Child/Adolescent Psychiatric-Mental Health Clinical Nurse Specialist-ANCC REVIEW

An adolescent client states, "My mother doesn't believe that I'm really in pain. She thinks it's all in my head, but I know I feel the pain." The child/adolescent psychiatric and mental health clinical nurse specialist responds: "Pain is real, whatever the cause. Many physical diseases are partially related to stress." "You never know what is real pain and what is psychological pain until you explore the source." "Your mother may be right. Let's try to figure out if that is the problem in your case." "Your mother thinks that I can help you; that is why you were sent to me."

"Pain is real, whatever the cause. Many physical diseases are partially related to stress."

The director of psychiatric services asks a child/adolescent psychiatric and mental health clinical nurse specialist to define and coordinate the standard of nursing care for psychiatric patients in the emergency department. The clinical nurse specialist is serving in the role of a change: Agent. Investigator. Recipient. Strategist.

Agent.

Dysregulation of gamma-aminobutyric acid is associated with a diagnosis of: Anxiety disorder. Delirium. Huntington disease. Schizophrenia.

Anxiety disorder.

A child/adolescent psychiatric and mental health clinical nurse specialist conducts a community meeting for children and adolescent patients. Several adolescent patients complain about the intrusive behavior of the younger children. The clinical nurse specialist maintains the therapeutic milieu by: Asking both the adolescents and the younger patients to provide solutions. Giving the younger patients room restrictions. Reviewing with the group the rules and consequences of intrusive behaviors. Scheduling a meeting with the adolescent patients and nurse manager for later in the day.

Asking both the adolescents and the younger patients to provide solutions.

Two child/adolescent psychiatric and mental health clinical nurse specialists are conducting a continuing education class for nurses, psychiatric technicians, and aides who have varying levels of experience and education. The clinical nurse specialists begin the class by introducing themselves and relating their backgrounds and experience. The class is then asked to do the same and tell why they are there. This method reflects which principle of adult learning theory? Assessment of group dynamics Assessment of knowledge and learning needs of participants Establishment of group cohesiveness and rapport with participants Establishment of the clinical nurse specialists' role as experts

Assessment of knowledge and learning needs of participants

A child/adolescent psychiatric and mental health clinical nurse specialist counsels the parent of a preschool-aged child who has fetal alcohol syndrome. When asked how to manage the child's excitability, the clinical nurse specialist advises the parent to: Avoid games with repetition of ideas and behaviors. Begin and end each play activity with less action. Increase interactions with other children. Play soft music in the background during play activities.

Begin and end each play activity with less action.

According to the Diagnostic and Statistical Manual of Mental Disorders, to diagnose attention-deficit hyperactivity disorder, a child/adolescent psychiatric and mental health clinical nurse specialist assesses a child's: Ability to listen when directly addressed. Ability to remain seated in a classroom. Behavioral functioning, both at home and at school. Intellectual functioning based on psychometric testing.

Behavioral functioning, both at home and at school.

After climbing on the trees that surround a six-year-old female child's home, the child reports that the "angry trees" made her fall. This animistic thinking is: A coping mechanism to allay the child's guilt feelings. An abnormal thought process for a child of this age. Characteristic of preoperational thought. Indicative of childhood schizophrenia.

Characteristic of preoperational thought.

The parent or legal guardian of a seven-year-old child must approve any medication orders, because a child of this age fails to meet which two of the four elements of informed consent? Autonomy and veracity. Competence and comprehension. Confidentiality and beneficence. Disclosure of information and voluntariness.

Competence and comprehension.

An eight-year-old female child is referred to the child/adolescent psychiatric and mental health clinical nurse specialist for verbalizing fears that her immigrant grandmother will die. The widowed grandmother wears heavy black clothes, prays throughout the day, and secludes herself from everyone except the child. Although the grandmother is physically healthly, she discusses her impending death with the child. The clinical nurse specialist recognizes that: Cultural factors may negate the significance of seemingly obvious symptoms. Religious fixations are common in delusional systems. The grandmother and the child communicate only in the grandmother's native language. The grandmother is exhibiting classic signs of endogenous depression.

Cultural factors may negate the significance of seemingly obvious symptoms.

A primary goal of a practice guideline is to: Document preferred practice patterns. Enhance subjective judgments. Expand access to care. Support expert opinion.

Document preferred practice patterns.

When conducting a longitudinal non-experimental study about various modalities to treat bipolar disorder in children and adolescents, a child/adolescent psychiatric and mental health clinical nurse specialist: Chooses two types of randomly assigned treatment. Evaluates each child and adolescent research participant every six months for five years. Initiates several clinical trials under strict criteria. Sets up a comparison group of patients who will not receive any treatment for a two-year period.

Evaluates each child and adolescent research participant every six months for five years.

A mother and father who have recently separated are in family therapy with their six-year-old child, who is experiencing behavioral problems. The father is now involved in a homosexual relationship. During this session, the mother initiates a heated discussion of her fears that the child is being exposed to age-inappropraite sexual behavior in the father's home. The child/adolescent psychiatric and mental health clinical nurse specialist's action is to: Exclude the child from future sessions because of the child's age and cognitive ability. Exclude the child from future sessions because of the sexual content being discussed. Exclude the child from this session because the issues being discussed are inappropriate for the child to hear. Include the child in this session because his or her presence provides useful data for clinical assessment.

Exclude the child from this session because the issues being discussed are inappropriate for the child to hear.

A child is receiving mental health care in a managed care setting. The child's father questions the confidentiality of the treatment records, fearing that the information could negatively impact his employment or future insurance coverage. In responding, a child/adolescent psychiatric and mental health clinical nurse specialist recognizes that the father is: Demonstrating resistance to therapy. Expressing a major concern for patients of managed care systems. Focused on personal, rather than treatment, issues. Having difficulty building a trusting, therapeutic relationship.

Expressing a major concern for patients of managed care systems.

A child/adolescent psychiatric and mental health clinical nurse specialist on the adolescent unit observes a group of three patients ostracizing a fourth patient. The members of the group use a special walk and wear similar outfits to define themselves. The clinical nurse specialist realizes that the: Group members must be separated from one another. Group's intolerance serves as a defense against their sense of identity confusion. Ostracized adolescent may not have reached the developmental stage of the others. Ostracized adolescent should be transferred to another unit or discharged.

Group's intolerance serves as a defense against their sense of identity confusion.

When beginning therapy with a six-year-old child with autism, the child/adolescent psychiatric and mental health clinical nurse specialist initially communicates with the child: Nonverbally, through facial expressions and simple gestures. Nonverbally, through tactile stimulation. Verbally, by giving full, detailed explanations. Verbally, by using humor and popular children's language.

Nonverbally, through facial expressions and simple gestures.

A mother brings her four-year-old son in for evaluation because he "does not get along with his step-siblings." The mother reports that her son refuses to play a game with his step-siblings unless they play by his rules. According to cognitive development theory, the explanation for the child's behavior is that he is in the: Developmental stage of industry versus inferiority and he may feel inadequate when competing with older children. Preconventional stage of thinking and his behavior is motivated by egocentrism. Preoperational stage of thinking and it is difficult for him to accept differing viewpoints. Stage of concrete operations.

Preoperational stage of thinking and it is difficult for him to accept differing viewpoints.

A child/adolecent psychiatric and mental health clinical nurse specialist meets regularly with the staff nurses of an adolescent inpatient psychiatric unit to improve the nurses' therapeutic interactions with the patients. Each nurse keeps a journal describing clinical interactions with an adolescent and examines the factors that hinder the nurse's ability to interact therapeutically with the patient. The clinical specialist reviews the entries and provides written feedback. This teaching strategy is known as: Concept mapping. Discovery learning. Problem-based learning. Reflective practice.

Reflective practice.

The adolescent parents of a three-year-old child attend an alternate high school that houses an onsite daycare center. The school nurse refers the parents to a child/adolescent psychiatric and mental health clinical nurse specialist to help them manage their child's temper tantrums. The focus of the treatment plan is a: Behavior modification program for the child that the parents will implement at home. Parenting class at a local mental health clinic for the parents to attend weekly during the evening. Play therapy session for the child, which the clinical nurse specialist conducts weekly. School-based intervention with the parents to convey that behavior is motivated by thoughts and feelings.

School-based intervention with the parents to convey that behavior is motivated by thoughts and feelings.

A 17-year-old patient arrives at the emergency department with nonspecific complaints. The patient's temperature is 100.8°F (38.2°C), pulse rate and blood pressure are elevated, and pupils are dilated with decreased reaction to light. Two days ago, the patient began taking sertraline (Zoloft) 50 mg daily for treatment of depression. The patient has a history of substance use and smoked marijuana one week ago. The diagnosis is: Alcohol withdrawal. Infection affecting the central nervous system. Neuroleptic malignant syndrome. Serotonin syndrome.

Serotonin syndrome.

A child/adolescent psychiatric and mental health clinical nurse specialist learns that a patient with bipolar affective disorder is moving out of state. The clinical nurse specialist refers the patient to a new provider for a followup appointment and prescribes enough medication to last until the appointment with the new clinical nurse specialist. These actions demonstrate the clinical nurse specialist's understanding of the: Disease process of bipolar affective disorder. Laws related to patient abandonment. Length of time needed to schedule a new appointment. Standards of practice.

Standards of practice.

For the past 18 months, an eight-year-old child has exhibited involuntary, purposeless, rapid recurrent movements of the arms and face as well as spontaneous unintelligible vocalizations. When receiving verbal cues, the child can decrease and sometimes extinguish the erratic movements for several minutes. The diagnosis is: Atypical tic disorder. Chronic motor tic disorder. Stereotypic movement disorder. Tourette disorder.

Tourette disorder.

Which of Yalom's curative factors in group therapy applies to female adolescents who have sustained incest? Altruism. Group cohesiveness. Imitative behaviors. Universality.

Universality.

A mother who has paranoid delusions has been isolating her seven-year-old child. The child is developing disruptive behavior and the family has come to the attention of several community agencies. The most effective means of addressing the family's needs is to: Allow the mother and child to determine their desired level of involvement with the community agencies. Encourage the mother and child to interact with representatives from the various agencies. Focus on a single need and service agency to help manage the anxiety level of the mother and child. Use multiple agencies with a primary clinician to clarify the roles and boundaries and coordinate interventions.

Use multiple agencies with a primary clinician to clarify the roles and boundaries and coordinate interventions.

Several months ago, a 12-year-old male client was involved in an exploitative homosexual relationship with an older adolescent. Now in therapy, the client expresses feelings of helplessness and fantasizes about "getting even" with the older youth. The child/adolescent psychiatric and mental health clinical nurse specialist encourages the client to: Engage in activities with boys who are his age. Take karate lessons to learn the skills needed to defend himself. Work out with a punching bag to displace his hostility. Write a letter to the perpetrator, expressing his rage at being exploited.

Write a letter to the perpetrator, expressing his rage at being exploited.