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A nurse assesses a 3-year-old diagnosed with autism spectrum disorder. Which finding is most associated with the child's disorder?
- A. Has occasional toileting accidents.
- B. Is unable to read children's books.
- C. Cries when separated from a parent.
- D. Continuously rocks in place for 30 minutes.
Correct Answer: D
Rationale: 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. The distracters are expected findings for a 3-year-old.
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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.
An adolescent diagnosed with generalized anxiety disorder says, 'My parents focus all their attention on my brother instead of me. He's perfect in their eyes.' Which type of therapy might promote the greatest change in this adolescent's behavior?
- A. Bibliotherapy
- B. Play therapy
- C. Family therapy
- D. Behavior modification therapy
Correct Answer: C
Rationale: Family therapy focuses on problematic family relationships and interactions. The patient has identified problems within the family. Bibliotherapy and play therapy are appropriate for children rather than adolescents. The adolescent's problem is interpersonal and relates to relationships and self-perception; therefore, behavior modification therapy would not help.
Which finding would prompt the nurse to carefully assess an 8-year-old child for development of a psychiatric disorder?
- A. Being raised by a parent with chronic major depressive disorder
- B. Moving to three new homes over a 2-year period
- C. Not being promoted to the next grade
- D. Having an imaginary friend
Correct Answer: A
Rationale: If the caregiver is unable to respond positively to the child, there is an increased risk of insecure attachment, developmental problems, and mental disorders. The chronicity of the parent's depression means it has been a consistent stressor. The other factors do not create ongoing stress.
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.
An 11-year-old child, who has been diagnosed with oppositional defiant disorder (ODD), becomes angry over the rules at a residential treatment program and begins shouting at the nurse. What is the best method to defuse the situation?
- A. Assign the child to a short time-out.
- B. Administer an antipsychotic medication.
- C. Place the child in a therapeutic hold.
- D. Call a staff member to seclude the child.
Correct Answer: A
Rationale: Time-out is a useful strategy for interrupting the angry expression of feelings and allows the child an opportunity to exert self-control. This method is the least restrictive alternative of those listed and should be tried before resorting to more restrictive measures.