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The health care provider prescribes medication for a child diagnosed with attention-deficit/hyperactivity disorder (ADHD). What is the desired behavior for which the nurse should monitor?
- A. Increased expressiveness in communicating with others.
- B. Improved ability for cooperative play with other children.
- C. Ability to identify anxiety and implement self-control strategies.
- D. Improved socialization skills with other children and authority figures.
Correct Answer: B
Rationale: The goal is improvement in the child's hyperactivity, distractibility, and play. The incorrect options are more relevant for a child with a developmental or anxiety disorder.
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A 4-year-old child cries and screams from the time the parents leave the child at preschool until the child is picked up 4 hours later. The child is calm and relaxed when the parents are present. The parents ask, 'What should we do?' What is the nurse's best recommendation?
- A. Send a picture of yourself to school to keep with the child.
- B. Arrange with the teacher to let the child call home at playtime.
- C. Talk with the school about withdrawing the child until maturity increases.
- D. Talk with your health care provider about a referral to a mental health professional.
Correct Answer: D
Rationale: Separation anxiety disorder becomes apparent when the child is separated from the attachment figure. The symptoms are considered normal up to age 1. Often, the first-time separation occurs when the child goes to kindergarten or nursery school. Separation anxiety may be based on the child's fear that something will happen to the attachment figure. The child needs professional help. None of the distractors accounts for the severity and length of the child's reaction.
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.
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 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.
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.