Nokea
A 4-year-old child cries and screams from the time the parents leave the child at preschool until the child is picked up 4 hours later. The child is calm and relaxed when the parents are present. The parents ask, 'What should we do?' What is the nurse's best recommendation?
- A. Send a picture of yourself to school to keep with the child.
- B. Arrange with the teacher to let the child call home at playtime.
- C. Talk with the school about withdrawing the child until maturity increases.
- D. Talk with your health care provider about a referral to a mental health professional.
Correct Answer: D
Rationale: Separation anxiety disorder becomes apparent when the child is separated from the attachment figure. The symptoms are considered normal up to age 1. Often, the first-time separation occurs when the child goes to kindergarten or nursery school. Separation anxiety may be based on the child's fear that something will happen to the attachment figure. The child needs professional help. None of the distractors accounts for the severity and length of the child's reaction.
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A child diagnosed with attention-deficit/hyperactivity disorder (ADHD) is going to begin medication therapy. The nurse should plan to teach the family about which classification of medications?
- A. Central nervous system stimulants and nonstimulants
- B. Monoamine oxidase inhibitors (MAOIs)
- C. Antipsychotic medications
- D. Anxiolytic medications
Correct Answer: A
Rationale: Central nervous system stimulants and nonstimulants increase blood flow to the brain and have proven helpful in reducing hyperactivity in children and adolescents with ADHD. The other medication categories listed would not be appropriate.
A 5-year-old child moves and talks constantly. The child awakens before the parents every morning. The child attends kindergarten, but the teacher reports difficulty handling the behavior. What is this child's most likely problem?
- A. Tic disorder
- B. Oppositional defiant disorder (ODD)
- C. Intellectual development disorder (IDD)
- D. Attention-deficit/hyperactivity disorder (ADHD)
Correct Answer: D
Rationale: The constant motion and excessive talkativeness suggest ADHD. Tic disorder is associated with stereotypical, rapid, and involuntary motor movements. Developmental delays would be observed if intellectual development disorder was present. ODD includes serious violations of the rights of others.
When a 5-year-old child is disruptive, the nurse says, 'You must take a time-out.' The expectation is that the child will demonstrate what behavior?
- A. Go to a quiet room until called for the next meal.
- B. Slowly count to 20 before returning to the group activity.
- C. Sit on the edge of the activity until able to regain self-control.
- D. Sit quietly on the lap of a staff member until able to apologize for the behavior.
Correct Answer: C
Rationale: Time-out is designed so that staff can be consistent in their interventions. Time-out may require having the child sit on the periphery of an activity until he or she gains self-control and reviews the episode with a staff member. Time-out may not require having the child go to a designated room and does not involve special attention such as holding. Having the child count to 10 or 20 is not sufficient.
A parent diagnosed with schizophrenia and her 13-year-old child live in a homeless shelter. The child has formed a trusting relationship with a shelter volunteer. The child says, 'My three friends and I got an A on our school science project.' The nurse can assess that the child is demonstrating what characteristic?
- A. Resiliency
- B. Shy temperament
- C. Early posttraumatic stress disorder
- D. Uses intellectualization to deal with problems
Correct Answer: A
Rationale: Resiliency enables a child to handle the stresses of a difficult childhood. Resilient children can adapt to changes in the environment, take advantage of nurturing relationships with adults other than parents, distance themselves from emotional chaos occurring within the family, learn, and use problem-solving skills. None of the distractors demonstrate a means of handling stress.
A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. The child has formed a trusting relationship with a volunteer. The teen says, 'I have three good friends at school. We talk and sit together at lunch.' What is the nurse's best suggestion to the treatment team?
- A. Suggest foster home placement.
- B. Seek assistance from an intimate partner violence program.
- C. Make referrals for existing and emerging developmental problems.
- D. Encourage healthy characteristics and existing environmental supports.
Correct Answer: D
Rationale: Because the teenager shows no evidence of poor mental health, the best action would be to foster existing healthy characteristics and environmental supports. No other option is necessary or appropriate under the current circumstances.