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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.
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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 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.
A desired outcome for a 12-year-old diagnosed with oppositional defiant disorder (ODD) is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care?
- A. Bibliotherapy
- B. Music therapy
- C. Social skills groups
- D. Behavior modification
Correct Answer: C
Rationale: Social skills training teaches the child to recognize the impact of his or her behavior on others. It uses instruction, role-playing, and positive reinforcement to enhance social outcomes. The other therapies would have lesser or no impact on peer relationships.
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.