pediatric Mental Health

8. A mother states that her 11-year-old son has really started to change in his understanding of concepts. The nurse knows that this could be true because: 1. Puberty has started to occur. 2. The increase in testosterone at this age causes the brain to mature. 3. The boy is modeling older boys. 4. Brain connections at this age are rewired to be more like an adult brain.

ANS: 4 Feedback 1. The child is too young for puberty to begin. 2. Testosterone does not influence the concept changes of this child. 3. The boy may be modeling older boys, but the child does not fully understand a concept when modeling. 4. The brain in growing rapidly and creates a higher level of cognitive ability at this age.

78. An 11-year-old girl has just been diagnosed with schizophrenia. The nurse is educating the parents on the disease. Which of the following statements indicates that the parents have a good understanding of the disorder? 1. As soon as she gets over this, we can get back to a normal life again. 2. The medications she will be taking may cause her to lose weight. 3. Since childhood schizophrenia is more common than adult schizophrenia, there is a good chance that she will grow out of it. 4. She may need to be on medication for this disorder for the rest of her life.

ANS: 4 Feedback 1. The illness is chronic, with periods of exacerbation and remission, and often needs lifelong medication management. 2. The antipsychotic medications used to treat schizophrenia can lead to weight gain. 3. Childhood schizophrenia is much rarer than later-onset or adult schizophrenia. 4. Childhood schizophrenia is much rarer than later-onset or adult schizophrenia. The illness is chronic, with periods of exacerbation and remission, and often needs lifelong medication management. The antipsychotic medications used to treat schizophrenia can lead to weight gain.

52. A teenager with a diagnosis of schizophrenia is at risk for other disorders. The teen should be assessed for all of the following disorders except: 1. Depression. 2. Drug abuse. 3. Renal disease. 4. Cardiac disease.

ANS: 3 Feedback 1. The teen is at risk for this disorder. 2. The teen is at risk for developing drug dependency. 3. The teen is not at risk for renal disease. 4. The teen is at risk for cardiac disease with this disorder.

1. Mental illness in children can be defined as: 1. A distorted view of self. 2. A personal inability to respond to the environmental norms. 3. Lack of insight about ones abilities and consequences of actions. 4. All of the above define mental illness.

ANS: 4 Feedback 1. A child has a false view of himself/herself. 2. The child does not respond to social and environmental cues. 3. The lack of consequences for actions causes stress for the child. 4. All define mental illness in children.

39. A mental health nurse is educating a mother on how to help her child deal with anxiety issues. The teaching should include: 1. Encouraging the child to talk about her feelings. 2. Decreasing environmental stimuli when the mother notices that her child is anxious. 3. Teaching problem-solving skills. 4. All of the above are correct

ANS: 4 Feedback 1. Discussing feelings can help a child understand how to deal with adversity and decrease anxiety. 2. Decreasing stimuli allows the brain to slow down and understand the actions around them, thus decreasing anxiety. 3. Problem-solving techniques can provide support so that the child does not feel as anxious. 4. All of the statements are needed to support and teach the child how to deal with anxiety when the parents are not present.

11. A mental health nurse is beginning her assessment of a teenager. What question would be appropriate for the situation? 1. What types of experiences have caused a major change in your life recently? 2. What types of medication do you take? 3. Please tell me three things you like about yourself. 4. All of the above are correct questions to ask in order to assess a teen.

ANS: 4 Feedback 1. This question may enable the teen to feel that someone is willing to listen to his/her feelings and ideas. 2. Medications may influence how the teen copes with situations. 3. This question asks for a response of three positive thoughts about for the teen regarding himself/herself, which allows the nurse to assess the teens self image. 4. All of the responses to these questions can be part of the assessment for the mental health professional to identify areas of concern as well as build a rapport and establish trust with the teen.

59. A nursing intervention for a child taking antipsychotic medications is: 1. Monitoring vital signs. 2. Monitoring for Metabolic Syndrome. 3. Education on the medications side effects. 4. All of the above should be done.

ANS: 4 Feedback 1. Vital signs should be monitored because some antipsychotic medications can cause allergic reactions. 2. Monitoring for Metabolic Syndrome should be done because it is a side effect of antipsychotic medications in children. 3. Any medication being taken should be accompanied with education so that the parents understand the full effects on their child. 4. Each intervention is an important feature for a child taking an antipsychotic medication.

58. A nurse notes that a patient has developed Neuroleptic Malignant Syndrome. The nursing priority should be to: 1. Stop the antipsychotic medication immediately and notify the doctor. 2. Prepare to administer Epinephrine to the patient. 3. Elevate the head of the patients bed. 4. Prepare to start IV fluids.

ANS: 1 Feedback 1. The syndrome requires the immediate interventions of stopping the medication and notifying the doctor. 2. Epinephrine is not a rescue medication in this situation. 3. Elevating the head of the bed will not change the development of the syndrome. 4. IV fluids will not stop the progression of the syndrome.

33. A family has decided to try ECT for their daughter. Prior to the ECT procedure, the nurse should: 1. Explain that the therapy is only used on severe patients. 2. Place the child on seizure precautions after the procedure. 3. Obtain informed consent for the procedure. 4. Explain that the procedure should not be done because the child can become more depressed.

ANS: 2 Feedback 1. ECT can be used in a variety of settings for success. 2. The child should be on fall precautions. 3. Informed consent will review the risk of the procedures. 4. ECT can decrease depression.

6. A child has been diagnosed with having dopamine deficiencies. The nurse would anticipate signs of _________ during an assessment. 1. Fatigue 2. Compulsions 3. Decreased motivation 4. A depressed mood

ANS: 3 Feedback 1. A child will be agitated. 2. A child will have decreased cognitive function. 3. The lack of motivation is noted in children with dopamine deficiencies. 4. A depressed mood is not a symptom of dopamine deficiencies.

85. In caring for a patient who is experiencing alcohol withdrawal, which of the following is the most appropriate tool for assessing the patients signs and symptoms? 1. CAGE 2. CINA 3. CIWA-Ar 4. SCOFF

ANS: 3 Feedback 1. CAGE is not an assessment tool used for alcohol withdrawal. 2. CINA is the assessment tool used to assess the severity narcotics withdrawal. 3. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) is an assessment tool used to quantify the severity of alcohol withdrawal syndrome as well as to monitor and medicate patients going through withdrawal. A score of 8 points or fewer corresponds with mild withdrawal. A score of 9 to 15 points corresponds to moderate withdrawal. Scores of 15 or greater correspond to severe withdrawal and an increased risk of delirium tremors and seizures. 4. The SCOFF tool is used to assess patients with eating disorders.

42. Exposure therapy should be referred for a child when: 1. The child is experiencing suicidal thoughts. 2. The child is hyperactive. 3. The child has a severe phobia toward social situations. 4. The child experiences alexithymia.

ANS: 3 Feedback 1. Exposure therapy could cause further suicidal thoughts because the child is unable to cope. 2. Exposure therapy would not be helpful for the child to learn to cope with racing thoughts. 3. Exposure therapy can gradually aid the child in facing fears in order to decrease the phobia of certain situations. 4. The child may experience alexithymia as a characteristic of a phobia, so exposure therapy will not treat the phobia.

46. Identify the non-stimulant ADHD medication. 1. Ritalin 2. Vyvanse 3. Intuniv 4. Adderall

ANS: 3 Feedback 1. Ritalin is a stimulant medication stimulant. 2. Vyvanse is a stimulant medication. 3. Intuniv is a non-stimulant and can be used for ADHD. 4. Adderall is a stimulant medication.

29. When using the SAD FACES depression screen, it is important to assess: 1. Anhedonia. 2. Suicidal ideations. 3. Sleep patterns. 4. All of the above

ANS: 4 Feedback 1. Lack of pleasure can indicate depression. 2. Suicidal ideations can indicate depression. 3. Too much sleep and fatigue can indicate depressive moods. 4. Lack of pleasure, ideations, and sleep patterns can indicate a depressive state in teens.

13. The nurse is providing care for a female adolescent at an in-patient facility for persons with eating disorders. The adolescent's current weight is less than 85% of ideal body weight. The adolescent appears to be unexpectedly agreeable with the interventions being implemented for weight gain. Which is an important intervention for the nurse to perform? 1. Eat with the client in order to demonstrate adequate intake. 2. Closely monitor the adolescent's bathroom behavior. 3. Allow the adolescent to select the flavor of nasogastric (NG) tube feedings. 4. Provide information about the effects of malnutrition on the body.

ANS 2 1 This is incorrect. Eating with the adolescent in order to demonstrate adequate intake is unlikely to be helpful. The adolescent's concern is about her body and her food intake. 2 This is correct. Because the adolescent seems to be unexpectedly agreeable with the interventions implemented for weight gain, the nurse needs to carefully monitor the adolescent's bathroom behavior. Patients with anorexia nervosa are likely to attempt to dispose of food in the toilet. Vomiting and pocketing of food is common. 3 This is incorrect. If NG tube feedings are prescribed for the patient with anorexia nervosa, the flavor is not of concern to the patient. 4 This is incorrect. When an adolescent weight is less than 85% of ideal body weight, information about the effects of malnutrition of the body is not likely to change the adolescent's perception of her body.

17. The nurse is providing care for a preschool child who is 4 years of age. The child is being treated for horrific abuse that occurred in the home since the child was an infant. Which comments by the child indicate to the nurse a possible dissociative disorder? Select all that apply. 1. "Someday I will live with grandma." 2. "If it hurts, I will just go away." 3. "I have a friend who always stays with me." 4. "I want a really big lunch and dinner." 5. "I can be invisible if they get mad at me."

ANS 2,3,5 1. This is incorrect. When the child voices "Someday I will live with grandma," it is not an example of dissociative disorder. 2. This is correct. The nurse will recognize that voicing the ability of "going away" if something hurts is a possible indication of dissociative disorder and is probably related to magical thinking. 3. This is correct. The nurse is aware that the child's belief that there is a friend who always stays with the child alerts the nurse to an imaginary friend and magical thinking, which can indicate dissociative thinking in an abused child. 4. This is incorrect. Expressing the desire for a big lunch and dinners is most likely an indication of hunger and not a dissociative disorder. 5. This is correct. The magical thinking of a child prompts the child to mentally become invisible if "they" are mad. This is indicative of dissociative thinking.

81. A nurse is working with a 15-year-old girl who has been diagnosed with Anorexia Nervosa. The nurse understands that the disorder differs from Bulimia in that Anorexia Nervosa patients: 1. Engage in self-starvation. 2. May exhibit tooth loss or poor dentition. 3. Take laxatives, vomit, or exercise excessively to purge food. 4. Usually present within the normal weight range for their height.

ANS: 1 Feedback 1. Some of the characteristics of anorexia nervosa are: self starvation; relentless pursuit of thinness; distorted body image despite extreme thinness; and significant weight loss, with weight less than 85 percent of their ideal body weight. Bulimic patients will: sneak food; have recurrent episodes of binge eating with or without purging; are usually of a normal body weight; use laxatives, vomiting or excessive exercise to purge food; lose enamel on their teeth from frequent exposure to the hydrochloric acid from the stomach when vomiting; and may have Russells sign, or teeth marks on the knuckles from self-induced vomiting. 2. Bulimic patients will lose enamel on their teeth from frequent exposure to the hydrochloric acid from the stomach when vomiting. 3. Bulimic patients will use laxatives. 4. Bulimic patients are usually of a normal body weight.

87. Pediatric mental health patients who have experienced a high level of psychological pain are often unable or unwilling to communicate feelings. This is referred to as: 1. Alexithymia. 2. Anhedonia. 3. Defiance. 4. Depersonalization.

ANS: 1 Feedback 1. Alexithymia translates as I have no words for my feelings, and occurs as the result of a high level of psychiatric pain, especially when the patient feels like he/she is unable or unwilling to communicate feelings. 2. Anhedonia is the lack of pleasure from an activity. 3. Defiance is open disobedience. 4. The patient is watching the act that he/she is doing and does not realize he/she is the cause.

32. A grandmother reports that her grandson has been taking an SSRI for the past month, along with St. Johns Wort. The grandmother states that there have been no changes in the adolescents behavior. She is concerned that the medications are just for junkies. The mental health nurse knows that: 1. St. Johns Wort can cause serotonin syndrome, so no benefit may occur. 2. The SSRI is probably the wrong medication for the adolescent. 3. The adolescent is exhibiting serotonin discontinuation syndrome 4. The SSRI needs to be stopped immediately because it is causing the adolescent more harm.

ANS: 1 Feedback 1. St. Johns Wort can cause the SSRI to be ineffective and should be stopped. 2. Because of the use of St. Johns Wort, a true assessment of the SSRI cannot be done. 3. The adolescent has not had a therapeutic effect of the SSRI because of the St. Johns Wort. He is experiencing serotonin syndrome, not discontinuation syndrome. 4. The St. Johns Wort needs to be discontinued, not the SSRI.

24. A mental health nurse is teaching the mother of a child with executive functioning issues ways to help her child. Interventions the mother should use include: 1. Placing visual aids on the bathroom mirror so that the child will follow the morning routine. 2. Give the child a choice in foods to eat. 3. Allowing the child to ask for help when needed. 4. Reminding the child to be nice to others

ANS: 1 Feedback 1. The visual aids help trigger the brain to recognize sequences. 2. Choices will confuse a child with functioning issues. 3. The child may not be able to verbalize his/her wants and requires a focus. 4. Treatment toward others is not an issue for children with this disorder.

93. MacDonalds Triad is the precursor to Antisocial Personality Disorder in adulthood. Which of the following are components of MacDonalds Triad? 1. Enuresis, cruelty to animals, and pyromania 2. Encopresis, hallucinations, and impulsivity 3. Hyperactivity, kleptomania, truancy 4. Difficulty sleeping, destruction of property, and lying

ANS: 1 Feedback 1. Young children who display bed-wetting, cruelty to animals, and pyromania will likely have Antisocial Personality Disorder as an adult. This is referred to as MacDonalds Triad. 2. Young children who display bed-wetting, cruelty to animals, and pyromania will likely have Antisocial Personality Disorder as an adult. This is referred to as MacDonalds Triad. 3. Young children who display bed-wetting, cruelty to animals, and pyromania will likely have Antisocial Personality Disorder as an adult. This is referred to as MacDonalds Triad. 4. Young children who display bed-wetting, cruelty to animals, and pyromania will likely have Antisocial Personality Disorder as an adult. This is referred to as MacDonalds Triad.

95. Soft restraints have been placed on a violent teenage girl. The nursing staff will follow protocol by: (Select all that apply.) 1. Checking to make sure two fingers can be placed between the restraints and the arm. 2. Releasing the teen from the restraints because they are illegal. 3. Provide one-on-one staff observations for the girl. 4. Place the teen in a prone position to provide safety for the staff. 5. Should not be placed in soft restraints as this is a violation of the Nursing Standards Act.

ANS: 1, 3 Feedback 1. The two fingers demonstrates that the restrains are snug, but not too tight, causing circulation issues. 2. The restrains are legal because the patient is violent and can cause harm to her or others at this time. 3. One-to-one observation is needed for a safety watch while wearing the restraints. 4. The patient should be placed in a supine position so that the airway is not compromised. 5. This is not a violation if the proper safety measures are observed.

66. An inpatient treatment facility has a 15-year-old patient receiving a Dopamine agonist for withdrawal of: 1. Heroin. 2. Cocaine. 3. Xanax. 4. Nicotine.

ANS: 2 Feedback 1. Heroin is a narcotic, and a dopamine agonist is not helpful for withdrawal of this drug. 2. Cocaine withdrawal will respond to the use of a Dopamine agonist. 3. Xanax is a Benzodiazepine, and a Dopamine agonist will not be helpful for the withdrawal. 4. Nicotine is a stimulant and will not respond to a Dopamine agonist for withdrawal.

84. A 16-year-old boy is admitted as an inpatient for alcohol substance abuse. As his nurse, part of the plan of care is to assess him for any signs and symptoms of delirium tremors, including: 1. Itchy skin. 2. Hallucinations. 3. Headaches. 4. Muscle cramps.

ANS: 2 Feedback 1. Itchy skin in not a sign of delirium tremors. 2. A delirium tremor is the most severe type of alcohol withdrawal, occurring within one week of cessation or severe reduction in alcohol use. Patients may experience visual or tactile hallucinations; disorientation; delusions and agitation; anxiety and feeling frightened; and grand mal seizures. 3. Headaches may occur before the delirium tremors begin. 4. Muscle cramps are not noted in delirium tremors.

90. In a patient experiencing Benzodiazepine withdrawal, such as with Xanax or Ativan, which of the following would be administered by the nurse as an intervention? 1. Sedatives 2. Phenobarbital 3. Amantidine 4. A substitute, such as methadone

ANS: 2 Feedback 1. Sedatives are used to treat withdrawal of hallucinogens. 2. Phenobarbital is one of the drugs used to treat Benzodiazepine withdrawal. Sedatives are used to treat withdrawal of hallucinogens. Amantidine is in the class of Dopamine agonists used to treat withdrawal from crack/cocaine. Methadone is used to treat opioid withdrawal. 3. Amantidine is in the class of dopamine agonists used to treat withdrawal from crack/cocaine. 4. Methadone is used to treat opioid withdrawal.

50. A 7-year-old child with a history of stealing candy from the teachers purse probably has which type of disorder? 1. Pyromania 2. Kleptomania 3. Dissociative identity 4. Severe post-traumatic stress disorder

ANS: 2 Feedback 1. The child is not starting fires. 2. The child is exhibiting signs of wanting what belongs to others. 3. The child is not dissociating from reality. 4. The child is not exhibiting signs of fear or reliving a traumatic event when stealing.

44. During an assessment of an 11-year-old boy, the nurse notes that the child does not recall events from two hours ago. Past history indicates that the child was removed and placed in foster care three days ago because of neglect and severe physical abuse. The nurse anticipates that the diagnosis for the child will be: 1. Dissociative fatigue. 2. Post-traumatic stress disorder. 3. Dissociative amnesia. 4. Dissociative identity disorder.

ANS: 3 Feedback 1. An assessment for fatigue is not indicated. 2. PTSD will cause frequent recall of the traumatic events. 3. The child is stepping away from remembering what occurred and does not have any memory of the events at this time. 4. The child can identify with himself and is not demonstrating destructive behaviors.

92. Electroconvulsive Therapy (ECT) would be an appropriate intervention for which of the following patients? 1. A 12-year-old girl diagnosed with schizophrenia three months ago who has now relapsed with another episode. 2. A 16-year-old girl diagnosed with Anorexia who has lost another 2 pounds. 3. A severely depressed 16-year-old boy who has not responded to psychotherapy or medication. 4. A 12-year-old boy who has Dissociative Identity Disorder with 10 apparent personalities.

ANS: 3 Feedback 1. Electroconvulsive therapy (ECT) is the last resort treatment for a pediatric psychiatric patient experiencing depression. 2. Electroconvulsive therapy (ECT) is the last resort treatment for a pediatric psychiatric patient experiencing depression. 3. Electroconvulsive therapy (ECT) is the last resort treatment for a pediatric psychiatric patient experiencing depression and will usually be used only for adolescents. 4. Electroconvulsive therapy (ECT) is the last resort treatment for a pediatric psychiatric patient experiencing depression.

41. A teacher asks the school nurse why a girl in her class continues to arrange the pencils on her desk and will wash her hands several times after another child touches the pencils. The nurse knows these are signs of ____________ in children. 1. Depression 2. ADD 3. Compulsive behaviors 4. Normal behavior patterns

ANS: 3 Feedback 1. The continuous, repetitive behaviors do not indicate depression. 2. These characteristics are not present with ADD. 3. The continuous and repetitive behaviors are characteristics of compulsive behaviors. 4. The childs actions are not normal and require further assessment.

83. A 13-year-old boy used to be able to drink two beers in order to feel a buzz. Now he has to drink four beers in order to achieve the same effect. This is referred to as: 1. Abuse. 2. Addiction. 3. Dependence. 4. Tolerance.

ANS: 4 Feedback 1. Abuse is substance use for the purpose of intoxication or for treatment beyond the intended use. 2. Addiction is the psychological and behavioral dependence on a substance. 3. Dependence is substance use despite adverse consequences where an individual feels normal only when on the drug. 4. Tolerance is defined as needing increasing amounts of a substance to achieve the same effect.

94. A nurse is working on the discharge plan of a 17-year-old female patient found to be abusing narcotics. The nurse should include which of the following in her plan? 1. Referral to a support group, such as Narcotics Anonymous 2. Administration of an opiate substitute, such as methadone 3. Educating the patient and family on the warning signs of a relapse 4. All of the above

ANS: 4 Feedback 1. Management of a patient abusing narcotics includes individual or group therapy and/or a referral to Narcotics Anonymous. 2. Management of a patient abusing narcotics includes administering opiate substitutes. 3. Patients and their families need to be educated on the warning signs of a relapse for early intervention. 4. Management of a patient abusing narcotics includes individual or group therapy and/or a referral to Narcotics Anonymous, assessing for the use of other substances, monitoring vital signs, administering opiate substitutes, and controlling withdrawal symptoms. Patients and their families need to be educated on the warning signs of relapse for early intervention. These include being around other users, having severe cravings, and ceasing or decreasing attendance at Narcotics Anonymous.

82. Which of the following are risk factors in the development of an eating disorder? 1. Caucasian race 2. Low self-esteem 3. Middle to upper class 4. All of the above

ANS: 4 Feedback 1. Risk factors in developing an eating disorder include being of the Caucasian race. 2. Risk factors in developing an eating disorder include low self-esteem. 3. Risk factors in developing an eating disorder include middle to upper class status. 4. All of the above are correct. Risk factors in developing an eating disorder include being of the Caucasian race; middle to upper class status; age adolescence into the 20s; genetic predisposition; neurochemical involvement; low self-esteem; conflicts over identity, role development, and body image; fears concerning sexuality; sexual abuse; parental over-emphasis or excessive worrying; and overly close mother-daughter relationships.

88. A 17-year-old boy is admitted as an inpatient after being diagnosed with Neuroleptic Malignant Syndrome. The nurse recognizes this as a life-threatening neurological disorder and includes which of the following in her plan of care? 1. Ask what antipsychotic medications and dosages the patient is taking at home 2. Assess and monitor the patients vital signs, including temperature 3. Monitor the patients creatine phosphokinase levels 4. All of the above.

ANS: 4 Feedback 1. The drug needs to be stopped immediately, and supportive care and relief of symptoms should be provided. 2. Signs and symptoms are summarized by the acronym FEVER: fever, encephalopathy, vitals unstable, elevated enzymes (CPK), and rigidity of muscles. 3. Signs and symptoms are summarized by the acronym FEVER: fever, encephalopathy, vitals unstable, elevated enzymes (CPK), and rigidity of muscles. The drug needs to be stopped immediately, and supportive care and relief of symptoms should be provided. 4. Neuroleptic malignant syndrome is a life-threatening disorder most often caused by an adverse reaction to antipsychotic medications. Signs and symptoms are summarized by the acronym FEVER: fever, encephalopathy, vitals unstable, elevated enzymes (CPK), and rigidity of muscles. The drug needs to be stopped immediately, and supportive care and relief of symptoms should be provided.

10. The nurse is counseling a parent of a child diagnosed with ADHD. The parent states, "He is now also diagnosed with oppositional defiant disorder (ODD). I don't know what to do." Which information does the nurse provide for the parent? 1. The fact that 40% to 60% of children with ADHD also have ODD. 2. The importance of not showing emotional reactions to the behaviors. 3. How to remain consistent with consequences related to ODD behaviors. 4. The need and availability of parent training for behavior management.

ANS 4 1 This is incorrect. Providing statistical information to the parent about the incidence of ADHD and ODD is not going to specifically address the parent's concern about behavioral management. 2 This is incorrect. Learning how to not show emotional reaction to ODD behavior is important but is only one point of learning presented in a parent training program. 3 This is incorrect. Remaining consistent about consequences related to ODD behavior is important but is only one point of learning presented in a parent training program. 4 This is correct. The nurse needs to provide information to the parent about how to learn how to manage ODD behavior. The parent needs to know about and how to access a parent training program.

48. A teacher is working with a child with a known diagnosis of Oppositional Defiant Disorder. The teacher should include which of the following in her approach to the child? 1. Be consistent with consequences 2. Require the child to sit at the front of the classroom 3. Allow the child to play outside only when good behavior is present 4. Obtain a paraeducator to help with school activities

ANS: 1 Feedback 1. Known consequences can facilitate boundaries that the child will understand. 2. Positioning in the room does not affect the behaviors. 3. Physical activity is important for the child to release energy and relax. 4. A paraeducator may be needed for some children, but not all require this measure.

45. A 14-year-old teen has been taking Strattera for several months. The nurse should be aware that Strattera can: 1. Increase the risk for suicidal ideations in adolescents. 2. Has an extended release formula. 3. Is the best option for ADHD in adolescents. 4. Requires frequent blood tests to check for therapeutic ranges.

ANS: 1 Feedback 1. Long-term use of Strattera can lead to suicidal ideations in teens. 2. No extended release formula is currently available. 3. Use of Strattera should be avoided in teens. 4. Therapeutic ranges are done through observations, not blood tests.

4. A teenager with a known deficit of norepinephrine may exhibit problems with which of the following? 1. Concentration 2. Social relationships 3. Self-confidence 4. Physical motor skills

ANS: 1 Feedback 1. Norepinephrine allows the brain to concentrate on tasks. 2. Social relationships usually are not influenced by norepinephrine deficits. 3. Self-confidence is a learned behavior and is not influenced by the norepinephrine deficit. 4. Norepinephrine does not influence physical mobility because it influences cognitive brain function.

28. A teen should be checked for depression at __________ physician visit(s). 1. Every 2. One 3. Monthly 4. Bi-yearly

ANS: 1 Feedback 1. Teens are relatively healthy and require infrequent physician visits. Speaking with the teen at every visit will help to identify depression early. 2. The teen may develop depression over time and questions should be asked at every visit. 3. Teens are relatively healthy and do not require monthly physician visits. 4. Every visit assessment should include a depression check.

34. An 11-year-old boy is exhibiting alexithymia. The nursing interventions for the child: 1. Require frequent assessments for non-verbal indications. 2. Require infrequent assessment of depressive feelings. 3. Require the head of the bed to be elevated 30 degrees. 4. Require a providers order to proceed with the assessment.

ANS: 1 Feedback 1. The patient is not able to verbally express pain, so non-verbal indications of pain should be observed. 2. Frequent assessments should be provided. 3. Positioning will not identify reasoning for the alexithymia. 4. An order is not required for the assessment

9. A mental health nurse is seeing a patient for the first time. It will be important for the nurse to assess: 1. The childs family, social, cultural and psychological aspects. 2. The childs psychological aspects. 3. The childs reasons for attending the therapy session. 4. The dynamics between the family members and the psychological factors.

ANS: 1 Feedback 1. These four aspects influence the childs mental health status. 2. Family, social, and cultural aspects influence the overall mental health of the individual, along with the physiological aspects. 3. The care provider will need to assess the childs family, social, cultural, and psychological aspects to understand the reason for attending therapy. 4. Family dynamics are an important influence on mental health, but can be influenced by the social, cultural, and psychological aspects as well.

76. A 12-year-old girl is being evaluated after she was caught stealing. She has reported to the nurse that she feels very tense prior to stealing, but experiences a sense of pleasure and relief afterwards. The nurse recognizes these characteristics as indicative of which of the following impulse-control disorders? 1. Phobia 2. Kleptomania 3. Pyromania 4. Panic disorder

ANS: 2 Feedback 1. The child is not fearful in this situation, thus it is not a phobia. 2. Kleptomania is characterized by a failure to resist the urge to steal, feeling tense prior to the theft, feeling pleasure and relief after the theft, and not having any known/recognized motives. 3. The child does not show an interest in fire. 4. The child is not fearful of the situation and finds pleasure in the activity.

65. A 13-year-old teen has been brought to the nurses office at school because the teacher is concerned about his red eyes and lack of concern for his appearance. The nurse should assess the student: 1. For Pink Eye. 2. For the use of drugs, especially marijuana. 3. For flu-like symptoms. 4. With the CAGE technique.

ANS: 2 Feedback 1. The lack of concern about appearance requires further assessment. 2. Lack of concern and red eyes are indicators of the use of drugs in a teen. 3. The lack of concern about appearance requires further assessment and is usually not an indicator for the flu. 4. The CAGE technique should not be used in the assessment of a teen with possible drug usage

69. A mother has brought her daughter to the clinic for the fifth time in one month. The mother is claiming that her daughter is exhibiting signs of a rare form of cancer. The child appears well upon assessment. The nurse should be concerned that the mother: 1. Is overprotective. 2. Is exhibiting signs of Munchausen syndrome by proxy. 3. Is overly concerned. 4. Is causing her child to undergo un-needed medical procedures.

ANS: 2 Feedback 1. The mother may be overprotective, but the indication of assessing for rare diseases is a warning sign requiring further investigation. 2. The characteristics are that of Munchausen syndrome by proxy. 3. Information about rare forms of cancer is not normal. The amount of times in the clinic is also not normal. 4. The mother is causing her child to undergo un-needed medical procedures, which is a characteristic of Munchausen syndrome by proxy.

16. A 16-year-old male has received a pink-slip from the police for inpatient psychiatric treatment. The teen has been expressing thoughts of hanging himself because Life sucks. The nursing staff should consider placing the child: 1. With peers. 2. In an area where he can be watched one-on-one. 3. With a roommate that is expressing the same concerns. 4. In an area close to an external door.

ANS: 2 Feedback 1. The patient is at extremely high risk for harm and should not be placed with peers. 2. The patient should be watched closely because of his current thought processes to harm himself. 3. The patient is at extremely high risk for harm and should not be placed with a roommate for concern of harming others. 4. The external door area may have an increased amount of traffic and noise. The individual needs to be in an area of lower external stimulation to help decrease anxieties and harmful thoughts because he is not coping.

63. A CAGE screening has been done on a 17-year-old male student. The nurse notes that the total score is 1. The nurse should: 1. Contact the doctor for further treatment options. 2. Understand that this score does not require further intervention. 3. Inform the doctor that the patient needs inpatient therapy. 4. Understand that this score is suggestive of the need for further treatment.

ANS: 2 Feedback 1. The score falls within normal range, and no further treatment is needed. 2. The range is normal and does not require further treatment. 3. The patient scored in the normal range, thus does not require therapy. 4. Further treatment is not needed at this time.

22. A child has been exhibiting the MacDonald Triad. These behaviors include: 1. Enuresis, pushing others, and pyromania. 2. Swinging a cat by the tail, bed-wetting, and lighting paper on fire in the trash can. 3. Playing with other children, laughing, and conversing with adults. 4. Playing with a campfire, watching television, and seeking adult attention.

ANS: 2 Feedback 1. The triad does not include physically touching human beings. 2. Causing harm to pets, bed-wetting, and lighting fires to cause harm are part of the MacDonald Triad. 3. The MacDonald Triad consists of abnormal/risky behavior patterns. 4. Watching television and seeking attention from adults is a normal behavior pattern for children.

3. Children with positive social environments: 1. Are at risk for mental illnesses. 2. Have less of a risk for developing mental illnesses. 3. Do not adjust to other cultures easily. 4. Must have control over their personal environment.

ANS: 2 Feedback 1. These children are not at risk. 2. Positive environments teach children confidence, empower children, and value the childs input. 3. Flexibility occurs in positive environments, thus letting a child adjust to new cultures. 4. The child does not need total control of the environment because the caregivers have the control.

37. An adolescent boy has recently had an increase in his Lithium dosage. The parents call the clinic because their son has been ill with a fever and chest congestion that seems to be getting worse. The nurse should: 1. State that this is not a side effect of the medication, and their son was probably exposed to a virus. 2. State that the patient is adjusting to the medication, and this is normal. 3. Be seen by the doctor immediately because these are signs of lithium toxicity. 4. Encourage the parents to give the child Acetaminophen to see if the symptoms subside.

ANS: 3 Feedback 1. Fever and chest congestion are indicators of lithium toxicity, and the patient should be seen immediately. 2. This is not normal and requires immediate intervention. 3. Fever and chest congestion are indicators of lithium toxicity, and the patient should be seen immediately. 4. Acetaminophen will not stop the lithium toxicity.

61. SCOFF is a tool used for: 1. Screening for autism. 2. Screening for Aspergers syndrome. 3. Screening for eating disorders. 4. Screening for obsessive-compulsive disorders.

ANS: 3 Feedback 1. It is used for screening for eating disorders, not autism. 2. It is used for screening for eating disorders, not Aspergers syndrome. 3. It is used for eating disorders to identify needs for further interventions. 4. It is used for screening for eating disorders, not obsessive-compulsive disorders.

38. Identify the type of anxiety that is common in toddlers. 1. Test anxiety 2. Separation anxiety 3. Situation anxiety 4. School anxiety

ANS: 2 Feedback 1. Occurs in school-age children 2. Separation from the people the child knows can increase anxiety for toddlers. 3. Exhibited in older children 4. Occurs in school-age children

71. An 11-year-old boy recently diagnosed with depression is starting a medication. Which one of the following would be a first-line drug in treating his depression? 1. Buspar 2. Depakote 3. Lexapro 4. Lithium

ANS: 3 Feedback 1. Selective Serotonin Reuptake Inhibitors (SSRI) are the first-line agents for treating depression. This medication is an anti-anxiety medication. 2. Selective Serotonin Reuptake Inhibitors (SSRI) are the first-line agents for treating depression. Depakote is an anticonvulsant. 3. Selective Serotonin Reuptake Inhibitors (SSRI) are the first-line agents for treating depression because they have fewer side effects than other classifications of drugs. Lexapro is one of those drugs in the SSRI class. 4. Selective Serotonin Reuptake Inhibitors (SSRI) are the first-line agents for treating depression. Lithium is mood stabilizer medication.

53. The acronym SLEPT is used for children with schizophrenia. The acronym stands for: 1. Sleep patterns, language, emotions, perceptions, and suicidal thoughts. 2. Social behavior, lack of language, emotions, perceptions, and thinking. 3. Social behavior, language, emotions, perceptions, and thinking. 4. Suicidal ideations, lack of language, lack of emotional control, poor self-perception, and lack of tolerance.

ANS: 3 Feedback 1. Sleep patterns and suicidal thoughts are not assessed with the SLEPT tool. 2. Lack of language is not assessed with the SLEPT tool. 3. All are characteristics of the SLEPT tool. 4. Suicidal ideations, lack of language and emotion, poor perception, and tolerance are not part of the SLEPT tool.

15. The nurse works in a facility where treatment of adolescents with addiction issues is the focus. A 14-year-old patient is being admitted for treatment of cocaine dependence. Which information does the nurse provide relative to the patient's withdrawal? 1. Acute symptoms of withdrawal last for 2 to 3 weeks. 2. The patient will be sedated throughout most of the process. 3. After acute withdrawal some symptoms may become chronic. 4. Close monitoring is important due to life-threatening symptoms.

ANS 3 1 This is incorrect. The symptoms related to acute withdrawal from cocaine will last for 4 to 10 days and include intense craving, agitation, depression, poor appetite, and insomnia. 2 This is incorrect. During cocaine withdrawal, the patient is not sedated throughout most of the process. The patient will receive anxiolytics, antidepressants, antipsychotics, and dopamine agonists (amantadine, bromocriptine) as ordered. 3 This is correct. After withdrawal from cocaine, some withdrawal symptoms may become chronic and may include fatigue, depression, anhedonia (lack of pleasure), mood disturbance, and cravings. 4 This is incorrect. Withdrawal from cocaine is rarely life-threatening; however, the nurse will monitor vital signs, especially heart rate and blood pressure.

64. A teenage female has been involuntarily admitted for alcohol abuse. The nurse taking care of the teen 36 hours after her last alcoholic beverage may exhibit: 1. Visual hallucinations. 2. A relaxed and conversational demeanor. 3. Violence toward the staff. 4.Anger Annoyance and request to be discharged because there is no reason for the admission.

ANS: 1 Feedback 1. Alcohol withdrawal can cause delirium tremors with hallucinations. 2. The teens body will be craving alcohol by this point, and withdrawal symptoms will start to appear. 3. Teens usually will not be violent because of the delirium tremors and hallucinations. 4. The teen is in withdrawal and cannot be discharged because of the involuntary placement.

7. The purpose of emotion intelligence is to measure: 1. A childs behavior pattern. 2. A childs mood changes. 3. A childs ability to be motivated. 4. A childs ability to ask for help.

ANS: 1 Feedback 1. Emotions are a response to the behaviors of a child. 2. Mood changes are influenced by emotions. 3. Motivation is a characteristic of emotions. 4. Asking for help is a tool to help with coping, but not the whole purpose of emotional intelligence.

35. An adolescent with a known history of bipolar disorder is in the school nurses office because a teacher reported that she was talking fast and acting like she was God. The school nurse assesses the girl and notes that: 1. She is probably in a manic phase and needs to be treated professionally. 2. She has had too much sleep and is now hyperactive. 3. She forgot to take her medications today. 4. She requires some food and rest before going back to class.

ANS: 1 Feedback 1. Excessive talking and superhuman characteristics are indications of a manic phase. 2. Bipolar patients in a manic phase tend not to sleep. 3. Patients with this disorder can go into a manic phase without medications, but they may also do this when medications are taken. 4. An intervention, more than food and rest, are needed to help the student.

60. A child with a known diagnosis of autism is receiving therapy for obsessions. The type of therapy that would be appropriate for the child would be: 1. Behavior modification therapy. 2. Family therapy. 3. Social skills training. 4. Medication.

ANS: 1 Feedback 1. Identifying an alternative to the obsessive behavior will aid the child with autism in changing the behavior. 2. Family therapy will aid in stopping the obsessive behaviors, but the child should also receive behavior modification therapy to reach the full potential. 3. Social skills are developed through interactions, and it is not for the treatment of obsessions. 4. Medications can help with obsessive behavior, but the child should also receive behavior modification therapy to reach the full potential.

75. Which one of the following medications used to treat ADHD has been associated with increased incidence of suicide in adolescents? 1. Strattera 2. Concerta 3. Intuniv 4. Adderall XR

ANS: 1 Feedback 1. Strattera has been associated with increased incidence of suicide in adolescents. The nurse needs to frequently assess children taking Strattera for any suicidal ideations. 2. This medication does not cause a risk for suicide ideations. 3. This medication does not cause a risk for suicide ideations. 4. This medication does not cause a risk for suicide ideations.

13. An involuntary admission means: 1. A child is refusing psychiatric treatments. 2. A child has been ordered by the police to receive inpatient psychiatric therapy. 3. A family has placed the child into inpatient psychiatric therapy. 4. A family is asking for help for the child

ANS: 2 Feedback 1. An involuntary admission would have law enforcement involvement. 2. The law enforcement requires treatment, otherwise legal consequences will occur. 3. The family can request placement because they are the legal guardians of the child. 4. Asking for help does not involve a legal matter, thus is not an involuntary admission.

31. A parent is asking the mental health nurse about the difference between Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT). The best explanation would be: 1. CBT is individual-based therapy, and IPT is done in group sessions. 2. IPT therapy is better suited for depressed adolescents because it can be done as a group or on an individual basis, but CBT is more suited for depressed children. 3. CBT has a better success rate than IPT. 4. IPT is used more with adults, but some studies are showing success with children.

ANS: 2 Feedback 1. Cognitive therapy concentrates on changing behavior patterns, while psychosocial therapy concentrates on personal interactions with others. 2. Adolescents have a better understanding of human interaction, while children need the one-to-one interaction in order to learn cognitive behavior. 3. This statement depends on the age of the child. 4. IPT can be used with adolescents.

54. An adolescent with a known diagnosis of schizophrenia has placed aluminum foil on all of his bedroom windows and refuses to come out because aliens are going to take him away. The adolescent is exhibiting signs of: 1. Hallucinations. 2. Delusions. 3. Exaggerated defense mechanisms. 4. Compensation for lack of self-confidence.

ANS: 2 Feedback 1. Fear of being taken away and planning for it is not a hallucination. 2. A fear and a plan are characteristics of a delusion. 3. The fear is not a defense mechanism. 4. Placing foil and isolation are not a compensatory mechanism for self-confidence.

55. A teen that is taking antipsychotic medications is complaining to the nurse that her tongue feels very thick. The nurse assesses the teen and notes that her eyes continuously look at the ceiling, and the tongue is not swollen. The nurse knows this could be a sign of: 1. Hallucinations 2. A side effect of the antipsychotic medications. 3. A chronic delusional state. 4. Dystonia.

ANS: 2 Feedback 1. Hallucinations would be auditory or visual in nature rather than giving the feeling of a swollen tongue. 2. These characteristics are common when taking antipsychotic medications. 3. These characteristics are indicative of a side effect, not a chronic state. 4. The patient is not demonstrating stiff muscle movement.

62. Complications from Anorexia Nervosa include all of the following except: 1. Muscle wasting. 2. Electrolyte imbalances. 3. Tooth enamel erosion. 4. Dehydration

ANS: 3 Feedback 1. The body begins to break down muscle to be used as a fuel source in severe anorexia. 2. Electrolytes are imbalanced because the body is not receiving the required nutrients from food. 3. Tooth enamel erosion occurs in Bulimic patients, not Anorexia Nervosa patients. 4. Dehydration occurs because of the lack of fluid and food intake.

57. CBC laboratory results have been returned on a pediatric patient with a history of schizophrenia. The doctor has ordered the nurse to start the patient on Clozapine. The nurse should: 1. Start giving the medication to the patient. 2. Check the WBC count prior to administering the medication. 3. Check the Hematocrit level prior to administering the medication. 4. Check the patients blood pressure prior to medication administration.

ANS: 2 Feedback 1. More pre-assessments should be completed prior to starting the medication. 2. A baseline WBC count should be taken because the medication should not be started if it is less than 3500. 3. A Hematocrit level is not required prior to administration. 4. A blood pressure check is not required prior to starting the medication.

21. An 8-year-old boy with a history of hallucinations and violent behavior has been place in a seclusion room at the hospital because he has been hurting others. The nurse checks on the patient and realizes she must take him out of the seclusion room when: 1. He is crying to be released. 2. He states, I will be a good boy now. 3. He starts headbutting the window. 4. He complains that his parents will file a lawsuit.

ANS: 3 Feedback 1. Crying is a common emotion when the child is experiencing hallucinations or violent behavior. 2. The statement is a manipulative behavior and is not true of a child in this state. 3. The headbutting causes severe self-harm, and an intervention must occur to stop the behavior. 4. The threats are a form of manipulation and should not be addressed at this time.

18. A mental health nurse has assessed a child and determined that the child exhibits behavioral challenges. When the school nurse explains this to a teacher, the best description would be: 1. The child may exhibit physical outbursts. 2. The child may exhibit violence toward others. 3. The child may be defiant or have tantrums. 4. The child will need special interventions for learning.

ANS: 3 Feedback 1. Physical outbursts are not descriptive of what the child exhibits. 2. Violence toward others is not defined as a behavioral challenge. 3. Defiance and tantrums describe the characteristics of behavioral challenges. 4. Interventions may be needed, but do not describe the types of behavioral challenges the child exhibits.

17. Learning disabilities in children have scientifically been linked to: 1. Poor nutrition. 2. The environment in which the child lives. 3. Genetics. 4. Watching more than four hours of television a day.

ANS: 3 Feedback 1. Poor nutrition can influence brain growth, but has not been scientifically proven to be a sole reason for learning disabilities. 2. The environment influences the stimulation a child receives, but has not been scientifically linked to causing learning disabilities. 3. Genetics provides a scientific link to reasons for learning disabilities. A child of a parent t with a learning disability has an increased risk. 4. Television does not stimulate the brain and can influence what the child is learning, but is not scientifically linked to learning disabilities.

27. A father reports that his adolescent daughter has gotten good grades up until the last quarter of school. She has been hanging out by herself and does not want to talk to him anymore. The mental health nurse should: 1. Realize that this is a natural part of growing up. 2. Perform a mental health screening to check for depression. 3. Attempt to get the adolescent to discuss why she does not like her father anymore. 4. Let the adolescent talk when she is ready.

ANS: 2 Feedback 1. A drop in grades and isolation are indicators of mental health issues. 2. Performing the mental health assessment will help to identify issues related to the isolation and drop in grades. 3. The isolation does not indicate that the teen does not like her father. 4. An intervention needs to occur because of the isolation and the lowering of grades.

89. Which of the following is an example of a patient with a dual diagnosis? 1. Depression and anxiety 2. Bipolar disorder and alcohol abuse 3. Anorexia Nervosa and Bulimia Nervosa 4. Child abuse and post-traumatic stress disorder

ANS: 2 Feedback 1. A substance issue is not addressed. 2. A dual diagnosis means having a primary mental health disorder with co-occurring substance issue. 3. The two diagnoses are eating disorders. 4. There is not a substance abuse issue.

36. A teenage girl with a known history of bipolar disorder has been taking Lithium for a year. The doctor has ordered that the teen start taking Haloperidol because of increased irrational behavior. The nurse should: 1. Educate the teen on the side effects of Haloperidol. 2. Ask the doctor to clarify the order because Haloperidol in contraindicated when taking lithium. 3. Give the medications at bedtime. 4. Verify the order with another staff nurse to make sure that the dosage for the Haloperidol and Lithium are in a therapeutic range.

ANS: 2 Feedback 1. Haloperidol is a contraindication with Lithium. 2. Clarification should be made for the patients safety. 3. The medications contraindicate each other and should not be given without clarification from the provider. 4. Verification needs to occur with the ordering provider.

67. Why is nicotine known as the gateway drug? 1. It is the first type of drug an adolescent may use. 2. It can lead to use of other illegal drugs, such as marijuana and alcohol. 3. It inhibits impulse control in adolescents. 4. It can create family issues.

ANS: 2 Feedback 1. Nicotine tends to be the first drug used, but has a high incidence of leading to further drug use. 2. Gateway indicates moving to sources other than nicotine. 3. The use of nicotine is a conscious decision. 4. Nicotine can create issues, but this is not why it is called a gateway drug.

51. A school-age child has been diagnosed with Intermittent Explosive Disorder. The nurse is providing discharge instructions and would need a clarification on the order because: 1. The child is to have Risperidone as a daily medication. 2. The child is to receive an SSRI. 3. The child has been recommended to have an ECT. 4. The child will need cognitive behavioral therapy.

ANS: 3 Feedback 1. Risperidone is an effective medication for this disorder. 2. The child does require an SSRI for this type of disorder. 3. ECTs are not recommended for a child with this disorder. 4. Cognitive behavioral therapy is an effective type of therapy for this treatment

74. A 13-year-old girl is receiving therapy for angry outbursts and is having difficulty with the teachers and authority figures at school. She recently broke the family TV by throwing a remote at the screen. The girl also attempted to choke her sister after getting into a verbal fight. In group therapy, the girl has shown no remorse for any of her actions. The nurse recognizes these characteristics as which of the following disorders? 1. Psychosis 2. Schizoaffective disorder 3. Conduct disorder 4. Intermittent explosive disorder

ANS: 3 Feedback 1. The child has not demonstrated that others are instigating her actions. 2. The child is not hearing voices indicating to do harm to others or herself. Usually, this disorder does not start to show signs until the lateteen, early-20s age range. 3. Conduct disorder is characterized by serious violations of social norms, including aggressive behavior, destruction of property, and cruelty to animals. Children with Conduct Disorder do not feel remorseful for their actions because they lack empathy. 4. The child is having trouble controlling multiple aspects of her life.

86. A mother brings in her 2-year-old daughter to be evaluated for blood in her urine. The mother brings in a urine specimen that appears to have blood in it. When completing the admission assessment, the nurse notes that the patient was admitted as an observation patient two weeks ago with the same complaint, but all studies were negative. When the nurse questions the mother about the previous admission, the mother insists that her daughters condition has remained unchanged. The nurse suspects which of the following disorders? 1. Urinary tract infection 2. Post-traumatic stress disorder 3. Munchausen syndrome by proxy 4. Schizoaffective disorder

ANS: 3 Feedback 1. The child is not demonstrating signs of urinary tract infections. 2. The child does not demonstrate signs of post-traumatic stress disorder. 3. Munchausen syndrome by proxy is when a caregiver, usually the mother, attempts to make the child appear ill. The caregiver may put blood in the childs urine, stool, or vomit, or report fake symptoms to health-care providers. The child may be admitted to the hospital for diagnostic tests. 4. The child does not demonstrate psychiatric issues.

56. An adolescent with schizophrenia has been refusing to take his medications on a daily schedule. The visiting nurse knows that it is important for medications to be taken to maintain a normal, balanced life. The visiting nurse discusses treatment options with the doctor. The best solution for this patient would be: 1. Inpatient therapy. 2. Daily in-home visits. 3. Risperdal Consta. 4. Seroquel.

ANS: 3 Feedback 1. The refusal of medication is not a reason for inpatient therapy and may cause more resentment for treatment. 2. Daily home visits may not be well received by the adolescent, causing further refusal for the daily medication. 3. Risperdal Consta only needs to be taken every two weeks and may help the adolescent exhibit more compliance than with the daily medication. 4. Seroquel is a daily mediation and could increase resistance to taking medications.

12. A nurse receives a C-GAS score of 80 from a psychiatrist treating a 10-year-old boy. The findings indicate that: 1. The child has a poor level of functioning and needs a substantial amount of care. 2. The child is at a normal level for his age and should continue with activities that are working. 3. The child is managing his daily life well and reassessment should be done as needed. 4. The child is at considerable risk and should have support systems set in place.

ANS: 3 Feedback 1. The score is higher and does not indicate a poor level of functioning. 2. The C-GAS is adaptable at each age and does not indicate a need for a follow-up visit. 3. A C-GAS score of 80 falls within the normal range and does not indicate a need for a follow-up visit. 4. The child is not at risk because the score indicates management of daily life.

10. A 14-year-old boy reports that he has been seeing and hearing things. His friends tell him it is like he goes to another world sometimes. The teen does not understand what is happening to him. The mental health nurse is aware that the teen could be experiencing: 1. Suicidal ideations. 2. Obsessive-compulsive behaviors. 3. Hallucinations. 4. Stress.

ANS: 3 Feedback 1. There are no indications of harm to himself or his peers at this time. 2. The teen is not demonstrating a repetitive behavioral pattern. 3. The teen is having auditory and visual hallucinations per his report because only he can experience this situation. 4. Stress can cause changes in behavior, but is not accompanied with auditory and visual hallucinations.

2. Risk factors for a child to develop a mental illness include all of the following except: 1. Low birth weight. 2. Family history. 3. Caregiver neglect. 4. A wealthy family

ANS: 4 Feedback 1. A low birth weight baby did not receive the adequate nutrition for proper brain development. 2. Many mental illnesses have a genetic link. Also, the environment in which a family lives can influence coping and various other mental illness issues. 3. A child needs to have a bond with someone to learn how to communicate, interact, and learn values and norms. If this is neglected, the child will struggle to learn psychosocial interactions throughout life. 4. A wealthy family can have mental health disorders, but has the means to seek treatment, have proper nutrition, and provide the needed love/support for a child.

79. Which of the following statements is true about autism? 1. Autistic children are more likely to be born to moms 35 and older and born breech. 2. Deficits, such as poor eye contact and not smiling, are apparent by the age of 18 months. 3. Diagnosis of the disorder is often made prior to the age of 3. 4. All of the above

ANS: 4 Feedback 1. Autistic children are more likely to be born to moms 35 and older and born breech. 2. Genetic mutations relating to autism have been discovered. The disorder is diagnosed prior to age 3, with deficits becoming apparent around 18 months. 3. The disorder is diagnosed prior to age 3, with deficits becoming apparent around 18 months. 4. Autistic children are more likely to be born to moms 35 and older and born breech. The disorder is diagnosed prior to age 3, with deficits becoming apparent around 18 months. Genetic mutations relating to autism have been discovered.

40. Buspar has been prescribed for a boy with a diagnosis of anxiety. The nurse knows that the medication: 1. Is reserved for extreme cases only. 2. Requires laboratory tests to maintain a therapeutic range. 3. Should not be given with citrus foods. 4. Is not addictive and can last for several hours

ANS: 4 Feedback 1. Buspar can be used in children with mild forms of anxiety. 2. Reports from the patient and the parents can indicate if the medication is working. 3. Citrus foods are not contraindicated with Buspar. 4. Buspar is commonly used in children because of the minimal side effects and success of treatment.

19. A child that has not exhibited enuresis in four years has exhibited this behavior pattern for the last week. The reason a child may revert back to this behavior pattern is because of: 1. Hallucinations. 2. Behavioral challenges. 3. Delusions. 4. Stress.

ANS: 4 Feedback 1. Hallucinations usually do not accompany enuresis episodes in children. 2. Behavioral challenges are noted by other people, not the child. 3. Delusions usually do not accompany enuresis episodes in children. 4. Stress can cause a child to exhibit enuresis because of the chemical release, causing the bladder to relax and defecate.

16. The nurse is presenting a program to the parents of school-age children about prescription drug abuse among adolescents. Which information does the nurse provide to parents about preventing their children from abusing prescription drugs? 1. Most drugs are obtained cost free from friends or family members. 2. The abused drugs are not commonly found in the normal household. 3. Adolescents are at great risk for life-threatening effects from these drugs. 4. Withdrawal from this type of drug can be managed by the adolescent's family.

ANS 1 1 This is correct. It is true that most prescription drugs are available at no cost from friends or family members. When this source is no longer available, the abuser will turn to opiates from street sources. 2 This is incorrect. Commonly abused prescription drugs include opioid pain relievers, stimulants, and benzodiazepines, which are frequently in the household medicine cabinets or bedside tables. 3 This is incorrect. It is possible to overdose on prescription drugs; however, the greatest life-threatening risk is from street opiates, because the content and strength is unregulated. 4 This is incorrect. The nurse will refer children who are prescription drug abusers to inpatient or outpatient withdrawal management. Withdrawal will require medical management and monitoring.

12. The nurse is discussing a child's diagnosis of autism (ASD) with the child's parents. The parents tell the nurse the child is completely resistant to any type of stimulation. The nurse suspects sensory processing disorder and will recommend which intervention? 1. Make a rocking horse or trampoline available to the child. 2. Place colored lights and automated toys in the child's room. 3. Set specific times of day when the child is held and cuddled. 4. Child-appropriate music is played throughout the day.

ANS 1 1 This is correct. Children with ASD often have a sensory processing disorder, which makes them highly sensitive to sensory stimuli. The nurse recommends short periods of exposure to increasing stimuli to build tolerance. The child is most receptive to items that cause motion, such as a rocking horse or trampoline. 2 This is incorrect. These children are highly sensitive to sensory stimuli. Lights seem extra bright, noises seem extra loud, and even mild tactile stimulation seems like a big push or shove. 3 This is incorrect. These children are highly sensitive to sensory stimuli. Lights seem extra bright, noises seem extra loud, and even mild tactile stimulation seems like a big push or shove. Holding the child and cuddling at specific times may not be effective. The stimulus is introduced slowly in order to build tolerance. 4 This is incorrect. These children are highly sensitive to sensory stimuli. Lights seem extra bright, noises seem extra loud, and even mild tactile stimulation seems like a big push or shove. Playing music throughout the day is likely to be stressful to this child. The stimulus is introduced slowly in order to build tolerance.

9. A parent of an adolescent tells the nurse, "He had some bad habits as a child, but now he is in trouble with the law for destruction of property, stealing, and hurting animals. I think his ODD is getting worse." Which comment by the nurse is accurate? 1. "Your son has developed conduct disorder." 2. "Increasing his ADHD medication may help." 3. "Right now he needs your feedback and support." 4. "There are lawyers that specifically help troubled teens."

ANS 1 1 This is correct. Children with conduct disorder (CD) generally also present with a history of developmental delays, ADHD, and ODD. Adolescents are often hostile, sarcastic, defensive, and provocative toward others. This comment by the nurse is most accurate. 2 This is incorrect. Increasing the adolescent's ADHD medication is not likely to be effective in the treatment of CD. Medications such as antipsychotics (e.g., haloperidol and low-dose risperidone), mood stabilizers (e.g., lithium carbonate), and Depakote are more likely to be prescribed. 3 This is incorrect. The nurse will recommend positive, specific feedback for desirable behavior, and allow for natural consequences of the adolescent's actions. CD is characterized by serious violations of social norms, including aggressive behaviors, destruction of property, and cruelty to animals, which cannot happen without consequences. 4 This is incorrect. There may be lawyers that specifically help troubled teens. However, the needs of an adolescent with CD go beyond assistance from a lawyer.

The nurse at a pediatric clinic is gathering assessment information on a school age patient who is 9 years of age. The mother expresses concern about a recent habit of handwashing to "get rid of germs." Which recommendation by the nurse is appropriate? 1. Allow the child to complete each session of handwashing. 2. Assign tasks to the child that involves putting hands in water. 3. Interrupt the handwashing by moving the child away from the sink. 4. During the handwashing, ask the child about worries and concerns.

ANS 1 1 This is correct. Obsessive-compulsive disorder (OCD) is characterized by severe obsessions (unwanted, reoccurring thoughts) and/or compulsions (repetitive behaviors) that interfere with quality of life. Obsessions create anxiety, and compulsions are performed to reduce anxiety. The child is allowed to complete the compulsive behavior; interrupting the behavior will increase anxiety. 2 This is incorrect. Assigning the child tasks that involves putting the hands in water will not fulfill the compulsive ritual the child uses to reduce anxiety. The nurse will not make this recommendation. 3 This is incorrect. Interrupting the handwashing and moving the child away from the sink will stop the behavior the child uses to reduce anxiety, but it will increase the level of anxiety. The nurse will not make this recommendation. 4 This is incorrect. The child may not be able to discuss the behavior or the cause of the behavior. The nurse needs to recommend professional assistance for the child.

20. A teacher in an elementary school voices concerns to the school nurse about a student in her second-grade class. The student has recently become withdrawn from adults but constantly tries to please the teacher. Today the teacher saw bruises around his neck. Which plan does the school nurse develop and implement? Select all that apply. 1. Talk to child alone in the school clinic about any pain or concerns. 2. Inspect the back, chest, and legs in the presence of the principal. 3. Report possible child abuse with assessment findings to proper authorities. 4. Call the parents and report that authorities have been notified of abuse. 5. Develop a trusting rapport with the child.

ANS 1,2,3,5 1. This is correct. Evaluation of the child should be done in a safe, supportive environment. 2. This is correct. Signs of physical abuse include bruises or lacerations, especially on areas that are not exposed by clothing; marks from objects such as belts, ropes, hands, or cords; bite marks from adults; and bald spots on hair. Involving a witness to the assessment is professionally and legally appropriate. 3. This is correct. Nurses are required by law to report any suspected abuse or neglect to child protective agencies. 4. This is incorrect. It is not the role of the nurse to inform the parents that possible abuse has been reported to the authorities. This is the role of social worker or police. 5. This is correct. Developing a trusting relationship will provide support to the child.

The nurse is performing a routine pediatric assessment on an 11-year-old student who is being medicated for ADHD. The parent reports disruptive behavior and acting out both at school and at home. The parent asks about a possible medication increase. Which information is the most important for the nurse to acquire? 1. Whether the student is having problems sleeping 2. How often the student is getting medication 3. The student's weight and level of appetite 4. The student's perception of medication effects

ANS 2 1 This is incorrect. The nurse will want to assess the student for possible side effects to the medication, especially with a parenteral request for an increase. However, other information is the most important to acquire. 2 This is correct. The nurse needs to ascertain how often the student is receiving the medication, which should be every day. In addition, ADHD medication has street value and may be sold by the parent instead of given to the student. 3 This is incorrect. The nurse will want to assess the student for possible side effects of the medication related to appetite and weight; however, there is other information that is the most important to acquire. 4 This is incorrect. The parent's description of the student's behavior is taken into consideration. The student's perception of how the medication is working is also important. However, other information is the most important to acquire.

18. Parents of an adolescent female are concerned about the adolescent's recent, rapid weight loss. Nursing assessment reveals the adolescent to be below the ideal weight for her height and age. Which questions will the nurse ask to help identify an eating disorder? Select all that apply. 1. "How much weight have you lost in the past 3 months?" 2. "What words would you use to describe your body right now?" 3. "Do you have a sports activity causing you to exercise excessively?" 4. "Can you tell me some of your daily thoughts about food?" 5. "Would you consider yourself to be a good student at school?"

ANS 2,3,4 1. This is incorrect. It is unlikely the adolescent will be honest about her weight loss over a 3-month period. A 3-month loss of 12 pounds or more is of concern. 2. This is correct. Asking the adolescent to describe her body will allow the nurse to assess the adolescent's physical perception and relate to her body image. 3. This is correct. Inquiring about the amount of exercise related to a sports activity will allow the nurse to determine whether the adolescent's current exercise regimen is excessive. 4. This is correct. Adolescents with eating disorders, whether anorexia, bulimia, or overeating, may find themselves thinking obsessively about food: when they will eat; what they will eat; the amount they will eat; and how they will deal with the effects eating will have on their body. 5. This is incorrect. Achievement in school does not necessarily relate to the problem of an eating disorder.

19. The nurse at a pediatric clinic notices a female high school student has had extensive dental work and is currently exhibiting additional dental caries. The nurse also identifies the bilateral existence of Russell's sign. Based on these findings, for which comorbid manifestation will the nurse assess the student? Select all that apply. 1. Frequent absenteeism from school 2. Issues with overspending 3. Thoughts of suicide 4. Presence of cutting activity 5. Casual sexual encounters

ANS 2,3,4,5 1. This is incorrect. The nurse recognizes some physiological manifestations related to bulimia nervosa. Frequent absenteeism is not a comorbid manifestation of bulimia; it is a possible sign of substance use. 2. This is correct. The nurse recognizes some physiological manifestations related to bulimia nervosa. It is important for the nurse to assess for comorbid conditions and behaviors that exist with the condition, such as issues with overspending or shoplifting. 3. This is correct. The nurse recognizes some physiological manifestations related to bulimia nervosa. It is important for the nurse to assess for comorbid conditions and behaviors that exist with the condition, such as suicidal thoughts. 4. This is correct. The nurse recognizes some physiological manifestations related to bulimia nervosa. It is important for the nurse to assess for comorbid conditions and behaviors that exist with the condition, such as cutting, an example of deliberate self-harm. 5. This is correct. The nurse recognizes some physiological manifestations related to bulimia nervosa. It is important for the nurse to assess for comorbid conditions and behaviors that exist with the condition, such as casual sexual encounters.

The nurse is performing a well-baby check on an infant at 6 months of age. The mother shares that the infant sometimes seems unhappy. Which question is most important for the nurse to ask the mother? 1. "Is it easy to make the baby laugh if he seems unhappy?" 2. "Can you cheer him up by playing with his favorite toys?" 3. "Do you ever remember feelings of being depressed or sad?" 4. "Are you noticing any problems with him eating or sleeping?"

ANS 3 1 This is incorrect. A manifestation of depression in an infant is a sad expression or lack of expression. Also, depressed infants will look away when spoken to. The question helps identify a characteristic of depression; however, another question is the most important. 2 This is incorrect. A depressed infant may lose interest in play; the nurse can ascertain if the infant is receptive to playing and if it changes the infant's mood. However, another question is the most important. 3 This is correct. The most important question for the nurse to ask is related to the moods of the mother. There is an increased risk of depression in infants of depressed mothers. 4 This is incorrect. Depression in infants can sometime be exhibited as problems with eating or sleeping, especially if the behavior is new or intermittent. This question helps the nurse identify a symptom of depression, but it is not the most important question for the nurse to ask.

7. The school nurse is called to attend to a child who is 10 years of age. The teacher reports the child panicked when asked to present a verbal book report to the class. Which intervention will the nurse initiate with the child? 1. Take the child to the clinic and report the event to the parents. 2. Place the child on a clinic bed and allow some alone time. 3. Walk with the child in the hallway and provide reassurance. 4. Join the teacher in attempting to find the source of panic.

ANS 3 1 This is incorrect. Taking the child to the clinic and informing the parents about the event is not an intervention that will assist the child with current feelings of panic. 2 This is incorrect. When a panic attack occurs, the person affected does not need to be alone. The nurse should stay with the child and offer reassurance that the nurse will not leave. 3 This is correct. The nurse's initial intervention is to assist the patient to an environment with minimal stimulation, such as a hallway. Walking with the patient will provide a physical outlet for panic. 4 This is incorrect. When experiencing a panic attack, the person affected is frequently unable to describe feeling or identify the cause. The nurse needs to stay with the child, offer assurance, and remain in a quiet environment with the child.

11. The nurse in a pediatric emergency department is providing care for a school-age child with first- and second-degree burns to the hands and arms. The parent states, "She is so fascinated with the color and movement of the flames; she just got too close." For which reason does the nurse recommend psychotherapy for this child? 1. The child is exhibiting an inability to recognize danger. 2. The child does not obey instructions to stay away from matches. 3. The child may have excessive interest in or attraction to fire. 4. The child is likely to repeat the behavior and cause worse injuries.

ANS 3 1 This is incorrect. The nurse does not recommend psychotherapy, because the child is exhibiting an inability to recognize danger. There is more concern about the fascination with fire. 2 This is incorrect. There is no information in the scenario that indicates that the child was warned to stay away from matches. 3 This is correct. The nurse may suspect the child is exhibiting manifestations of pyromania because of fascination and interest in a fire that led to burns. The nurse recognizes the child may benefit from psychotherapy or psychoanalysis. 4 This is incorrect. The nurse would discuss safety and obedience if the concern was of the child repeating the behavior. The nurse is most likely concerned about the behavior escalating.

14. A middle-school teacher notifies the school nurse of a student who sleeps in class, smells of alcohol, and exhibits behavior impairment. The student tells the nurse, "I drink too much and want to quit, but I keep failing." Which recommendation does the nurse make to the student? 1. "You may be the perfect candidate for attending AA meetings." 2. "Many young people benefit from individual and group therapy." 3. "Maybe you need a few days at home to see if you can quit on your own." 4. "I am suggesting you and your parents see a doctor who can help."

ANS 4 1 This is incorrect. At some point, recommending AA meetings may be appropriate. However, the student is admitting to unsuccessful attempts at stopping. 2 This is incorrect. Individual and group therapy is often successful after an alcoholic stops drinking; however, the student needs some assistance with ceasing to drink. 3 This is incorrect. The student may be at risk for serious withdrawal manifestations, which place the student at a high level of risk. The student is not encouraged to stop drinking when physically alone. 4 This is correct. Because the student shares unsuccessful attempts to stop drinking independently, the nurse needs to recommend the assistance of a physician or medical facility that can help the student quit. Because the student is most likely a minor, the parents will need to participate and be financially responsible.

The nurse is attending a high school sports event when a student suddenly stands and shouts, "I need to get out of here—get me out!" Which intervention by the nurse is most appropriate at this time? 1. Attempt to calm the student with quiet breathing and relaxation. 2. Identify the events that led to the student's behaviors. 3. Look for the student's parents and ask about the behavior. 4. Assist the student to a quiet place and remain with the student.

ANS 4 1 This is incorrect. At some point, the nurse will attempt to calm the student; however, the student needs to be removed from the scene first. 2 This is incorrect. The student may or may not be able to express the cause of anxiety. This information is not necessary at this time. 3 This is incorrect. The student's parents may or may not be present. The nurse's action at this time involves getting the student to a quiet environment. 4 This is correct. The nurse's best intervention at this time is to move the student to a quiet environment to reduce stimuli and to remain with the student until the anxiety passes and the student is calm.

8. A parent brings a toddler to a pediatric clinic for advice about dealing with a fear of water. The parent shares that the toddler screams and throws a tantrum if anyone attempts to get him into a pool. The nurse also learns of an incident when the toddler was pushed into a pool. Which recommendation will the nurse make to help the toddler overcome this phobia? 1. Make sure the toddler has a safe flotation device. 2. Talk calmly as the toddler is taken slowly into the pool. 3. Plan recreation activities that do not involve water. 4. Allow the toddler to decide his own approach to the pool.

ANS 4 1 This is incorrect. Making sure the toddler has a safe flotation device is appropriate for water safety; however, it will not help the toddler overcome a phobia about water. 2 This is incorrect. Talking calmly while taking the toddler into the pool may be an attempt at exposure therapy; however, this action may compound and intensify the anxiety related to the phobia. 3 This is incorrect. The toddler is already exhibiting avoidance behavior by screaming and throwing a tantrum. The complete avoidance of recreational water may reinforce the toddler's phobia. 4 This is correct. The best advice by the nurse is to allow the toddler to decide his own approach to the pool. Initial behavior may involve playing in the kiddy pool, placing his feet in the shallow end of the pool, or sitting on the pool steps. The parents should encourage any positive behavior and protect the toddler from additional negative experiences.

6. The nurse is providing care for a student who was involved in a school violence incidence. The student becomes agitated and angry on the anniversary of the event. Which action by the nurse is most helpful to the student? 1. Administer the physician-prescribed dose of propranolol (Inderal). 2. Gently and quietly try to verbally and physically soothe the student. 3. Call for a psychotherapist to come and assist the student with PTSD. 4. Offer verbal support and encourage the student to express feelings.

ANS 4 1 This is incorrect. Research shows that administering a dose of propranolol (Inderal) right after a trauma decreases the risk for PTSD. At the time of the event's anniversary, the time has passed for this intervention to be effective. 2 This is incorrect. The student is exhibiting signs of PTSD and may be having a flashback. The nurse should not attempt to interact with a patient who is experiencing a flashback. If the nurse touches or talks to the patient, the nurse can become a part of the flashback and could be in physical danger. 3 This is incorrect. It is likely the student is under the care of a psychotherapist for PTSD caused by a violent event. Calling for the psychotherapist to come and assist the student does not address the student's immediate needs. 4 This is correct. If the possibility of a flashback passes or resolves, the nurse needs to offer the student verbal support and ask the student to talk about feelings.

The school nurse in a middle school is aware of a student who takes lithium for a bipolar disorder type 1. Which observation by the nurse will indicate a need for a laboratory test? 1. The student is exhibiting multiple signs of mania. 2. The student gets a bathroom pass during every class. 3. The student shoved other students at lunch and in the hall. 4. The student is exhibiting signs of a respiratory infection.

ANS 4 1 This is incorrect. The nurse expects the student with bipolar disorder type 1 to exhibit multiple manifestations of mania, even when taking lithium. 2 This is incorrect. When a student is taking lithium for bipolar disorder, a common side effect is polyuria, along with polydipsia, weight gain, and gastrointestinal upset. This observation does not indicate a need for a laboratory test. 3 This is incorrect. During a manic phase of bipolar disorder type 1, the nurse is aware that the student may exhibit boundary violations. The nurse will address the behavior but will not necessarily recommend a lab test. 4 This is correct. The greatest concern for a patient taking lithium is the possibility of toxicity. The student appears to have signs of a respiratory infection but may actually be exhibiting signs of lithium toxicity. Signs of toxicity include runny nose, coughing, chest congestion, and fever. The nurse will seek a prescription for a laboratory test.

77. A 13-year-old boy who has been on antipsychotic medications for a month has begun experiencing extrapyramidal effects, reporting muscle paralysis in his lower extremities. This is referred to as: 1. Akinesia. 2. Akathesia. 3. Dystonia. 4. Tardive Dyskinesia

ANS: 1 Feedback 1. Akinesia is defined as muscular paralysis and is one of the extrapyramidal effects of antipsychotic medications. Akathesia is motor restlessness. Dystonia is muscle tone impairment. Tardive Dyskinesia is involuntary muscle movements. 2. Akathesia is motor restlessness, not muscular paralysis. 3. Dystonia is muscle tone impairment, not muscular paralysis. 4. Tardive Dyskinesia is involuntary muscle movements, not muscular paralysis.

20. An 18-year-old male has called the crisis line for help. The crisis nurse recognizes the intervention needs may consist of all of the following except: 1. Discussing the individuals everyday activities. 2. Recognizing that the patient may be in a catharsis state. 3. Expressing empathy toward the caller. 4. Avoiding entropy.

ANS: 1 Feedback 1. Discussion of everyday activities with the caller does not lead to an understanding of issues leading to the call. 2. The catharsis state can be an indication that the patient has a plan for causing harm to himself or others. Because the teen called, this is an indication of wanting help at this time. 3. Empathy will demonstrate a sense of caring for the caller and help build trust to encourage the caller to seek help. 4. The caller is seeking to organize his thoughts by reaching out to the nurse and discussing the situation for the call.

72. A 7-year-old boy diagnosed with Attention Deficit-Hyperactivity Disorder is starting medications. The nurse is providing education to his parents regarding his medication. Which of the following statements is true regarding these medications? 1. These medications may cause him to gain some weight. 2. He may experience some side effects, such as difficulty sleeping or compulsive behaviors. 3. Have him take these medications only when school is in session. 4. All of the above

ANS: 2 Feedback 1. ADHD medications may cause children to experience a decreased appetite and rapid weight loss. 2. ADHD medications may cause children to experience a decreased appetite and rapid weight loss, insomnia, an increase in tics and/or compulsive behaviors and/or psychotic reactions. 3. These medications should be given every day, regardless of whether school is in session to maintain control of the life functions. 4. ADHD medications may cause children to experience a decreased appetite and rapid weight loss, insomnia, an increase in tics and/or compulsive behaviors and/or psychotic reactions. These medications should be given every day, regardless of whether school is in session.

25. Ellie, a 9-year-old girl, was adopted by a family at the age of 4 after several years of severe neglect by her birth family. The adoptive family has been reporting that Ellie is angry a lot, manipulative with her teachers, and does not seek positive attention. The nurse working with Ellie will need to: 1. Provide education on decreasing stimuli in the home environment that triggers the anger. 2. Realize Ellie may have attachment issues related to her previous history and will need to encourage the family to be active in her care. 3. Support the family in the decision-making process of continuing to let Ellie live in the home. 4. Discuss inpatient therapy to decrease Ellies manipulative behavior patterns.

ANS: 2 Feedback 1. Triggers for anger should be identified, but will not aid in dealing with the manipulative behaviors or negative attention-seeking habits. 2. Anger, manipulative behaviors, and negative attention seeking, along with the severe neglect experienced for the first four years of life, indicate the need for active family involvement. 3. When adopting a child with severe neglect, the child is at risk for these behaviors and should be discussed prior to adoption, which is a lifelong commitment. 4. Inpatient therapy will not decrease the manipulative behavior patterns. Ongoing support and therapy will be needed to be successful.

68. A teenager expresses concern about how often he has to use the toilet during the evening. The nurse should asses the teen for: 1. Water consumption throughout the day. 2. Caffeine consumption after school. 3. Kidney function. 4. The number of bowel movements during the day.

ANS: 2 Feedback 1. Water consumption throughout the day should not cause an increase in the use of the toilet only at night. 2. Caffeine is a diuretic and, when consumed only after school, can cause increased urination at night. 3. The kidney function is normal for a teen if he/she is consuming too much caffeine after school. 4. Bowel movements will not influence urination.

43. An 8-year-old girl has been brought to the emergency room after being in a motor vehicle accident, which killed her brother and mother. The doctor orders Proponolol for the child. The nurse knows that this order: 1. Should be questioned because of the age of the child. 2. Is preparing the child for the operating room. 3. Can help decrease the risk of post-traumatic stress disorder in children. 4. Requires parental consent.

ANS: 3 Feedback 1. A child of this age can have the medication. 2. The question does not indicate the use of the operating room, so Proponolol will not help the child in this situation. 3. Proponolol can help decrease the post-traumatic stress in this child due to being part of the accident and being the only survivor. 4. Proponolol does not need parental consent in this situation.

23. A teenager diagnosed with borderline personality disorder should have discharge planning instructions of: 1. A consistent caregiver. 2. Monitoring of media, such as the Internet, television, and video games. 3. Obtaining support from family and friends. 4. Seeking medical attention when the teenager feels good.

ANS: 3 Feedback 1. A consistent caregiver is important, but not a requirement for this teen. 2. Monitoring of media should occur with any teen, but is not a recommended method of discharge planning. 3. Support is needed for a teen to maintain less stress and to learn coping mechanisms with discharge planning. 4. Medical attention will be needed when issues arise for the teen, but not as much intervention is needed while doing well.

14. One of the pitfalls of inpatient psychiatric treatment centers is: 1. The treatment is usually not effective. 2. Heavy sedation is needed to control the children. 3. Some children view the placement as a way to get more attention. 4. A child will have increased suicidal ideations after admission.

ANS: 3 Feedback 1. A variety of treatment centers are available and can be effective, depending on the family, social, cultural, and psychological factors for the patient. 2. Heavy sedation is rarely used in an inpatient treatment facility. 3. The placement may empower the child to feel that they can exhibit negative behaviors to be successful in getting attention. 4. Not all children have suicidal ideations.

30. A school nurse is giving an in-service to teachers on bullycide. The main reason for the teaching is so that: 1. Teachers are aware bullying occurs. 2. Teachers are able to identify students who are risk. 3. Teachers can be aware of the fact that suicides can happen due to bullying by others. 4. Teachers are aware of their role in causing bullycide.

ANS: 3 Feedback 1. Bullycide is the action that occurs because of bullying. 2. Teachers who identify students at risk can help with interventions, but need to understand what can occur. The in-service can teach this. 3. Bullying can lead to depression and suicide. Teachers must be aware of the signs. 4. Teachers must be aware of the signs of bullycide, not just their role.

80. A mother brings her infant daughter in to be evaluated. She reports that her daughter was doing well until about the time she turned 5 months old. Her mother then noticed that she was not making good eye contact and was not interacting with her toys. When completing her assessment, the nurse identified that the babys head circumference had decreased. These are characteristics of which of the following disorders? 1. Aspergers disorder 2. Atypical autism 3. Rhetts disorder 4. Sensory processing disorder

ANS: 3 Feedback 1. Children with Aspergers disorder do not exhibit a decrease in head circumference. 2. The child lacks social interaction skills. 3. Children with Rhetts disorder usually have non-significant prenatal and perinatal development, followed by normal growth and development until the age of 5 months. The child then experiences a decrease in head circumference and the loss of motor skills, social engagement, and language skills. 4. A child would cry and have a normal growth curve with a sensory processing disorder.

49. The nurse is explaining the difference of Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) to a parent. The best explanation is: 1. A child with CD is remorseful for bad behavior. 2. A child who has ADHD will have ODD too. 3. A child with ODD feels bad after breaking the rules, while a child with CD does not care if the rules are broken. 4. A child with CD requires constant intervention to be able to function in society.

ANS: 3 Feedback 1. Children with CD are usually not remorseful. 2. The ADHD and ODD combination does not happen in all individuals. 3. A child with ODD understands boundaries and the fact that feelings can be hurt, thus being remorseful. Children with CD are not remorseful for their actions. 4. A child with CD requires consistency, but this does not mean that the child will be successful in his/her adult life.

70. The mother of a 6-month-old baby brings her son in for his follow-up well-child appointment. The mother informs the nurse that the baby seems depressed. Which of the following would be an appropriate response by the nurse to the mother? 1. Infants are too young and cant be diagnosed with depression. 2. Since you havent had any episodes of depression, the baby is not at risk for developing depression. 3. The baby appears to be interactive and happy here. 4. I see that the baby looks away from you when you talk to him and shows little interest in his rattle.

ANS: 4 Feedback 1. Infants are at risk for depression when separated from their primary caregiver for an extended period of time. 2. The chemical makeup of each individual is different, and depression is not always hereditary. 3. Depression in infants manifests as a sad expression or lack of expression, looking away when spoken to, lacking interest in play, and having trouble sleeping or eating. The nurse should seek information about the infants interactions. 4. Depression in infants manifests as a sad expression or lack of expression, looking away when spoken to, lacking interest in play, and having trouble sleeping or eating. Infants are at risk for depression when separated from their primary caregiver for an extended period of time or if the mother is depressed.

91. A 15-year-old girl is admitted as an inpatient for an attempted suicide from an overdose of narcotics. She is placed on suicide precautions. Which of the following is included in these precautions? 1. She can only eat finger foods. 2. She must wear a cloth or paper gown. 3. The patients room must be near the nurses station. 4. All of the above

ANS: 4 Feedback 1. Interventions for patients in suicide precautions include allowing the patient to eat only finger foods. 2. Interventions for patients in suicide precautions include wearing a cloth or paper gown. 3. Interventions for patients in suicide precautions include placing the patient in a room near the nurses station. 4. Interventions for patients in suicide precautions include frequently reassessing for suicidal thoughts, having the patient wear a cloth or paper gown, monitoring the patient with one-on-one supervision, placing the patient in a room near the nurses station, and allowing the patient to eat only finger foods.

15. A nurse is explaining the therapeutic milieu to a new nurse. The best explanation of this term would be: 1. The place where the child is receiving care. 2. Group therapy. 3. Personal interactions between patients and staff. 4. All of the above are correct.

ANS: 4 Feedback 1. Milieu indicates a setting. The setting is where the child is receiving services. 2. Group therapy is one activity used in a therapeutic milieu. 3. Personal interactions are one activity used in the therapeutic milieu to help the child. 4. The setting and types of activities enhance the treatment in a therapeutic milieu.

Serotonin deficiencies can cause ________ in children. 1. Panic 2. Obsessions 3. Bulimia 4. All of the above are correct

ANS: 4 Feedback 1. Panic occurs because serotonin influences the synapses in the brain. 2. The lack of serotonin does not allow for a gap in the synapses, causing an obsession behavior pattern. 3. Bulimia is an obsessive behavior pattern which is can be caused by a lack of serotonin in the brain. 4. Panic, obsessions, and bulimia are influenced by the serotonin levels in the brain because of the lack of chemicals for neurotransmission in the synapses of the brain

47. A school nurse is giving an in-service to teachers to teach them how to deal with children with ADHD. The nurse should include all of the following topics for discussion except: 1. Giving shorter assignments. 2. Letting the child stand at the desk while working on projects. 3. Color coding folders for each subject. 4. Requiring 30 minutes of continuous reading each day during class.

ANS: 4 Feedback 1. Shorter assignments will help the child focus for short amounts of time and be more successful because this is his/her length of concentration. 2. Shifting weight on the legs while standing can be enough of an activity for a child with ADHD to concentrate. 3. Color coding can aid the child to easily identify items and not become frustrated when attempting to find items in a desk or locker. 4. A classroom can have too much stimuli for a child with ADHD, and that length of time may cause the child to lose concentration.

73. A school nurse and a teacher are working on interventions for an 8-year-old boy diagnosed with Attention Deficit-Hyperactivity Disorder (ADHD). Which of the following should be included in the treatment plan? 1. The boy should be seated near the teacher. 2. The teacher should allow extra time for him to complete assignments or tests. 3. The teacher should assign him periodic tasks, such as taking notes to the office. 4. All of the above

ANS: 4 Feedback 1. Sitting near the teacher will help the child stay accountable for his actions. 2. Extra time for assignments and tests are needed because the child may need small breaks to complete the tasks. 3. Allowing the child to physically be outside of the room may help keep his attention when in the classroom. 4. All of these interventions should be included in the treatment plan.

26. An infant displays depression by: 1. Smiling at strangers. 2. Bonding to someone other than the immediate family. 3. Crying more than an average infant. 4. Looks away when an adult attempts to play with the infant.

ANS: 4 Feedback 1. Smiling is a normal positive reaction for an infant. 2. Bonding to another person indicates that the infant feels secure with his/her surroundings. 3. Crying can indicate many different things for an infant. It is a normal reaction and is not necessarily an indication of depression. 4. Infants seek to make eye contact to learn. The lack of eye contact is a concern