Chapter 17: Disorders of Infancy, Childhood, and Adolescence My Nursing Test Banks

Fortinash: Psychiatric Mental Health Nursing, 5th Edition

Chapter 17: Disorders of Infancy, Childhood, and Adolescence

Test Bank

MULTIPLE CHOICE

1. Which complaint is representative of anxiety in a 6-year-old child?

a.

I worry that my dad will get hurt at work.

b.

I get a stomach ache when its my weekend at my dads house.

c.

I cant sleep when I stay at Grandmas because I worry about my mom.

d.

Im not going to sports camp because I dont like being away from my friends.

ANS: A

Developmental differences exist with regard to the symptoms of anxiety. Children between the ages of 5 and 8 years old most commonly report unrealistic worry about harm to their parents. Between the ages of 9 and 12 years, children report excessive distress during times of separation. Adolescents typically report somatic complaints.

DIF: Cognitive Level: Application REF: Page 409

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. Which of the following meets the DSM-IV-TR criteria for moderate mental retardation?

a.

Requires constant one-on-one supervision and total physical care

b.

Advanced as far as the sixth grade and works at a warehouse every day and supports himself

c.

Advanced as far as the second grade and provides her own personal care with supervision

d.

Attends the local community college for developmental English and math courses

ANS: C

Individuals diagnosed as having moderate mental retardation acquire some communication skills, but rarely advance academically beyond the second grade. With supervision they can provide for their own personal care. Persons requiring constant supervision and total physical care would be considered profoundly retarded. Persons achieving elementary or above learning skills would be considered mildly retarded.

DIF: Cognitive Level: Application REF: Page 397

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

3. The nurse is assessing a child with autism. Which of the following behaviors would the nurse expect to observe?

a.

Referring to their imaginary friend, Skipper

b.

Asking to telephone my friends on the weekends

c.

Repeating, milk, milk, milk, milk until given a drink

d.

Is insistent that a dim light be left on in the bedroom at night

ANS: C

Stereotyped and repetitive use of language or idiosyncratic language is one of the characteristic behaviors seen in autism. The remaining options are normal characteristics of a child in various developmental stages.

DIF: Cognitive Level: Application REF: Page 398

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

4. Which behavior best supports the diagnosis of attention-deficit/hyperactivity disorder in an 8-year-old child?

a.

Cries when separated from his mother or father

b.

Refuses to pick up toys as instructed by his parents

c.

Is fascinated with spinning and moving toys and objects

d.

Can concentrate on school work for only very short periods of time

ANS: D

Experiencing difficulty concentrating on tasks is a hallmark for ADHD. Crying is a characteristic of separation anxiety. Disobedience as described may represent oppositional behavior. Focusing on repetitious motion is characteristic of autism.

DIF: Cognitive Level: Application REF: Page 402

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5. Which behavior is most characteristic of a conduct disorder?

a.

Frequently getting up and interrupting while being read to

b.

Only apologizes for hitting a friend to avoid being punished

c.

Finds it difficult to spend the night away from family members

d.

Becomes extremely agitated when the television is turned off

ANS: B

Children or adolescents with conduct disorder generally do not empathize with other peoples feelings and are unconcerned with others situations or needs. They exhibit uncaring behavior, but they will often express words of guilt or remorse because they have learned that it reduces or prevents punishment. ADHD is often characterized by hyperactivity. Separation anxiety is often responsible for a childs resistance to spending time away from home. Autism can be the cause of exaggerated responses.

DIF: Cognitive Level: Application REF: Pages 404-405

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

6. Which assessment finding should be considered a high risk factor for adolescent suicide?

a.

Being sexually abused

b.

Having experienced panic attacks

c.

Being mildly cognitively impaired

d.

Having a diagnosis of type 1 diabetes

ANS: A

Suicide risk factors include a history of sexual abuse. There is no current research to support a strong relationship between suicide attempts and any of the other options.

DIF: Cognitive Level: Application REF: Page 406

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

7. Planning for a patient with Aspergers disorder will be facilitated if the nurse understands that this disorder is different from autism. The nurse will base care on knowledge that Aspergers disorder is characterized by:

a.

Repetitive patterns of behavior

b.

Age-appropriate language development

c.

Stereotypic movements and speech patterns

d.

Obsession with objects that move in a spinning motion

ANS: B

Communication will be facilitated knowing that a patient with Aspergers disorder has no clinically significant delays in language or cognitive function. The remaining options are characteristics of both disorders.

DIF: Cognitive Level: Application REF: Page 399 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

8. Which behaviors would support a diagnosis of oppositional-defiant disorder?

a.

Exhibits involuntary facial twitching and blinking and makes barking sounds

b.

Negative, hostile, and spiteful toward parents and blames others for misbehavior

c.

Displays high anxiety when away from parents, has nightmares, and fears being kidnapped

d.

Violates others rights, is cruel to people or animals, lies and steals, and is truant from school

ANS: B

Children with oppositional defiant disorder argue with adults, actively defy adults requests, deliberately annoy adults, and refuse to take responsibility for their behaviors. Lying, stealing, and animal cruelty describes a child with conduct disorder. Being afraid of being kidnapped describes a child with separation anxiety. Facial twitching is associated with Tourettes disorder.

DIF: Cognitive Level: Application REF: Page 404

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

9. Which childs history is a risk for developing a reactive attachment disorder?

a.

Father is a chronic alcoholic

b.

Was born with a congenital cardiac disorder

c.

Experienced head trauma at age 7 months of age

d.

Spent first 12 months of life in an Asian orphanage

ANS: D

Reactive attachment disorder is a disorder that occurs in some children who are institutionalized.

DIF: Cognitive Level: Application REF: Page 399

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

10. Which intervention will best help a teenager manage aggressive behavior?

a.

Administering prescribed medication as ordered

b.

Supporting the patients interest in writing poetry

c.

Reenacting situations that may trigger aggression

d.

Providing information on anger management techniques

ANS: C

Role-play situations that trigger aggressiveness explore and reinforce alternative methods of coping. The other options although appropriate lack the opportunity to reflect on the triggers and practice the coping skills.

DIF: Cognitive Level: Application REF: Page 411

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

11. Which intervention will best help a child manage hyperactive behavior?

a.

Arranging for the child to play basketball 4 times a week

b.

Allowing the child to play a favorite video game as a reward

c.

Using a favorite food and beverage to distract the child

d.

Placing the child in a low stimulation environment for 30-60 minutes

ANS: A

Redirect disruptive behavior with recreational activities to channel excess energy. The remaining options will have little positive effect on the childs energy level.

DIF: Cognitive Level: Application REF: Page 411

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

12. The nursing diagnosis that would be universally applicable for children with autistic disorder would be:

a.

Risk for constipation related to odd eating habits

b.

Chronic low self-esteem related to negative social feedback

c.

Impaired social interaction related to inability to relate to others

d.

Disturbed thought processes related a neurological dysfunction

ANS: C

Children with autistic disorder display profoundly disturbed social relationships. Essentially, they lack social reciprocity. They seem aloof and indifferent to others and prefer inanimate objects to people. The remaining options are not necessarily true of this mental illness.

DIF: Cognitive Level: Application REF: Page 398 TOP: Nursing Process: Analysis

MSC: NCLEX: Psychosocial Integrity

13. A childs diagnosis of conduct disorder is supported by the fact that:

a.

The childs mother is a chronic alcoholic.

b.

The child engages in ritualistic behaviors.

c.

A brain scan shows structural abnormalities.

d.

There is a family history of respiratory disorders.

ANS: B

Conduct disorder occurs more frequently when a biologic parent has alcohol dependency. There is no research to support a connection between a conduct disorder and any of the remaining options.

DIF: Cognitive Level: Application REF: Page 404

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

14. Which intervention will best help minimize parental guilt in the family of a child diagnosed with a psychiatric disorder?

a.

Helping them to develop realistic expectations for their child

b.

Educating them on the need to provide the child with boundaries

c.

Providing them with information regarding locally available services

d.

Encouraging them to use respite care periodically to allow for downtime

ANS: A

Teach the parents about the patients disorder to minimize their guilt related to causing or caring for the child. The remaining options although appropriate do not focus on the potential for self guilt.

DIF: Cognitive Level: Application REF: Page 412

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

15. Which behavior demonstrates that a child is achieving appropriate management of separation anxiety?

a.

Earned two As, three Bs, and one C this report card period

b.

Falls asleep with a parent sitting outside the bedroom door

c.

Sleeps on a chair in the parents bedroom rather than in their bed

d.

Reports having only a little stomach ache during breakfast on school days

ANS: A

Children with separation anxiety disorder demonstrate academic difficulties resulting from a refusal to attend school or frequent absences resulting from somatic illnesses. The other options show continued behaviors seen with this disorder.

DIF: Cognitive Level: Application REF: Page 400 TOP: Nursing Process: Evaluation

MSC: NCLEX: Psychosocial Integrity

16. A 15-year-old has been diagnosed with major depression and admitted to the adolescent unit. Which behavior would the nurse expect to observe in this patient?

a.

Discussing repeated run-ins with the law

b.

Being manipulative and callous towards others

c.

Blaming adults for his admission to the adolescent unit

d.

Reporting decreased enjoyment of school-related activities

ANS: D

Anhedonia, the absence of pleasure, is a common manifestation of depression. Legal behavior and manipulative and uncaring behavior are characteristic of conduct disorder. Seeing adults as the root of their problems is common in conduct disorder and oppositional-defiant disorder.

DIF: Cognitive Level: Application REF: Page 408

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

17. When discussing depression and suicide with parents of teenagers, the nurse is accurate in reporting that the most common method used in late adolescent suicide is:

a.

Hanging

b.

Firearms

c.

Oral poisoning

d.

Drug overdose

ANS: B

Statistics show the use of firearms is the most commonly used method of committing suicide among adolescents. With this in mind, the nurse could counsel parents about the importance of keeping firearms locked away from teens. The other options are less-often used methods for attempting suicide.

DIF: Cognitive Level: Comprehension REF: Page 406

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

18. Planning safety interventions for a teenager with a history of self-injurious behavior is based on what research-based information?

a.

Teenagers rarely entertain the idea of suicide.

b.

Suicides can occur accidentally as a result of self-injurious behaviors.

c.

Self-injury is always viewed as a risk factor for future suicidal attempts.

d.

Assessment for suicidal ideations is a vital component of this childs care.

ANS: B

Self-injurious behavior is not suicidal behavior and is not viewed as a risk factor for suicidal ideations or attempts, but some teenagers accidentally commit suicide in the process. Teenagers are acting on suicidal thoughts at an alarming rate.

DIF: Cognitive Level: Application REF: Page 407 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

19. Which statement made by a teenage male hospitalized after a failed suicide attempt is most concerning to the nurse?

a.

My uncle shot himself but he didnt die.

b.

I dont know why I get so depressed and want to die.

c.

The gun I got for my birthday is my most prized possession.

d.

I hope I dont ever get depressed enough to try and hurt myself again.

ANS: C

Factors associated with suicidal behaviors include access to firearms providing the teenage patient with the opportunity and means to harm himself if he again becomes depressed. Although the remaining options represent possible risk factors, none provide insight into opportunity and means.

DIF: Cognitive Level: Analysis REF: Page 406

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20. The mother of a child describes her childs annoying behavior as not being able to sit still or to stop jerking his arms when told to. Which disorder does the nurse suspect?

a.

Tourettes disorder

b.

Oppositional-defiant disorder

c.

Pervasive developmental disorder

d.

Attention-deficit/hyperactivity disorder

ANS: A

The parent describes simple motor tics that are involuntary behaviors and characteristic of Tourettes disorder. The child is not being defiant because he has no control of the tics. Although the child displays repeated motor behaviors, they are unrelated to hyperactivity because they are not generalized and occur only sporadically. These involuntary tics are not seen in pervasive developmental disorders such as autism.

DIF: Cognitive Level: Comprehension REF: Page 401

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

21. Which response is most therapeutic when a parent whose child is diagnosed with Tourettes disorder voices concerns that their childs facial contortions are merely acts of defiance?

a.

Your child isnt defiant but rather mentally ill.

b.

What makes you think he is doing that out of defiance?

c.

I think with the use of some behavior modification techniques, he can learn to control the facial tics.

d.

Your sons behavior is likely due to a neurological dysfunction that causes those involuntary facial tics.

ANS: D

Tourettes disorder is most often thought to be a genetic neurologic disorder whose characteristic behaviors are involuntary in nature. Referring to the child as mentally ill is not a true description of the situation. Asking the parent to further discuss the idea that the tics are an act of defiance is inappropriate since that is not true. Behavioral modification is not effective on involuntary behaviors.

DIF: Cognitive Level: Application REF: Page 401

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

22. Which description is characteristic of an impulsive child?

a.

Pacing and speaking in a very loud, disruptive voice

b.

Frequently talking about hearing voices telling him what to do

c.

Running out into the street regardless of frequent instruction to look both ways first

d.

Having a difficult time concentrating on reading since his attention is easily diverted

ANS: C

Running into the street is an example of impulsive behavior because it is clearly taking action before considering consequences. Hyperactivity refers to such things as increased pace and volume of activity. Thought disorders include such perceptual dysfunction as auditory hallucinations. Distractibility is characterized by poor concentration.

DIF: Cognitive Level: Application REF: Page 403

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

23. Which intervention would qualify as primary prevention of violent behaviors in children and adolescents?

a.

Forbidding the child to continue friendships with violent peers

b.

Limiting exposure to violence on TV, video, and computer games

c.

Seeking counseling for a child who has been experimenting with drugs

d.

Showing a unified approach to parenting when dealing with a violent child

ANS: B

Studies suggest that an obsession with violence in video games, movies, music, and writings increases aggressiveness in children and adolescents. The other options are relevant only after the risk for violence has been established.

DIF: Cognitive Level: Application REF: Page 407 TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

24. A friend says to a nurse, I am not going to get vaccines for my baby. I hear that vaccines cause autism. The nurses best reply is:

a.

The exact cause of autism is not really known

b.

Its believed that autism is really a result of birth trauma.

c.

There is no conclusive evidence to connect autism to vaccinations.

d.

Please tell me more about where you got that information about autism?

ANS: C

There is no research to connect autism to a reaction to vaccinations or to birth trauma. The exact cause of autism remains undetermined but that response doesnt address the patients statement nor does asking the patient to give additional information regarding their original statement.

DIF: Cognitive Level: Application REF: Page 397

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

25. A 5-year-old girl on a behavior modification program is admitted to the unit. The nurse would expect to participate in which activity based on this approach?

a.

Firmly challenging the childs irrational thoughts

b.

Including the child in the creation of a behavioral contract

c.

Family therapy with every member present for each session

d.

Play therapy with dolls representing every member of the family

ANS: B

Behavior modification includes constructing a contract that outlines behavioral changes that is a result of the input of therapists, family and the child. Family therapy, play therapy, and thought challenging are not generally used with a behavior modification program.

DIF: Cognitive Level: Application REF: Page 414 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

26. A mother asks why the whole family needs to meet with the therapist because it is her teenage stepdaughter who has the substance abuse problem. The nurse replies with the knowledge that:

a.

Mothers usually have insight into their childrens problem.

b.

The parents are responsible for changing the teens behavior.

c.

The family will probably use behavior modification with the teen.

d.

Sometimes the teenaged patient is actually acting out family dynamics.

ANS: D

It is important to remember that children will often act out the underlying family dynamics or family psychopathology. Mothers may not have an understanding of the problems their children are experiencing. Behavior modification is not typically a treatment for teen substance abuse. The teen is responsible for changing personal behavior.

DIF: Cognitive Level: Application REF: Page 409

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. The parents of a child diagnosed with ADHD ask the nurse what current medications are available for their child. The nurse should list which of the following medications? (Select all that apply.)

a.

Methylphenidate (Concerta)

b.

Zolpidem (Ambien)

c.

Dextroamphetamine (Adderall)

d.

Atomoxetine (Strattera)

e.

Haloperidol (Haldol)

ANS: A, C, D

Ambien is a sleeping medication and not typically used to treat ADHD. Haldol is an antipsychotic that is not specified for use for ADHD. The other medications are sometimes used for ADHD.

DIF: Cognitive Level: Application REF: Page 412

TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Copyright 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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