Disorders of Infants, Children and Adolescents – Flashcards

3) Negativistic, disobedient behaviors toward authority figures

1) The client and the entire family should all be included when planning care.

3) Assume a nonpunitive attitude and remove the client from the conflict.

3) Encourage dividing tasks into smaller, attainable steps and reward successful completion.

Tourette's disorder

4) Both ADHD and narcolepsy respond positively to an increase in levels of neurotransmitters.

1) Oppositional defiant disorder (ODD) 4) Conduct disorder 5) Substance abuse Feedback 1: ODD, a disorder characterized by persistent angry mood and defiant behavior beyond that expected for children of similar age and developmental level, is a common comorbidity with ADHD. Feedback 2: Narcissistic personality disorder may be difficult to distinguish from ADHD because they share common features of disorganization, intrusiveness, cognitive dysregulation, and emotional dysregulation. However, people with narcissistic personality disorders also have features such as self-injury, fear of abandonment, and ambivalence that are not characteristic of ADHD. These disorders have not been identified as common comorbidities. Feedback 3: Schizophrenia is a disorder characterized by the presence of psychotic features and/or disorganized speech, as well as a host of other symptoms of impaired function. It has not been commonly identified as a condition that is comorbid with ADHD. Feedback 4: Conduct disorder is characterized by a persistent pattern of behavior in which the rights of others and societal norms are violated. It is commonly seen as a comorbid condition with ADHD. Feedback 5: Substance abuse is commonly seen as a comorbid disorder in people with ADHD, so it is essential to assess for its presence and to develop a plan of care that addresses dual diagnosis where it is relevant.

1) Play provides a means for children to express their inner feelings. 2) Playing with toys allows children to transfer anxieties and fears to objects rather than people. 3) Play allows children the opportunity to change unmanageable situations into manageable ones through symbolic representation. Feedback 1: Play therapy provides children an opportunity to safely express their inner feelings because they can distance themselves from traumatic events and experiences. Feedback 2: Playing with toys, such as dolls, allows children to express their feelings as if they were the feelings of the doll and thereby provides a safe opportunity to explore options for problem-solving. Feedback 3: Playing allows children to safely imagine different outcomes or different solutions to problems through externalizing the situation. Feedback 4: Although play can be relaxing and a distraction from problem solving, play therapy is designed to use this format for problem-solving. Feedback 5: Although play therapy engages children in age-appropriate activities, its purpose is not to teach children about the games and activities but rather to use them as a therapeutic tool.

1. Research has revealed strong evidence that genetic factors may play a significant role in the etiology of autism spectrum disorder. Studies show that parents who have one child with this disorder are at an increased risk for having more than one child with the disorder. Also, monozygotic and dizygotic twin studies have provided evidence of genetic involvement.

4) A decrease in rate of growth and development

2) Antisocial personality disorder

2. Children diagnosed with congenital rubella, postnatal neurological infections, phenylketonuria, or fragile X syndrome are predisposed to being diagnosed with autism spectrum disorder.

2. Mahler's theory suggests that a child with ADHD has psychodynamic problems. Mahler describes these children as fixed in the symbiotic phase of development. They have not differentiated self from mother. Ego development is retarded, and impulsive behavior, dictated by the id, is manifested.

1. According to the theory of family dynamics, frequent shifting of parental figures has been implicated as a contributing factor in the predisposition to conduct disorder. An example of frequent shifting of parental figures may include, but is not limited to, divorce, death, and inconsistent foster care. 3. According to the theory of family dynamics, the absence of a father, or the presence of a father diagnosed with alcohol use disorder, has been implicated as a contributing factor to the diagnosis of conduct disorder. 4. According to the theory of family dynamics, large family size has been implicated as a contributing factor in the predisposition to conduct disorder. The quality of family relationships needs to be assessed for evidence of overcrowding, poverty, neglect, and abuse to determine this risk factor.

2. Abnormalities in levels of dopamine, serotonin, dynorphin, gamma-aminobutyric acid, acetylcholine, and norepinephrine have been associated with Tourette's disorder. This etiology is from a biochemical perspective.

4. An IQ level of 40 is within the range of moderate IDD (IQ level 35 to 49). Academic skill to the second-grade level would be a developmental characteristic expected of an individual in this IQ range.

4. One of the first characteristics that the nurse would note is the client's abnormal language patterning or total absence of language. Children diagnosed with autism spectrum disorder display an uneven development of intellectual skills. Impairments are noted in verbal and nonverbal communication. These children cannot use or understand abstract language, and they may make unintelligible sounds or say the same word repeatedly.

1. Essential diagnostic criteria for ADHD includes inattention, along with hyperactivity and impulsivity. Children with this disorder are highly distractible and have extremely limited attention spans.

3. A history of physical cruelty toward people and animals is commonly associated with conduct disorder. These children may bury animals alive and set fires intending to cause harm and damage.

3. The symptoms of ODD usually appear no later than early adolescence. A child diagnosed with ODD presents with a pattern of negativity, disobedience, and hostile behavior toward authority figures. This pattern of behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

1. A symptom of depression in adolescence is poor self-esteem. Puberty and maturity are gradual processes and vary among individuals. Adolescents may experience a lack of self-esteem when their expectations of maturity are not met or when they compare themselves unfavorably with peers. 2. Eating and sleeping disturbances are common signs and symptoms of depression in adolescents. 3. Acting out sexually and expressing inappropriate anger are symptoms of depression in adolescence. The fluctuating hormone levels that accompany puberty contribute to these behaviors. A manifestation of behavioral change that lasts for several weeks is the best indicator of a mood disorder in an adolescent. 5. Exaggerated psychosomatic complaints are symptoms of depression in adolescence. Between the ages of 11 and 16, normal rapid changes to the body occur, and psychosomatic complaints are common. These complaints must be differentiated from the exaggerated psychosomatic complaints that occur in adolescent depression. TEST-TAKING HINT: To answer this question correctly, the test taker needs to differentiate between the symptoms of depression and the normal physical and psychological changes that occur during childhood and adolescence.

3. Impaired verbal communication R/T developmental alteration is the appropriate nursing diagnosis for a child diagnosed with mild to moderate IDD who is having difficulties making needs and desires understood to staff members. Clients diagnosed with mild to moderate IDD often have deficits in communication. TEST-TAKING HINT: The test taker needs to understand that the selection of an appropriate nursing diagnosis for clients diagnosed with IDD depends largely on client behaviors, the extent of the client's capabilities, and the severity of the condition. The test taker must look at the client behaviors described in the question to determine the appropriate nursing diagnosis. In this question, the keywords "difficulty making desires known" suggests a lack of verbal communication.

3. The nursing diagnosis of altered growth and development related to inadequate environmental stimulation would best address this child's problem of failure to thrive. Failure to thrive frequently results from neglect and abuse. TEST-TAKING HINT: To answer this question correctly, the test taker needs to match the problem presented in the question with the nursing diagnosis that reflects the client's problem. Other nursing diagnoses may apply to clients diagnosed with severe IDD, but only answer 3 addresses failure to thrive.

3. Children diagnosed with autism spectrum disorder frequently head bang because of neurological alterations, increased anxiety, or catastrophic reactions to changes in the environment. Because the nurse is responsible for ensuring client safety, the nursing diagnosis of risk for injury takes priority. TEST-TAKING HINT: Although all nursing diagnoses presented may apply to clients diagnosed with autism spectrum disorder, the test taker needs to understand that client safety is always the nurse's primary responsibility. The keywords "head bangs" in the question should alert the test taker to choose the nursing diagnosis of risk for injury as the priority client problem.

3. Risk for violence: directed at others is defined as behaviors in which an individual demonstrates that he or she can be physically, emotionally, or sexually harmful to others. Children diagnosed with ODD have a pattern of negativistic, spiteful, and vindictive behaviors. The foster child described in the question also has a history of aggressive behaviors. Because maintaining safety is a critical responsibility of the nurse, risk for violence: directed at others would be the priority nursing diagnosis. TEST-TAKING HINT: To answer this question correctly, the test taker needs to correlate the data collected during the nursing assessment with the appropriate nursing diagnosis in order of priority. Maintaining safety always is prioritized.

2. Ineffective coping is defined as the inability to form a valid appraisal of the stressors, ineffective choices of practiced responses, or inability to use available resources. A child diagnosed with separation anxiety often refuses to go to school or bed because of fears of separation from home or from individuals to whom the child is attached. The child in the question is refusing to go to bed as a way to cope with fear and anxiety. The nursing diagnosis of ineffective coping would be an appropriate documentation of this client's problem. TEST-TAKING HINT: The test taker must read this question carefully to recognize that the question is asking for documentation of the client problem presented in the question rather than asking which client problem takes priority.

4. A child diagnosed with moderate IDD who resorts to self-mutilation during times of peer and staff conflict must be protected from self-harm. A realistic, measurable outcome would be that the client would experience no physical harm during this shift. TEST-TAKING HINT: To answer this question correctly, the test taker must be able to identify and select appropriate outcomes that are based on client behaviors described. Selfmutilation behaviors should lead the test taker to focus on safety-related outcomes.

1. With appropriately implemented interventions that direct the client back to previously supervised hygiene performance, the short-term outcome of client adherence and participation by day 2 can be a reasonable expectation. To achieve this outcome, interventions might include exploring reasons for nonadherence; maintaining consistency of staff members; or providing the client with familiar objects, such as an old versus new toothbrush. TEST-TAKING HINT: To answer this question correctly, the test taker needs to know the reasonable expectations of clients diagnosed with IDD. The level of severity of IDD should determine realistic outcomes for these clients.

3. A child diagnosed with autism spectrum disorder who bites self when care is attempted is at risk for injury R/T selfmutilation. Self-injurious behaviors, such as head banging and hand and arm biting, are used as a means to relieve tension. Considering that the nurse's primary responsibility is client safety, expecting the child to refrain from inflicting self-harm during a 24-hour period is the short-term outcome that should take priority. TEST-TAKING HINT: To select the correct answer, the test taker must remember that client safety is the nurse's primary responsibility. The client's self-mutilating behavior must be addressed as a priority.

3. Accepting direction without becoming defensive by discharge is a specific, measurable, positive, realistic, client-centered outcome for this child. The disruption and nonadherence to rules on the milieu is this child's defensive coping mechanism. Helping the child to see the correlation between this defensiveness and the child's low self-esteem, anger, and frustration would assist in meeting this outcome. TEST-TAKING HINT: To select the correct answer, the test taker must match the client behavior presented in the question with the appropriate outcome. In this question, recognizing that an outcome must be realistic should lead the test taker to eliminate answer 2.

3. A client diagnosed with profound IDD requires constant care and supervision. Keeping this client in line of sight continuously during the shift is an appropriate intervention for a child with an IQ level ,20. TEST-TAKING HINT: To select the correct answer choice, the test taker needs to understand the developmental characteristics of IDD by degree of severity and match client deficits with appropriate interventions.

3. The nurse assumes the role of advocate and social mediator when the nurse remains with the client during initial interactions with others on the unit. The presence of a trusted individual provides a feeling of security and supports the client while appropriate socialization skills are learned. 4. Positive reinforcements can contribute to desired changes in socialization behaviors. These privileges are individually determined as staff members learn the client's likes and dislikes. 5. By explaining to peers the meaning behind some of the client's nonverbal gestures, signals, and communication attempts, the nurse facilitates social interactions. With this understanding, others in the client's social setting would be more receptive to social interactions. TEST-TAKING HINT: To answer this question correctly, the test taker must look for interventions focused on correcting socialization problems. Other interventions may be appropriate for this client, but they do not address the client's shyness and withdrawal into self.

2. A child diagnosed with autism spectrum disorder has impairment in communication affecting verbal and nonverbal skills. Nonverbal communication, such as facial expression, eye contact, or gestures, is often absent or socially inappropriate. Eye-to-eye and face-to-face contact expresses genuine interest in, and respect for, the individual and role-models correct nonverbal expressions. TEST-TAKING HINT: To select the correct answer, the test taker must be able to pair the nursing diagnosis presented in the question with the correct nursing intervention. There must always be a correlation between the stated problem and the nursing action that addresses the problem.

2. Accompanying the child to a quiet area to decrease external stimuli is the most beneficial action for this child. This action would aid in decreasing anger and hostility expressed by the child's outburst and inappropriate language. Later, the nurse may sit with the child and develop a system of rewards for adherence with therapy and consequences for nonadherence. This can be accomplished by starting with minimal expectations and increasing these expectations as the child begins to manifest evidence of control and adherence. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that when managing a child diagnosed with ODD, support, understanding, and firm guidelines are critical. These criteria are missing in answers 1, 3, and 4.

3. Keeping a child who is at high risk for suicide safe from self-harm would take immediate priority over any other intervention. Monitoring the child continuously while no longer than an arm's length away would be an appropriate nursing intervention. This observation would allow the nurse to note self-harm behaviors and intervene immediately if necessary. TEST-TAKING HINT: To answer this question correctly, the test taker must remember that client safety is always the nurse's first priority, especially when clients are at high risk for suicide.

1. The question implies that the client defensively copes with frustration by lashing out and hitting people. New coping skills have been achieved through behavior modification when the client states, "I didn't hit Johnny. Can I have my Tootsie Roll?" The intervention used to achieve this outcome is a reward system that recognizes and appreciates appropriate behavior, modifying behavior that was previously unacceptable. TEST-TAKING HINT: To answer this question correctly, the test taker needs to recognize a statement that indicates that behavior modification is being used and that it has been used successfully. Only answer 1 meets both of these criteria.

2. During activity therapy, clients interact with peers and staff. This participation in a social activity reflects a successful outcome for the nursing diagnosis of social isolation. TEST-TAKING HINT: To answer this question correctly, the test taker needs to correlate the nursing diagnosis presented in the question (social isolation) with the charting entry that documents a successful outcome. The only answer choice that addresses social isolation is answer 2.

2. By making eye contact and allowing physical touch, this child is experiencing improved social interaction, making this an accurate evaluative statement. TEST-TAKING HINT: To select the correct answer, the test taker must understand that making eye contact and allowing physical touch are behaviors that evaluate improved social interaction in children diagnosed with autism spectrum disorders.

3. The nurse should administer stimulants after meals for clients to be able to consume a balanced diet before experiencing the potential side effect of anorexia. 5. Encouraging frequent high caloric snacks would help the client achieve balanced nutrition if he or she were experiencing anorexia. TEST-TAKING HINT: To answer this question correctly, the test taker must pair the nursing intervention with the nursing diagnosis presented in the question.

4. The outcome of the client eating 80% of meals is realistic, has a time frame, and is appropriate for the stated nursing diagnosis. TEST-TAKING HINT: To answer this question correctly, the test taker must pair the stated outcome with the nursing diagnosis presented in the question. Correctly stated outcomes are client centered, realistic, and measurable. Including a time frame in the outcome makes the outcome measurable.

3. Methylphenidate lowers the client's activity level, which decreases the use of glucose and increases glucose levels. Because of this, it is necessary to monitor fasting blood sugar levels regularly. TEST-TAKING HINT: The test taker must note keywords in the question, such as "both diagnoses." If the answer choices address only one diagnosis, as in 1, 2, and 4, they can be eliminated.