Nokea
A 12-year-old child has been the neighborhood bully for several years. The parents say, 'We can't believe anything our child says.' Recently, the child shot a dog with a pellet gun and set fire to a trash bin outside a store. The child's behaviors are most consistent with which disorder?
- A. Conduct disorder (CD)
- B. Defiance of authority
- C. Anxiety over separation from a parent
- D. Attention-deficit/hyperactivity disorder (ADHD)
Correct Answer: A
Rationale: The behaviors mentioned are most consistent with the DSM-5 criteria for CD: aggression against people and animals; destruction of property; deceitfulness; rule violations; and impairment in social, academic, or occupational functioning. The behaviors are not consistent with ADHD and separation anxiety and are more pervasive than defiance of authority.
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A nurse prepares the plan of care for a 15-year-old adolescent diagnosed with moderate intellectual developmental disorder (IDD) is believed capable of ultimately functioning at a second-grade level. What are the highest outcomes realistic for this person to demonstrate within 5 years?
- A. Live unaided in an apartment.
- B. Obtain employment in a local sheltered workshop.
- C. Correctly use public buses to travel in the community.
- D. Independently perform his or her own personal hygiene.
- E. Complete high school or earn a general equivalency diploma (GED).
Correct Answer: B,C,D
Rationale: Individuals with moderate intellectual developmental disorder progress academically to about a second-grade level. These people can learn to travel in familiar areas and perform unskilled or semiskilled work. With supervision, they can function in the community, but independent living is not likely.
A 15-year-old adolescent is referred to a residential program after an arrest for theft and running away from home. At the program, the adolescent refuses to participate in scheduled activities and pushes a staff member, causing a fall. Which approach by the nursing staff would be most therapeutic?
- A. Neutrally permit refusals.
- B. Coax to gain compliance.
- C. Offer rewards in advance.
- D. Establish firm limits.
Correct Answer: D
Rationale: Firm limits are necessary to ensure physical safety and emotional security. Limit setting will also protect other patients from the teenager'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.
A nurse assesses the four children below. Which assessment findings should prompt the nurse to refer the child for further evaluation?
- A. A 4-year-old who stuttered for 3 weeks after the birth of a sibling.
- B. A 9-month-old who does not eat vegetables and likes to be rocked.
- C. A 3-month-old who cries after feeding until burped and sucks a thumb.
- D. A 3-year-old who is mute, passive toward adults, and twirls while walking.
Correct Answer: D
Rationale: Symptoms consistent with an autistic spectrum disorder (ASD) are evident in the correct answer. The behaviors of the other children are expected and within normal ranges.
A nurse will prepare teaching materials regarding which medication for the parents of a child diagnosed with enuresis?
- A. Haloperidol
- B. Desmopressin
- C. Methylphenidate
- D. Carbamazepine
Correct Answer: B
Rationale: Pharmacological treatment of enuresis commonly includes desmopressin, oxybutynin, various stimulants, indomethacin, and/or SSRI antidepressants. Limited evidence exists for the use of imipramine. None of the other drugs are appropriate to treat enuresis.
The parent of a child diagnosed with Tourette's disorder says to the nurse, 'I think my child is faking the tics because they come and go.' Which response by the nurse is accurate?
- 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 aren't real.
- D. This finding is unexpected. How have you been administering your child's medication?
Correct Answer: C
Rationale: Tics are sudden, rapid, involuntary, repetitive movements, or vocalizations characteristic of Tourette's disorder. They often fluctuate in frequency and severity and are reduced or absent during sleep.