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Mental Health Nursing: ADHD
Unfolding Case Study
Chapter 11 in Varcarolis
Points: 10
Estimated Time: 30–40 minutes
Format: Select all that apply, multiple choice, short answer
Model Used: NCSBN Clinical Judgment Model
Stage 1 – Recognize Cues
Jacob, an 8-year-old male, is brought to the outpatient clinic by his mother. She reports
concerns about his inability to sit still, constant talking, difficulty focusing on tasks, and
frequent discipline at school. His teacher has noted that he often leaves his seat and
interrupts during class.
• Question 1 – Recognize Cues (1 pt)
Which of the following are relevant cues that support a possible ADHD diagnosis? (Select all
that apply)
A. Jacob interrupts frequently in class
B. Jacob has a fever of 101°F
C. Jacob is unable to complete homework
D. Jacob often runs or climbs in inappropriate situations
E. Jacob sleeps 10 hours per night without issue
Stage 2 – Analyze Cues and Prioritize Hypotheses
Jacob’s pediatrician diagnoses him with ADHD – Combined Type and starts him on
methylphenidate. His mother expresses concern about using medications and asks about
possible side effects.
• Question 2 – Analyze Cues (1 pt)
Which side effects should the nurse include in parent teaching about stimulant
medications? (Select all that apply)
A. Weight gain
B. Insomnia
C. Decreased appetite
D. Slower growth rate
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E. Improved blood pressure
• Question 3 – Prioritize Hypotheses (1 pt)
What is Jacob’s most immediate need related to his diagnosis and treatment plan?
A. Support for low self-esteem
B. A structured school environment
C. Monitoring for medication side effects
D. Peer conflict resolution
Stage 3 – Generate Solutions and Take Action
Jacob’s teacher contacts the clinic to report that he is doing better staying seated but now
appears withdrawn and less engaged.
• Question 4 – Generate Solutions (1 pt)
What is the best nursing action in response to this update?
A. Suggest increasing the medication dose
B. Recommend removing him from the classroom
C. Collaborate with the provider about a possible dosage adjustment
D. Refer Jacob to a special education school
• Question 5 – Take Action (1 pt)
The nurse develops a care plan for Jacob. Which intervention promotes success in both
home and school environments?
A. Encouraging Jacob to “try harder”
B. Using unstructured free time
C. Providing consistent daily routines and clear expectations
D. Giving long verbal instructions
Stage 4 – Evaluate Outcomes
After 4 weeks, Jacob shows improved attention span and behavior at school. His appetite
has decreased, and he has lost 2 pounds.
• Question 6 – Evaluate Outcomes (1 pt)
Which evaluation findings suggest a need for follow-up? (Select all that apply)
A. Decreased appetite
B. Improved attention
C. Weight loss
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Mental Health Nursing: ADHD
Unfolding Case Study
Chapter 11 in Varcarolis
Points: 10
Estimated Time: 30–40 minutes
Format: Select all that apply, multiple choice, short answer
Model Used: NCSBN Clinical Judgment Model
Stage 1 – Recognize Cues
Jacob, an 8-year-old male, is brought to the outpatient clinic by his mother. She reports
concerns about his inability to sit still, constant talking, difficulty focusing on tasks, and
frequent discipline at school. His teacher has noted that he often leaves his seat and
interrupts during class.
• Question 1 – Recognize Cues (1 pt)
Which of the following are relevant cues that support a possible ADHD diagnosis? (Select all
that apply)
A. Jacob interrupts frequently in class
B. Jacob has a fever of 101°F
C. Jacob is unable to complete homework
D. Jacob often runs or climbs in inappropriate situations
E. Jacob sleeps 10 hours per night without issue
Stage 2 – Analyze Cues and Prioritize Hypotheses
Jacob’s pediatrician diagnoses him with ADHD – Combined Type and starts him on
methylphenidate. His mother expresses concern about using medications and asks about
possible side effects.
• Question 2 – Analyze Cues (1 pt)
Which side effects should the nurse include in parent teaching about stimulant
medications? (Select all that apply)
A. Weight gain
B. Insomnia
C. Decreased appetite
D. Slower growth rate
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E. Improved blood pressure
• Question 3 – Prioritize Hypotheses (1 pt)
What is Jacob’s most immediate need related to his diagnosis and treatment plan?
A. Support for low self-esteem
B. A structured school environment
C. Monitoring for medication side effects
D. Peer conflict resolution
Stage 3 – Generate Solutions and Take Action
Jacob’s teacher contacts the clinic to report that he is doing better staying seated but now
appears withdrawn and less engaged.
• Question 4 – Generate Solutions (1 pt)
What is the best nursing action in response to this update?
A. Suggest increasing the medication dose
B. Recommend removing him from the classroom
C. Collaborate with the provider about a possible dosage adjustment
D. Refer Jacob to a special education school
• Question 5 – Take Action (1 pt)
The nurse develops a care plan for Jacob. Which intervention promotes success in both
home and school environments?
A. Encouraging Jacob to “try harder”
B. Using unstructured free time
C. Providing consistent daily routines and clear expectations
D. Giving long verbal instructions
Stage 4 – Evaluate Outcomes
After 4 weeks, Jacob shows improved attention span and behavior at school. His appetite
has decreased, and he has lost 2 pounds.
• Question 6 – Evaluate Outcomes (1 pt)
Which evaluation findings suggest a need for follow-up? (Select all that apply)
A. Decreased appetite
B. Improved attention
C. Weight loss
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