Lippincott NCLEX Review Children and Adolescents With Behavior Problems
A 7-year-old client is diagnosed with conduct disorder. After admission, the nurse identifies his problematic behaviors as cruelty to animals, stealing, truancy, aggression with peers, lying, and explosive angry outbursts resulting in destruction of property. The nurse is now talking with the client about his behavioral contract, which should include which crucial components? Select all that apply. 1. Taking prescribed medications. 2. Acceptable methods for expressing anger. 3. Consequences for unacceptable behaviors. 4. Rules for interacting with staff and other clients. 5. Personal possessions allowed on the unit.
1, 2, 3, 4. The crucial elements of a behavioral contract include compliance with the medication regimen if medication is prescribed, appropriate anger management, consequences for unacceptable behaviors, and rules for interactions with others. Personal possessions may be limited by unit rules, but are not part of an individualized behavioral contract
The nurse is meeting weekly with an adolescent recently diagnosed with depression to monitor progress with therapy and antidepressant medication. The nurse should be most concerned when the client reports which of the following? 1. An acquaintance hung herself 2 days ago. 2. She is experiencing intermittent headaches as a side effect of taking the antidepressant. 3. She received a low score on her last history test. 4. Her younger brother has been starting fights with her for the last week.
1. While all the occurrences could upset the client in the early stage of treatment, the one involving the most risk to safety is the suicide completion of a peer. Adolescents are susceptible to "copycat" suicides. The fact that she knows the method of suicide of the acquaintance and is at a critical period in treatment, when her antidepressant may have given her increased energy while still experiencing low self-esteem, can put her at significant risk for suicide.
Assessment of suicidal risk in children and adolescents requires the nurse to know which of the following? 1. Children rarely commit suicide unless one of their parents has already committed suicide, especially in the past year. 2. The risk of suicide increases during adolescence, with those who have recently suffered a loss, abuse, or family discord being most at risk. 3. Children do have a suicidal risk that coincides with some significant event such as a recent gun purchase in the family. 4. Adolescents typically don't choose suicide unless they live in certain geographical regions of the United States and Canada.
2. Adolescents are more likely than children to attempt or commit suicide. Loss, abuse, and family discord remain significant risk factors. There is no evidence to support that children rarely commit suicide. Additionally, evidence fails to support the belief that children who have lost a parent to suicide will attempt it themselves. Significant events, such as a recent firearm purchase, have not been linked to suicide attempts in children. No geographical region in the United States or Canada is free from adolescent suicide.
A 15-year-old girl is sent to the school nurse with dizziness and nausea. While assessing the girl, who denies any health problems, the nurse smells alcohol on her breath. Which of the following responses by the nurse is most appropriate? 1. "Don't tell me that you have been drinking alcohol before you came to school this morning!" 2. "Why don't you tell me the real reason that you are feeling sick this morning?" 3. "Tell me everything that you have had to eat and drink yesterday and today." 4. "I know that high school is stressful, but drinking alcohol is not the best way to handle it."
3. Asking the client to report everything that she has had to eat and drink yesterday and today is the least judgmental approach and also provides helpful information. Confronting the client about drinking alcohol or asking the client to admit the real reason for feeling sick can put the girl on the defensive and block further communication. The nurse should avoid putting the client on the defensive to facilitate communication that may eventually enable the nurse to get the truth and identify interventions.
A child with Asperger's disorder is being referred to the mental health clinic along with his parents. To provide the best care for this family, the nurse makes a care plan based on the fact that this disorder differs from autism in which of the following areas? 1. Asperger's disorder, commonly diagnosed earlier than autism, is associated with fewer major problems in interpersonal interactions. 2. In Asperger's disorder, behavior commonly is similar to that of other children with autism but without the problems with school. 3. Asperger's disorder is recognized later than autism, and interpersonal interaction problems typically become more apparent when the child begins school. 4. There are significant problems with language development, as with autism, but there are no delays or difficulties with motor development.
3. Asperger's disorder is recognized later than autism, and the interpersonal problems worsen with school attendance. These children usually have restricted and repetitive patterns of behavior. School problems exist as a result of the interaction difficulties and behavior differences. Motor development may be delayed, but language commonly progresses normally.
The nurse is with the parents of a 16-year-old boy who recently attempted suicide. The nurse cautions the parents to be especially alert for which of the following in their son? 1. Expression of a desire to date. 2. Decision to try out for an extracurricular activity. 3. Giving away valued personal items. 4. Desire to spend more time with friends.
3. Giving away personal items has consistently been shown to be an indicator of suicide plans in a depressed and suicidal individual. Expression of a desire to date, trying out for an extracurricular activity, or the desire to spend more time with friends indicates a return of interest in normal adolescent activities.
When collaborating with the health care provider to develop the plan of care for a child diagnosed with attention deficit hyperactivity disorder (ADHD), the treatment plan will likely include which of the following? 1. Antianxiety medications, such as buspirone (BuSpar), and homeschooling. 2. Antidepressant medications, such as imipramine (Tofranil), and family therapy. 3. Anticonvulsant medications, such as carbamazepine (Tegretol), and monthly blood levels. 4. Psychostimulant medications, such as methylphenidate (Ritalin), and behavior modification.
4. ADHD is typically managed by psychostimulant medications, such as methylphenidate and pemoline (Cylert), along with behavior modification. Antianxiety medications, such as buspirone, are not appropriate for treating ADHD. Homeschooling commonly is not a possibility because both parents work outside the home. Antidepressants, such as imipramine, are not recommended for use in children. Family therapy may be a part of the treatment. Anticonvulsant medications, such as carbamazepine, are not appropriate for ADHD. Also, carbamazepine levels are obtained weekly early during therapy to avoid toxicity and ascertain therapeutic levels.
A young school-age girl whose mother and aunt have been diagnosed as having bipolar disorder and whose father is diagnosed with depression is brought to the child psychiatrist's office by her father who has custody since the parents divorced. The father has brought the child to the office because of problems with behavior and attention in school and inability to sleep at night. The child says, "My brain doesn't turn off at night." The psychiatrist diagnoses the child as experiencing attention deficit hyperactivity disorder (ADHD) with a possibility of bipolar disorder as well as the ADHD. What should the office nurse say to the father to explain what the psychiatrist said? Select all that apply. 1. "The psychiatrist diagnosed your child as having ADHD because of her attention and behavior problems at school." 2. "ADHD involves difficulty with attention, impulse control, and hyperactivity at school, home, or in both settings." 3. "The psychiatrist does not know how to diagnose your child's illness since she has symptoms of both bipolar disorder and ADHD." 4. "The child's description of her inability to sleep is irrelevant to diagnosing her condition since she stays up late." 5. "The psychiatrist is considering a bipolar diagnosis because of your child's family history of bipolar disorder and her sleep issues."
1, 2, 5. The client's school problems, the presence of first-degree relatives diagnosed with bipolar disorder and depression, and her inability to sleep at night mirror aspects of both ADHD and bipolar disorder, which are difficult to distinguish from each other in children. Psychiatrists are reluctant to diagnose young children as bipolar at this age. She may have only one disorder or the other or both. Further monitoring and her response to medication will differentiate whether she is suffering from one of the disorders or both. Any comments indicating that the psychiatrist does not know what he or she is doing or that the child's perceptions of her illness are not valid will undermine any trust the father and child might be developing in their caregiver and so should be avoided.
The parents of a preschool child diagnosed with autism must take their child on a plane flight and are concerned about how they can make the experience less stressful for her and their fellow travelers. The nurse in their psychiatrist's office suggests a dry run to the airport in which they simulate going through security and boarding a plane. In addition, the nurse suggests taking items to help the child be calm during the flight. In what order of priority from first to last should the parents employ the items listed below? 1. A DVD player with headphones and favorite games, cartoons, and child films. 2. A favorite stuffed toy animal or other soft toy. 3. A favorite nonelectronic game. 4. Medication that can be given as needed to calm the child.
1. A DVD player with headphones and favorite games, cartoons, and child films. 3. A favorite nonelectronic game. 2. A favorite stuffed toy animal or other soft toy. 4. Medication that can be given as needed to calm the child. Electronic games and stories are favorites of most children, but are particularly enjoyed by children on the autism spectrum. The headphones block out some of the noises that might be upsetting to a child on the autism spectrum. If the child cannot be engaged electronically, a favorite nonelectronic toy would be the next choice. Stuffed animals or other soft toys can soothe a child who is starting to become upset. Medication should be a last resort as it can have a paradoxical effect if it is an antianxiety medication or may cause too much sedation during the flight.
A parent of a 7-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) since he was 5 years old is talking to the school nurse about her concerns about the son's physical condition. The parent states that his medication, Concerta (methylphenidate extended release), controls his symptoms well but is causing him to lose weight. It is difficult to get him up and ready for school in the morning unless he is given the medication as soon as he awakens. Then he does not eat breakfast or very much of his lunch at school. He eats dinner, but only an average amount of food. He has lost 3 lb (1.4 kg) in the last 2 weeks. Which of the following should the nurse suggest the parent do first? 1. Have the child eat a breakfast bar, banana, and a glass of milk at his bedside at the same time he takes his Concerta every morning. 2. Monitor the child's weight closely for a month since he is likely to stop losing weight when the school year ends in 2 weeks. 3. Suggest a change of medication to a nonstimulant drug that will treat his ADHD without causing the appetite decrease. 4. Suggest that the parent supplement the child's dinner with a high-protein drink or other food that will increase his caloric intake.
1. Because weight loss is a common side effect of methylphenidate and because the child's symptoms are controlled with the stimulant, the first action should be to increase the child's oral intake before the medication's side effects begin. Weight should be monitored, but since the child has already lost weight, a remedy is needed as well as monitoring. The weight loss is directly due to the medication's side effects, so the child will continue to lose weight unless an intervention is made whether or not he is enrolled in school or on summer vacation. A high-protein drink could work, but then the child is taking in all his calories in the evening, which is not best nutritionally. A change of medication should be the last resort since methylphenidate is the most effective medication for ADHD and has been successful with this child.
A 15-year-old is a heavy user of marijuana and alcohol. When the nurse confronts the client about his drug and alcohol use, he admits previous heavy use in order to feel more comfortable around peers and achieve social acceptance. He says he has been trying to stay clean since his parents found out and had him seek treatment. When the nurse develops a plan of care with the client, what should be the highest priority to help him maintain sobriety? 1. Peer recognition that does not involve substance use. 2. Support and guidance from his parents. 3. A strict no-drug policy at his high school. 4. The threat of legal charges if caught drinking or smoking marijuana.
1. Peer acceptance and recognition is a very powerful force in the lives of adolescents, leading to positive or negative behavior depending on the child's peers. While the influence of parents remains strong, peer acceptance combined with the adolescent's desire for independence can lead to disobeying the parents. The sanctions provided at school and in the community by law enforcement will support those teens that have other support in their lives, but are generally not sufficient to prevent substance use in adolescents lacking support at home and with peers.
At the admission interview, the father of a 4-year-old boy with attention deficit hyperactivity disorder (ADHD) says to the nurse, "I know that my wife or I must have caused this disease." Which of the following is the nurse's best response? 1. "ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder." 2. "What do you think you might have done that could have led to causing this disorder to develop in your son?" 3. "Many parents feel this way, but I doubt there is anything that you did that caused ADHD to develop in your child." 4. "Let's not focus on the cause but rather on what needs to be done to help your son get better. I know that you and your wife are very interested in helping him to improve his behavior."
1. Stating that attention deficit hyperactivity disorder occurs more commonly in families takes the opportunity for teaching while also helping the father realize that he and his wife are not to blame. Parents who are commonly blamed by society for their child's behavior need help with education. Questioning the father on what he thinks he may have done implies that the parents played some role in this disorder, possibly contributing to the father's guilt. Telling the father that many parents feel this way and that the nurse does not think the parents are at fault is premature at this point. Telling the father that he should focus on what needs to be done, rather than what caused the disorder, minimizes the father's concerns and feelings.
The nurse meets with the mother of a child diagnosed with attention deficit hyperactivity disorder. The mother states, "I feel so guilty that he has this disease, like I did something wrong. I feel like I need to be with him constantly in order for him to get better. But still sometimes I feel like I'm going to lose control and hurt him." The nurse should suggest which of the following to the mother? 1. Arranging for respite care to watch her child and give herself a regular break. 2. Taking a job to allow herself to feel some success because her child won't ever improve. 3. Arranging to have coffee with friends daily as a way to begin a support group. 4. Considering foster care if she feels that she can't handle her child's problems.
1. Suggesting that the mother arrange for respite care so that she can have a regular break would help to alleviate some of the stress that she feels when she is with her child constantly. The mother also could use family and friends to provide some care, thereby helping with giving her a break. The child may improve, so suggesting that the mother take a job to provide a feeling of success would be inappropriate. Having coffee daily with friends may provide some opportunities for socialization. However, friends may not be able to provide the verbal support that the mother needs. Rather, attending a support group of other parents with children with attention deficit hyperactivity disorder might be helpful. Placing the child in foster care is an extreme measure that may damage the therapeutic relationship with the nurse and dramatically and negatively affect the relationship between the mother and child.
A teacher is talking to the school nurse about a child in her classroom who has a tic disorder. The teacher mentions that the boy frequently trips other children although no one has ever been hurt. The teacher then further states that she ignores him when that happens because it is part of his disorder. The nurse should tell the teacher: 1. "Tripping other children is not a tic, so you can respond to that as you would in any other child." 2. "I can't believe that you actually allow him to get away with that!" 3. "I think that is the best choice unless some parents of the other children start to protest about it." 4. "If no one else is getting hurt, then it seems harmless and might prevent the development of a worse behavior."
1. The teacher needs to be informed that this behavior is inappropriate. Therefore, educating the teacher and encouraging her to respond to misbehavior consistently is correct. Telling the teacher that the nurse can't believe the teacher lets the child get away with the behavior is demeaning and condescending. Allowing the child to continue the misbehavior is counterproductive to discipline and could create other problems
The school nurse assesses a 10-year-old girl who excessively cleans and categorizes. Her parents report that she has always been orderly, but since her brother died of cancer 6 months ago, her cleaning and categorizing have escalated. In school, she reads instead of playing with other children. These behaviors are now interfering with homework and leisure activities. To bolster her self-esteem, the nurse should encourage the child to: 1. Be a library helper. 2. Organize a party for the class. 3. Be in charge of a group project with four peers. 4. Be captain of the kickball team.
1. This child is demonstrating signs of anxiety and withdrawal. Being a library helper enables the client to use an interest (reading) when interacting with others and gaining pride in helping others. Most interaction will be one-to-one and with adults, which is likely to be more comfortable for her in her state of anxiety. Organizing a class party, a group project with her peers, and a kickball team involve multiple peer interactions, which are likely to be difficult for her at this time. Also, there is no mention of the child liking sports, so kickball would not be an appropriate activity.
A 17-year-old client who has been taking an antidepressant for 6 weeks has returned to the clinic for a medication check. When the nurse talks with the client and her mother, the mother reports that she has to remind the client to take her antidepressant every day. The client says, "Yeah, I'm pretty bad about remembering to take my meds, but I never miss a dose because Mom always bugs me about taking it." Which of the following responses would be effective for the nurse to make to the client? 1. "It's a good thing your mom takes care of you by reminding you to take your meds." 2. "It seems there are some difficulties with being responsible for your medications that we need to address." 3. "You'll never be able to handle your medication administration at college next year if you're so dependent on her." 4. "I'm surprised your mother allows you to be so irresponsible."
2. The client and mother need to address the issue of responsibility for medication administration. Reinforcing the mother's overinvolvement in medication taking or making negative comments about the client and mother t are unlikely to engage them in problem solving about the matter
The nurse leading a group session for parents of children diagnosed with oppositional defiant disorder. The nurse should give which of the following recommendations for discipline? 1. Avoid limiting the child's use of the television and computer for punishment. 2. Be consistent with discipline while assisting with ways for the child to more positively express anger and frustration. 3. Use primarily positive reinforcement for good behavior while ignoring any demonstrated bad behavior. 4. Use time-out as the primary means of punishment for the child regardless of what the child has done.
2. Consistent discipline and alternative methods of anger management are two important tools for parents who have a child with oppositional defiant disorder. Consistent discipline sets limits for the child. Helping the child learn more appropriate ways to manage anger assists the child in living within societal expectations. Avoiding restriction of television and computer time for punishment or using time-out as the primary means of punishment has not been suggested as an appropriate management method. Typically, using many strategies is more effective. Ignoring bad behavior could be dangerous and does not reinforce to the child that limits on behavior exist in society.
Parents of a 7-year-old child newly diagnosed with attention deficit hyperactivity disorder (ADHD) ask the nurse whether their son will always have to take medication for this condition. The nurse should tell the parents: 1. "Yes, almost everyone with this disorder has to continue taking medication forever." 2. "Between one-third and one-half of children experiencing ADHD and taking medication will need to continue to take medication as adults." 3. "Most children with this disorder do not need to continue taking medications as adults." 4. "There is just a small percentage of adults with ADHD who can manage without medications."
2. Studies show that usually one-third to one-half of people diagnosed with ADHD do not need medication as adults.
A mother states to the nurse in her primary care provider's office that she is frustrated regarding her 7-year-old son's nightly enuresis for the past 3 years. She says she has limited his evening fluids, eliminated all caffeine and soft drinks from his diet, and has had him wash his own sheets, but he still wets the bed almost every night. Her husband has told her he was a bed wetter as a child. He thinks the son will "get over it." The mother is worried that it could negatively affect the son's peer relationships as he grows older. Which of the following actions should the nurse take? 1. Tell the mother her husband is correct and she should be patient since her husband's enuresis stopped without intervention. 2. Suggest asking the primary care provider about medication treatment to deal with the enuresis. 3. Discuss a behavioral treatment plan for the child focusing on the improvement of his social skills. 4. Suggest the mother ask the primary care provider about hospitalization for a complete renal workup since the enuresis has gone on a long time.
2. The mother's distress and length of time the problem has existed combined with the efforts she has made to address the problem demonstrate that medication treatment should be considered. The absence of any other symptoms make a renal workup unnecessary at this time. It is unlikely that social skills training alone will change his nocturnal enuresis. Just waiting for the behavior to stop is likely to further tax the mother and son.
The mother of a 14-year-old girl who is diagnosed with oppositional defiant disorder tells the nurse that she has read extensively on this disorder and does not believe the diagnosis is correct for her daughter. Which of the following responses by the nurse is appropriate? 1. "It sounds like you are very interested in your daughter. Let's focus on what is best for her." "Tell me what you have found in your reading that is leading you to that conclusion." 3. "Your doctor has had many years of education and experience, so you can believe he's right." 4. "That doesn't matter now because we just need to help her get better."
2. The nurse needs to find out what exactly the mother knows and has read. Reviewing what the mother has found in her reading that is leading her to doubt the diagnosis will help direct the nurse's teaching and clarify any misperceptions or misinformation that the mother may have. The primary health care provider may indeed have many years of education and experience, and the focus should be on the daughter, but the nurse needs to address the mother's concerns at this time.
A 17-year-old is admitted to a psychiatric day treatment program due to severe lower back pain since her mother's death 3 years ago. Medical examinations have not discovered a physical cause for her pain. She cares for her four younger siblings after school and on weekends because of her father's long work hours. Which predischarge statement indicates that treatment for her condition has been successful? 1. "I understand now why my father spends so much time away from home." "My back pain is worse on weekends with more chores and homework." 3. "I don't want to talk about my family. It's my back that is hurting." 4. "I just need more rest and relaxation and then my back will feel fine."
2. This statement indicates insight into possible emotional causes for her pain. After insight is achieved, the client can make behavior changes to effectively cope with her anxiety-related disorder. Saying that she understands why her father is away so often demonstrates insight into her father's actions rather than her own. Wanting to discuss her pain and not her family indicates denial of any connection between her pain and her stress, which perpetuates her current situation. While rest may help her back, the client's statement does not address psychological issues related to the back pain.
An 8-year-old child was recently hospitalized at a child psychiatric unit for inattention and acting out behavior at school and home. His psychiatrist prescribed the methylphenidate/ritalin patch to control his attention deficit hyperactivity disorder symptoms, and inpatient unit staff worked with him on behavioral control measures. The office nurse discovers at his first visit after his discharge from the hospital that the boy has been taking off his patch during the day, which is causing problems at school and at home. In which order of priority from first to last should the nurse take the following actions? 1. Explain to the family, in terms the child can understand, the benefits of his medication in dealing with school and home problems he is experiencing. 2. Explore the parents' attitudes about medication administration in general and their child's medication in particular. 3. Explore the child's reasons for removing the patch during the day rather than at the end of the day. 4. Have the psychiatrist discuss with the child and parents a trial of a different medication.
3. Explore the child's reasons for removing the patch during the day rather than at the end of the day. 2. Explore the parents' attitudes about medication administration in general and their child's medication in particular. 1. Explain to the family, in terms the child can understand, the benefits of his medication in dealing with school and home problems he is experiencing. 4. Have the psychiatrist discuss with the child and parents a trial of a different medication. First, the child's reasons for removing the patch need to be explored to determine what needs to be done to solve the problem of inadequate medication administration. Since the child is probably heavily influenced by his parents' attitudes about taking medications, their attitudes need to be addressed next to determine if they openly or subtly oppose the medication or its method of administration. Once the knowledge of the child's and parent's feelings about medication are known, education can be offered to be sure the child understands how the medication can help him cope better in school and home. If the child continues to take off his patch or demonstrates an allergic response to the patch or if it is determined that his parents are not supportive of the patch, discussion of a trial of another medication to treat the child's symptoms should occur.
A member of a nurse-led group for depressed adolescents tells the group that she is not coming back because she is taking medication and no longer needs to talk about her problems. Which of the following responses by the nurse is most appropriate? 1. "I'm glad that you are taking your medication, but how can we know that you will continue to take it? After all, you haven't been on it for very long and you might decide to stop taking it." 2. "I think that it is important to let everyone respond to what you said, so let's go around the group and let everyone give their thoughts about what you have decided." 3. "The purpose of the group is to provide each of you with a place to discuss the problems of being a teenager with depression with others who also are experiencing a similar situation." 4. "You don't have to stay in the group if you don't want to, but if you choose to leave, then you won't be able to change your mind later and return to the group."
3. Focusing on the purpose of the group is the best response. Adolescents are greatly influenced by their peers. Medication alone is not typically the most successful treatment strategy. Questioning whether the client will continue the medication is negative and is not the reason for her to stay in the group. Asking the rest of the group to respond may or may not give the nurse support for the teenager remaining in the group. Groups commonly have rules regarding movement of members in and out of the group, but this does not address the reasons for the client to remain in the group.
Which of the following should the nurse include in the teaching plan for the parents of a child who is receiving methylphenidate (Ritalin)? 1. Giving the medication at the same time every evening. 2. Having the child take two doses at the same time if the last dose was missed. 3. Giving the single-dose form of the medication early in the day. 4. Allowing concurrent use of any over-the-counter medications with this drug.
3. The single-dose form of methylphenidate should be taken 10 to 14 hours before bedtime to prevent problems with insomnia, which can occur when the daily or last dose of the medication is taken within 6 hours (for multiple dosing) or 10 to 14 hours (for single dosing) before bedtime. It is recommended that a missed dose be taken as soon as possible; the dose is skipped if it is not remembered until the next dose is due. Any other medication, including over-the-counter medications, should be discussed with the health care provider before use to eliminate the risk of a possible drug interaction.
A 15-year-old boy being successfully treated for Tourette's syndrome tells the nurse, "I'm not going to take this medication anymore. Anyone who is really my friend will accept me as I am, tics and all!" The nurse should tell the client: 1. "You and your family came to the clinic for treatment, so you can terminate it whenever you wish." 2. "Won't your lack of medication cause more tics and make you be less attractive to girls?" 3. "Let's talk about what brought you into treatment and why you now want to stop taking medication." 4. "I think that is a very unwise decision, but you're entitled to do whatever you wish."
3. When an adolescent wants to stop treatment with medication, it represents a desire for more control over his/her life as well as a wish to be free of the disorder with which they have been diagnosed. If the caregiver merely acknowledges the client's right to stop treatment or warns of consequences if the client stops medication, he or she abdicates the adult role of health care advisor. Before any action is taken, the nurse should explore the client's reasoning to see if anything in the medication regimen could be changed to make it more palatable for the client. The client also needs to know that if his current objections cannot be overcome, he can return later to restart his medication.
A 13-year-old junior high school student has come to the school nurse, stating that her father has physically abused her for 3 years. Initially, the client accepted the abuse, thinking it was because her father had been laid off, but the abuse continued after he got a job 4 months ago. She fears that her mother will not believe her and her father will reject her if they discover she has revealed the abuse. The nurse should first: 1. Inform the mother in a face-to-face meeting without the girl present. 2. Call the father, confront him, and then call the police to have him arrested. 3. Meet with both parents together. Include the daughter in the meeting so she can speak for herself. 4. Report the alleged abuse to Child Protective Services (Ministry of Children and Family) that day, and then provide for the child's safety.
4. All suspected child abuse must be reported, but this child's age and ability to describe the abuse make this allegation particularly strong. Because parental reaction to her allegation is not predictable, the nurse must ensure the child's safety. The nurse should not discuss the situation with the client or the parents. The nurse must refer this case to Child Protective Services (the Ministry of Children and Family).
When assessing a 17-year-old male client with depression for suicide risk, which of the following questions is best? 1. "What movies about death have you watched lately?" 2. "Can you tell me what you think about suicide?" 3. "Has anyone in your family ever committed suicide?" 4. "Are you thinking about killing yourself?"
4. Asking whether the client is thinking about killing himself is the most direct and therefore the best way to assess suicidal risk. Knowing whether the client has watched movies on suicide and death, what the client thinks about suicide, and whether other family members have committed suicide will not tell the nurse whether the client is thinking about committing suicide right now.
An adolescent is brought to the Emergency Department (ED) after accidentally taking an overdose of heroin (the strength of the heroin he got was greater than the heroin he had been taking). The adolescent is semiconscious, unable to respond appropriately to questions, slurs his words, has constricted pupils, and vital signs of blood pressure 60/50, pulse 50, and respirations 8. Narcan (nalaxone acetate) is administered to temporarily reverse the effects of the heroin. Which of the following would first indicate that the Narcan administration had been effective? 1. The client's blood opiate level drops to a nontoxic level. 2. The client becomes talkative and physically active. 3. The client's memory and attention become normal. 4. The client's respirations improve to 12/min.
4. Decreased respirations and coma are the two most dangerous effects of heroin overdose, so an increase in respirations after administration of the Narcan demonstrates initial effectiveness of the medication. Changes in cognition and psychomotor activity will take more time to become apparent. The client's blood opioid level may not drop to a nontoxic level for a few days.
A 19-year-old has struggled academically throughout high school and realizes during her last semester in school that she is not going to graduate with her class, which will delay her admission to college. In the past, she has intermittently used drugs and alcohol to deal with her anxiety, but now her involvement with substances escalates to daily use. In what order of priority from first to last should the school nurse, who has become aware of the problem, take the following actions? 1. Refer her to the school authorities to address her academic issues so she can graduate next semester. 2. Refer her to a program at the local community college to improve the client's readiness for college and decrease her anxiety. 3. Refer her to an outpatient program that treats clients with chemical dependency issues. 4. Refer her to a psychiatric clinic so she can get an appropriate diagnosis and medication for her anxiety.
4. Refer her to a psychiatric clinic so she can get an appropriate diagnosis and medication for her anxiety. 3. Refer her to an outpatient program that treats clients with chemical dependency issues. 1. Refer her to the school authorities to address her academic issues so she can graduate next semester. 2. Refer her to a program at the local community college to improve the client's readiness for college and decrease her anxiety. The client's anxiety seems to fuel her substance abuse, so treatment for her anxiety is paramount, followed by treatment for substance abuse. Those two interventions should increase her readiness to profit from academic aid offered by the school. Referral to a community college program would help her get ready for college, which will likely decrease her anxiety.
