Children and Adolescents

Multiple Choice

1. Which developmental characteristic should a nurse identify as typical of a client diagnosed with severe intellectual developmental disorder (IDD)?
1. The client can perform some self-care activities independently.
2. The client has more advanced speech development.
3. Other than possible coordination problems, the client’s psychomotor skills are not affected.
4. The client communicates wants and needs by “acting out” behaviors.

ANS: 4
Rationale: The nurse should identify that a client diagnosed with severe IDD may communicate wants and needs by “acting out” behaviors. Severe IDD indicates an IQ between 20 and 34. Individuals diagnosed with severe IDD require complete supervision and have minimal verbal skills and poor psychomotor development.

Cognitive Level: Application
Integrated Process: Assessment

2. Which nursing intervention related to self-care would be most appropriate for a teenager diagnosed with moderate IDD?
1. Meeting all of the client’s self-care needs to avoid injury to the client
2. Providing simple directions and praising client’s independent self-care efforts
3. Avoid interfering with the client’s self-care efforts in order to promote autonomy
4. Encouraging family to meet the client’s self-care needs to promote bonding

ANS: 2
Rationale: Providing simple directions and praise is an appropriate intervention for a teenager diagnosed with moderate IDD. Individuals with moderate mental retardation can perform some activities independently and may be capable of academic skill to a second-grade level.

Cognitive Level: Application
Integrated Process: Implementation

3. A child has been diagnosed with autistic spectrum disorder. The distraught mother cries out, “I’m such a terrible mother. What did I do to cause this?” Which nursing response is most appropriate?
1. “Researchers really don’t know what causes autistic spectrum disorder, but the relationship between autistic disorder and fetal alcohol syndrome is being explored.”
2. “Poor parenting doesn’t cause autistic spectrum disorder. Research has shown that abnormalities in brain structure or function are to blame. This is beyond your control.”
3. “Research has shown that the mother appears to play a greater role in the development of autistic spectrum disorder than the father.”
4. “Lack of early infant bonding with the mother has shown to be a cause of autistic spectrum disorder. Did you breastfeed or bottle-feed?”

ANS: 2
Rationale: The most appropriate response by the nurse is to explain to the parent that autistic spectrum disorder is believed to be caused by abnormalities in brain structure or function, not poor parenting. Autism occurs in approximately 11.3 per 1,000 children and is about 4.5 times more likely to occur in boys than girls.

Cognitive Level: Application
Integrated Process: Implementation

4. In planning care for a child diagnosed with autistic spectrum disorder, which would be a realistic client outcome?
1. The client will communicate all needs verbally by discharge.
2. The client will participate with peers in a team sport by day four.
3. The client will establish trust with at least one caregiver by day five.
4. The client will perform most self-care tasks independently.

ANS: 3
Rationale: The most realistic client outcome for a child diagnosed with autistic spectrum disorder is for the client to establish trust with at least one caregiver. Trust should be evidenced by facial responsiveness and eye contact. This outcome relates to the nursing diagnosis impaired social interaction.

Cognitive Level: Application
Integrated Process: Planning

5. After an adolescent diagnosed with attention deficit-hyperactivity disorder (ADHD) begins methylphenidate (Ritalin) therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. What is the best explanation for this weight loss?
1. The pharmacological action of Ritalin causes a decrease in appetite.
2. Hyperactivity seen in ADHD causes increased caloric expenditure.
3. Side effects of Ritalin cause nausea, and, therefore, caloric intake is decreased.
4. Increased ability to concentrate allows the client to focus on activities rather than food.

ANS: 1
Rationale: The pharmacological action of Ritalin causes a decrease in appetite, which often leads to weight loss. Methylphenidate is a central nervous symptom stimulant that serves to increase attention span, control hyperactive behaviors, and improve learning ability.

Cognitive Level: Comprehension
Integrated Process: Evaluation

6. A nurse assesses an adolescent client diagnosed with conduct disorder who, at the age of 8, was sentenced to juvenile detention. How should the nurse interpret this assessment data?
1. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood.
2. Childhood-onset conduct disorder is caused by a difficult temperament, and the child is likely to outgrow these behaviors by adulthood.
3. Childhood-onset conduct disorder is diagnosed only when behaviors emerge before the age of 5, and, therefore, improvement is likely.
4. Childhood-onset conduct disorder has no treatment or cure, and children diagnosed with this disorder are likely to develop progressive oppositional defiant disorder.

ANS: 1
Rationale: The nurse should determine that childhood-onset conduct disorder is more severe than adolescent-onset type. These individuals are likely to develop antisocial personality disorder in adulthood. Individuals with this subtype are usually boys and frequently display physical aggression and have disturbed peer relationships.

Cognitive Level: Application
Integrated Process: Analysis

7. Which finding should a nurse expect when assessing a child diagnosed with separation anxiety disorder?
1. The child has a history of antisocial behaviors.
2. The child’s mother is diagnosed with an anxiety disorder.
3. The child previously had an extroverted temperament.
4. The child’s mother and father have an inconsistent parenting style.

ANS: 2
Rationale: The nurse should expect to find a mother diagnosed with an anxiety disorder when assessing a child with separation anxiety. Some parents instill anxiety in their children by being overprotective or by exaggerating dangers. Research studies speculate that there is a hereditary influence in the development of separation anxiety disorder.

Cognitive Level: Comprehension
Integrated Process: Assessment

8. A child has been recently diagnosed with mild IDD. What information about this diagnosis should the nurse include when teaching the child’s mother?
1. Children with mild IDD need constant supervision.
2. Children with mild IDD develop academic skills up to a sixth-grade level.
3. Children with mild IDD appear different from their peers.
4. Children with mild IDD have significant sensory-motor impairment.

ANS: 2
Rationale: The nurse should inform the child’s mother that children with mild IDD develop academic skills up to a sixth-grade level. Individuals with mild IDD are capable of independent living, capable of developing social skills, and have normal psychomotor skills.

Cognitive Level: Application
Integrated Process: Teaching/learning

9. A nursing instructor is teaching about the developmental characteristics of clients diagnosed with moderate intellectual developmental disorder (IDD). Which student statement indicates that further instruction is needed?
1. “These clients can work in a sheltered workshop setting.”
2. “These clients can perform some personal care activities.”
3. “These clients may have difficulties relating to peers.”
4. “These clients can successfully complete elementary school.”

ANS: 4
Rationale: The nursing student needs further instruction about moderate IDD, because individuals diagnosed with moderate IDD are capable of academic skill up to a second-grade level. Moderate IDD reflects an IQ range of 35 to 49.

Cognitive Level: Application
Integrated Process: Evaluation

10. A preschool child is admitted to a psychiatric unit with the diagnosis autistic spectrum disorder. To help the child feel more secure on the unit, which intervention should a nurse include in this client’s plan of care?
1. Encourage and reward peer contact.
2. Provide consistent caregivers.
3. Provide a variety of safe daily activities.
4. Maintain close physical contact throughout the day.

ANS: 2
Rationale: The nurse should provide consistent caregivers as part of the plan of care for a child diagnosed with autistic spectrum disorder. Children diagnosed with autistic spectrum disorder have an inability to trust. Providing consistent caregivers allows the client to develop trust and a sense of security.

Cognitive Level: Application
Integrated Process: Implementation

11. A preschool child diagnosed with autistic spectrum disorder has been engaging in constant head-banging behavior. Which nursing intervention is appropriate?
1. Place client in restraints until the aggression subsides.
2. Sedate the client with neuroleptic medications.
3. Hold client’s head steady and apply a helmet.
4. Distract the client with a variety of games and puzzles.

ANS: 3
Rationale: The most appropriate intervention for head banging is to hold the client’s head steady and apply a helmet. The helmet is the least restrictive intervention and will serve to protect the client’s head from injury.

Cognitive Level: Application
Integrated Process: Implementation

12. When planning care for a client, which medication classification should a nurse recognize as effective in the treatment of Tourette’s syndrome?
1. Neuroleptic medications
2. Anti-manic medications
3. Tricyclic antidepressant medications
4. Monoamine oxidase inhibitor medications

ANS: 1
Rationale: The nurse should recognize that neuroleptic (antipsychotic) medications are effective in the treatment of Tourette’s syndrome. These medications are used to reduce the severity of tics and are most effective when combined with psychosocial therapy.

Cognitive Level: Application
Integrated Process: Planning

13. Which behavioral approach should a nurse use when caring for children diagnosed with disruptive behavior disorders?
1. Involving parents in designing and implementing the treatment process
2. Reinforcing positive actions to encourage repetition of desirable behaviors
3. Providing opportunities to learn appropriate peer interactions
4. Administering psychotropic medications to improve quality of life

ANS: 2
Rationale: The nurse should reinforce positive actions to encourage repetition of desirable behaviors when caring for children diagnosed with disruptive behavior disorder. Behavior therapy is based on the concepts of classical conditioning and operant conditioning.

Cognitive Level: Application
Integrated Process: Implementation

14. A child diagnosed with severe autistic spectrum disorder has the nursing diagnosis disturbed personal identity. Which outcome would best address this client diagnosis?
1. The client will name own body parts as separate from others by day five.
2. The client will establish a means of communicating personal needs by discharge.
3. The client will initiate social interactions with caregivers by day four.
4. The client will not harm self or others by discharge.

ANS: 1
Rationale: An appropriate outcome for this client is to name own body parts as separate from others. The nurse should assist the client in the recognition of separateness during self-care activities, such as dressing and feeding. The long-term goal for disturbed personal identity is for the client to develop an ego identity.

Cognitive Level: Application
Integrated Process: Planning

15. A nursing instructor presents a case study in which a three-year-old child is in constant motion and is unable to sit still during story time. She asks a student to evaluate this child’s behavior. Which student response indicates an appropriate evaluation of the situation?
1. “This child’s behavior must be evaluated according to developmental norms.”
2. “This child has symptoms of attention deficit-hyperactivity disorder.”
3. “This child has symptoms of the early stages of autistic disorder.”
4. “This child’s behavior indicates possible symptoms of oppositional defiant disorder.”

ANS: 1
Rationale: The student’s evaluation of the situation is appropriate when indicating a need for the client to be evaluated according to developmental norms. The DSM-5 indicates that emotional problems exist if the behavioral manifestations are not age-appropriate, deviate from cultural norms, or create deficits or impairments in adaptive functioning.

Cognitive Level: Application
Integrated Process: Evaluation

16. A client has an IQ of 47. Which nursing diagnosis best addresses a client problem associated with this degree of IDD?
1. Risk for injury R/T self-mutilation
2. Altered social interaction R/T non-adherence to social convention
3. Altered verbal communication R/T delusional thinking
4. Social isolation R/T severely decreased gross motor skills

ANS: 2
Rationale: The appropriate nursing diagnosis associated with this degree of IDD is altered social interaction R/T non-adherence to social convention. A client with an IQ of 47 would be diagnosed with moderate intellectual developmental disorder and may also experience some limitations in speech communications.

Cognitive Level: Analysis
Integrated Process: Analysis

17. A physician orders methylphenidate (Ritalin) for a child diagnosed with ADHD. Which information about this medication should the nurse provide to the parents?
1. If one dose of Ritalin is missed, double the next dose.
2. Administer Ritalin to the child after breakfast.
3. Administer Ritalin to the child just prior to bedtime.
4. A side effect of Ritalin is decreased ability to learn.

ANS: 2
Rationale: The nurse should instruct the parents to administer Ritalin to the child after breakfast. Ritalin is a central nervous system stimulant and can cause decreased appetite. Central nervous system stimulants can also temporarily interrupt growth and development.

Cognitive Level: Application
Integrated Process: Implementation

18. Which should be the priority nursing intervention when caring for a child diagnosed with conduct disorder?
1. Modify environment to decrease stimulation and provide opportunities for quiet reflection.
2. Convey unconditional acceptance and positive regard.
3. Recognize escalating aggressive behavior and intervene before violence occurs.
4. Provide immediate positive feedback for appropriate behaviors.

ANS: 3
Rationale: The priority nursing intervention when caring for a child diagnosed with conduct disorder should be to recognize escalating aggressive behavior and to intervene before violence occurs. This intervention serves to keep the client as well as others safe, which is the priority nursing concern.

Cognitive Level: Application
Integrated Process: Implementation

19. A mother questions the decreased effectiveness of methylphenidate (Ritalin), prescribed for her child’s ADHD. Which nursing response best addresses the mother’s concern?
1. “The physician will probably switch from Ritalin to a central nervous system stimulant.”
2. “The physician may prescribe an antihistamine with the Ritalin to improve effectiveness.”
3. “Your child has probably developed a tolerance to Ritalin and may need a higher dosage.”
4. “Your child has developed sensitivity to Ritalin and may be exhibiting an allergy.”

ANS: 3
Rationale: The nurse should explain to the mother that the child has probably developed a tolerance to Ritalin and may need a higher dosage. Methylphenidate is a central nervous system stimulant, and tolerance can develop rapidly. Physical and psychological dependence can also occur.

Cognitive Level: Application
Integrated Process: Implementation

20. After studying the DSM-5 criteria for oppositional defiant disorder (ODD), which listed symptom would a student nurse recognize?
1. Arguing and annoying older sibling over the past year
2. Angry and resentful behavior over a three-month period
3. Initiating physical fights for more than 18 months
4. Arguing with authority figures for more than six months

ANS: 4
Rationale: The DSM-5 rules out the diagnosis of ODD when only siblings are involved in argumentative interactions. Angry and resentful behavior over more than six months, not three months, would be considered a symptom of ODD. Initiating physical fights is a symptom of conduct disorder, not ODD. Arguing with authority figures for more than six months is listed by the DSM-5 as a symptom for the diagnosis of ODD.

Cognitive Level: Application
Integrated Process: Evaluation

Multiple Response

21. Which of the following risk factors, if noted during a family history assessment, should a nurse associate with the development of IDD? (Select all that apply.)
1. A family history of Tay-Sachs disease
2. Childhood meningococcal infection
3. Deprivation of nurturance and social contact
4. History of maternal multiple motor and verbal tics
5. A diagnosis of maternal major depressive disorder

ANS: 1, 2, 3
Rationale: The nurse should recognize a family history of Tay-Sachs disease, childhood meningococcal infections, and deprivation of nurturance and social contact as risk factors that would predispose a child to IDD. There are five major predisposing factors of IDD: hereditary factors, early alterations in embryonic development, pregnancy and perinatal factors, medical conditions acquired in infancy or childhood, and environmental influences and other mental disorders.

Cognitive Level: Application
Integrated Process: Assessment

22. Which of the following findings should a nurse identify that would contribute to a client’s development of ADHD? (Select all that apply.)
1. The client’s father was a smoker.
2. The client was born 7 weeks premature.
3. The client is lactose intolerant.
4. The client has a sibling diagnosed with ADHD.
5. The client has been diagnosed with dyslexia.

ANS: 2, 4
Rationale: The nurse should identify that premature birth and having a sibling diagnosed with ADHD would predispose a client to the development of ADHD. Research indicates evidence of genetic influences in the etiology of ADHD. Studies also indicate that environmental influences, such as lead exposure and diet, can be linked with the development of ADHD.

Cognitive Level: Application
Integrated Process: Assessment

Fill-in-the-Blank

23. The DSM-5 criteria for ODD specifies that: A persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness must be evident and last at least ______________ months.
ANS: six
Rationale: A persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness must be evident and last at least six months according to the DSM-5 criteria for the diagnosis of ODD.

Cognitive Level: Application
Integrated Process: Assessment