Nokea
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.
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A 5-year-old child diagnosed with attention-deficit/hyperactivity disorder (ADHD) bounces out of a chair in the waiting room, runs across the room, and begins to slap another child. What is the nurse's best action?
- A. Call for emergency assistance from another staff member.
- B. Instruct the parents to take the child home immediately.
- C. Direct this child to stop, and then comfort the other child.
- D. Take the child into another room with toys to act out feelings.
Correct Answer: D
Rationale: The use of play to express feelings is appropriate; the cognitive and language abilities of the child may require the acting out of feelings if verbal expression is limited. The incorrect options provide no outlet for feelings or opportunity to develop coping skills.
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.
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.
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.
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.