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Shortly after a 15-year-old's parents announce a plan to divorce, the adolescent stops participating in sports, sits alone at lunch, and avoids former friends. The adolescent says, 'All the other kids have families. If my parents loved me, then they would stay together.' Which nursing intervention is most appropriate?
- A. Develop a plan for activities of daily living.
- B. Communicate disbelief relative to the adolescent's feelings.
- C. Assist the adolescent to differentiate reality from perceptions.
- D. Assess and document the adolescent's level of depression daily.
Correct Answer: C
Rationale: The patient's perceptions that 'all the other kids' are from two-parent households and that he or she is different are not based in reality. Assisting the patient to test the accuracy of the perceptions is helpful.
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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.
The child most likely to receive propranolol to manage tremors is one diagnosed with which disorder?
- A. Attention-deficit/hyperactivity disorder (ADHD)
- B. Posttraumatic stress disorder (PTSD)
- C. A motor disorder
- D. Separation anxiety
Correct Answer: C
Rationale: Propranolol is useful for managing tremors associated with various motor disorders. This medication is not indicated in any of the other disorders.
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.
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 nurse prepares to lead a discussion at a community health center regarding children's health. The nurse wants to use current terminology when teaching about these issues. Which terms are appropriate for the nurse to use?
- A. Mental retardation
- B. Asperger's disorder
- C. Autism spectrum disorder
- D. Pervasive developmental disorder
- E. Intellectual development disorder
Correct Answer: C,E
Rationale: The terms 'Autism spectrum disorder' and 'Intellectual development disorder' are current and appropriate, as they reflect the terminology used in the DSM-5. 'Mental retardation' and 'Pervasive developmental disorder' are outdated, and 'Asperger's disorder' is no longer used as a distinct diagnosis, as it is now included under autism spectrum disorder.