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When assessing a 2-year-old diagnosed with autism spectrum disorder, what should a nurse expect?
- A. Hyperactivity and attention deficits
- B. Failure to develop interpersonal social skills
- C. History of disobedience and destructive acts
- D. High levels of anxiety when separated from a parent
Correct Answer: B
Rationale: Autism spectrum disorder involves distortions in the development of social skills and language that include perception, motor movement, attention, and reality testing. Caretakers frequently mention the child's failure to develop interpersonal skills. The distractors are more relevant to ADHD, separation anxiety, and CD.
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When group therapy is to be used as a treatment modality, the nurse should suggest placing a 9-year-old in a group that focuses on what?
- A. Play activities exclusively.
- B. Group discussion exclusively.
- C. Talk focused on a specific issue.
- D. Play and then talk about the play activity.
Correct Answer: D
Rationale: Group therapy for young children takes the form of play. For elementary school children, therapy combines play and talk about the activity. For adolescents, group therapy involves more talking.
A 12-year-old child has been the neighborhood bully for several years. The parents say, 'We can't believe anything our child says.' Recently, the child shot a dog with a pellet gun and set fire to a trash bin outside a store. The child's behaviors are most consistent with which disorder?
- A. Conduct disorder (CD)
- B. Defiance of authority
- C. Anxiety over separation from a parent
- D. Attention-deficit/hyperactivity disorder (ADHD)
Correct Answer: A
Rationale: The behaviors mentioned are most consistent with the DSM-5 criteria for CD: aggression against people and animals; destruction of property; deceitfulness; rule violations; and impairment in social, academic, or occupational functioning. The behaviors are not consistent with ADHD and separation anxiety and are more pervasive than defiance of authority.
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.
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.
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.