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ADHD--Lippincott

Terms in this set (10)

41. The school nurse assesses a 10-year-old girl who excessively cleans and categorizes. Her parents report that she has always been orderly, but since her brother died of cancer 6 months ago, her cleaning and categorizing have escalated. Initially, the client accepted the abuse, thinking it was because her father had been laid off, but the abuse continued after he got a job 4 months ago. She fears that her mother will not believe her and her father will reject her if they discover she has revealed the abuse. The nurse should first:

1. Inform the mother in a face-to-face meeting without the girl present. 2. Call the father, confront him, and then call the police to have him arrested. 3. Meet with both parents together. Include the daughter in the meeting so she can speak for herself. 4. Report the alleged abuse to Child Protective Services that day, and then provide for the child's safety.

Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44885-44887). Wolters Kluwer Health. Kindle Edition.
41. 1. This child is demonstrating signs of anxiety and withdrawal. Being a library helper
enables the client to use an interest (reading) when interacting with others and gaining pride
in helping others. Most interaction will be one-to-one and with adults, which is likely to be
more comfortable for her in her state of anxiety. Organizing a class party, a group project
with her peers, and a kickball team involve multiple peer interactions, which are likely to be
difficult for her at this time. Also, there is no mention of the child liking sports, so kickball
would not be an appropriate activity.
45. When collaborating with the health care provider to develop the plan of care for a child diagnosed with attention deficit hyperactivity disorder (ADHD), the treatment plan will likely include which of the following?

1. Antianxiety medications, such as buspirone (BuSpar), and homeschooling. 2. Antidepressant medications, such as imipramine (Tofranil), and family therapy. 3. Anticonvulsant medications, such as carbamazepine (Tegretol), and monthly blood levels. 4. Psychostimulant medications, such as methylphenidate (Ritalin), and behavior modification.

Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44907-44912). Wolters Kluwer Health. Kindle Edition.
45. 4. ADHD is typically managed by psychostimulant medications, such as
methylphenidate and pemoline (Cylert), along with behavior modification. Antianxiety
medications, such as buspirone, are not appropriate for treating ADHD. Homeschooling
commonly is not a possibility because both parents work outside the home. Antidepressants,
such as imipramine, are not recommended for use in children. Family therapy may be a part
of the treatment. Anticonvulsant medications, such as carbamazepine, are not appropriate for
ADHD. Also, carbamazepine levels are obtained weekly early during therapy to avoid
toxicity and ascertain therapeutic levels.
46. The nurse meets with the mother of a child diagnosed with attention deficit hyperactivity disorder. The mother states, "I feel so guilty that he has this disease, like I did something wrong. I feel like I need to be with him constantly in order for him to get better. But still sometimes I feel like I'm going to lose control and hurt him." The nurse should suggest which of the following to the mother?

1. Arranging for respite care to watch her child and give herself a regular break. 2. Taking a job to allow herself to feel some success because her child won't ever improve. 3. Arranging to have coffee with friends daily as a way to begin a support group. 4. Considering foster care if she feels that she can't handle her child's problems.

Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44918-44921). Wolters Kluwer Health. Kindle Edition.
46. 1. Suggesting that the mother arrange for respite care so that she can have a regular
break would help to alleviate some of the stress that she feels when she is with her child
constantly. The mother also could use family and friends to provide some care, thereby
helping with giving her a break. The child may improve, so suggesting that the mother take a
job to provide a feeling of success would be inappropriate. Having coffee daily with friends
may provide some opportunities for socialization. However, friends may not be able to
provide the verbal support that the mother needs. Rather, attending a support group of other
parents with children with attention deficit hyperactivity disorder might be helpful. Placing
the child in foster care is an extreme measure that may damage the therapeutic relationship
with the nurse and dramatically and negatively affect the relationship between the mother
and child
50. A parent of a 7-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) since he was 5 years old is talking to the school nurse about her concerns about the son's physical condition. The parent states that his medication, Concerta (methylphenidate extended release), controls his symptoms well but is causing him to lose weight. It is difficult to get him up and ready for school in the morning unless he is given the medication as soon as he awakens. Then he does not eat breakfast or very much of his lunch at school. He eats dinner, but only an average amount of food. He has lost 3 lb in the last 2 weeks. Which of the following should the nurse suggest the parent do first?

1. Have the child eat a breakfast bar, banana, and a glass of milk at his bedside at the same time he takes his
Concerta every morning. 2. Monitor the child's weight closely for a month since he is likely to stop losing weight when the school year ends in 2 weeks. 3. Suggest a change of medication to a nonstimulant drug that will treat his ADHD without causing the appetite decrease. 4. Suggest that the parent supplement the child's dinner with a high-protein drink or other food that will increase his caloric intake.

Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Location 44962). Wolters Kluwer Health. Kindle Edition.
50. 1. Because weight loss is a common side effect of methylphenidate and because the
child's symptoms are controlled with the stimulant, the first action should be to increase the
child's oral intake before the medication's side effects begin. Weight should be monitored,
but since the child has already lost weight, a remedy is needed as well as monitoring. The
weight loss is directly due to the medication's side effects, so the child will continue to lose
weight unless an intervention is made whether or not he is enrolled in school or on summer
vacation. A high-protein drink could work, but then the child is taking in all his calories in
the evening, which is not best nutritionally. A change of medication should be the last resort
since methylphenidate is the most effective medication for ADHD and has been successful
with this child.
51. An adolescent is brought to the Emergency Department (ED) after accidentally taking
an overdose of heroin (the strength of the heroin he got was greater than the heroin he had
been taking). The adolescent is semiconscious, unable to respond appropriately to questions,
slurs his words, has constricted pupils, and vital signs of blood pressure 60/50, pulse 50,
and respirations 8. Narcan (nalaxone acetate) is administered to temporarily reverse the
effects of the heroin. Which of the following would first indicate that the Narcan
administration had been effective?
1. The client's blood opiate level drops to a nontoxic level.
2. The client becomes talkative and physically active.
3. The client's memory and attention become normal.
4. The client's respirations improve to 12/min.
51. 4. Decreased respirations and coma are the two most dangerous effects of heroin
overdose, so an increase in respirations after administration of the Narcan demonstrates
initial effectiveness of the medication. Changes in cognition and psychomotor activity will
take more time to become apparent. The client's blood opioid level may not drop to a
nontoxic level for a few days.
56. A young school-age girl whose mother and aunt have been diagnosed as having bipolar
disorder and whose father is diagnosed with depression is brought to the child psychiatrist's
office by her father who has custody since the parents divorced. The father has brought the
child to the office because of problems with behavior and attention in school and inability to
sleep at night. The child says, "My brain doesn't turn off at night." The psychiatrist
diagnoses the child as experiencing attention deficit hyperactivity disorder (ADHD) with a
possibility of bipolar disorder as well as the ADHD. What should the office nurse say to the
father to explain what the psychiatrist said? Select all that apply.
1. "The psychiatrist diagnosed your child as having ADHD because of her attention and
behavior problems at school."
2. "ADHD involves difficulty with attention, impulse control, and hyperactivity at
school, home, or in both settings."
3. "The psychiatrist does not know how to diagnose your child's illness since she has
symptoms of both bipolar disorder and ADHD."
4. "The child's description of her inability to sleep is irrelevant to diagnosing her
condition since she stays up late."
5. "The psychiatrist is considering a bipolar diagnosis because of your child's family
history of bipolar disorder and her sleep issues."
56. 1, 2, 5. The client's school problems, the presence of first-degree relatives diagnosed
with bipolar disorder and depression, and her inability to sleep at night mirror aspects of
both ADHD and bipolar disorder, which are difficult to distinguish from each other in
children. Psychiatrists are reluctant to diagnose young children as bipolar at this age. She
may have only one disorder or the other or both. Further monitoring and her response to
medication will differentiate whether she is suffering from one of the disorders or both. Any
comments indicating that the psychiatrist does not know what he or she is doing or that the
child's perceptions of her illness are not valid will undermine any trust the father and child
might be developing in their caregiver and so should be avoided.
57. At the admission interview, the father of a 4-year-old boy with attention deficit
hyperactivity disorder (ADHD) says to the nurse, "I know that my wife or I must have
caused this disease." Which of the following is the nurse's best response?
1. "ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder."
2. "What do you think you might have done that could have led to causing this disorder to
develop in your son?"
3. "Many parents feel this way, but I doubt there is anything that you did that caused
ADHD to develop in your child."
4. "Let's not focus on the cause but rather on what needs to be done to help your son get
better. I know that you and your wife are very interested in helping him to improve his
behavior."
57. 1. Stating that attention deficit hyperactivity disorder occurs more commonly in
families takes the opportunity for teaching while also helping the father realize that he and
his wife are not to blame. Parents who are commonly blamed by society for their child's
behavior need help with education. Questioning the father on what he thinks he may have
done implies that the parents played some role in this disorder, possibly contributing to the
father's guilt. Telling the father that many parents feel this way and that the nurse does not
think the parents are at fault is premature at this point. Telling the father that he should focus
on what needs to be done, rather than what caused the disorder, minimizes the father's
concerns and feelings.
64. Parents of a 7-year-old child newly diagnosed with attention deficit hyperactivity
disorder (ADHD) ask the nurse whether their son will always have to take medication for
this condition. The nurse should tell the parents:
1. "Yes, almost everyone with this disorder has to continue taking medication forever."
2. "Between one-third and one-half of children experiencing ADHD and taking
medication will need to continue to take medication as adults."
3. "Most children with this disorder do not need to continue taking medications as
adults."
4. "There is just a small percentage of adults with ADHD who can manage without
medications."
64. 2. Studies show that usually one-third to one-half of people diagnosed with ADHD do
not need medication as adults.
65. Which of the following should the nurse include in the teaching plan for the parents of
a child who is receiving methylphenidate (Ritalin)?
1. Giving the medication at the same time every evening.
2. Having the child take two doses at the same time if the last dose was missed.
3. Giving the single-dose form of the medication early in the day.
4. Allowing concurrent use of any over-the-counter medications with this drug.
65. 3. The single-dose form of methylphenidate should be taken 10 to 14 hours before
bedtime to prevent problems with insomnia, which can occur when the daily or last dose of
the medication is taken within 6 hours (for multiple dosing) or 10 to 14 hours (for single
dosing) before bedtime. It is recommended that a missed dose be taken as soon as possible;
the dose is skipped if it is not remembered until the next dose is due. Any other medication,
including over-the-counter medications, should be discussed with the health care provider before use to eliminate the risk of a possible drug interaction.
66. An 8-year-old child was recently hospitalized at a child psychiatric unit for inattention
and acting out behavior at school and home. His psychiatrist prescribed the Daytrana
(methylphenidate) patch to control his attention deficit hyperactivity disorder symptoms, and
inpatient unit staff worked with him on behavioral control measures. The office nurse
discovers at his first visit after his discharge from the hospital that the boy has been taking off his patch during the day, which is causing problems at school and at home. In which
order of priority from first to last should the nurse take the following actions?
1. Explain to the family, in terms the child can understand, the benefits of his medication in
dealing with school and home problems he is experiencing.
2. Explore the parents' attitudes about medication administration in general and their
child's medication in particular.
3. Explore the child's reasons for removing the patch during the day rather than at the end
of the day.
4. Have the psychiatrist discuss with the child and parents a trial of a different medication.
66.
3. Explore the child's reasons for removing the patch during the day rather than at the end
of the day.
2. Explore the parents' attitudes about medication administration in general and their
child's medication in particular.
1. Explain to the family, in terms the child can understand, the benefits of his medication in
dealing with school and home problems he is experiencing.
4. Have the psychiatrist discuss with the child and parents a trial of a different medication.
First, the child's reasons for removing the patch need to be explored to determine what
needs to be done to solve the problem of inadequate medication administration. Since the
child is probably heavily influenced by his parents' attitudes about taking medications, their
attitudes need to be addressed next to determine if they openly or subtly oppose the
medication or its method of administration. Once the knowledge of the child's and parent's
feelings about medication are known, education can be offered to be sure the child
understands how the medication can help him cope better in school and home. If the child continues to take off his patch or demonstrates an allergic response to the patch or if it is
determined that his parents are not supportive of the patch, discussion of a trial of another
medication to treat the child's symptoms should occur.
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