Chapter 33: The Child with an Emotional or Behavioral Condition

24. The nurse counsels parents that the early school years create nervous tension in the child manifested by which abnormal behavior(s)? Select all that apply.

A. Masturbation B. Food fads C. Stuttering D. Aggressive behavior E. Nonnutritive sucking ANS: C, D, E Stuttering, aggressive behavior, and finger or thumb sucking that appear suddenly with no previous history are a clue to increased nervous tension in the young school-age child. Masturbation and food fads are normal behavioral phenomena is the early school-age child.

22. The nurse recognizes the child of an alcoholic who tries to do everything perfectly has assumed the role of the:

A. Perfect child. B. Super coper. C. Flight. D. Helper. ANS: B Of the four roles for the child of the alcoholic the super coper is one who tries to do everything perfectly and feels overly responsible. The perfect child is the child who tries to earn love by never causing any trouble.

11. An appropriate nursing intervention for a hospitalized child who is autistic would be to:

A. Place the child in a location where she can watch all of the activity on the unit. B. Use the child's chronological age as a guide for communication. C. Keep the child's room free of toys or objects that she might want to take home with her. D. Organize care to provide as few disruptions to the routine as possible. ANS: D During hospitalization, the nurse should provide a highly structured environment with few distractions for a child who is autistic.

25. The nurse states that the members of a mental health team for child guidance include which member(s)? Select all that apply.

A. Psychiatrist B. Pediatrician C. Psychologist D. Dietitian E. Social worker ANS: A, B, C, E The traditional members of the child guidance team are the psychiatrist, pediatrician, psychologist, and social worker. The dietitian is not usually on the treatment team.

15. The member of the child guidance team who is a medical doctor with special training in psychoanalytic theory is the:

A. Psychiatrist. B. Psychoanalyst. C. Psychologist. D. Counselor. ANS: A The psychiatrist is a medical doctor; the psychoanalyst may be a medical doctor or a psychologist. The psychologist is not a medical doctor, and neither is the counselor.

8. The nurse explains that the person who is bulimic:

A. Is severely underweight. B. Alternates binge eating with purging. C. Is an introverted perfectionist. D. Has extremely close family relationships. ANS: B Bulimia is characterized by alternating binge eating and purge behavior.

1. When a parent asks the nurse to describe what is meant by a "learning disability," the nurse's most helpful response would be:

A. "A child may have difficulty with perception, language, comprehension, or memory." B. "It is characterized by inattention, impulsiveness, and hyperactivity." C. "The child's intellectual ability limits his learning." D. "The child has difficulty learning because of brain damage." ANS: A Learning disability is an educational term. Children with learning disabilities may have average to above-average intelligence, but they may experience difficulties in perception, language, comprehension, and conceptualization.

23. The nurse working with children from dysfunctional families must be prepared to address what associated problem(s)? Select all that apply.

A. Lack of trust B. Acting out C. Exaggerated self-confidence D. Blaming others for problems E. Depression ANS: A, B, E Children from dysfunctional families exhibit lack of trust, act out, and show signs of depression.

4. The nurse answering phone calls at a local suicide prevention hotline would recognize the statement indicating the greatest risk of suicide is:

A. "I just needed to talk to someone to keep myself from thinking silly thoughts about killing myself." B. "My parents aren't home and won't be back for 4 hours. That should be enough time for the pills to work. I've got a hundred of them." C. "My dad will be home first, so he'll find me. So I think I'll use his gun. I hope he didn't lock the cabinet." D. "My girlfriend is here with me. She told me to call because I was talking crazy about killing myself." ANS: B The risk of death increases when there is a definite plan of action, the means are readily available, and the person has few resources for help and support.

10. The statement made by a parent of an adolescent with anorexia nervosa indicating an understanding of this condition is:

A. "There really isn't anything to worry about. Don't they say you can never be too thin?" B. "My daughter just doesn't have much of an appetite." C. "She is just trying to punish me for divorcing her father." D. "She seems to see herself as fat, even though her weight is below normal." ANS: D Individuals with anorexia nervosa have a disturbed body image, which this parent correctly recognizes.

2. What would be the appropriate response to an adolescent who states, "This has been the worst day of my life"?

A. "You should focus your mind on positive thoughts." B. "Everybody has a bad day now and then." C. "You're young. What could be so terrible?" D. "Tell me about the worst day of your life." ANS: D The nurse establishes a rapport with the adolescent by acknowledging his or her feelings and giving the adolescent full attention.

3. The nurse asks, "Do your parents drink every day?" The adolescent suddenly shouts, "I'm not going to talk about that! It's none of your business, anyway! Leave me alone!" The nurse recognizes that the outburst was stimulated by the fact that the adolescent is:

A. Acting out and needs to be brought under control so the conference can continue. B. Trying to shift the focus of the conference away from himself, and the nurse needs to refocus. C. Demonstrating that this problem requires the assistance of a psychiatrist. D. Responding to the discrediting of his parents, which causes anxiety in the child. ANS: D Discrediting parents threatens the child's security and creates anxiety.

13. An adolescent is brought to the emergency department after an automobile accident. When the nurse approaches the adolescent, he becomes combative. The nurse notes his speech is slurred and his gait is ataxic. The nurse suspects the adolescent has used:

A. Alcohol. B. Cocaine. C. Amphetamines. D. PCP. ANS: A Behavioral signs of alcohol ingestion include slurred speech, short attention span, drowsiness, combativeness, and violence.

21. The nurse warns that exposure to HIV and hepatitis B is a major risk for persons who use:

A. Alcohol. B. Opiates. C. Cocaine. D. Marijuana. ANS: B The use of opiates coupled with sharing needles put the user at risk for HIV and hepatitis B.

9. A 14-year-old girl with obsessive-compulsive disorder (OCD) tells the nurse other adolescents tease her because she washes her hands many times during the school day. The nurse is aware that this disorder puts the adolescent at greater risk for:

A. Aorexia nervosa. B. Depression. C. ADHD. D. A learning disability. ANS: B OCD is related to depression and other psychiatric disorders. Suicidal behavior is a high risk for adolescents with OCD.

16. Because young children cannot express themselves well, the nurse uses the therapeutic intervention that allows children to act out their feelings, which is:

A. Art therapy. B. Play therapy. C. Music therapy. D. Bibliotherapy. ANS: B Play therapy allows a young child to act out with dolls or figures concerns that the child may be unable to adequately express verbally.

14. When the nurse is collecting a nursing history, an adolescent states that she has tried speed. The nurse recognizes this as the street name for:

A. Barbiturates. B. Cocaine. C. Methamphetamine. D. Marijuana. ANS: C "Speed" is the street name for methamphetamine.

19. As the pediatric nurse listens to a 9-year-old child read to his 6-year-old roommate, the nurse assesses possible dyslexia when the child:

A. Becomes hyperactive and ceases to read. B. Reads the word dog as God. C. Makes up a story rather than reading the text. D. Stutters as he reads. ANS: B Dyslexics often transpose a word as they read; for example, the word is dog, but it appears to the dyslexic child as the word God.

18. A 9-year-old has been admitted to the hospital after "huffing" lighter fluid and is in a high euphoric state. The nurse should assess for:

A. Depressed respiration. B. Severe vomiting. C. Frightening hallucinations. D. Elevation of temperature. ANS: A Inhaling hydrocarbons depresses the central nervous system, including respiratory rate and general sensorium.

27. The nurse takes into consideration in planning the care of an adolescent with anorexia nervosa that what characteristic(s) cause this disorder? Select all that apply.

A. Discomfort relative to emerging sexuality B. Fear of intimacy C. Pervasive low self-esteem D. Egocentricity E. Inability to meet developmental needs ANS: A, B, C, D, E All options listed are considered to be a cause of anorexia nervosa.

5. The nurse assesses an early sign of depression in a 15-year-old boy who previously was active in a band and had saved his money to buy a special guitar when he:

A. Gives up the band to spend time with his girlfriend. B. Spends all of his time at the library studying in order to qualify for the honor society. C. Gives his guitar away and spends his time listening to music in his room. D. Withdraws all of his money out of the bank to buy an expensive leather jacket. ANS: C A major depression is characterized by a prolonged behavioral change from baseline that interferes with school, family life, and age-specific activities, frequently signaled by giving prized possessions away.

26. The school nurse cautions a group of parents about the prevalence of children who get high by inhaling hydrocarbons and fluorocarbons that are included in which product(s)? Select all that apply.

A. Glue B. Chlorine C. Cleaning fluid D. Copy machine toner E. Aerosol sprays ANS: A, C, E Although there are many products that could be inhaled, the most frequently used products are glue, cleaning fluid, aerosol sprays, Freon, shoe polish, and gasoline products.

20. The nurse reminds concerned parents that gateway substance is defined as a:

A. Recreational drug used occasionally. B. Nonaddictive drug used daily. C. Drug used to wean from stronger drugs. D. Substance that can lead to use of stronger drugs. ANS: D A gateway drug is a substance that creates a high that can lead to the use of stronger drugs.

7. The school nurse suggests to the classroom teacher that the most appropriate classroom intervention for a child with attention deficit hyperactivity disorder (ADHD) would be to:

A. Seat the child in the back of the room to prevent distractions for other children. B. Pair the child with a student buddy to offer reminders to pay attention. C. Divide work assignments into shorter periods with breaks in between. D. Separate the child from others to increase his focus on schoolwork. ANS: C The child with ADHD needs breaks between periods of work and study.

17. The nurse explains that use of stimulants will decrease hyperactivity in the autistic child but has the negative aspect of:

A. Sedating the child. B. Impairing cognition. C. Causing hypotension. D. Creating fluid retention. ANS: B Stimulants that decrease the hyperactivity in the autistic child also impair cognition and may increase the potential of self-injuring behavior.

12. A nurse planning to speak with a parent support group about childhood autism would include that:

A. Significant signs of the disorder manifest by 1 year of age. B. The earliest signs of autism are impulsivity and overactivity. C. Autism is usually diagnosed when the child goes to elementary school. D. Medications can cure childhood autism. ANS: A Failure to use eye contact and look at others, poor attention span, and poor orienting to one's name are significant signs of dysfunction by 1 year of age.

6. A mother is concerned because her adolescent son is always in trouble for fighting at school and always seems to be angry. She mentions that her husband drinks a bit. The understanding guiding the nurse's response is:

A. The boy is displaying antisocial behavior and should be evaluated for mental illness. B. The boy is displaying one of the typical defense patterns of children of alcoholics and should receive immediate treatment. C. The mother is displaying her own anger with her husband's drinking, and she needs immediate intervention. D. The boy is only one member of the family affected by alcoholism, and all members should receive immediate intervention. ANS: D Early recognition of and intervention for children of alcoholics are paramount. This adolescent is using the coping pattern of acting-out behaviors to deal with the family situation.