A 9-year-old boy is referred to the PMHNP by the school counselor after his parents request help with his behavioral issues. He is in third grade, and although he is doing "fine" academically, he constantly interrupts, fidgets, talks excessively, and gets out of his seat and walks around the classroom. He has friends, but they often get frustrated with him because he talks over them and he wants to play sports nonstop. At home, he can barely stay in his seat to do his homework or eat a meal. He often gets upset with his parents for trying to redirect him to finish his chores or his schoolwork, and they end up sending him to his room. He does show remorse when his behavior is pointed out to him, yet he is unable to inhibit himself. What is the most likely diagnosis?
Bipolar disorder
Specific learning disorder
Generalized anxiety disorder
Attention-deficit hyperactivity disorder, predominantly hyperactive/impulsive
The Correct Answer is D
Choice A reason: Bipolar disorder involves distinct mood episodes (mania or depression) with marked functional changes. This child’s presentation of persistent hyperactivity and impulsivity without episodic mood changes does not fit this diagnosis.
Choice B reason: Specific learning disorder affects academic skill acquisition but does not account for hyperactivity, impulsivity, and behavioral regulation difficulties seen across settings.
Choice C reason: Generalized anxiety disorder can lead to restlessness or distractibility, but the pattern of constant motor hyperactivity, impulsive behaviors, and difficulty remaining seated is more consistent with ADHD.
Choice D reason: ADHD, predominantly hyperactive/impulsive type, is characterized by excessive motor activity, impulsivity, difficulty remaining seated, talking excessively, and inability to inhibit behaviors despite awareness of social norms. The child’s presentation aligns closely with this diagnosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Rett syndrome is a genetic disorder primarily affecting females, with developmental regression, hand stereotypies, and loss of purposeful hand skills, not selective speaking behavior.
Choice B reason: Selective mutism is an anxiety disorder characterized by consistent failure to speak in specific social situations (such as school) despite speaking in other settings. It typically presents in children around age 5–7 and is associated with social anxiety.
Choice C reason: Autism spectrum disorder involves social communication deficits, restricted interests, and repetitive behaviors. While mutism may occur, the key feature here is situation-specific silence rather than global social communication deficits.
Choice D reason: Rumination disorder involves repeated regurgitation of food and is unrelated to selective speech behavior.
Correct Answer is D
Explanation
Choice A reason: While increased circulation is a proposed benefit of massage, the mechanism of anxiety reduction is more complex and involves nervous system modulation, not solely lymph flow or muscle tone.
Choice B reason: The idea of manipulating points of energy flow is not supported by scientific evidence; endorphin release may occur, but this description is oversimplified and partly inaccurate.
Choice C reason: The statement about crystalline deposits and energy flow is pseudoscientific and does not reflect physiologic mechanisms.
Choice D reason: Massage therapy has demonstrated physiologic effects including reductions in heart rate, blood pressure, and respiratory rate. Studies also show increased alpha brain wave activity, indicating relaxation, and decreased perceived anxiety. These responses reflect modulation of the autonomic nervous system and central nervous system, explaining the observed relaxation.
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