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Which behavioral assessment in a child is most consistent with a diagnosis of conduct disorder?
A
Arguing with adults
B
Gross impairment in communication
C
Physical aggression toward others
D
Refusal to separate from caretaker
C
Physical aggression toward others
Physical aggression toward others is a significant criterion consistent with the diagnoses of conduct disorder. Arguing with adults may indicate a lesser disorder, oppositional defiant disorder. Conduct disorder is a problem that involves violation of social rules. 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.
Alexi who has
separation anxiety disorder has not attended school for 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:
A
Assist the child in returning to school immediately with family support.
B
Arrange for a home-school teacher to visit for 2 weeks.
C
Encourage family discussion of various problem areas.
D
Use play therapy to help the child express her
feelings
A
Assist the child in returning to school immediately with family support.
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 to return to school immediately with support from the family. Arranging for a home-school teacher would reinforce the behavior of not attending school. 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.
A 15-year-old boy was hospitalized in a psychiatric unit because he initiates frequent fights with peers. Which implementation is most appropriate?
A
Anticipate and neutralize potentially explosive situations.
B
Ignore minor infractions of rules against fighting.
C
Isolate the adolescent from
contact with peers.
D
Talk to the adolescent each time fighting occurs
A
Anticipate and neutralize potentially explosive situations.
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 to intervene to neutralize the situation, thereby preventing a fight. Ignoring minor infractions of rules against fighting on 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. Isolation and seclusion are methods of intervention that can be used as a last resort after less restrictive means are employed. 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.
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?
A
Anxiety levels
B
Generational boundaries
C
Knowledge of growth and development
D
Quality of communication
B
Generational boundaries
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. 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. 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.
Nurse Tiffany reinforces the behavioral contract for a child having difficulty controlling aggressive behaviors on the psychiatric unit. Which of the following is the best rationale for this method of treatment?
A
It will assist the child to develop more adaptive coping methods.
B
It will avoid having the nurse be responsible for setting the rules.
C
It will maintain the nurse's role in controlling the child's
behavior.
D
It will prevent the child from manipulating the nurse.
A. It will assist the child to develop more adaptive coping methods.
Behavioral therapy is employed for the purpose of developing adaptive behavior that will improve coping. The nurse does not avoid setting rules; it is the responsibility of the nurse to establish and maintain appropriate limits. The nurse works to enhance the child's self-functioning and responsibility for his own behavior using appropriate means to develop better coping. Although reinforcing behavioral contracts will help prevent manipulative behavior by the child, this is not the best rationale for using behavioral treatment, which aims to improve client behavior.
Nurse Sophia is teaching the parents of a child with pervasive developmental disorder about how to deal with the child when his behavior escalates and he begins throwing things and screaming.
Which guideline would be most helpful for the parents to deal with the situation?
A
Accept the child's limitations, and ignore this behavior.
B
Decrease stimulation in the environment, and provide a time-out.
C
Seek help when feeling overwhelmed by the child's behavior.
D
Tell the child to calm down, and encourage quiet activity.
B
Decrease stimulation in the environment, and provide a time-out.
A child with a pervasive developmental disorder can have bizarre responses to environmental stimuli. By decreasing that stimulating effect and providing a time-out, the child can more readily de-escalate the behaviors. Escalating behaviors, such as those described, require intervention to promote safety. It is inappropriate to ignore this. The situation requires immediate intervention. The parents should seek help when overwhelmed, but they must intervene when safety is an issue. The response in option D is inadequate; the child will not be able to calm down without assistance.
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