs disease
B)Childhood meningococcal infection
C)Deprivation of nurturance and social contact
D)History of maternal multiple motor and verbal tics
E)A diagnosis of maternal major depressive disorder

Question 25

A nursing instructor is teaching about pharmacological treatments for attention deficit-hyperactivity disorder (ADHD). Which information about atomoxetine (Strattera) should be included in the lesson plan?

A)Strattera, unlike methylphenidate (Ritalin), is a central nervous system depressant.
B)When taking Strattera, a client should eliminate all red food coloring from the diet.
C)Strattera will be a life-long intervention for clients diagnosed with this disorder.
D)Strattera, unlike methylphenidate (Ritalin), is a selective norepinephrine reuptake inhibitor.

Question 26

Which of the following interventions should a nurse anticipate implementing when planning care for children diagnosed with attention deficit-hyperactivity disorder (ADHD)? (Select all that apply.)

A)Behavior modification
B)Antianxiety medications
C)Competitive group sports
D)Group therapy
E)Family therapy

Question 27

The nurse should recognize which of the following findings contribute to a client's development of attention deficit-hyperactivity disorder (ADHD)? (Select all that apply.)

A)The client's father was a smoker.
B)The client was born 7 weeks premature.
C)The client is lactose intolerant.
D)The client has a sibling diagnosed with ADHD.
E)The client has been diagnosed with dyslexia.

Question 28

A 6-year-old client is prescribed methylphenidate (Ritalin) for a diagnosis of attention deficit-hyperactivity disorder (ADHD). When teaching the parents about this medication, which nursing statement explains how Ritalin works?

A)"Ritalin's sedation side effect assists children by decreasing their energy level."
B)"How Ritalin works is unknown.It is a stimulant; however, it does combat the symptoms of ADHD."
C)"Ritalin helps the child focus by decreasing the amount of dopamine in the basal ganglia and neuron synapse."
D)"Ritalin decreases hyperactivity by increasing serotonin levels."