Comparing practice test questions on infant, child, and adolescents with mental health needs

These are questions taken from Lippincott's NCLEX-PN Review.  I highly recommend it if you're taking your PN exam.  In fact, I prettymuch recommend anything from Lippincott.  And no, I'm not being paid to say that.

Normal Child:

A 2 year old child throws temper tantrum in a grocery store because her mother refuses to buy her candy.  The mother buys the candy so the child stops screaming.  What is the most appropriate nursing recommendation for this mother to help her eliminate her child's temper tantrums at the grocery store?

1) Give the child candy before entering the store.

2) Ignore the unacceptable behavior.

3) Explain to the child how his behavior is unacceptable.

4) Remind the child how a big person acts.

The correct answer is 2) Ignore the unacceptable behavior.  Children learn how to manipulate others through certain types of behavior.  When a child realizes that a tantrum will not obtain the desired result, the child will stop that behavior.

Which, if you interview real-life parents (as I posed the question to my classmates, who unanimously voted to spank that child), is freaking insane.  

Autistic Child: 

An autistic child will get dressed independently but will not eat unless fed by someone.  Which suggestion by the nurse would be most beneficial for the child's nutrition at this time?

1) Continue to feed the child until the child tries to pick up food.

2) Try giving the child finger foods while in the act of dressing.

3) Leave the food until the child becomes hungry enough to eat it.

4) Offer food more frequently during the day.

The correct answer is: 1) Continue to feed the child until the child tries to pick up food.  

First of all, the question asks what is most beneficial for the child's nutrition--not what is best for eliminating this reliance on being fed behavior.  With Maslow's hierarchy of needs, it is never a good idea to deprive a patient of food.  Second, all autistic children have at least some level of impairment. Autistic children are different from non-autistic children in that they are prone to rigid routines and rarely respond to other people's actions.  They also demonstrate insensitivity to pain, and, if their behaviors are interrupted, they often erupt into violent temper tantrums with self-harm.  Therefore, learning by negative reinforcement is not necessarily going to work (option 3), and interfering with the child's routine is detrimental (option 2).  You can always offer more food more frequently during the day, however, the primary action would be to continue to feed the child until he decides to pick up food.