James Chapter 29: Psychosocial Problems in Children and Families

The long-term treatment plan for an adolescent with an eating disorder focuses on:

restructuring the perception of body image.

A nurse is caring for a child admitted for substance abuse. The nurse plans care with the recognition that substance abuse primarily affects which organ of the body?

brain

A nurse working on the pediatric unit should be aware that children admitted with which assessment findings are suggestive of physical child abuse? Select all that apply.

Bruises in various stages of healing Burns on the palms of the hands Rib fractures in an infant

The nurse is reviewing the importance of role learning for children. The nurse understands that children's roles are primarily shaped by which members? a. Peers b. Parents c. Siblings d. Grandparents

ANS: B Children's roles are shaped primarily by the parents, who apply direct or indirect pressures to induce or force children into the desired patterns of behavior or direct their efforts toward modification of the role responses of the child on a mutually acceptable basis.

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.

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.

34. A nurse works with a client diagnosed with bulimia . What is an appropriate long-term client goal for this client? 1. Eating meals at home without binging or purging. 2. Being able to eat out without binging or purging. 3. Managing stresses in life without binging or purging. 4. Being able to attend college in another state without binging or purging.

34. 3. A successful outcome for a bulimic client is to avoid using the eating disorder as a coping measure when dealing with stress. Being able to attend college in another state, eat at home, and eat out without binging and purging are important goals, but do not address the primaryproblem of stress management and its connection to eating.

47. The nurse is with the parents of a 16-year-old boy who recently attempted suicide. The nurse cautions the parents to be especially alert for which of the following in their son? 1. Expression of a desire to date. 2. Decision to try out for an extracurricular activity. 3. Giving away valued personal items. 4. Desire to spend more time with friends.

47. 3. Giving away personal items has consistently been shown to be an indicator of suicide plans in a depressed and suicidal individual. Expression of a desire to date, trying out for an extracurricular activity, or the desire to spend more time with friends indicates a return of interest in normal adolescent activities.

59. When assessing a 17-year-old male client with depression for suicide risk, which of the following questions is best? 1. "What movies about death have you watched lately?" 2. "Can you tell me what you think about suicide?" 3. "Has anyone in your family ever committedsuicide?" "Are you thinking about killing yourself?"

59. 4. Asking whether the client is thinking about killing himself is the most direct and therefore the best way to assess suicidal risk. Knowing whether the client has watched movies on suicide and death, what the client thinks about suicide, and whether other family members have committed suicide will not tell the nurse whether the client is thinking about committing suicide right now.

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 thatthe 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.

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.

2. Which statement about suicide is correct? a. Children younger than 10 years of age do not attempt suicide. b. Suicide risk decreases with age. c. Suicide is usually an isolated event in a school community. d. The prevalence of suicide attempts is higher among males.

ANS: A Feedback A Suicide by children under the age of 10 is uncommon. B The risk of suicide increases with age. C It is common for suicide to occur in a cluster within a community (e.g., schools). D Males have a 4% rate of suicide attempts compared to 8% in females however, males are more likely to die after a suicide attempt. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1457 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

The parents of a 5-year-old child ask the nurse how they can minimize misbehavior. Which responses should the nurse give? (Select all that apply.) a. Set clear and reasonable goals. b. Praise your child for desirable behavior. c. Don't call attention to unacceptable behavior. d. Teach desirable behavior through your own example. e. Don't provide an opportunity for your child to have any control.

ANS: A, B, D To minimize misbehavior, parents should (1) set clear and reasonable rules and expect the same behavior regardless of the circumstances, (2) praise children for desirable behavior with attention and verbal approval, and (3) teach desirable behavior through their own example. Parents should call attention to unacceptable behavior as soon as it begins and provide children with opportunities for power and control.

The school nurse understands that children are impacted by divorce. Which has the most impact on the positive outcome of a divorce? a. Age of the child b. Gender of the child c. Family characteristics d. Ongoing family conflict

ANS: C Family characteristics are more crucial to the child's well-being during a divorce than specific child characteristics, such as age or sex. High levels of ongoing family conflict are related to problems of social development, emotional stability, and cognitive skills for the child.

A nurse is assessing a child with attention-deficit hyperactivity disorder (ADHD). Which manifestation should the nurse not expect to assess?

Acting withdrawn in social situations

A nurse is caring for an infant with neonatal abstinence syndrome. Which manifestation should the nurse expect to assess?

High-pitched persistent cry

A parent of a child with a psychosocial disorder states, "I don't know how my child developed this problem." The nurse should base a response on which information?

Neurobiological, family, and sociocultural factors can contribute to the development of psychosocial disorders in children.

Which should be the most appropriate nursing intervention for the infant who is not gaining weight?

Observe and document the parent-infant interaction.

A 14-year-old child admits to using marijuana every day. Which phase of substance abuse should the nurse assess for?

True drug addiction

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.

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.

What is the best response for the nurse to make to an adolescent who states, "I am very sad. I wish I wasn't alive."?

"Have you thought about hurting yourself?"

The Client Experiencing Abuse 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 thefamily. 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.

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.

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.

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.

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.

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.

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? "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."

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.

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. "Play out" the event using anatomically correctdolls. 4. Name the perpetrator.

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 nonverbally 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.

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.

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.

29. When teaching a group of adolescents about anorexia nervosa, the nurse should describe this disorder as being characterized by which of the following? 1. Excessive fear of becoming obese, near-normal weight, and a self-critical body image . 2. Obsession with the weight of others, chronic dieting, and an altered body image. 3. Extreme concern about dieting, calorie counting, and an unrealistic body image. 4. Intense fear of becoming obese, emaciation, and a disturbed body image.

29. 4. An intense fear of becoming obese, emaciation, and a disturbed body image all are considered to be characteristic of anorexia nervosa. Near-normal weight is not associated with anorexia. The weight of others is not a primary factor. Concern about dieting is not strong enough language to describe the control of food intake in the individual with anorexia nervosa.

31. The parents of a newly diagnosed 15-year-old with anorexia nervosa are meeting with the nurse during the admission process. Which of the following remarks by the parents should the nurse interpret as typical for a client with anorexia nervosa? 1. "We've given her everything, and look how she repays us!" 2. "She's had behavior problems for the past year both at home and at school." "She's been a model child. We've never had any problems with her." 4. "We have five children, all normal kids with some problems at times."

31. 3. Parents commonly describe their child as a model child who is a high achiever and compliant. These adolescents are typically well liked by teachers and peers. It is not typical for behavior problems to be reported. The description about having given the child everything and being repaid is more likely to describe an adolescent who is exhibiting behavior problems.

35. While coaching a youth soccer team, the nurse has observed one of the teammates binging and purging on multiple occasions. The nurse asks the girl's mother to stay after practice and talk privately. Which of the following ways is best for the nurse to begin the conversation? 1. "Thank you for letting your daughter play on the team. She's a very good player and is also pleasant and easy to coach." 2. "I have some very bad news for you. Your daughter has a serious problem that is diagnosed as an eating disorder." "I am a nurse. I have seen your daughter doing things that are considered to be part of an eating disorder." 4. "Let me get right to the point. Your daughter is very sick and needs to see a mental health therapist right away."

35. 3. By telling the mother that the coach is a nurse and relaying the behaviors observed, the nurse gives the mother a chance to recognize the expertise of the coach and introduces the possibility of an eating disorder. Thanking the mother and complimenting the player does not begin to approach the topic. Telling the mother that the nurse has some very bad news is negative and dramatic. Additionally, although the observed behaviors suggest an eating disorder, it would be inappropriate for the nurse to medically diagnose the daughter. Although the daughter may indeed be very sick and need to see a therapist, the nurse should relate the information in a matter-of-fact, unemotional way.

38. During the initial interview, a client with a compulsive eating disorder remarks, "I can't stand myself and the way I look." Which of the following statements by the nurse is most therapeutic? 1. "Everyone who has the same problem feels like you do." 2. "I don't think you look bad at all." 3. "Don't worry, you'll soon be back in shape." "Tell me more about your feelings."

38. 4. The nurse needs to explore more about the client's feelings to assess what underlies the eating disorder. The nurse also needs to evaluate the client's suicide risk. The other statements are not therapeutic because they minimize the client's feelings.

39. A community health nurse working with a group of fifth-grade girls is planning a primary prevention to help the girls avoid developing eating disorders during their teen years. Thenurse should focus on which of the following? 1. Working with the school nurse to closely monitor the girls' weight during middle school. 2. Limiting the girls' access to media images of very thin models and celebrities. 3. Telling the girls' parents to monitor their daughter's weight and media access. 4. Helping the girls accept and appreciate their bodies and feel good about themselves.

39. 4. The goal of a primary prevention program for eating disorders is for the girls to have positive feelings about themselves and their bodies. Monitoring of weight by parents and/ or school nurses might note eating disorders early, particularly anorexia, but will not address the cause of the disorder. Limiting the girls' access to media would be impossible and does not prevent distress with one's body image.

Children and Adolescents With Behavior Problems 40. A 17-year-old client who has been taking an antidepressant for 6 weeks has returned to the clinic for a medication check. When the nurse talks with the client and her mother, the mother reports that she has to remind the client to take her antidepressant every day. The client says , "Yeah, I'm pretty bad about remembering to take my meds , but I never miss a dose because Mom always bugs me about taking it." Which of the following responses would be effective for the nurse to make to the client? 1. "It's a good thing your mom takes care of you by reminding you to take your meds." "It seems there are some difficulties with being responsible for your medications that we need to address." 3. "You'll never be able to handle your medication administration at college next year if you're so dependent on her." 4. "I'm surprised your mother allows you to be so irresponsible."

40. 2. The client and mother need to address the issue of responsibility for medication administration. Reinforcing the mother'soverinvolvement in medication taking or making negative comments about the client and mother t are unlikely to engage them in problem solving about the matter.

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." "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."

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.

64. Parents of a 7-year-old child newly diagnosed with attention deficit hyperactivity disorder (ADHD) ask the nurse whether their son will always have to take medication for this condition. The nurse should tell the parents: 1. "Yes, almost everyone with this disorder has to continue taking medication forever." "Between one-third and one-half of childrenexperiencing ADHD and taking medication will need to continue to take medication as adults." 3. "Most children with this disorder do not need to continue taking medications as adults." 4. "There is just a small percentage of adults with ADHD who can manage without medications."

64. 2. Studies show that usually one-third to one-half of people diagnosed with ADHD do not need medication as adults.

68. The nurse is meeting weekly with an adolescent recently diagnosed with depression to monitor progress with therapy and antidepressant medication. The nurse should be most concerned when the client reports which ofthe following? 1. An acquaintance hung herself 2 days ago. 2. She is experiencing intermittent headaches as a side effect of taking the antidepressant. 3. She received a low score on her last history test. 4. Her younger brother has been starting fights with her for the last week.

68. 1. While all the occurrences could upset the client in the early stage of treatment, the one involving the most risk to safety is the suicide completion of a peer. Adolescents are susceptibleto "copycat" suicides. The fact that she knows the method of suicide of the acquaintance and is at a critical period in treatment, when her antidepressant may have given her increased energy while still experiencing low self-esteem, can put her at significant risk for suicide.

73. Which of the following children should the nurse identify as being more at risk for an episode of major depression? 1. A 16-year-old male, who has been struggling in school, making only Cs and Ds. 2. A 13-year-old female, who was upset over not being chosen as a cheerleader. 3. A 10-year-old male, who has never liked school and has few friends. 4. A 14-year-old, who recently moved to a new school after her parents' divorce.

73. 4. Children who experience serious losses,especially multiple losses, such as old friends or a parent, are more at risk for depression. Girls also are at greater risk than boys during the adolescent years.

77. Which of the following adolescents would the nurse determine needs further evaluation? 1. A young adolescent girl whose mood changes when upset with her parents, though she has never been in trouble in school or the community. 2. A young adolescent boy who coughs for 5 minutes after trying his first marijuana cigarette and declares he does not want to do it again. 3. A young adolescent boy who restricts his food and fluid intake in order to be able to box in a lower weight class. 4. A young adolescent girl who reads "dark" novels and questions why God allows

77. 3. Restricting intake to lose weight is a first step toward an eating disorder for males as well as females , so this behavior should be investigated further, especially since males of this age are usually unconcerned about their weight . Quick mood changes are common in young adolescents, particularly girls. Such mood changes should not be considered problematic if the adolescent is not experiencing trouble in major areas of his/ her life. Experimenting with alcohol or other substances is fairly common in the teen years, but one or two uses do not generally lead to addiction. The negative effect of the coughing may be a deterrent to further use. Religious questioning and exploration of "dark" subjects is common among teens and is part of the development of mature thinking. In the absence of other signs of depression, it does not warrant further evaluation.

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.

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 andconfusion, carrying out home and work routines , and resolving grief over any losses represent steps along the way to becoming a survivor.

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.

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.

A nurse is teaching parents about symptoms associated with suicide. Which statement about suicide should the nurse include in the teaching plan?

A child who attempts suicide is usually depressed and has low self-esteem.

9. A child who has symptoms of irritable mood, changes in sleep and appetite patterns, decreased self-esteem, and disengagement from family and friends lasting 3 weeks meets the criteria for which depressive disorder? a. Major depressive disorder b. Dysthymic disorder c. Cyclothymic disorder d. Panic disorder

ANS: A Feedback A A 2-week (or longer) episode of depressed or irritable mood in addition to disturbances in appetite, sleep, energy, or self-esteem meets the criteria for a major depressive disorder. B A dysthymic disorder is associated with a depressed or irritable mood for at least a year. C A cyclothymic or bipolar mood disorder is characterized by chronic, fluctuating mood disturbances between depressive lows and highs for a year. D A panic disorder is a type of anxiety disorder. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1453 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

Which describe the feelings and behaviors of adolescents related to divorce? (Select all that apply.) a. Disturbed concept of sexuality b. May withdraw from family and friends c. Worry about themselves, parents, or siblings d. Expression of anger, sadness, shame, or embarrassment e. Engage in fantasy to seek understanding of the divorce

ANS: A, B, C, D Feelings and behaviors of adolescents related to divorce include a disturbed concept of sexuality; withdrawing from family and friends; worrying about themselves, parents, and siblings; and expressions of anger, sadness, shame, and embarrassment. Engaging in fantasy to seek understanding of the divorce is a reaction by a child who has preconceptual cognitive processes, not the formal thinking processes adolescents have

Which type of family should the nurse recognize when a mother, her children, and a stepfather live together? a. Traditional nuclear b. Blended c. Extended d. Binuclear

ANS: B A blended family contains at least one stepparent, stepsibling, or half-sibling. A traditional nuclear family consists of a married couple and their biologic children. No other relatives or nonrelatives are present in the household. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

The nurse is teaching a group of new nursing graduates about identifiable qualities of strong families that help them function effectively. Which quality should be included in the teaching? a. Lack of congruence among family members b. Clear set of family values, rules, and beliefs c. Adoption of one coping strategy that always promotes positive functioning in dealing with life events d. Sense of commitment toward growth of individual family members as opposed to that of the family unit

ANS: B A clear set of family rules, values, and beliefs that establish expectations about acceptable and desired behavior is one of the qualities of strong families that help them function effectively. Strong families have a sense of congruence among family members regarding the value and importance of assigning time and energy to meet needs. Varied coping strategies are used by strong families. The sense of commitment is toward the growth and well-being of individual family members, as well as the family unit.

Which family theory is described as a series of tasks for the family throughout its life span? a. Exchange theory b. Developmental theory c. Structural-functional theory d. Symbolic interactional theory

ANS: B In developmental systems theory, the family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others. Exchange theory assumes that humans, families, and groups seek rewarding statuses so that rewards are maximized while costs are minimized. Structural-functional theory states that the family performs at least one societal function while also meeting family needs. Symbolic interactional theory describes the family as a unit of interacting persons with each occupying a position within the family.

A parent of a school-age child tells the school nurse that the parents are going through a divorce. The child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as what? a. Indicative of maladjustment b. A common reaction to divorce c. Suggestive of a lack of adequate parenting d. An unusual response that indicates a need for referral

ANS: B Parental divorce affects school-age children in many ways. In addition to difficulties in school, they often have profound sadness, depression, fear, insecurity, frequent crying, loss of appetite, and sleep disorders. The child's responses are common reactions of school-age children to parental divorce.

Which term best describes the sharing of common characteristics that differentiates one group from other groups in a society? a. Race b. Culture c. Ethnicity d. Superiority

ANS: C Ethnicity is a classification aimed at grouping individuals who consider themselves, or are considered by others, to share common characteristics that differentiate them from the other collectivities in a society, and from which they develop their distinctive cultural behavior. Race is a term that groups together people by their outward physical appearance. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perception and judgments. Superiority is the state or quality of being superior; it does not apply to ethnicity

The parents of a young child ask the nurse for suggestions about discipline. When discussing the use of time-outs, which should the nurse include? a. Send the child to his or her room if the child has one. b. A general rule for length of time is 1 hour per year of age. c. Select an area that is safe and nonstimulating, such as a hallway. d. If the child cries, refuses, or is more disruptive, try another approach.

ANS: C The area must be nonstimulating and safe. The child becomes bored in this environment and then changes behavior to rejoin activities. The child's room may have toys and activities that negate the effect of being separated from the family. The general rule is 1 minute per year of age. An hour per year is excessive. When the child cries, refuses, or is more disruptive, the time-out does not start; the time-out begins when the child quiets.

The nurse is discussing parenting in reconstituted families with a new stepparent. The nurse is aware that the new stepparent understands the teaching when which statement is made? a. "I am glad there will be no disruption in my lifestyle." b. "I don't think children really want to live in a two-parent home." c. "I realize there may be power conflicts bringing two households together." d. "I understand contact between grandparents should be kept to a minimum."

ANS: C The entry of a stepparent into a ready-made family requires adjustments for all family members. Power conflicts are expected, and flexibility, mutual support, and open communication are critical in successful relationships. So the statement that power conflicts are possible means teaching was understood. Some obstacles to the role adjustments and family problem solving include disruption of previous lifestyles and interaction patterns, complexity in the formation of new ones, and lack of social supports. Most children from divorced families want to live in a two-parent home. There should be continued contact with grandparents.

10. What is the goal of therapeutic management for a child diagnosed with ADHD? a. Administer stimulant medications. b. Assess the child for other psychosocial disorders. c. Correct nutritional imbalances. d. Reduce the frequency and intensity of unsocialized behaviors.

ANS: D Feedback A Although medications are effective in managing behaviors associated with ADHD, all families do not choose to give their child medication. Administering medication is not the primary goal. B Children with ADHD may have other psychosocial or learning problems however, diagnosing these is not the primary goal. C Interventions to correct nutritional imbalances are the primary focus of care for eating disorders. D The primary goal of therapeutic management for the child with ADHD is to reduce the intensity and frequency of unsocialized behaviors. PTS: 1 DIF: Cognitive Level: Application REF: p. 1460 OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

Which is an accurate description of homosexual (or gay-lesbian) families? a. A nurturing environment is lacking. b. The children become homosexual like their parents. c. The stability needed to raise healthy children is lacking. d. The quality of parenting is equivalent to that of nongay parents.

ANS: D Although gay or lesbian families may be different from heterosexual families, the environment can be as healthy as any other. Lacking a nurturing environment and stability is reflective on the parents and family, not the type of family. There is little evidence to support that children become homosexual like their parents.

How is family systems theory best described? a. The family is viewed as the sum of individual members. b. A change in one family member cannot create a change in other members. c. Individual family members are readily identified as the source of a problem. d. When the family system is disrupted, change can occur at any point in the system.

ANS: D Family systems theory describes an interactional model. Any change in one member will create change in others. Although the family is the sum of the individual members, family systems theory focuses on the number of dyad interactions that can occur. The interactions, not the individual members, are considered to be the problem.

Which is a consequence of the physical punishment of children, such as spanking? a. The psychologic impact is usually minimal. b. The child's development of reasoning increases. c. Children rarely become accustomed to spanking. d. Misbehavior is likely to occur when parents are not present.

ANS: D Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake but rather out of fear of punishment. Spanking can cause severe physical and psychologic injury and interfere with effective parent-child interaction. The use of corporal punishment may interfere with the child's development of moral reasoning. Children do become accustomed to spanking, requiring more severe corporal punishment each time.

TRUE/FALSE 1. Bipolar disorder is characterized by chronic, fluctuating, and extreme mood disturbances. Onset for this disorder occurs most often during the late preschool to early school-age stage of development. Is this statement true or false?

ANS: F Bipolar disorder occurs most often in late adolescence or early adulthood. Depression and lowered mood, alternate with episodes of the elation and aggression. Impaired social relationships are common. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 1454 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychological Integrity

Which finding noted by the nurse on a physical assessment may suggest that a child has been sexually abused?

Swelling of the genitalia and pain on urination

Which statement made by a parent of a toddler who is not gaining weight indicates the need for education about feeding small children?

"He doesn't want to eat, so I put the cereal in his bottle."

Culture characterizes a particular group with its values, beliefs, norms, patterns, and practices that are learned, shared, and transmitted from one generation to another. Match the terms used to describe groups with shared values, beliefs, norms, patterns, and practices. a. Race b. Gender c. Ethnicity d. Social class e. Socialization 1. Incorporates levels of education, occupation, income, and access to resources 2. Distinguishes humans by physical traits 3. Persons who have unique cultural, social, and linguistic heritage 4. Process by which society communicates its competencies, values, and expectations 5. An individual's self-identification as man or woman

1. ANS: D 2. ANS: A 3. ANS: C 4. ANS: E 5. ANS: B

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 aspossible. 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.

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 that the rapist will be caught, tried, and jailed. Most rapists are not caught or convicted.

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. ""I get so angry at times that I have to have a couple of drinks before I sleep."

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 thatsuicide 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.

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.

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.

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.

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.

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.

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 theclient 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 self-mutilation. Binging and purging is commonly done in addition to , not instead of, self-mutilation . 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?" "Does your abuser still have contact with young children?"

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 ofabuse, 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.

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.

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.

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.

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.

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.

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 handlingthe 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.

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.

25. A shy middle school student set up a Facebook 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 aboutthe 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.

25. 2, 3, 4, 5. Education of all students in the school about cyberbullying is appropriate and possible as programs exist to educate students inmany 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.

The Adolescent With Eating Disorders 26. The nurse is planning an eating disorder protocol for hospitalized clients experiencing bulimia and anorexia. Which elements should be included in the protocol? Select all that apply. 1. Clients must eat within view of a staff member. 2. Clients are not told their weight and cannot see their weight while being weighed. 3. Clients are not allowed to discuss food or eating in groups or informal conversation with peers. 4. Clients must rest within view of a staff member and not go to the bathroom for one-half hour to an hour after eating. 5. Clients cannot participate in any groups after admission until they gain 1 lb (0.45 kg).

26. 1, 2, 4. In hospital settings, clients are not allowed to know their weight at the time they are being weighed to decrease obsessing about weight gain. They must also eat and rest in staff view and cannot use the bathroom for a period to prevent discarding food or vomiting ingested food (purging). The rest prevents the client from exercising off the calories they just consumed . Barring clients from ever talking about food or attending groups until they have gained weight diminishes the therapeutic value of the inpatient hospital stay.

27. A hospitalized adolescent diagnosed with anorexia nervosa refuses to comply with her daily before-breakfast weigh- in. She states that she just drank a glass of water, which she feels will unfairly increase her weight. What is the nurse's best response to the client? 1. "You are here to gain weight so that will work in your favor." 2. "Don't drink or eat for 2 hours and then I'll weigh you." "You must weigh in every day at this time. Please step on the scale." 4. "If you don't get on the scale, I will be forced to call your doctor."

27. 3. In responding to the client, the nurse must be nonjudgmental and matter of fact . Telling her that weight gain is in her favor ignores the client's extreme fear of gaining weight . Putting off the weigh-in for 2 hours allows the client to manipulate the nurse and interferes with the need to weigh the client at the same time each day. Threatening to call the doctor is not likely to build rapport or a working relationship with the client.

28. The nurse discovers that an adolescent client with anorexia nervosa is taking diet pills rather than complying with the diet. What should the nurse do first? 1. Explain to the client how diet pills can jeopardize health. 2. Listen to the client about fears of losing control of eating while being treated. 3. Talk with the client about how weight loss and emaciation worry the health care providers. 4. Inquire about worries of the client's family concerning the client's physical and emotional health.

28. 2. A client with anorexia nervosa commonly has an extreme fear of not being able to control weight. The nurse should address this fear. Explaining the dangers of diet pills or discussing health care provider or family concerns focuses on the effect of the client's weight loss on other people rather than the client. Unless the client is motivated to stop, the client will likely not be successful.

30. When developing a teaching plan for a high school health class about anorexia nervosa , which of the following should the nurse include asthe primary group affected by this disease? 1. Women, age at onset between 12 and 20 years. 2. Men, onset during the college years. 3. Women, onset typically after 30 years. 4. Men, onset after 20 years.

30. 1. Anorexia nervosa occurs most commonly in girls and women, with the age at onset between 12 and 20 years. It begins less commonly after 30 years . Although anorexia occurs in men, the prevalence rate is less than 5% to 10% of all cases of anorexia. CN: Psychosocial integrity;

32. A young adult female client and her roommate go the emergency department due to gastrointestinal problems. The client reveals that she attends college and works at a coffee shop each evening. A diet history indicates that the client has unhealthy eating habits, commonly eating large amounts of carbohydrates and junk food with few fruits and vegetables. "Her stomach is upset a lot," the roommate says. She further reports that the client is "in the bathroom all the time." The nurse should refer the client to: 1. A mental health clinic. 2. A weight loss program. 3. An overeating support group. 4. The client's family primary health care provider.

32. 1. The large carbohydrate intake andsignificant time in the bathroom are characteristics of bulimia. To address the problem, the client must obtain an evaluation of her physical and psychological status. Suggesting going to a weight loss program or overeating support group frames the problem as strictly a weight issue and ignores the psychological etiology of the problem . Seeing the family's primary health care provider does not address the psychological aspect of the client's illness, and the client must make the appointment herself.

33. A nurse is working with a client with bulimia. Which of the following goals should beincluded in the care plan? Select all that apply. 1. The client will maintain normal weight. 2. The client will comply with medication therapy. 3. The client will achieve a positive self-concept. 4. The client will acknowledge the disorder. 5. The client will never have the desire to purge again.

33. 1, 2, 3, 4. Because of the large number of calories ingested in a binge and the fact that a purge does not eliminate all calories consumed , the client with bulimia is of more normal weight but still must have a goal of maintaining that weight. Research has shown that selective serotonin reuptake inhibitors are effective in treating bulimia, and the client is usually amenable to taking the medication. The client with an eating disorder (bulimia and anorexia ) has negative self-concepts that fuel her disordered eating, and attaining a positive self-concept is an appropriate goal. The nurse should work with the client with bulimia to help her recognize her eating as disordered. That recognition can make the client more amenable to treatment. It is not realistic to establish a goal that the client with bulimia will never have the desire to purge again.

36. A client newly diagnosed with bulimia is attending the nurse-led group at the mental health center. She tells the group that she came only because her husband said he would divorce her if she didn't get help. Which of the following responses by the nurse is appropriate? 1. "You sound angry with your husband. Is that correct?" 2. "You will find that you like coming to group. These people are a lot of fun." "Tell me more about why you are here and how you feel about that." 4. "Tell me something about what has caused you to be bulimic."

36. 3. Encouraging the client to talk about why she is here and her feelings may reveal more information about what led her to come to the group and what led to her diagnosis. It also provides the nurse with valuable information needed to develop an appropriate plan of care . The comment that the client sounds angry presumes what the client is feeling and focuses the talk on her husband. The focus should be on the client, not the husband. Telling the client that she will like coming to group imposes the nurse's view onto the client. The statement also focuses on having fun in the group instead of stressing the therapeutic value. Having the client tell the nurse something about the cause of her bulimia ignores the client's original statement. In addition, it requires the client to have insight into the cause of her disease, which may not be possible at this point. Also, it may be too early in the relationship

37. A client diagnosed with bulimia tells the nurse she only eats excessively when upset with her best friend, and then she vomits to avoid gaining a lot of weight. The nurse should next: 1. Schedule daily family therapy sessions. 2. Enroll client in a coping skills group. 3. Work with the client to limit her purging. 4. Have client take lorazepam (Ativan) 1 mg as needed whenever she feels the urge to binge.

37. 2. Because the client eats excessively when upset, the best treatment would be a group to help her learn alternative coping skills. Trying to limit purging without controlling binging would result in weight gain and likely increase the client's purging. Daily family therapy sessions are not realistic. Taking lorazepam whenever she feels she needs to binge may temporarily calm the client, but does not address the cause of the binging and purging and further, will lead to drug dependence with long-term use.

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.

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.

41. The school nurse assesses a 10-year-old girl who excessively cleans and categorizes. Her parents report that she has always been orderlybut since her brother died of cancer 6 months ago, her cleaning and categorizing have escalated. In school, she reads instead of playing with other children. These behaviors are now interfering with homework and leisure activities. To bolster her self-esteem, the nurse should encourage the child to: 1. Be a library helper. 2. Organize a party for the class. 3. Be in charge of a group project with four peers. 4. Be captain of the kickball team.

41. 1. This child is demonstrating signs of anxiety and withdrawal . Being a library helper enables the client to use an interest (reading) when interacting with others and gaining pride in helping others. Most interaction will be one-to-one and with adults, which is likely to be more comfortable for her in her state of anxiety. Organizing a class party, a group project with her peers, and a kickball team involve multiple peer interactions, which are likely to be difficult for her at this time. Also, there is no mention of the child liking sports, so kickball would not be an appropriate activity.

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 (Ministry of Children and Family) that day , and then provide for the child's safety.

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 (the Ministry of Children and Family).

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 stayclean 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.

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 theparents. 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.

44. A 17-year-old is admitted to a psychiatric day treatment program due to severe lower back pain since her mother's death 3 years ago . Medical examinations have not discovered a physical cause for her pain. She cares for her four younger siblings after school and on weekends because of her father's long work hours. Which predischarge statement indicates that treatment for her condition has been successful? 1. "I understand now why my father spends so much time away from home." "My back pain is worse on weekends with more chores and homework." 3. "I don't want to talk about my family. It's my back that is hurting." 4. "I just need more rest and relaxation and then my back will feel fine."

44. 2. This statement indicates insight into possible emotional causes for her pain. After insight is achieved, the client can make behavior changes to effectively cope with her anxiety -related disorder. Saying that she understands why her father is away so often demonstrates insight into her father's actions rather than her own. Wanting to discuss her pain and not her family indicates denial of any connection between her pain and her stress, which perpetuates her current situation. While rest may help her back, the client's statement does not address psychological issues related to the back pain.

45. When collaborating with the health care provider to develop the plan of care for a child diagnosed with attention deficit hyperactivity disorder (ADHD ), the treatment plan will likely include which of the following? 1. Antianxiety medications, such as buspirone (BuSpar), and homeschooling. 2. Antidepressant medications, such as imipramine (Tofranil), and family therapy. 3. Anticonvulsant medications, such as carbamazepine (Tegretol), and monthlyblood levels. 4. Psychostimulant medications, such as methylphenidate (Ritalin), and behavior modification.

45. 4. ADHD is typically managed by psychostimulant medications, such as methylphenidate and pemoline (Cylert), along with behavior modification. Antianxiety medications, such as buspirone, are not appropriate for treating ADHD. Homeschooling commonly is not a possibility because both parents work outside the home. Antidepressants, such as imipramine, are not recommended for use in children. Family therapy may be a part of the treatment. Anticonvulsant medications, such as carbamazepine, are not appropriate for ADHD. Also, carbamazepine levels are obtained weekly early during therapy to avoid toxicity and ascertain therapeutic levels.

46. The nurse meets with the mother of a child diagnosed with attention deficit hyperactivity disorder. The mother states, "I feel so guilty that he has this disease, like I did something wrong. I feel like I need to be with him constantly in order for him to get better. But still sometimes I feel like I'm going to lose control and hurt him." The nurse should suggest which of the following to the mother? 1. Arranging for respite care to watch her child and give herself a regular break. 2. Taking a job to allow herself to feel some success because her child won't ever improve. 3. Arranging to have coffee with friends daily as a way to begin a support group. 4. Considering foster care if she feels that she can't handle her child's problems.

46. 1. Suggesting that the mother arrange for respite care so that she can have a regular break would help to alleviate some of the stress that she feels when she is with her child constantly. The mother also could use family and friends to provide some care, thereby helping with giving her a break. The child may improve, so suggesting that the mother take a job to provide a feeling of success would be inappropriate. Having coffee daily with friends may provide some opportunities for socialization. However, friends may not be able to provide the verbal support that the mother needs. Rather, attending a support group of other parents with children with attention deficit hyperactivity disorder might be helpful. Placing the child in foster care is an extreme measure that may damage the therapeutic relationship with the nurse and dramatically and negatively affect the relationship between the mother and child.

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 withsubstances 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.

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.

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 actionsshould 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.

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.

5. After months of counseling , a client abused by her husband tells the nurse that she has decided to stop treatment. There has been noabuse 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.

5. 2. The nurse needs more information about the client's decision before deciding what intervention is most appropriate. Judgmentalresponses 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.

50. A parent of a 7-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) since he was 5 years old is talking to the school nurse about her concerns about the son's physical condition. The parent states that his medication, Concerta (methylphenidate extended release), controls his symptoms well but is causing him to lose weight. It is difficult to get him up and ready for school in the morning unless he is given the medication as soon as he awakens. Then he does not eat breakfast or very much of his lunch at school. He eats dinner, but only an average amount of food. He has lost 3 lb (1.4 kg) in the last 2 weeks. Which of the following should the nurse suggest the parent do first? 1. Have the child eat a breakfast bar, banana, and a glass of milk at his bedside at the same time he takes his Concerta every morning. 2. Monitor the child's weight closely for a month since he is likely to stop losing weight when the school year ends in 2 weeks 3. Suggest a change of medication to anonstimulant drug that will treat his ADHD without causing the appetite decrease. 4. Suggest that the parent supplement the child's dinner with a high-protein drink or other food that will increase his caloric intake.

50. 1. Because weight loss is a common side effect of methylphenidate and because the child's symptoms are controlled with the stimulant, the first action should be to increase the child's oral intake before the medication's side effects begin . Weight should be monitored, but since the child has already lost weight, a remedy is needed as well as monitoring. The weight loss is directly due to the medication's side effects, so the child willcontinue to lose weight unless an intervention is made whether or not he is enrolled in school or on summer vacation. A high-protein drink could work, but then the child is taking in all his calories in the evening, which is not best nutritionally. A change of medication should be the last resort since methylphenidate is the most effective medication for ADHD and has been successful with this child.

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.

52. Assessment of suicidal risk in children and adolescents requires the nurse to know which of the following? 1. Children rarely commit suicide unless one of their parents has already committed suicide, especially in the past year. 2. The risk of suicide increases during adolescence, with those who have recently suffered a loss, abuse, or family discord being most at risk. 3. Children do have a suicidal risk that coincides with some significant event such as a recent gun purchase in the family. 4. Adolescents typically don't choose suicide unless they live in certain geographical regions of the United States and Canada.

52. 2. Adolescents are more likely than children to attempt or commit suicide. Loss, abuse, and family discord remain significant risk factors. There is no evidence to support that children rarely commit suicide. Additionally, evidence fails to support the belief that children who have lost a parent to suicide will attempt it themselves. Significant events, such as a recent firearm purchase, have not been linked to suicide attempts in children. No geographical region in the United States or Canada is free from adolescent suicide.

53. A child with Asperger's disorder is being referred to the mental health clinic along with his parents. To provide the best care for this family, the nurse makes a care plan based on the fact that this disorder differs from autism in which of the following areas? 1. Asperger's disorder, commonly diagnosed earlier than autism, is associated with fewer major problems in interpersonal interactions. 2. In Asperger's disorder, behavior commonly is similar to that of other children with autism but without the problems with school. 3. Asperger's disorder is recognized later than autism, and interpersonal interaction problems typically become more apparent when the child begins school. 4. There are significant problems with language development, as with autism, but there are no delays or difficulties with motor development.

53. 3. Asperger's disorder is recognized later than autism, and the interpersonal problems worsen with school attendance. These childrenusually have restricted and repetitive patterns of behavior. School problems exist as a result of the interaction difficulties and behavior differences. Motor development may be delayed, but language commonly progresses normally.

54. The mother of a 14-year-old girl who is diagnosed with oppositional defiant disorder tells the nurse that she has read extensively on this disorder and does not believe the diagnosis is correct for her daughter. Which of the following responses by the nurse is appropriate? 1. "It sounds like you are very interested in your daughter. Let's focus on what is best for her." "Tell me what you have found in your reading that is leading you to that conclusion." 3. "Your doctor has had many years of education and experience, so you canbelieve he's right." 4. "That doesn't matter now because we just need to help her get better."

54. 2. The nurse needs to find out what exactly the mother knows and has read. Reviewing what the mother has found in her reading that is leading her to doubt the diagnosis will help direct the nurse's teaching and clarify any misperceptions or misinformation that the mother may have. The primary health care provider may indeed have many years of education and experience , and the focus should be on the daughter, but the nurse needs to address the mother's concerns at this time.

55. The parents of a preschool child diagnosed with autism must take their child on a plane flight and are concerned about how they can make the experience less stressful for her and their fellow travelers . The nurse in their psychiatrist's office suggests a dry run to the airport in which they simulate going through security and boarding a plane. In addition, the nurse suggests taking items to help the child be calm during the flight. In what order of priority from first to last should the parents employ the items listed below? 1. A DVD player with headphones and favorite games, cartoons, and child films . 2. A favorite stuffed toy animal or other soft toy. 3. A favorite nonelectronic game. 4. Medication that can be given as needed to calm the child.

55. 1. A DVD player with headphones and favorite games, cartoons, and child films. 3. A favorite nonelectronic game. 2. A favorite stuffed toy animal or other soft toy. 4. Medication that can be given as needed to calm the child. Electronic games and stories are favorites of most children, but are particularly enjoyed by children on the autism spectrum. The headphones block out some of the noises that might be upsetting to a child on the autism spectrum. If the child cannot be engaged electronically, a favorite nonelectronic toy would be the next choice. Stuffed animals or other soft toys can soothe a child who is starting to become upset. Medication should be a last resort as it canhave a paradoxical effect if it is an antianxiety medication or may cause too much sedation during the flight.

56. A young school-age girl whose mother and aunt have been diagnosed as having bipolar disorder and whose father is diagnosed with depression is brought to the child psychiatrist's office by her father who has custody since the parents divorced. The father has brought the child to the office because of problems with behavior and attention in school and inability tosleep at night. The child says, "My brain doesn't turn off at night." The psychiatrist diagnoses the child as experiencing attention deficit hyperactivity disorder (ADHD) with a possibility of bipolar disorder as well as the ADHD. What should the office nurse say to the father to explain what the psychiatrist said? Select all that apply. "The psychiatrist diagnosed your child as having ADHD because of her attention and behavior problems at school. ""ADHD involves difficulty with attention, impulse control, and hyperactivity at school, home, or in both settings." 3. "The psychiatrist does not know how to diagnose your child's illness since she has symptoms of both bipolar disorder and ADHD." 4. "The child's description of her inability to sleep is irrelevant to diagnosing her condition since she stays up late. ""The psychiatrist is considering a bipolar diagnosis because of your child's family history of bipolar disorder and her sleep issues."

56. 1, 2, 5. The client's school problems, the presence of first-degree relatives diagnosed with bipolar disorder and depression, and her inability to sleep at night mirror aspects of both ADHD and bipolar disorder, which are difficult to distinguish from each other in children . Psychiatrists are reluctant to diagnose young children as bipolar at this age. She may have only one disorder or the other or both. Further monitoring and her response to medication will differentiate whether she is suffering from one of the disorders or both. Any comments indicating that the psychiatrist does not know what he or she is doing or that the child's perceptions of her illness are not valid will undermine any trust the father and child might be developing in their caregiver and so should be avoided.

57. At the admission interview, the father of a 4-year-old boy with attention deficit hyperactivity disorder (ADHD) says to the nurse, "I know that my wife or I must have caused this disease." Which of the following is the nurse's best response? "ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder." 2. "What do you think you might have done that could have led to causing this disorder to develop in your son?" 3. "Many parents feel this way, but I doubt there is anything that you did that causedADHD to develop in your child." 4. "Let's not focus on the cause but rather on what needs to be done to help your son get better. I know that you and your wife are very interested in helping him to improve his behavior."

57. 1. Stating that attention deficit hyperactivity disorder occurs more commonly in families takes the opportunity for teaching while also helping the father realize that he and his wife are not to blame. Parents who are commonly blamed by society for their child's behavior need help with education. Questioning the father on what he thinks he may have done implies that the parents played some role in this disorder, possibly contributing to the father's guilt. Telling the father that many parents feel this way and that the nurse does not think the parents are at fault is premature at this point. Telling the father that he should focus on what needs to be done, rather than what caused the disorder, minimizes the father's concerns and feelings.

58. A member of a nurse-led group for depressed adolescents tells the group that she is not coming back because she is taking medication and no longer needs to talk about her problems. Which of the following responses by the nurse is most appropriate? 1. "I'm glad that you are taking your medication, but how can we know that you will continue to take it? After all, you haven't been on it for very long and you might decide to stop taking it." 2. "I think that it is important to let everyone respond to what you said, so let's go around the group and let everyone give their thoughts about what you have decided. ""The purpose of the group is to provide each of you with a place to discuss the problems of being a teenager with depression with others who also are experiencing a similar situation." 4. "You don't have to stay in the group if you don't want to, but if you choose to leave, then you won't be able to change your mind later and return to the group."

58. 3. Focusing on the purpose of the group is the best response. Adolescents are greatly influenced by their peers. Medication alone is not typically the most successful treatment strategy . Questioning whether the client will continue the medication is negative and is not the reason for her to stay in the group . Asking the rest of the group to respond may or may not give the nurse support for the teenager remaining in the group. Groups commonly have rules regarding movement of members in and out of the group, but this does not address the reasons for the client to remain in the group.

60. A teacher is talking to the school nurse about a child in her classroom who has a tic disorder. The teacher mentions that the boy frequently trips other children although no one has ever been hurt. The teacher then further states that she ignores him when that happens because it is part of his disorder. The nurse should tell the teacher: "Tripping other children is not a tic, so you can respond to that as you would in any other child." 2. "I can't believe that you actually allow him to get away with that!" 3. "I think that is the best choice unless some parents of the other children start to protest about it." 4. "If no one else is getting hurt, then it seems harmless and might prevent the development of a worse behavior."

60. 1. The teacher needs to be informed that this behavior is inappropriate. Therefore, educating the teacher and encouraging her to respond to misbehavior consistently is correct . Telling the teacher that the nurse can't believe the teacher lets the child get away with the behavior is demeaning and condescending. Allowing the child to continue the misbehavior is counterproductive to discipline and could create other problems.

61. A 15-year-old boy being successfully treated for Tourette's syndrome tells the nurse , "I'm not going to take this medication anymore . Anyone who is really my friend will accept me as I am, tics and all!" The nurse should tell the client: 1. "You and your family came to the clinic for treatment, so you can terminate it whenever you wish." 2. "Won't your lack of medication cause more tics and make you be less attractive to girls?" "Let's talk about what brought you into treatment and why you now want to stop taking medication." 4. "I think that is a very unwise decision, but you're entitled to do whatever you wish."

61. 3. When an adolescent wants to stoptreatment with medication, it represents a desire for more control over his /her life as well as a wish to be free of the disorder with which they have been diagnosed. If the caregiver merely acknowledges the client's right to stop treatment or warns of consequences if the client stops medication, he or she abdicates the adult role of health care advisor. Before any action is taken, the nurse should explore the client's reasoning to see if anything in the medication regimen could be changed to make it more palatable for the client. The client also needs to know that if his current objections cannot be overcome, he can return later to restart his medication.

62. The nurse leading a group session forparents of children diagnosed with oppositional defiant disorder. The nurse should give which of the following recommendations for discipline? 1. Avoid limiting the child's use of the television and computer for punishment. 2. Be consistent with discipline while assisting with ways for the child to more positively express anger and frustration. 3. Use primarily positive reinforcement for good behavior while ignoring any demonstrated bad behavior. 4. Use time -out as the primary means of punishment for the child regardless of what the child has done.

62. 2. Consistent discipline and alternative methods of anger management are two important tools for parents who have a child with oppositional defiant disorder. Consistent discipline sets limits for the child. Helping the child learn more appropriate ways to manage anger assists the child in living within societal expectations. Avoiding restriction of television and computer time for punishment or using time -out as the primary means of punishment has not been suggested as an appropriate management method. Typically, using many strategies is more effective. Ignoring bad behavior could be dangerous and does not reinforce to the child that limits on behavior exist in society.

63. A 15-year-old girl is sent to the school nurse with dizziness and nausea. While assessing the girl, who denies any health problems, the nurse smells alcohol on her breath. Which of the following responses by the nurse is most appropriate? 1. "Don't tell me that you have been drinking alcohol before you came to school this morning!" 2. "Why don't you tell me the real reason that you are feeling sick this morning?" "Tell me everything that you have had to eat and drink yesterday and today." 4. "I know that high school is stressful, but drinking alcohol is not the best way to handle it."

63. 3. Asking the client to report everything that she has had to eat and drink yesterday and today is the least judgmental approach and also provides helpful information. Confronting the client about drinking alcohol or asking the client to admit the real reason for feeling sick can put the girl on the defensive and block furthercommunication. The nurse should avoid putting the client on the defensive to facilitate communication that may eventually enable the nurse to get the truth and identify interventions.

65. Which of the following should the nurse include in the teaching plan for the parents of a child who is receiving methylphenidate (Ritalin)? 1. Giving the medication at the same time every evening. 2. Having the child take two doses at the same time if the last dose was missed. 3. Giving the single-dose form of the medication early in the day. 4. Allowing concurrent use of any over-the-counter medications with this drug.

65. 3. The single-dose form of methylphenidate should be taken 10 to 14 hours before bedtime to prevent problems with insomnia, which can occur when the daily or last dose of the medication is taken within 6 hours (for multiple dosing) or 10 to 14 hours (for single dosing) before bedtime. It is recommended that a missed dose be taken as soon as possible; the dose is skipped if it is not remembered until the next dose is due. Any other medication , including over-the-counter medications, should be discussed with the health care provider before use to eliminate the risk of a possible drug interaction.

66. An 8-year-old child was recently hospitalized at a child psychiatric unit for inattention and acting out behavior at school and home. His psychiatrist prescribed the methylphenidate/ ritalin patch to control his attention deficit hyperactivity disorder symptoms, and inpatient unit staff worked with him on behavioral control measures. The office nurse discovers at his first visit after his discharge from the hospital that the boy has been taking off his patch during the day, which is causing problems at school and at home. In which order of priority from first to last should the nurse take the following actions? 1. Explain to the family, in terms the child can understand, the benefits of his medication in dealing with school and home problems he is experiencing .2. Explore the parents ' attitudes about medication administration in general and their child's medication in particular. 3. Explore the child's reasons for removing the patch during the day rather than at the end of the day. 4. Have the psychiatrist discuss with the child and parents a trial of a different medication.

66. 3. Explore the child's reasons for removing the patch during the day rather than at the end of the day. 2. Explore the parents ' attitudes about medication administration in general and their child's medication in particular. 1. Explain to the family, in terms the child can understand, the benefits of his medication in dealing with school and home problems he is experiencing.4. Have the psychiatrist discuss with the child and parents a trial of a different medication. First, the child's reasons for removing the patch need to be explored to determine what needs to be done to solve the problem of inadequate medication administration. Since the child is probably heavily influenced by his parents' attitudes about taking medications, their attitudes need to be addressed next to determine if they openly or subtly oppose the medication or its method of administration. Once the knowledge of the child's and parent's feelings about medication are known, education can be offered to be sure the child understands how the medication can help him cope better in school and home. If the child continues to take off his patch or demonstrates an allergic response to the patch or if it is determined that his parents are not supportive of the patch, discussion of a trial of another medication to treat the child's symptoms should occur.

67. A 7-year-old client is diagnosed with conduct disorder. After admission, the nurse identifies his problematic behaviors as cruelty to animals, stealing , truancy, aggression with peers , lying, and explosive angry outbursts resulting in destruction of property. The nurse is now talking with the client about his behavioral contract, which should include which crucial components ? Select all that apply.\ 1. Taking prescribed medications. 2. Acceptable methods for expressing anger. 3. Consequences for unacceptable behaviors. 4. Rules for interacting with staff and other clients . 5. Personal possessions allowed on the unit.

67. 1, 2, 3, 4. The crucial elements of a behavioral contract include compliance with the medication regimen if medication is prescribed, appropriate anger management, consequences for unacceptable behaviors, and rules for interactions with others. Personal possessions may be limited by unit rules, but are not part of an individualized behavioral contract.

The Child and Adolescent with Adjustment Disorders 69. A 19-year-old male is seriously ill with cystic fibrosis (CF), which he has had since infancy. He is frequently hospitalized for lung infections and is in need of a lung transplant. However, he has a rare blood type that complicates the process of obtaining a donor organ. He has also been diagnosed with bipolar disorder and treated successfully since midadolescence with medication and therapy. How should the nurse on the unit on which he is hospitalized for pneumonia interpret his request for a chaplain to help him make plans for a funeral and donation of his body to science after death? 1. It is a signal of the depressive side of his bipolar disorder , and he should be checked for suicidal thoughts/ plans. 2. It is a signal of an exacerbation of the client's CF and warrants further assessment by his lung specialist. 3. It is a signal of the client's awareness he is likely to have a shortened life span and should be supported by unit staff. It is a signal of delirium as a result of the many medications he is taking and requires further assessment by the pharmacist or

69. 3. A client who has endured serious chronic illness (both psychiatric and medical ) would be well aware of his shortened lifespan, particularly if he is unable to get a lung transplant. It would not be unusual for him to want to plan ahead, so his wishes would be honored in the event of his death. In the absence of other physical signs, an exacerbation of CF or delirium is not demonstrated. Likewise, his successful bipolar treatment in the absence of any other signs rules depression out as a reason for his behavior. Though it may be difficult for us to think about a young person in terms of dying, the client's consideration of the future is a rational decision.

70. A 6-year -old boy has experienced the death of his mother in the last 3 months. He and his father are involved in a grief support program that has sessions for all ages. A nurse is educating the parents about the normal grief reactions of children to help them distinguish normal behavior from behavior that is unusual and possibly indicative of depression or other psychological issues. Which of the following represents normal grief behavior for this young child after the death of his mother? Select all that apply. 1. Talking to his mother as if she were present in the room. 2. Crying followed in a few minutes by laughing. 3. Playing with a rope, saying he is going to be with his mother 4. Yelling and being angry at his mother for leaving him. 5. Playing with a friend right after saying he misses his mother.

70. 1, 2, 4, 5. Young children cannot be sad all the time after a loss, but that does not mean they grieve less. Their moods change more quickly and they often work out their issues through play rather than talking. Because young children do not have a full understanding of death's finality, they may talk to a deceased loved one as if they are present. They also may not understand the circumstances of the death and so may think the loved one left voluntarily and be angry at the deceased for leaving them. Play involving adangerous object such as a rope, coupled with a stated desire to join the deceased parent, would be cause for alarm as the child could harm himself either purposely or accidentally. CN: Psychosocial integrity; CL: Apply

71. When counseling a 5-year-old girl who recently suffered the loss of her mother, which of the following statements reflects the typical understanding about death at this age? "My mommy died last week, but I'm going to see her again." 2. "My daddy said mommy went to heaven, and I'm glad Jesus took her there." 3. "My dog died and now we got another one." 4. "I think Mommy went to heaven and I'll get to see her someday when I die."

71. 1. Five- year-old children view death as reversible, so talking about seeing her mother again is a normal statement for a child of this age . A child this age would not usually state that she was glad Jesus took her mom but instead might be afraid that Jesus would also take her or her dad. The idea of replacing her mother with a new one, as hinted in the statement that they got another dog after the dog died, has not been supported by studies of grieving children. Stating that mommy went to heaven and that the child will see her someday when the child dies is reflective of more advanced abstract thinking than a 5-year-old would demonstrate.

72. A shy 12-year-old girl who must change school systems just before she begins junior high school begins cutting her arms to relieve the stress that she feels about leaving long-standingfriends, having to develop new friendships, and meeting high academic standards in her new school. After she has been cutting for a few weeks , her parent discovers the injuries and takes her to a psychiatrist who prescribes a therapeutic group at the local mental health center and medication to help decrease her anxiety. The nurse who is leading the group would determine that the girl had made appropriate progress toward recovery when which of the following occurred? Select all that apply. 1. The girl indicated that she had joined three clubs at school and agreed to be an officer in one of them. 2. The girl says she has developed a friendship with a girl in her class and one in her therapy group. 3. The girl wears short-sleeved and/ or sleeveless tops when the weather is warm. 4. The girl's grades are good, and her hours of study are not excessive. 5. The girl begins saying she must study hard so she can get into a good university.

72. 2, 3, 4. The development of friendships and good grades with moderate amounts of study are positive signs since friends and grades in the new school were sources of stress and anxiety for the girl. The ability to wear clothes appropriate to the weather rather than hiding her arms is a sign she is no longer injuring her arms. Joining three clubs and being an officer in one of them is unlikely and would probably be an additional source of stress for the girl as would be pushing herself to extraordinary academic achievement to secure a place in college when she has just entered junior high.

74. A staff nurse on the mental health unit tells the nurse manager that kids with conduct disorders might as well be jailed because they all end up as adults with antisocial personality disorder anyway. What is the best reply by the nurse manager? 1. "You really sound burned out. Do you have a vacation coming up soon?" 2. "These children are more likely to have problems with depression and anxiety disorder as adults." "You sound really frustrated. Let's talk about the meaning of their behavior." 4. "My experience hasn't been that negative. Let's see what the other staff members think; maybe I'm wrong."

74. 3. The nurse manager needs to focus on the frustration that the nurse is expressing. Additionally, the nurse manager needs to correct any misinformation or misinterpretation that the staff nurse has. Saying that the nurse sounds burned out and asking about a vacation does not focus on the nurse's frustration or address the inaccuracy of the nurse's statement. There is no evidence to suggest that children with conduct disorder have more than the average adult's risk of depression or anxiety. Therefore, this response is inaccurate and inappropriate. Anecdotal information from personal experience does not supply the nurse with accurate, reliable information.

75. Which of the following children should the nurse assess as demonstrating behaviors that need further evaluation? 1. Joey, age 2, who refuses to be toilet-trained and talks to himself. 2. Adrienne, age 6, who sucks her thumb when tired and has never spent the night with a friend. 3. Curt, age 10, who frequently tells his mother that he is going to run away whenever they argue. 4. Stephen, age 2, who is indifferent to other children and adults and is mute.

75. 4. Indifference to other people and mutism may be indicators of autism and would require further investigation. A 2-year-old who talks to himself and refuses to cooperate with toilet training is displaying behaviors typical for this age. Occasional thumb sucking and not having spent the night with a friend would be normal at age 6. Threats to run away when angry is considered within the range of normal behaviors for a 10-year-old child.

76. A nurse has been caring for a 12-year-old adolescent client in a residential facility. The child has been through a series of foster placements since infancy with no success in any placement until the age of 7 when placed with a middle-aged single woman. The client thrived there until the woman was killed in a car accident. The client attempted suicide after her foster mother died in response to the loss and the child was placed inthe residential facility. The nurse has become close to this client and wants to help her address her issues and move on with her life. Which of the following comments to the manager demonstrates that the nurse understands the client's issues and is able to respond appropriately to the client's needs? "It's difficult for her to love and trust again after her losses. In this facility, she can learn to deal with her loss in a less emotionally charged environment than a foster home." 2. "She just needs someone who will love her and give her the things she has missed out on in life. An adoptive family needs to be found for her as soon as possible." 3. "I'm not sure she is going to be able to get past all the loss and rejection she's experienced. I don't think adoption will ever be a viable option for her." 4. "I know her well and am familiar with her issues. I think the best chance for success for her would be if she was adopted into my family."

76. 1. The severe emotional trauma the girl has experienced will likely make it difficult for her to be successful in an adoptive placement at thepresent time, whether that placement is with someone she knows (the nurse) or another adoptive family. Additionally, adoption by the nurse is inappropriate because it blurs the lines between her professional and personal life and is likely to confuse the client . It is clear that the client has many issues and that love alone is not likely to solve all her problems. Treatment at the residential facility will allow her to work through emotional issues in a more therapeutic environment. Though not currently ready for adoption, she may be ready for adoption in the future after sufficient treatment.

78. A new client has just been admitted to an adolescent psychiatric inpatient unit. The charge nurse and an aide are discussing the client's needs. The aide says, "She is just showing off to try and get our sympathy. There is no need for her to cut herself. Why would adolescents want to do such a thing to themselves?" Which of the following responses by the charge nurse would most help the aide understand the client and her illness? 1. "She is not doing the cutting for attention since she always wears clothing that covers up her injuries and further, she is not willing to talk about it." "It is hard to see a young person harm herself as she does, but she has serious family issues and does not know better ways to handle them, so we have to help her with that." 3. "You do not understand her problems and do not take them seriously , so you should not be allowed to work with her during her hospitalization." 4. "Perhaps you should transfer to another unit where you are able to have empathy for the clients."

78. 2. The aide is concerned about the behavior of the client and confused about why it is occurring, so the nurse needs to explain a bit about the issues involved as well as demonstrateempathy for the aide. It is appropriate to explain that the client is not cutting for attention, but the nurse's response does not address the reason for the teen's behavior so is inadequate and sounds a little like the nurse is denigrating the aide, which will not encourage the aide to listen to what she has to say. The comments that the aide cannot work with the client or that she should transfer are punitive and do nothing to help the aide understand self-mutilation.

COMPLETION 1. The rapid onset of physical, cognitive, and emotional symptoms that results in chest pain, shortness of breath, and the signs of impending doom is known as ________________.

ANS: panic disorder Also referred to as panic attacks. Before considering a diagnosis of panic disorder, organic causes should be ruled out. These may include hyperthyroidism, hyperglycemia, epilepsy, and mitral valve prolapse. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1452 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity, Psychological Integrity

5. A parent of a child with an anxiety disorder states, "I don't know how my child developed this problem." On what information should the nurse base a response? a. Genetic factors, hormonal imbalances, and societal influences all contribute to the development of anxiety disorders in children. b. Like many conditions affecting children, the etiology of anxiety disorders is unknown. c. The majority of anxiety disorders have a clear pattern of genetic inheritance. d. Dysfunctional family patterns are usually identified as the cause of an anxiety disorder.

ANS: A Feedback A Anxiety disorders are responses to stress and may be manifested as disturbances in feeling, body functions, behavior, or performance. Children with a history of verbal, physical, or sexual abuse frequent separation from or loss of loved ones drug use, incarceration, or lower socioeconomic status homosexuality chronic illnes behavioral disorders and dysfunctional families are more likely than peers with healthy family patterns to have anxiety disorders. B The etiology of many anxiety disorders in children can be identified. C Some anxiety disorders are inheritable disorders. Others have been identified as having other origins. D Research consistently shows that psychosocial disorders are caused by a combination of predisposing or inherent factors and environmental or interactional factors. PTS: 1 DIF: Cognitive Level: Application REF: p. 1451 OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

Chapter 53: Psychosocial Problems in Children and Families Test Bank MULTIPLE CHOICE 1. Which sign or symptom is likely to be manifested by an adolescent with a depressive disorder? a. Abuse of alcohol b. Impulsivity and distractibility c. Carelessness and inattention to details d. Refusal to leave the house

ANS: A Feedback A Depression often manifests in conjunction with substance abuse, so children who abuse substances should be evaluated for depression as well. B Impulsivity and distractibility are manifestations of attention-deficit/hyperactivity disorder (ADHD). C A diminished ability to think or concentrate, carelessness, and inattention to details is a clinical manifestation of ADHD. D A refusal to leave the house, even to play with friends, is characteristic of separation anxiety disorder. PTS: 1 DIF: Cognitive Level: Application REF: p. 1453 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

13. Which finding noted by the nurse on a physical assessment is most suggestive that a child has been sexually abused? a. Swelling of the genitalia and pain on urination b. Smooth philtrum and thin upper lip c. Speech and physical development delays d. History of constipation, drowsiness, and constricted pupils

ANS: A Feedback A Physical indicators of sexual abuse may include swelling or itching of the genitalia and pain on urination. Other indicators may include bruises, bleeding, or lacerations of the external genitalia, vagina, or anal area. B The infant with fetal alcohol syndrome may have microphthalmia or abnormally small eyes or short palpebral fissures, a thin upper lip, and a poorly developed philtrum. C Children who have been emotionally abused may exhibit speech disorders, lags in physical development, failure to thrive, or hyperactive and disruptive behaviors. Although there is a possibility for speech and developmental delays, these are not more suggestive of sexual abuse than swollen genitalia and pain on urination. D Opiates can cause detachment and apathy, drowsiness, constricted pupils, constipation, slurred speech, and impaired judgment. PTS: 1 DIF: Cognitive Level: Application REF: p. 1469 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

The nurse is caring for an adolescent hospitalized for asthma. The adolescent belongs to a large family. The nurse recognizes that the adolescent is likely to relate to which group? a. Peers b. Parents c. Siblings d. Teachers

ANS: A Adolescents from a large family are more peer oriented than family oriented. Adolescents in small families identify more strongly with their parents and rely more on them for advice.

When discussing discipline with the mother of a 4-year-old child, which should the nurse include? a. Parental control should be consistent. b. Withdrawal of love and approval is effective at this age. c. Children as young as 4 years rarely need to be disciplined. d. One should expect rules to be followed rigidly and unquestioningly.

ANS: A For effective discipline, parents must be consistent and must follow through with agreed-on actions. Withdrawal of love and approval is never appropriate or effective. The 4-year-old child will test limits and may misbehave. Children of this age do not respond to verbal reasoning. Realistic goals should be set for this age group. Discipline is necessary to reinforce these goals. Discipline strategies should be appropriate to the child's age and temperament and the severity of the misbehavior. Following rules rigidly and unquestioningly is beyond the developmental capabilities of a 4-year-old child.

When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called which? a. Permissive b. Dictatorial c. Democratic d. Authoritarian

ANS: A Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children's actions. Dictatorial or authoritarian parents attempt to control their children's behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their children's behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect their children's individual natures.

The nurse is planning care for a patient with a different ethnic background. Which should be an appropriate goal? a. Adapt, as necessary, ethnic practices to health needs. b. Attempt, in a nonjudgmental way, to change ethnic beliefs. c. Encourage continuation of ethnic practices in the hospital setting. d. Strive to keep ethnic background from influencing health needs.

ANS: A Whenever possible, nurses should facilitate the integration of ethnic practices into health care provision. The ethnic background is part of the individual; it should be difficult to eliminate the influence of ethnic background. The ethnic practices need to be evaluated within the context of the health care setting to determine whether they are conflicting.

The nurse is teaching parents about the effects of media on childhood obesity. The nurse realizes the parents understand the teaching if they make which statements? (Select all that apply.) a. "Advertising of unhealthy food can increase snacking." b. "Increased screen time may be related to unhealthy sleep." c. "There is a link between the amount of screen time and obesity." d. "Increased screen time can lead to better knowledge of nutrition." e. "Physical activity increases when children increase the amount of screen time."

ANS: A, B, C A number of studies have demonstrated a link between the amount of screen time and obesity. Advertising of unhealthy food to children is a long-standing marketing practice, which may increase snacking in the face of decreased activity. In addition, both increased screen time and unhealthy eating may also be related to unhealthy sleep. Increased screen time does not lead to a better knowledge of nutrition or increased physical activity.

Which describe the feelings and behaviors of early preschool children related to divorce? (Select all that apply.) a. Regressive behavior b. Fear of abandonment c. Fear regarding the future d. Blame themselves for the divorce e. Intense desire for reconciliation of parents

ANS: A, B, D Feelings and behaviors of early preschool children related to divorce include regressive behavior, fear of abandonment, and blaming themselves for the divorce. Fear regarding the future and intense desire for reconciliation of parents is a reaction later school-age children have to divorce.

The nurse is presenting a staff development program about understanding culture in the health care encounter. Which components should the nurse include in the program? (Select all that apply.) a. Cultural humility b. Cultural research c. Cultural sensitivity d. Cultural competency

ANS: A, C, D There are several different ways health care providers can best attend to all the different facets that make up an individual's culture. Cultural competence tends to promote building information about a specific culture. Cultural sensitivity, a second way of understanding culture in the context of the clinical encounter, may be understood as a way of using one's knowledge, consideration, understanding, respect, and tailoring after realizing awareness of self and others and encountering a diverse group or individual. Cultural humility, the third component, is a commitment and active engagement in a lifelong process that individuals enter into for an ongoing basis with patients, communities, colleagues, and themselves. Cultural research is not a component of understanding culture in the health care encounter.

2. A nurse working on the pediatric unit should be aware that children admitted with which of the following assessment findings are suggestive of physical child abuse? Select all that apply. a. Bruises in various stages of healing b. Bruises over the shins or bony prominences c. Burns on the palms of the hands d. A fracture of the right wrist from a sports accident e. Rib fractures in an infant

ANS: A, C, E Feedback Correct Bruises in various stages of healing and burns on the palms of the hand may be indicative of physical abuse. Rib fractures in an infant are another indicator of physical abuse. Incorrect Bruises over the shins or bony prominences are seen in children beginning to walk. A fracture of the right wrist can occur as the child begins to participate in sports activities. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1468 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

3. The nurse is aware that suicide risk increases if the child displays which characteristics? Select all that apply. a. Previous suicide attempt b. No previous exposure to violence in the home c. Recent loss d. Effective social network e. History of physical abuse

ANS: A, C, E Feedback Correct The risk of suicide increases if the child has had a previous suicide attempt, a recent loss, or a history of physical abuse. Incorrect No previous violence in the home or having an effective social network decreases the risk of suicide. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1457 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

12. Which behavior verbalized by a school-age child should alert the school nurse to a problem of possible obsessive-compulsive disorder (OCD)? a. States feelings of worthlessness and sadness everyday b. Feels need to ride a bike around the tree in front of the house seven times every day before entering the house c. Recurrent episodes of chest pain, heart palpations, and shortness of breath when entering the computer classroom d. Deterioration of relationships with family members

ANS: B Feedback A Feelings of worthlessness and sadness are suggestive of a depressive disorder. B Obsessive-compulsive disorder (OCD) manifests repetitive unwanted thoughts (obsessions) or ritualistic actions (compulsions) or both. C Panic disorders often cause recurrent episodes of chest pain, heart palpations, and shortness of breath. These symptoms may be accompanied by a feeling of impending doom. D Deterioration of relationships with family members, irregular school attendance, low grades, rebellious or aggressive behavior, and excessive dependence on peer influence are behaviors that may indicate substance abuse. PTS: 1 DIF: Cognitive Level: Application REF: p. 1453 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

8. The school nurse observes an unkempt child dressed in inappropriate clothing who repeatedly asks for food. About which problem is the nurse concerned? a. Physical abuse b. Physical neglect c. Emotional abuse d. Sexual abuse

ANS: B Feedback A There are no physical indicators of actual abuse in this description. Behavioral indicators of physical abuse reflect an impaired relationship with parents and other adults. B These physical and behavioral indicators suggest that parental attention is not being given to the child's physical needs. The child is being neglected. C Emotional abuse is manifested by developmental problems or maladaptive behaviors. D Physical indicators of sexual abuse are focused on the genitourinary system. A variety of behavioral indicators range from bizarre sexual behavior to eating and sleeping disturbances. PTS: 1 DIF: Cognitive Level: Application REF: p. 1468 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

The nurse is explaining different parenting styles to a group of parents. The nurse explains that an authoritative parenting style can lead to which child behavior? a. Shyness b. Self-reliance c. Submissiveness d. Self-consciousness

ANS: B Children raised by parents with an authoritative parenting style tend to have high self-esteem and are self-reliant, assertive, inquisitive, content, and highly interactive with other children. Children raised by parents with an authoritarian parenting style tend to be sensitive, shy, self-conscious, retiring, and submissive.

A foster parent is talking to the nurse about the health care needs for the child who has been placed in the parent's care. Which statement best describes the health care needs of foster children? a. Foster children always come from abusive households and are emotionally fragile. b. Foster children tend to have a higher than normal incidence of acute and chronic health problems. c. Foster children are usually born prematurely and require technologically advanced health care. d. Foster children will not stay in the home for an extended period, so health care needs are not as important as emotional fulfillment.

ANS: B Children who are placed in foster care have a higher incidence of acute and chronic health problems and may experience feelings of isolation and confusion; therefore, they should be monitored closely. Foster children do not always come from abusive households and may or may not be emotionally fragile; not all foster children are born prematurely or require technically advanced health care; and foster children may stay in the home for extended periods, so their health care needs require attention.

The nurse is aware that if patients' different cultures are implied to be inferior, the emotional attitude the nurse is displaying is what? a. Acculturation b. Ethnocentrism c. Cultural shock d. Cultural sensitivity

ANS: B Ethnocentrism is the belief that one's way of living and behaving is the best way. This includes the emotional attitude that the values, beliefs, and perceptions of one's ethnic group are superior to those of others. Acculturation is the gradual changes that are produced in a culture by the influence of another culture that cause one or both cultures to become more similar. The minority culture is forced to learn the majority culture to survive. Cultural shock is the helpless feeling and state of disorientation felt by an outsider attempting to adapt to a different culture group. Cultural sensitivity, a component of culturally competent care, is an awareness of cultural similarities and differences.

Which family theory explains how families react to stressful events and suggests factors that promote adaptation to these events? a. Interactional theory b. Family stress theory c. Erikson's psychosocial theory d. Developmental systems theory

ANS: B Family stress theory explains the reaction of families to stressful events. In addition, the theory helps suggest factors that promote adaptation to the stress. Stressors, both positive and negative, are cumulative and affect the family. Adaptation requires a change in family structure or interaction. Interactional theory is not a family theory. Interactions are the basis of general systems theory. Erikson's theory applies to individual growth and development, not families. Developmental systems theory is an outgrowth of Duvall's theory. The family is described as a small group, a semiclosed system of personalities that interact with the larger cultural system. Changes do not occur in one part of the family without changes in others

The nurse is discussing issues that are important with parents considering a cross-racial adoption. Which statement made by the parents indicates further teaching is needed? a. "We will try to preserve the adopted child's racial heritage." b. "We are glad we will be getting full medical information when we adopt our child." c. "We will make sure to have everyone realize this is our child and a member of the family." d. "We understand strangers may make thoughtless comments about our child being different from us."

ANS: B In international adoptions, the medical information the parents receive may be incomplete or sketchy; weight, height, and head circumference are often the only objective information present in the child's medical record. Further teaching is needed if the parents expect full medical information. It is advised that parents who adopt children with different ethnic backgrounds do everything to preserve the adopted children's racial heritage. Strangers may make thoughtless comments and talk about the children as though they were not members of the family. It is vital that family members declare to others that this is their child and a cherished member of the family.

Children may believe that they are responsible for their parents' divorce and interpret the separation as punishment. At which age is this most likely to occur? a. 1 year b. 4 years c. 8 years d. 13 years

ANS: B Preschool-age children are most likely to blame themselves for the divorce. A 4-year-old child will fear abandonment and express bewilderment regarding all human relationships. A 4-year-old child has magical thinking and believes his or her actions cause consequences, such as divorce. For infants, divorce may increase their irritability and interfere with the attachment process, but they are too young to feel responsibility. School-age children will have feelings of deprivation, including the loss of a parent, attention, money, and a secure future. Adolescents are able to disengage themselves from the parental conflict.

After the family, which has the greatest influence on providing continuity between generations? a. Race b. School c. Social class d. Government

ANS: B Schools convey a tremendous amount of culture from the older members to the younger members of society. They prepare children to carry out the traditional social roles that will be expected of them as adults. Race is defined as a division of humankind possessing traits that are transmissible by descent and are sufficient to characterize race as a distinct human type; although race may have an influence on childrearing practices, its role is not as significant as that of schools. Social class refers to the family's economic and educational levels. The social class of a family may change between generations. The government establishes parameters for children, including amount of schooling, but this is usually at a local level. The school culture has the most significant influence on continuity besides family.

The nurse discovers welts on the back of a Vietnamese child during a home health visit. The child's mother says she has rubbed the edge of a coin on her child's oiled skin. The nurse should recognize this as what? a. Child abuse b. Cultural practice to rid the body of disease c. Cultural practice to treat enuresis or temper tantrums d. Child discipline measure common in the Vietnamese culture

ANS: B This is descriptive of coining. The welts are created by repeatedly rubbing a coin on the child's oiled skin. The mother is attempting to rid the child's body of disease. Coining is a cultural healing practice. Coining is not specific for enuresis or temper tantrums. This is not child abuse or discipline.

MULTIPLE RESPONSE 1. The parents of a teen suspect their child is using amphetamines. Manifestations of amphetamine use include (select all that apply) a. Weight gain b. Excessive talking and activity c. Excessive sleeping d. Insomnia e. Agitation

ANS: B, D, E Feedback Correct Euphoria, hyperactivity, agitation, irritability, insomnia, weight loss, tachycardia, and hypertension are expected behaviors and effects of amphetamine abuse. Incorrect The adolescent using amphetamines is likely to have weight loss not weight gain. Excessive sleeping may be associated with alcohol abuse or abuse of barbiturates. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1465 | Table 53-1 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

6. In counseling an adolescent who is abusing alcohol, the nurse explains that alcohol abuse primarily affects which organ of the body? a. Heart b. Liver c. Brain d. Lungs

ANS: C Feedback A Although an excessive amount of a chemical can cause cardiac abnormalities, the brain is the most commonly affected organ. B Long-term alcohol use is known to impair the liverhowever, brain function is decreased by any amount of alcohol intake. C The primary effect of substance abuse is on the brain and residually on the rest of the body. Alcohol affects the entire brain by decreasing its responsiveness. D The pulmonary system is not the primary target however, brain function is decreased by any amount of alcohol intake. C The primary effect of substance abuse is on the brain and residually on the rest of the body. Alcohol affects the entire brain by decreasing its responsiveness. D The pulmonary system is not the primary target

14. Which manifestation is atypical of ADHD? a. Talking incessantly b. Blurting out the answers to questions before the questions have been completed c. Acting withdrawn in social situations d. Fidgeting with hands or feet

ANS: C Feedback A Talking excessively is a characteristic of impulsivity/hyperactivity. B Blurting out the answers to questions before the questions have been completed is an indication of the impulse control that is often lacking in children with ADHD. C The child with ADHD tends to be talkative, often interrupting conversations, rather than withdrawn in social situations. D Fidgeting is typical of the overactivity that is associated with ADHD. PTS: 1 DIF: Cognitive Level: Application REF: p. 1459 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

7. The outpatient nurse understands that the phase of substance abuse characterized by a 14-year-old child admitting to using marijuana every day with friends after attending school is a. Experimentation b. Early drug use c. True drug addiction d. Severe drug addiction

ANS: C Feedback A With experimentation, the individual tries the drug to see what it is like or to satisfy peers. B Early drug use is identified as using drugs with some degree of regularity for their desirable effects. C True drug addiction is identified as regular use of drugs. Physical dependence may be present. Social functioning has a drug focus. D In severe drug addiction, the physical condition of the individual deteriorates and all activities are related to drug use. PTS: 1 DIF: Cognitive Level: Application REF: p. 1466 | Box 53-2 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

Which type of family should the nurse recognize when the paternal grandmother, the parents, and two minor children live together? a. Blended b. Nuclear c. Extended d. Binuclear

ANS: C An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one stepparent, stepsibling, or half-sibling. A nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

A mother brings 6-month-old Eric to the clinic for a well-baby checkup. She comments, "I want to go back to work, but I don't want Eric to suffer because I'll have less time with him." Which is the nurse's most appropriate answer? a. "I'm sure he'll be fine if you get a good babysitter." b. "You will need to stay home until Eric starts school." c. "Let's talk about the child care options that will be best for Eric." d. "You should go back to work so Eric will get used to being with others."

ANS: C Asking the mother about child care options is an open-ended statement that will assist the mother in exploring her concerns about what is best for both her and Eric. The other three answers are directive; they do not address the effect that her working will have on Eric.

The nurse is planning to counsel family members as a group to assess the family's group dynamics. Which theoretic family model is the nurse using as a framework? a. Feminist theory b. Family stress theory c. Family systems theory d. Developmental theory

ANS: C In family systems theory, the family is viewed as a system that continually interacts with its members and the environment. The emphasis is on the interaction between the members; a change in one family member creates a change in other members, which in turn results in a new change in the original member. Assessing the family's group dynamics is an example of using this theory as a framework. Family stress theory explains how families react to stressful events and suggests factors that promote adaptation to stress. Developmental theory addresses family change over time using Duvall's family life cycle stages based on the predictable changes in the family's structure, function, and roles, with the age of the oldest child as the marker for stage transition. Feminist theories assume that privilege and power are inequitably distributed based upon gender, race, and class.

A Hispanic toddler has pneumonia. The nurse notices that the parent consistently feeds the child only the broth that comes on the clear liquid tray. Food items, such as Jell-O, Popsicles, and juices, are left. Which statement best explains this? a. The parent is trying to feed the child only what the child likes most. b. Hispanics believe the "evil eye" enters when a person gets cold. c. The parent is trying to restore normal balance through appropriate "hot" remedies. d. Hispanics believe an innate energy called chi is strengthened by eating soup.

ANS: C In several cultures, including Filipino, Chinese, Arabic, and Hispanic, hot and cold describe certain properties completely unrelated to temperature. Respiratory conditions such as pneumonia are "cold" conditions and are treated with "hot" foods. The child may like broth but is unlikely to always prefer it to Jell-O, Popsicles, and juice. The evil eye applies to a state of imbalance of health, not curative actions. Chinese individuals, not Hispanic individuals, believe in chi as an innate energy.

Children are taught the values of their culture through observation and feedback relative to their own behavior. In teaching a class on cultural competence, the nurse should be aware that which factor may be culturally determined? a. Ethnicity b. Racial variation c. Status d. Geographic boundaries

ANS: C Status is culturally determined and varies according to each culture. Some cultures ascribe higher status to age or socioeconomic position. Social roles also are influenced by the culture. Ethnicity is an affiliation of a set of persons who share a unique cultural, social, and linguistic heritage. It is one component of culture. Race and culture are two distinct attributes. Whereas racial grouping describes transmissible traits, culture is determined by the pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. Cultural development may be limited by geographic boundaries, but the boundaries are not culturally determined.

11. Which behavior demonstrated by an adolescent should alert the school nurse to a problem of substance abuse? a. States feelings of worthlessness b. Increased desire for social conformity c. Does not feel need for peer approval d. Deterioration of relationships with family members

ANS: D Feedback A Feelings of worthlessness are suggestive of a depressive disorder. An adolescent with a substance abuse problem may be depressed, but this behavior is not a manifestation of substance abuse. B The clinical manifestations of substance abuse are marked by an increase in antisocial behavior as the desire for social conformity decreases and the need for the substance increases. C The adolescent with a substance abuse problem may demonstrate an excessive dependence on peer influence. D Deterioration of relationships with family members, irregular school attendance, low grades, rebellious or aggressive behavior, and excessive dependence on peer influence are behaviors that may indicate substance abuse. PTS: 1 DIF: Cognitive Level: Application REF: p. 1466 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

4. The long-term treatment plan for an adolescent with an eating disorder focuses on a. Managing the effects of malnutrition b. Establishing sufficient caloric intake c. Improving family dynamics d. Restructuring perception of body image

ANS: D Feedback A The treatment of eating disorders is initially focused on reestablishing physiologic homeostasis. B Once body systems are stabilized, the next goal of treatment for eating disorders is maintaining adequate caloric intake. C Although family therapy is indicated when dysfunctional family relationships exist, the primary focus of therapy for eating disorders is to help the adolescent cope with complex issues. D The focus of treatment in individual therapy for an eating disorder involves restructuring cognitive perceptions about the individual's body image. PTS: 1 DIF: Cognitive Level: Application REF: p. 1465 OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

3. The best response for the nurse to make to an adolescent who states, "I am very sad. I wish I was not alive." is a. "Everyone feels sad once in a while." b. "You are just trying to escape your problems." c. "Have you told your parents how you feel?" d. "Have you thought about hurting yourself?"

ANS: D Feedback A This is a judgmental response that ignores the adolescent's obvious statement indicating a need for professional help. B This is a judgmental response that could increase the adolescent's sense of isolation and rejection. C The parents should be made aware of an adolescent's precarious mental state however, this response does not address the adolescent's statement. D This response acknowledges the adolescent's suicide gesture and further assesses the adolescent's condition. PTS: 1 DIF: Cognitive Level: Application REF: p. 1458 | Box 53-1 OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

A 3-year-old child was adopted immediately after birth. The parents have just asked the nurse how they should tell the child that she is adopted. Which guideline concerning adoption should the nurse use in planning a response? a. It is best to wait until the child asks about it. b. The best time to tell the child is between the ages of 7 and 10 years. c. It is not necessary to tell a child who was adopted so young. d. Telling the child is an important aspect of their parental responsibilities.

ANS: D It is important for the parents not to withhold information about the adoption from the child. It is an essential component of the child's identity. There is no recommended best time to tell children. It is believed that children should be told young enough so they do not remember a time when they did not know. It should be done before the children enter school to prevent third parties from telling the children before the parents have had the opportunity.

Parents of a preschool child ask the nurse, "Should we set rules for our child as part of a discipline plan?" Which is an accurate response by the nurse? a. "It is best to delay the punishment if a rule is broken." b. "The child is too young for rules. At this age, unrestricted freedom is best." c. "It is best to set the rules and reason with the child when the rules are broken." d. "Set clear and reasonable rules and expect the same behavior regardless of the circumstances."

ANS: D Nurses can help parents establish realistic and concrete "rules." The clearer the limits that are set and the more consistently they are enforced, the less need there is for disciplinary action. Delaying punishment weakens its intent. Children want and need limits. Unrestricted freedom is a threat to their security and safety. Reasoning involves explaining why an act is wrong and is usually appropriate for older children, especially when moral issues are involved. However, young children cannot be expected to "see the other side" because of their egocentrism

2. Munchausen syndrome by proxy occurs when a person falsifies illness in their child. The pediatric nurse who is admitting a preschooler with this potential diagnosis understands that this is the most difficult form of child abuse to diagnose. Is this statement true or false?

ANS: T This is correct. The most common reasons these caretakers give for seeking treatment for the child include: bleeding, seizures, central nervous system depression, apnea, vomiting, diarrhea, fever, and rash. The parent's behavior reflects a serious psychiatric disturbance that requires both psychiatric treatment and removal of the child from their care. PTS: 1 DIF: Cognitive Level: Application REF: p. 1470 OBJ: Nursing Process: Diagnosis

A nurse is assessing a child with a depressive disorder. Which symptom is likely to be manifested by the child?

Increased nighttime waking

A child who has symptoms of irritable mood and changes in sleep and appetite patterns lasting 3 weeks meets the criteria for which depressive disorder?

Major depressive disorder

Which intervention should the nurse teach parents about caring for an infant experiencing drug withdrawal?

Organize care to minimize disruptions.

The school nurse observes an unkempt child dressed in inappropriate clothing who repeatedly asks for food. The nurse is concerned about which problem?

Physical neglect

The nurse is aware that suicide risk increases if the child displays which characteristics? Select all that apply.

Previous suicide attempt Recent loss History of physical abuse

Which behavior demonstrated by an adolescent should alert the school nurse to a problem of substance abuse?

Rebellious behavior

What is the goal of therapeutic management for a child diagnosed with attention-deficit hyperactivity (ADHD) disorder?

Reduce the frequency and intensity of unsocialized behaviors.

A nurse is teaching parents about family relationship patterns associated with eating disorders. Which family relationship pattern should the nurse teach that is consistent for an adolescent female diagnosed with an eating disorder?

The adolescent is viewed as an extension of the parent.