NCLEX Quiz: Childhood And Adolescent Psychiatric Disorders

1. The community nurse visits the home of George. a child recently diagnosed with autism. The parents express feelings of shame and guilt about having somehow caused this problem. Which statement by the nurse would best help alleviate parental guilt?

“Autism is a rare disorder. Your other children shouldn’t be affected.”

“Sometimes a lack of prenatal care can be cause of autism.”

“Although autism is genetically inherited if you didn’t have testing you could not have known this would happen.”

This statement is factual and does not cast blame on anything the parents did or did not do.Option A: The parents are not questioning whether other children will be affected; their concern is directed to the current situation and their feelings about it.Option C: Lack of prenatal care may be a risk factor in pervasive developmental disorders. but it is not the cause of autism.Option D: Although it is thought that there is a genetic component in autism. research has not identified specific genes. and there is no diagnostic test for this. The statement is misleading and would not alleviate guilt.

Explanation

This statement is factual and does not cast blame on anything the parents did or did not do.Option A: The parents are not questioning whether other children will be affected; their concern is directed to the current situation and their feelings about it.Option C: Lack of prenatal care may be a risk factor in pervasive developmental disorders. but it is not the cause of autism.Option D: Although it is thought that there is a genetic component in autism. research has not identified specific genes. and there is no diagnostic test for this. The statement is misleading and would not alleviate guilt.

2. The parents of Suzanne. a child with attention deficit hyperactivity disorder. tell the nurse they have tried everything to calm their child and nothing has worked. Which action by the nurse is most appropriate initially?

Actively listen to the parents’ concern before planning interventions.

Encourage the parents to discuss these issues with the mental health team.

Provide literature regarding the disorder and its management.

Tell the parents they are overacting to the problem.

The nurse would encourage parents to fully discuss and describe their perception of the problem in order to assess the family system before determining appropriate interventions.Option B: the nurse has not explored the problem and is deciding before adequately assessing the situation that the mental team should be consulted.Option C: Providing literature regarding the disorder and its management may be useful intervention; however. the initial action needs to involve a more thorough exploration of the parents’ concerns.Option D: Telling the parents they are overreacting to the problem is inappropriate because it dismisses the parents’ legitimate concerns and belittles their feelings.

Explanation

The nurse would encourage parents to fully discuss and describe their perception of the problem in order to assess the family system before determining appropriate interventions.Option B: the nurse has not explored the problem and is deciding before adequately assessing the situation that the mental team should be consulted.Option C: Providing literature regarding the disorder and its management may be useful intervention; however. the initial action needs to involve a more thorough exploration of the parents’ concerns.Option D: Telling the parents they are overreacting to the problem is inappropriate because it dismisses the parents’ legitimate concerns and belittles their feelings.

3. Nurse Bennet is a community nurse practicing primary prevention for psychiatric disorders in children. On which of the following risk factors would he focus?

Being raised in a single-parent home

Family history of mental illness

Lack of peer friendship

Family culture

Abnormal genes and family history of mental illness have been implicated in many psychiatric disorders occurring in children and adolescents.Option A: There is no evidence that being raised in a single-parent home will increase a child’s risk of developing a psychiatric disorder.Option C: Children who have problems with peers and withdraw from social interaction may have a psychiatric disorder; however. the nurse noting this problem would be practicing secondary. not primary. prevention.Option D: Family culture is not a risk factor unless the parental behavior is dramatically atypical from surrounding culture.

Explanation

Abnormal genes and family history of mental illness have been implicated in many psychiatric disorders occurring in children and adolescents.Option A: There is no evidence that being raised in a single-parent home will increase a child’s risk of developing a psychiatric disorder.Option C: Children who have problems with peers and withdraw from social interaction may have a psychiatric disorder; however. the nurse noting this problem would be practicing secondary. not primary. prevention.Option D: Family culture is not a risk factor unless the parental behavior is dramatically atypical from surrounding culture.

4. A 15-year-old boy was hospitalized in a psychiatric unit because he initiates frequent fights with peers. Which implementation is most appropriate?

Anticipate and neutralize potentially explosive situations.

Ignore minor infractions of rules against fighting.

Isolate the adolescent from contact with peers.

Talk to the adolescent each time fighting occurs.

The nurse is responsible for maintaining a safe environment; therefore. it would be appropriate to observe for signs that an explosive situation is developing and intervening to neutralize the situation. thereby preventing a fight.Option B: Ignoring minor infractions of rules against fighting in a psychiatric unit would not be a minor infraction and should not be ignored. This could lead to unsafe situations that could escalate out of control.Option C: Isolation and seclusion are methods of intervention that can be used as a last resort after less restrictive means are employed.Option D: Talking to the adolescent each time a fight occurs does not indicate that the nurse is setting and enforcing clear. consistent rules. The nurse needs to maintain safety and would not allow fighting to occur if it could be avoided.

Explanation

The nurse is responsible for maintaining a safe environment; therefore. it would be appropriate to observe for signs that an explosive situation is developing and intervening to neutralize the situation. thereby preventing a fight.Option B: Ignoring minor infractions of rules against fighting in a psychiatric unit would not be a minor infraction and should not be ignored. This could lead to unsafe situations that could escalate out of control.Option C: Isolation and seclusion are methods of intervention that can be used as a last resort after less restrictive means are employed.Option D: Talking to the adolescent each time a fight occurs does not indicate that the nurse is setting and enforcing clear. consistent rules. The nurse needs to maintain safety and would not allow fighting to occur if it could be avoided.

5. Nurse Daya. a school nurse. is meeting with the school and health treatment team about a child who has been receiving methylphenidate (Ritalin) for two (2) months. The meeting is to evaluate the results of the child's medication use. Which behavior change noted by the teacher will help determine the medication's effectiveness.

Decrease repetitive behaviors

Decreased signs of anxiety

Increased depressed mood

Increased ability to concentrate on tasks

Methylphenidate (Ritalin) is used as a method of treatment of ADHD. Evidence of increased ability to concentrate on tasks while taking this medication would establish the drug’s effectiveness.

Explanation

Methylphenidate (Ritalin) is used as a method of treatment of ADHD. Evidence of increased ability to concentrate on tasks while taking this medication would establish the drug’s effectiveness.

6. Which behavioral assessment in a child is most consistent with a diagnosis of conduct disorder?

Arguing with adults

Gross impairment in communication

Physical aggression toward others

Refusal to separate from caretaker

Physical aggression toward others is a significant criterion consistent with the diagnoses of conduct disorder.Option A: Arguing with adults may indicate a lesser disorder. oppositional defiant disorder. Conduct disorder is a problem that involves violation of social rules.Options B and D: Gross impairment in communication and refusal to separate from a caretaker are behaviors that are more consistent with other mental disorders that can affect children.

Explanation

Physical aggression toward others is a significant criterion consistent with the diagnoses of conduct disorder.Option A: Arguing with adults may indicate a lesser disorder. oppositional defiant disorder. Conduct disorder is a problem that involves violation of social rules.Options B and D: Gross impairment in communication and refusal to separate from a caretaker are behaviors that are more consistent with other mental disorders that can affect children.

7. Martin Sanchez is a nine (9)-year-old child admitted to a psychiatric treatment unit accompanied by Mr. and Mrs. Sanchez. To establish trust and position of neutrality. which action would the nurse take?

Encourage Mr. and Mrs. Sanchez to leave while Martin is being interviewed.

Interview Martin with his parents together. observing their interaction.

Provide diversion for Martin. and interview Mr. and Mrs. Sanchez alone.

Review the clinical record prior to interviewing Mr. and Mrs. Sanchez.

It is important for the nurse to be seen as a neutral person who is interested in the family as an adaptive functioning unit. By conducting the admission interview with the parents and child together. the nurse establishes this neutral role from the beginning.The responses on options A and C separate the parents and the child. and thus the nurse does not have an opportunity to establish a position of neutrality.Option D: Although the nurse would review the clinical record. this does not demonstrate to the family that she is an advocate for both parents and the child.

Explanation

It is important for the nurse to be seen as a neutral person who is interested in the family as an adaptive functioning unit. By conducting the admission interview with the parents and child together. the nurse establishes this neutral role from the beginning.The responses on options A and C separate the parents and the child. and thus the nurse does not have an opportunity to establish a position of neutrality.Option D: Although the nurse would review the clinical record. this does not demonstrate to the family that she is an advocate for both parents and the child.

8. Alexi who has separation anxiety disorder has not attended school for three (3) weeks. and she cries and exhibits clinging behaviors when her mother encourages attendance. The priority nursing action by the home-care psychiatric nurse would be to:

Assist the child in returning to school immediately with family support.

Arrange for a home-school teacher to visit for two (2) weeks

Encourage family discussion of various problem areas.

Use play therapy to help the child express her feelings.

When a child refuses to attend school as part of separation anxiety disorder. it is important to avoid reinforcing this behavior. The nurse’s priority would be to assist the child in returning to school immediately with support from the family.Option B: Arranging for a home-school teacher would reinforce the behavior of not attending school.Options C and D: Although encouraging family discussion of problem areas and the use of play therapy are appropriate treatment interventions; the priority is returning the child to school.

Explanation

When a child refuses to attend school as part of separation anxiety disorder. it is important to avoid reinforcing this behavior. The nurse’s priority would be to assist the child in returning to school immediately with support from the family.Option B: Arranging for a home-school teacher would reinforce the behavior of not attending school.Options C and D: Although encouraging family discussion of problem areas and the use of play therapy are appropriate treatment interventions; the priority is returning the child to school.

9. Nurse Gloria questions the parents of a child with oppositional defiant disorder about the roles of each parent in setting rules of behavior. The purpose for this type of questioning is to assess which element of the family system?

Anxiety levels

Generational boundaries

Knowledge of growth and development

Quality of communication

An important element in assessing the family system is determining if the parents establish and maintain appropriate generational boundaries. establishing clear rules and expectations as part of the parental role.Option A: Although the parents may have anxiety regarding the role of parental rule-setting. the nurse’s question is not adequate to assess the anxiety levels.Options C and D: The question concerns the roles of the parents and the child in rule setting. It does not provide data regarding knowledge of growth and development or communication quality.

Explanation

An important element in assessing the family system is determining if the parents establish and maintain appropriate generational boundaries. establishing clear rules and expectations as part of the parental role.Option A: Although the parents may have anxiety regarding the role of parental rule-setting. the nurse’s question is not adequate to assess the anxiety levels.Options C and D: The question concerns the roles of the parents and the child in rule setting. It does not provide data regarding knowledge of growth and development or communication quality.

10. An adolescent with a depressive disorder is more likely than an adult with the same disorder to exhibit:

Negativism and acting out.

Sadness and crying.

Suicidal thoughts.

Weight gain.

Adolescents sometimes demonstrate behavior that is uncharacteristic of an adult with a psychiatric disorder. In a depressive disorder. an adolescent’s negativism and acting out could be signs of depression.Options B and C: Sadness. crying. and suicidal thoughts are behaviors of both adolescents and adults.Option D: An adult may experience either weight loss or weight gain while depressed. whereas an adolescent may experience weight loss.

Explanation

Adolescents sometimes demonstrate behavior that is uncharacteristic of an adult with a psychiatric disorder. In a depressive disorder. an adolescent’s negativism and acting out could be signs of depression.Options B and C: Sadness. crying. and suicidal thoughts are behaviors of both adolescents and adults.Option D: An adult may experience either weight loss or weight gain while depressed. whereas an adolescent may experience weight loss.