Peds Psychosocial

The school nurse is teaching a class on injury prevention. Which of the following should be included when discussing firearms? a. Adolescents are too young to use a gun properly for hunting. b. Gun carrying among adolescents is on the rise, primarily among inner-city youth. c. Nonpowder guns (air rifles, BB guns) are a relatively safe alternative to powder guns. d. Adolescence is the peak age for being a victim or offender in the case of injury involving a firearm.

ANS: D The increase in gun availability in the general population is linked to increased gun deaths among children, especially adolescents. Gun carrying among adolescents is on the rise and not limited to the stereotypic inner-city youth. Adolescents can be taught to safely use guns for hunting, but they must be stored properly and used only with supervision. Nonpowder guns (air rifles, BB guns) cause almost as many injuries as powder guns.

A school nurse is preparing a physical education plan for a child with Down syndrome. Before preparing the plan, the nurse obtains a copy of an x-ray report of the child's: 1. Cervical spine 2. Hands 3. Heart 4. Chest and lungs

1. Cervical spine Rationale: Children with Down syndrome frequently have instability of the space between the first two cervical vertebrae. They require diagnostic studies (an x-ray of the cervical spine) to determine if this is present before participating in activities that put pressure on the head and neck, which could cause spinal cord compression. Options 2, 3, and 4 are not necessary.

Which of the following suggestions would be most helpful to the parents of a 2-year-old child when managing separation anxiety during hospitalization? 1. Leave while the child is sleeping. 2. Bring the child's favorite toys from home. 3. Tell the child the time they are leaving and returning. 4. Keep the visit time short.

2. Bringing a child's favorite toys, security blanket, or familiar objects from home can make the transition from home to hospital less stressful.

Which of the following assessment findings should the nurse expect in an infant with colic? 1. Failure to gain weight. 2. Expulsion of flatus. 3. Soft abdomen. 4. Difficulty with burping.

2. Infants with colic have paroxysmal pain or cramping caused by the production and accumulation of gas.

Parents of a 15-year-old state that he is moody and rude. The nurse should advise his parents to: 1) Restrict his activities. 2) Discuss their feelings with their child. 3) Obtain family counseling. 4) Talk to other parents of adolescents.

2. Parents need to discuss with their adolescent how they perceive his behavior and how they feel about it.

A 16-year-old girl comes to the school nurse complaining of cramps, backache, and nausea with her periods. The nurse most likely would interpret these symptoms as which of the following? 1. Pathologic. 2. Physiologic. 3. Psychogenic. 4. Psychosomatic.

2. Physiologic.

The mother of a child arrives at the clinic because the child has been experiencing scratchy, red, and swollen eyes. The nurse notes a discharge from the eyes and a culture is sent to the laboratory for analysis. Chlamydial conjunctivitis is diagnosed. Based on this diagnosis, which of the following would require further investigation? 1. Possible trauma 2. Possible sexual abuse 3. The presence of an allergy 4. The presence of a respiratory infection

2. Possible sexual abuse Rationale: A diagnosis of chlamydial conjunctivitis in a non-sexually active child should signal the health care provider to assess the child for possible sexual abuse. Allergy, infection, and trauma can cause conjunctivitis but not chlamydial conjunctivitis.

A nurse collecting data on a child suspects physical abuse. The nurse understands that which of the following is a primary and legal nursing responsibility? 1. Document the child's physical assessment findings accurately and thoroughly. 2. Report the case in which the abuse is suspected. 3. Refer the family to the appropriate support groups. 4. Assist the family in identifying resources and support systems.

2. Report the case in which the abuse is suspected. Rationale: The primary legal nursing responsibility when child abuse is suspected is to report the case. All 50 states require health care professionals to report all cases of suspected abuse. Although documentation of findings, assisting the family, and referring the family to appropriate resources and support groups are important, the primary legal responsibility is to report the case.

17. A 6-year-old with leukemia asks, "Who will take care of me in heaven?" The best response for the nurse to make is: a. "Who do you think will take care of you?" b. "Your grandparents and God will take care of you." c. "Your mom will know more about that than I do." d. "Why are you asking me that?"

ANS: A This response gives the child an opportunity to verbalize his or her feelings and concerns, whereas closed responses shut off communication. The asking of a "why" question is not therapeutic as it calls for justification. DIF: Cognitive Level: Application REF: p. 637 OBJ: 15 TOP: Leukemia KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

Which of the following statements is correct about young children who report sexual abuse? a. They may exhibit various behavioral manifestations. b. In more than half the cases the child has fabricated the story. c. Their stories should not be believed unless other evidence is apparent. d. They should be able to retell the story the same way to another person.

ANS: A Victims of sexual abuse have no typical profile. The child may exhibit various behavioral manifestations, none of which is diagnostic for sexual abuse. When children report potentially sexually abusive experiences, their reports need to be taken seriously. Other children in the household also need to be evaluated. In children who are sexually abused, it is often difficult to identify other evidence. In one study, approximately 96% of children who were sexually abused had normal genital and anal findings. The ability to retell the story is partly dependent on the child's cognitive level. Children who repeatedly tell identical stories may have been coached.

25. Why would the nurse urge the family of a dying 12-year-old boy to include his 8-year-old sister in care? Select all that apply. a. She will feel less neglected by the parents. b. She can make amends for past hostilities to her brother. c. She will feel less helpless. d. She can express her feelings through care. e. She can experience being supportive of her parents and brother.

ANS: A, B, C, D, E All options are potential benefits to including the sibling in the care of a dying child.

Which of the following aspects of cognition develops during adolescence? a. Ability to see things from the point of view of another b. Capability of using a future time perspective c. Capability of placing things in a sensible and logical order d. Progress from making judgments based on what they see to making judgments based on what they reason

ANS: B Adolescents are no longer restricted to the real and actual. They also are concerned with the possible; they think beyond the present. During concrete operations (between ages 7 and 11 years) children exhibit thought processes that enable them to see things from the point of view of another, place things in a sensible and logical order, and progress from making judgments based on what they see to making judgments based on what they reason.

A method for conducting a health-screening interview with adolescents is "SAFE TIMES." The nurse working with adolescents should know that "SAFE" is an acronym for: a. social roles, apathy/anger, frustration, emotional growth. b. sexuality, affect/abuse, family, examination. c. safety issues, appropriate/inappropriate behavior, firearms, employment. d. security, acceptance/nonacceptance by peers, friends, education.

ANS: B SAFE TIMES is a method for conducting health-screening interviews with adolescents as a way to ensure that all topics are covered; it is best used in reverse order. SAFE is an acronym for Sexuality, Affect and Abuse, Family, and Examination; TIMES is the acronym for Timing of development, Immunization, Minerals, Education and Employment, and Safety.

SELECT ALL THAT APPLY. The nurse is caring for children on an adolescent-only unit. Which of the following growth and development milestones would the nurse expect from 13- and 14-year-old children? a. Self-centered with increased narcissism b. No major conflicts with parents c. Established abstract thought process d. Have a rich, idealistic fantasy life e. Highly value conformity to group norms f. Secondary sexual characteristics appear

ANS: B, E, F Growth and development milestones in the 11- to 14-year-old age-group include minimal conflicts with parents (compared with the 15- to 17-year-old age-group), a high value placed on conformity to the norm, and the appearance of secondary sexual characteristics. Self-centeredness and narcissism are seen in the 15- to 17-year-old age-group, along with a rich and idealistic fantasy life. Abstract thought processes are not well established until the 18- to 20-year-old age-group.

Which of the following is an important consideration for the school nurse planning a class on injury prevention for adolescents? a. Adolescents generally are not risk takers. b. Adolescents can anticipate the long-term consequences of serious injuries. c. Adolescents need to discharge energy, often at the expense of logical thinking. d. During adolescence, participation in sports should be limited to prevent permanent injuries.

ANS: C The physical, sensory, and psychomotor development of adolescents provides a sense of strength and confidence. There is also an increase in energy coupled with risk taking that puts them at risk. Adolescents are risk takers because their feelings of indestructibility interfere with understanding of consequences. Sports can be a useful way for adolescents to discharge energy. Care must be taken to avoid overuse injuries.

18. When dealing with a preschool-age child with a life-threatening illness, the nurse should remember that at this age the child's concept of death includes: a. that it is final. b. only a fear of separation from her parents. c. that a person becomes alive again soon after death. d. an understanding based on simple logic.

ANS: C The preschooler views death as reversible and temporary. DIF: Cognitive Level: Comprehension REF: pp. 642-643 OBJ: 18 TOP: Nursing Care of the Dying Child KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

Which of the following is the most common form of child maltreatment? a. Sexual abuse b. Child neglect c. Physical abuse d. Emotional abuse

b. Child neglect

Which of the following is most descriptive of the spiritual development of the older adolescent? a. Beliefs become more abstract. b. Rituals and practices become increasingly important. c. Strict observance of religious customs is common. d. Emphasis is placed on external manifestations, such as whether a person goes to church.

ANS: A Because of their abstract thinking abilities, adolescents are able to interpret analogies and symbols. Rituals, practices, and strict observance of religious customs become less important as the adolescent questions values and ideals of families. Adolescents question external manifestations when not supported by adherence to supportive behaviors.

The nurse is preparing a pamphlet for parents of adolescents about guidance during the adolescent years. Which of the following suggestions should the nurse include in the pamphlet? a. Provide criticism when mistakes are made or when views are different. b. Use comparisons to older siblings or extended family to promote good outcomes. c. Begin to disengage from school functions to allow the adolescent to gain independence. d. Provide clear, reasonable limits and define consequences when rules are broken.

ANS: D An anticipatory guideline to include when teaching parents of adolescents is to provide clear, reasonable limits and have clear consequences when rules are broken. Parents should avoid criticism when mistakes are made and should allow opportunities for the teen to voice different views and opinions. Parents should try to avoid comparing the teen to a sibling or extended family member. Parents should try to be more engaged in the teen's school functions to show support and unconditional love.

Several high-school seniors are referred to the school nurse because of suspected alcohol misuse. When the nurse assesses the situation, what would be most important to determine? 1) What they know about the legal implications of drinking. 2) The type of alcohol they usually drink. 3) The reasons they choose to use alcohol. 4) When and with whom they use alcohol.

3. Information about why adolescents choose to use alcohol or other drugs can be used to determine whether they are becoming responsible users or problem users.

An adolescent tells the nurse that he would like to lose weight and asks the nurse's opinion on how to accomplish his goal. Which of the following suggestions would be most appropriate? 1. Exercising more often. 2. Severely limiting calorie intake. 3. Participating in an adolescent weight-reduction program. 4. Cutting down on sweets and other snacks.

3. Weight loss treatment modalities that include peer involvement have been proven to be the most successful approach with obese adolescents.

A nurse is developing a plan of care for a child with autism. The nurse identifies which of the following as the priority problem for this child? 1. Inability to interact socially 2. Risk for injury 3. Troubling thought processes 4. Inability to verbally communicate

2. Risk for injury Rationale: Risk for injury related to an inability to anticipate danger, a tendency for self-mutilation, and sensory perceptual deficits is the priority concern. Inability to interact socially, troubling thought processes, and inability to verbally communicate are also appropriate problems for the child with autism, but the priority is the risk for injury.

A child with Down syndrome has an IQ of about 40. The nurse should expect which of the following as the type of environment and interdisciplinary program to most likely benefit this child? 1. Custodial. 2. Institutional. 3. Task analysis. 4. Vocational training.

3. Habit-training task analysis, a step-by-step process in which each step is taught before moving onto the next step, would be most beneficial.

A 9-year-old child is diagnosed with chlamydial conjunctivitis. The nurse consults with the primary health care provider regarding necessary follow-up because this infection can be associated with: 1. The presence of systemic allergies 2. The cleanliness of the home environment 3. The presence of otitis media 4. Possible sexual abuse

4. Possible sexual abuse Rationale: A diagnosis of chlamydial conjunctivitis in a child who is not sexually active should signal the health care provider to assess the child for possible sexual abuse. Allergy and infection can cause conjunctivitis, but the infecting organism would not be chlamydial. Although the infection can be transmitted, it is not directly associated with cleanliness in the home. Chlamydial conjunctivitis also may be suspected in a sexually active adolescent with chronic infection that is unresponsive to other treatment.

According to Piaget, adolescents tend to be in which stage of cognitive development? a. Concrete operations b. Conventional thought c. Postconventional thought d. Formal operational thought

ANS: D Cognitive thinking culminates in the capacity for abstract thinking. This stage, the period of formal operations, is Piaget's fourth and last stage. Concrete operations usually occur between ages 7 and 11 years. Conventional and postconventional thought refers to Kohlberg's stages of moral development.

Which of the following is true concerning the development of autonomy during adolescence? a. Development of autonomy typically involves rebellion. b. Development of autonomy typically involves parent-child conflicts. c. Parent and peer influences are opposing forces in the development of autonomy. d. Conformity to both parents and peers gradually declines toward the end of adolescence.

ANS: D During middle and late adolescence the conformity to parents and peers declines. Subjective feelings of self-reliance increase steadily over the adolescent years. The adolescent has genuine behavioral autonomy. Rebellion is not typically part of adolescence. It can occur in response to excessively controlling circumstances or to growing up in the absence of clear standards. Parent and peer relationships can play complementary roles in the development of a healthy degree of individual independence.

Adolescents often do not use reasoned decision making when issues such as substance abuse and sexual behavior are involved. This is because they: a. tend to be immature. b. do not need to use reasoned decision making. c. lack cognitive skills to use reasoned decision making. d. are dealing with issues that are stressful and emotionally laden.

ANS: D In the face of time pressures, personal stress, or overwhelming peer pressure, young people are more likely to abandon rational thought processes. Many of the health-related decisions adolescents confront are emotionally laden or new. Under such conditions, many people do not use their capacity for formal decision making. The majority of adolescents have cognitive skills and are capable of reasoned decision making. Stress affects their ability to process information. Reasoned decision making should be used in issues that are crucial such as substance abuse and sexual behavior.