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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.
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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.
What are the primary distinguishing factors between the behavior of children diagnosed with oppositional defiant disorder (ODD) and those diagnosed with conduct disorder (CD)? The child diagnosed with:
- A. ODD relives traumatic events by acting them out.
- B. ODD tests limits and disobeys authority figures.
- C. ODD has difficulty separating from the parents.
- D. CD uses stereotypical or repetitive language.
- E. CD often violates the rights of others.
Correct Answer: B,E
Rationale: Children with ODD are negativistic, disobedient, and defiant toward authority figures without seriously violating the basic rights of others, whereas children with CD frequently behave in ways that violate the rights of others and age-appropriate societal norms. Reliving traumatic events occurs with posttraumatic stress disorder. Stereotypical language behaviors are observed in autistic children. Separation problems with resultant anxiety occur with separation anxiety disorder.
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.
A 15-year-old adolescent has run away from home six times. After the adolescent was arrested for prostitution, the parents told the court, 'We can't manage our teenager.' The adolescent is physically abusive to the mother and defiant with the father. The adolescent's problem is most consistent with criteria for which disorder?
- A. Attention-deficit/hyperactivity disorder (ADHD)
- B. Childhood depression
- C. Conduct disorder (CD)
- D. Autism spectrum disorder (ASD)
Correct Answer: C
Rationale: CDs are manifested by a persistent pattern of behavior in which the rights of others and age-appropriate societal norms are violated. The Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5) identifies CDs as serious violations of rules. The patient's clinical manifestations do not coincide with the other disorders listed.
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.