Abuse Lippincott

20. A 3-year-old child with a history of being abused has blood drawn. The child lies very still and makes no sound during the procedure. Which of the following comments by the nurse would be most appropriate? 1. "It's okay to cry when something hurts." 2. "That really didn't hurt, did it?" 3. "We're mean to hurt you that way, aren't we?" 4. "You were very good not to cry with the needle." Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Location 44704). Wolters Kluwer Health. Kindle Edition.

20. 1. It is not normal for a preschooler to be totally passive during a painful procedure. Typically, a preschooler reacts to a painful procedure by crying or pulling away because of the fear of pain. However, an abused child may become "immune" to pain and may find that crying can bring on more pain. The child needs to learn that appropriate emotional expression is acceptable. Telling the child that it really didn't hurt is inappropriate because it is untrue. Telling the child that nurses are mean does not build a trusting relationship. Praising the child will reinforce the child's response not to cry, even though it is acceptable to do so. CN:

24. A 15-year-old boy has been shy and quiet throughout his schooling. In the past, he has been teased about being "big" and "fat," leading him to get angry and fight those who called him names. This school year, he joined the wrestling team and showed some promise, though he had to lose weight to compete in a lower weight class. This spring his mother called the school nurse and said she had noticed that her son was wearing long-sleeved shirts all the time and spending a lot of time in the bathroom at home. She has seen scars on his wrists that the boy attributes to wrestling although the season has been over for awhile. She and the boy's father are going through a contentious divorce that she thinks may be upsetting her son. In what order of priority from first to last should the school nurse initiate the following actions? 1. Interview the teen about how he is handling the divorce, any bullying he may be experiencing, and his current grades. 2. Interview the mother further about the child's early childhood and any potential antecedents to his current behavior. 3. Interview the father about his awareness of his son's behavior and perspective concerning it as well as the relationship between him and his son. 4. Ask the boy about self-injury, depression, and suicidality in connection with the scars on his wrists. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44730-44734). Wolters Kluwer Health. Kindle Edition.

24. 1. Interview the teen about how he is handling the divorce, any bullying he may be experiencing, and his current grades. 4. Ask the boy about self-injury, depression, and suicidality in connection with the scars on his wrists. 2. Interview the mother further about the child's early childhood and any potential antecedents to his current behavior. 3. Interview the father about his awareness of his son's behavior and perspective concerning it as well as the relationship between him and his son. The nurse should talk to the boy directly about how he is dealing with the stresses in his life, but he may not be forthcoming if the nurse approaches the self-injury first. Once the nurse has established rapport and learned about the client's view of his situation, it will be more likely that the client will be honest about his self-injury and any depression or suicidal thoughts or plans he may have. Since the mother called the nurse with her concerns about her son, a further interview with the mother would be the next step to take. Because there is conflict in the home, it would be necessary to also interview the father for his perspective of the situation. If he is not aware of his son's self-injury, he needs to be informed of it. CN: Safety and infection control; CL: Create;

3. When planning the care for a client who is being abused, which of the following measures is most important to include? 1. Being compassionate and empathetic. 2. Teaching the client about abuse and the cycle of violence. 3. Explaining to the client about the client's personal and legal rights. 4. Helping the client develop a safety plan. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44580-44582). Wolters Kluwer Health. Kindle Edition.

3. 4. The client's safety, including the need to stay alive, is crucial. Therefore, helping the client develop a safety plan is most important to include in the plan of care to ensure the client's safety. Being empathetic, teaching about abuse, and explaining the person's rights are also important after safety is ensured. CN: Psychosocial integrity; CL: Synthesize

7. The mother of a school-aged child tells the nurse that, "For most of the past year, my husband was unemployed and I worked a second job. Twice during the year I spanked my son repeatedly when he refused to obey. It has not happened again. Our family is back to normal." After assessing the family, the nurse decides that the child is still at risk for abuse. Which of the following observations best supports this conclusion? 1. The parents say they are taking away privileges when their son refuses to obey. 2. The child has talked about family activities with the nurse. 3. The parent's are less negative toward the nurse. 4. The child wears long-sleeved shirts and long pants, even in warm weather. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44615-44616). Wolters Kluwer Health. Kindle Edition.

7. 4. Parental use of nonviolent discipline, the child's talk about what the family is doing and the easing of the parent's negativity toward the school nurse are all signs of progress. Avoidance and wearing clothes inappropriate for the weather implies that the child has something to hide, likely signs of physical abuse. CN: Psychosocial integrity; CL: Analyze

8. When caring for a client who was a victim of a crime, the nurse is aware that recovery from any crime can be a long and difficult process depending on the meaning it has for the client. Which of the following should the nurse establish as a victim's ultimate goal in reconstructing his or her life? 1. Getting through the shock and confusion. 2. Carrying out home and work routines. 3. Resolving grief over any losses. 4. Regaining a sense of security and 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 44622-44623). Wolters Kluwer Health. Kindle Edition.

8. 4. Ultimately, a victim of a crime needs to move from being a victim to being a survivor. A reasonable sense of safety and security is key to this transition. Getting through the shock and confusion, carrying out home and work routines, and resolving grief over any losses represent steps along the way to becoming a survivor. CN: Psychosocial integrity; CL: Synthesize

48. A 19-year-old has struggled academically throughout high school and realizes during her last semester in school that she is not going to graduate with her class, which will delay her admission to college. In the past, she has intermittently used drugs and alcohol to deal with her anxiety, but now her involvement with substances escalates to daily use. In what order of priority from first to last should the school nurse, who has become aware of the problem, take the following actions? 1. Refer her to the school authorities to address her academic issues so she can graduate next semester. 2. Refer her to a program at the local community college to improve the client's readiness for college and decrease her anxiety. 3. Refer her to an outpatient program that treats clients with chemical dependency issues. 4. Refer her to a psychiatric clinic so she can get an appropriate diagnosis and medication for her anxiety. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44935-44937). Wolters Kluwer Health. Kindle Edition.

48. 4. Refer her to a psychiatric clinic so she can get an appropriate diagnosis and medication for her anxiety. 3. Refer her to an outpatient program that treats clients with chemical dependency issues. 1. Refer her to the school authorities to address her academic issues so she can graduate next semester. 2. Refer her to a program at the local community college to improve the client's readiness for college and decrease her anxiety. The client's anxiety seems to fuel her substance abuse, so treatment for her anxiety is paramount, followed by treatment for substance abuse. Those two interventions should increase her readiness to profit from academic aid offered by the school. Referral to a community college program would help her get ready for college, which will likely decrease her anxiety.

5. After months of counseling, a client abused by her husband tells the nurse that she has decided to stop treatment. There has been no abuse during this time, and she feels better able to cope with the needs of her husband and children. In discussing this decision with the client, the nurse should: 1. Tell the client that this is a bad decision that she will regret in the future. 2. Find out more about the client's rationale for her decision to stop treatment. 3. Warn the client that abuse commonly stops when one partner is in treatment, only to begin again later. 4. Remind the client of her duty to protect her children by continuing treatment. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Location 44597). Wolters Kluwer Health. Kindle Edition.

5. 2. The nurse needs more information about the client's decision before deciding what intervention is most appropriate. Judgmental responses could make it difficult for the client to return for treatment should she want to do so. Telling the client that this is a bad decision that she will regret is inappropriate because the nurse is making an assumption. Warning the client that abuse commonly stops when one partner is involved in treatment may be true for some clients. However, until the nurse determines the basis for the client's decision, this type of response is an assumption and therefore inappropriate. Reminding the client about her duty to protect the children would be appropriate if the client had talked about episodes of current abuse by her partner and the fear that her children might be hurt by him. CN: Psychosocial integrity; CL: Synthesize

23. When planning interventions for parents who are abusive, the nurse should incorporate knowledge of which factor as a common parental indicator? 1. Lower socioeconomic group. 2. Unemployment. 3. Low self-esteem. 4. Loss of emotional family attachments. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44721-44722). Wolters Kluwer Health. Kindle Edition.

23. 3. Parents who are abusive often suffer from low self-esteem, commonly because of the way they were parented, including not being able to develop trust in caretakers and not being encouraged or offered emotional support by parents. Therefore, the nurse works to bolster the parents' self-esteem. This can be achieved by praising the parents for appropriate parenting. Employment and socioeconomic status are not indicators of abusive parents. Abusive parents usually are attached to their children and do not want to give them up to foster care. Parents who are abusive love their children and feel close to them emotionally. CN: Psychosocial integrity; CL: Analyze

49. A mother states to the nurse in her primary care provider's office that she is frustrated regarding her 7-year-old son's nightly enuresis for the past 3 years. She says she has limited his evening fluids, eliminated all caffeine and soft drinks from his diet, and has had him wash his own sheets, but he still wets the bed almost every night. Her husband has told her he was a bed wetter as a child. He thinks the son will "get over it." The mother is worried that it could negatively affect the son's peer relationships as he grows older. Which of the following actions should the nurse take? 1. Tell the mother her husband is correct and she should be patient since her husband's enuresis stopped without intervention. 2. Suggest asking the primary care provider about medication treatment to deal with the enuresis. 3. Discuss a behavioral treatment plan for the child focusing on the improvement of his social skills. 4. Suggest the mother ask the primary care provider about hospitalization for a complete renal workup since the enuresis has gone on a long time. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44949-44950). Wolters Kluwer Health. Kindle Edition.

49. 2. The mother's distress and length of time the problem has existed combined with the efforts she has made to address the problem demonstrate that medication treatment should be considered. The absence of any other symptoms make a renal workup unnecessary at this time. It is unlikely that social skills training alone will change his nocturnal enuresis. Just waiting for the behavior to stop is likely to further tax the mother and son. CN: Psychosocial integrity; CL: Create

1. A married female client has been referred to the mental health center because she is depressed. The nurse notices bruises on her upper arms and asks about them. After denying any problems, the client starts to cry and says, "He didn't really mean to hurt me, but I hate for the kids to see this. I'm so worried about them." Which of the following is the most crucial information for the nurse to determine? 1. The type and extent of abuse occurring in the family. 2. The potential of immediate danger to the client and her children. 3. The resources available to the client. 4. Whether the client wants to be separated from her husband. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44565-44568). Wolters Kluwer Health. Kindle Edition.

1. 2. The safety of the client and her children is the most immediate concern. If there is immediate danger, action must be taken to protect them. The other options can be discussed after the client's safety is assured. CN: Psychosocial integrity; CL: Analyze

15. A young child who has been sexually abused has difficulty putting feelings into words. Which of the following should the nurse employ with the child? 1. Engaging in play therapy. 2. Role-playing. 3. Giving the child's drawings to the abuser. 4. Reporting the abuse to a prosecutor. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44664-44670). Wolters Kluwer Health. Kindle Edition.

15. 1. The dolls and toys in a play therapy room are useful props to help the child remember situations and re-experience the feelings, acting out the experience with the toys rather than putting the feelings into words. Role-playing without props commonly is more difficult for a child. Although drawing itself can be therapeutic, having the abuser see the pictures is usually threatening for the child. Reporting abuse to authorities is mandatory, but doesn't help the child express feelings.

10. In working with a rape victim, which of the following is most important? 1. Continuing to encourage the client to report the rape to the legal authorities. 2. Recommending that the client resume sexual relations with her partner as soon as possible. 3. Periodically reminding the client that she did not deserve and did not cause the rape. 4. Telling the client that the rapist will eventually be caught, put on trial, and jailed. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44630-44637). Wolters Kluwer Health. Kindle Edition.

10. 3. Guilt and self-blame are common feelings that need to be addressed directly and frequently. The client needs to be reminded periodically that she did not deserve and did not cause the rape. Continually encouraging the client to report the rape pressures the client and is not helpful. In most cases, resuming sexual relations is a difficult process that is not likely to occur quickly. It is not necessarily true

16. When working with a group of adult survivors of childhood sexual abuse, dealing with anger and rage is a major focus. Which strategy should the nurse expect to be successful? Select all that apply. 1. Directly confronting the abuser. 2. Using a foam bat while symbolically confronting the abuser. 3. Keeping a journal of memories and feelings. 4. Writing letters to the abusers that are not sent. 5. Writing letters to the adults who did not protect them that are not sent. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44670-44678). Wolters Kluwer Health. Kindle Edition.

16. 2, 3, 4, 5. Using a foam bat while symbolically confronting the abuser, keeping a journal of memories and feelings, and writing letters about the abuse but not sending them are appropriate strategies because they allow anger to be expressed safely. Directly confronting the abuser is likely to result in further harm because the abusers commonly deny the abuse, rationalize about it, or blame the victim.

19. When obtaining a nursing history from parents who are suspected of abusing their child, which of the following characteristics about the parents should the nurse particularly assess? 1. Attentiveness to the child's needs. 2. Self-blame for the injury to the child. 3. Ability to relate the child's developmental achievements. 4. Difficulty with controlling aggression. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44695-44697). Wolters Kluwer Health. Kindle Edition.

19. 4. Parents of an abused child have difficulty controlling their aggressive behaviors. They may blame the child or others for the injury, may not ask questions about treatment, and may not know developmental information. CN: Psychosocial integrity; CL: Analyze

2. A client with suspected abuse describes her husband as a good man who works hard and provides well for his family. She does not work outside the home and states that she is proud to be a wife and mother just like her own mother. The nurse interprets the family pattern described by the client as best illustrating which of the following as characteristic of abusive families? 1. Tight, impermeable boundaries. 2. Unbalanced power ratio. 3. Role stereotyping. 4. Dysfunctional feeling tone. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44571-44576). Wolters Kluwer Health. Kindle Edition.

2. 3. The traditional and rigid gender roles described by the client are examples of role stereotyping. Impermeable boundaries, unbalanced power ratio, and dysfunctional feeling tone are also common in abusive families.

21. While interviewing a 3-year-old girl who has been sexually abused about the event, which approach would be most effective? 1. Describe what happened during the abusive act. 2. Draw a picture and explain what it means. 3. "Play out" the event using anatomically correct dolls. 4. Name the perpetrator. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44704-44710). Wolters Kluwer Health. Kindle Edition.

21. 3. A 3-year-old child has limited verbal skills and should not be asked to describe an event, explain a picture, or respond verbally or nonver- bally to questions. More appropriately, the child can act out an event using dolls. The child is likely to be too fearful to name the perpetrator or will not be able to do so.

4. A nurse is assessing a client who is being abused. The nurse should assess the client for which characteristic? Select all that apply. 1. Assertiveness. 2. Self-blame. 3. Alcohol abuse. 4. Suicidal thoughts. 5. Guilt. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44583-44588). Wolters Kluwer Health. Kindle Edition.

4. 2, 3, 4, 5. The victim of abuse is usually compliant with the spouse and feels guilt, shame, and some responsibility for the battering. Self-blame, substance abuse, and suicidal thoughts and attempts are possible dysfunctional coping methods used by abuse victims. The victim of abuse is not likely to demonstrate assertiveness. CN: Psychosocial integrity; CL: Analyze

9. A client tells the nurse that she has been raped but has not reported it to the police. After determining whether the client was injured, whether it is still possible to collect evidence, and whether to file a report, the nurse's next priority is to offer which of the following to the client? 1. Legal assistance. 2. Crisis intervention. 3. A rape support group. 4. Medication for disturbed sleep. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44623-44630). Wolters Kluwer Health. Kindle Edition.

9. 2. The experience of rape is a crisis. Crisis intervention services, especially with a rape crisis nurse, are essential to help the client begin dealing with the aftermath of a rape. Legal assistance may be recommended if the client decides to report the rape and only after crisis intervention services have been provided. A rape support group can be helpful later in the recovery process. Medications for sleep disturbance, especially benzodiazepines, should be avoided if possible. Benzodiazepines are potentially addictive and can be used in suicide attempts, especially when consumed with alcohol. CN: Psychosocial integrity; CL: Synthesize

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.

11. In the process of dealing with intense feelings about being raped, victims commonly verbalize that they were afraid they would be killed during the rape and wish that they had been. The nurse should decide that further counseling is needed if the client voices which of the following? 1. "I didn't fight him, but I guess I did the right thing because I'm alive." 2. "Suicide would be an easy escape from all this pain, but I couldn't do it to myself." 3. "I wish they gave the death penalty to all rapists and other sexual predators." 4. "I get so angry at times that I have to have a couple of drinks before I sleep." Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44637-44644). Wolters Kluwer Health. Kindle Edition.

11. 4. Use of alcohol reflects unhealthy coping mechanisms. A client's report of needing alcohol to calm down needs to be addressed. Survival is the most important goal during a rape. The client's acknowledging this indicates that she is aware that she made the right choice. Although suicidal thoughts are common, the statement that suicide is an easy escape but the client would be unable to do it indicates low risk. Fantasies of revenge, such as giving the death penalty to all rapists, are natural reactions and are a problem only if the client intends to carry them out directly. CN: Psychosocial integrity; CL:

12. One of the myths about sexual abuse of young children is that it usually involves physically violent acts. Which of the following behaviors is more likely to be used by the abusers? 1. Tying the child down. 2. Bribery with money. 3. Coercion as a result of the trusting relationship. 4. Asking for the child's consent for sex. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44646-44651). Wolters Kluwer Health. Kindle Edition.

12. 3. Coercion is the most common strategy used because the child commonly trusts the abuser. Tying the child down usually is not necessary. Typically, the abusive person can control the child by his or her size and weight alone. Bribery usually is not necessary because the child wants love and affection from the abusive person, not money. Young children are not capable of giving consent for sex before they develop an adult concept of what sex is. CN:

13. A preadolescent child is suspected of being sexually abused because he demonstrates the self-destructive behaviors of self-mutilation and attempted suicide. Which common behavior should the nurse also expect to assess? 1. Inability to play. 2. Truancy and running away. 3. Head banging. 4. Overcontrol of anger. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44652-44658). Wolters Kluwer Health. Kindle Edition.

13. 2. Truancy and running away are common symptoms for young children and adolescents. The stress of the abuse interferes with school success, leading to the avoidance of school. Running away is an effort to escape the abuse and/or lack of support at home. Rather than an inability to play or a lack of play, play is likely to be aggressive with sexual overtones. Children tend to act out anger rather than control it. Head banging is a behavior typically seen with very young children who are abused.

25. A shy middle school student set up a Face- book page. A popular student sent a message that included a suggestive picture of himself and suggested the student send a similar picture. When the student sent back a picture of himself dressed only in his boxers, the popular student sent it to all his friends and encouraged them to pass it along. Soon the whole school had seen the picture identified as "Joe's Crotch." The student was so distressed and mortified he tried to hang himself but was found by his parent before he succeeded. Which of the following outcomes would be most realistic and appropriate with regard to this situation? Select all that apply. 1. The Facebook privileges of all those who forwarded the message are revoked for a year. 2. All students in the school are educated about the risks of cyberbullying and how to respond to it. 3. The popular student who sent the message to his friends is disciplined by the school authorities. 4. Joe can use the Internet safely after being educated about cyberbullying and completing a safety plan. 5. Through therapy, Joe learns social skills to improve his confidence level and help him relate to peers more easily. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44746-44748). Wolters Kluwer Health. Kindle Edition. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44736-44739). Wolters Kluwer Health. Kindle Edition.

25. 2, 3, 4, 5. Education of all students in the school about cyberbullying is appropriate and possible as programs exist to educate students in many communities. That education and his therapy should enable Joe to eventually return to using the Internet safely and to feel more confidence interacting with classmates. Disciplining of the student who posted Joe's picture by school authorities is appropriate and can be helpful in reducing further incidents of cyberbullying. It is unrealistic to think that all those who forwarded the message could be identified, much less taken off Facebook. CN: Psychosocial integrity; CL: Evaluate

6. A third-grade child is referred to the mental health clinic by the school nurse because he is fearful, anxious, and socially isolated. After meeting with the client, the nurse talks with his mother, who says, "It's that school nurse again. She's done nothing but try to make trouble for our family since my son started school. And now you're in on it." The nurse should respond by saying: 1. "The school nurse is concerned about your son and is only doing her job." 2. "We see a number of children who go to your son's school. He isn't the only one." 3. "You sound pretty angry with the school nurse. Tell me what has happened." 4. "Let me tell you why your son was referred, and then you can tell me about your concerns." Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44602-44607). Wolters Kluwer Health. Kindle Edition.

6. 3. The mother's feelings are the priority here. Addressing the mother's feelings and asking for her view of the situation is most important in building a relationship with the family. Ignoring the mother's feelings will hinder the relationship. Defending the school nurse and the school puts the client's mother on the defensive and stifles communication. CN: Psychosocial integrity; CL: Synthesize

14. Adolescents and adults who were sexually abused as children commonly mutilate themselves. The nurse interprets this behavior as: 1. The need to make themselves less sexually attractive. 2. An alternative to binging and purging. 3. Use of physical pain to avoid dealing with emotional pain. 4. An alternative to getting high on drugs. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44661-44664). Wolters Kluwer Health. Kindle Edition.

14. 3. Dealing with the physical pain associated with mutilation is viewed as easier than dealing with the intense anger and emotional pain. The client fears an aggressive outburst when anger and emotional pain increase. Self-mutilation seems easier and safer. Additionally, self-mutilation may occur if the client feels unreal or numb or is dissociating. Here, the mutilation proves to the client that he or she is alive and capable of feeling. The client may want to be less sexually attractive, but this aspect usually is not related to selfmutilation. Binging and purging is commonly done in addition to, not instead of, selfmutilation. Although a few clients report an occasional high with self-mutilation, usually the experience is just relief from anger and rage.

17. After a client reveals a history of childhood sexual abuse, the nurse should ask which of the following questions first? 1. "What other forms of abuse did you experience?" 2. "How long did the abuse go on?" 3. "Was there a time when you did not remember the abuse?" 4. "Does your abuser still have contact with young children?" Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44678-44684). Wolters Kluwer Health. Kindle Edition.

17. 4. The safety of other children is a primary concern. It is critical to know whether other children are at risk for being sexually abused by the same perpetrator. Asking about other forms of abuse, how long the abuse went on, and if the victim did not remember the abuse are important questions after the safety of other children is determined.

18. Which parental characteristic is least likely to be a risk factor for child abuse? 1. Low self-esteem. 2. History of substance abuse. 3. Inadequate knowledge of normal growth and development patterns. 4. Being a member of a large family. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44686-44690). Wolters Kluwer Health. Kindle Edition.

18. 4. From documented cases of child abuse, a profile has emerged of a high-risk parent as a person who is isolated, impulsive, impatient, and single with low self-esteem, a history of substance abuse, a lack of knowledge about a child's normal growth and development, and multiple life stressors. Just because a parent comes from a large family, there is no increase in the incidence of the parent abusing their own children unless they possess the other risk factors.

22. Which of the following observations by the nurse should suggest that a 15-month-old toddler has been abused? 1. The child appears happy when personnel work with him. 2. The child plays alongside others contentedly. 3. The child is underdeveloped for his age. 4. The child sucks his thumb. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44712-44716). Wolters Kluwer Health. Kindle Edition.

22. 3. An almost universal finding in descriptions of abused children is underdevelopment for age. This may be reflected in small physical size or in poor psychosocial development. The child should be evaluated further until a plausible diagnosis can be established. A child who appears happy when personnel work with him is exhibiting normal behavior. Children who are abused often are suspicious of others, especially adults. A child who plays alongside others is exhibiting normal behavior, that of parallel play. A child who sucks his thumb contentedly is also exhibiting normal behavior.

42. A 13-year-old junior high school student has come to the school nurse, stating that her father has physically abused her for 3 years. 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. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44879-44885). Wolters Kluwer Health. Kindle Edition.

42. 4. All suspected child abuse must be reported, but this child's age and ability to describe the abuse make this allegation particularly strong. Because parental reaction to her allegation is not predictable, the nurse must ensure the child's safety. The nurse should not discuss the situation with the client or the parents. The nurse must refer this case to Child Protective Services.

43. A 15-year-old is a heavy user of marijuana and alcohol. When the nurse confronts the client about his drug and alcohol use, he admits previous heavy use in order to feel more comfortable around peers and achieve social acceptance. He says he has been trying to stay clean since his parents found out and had him seek treatment. When the nurse develops a plan of care with the client, what should be the highest priority to help him maintain sobriety? 1. Peer recognition that does not involve substance use. 2. Support and guidance from his parents. 3. A strict no-drug policy at his high school. 4. The threat of legal charges if caught drinking or smoking marijuana. Billings, Diane M.; Hensel, Desiree (2013-03-01). Lippincott's Q&A Review for NCLEX-RN (Lippincott's Review for Nclex-Rn) (Kindle Locations 44889-44895). Wolters Kluwer Health. Kindle Edition.

43. 1. Peer acceptance and recognition is a very powerful force in the lives of adolescents, leading to positive or negative behavior depending on the child's peers. While the influence of parents remains strong, peer acceptance combined with the adolescent's desire for independence can lead to disobeying the parents. The sanctions provided at school and in the community by law enforcement will support those teens that have other support in their lives, but are generally not sufficient to prevent substance use in adolescents lacking support at home and with peers. CN: Psychosocial integrity; CL: