Nokea
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.
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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.
Which behavior indicates that the treatment plan for a child diagnosed with autism spectrum disorder was effective?
- A. Plays with one toy for 90 minutes.
- B. Repeats words spoken by a parent.
- C. Holds the parent's hand while walking.
- D. Spins around and claps hands while walking.
Correct Answer: C
Rationale: Holding the hand of another person suggests relatedness. Usually, a child with autism would resist holding someone's hand and stand or walk alone, perhaps flapping arms or moving in a stereotypical pattern. The other options reflect behaviors that are consistent with autistic disorder.
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.
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.
A 5-year-old child diagnosed with attention-deficit/hyperactivity disorder (ADHD) bounces out of a chair in the waiting room, runs across the room, and begins to slap another child. What is the nurse's best action?
- A. Call for emergency assistance from another staff member.
- B. Instruct the parents to take the child home immediately.
- C. Direct this child to stop, and then comfort the other child.
- D. Take the child into another room with toys to act out feelings.
Correct Answer: D
Rationale: The use of play to express feelings is appropriate; the cognitive and language abilities of the child may require the acting out of feelings if verbal expression is limited. The incorrect options provide no outlet for feelings or opportunity to develop coping skills.