Ch 16: Mental Health Promotion for Children and Adolescents

c) Scapegoat Pg. The "scapegoat" in the family is the person or persons who divert attention away from the parent with alcoholism. The "hero" is the overly responsible child who may ignore personal needs to take care of parents and other children. The "lost child" is a child who suffers in silence but may exhibit difficulties at school or later in life. The "mascot" is the family clown who relieves tension and masks feelings through joking.

16. Which of the following describes a child of a parent diagnosed with alcoholism who diverts attention away from the parent with alcoholism? a) Hero b) Lost child c) Scapegoat d) Mascot

a) Bald spots interspersed with normal hair c) Clusters of lacerations on the torso d) Fear of adults, especially parents Pg. 252 Signs of physical abuse include: clusters of bruises or lacerations, especially on back, buttocks, thighs, or large areas of the torso, bald spots interspersed with hair, failing to cry when hurt, unwillingness to change clothes in front of others, and a fear of adults, especially parents.

17. A nurse is conducting an in-service education program for a group of nurses working in ambulatory care centers. The topic is child abuse. The nurse determines that the teaching was successful when the group identifies which finding as suggestive of possible physical abuse? Select all that apply. a) Bald spots interspersed with normal hair b) Willingness to change clothes in front of others c) Clusters of lacerations on the torso d) Fear of adults, especially parents e) Crying loudly when hurt or injured

d) Determinant of the success of later relationships Pg. 244 Studies of attachment show that the quality of the emotional bond between the child and parental figure is an important determinant of the success of later relationships.

18. Studies of attachment show that the quality of the emotional bond between the child and parental figure is a ... a) Sign of an enmeshed family b) Determinant of overprotection of the parent c) Sign of poor coping skills with their peers d) Determinant of the success of later relationships

a) Adolescents Pg. 245 Adolescents may be fascinated by death, enjoy morbid books and movies, and listen to rock music about death and suicide.

23. In which age group would a nursing student expect to see a person fascinated with death and enjoying morbid books and movies? a) Adolescents b) Adults c) Elderly d) Children

b) 7 years Pg. 245 Children begin to perceive death as permanent by the age of 7 years.

29. The nurse is planning to make a presentation about loss and grief to a group of parents. The nurse should plan to instruct the group that children begin to perceive death as permanent by the age of a) 6 years b) 7 years c) 4 years d) 5 years

c) Scapegoat Pg. The roles include the "hero" (overly responsible children who may ignore their own needs to take care of their parents and other children), "scapegoat" ("problem children" who divert attention away from the parent with alcoholism), "mascot" (family clowns who relieve tension and mask feelings through joking), and "lost child" (children who suffer in silence but may exhibit difficulties at school or later in life).

31. The literature on children of parents with alcoholism has described several typical roles that children assume. Which role is described as problem children who divert attention away from the parent with alcoholism? a) Lost child b) Hero c) Scapegoat d) Mascot

d) Death Pg. 246 The child's response to divorce is similar to the response to death.

5. The child's response to divorce is similar to which of the following? a) Sibling rivalry b) Bullying c) Physical illness d) Death

d) Social skills training Pg. 254 Social skills training may be particularly helpful for children who are bullies or rejected by their peers.

19. Which type of intervention may be helpful for children who are bullies? a) Play therapy b) Art therapy c) Bibliotherapy d) Social skills training

b) Children Pg. 245 The expression of grief through regression, or somatic complaints or withdrawal, describes the grief of children.

35. The expression of grief through regression, or somatic complaints or withdrawal, describes the grief of... a) Adolescents b) Children c) Elderly d) Adults

b) Anxiety around strangers Pg. 249 Children of this age often regress to earlier behaviors when hospitalized. The child will likely exhibit anxiety around strangers such as health care providers. They may also have magical thinking about their illness.

1. A 3-year-old child has been admitted to the hospital after an automobile accident. The nurse can anticipate that the child will exhibit ... a) Guilt related to the accident b) Anxiety around strangers c) Mood swings d) Body image disturbance

c) Boundary-free home setting Pg. 247 Protective factors against emotional problems in children of divorce and remarriage include a structured home and school environment with reasonable and consistent limit setting and a warm, supportive relationship with stepparents.

10. A nurse is working with a couple who is in the process of divorcing. After discussing the effect of divorce on children's mental health, the nurse determines that additional teaching is needed when the couple identify which factor as protecting the children's mental health? a) Structured school environment b) Supportive stepparent relationship c) Boundary-free home setting d) Consistently set limits

a) "Be honest in your statements about the death and repeat them as necessary" c) "When the child sees you're upset, reassure them that you will be okay" e) "Allow the child to express how they are feeling through their play" Pg. 245 The preschool-aged child may react more to the parents' distress about a death than to the death itself. Young children who depend totally on their parents may be frightened when they see their parents upset. Anything the parent can do to alleviate their children's anxiety, such as reassuring them that the parent will be okay and continuing the child's routine (e.g., normal bedtimes, snacks, play times) will help the child to feel secure. Because preschool-aged children have limited ability to verbalize their feelings, they may need to express them through fantasy play and activities. Parents should take care not to use euphemisms that could fuel misconceptions of death, such as "He went to sleep" or "Jesus took him." Young children may interpret these messages literally and fear going to sleep (because they might die) or focus their natural, grief-related anger on the irrational idea that the person deliberately has not returned. The best approach is to explain honestly that the person has died and is not coming back, elicit the child's understanding and questions about what has happened, and then repeat this process continually as the child gradually begins to grasp the reality of the situation.

11. A psychiatric-mental health nurse is conducting a program for young and middle-aged adults who are providing care to their aging parents who are receiving hospice care. One of the participants asks the nurse, "When my dad dies, how should we handle it with our 4-year-old?" Which response by the nurse would be most appropriate? Select all that apply. a) "Be honest in your statements about the death and repeat them as necessary" b) "Don't worry about the usual routines during this stressful time" c) "When the child sees you're upset, reassure them that you will be okay" d) "Emphasize that your father just went to sleep and didn't wake up" e) "Allow the child to express how they are feeling through their play"

c) Hero Pg. The literature on children of parents who have alcoholism has described several typical roles that children assume, including the "hero" (overly responsible children who may ignore their own needs to take care of parents and other children), "scapegoat" (problem children who divert attention away from the parent with alcoholism), "mascot" (family clowns who relieve tension and mask feelings through joking), and "lost child" (children who suffer in silence but may exhibit difficulties at school or in later life).

12. During an interview, a child whose parent abuses alcohol tells the nurse, "When I get home from school every day, I pick up my younger brother and sister from the bus stop and get them a snack before I start making dinner for everyone. I also make sure that my parents eat." The nurse interprets this behavior as the child fulfilling which role? a) Scapegoat b) Mascot c) Hero d) Lost child

b) 7 years Pg. 245 As early as 3 years of age, children have some concept of death; however, not until approximately age 7 years can most children understand the permanence of death.

13. A nursing instructor is teaching about how death affects children at different ages. At what age does the teacher tell students that most children can understand the permanence of death? a) 3 years b) 7 years c) 12 years d) 10 years

d) Physical aggression Pg. 249 Boys are more likely to use physical aggression while some studies suggest that girls are more likely to use relational aggression, which involves disrupting peer relationships by excluding or manipulating others and spreading rumors.

14. A nurse is conducting a program for a local school district on bullying. When describing the types of activities involved, the nurse describes relational aggression. The nurse determines that additional teaching is needed when the group identifies which behavior as an example? a) Spreading rumors b) Manipulating a person c) Excluding a member from the group d) Physical aggression

c) Child makes jokes and clowns around to relieve the tension Pg. 252-253 The literature on children of parents who have alcoholism has described several typical roles that children assume, including the "hero" (overly responsible children who may ignore their own needs to take care of parents and other children), "scapegoat" (problem children who divert attention away from the parent with alcoholism), "mascot" (family clowns who relieve tension and mask feelings through joking), and "lost child" (children who suffer in silence but may exhibit difficulties at school or in later life).

15. A nurse is assessing a family in which a parent has a problem with alcohol abuse. When interviewing the family, one of the children demonstrates behavior that the nurse suspects as fulfilling the role of the family mascot. Which behavior would support the nurse's suspicion? a) Child remains silent but is experiencing difficulties in school b) Child assumes care of the parents and other children in the family c) Child makes jokes and clowns around to relieve the tension d) Child exhibits problem behavior that takes the focus off the parent with the problem

c) Guilt Pg. 245 The death of a sibling can be a particularly difficult loss for both the child and the family. Common reactions to this are for the surviving child to feel guilty because of natural sibling rivalry and for the parents to unconsciously endow the surviving child with qualities of the lost sibling as if to fill the empty space in the family. Abstract conceptualization and romanticizing about death would be more common seen with adolescents in general. School-aged children tent to express their grief through somatic issues. They may think that others expect them to cry and react with immediate emotional intensity to the death. When they do not react this way, they feel guilty.

2. A psychiatric-mental health nurse is providing counseling to parents who have just lost a child to cancer. They have a school-aged child at home. When explaining the concept of grief for the surviving child, which reaction would the nurse explain as being most commonly experienced by surviving siblings? a) Romanticizing of death b) Abstract conceptualization c) Guilt d) Intense crying

b) 7 years old Pg. 245 Children's responses to loss reflect their developmental level. As early as age 3 years, children have some concept of death. For example, the death of a goldfish provides an opportunity for the child to grasp the idea that the fish will never swim again. However, not until about age 7 years can most children understand the permanence of death. Before this age, they may verbalize that someone has "died" but in the next sentence ask when the dead person will be "coming back."

20. A psychiatric-mental health nurse is conducting a teaching session about death and grieving for a group of parents. The parents have children ranging in age from 2 years to 18 years. When discussing the concept of death, the nurse would explain that children of which age would be capable of understanding about the permanence of death? a) 6 years old b) 7 years old c) 4 years old d) 5 years old

a) Difficult temperament Pg. 244 If the parents identify a difficult temperament as promoting mental health, additional teaching is required. Supportive social networks and positive childhood and adolescent experiences maximize the mental health of children and adolescents. Children are more likely to be mentally healthy if they have good physical health, positive social development, an easy temperament (adaptable, low intensity, positive mood), and secure attachment established through the emotional bonds formed between them and their parents at an early age.

21. A psychiatric-mental health nurse is preparing a presentation for a group of new parents in the local community about how to promote their children's mental health. After providing the parents with instruction, the nurse determines the need for additional teaching when the group identifies which factor as promoting mentally healthy children? a) Difficult temperament b) Good physical health c) Positive social development d) Secure attachment

c) "It involves instruction, feedback, support and practice to help the child interact with others" Pg. 254 Social skills training involves instruction, feedback, support, and practice with learning behaviors that help children to interact more effectively with peers and adults. Bibliotherapy is a particularly potent form of intervention because it empowers families to learn and develop coping mechanisms on their own using books on various topics as well as pamphlets designed to educate parents and children about various physical and psychological problems. Psychoeducational programs are designed to teach parents and children basic coping skills for dealing with various stressors. They focus on normalization (teaching families normal behaviors and expected responses) and provide families with information about typical child development and expected reactions to various stressors. Early intervention programs offer regular home visits, support, education, and concrete services to those in need.

22. Social skills training is suggested for a child who has engaged in bullying. The parent asks the nurse, "What exactly is involved with this training?" Which information would the nurse most likely include in the response? a) "It involves home visits and referral for supportive services so the child isn't isolated from others" b) "It involves using books and pamphlets to teach the appropriate way to interact with others" c) "It involves instruction, feedback, support and practice to help the child interact with others" d) "It involves teaching how to cope with stress and how to behave normally around others"

c) 7 Pg. 245 Not until about age 7 years can most children understand the permanence of death. Before this age, they may verbalize that someone has "died" but in the next sentence ask when the dead person will be "coming back."

24. At approximately what age do children understand the permanence of death? a) 5 b) 4 c) 7 d) 6

a) Bruising on the genitals b) Hyperalertness d) Positive test for gonorrhea Pg. 252 Signs of possible sexual abuse include: bruising or bleeding on the genitals or rectum, vaginal or penile discharge, evidence of sexually transmitted infection, hyperalertness to the environment, and withdrawal.

25. A 10-year-old girl is brought to the emergency department. After conducting the assessment, the nurse suspects that the child may have been sexually abused. Which finding would support the nurse's suspicion? Select all that apply. a) Bruising on the genitals b) Hyperalertness c) Absence of vaginal discharge d) Positive test for gonorrhea e) Actively engaging with others

a) Egocentric thinking Pg. 245 The parents are describing the adolescent's view of themselves as invincible and immune to danger which reflects the adolescent's egocentric thinking. This behavior is not related to a difficult temperament or regression. Formal operations is a stage of development for adolescents but this stage is characterized by the ability to use abstract reasoning to conceptualize and solve problems, not engage in dangerous behavior because of feelings of being immune.

26. The parents of an adolescent are concerned that their child is engaging in activities that put the child in danger. "We're so worried. When we ask our child about these activities, it's as if our child thinks nothing will ever happen." When counseling the parents, the nurse integrates understanding that this behavior is reflective of which aspect of adolescence? a) Egocentric thinking b) Formal operations c) Regression d) Difficult temperament

d) Cyberbullying Pg. 249 Cyberbullying involves spreading pictures, rumors, or smear campaigns via the Internet. Relational aggression involves disrupting peer relationships by excluding or manipulating others and spreading rumors. With egocentric thinking, children naturally view themselves as the center of their own universe. The invincibility fable is an aspect of egocentric thinking in adolescence that causes teens to view themselves as immune to dangerous situations, such as unprotected sex, fast driving, and drug abuse.

27. A nurse is conducting the interview of a girl who has been accused of bullying by spreading rumors online about two other children in the class. The nurse interprets this action as: a) Invincibility fable b) Relational aggression c) Egocentric thinking d) Cyberbullying

d) A school-age male who has divorced parents and a history of physical abuse Pg. 249 Children who have insecure attachments (e.g., divorced parents); who have distant or authoritarian parents; and who have been physically, sexually, or verbally abused are at risk for becoming bullies. In addition, males exhibit bullying behaviors more often than females. Based on this data, the child with the greatest risk for exhibiting bullying behavior has several risk factors, including male gender, parents who are divorced, and a history of physical abuse. The adolescent female has one risk factor for bullying behaviors, which is insecure attachment. The school-age male whose mother recently remarried has one risk factor: male gender. The adolescent female is likely the victim of bullying based on the clinical manifestations of low self-esteem and relationship difficulties.

28. Which child has the greatest risk for exhibiting bullying behaviors? a) An adolescent female who exhibits low self-esteem and relationship difficulties b) An adolescent female whose parents are divorced c) A school-age male whose mother recently remarried d) A school-age male who has divorced parents and a history of physical abuse

d) Egocentric Pg. 247 Egocentric thinking, which is normal for children, may cause the child to believe that he or she is at the root of the problem. It is important to make it clear to children that divorce is not caused by them. Fantasy, irrational, and idealistic thinking are not types of thinking that may cause children to believe that they are at the root of their parents' problems.

3. A child's parents are getting a divorce. Which type of thinking may cause the child to believe that he or she is the root of the parents' problems? a) Irrational b) Fantasy c) Idealistic d) Egocentric

a) Egocentric thinking Pg. 245 The invincibility fable is an aspect of egocentric thinking in adolescence that causes teens to view themselves as immune to dangerous situations, such as unprotected sex, fast driving, and drug abuse. It is not related to identity or independence. Formal operations is characterized by the adolescent's ability to use abstract reasoning to conceptualize and solve problems.

30. When explaining the invincibility fable phenomenon to the parents of an adolescent, the nurse describes it as reflective of which concept of adolescent development? a) Egocentric thinking b) Independence c) Identity d) Formal operations

d) Vulnerable child syndrome Pg. 249 The mother's statement reflects the phenomenon of vulnerable child syndrome, in which the family perceives the child as fragile despite current good health and, as a result, is overprotective of the child. Relational aggression, a type of bullying used by girls, involves disrupting peer relationships by excluding or manipulating other and spreading rumors. With egocentric thinking, children naturally view themselves as the center of their own universe. The invincibility fable is an aspect of egocentric thinking in adolescence that causes teens to view themselves as immune to dangerous situations, such as unprotected sex, fast driving, and drug abuse.

32. A child has been hospitalized numerous times for problems related to recurrent and severe asthma attacks. As a result of the child's chronic illness, the child has had to limit his physical activity level, engaging only in sedentary activities. While interviewing the parents, the child's mother says, "He's been so sick and so often that we don't let him do anything for fear that his asthma might flare up again." The nurse interprets this statement as: a) Invincibility fable b) Egocentric thinking c) Relational aggression d) Vulnerable child syndrome

b) A structured home and school environment can lessen the emotional problems Pg. 247 The first 2 or 3 years following the marital break up are the hardest. A structured home and school environment can serve as a protective factor against the development of emotional problems in the childen.

33. The nurse is counseling a couple who have just gotten divorced. The wife has custody of the two children, ages 7 and 9 years. The nurse should instruct the couple that divorce can affect the children and that ... a) It takes many years for the children to accept the reality b) A structured home and school environment can lessen the emotional problems c) Sibling rivalry may develop after the couple divorces d) Children usually adjust quickly if remarriage occurs for one parent

b) Child Pg. 252 Nurses working with abused children should resist the temptation to view the child as the only victim. Remembering that most abusive parents were abused themselves as children and therefore may have limited coping mechanisms or little access to positive parental role models will help the nurse maintain empathy toward the parents. Thus the victim is the family. After state agencies intervene to establish the child's safety, a family systems approach that is supportive of the whole family unit is most effective.

34. A nurse is conducting an in-service presentation on child abuse for a group of nurses working in the emergency department of a local acute care facility. The nurse determines that the teaching was successful when the group identifies which person as the victim? a) Siblings b) Child c) Parents d) Family

a) Primary prevention Pg. Educating children in healthy inter- and intrapersonal skills prevents the development of social and emotional dysfunction during the years of significant personality development.

36. Preschool programs that target children's social and emotional competencies are an example of... a) Primary prevention b) Secondary prevention c) Quaternary prevention d) Tertiary prevention

c) The most difficult time for the children is usually the first 2 to 3 years after the couple's breakup Pg. 246-247 The first 2 or 3 years after the couple's breakup tend to be the most difficult. Although many families adapt to separation and divorce without long-term negative effects for the children, youth often show at least temporary difficulties in dealing with this common stressor. A child's response to divorce is similar to the response to death. The response to the loss that divorce imposes is affected by several variables, including the child's temperament; the parents' interventions; and the level of stress, change, and conflict surrounding the divorce.

37. A psychiatric-mental health nurse is working with a couple who are getting a divorce. The couple has 2 children, ages 5 and 7 years. When discussing the effects of divorce on the children, which information would the nurse most likely include? a) A child's temperament is the primary determining factor on how the child responds b) Studies show that most children experience at least one long-term effect associated with divorce c) The most difficult time for the children is usually the first 2 to 3 years after the couple's breakup d) A child's response to divorce is much different than that associated with a death

a) Teens role modeling positive behaviors d) Discussion that encourages questions about risky behaviors e) Peer group social skills training Pg. 250 When working with adolescents, it is important to employ strategies address the adolescents' developmental stage. Adolescence is a time of growing independence and peer support is important. Successful strategies include discussions that encourage questions, involvement in peer counseling, such as peer group social skills training, and role modeling by teens. These strategies help build self-esteem and set positive examples. Strategies that have been found to be ineffective include mere education about dangerous activities without behavior training and programs that provide inadequate training for the professionals implementing them. In any intervention, it is also important to keep in mind that adolescents are skeptical of authority figures and tend to take cues from one another. Nurses working with teenagers find it helpful to use a discussion approach that encourages questioning and argument as opposed to talking down to or "talking at" teenagers.

38. A nurse is working at a community health center that serves a large adolescent population. When implementing activities to address the risk-taking behaviors of adolescents, which strategy would the nurse most likely employ? Select all that apply. a) Teens role modeling positive behaviors b) Expert panels addressing common risk-taking behaviors c) Lectures about the effects of risk behaviors d) Discussion that encourages questions about risky behaviors e) Peer group social skills training

b) "Does the child have a basic understanding about death?" Pg. 245-246 The first question that should be asked when deciding whether or not a child should attend a funeral is one that determines the child's developmental level; that is, if the child has a basic understanding of death and has good coping skills. Questions about cultural beliefs, available support and supervision by another adult, and the child's wishes would be appropriate once the child's developmental level is determined.

39. The mother of a 5-year-old child asks the nurse if the child should attend their grandfather's funeral. Which question should the nurse ask first to assist the mother in making this decision? a) "Is there an adult available who can keep an eye on the child's needs?" b) "Does the child have a basic understanding about death?" c) "Has the child voiced a desire to attend the funeral?" d) "Does your culture commonly encourage children to attend funerals?"

a) "Tell them honestly that the person has died and won't be coming back" Pg. 245 The best approach is to explain honestly that the person has died and is not coming back, elicit the child's understanding and questions about what has happened, and then repeat this process continually as the child gradually begins to grasp the reality of the situation. Questions should not be discouraged. Parents should take care not to use euphemisms that could fuel misconceptions of death, such as "He went to sleep" or "Jesus took him." Young children may interpret these messages literally and fear going to sleep (because they might die) or focus their natural, grief-related anger on the irrational idea that the person deliberately has not returned.

4. A nurse is teaching a group of parents about how children respond to loss and death. Which statement by the nurse would be most appropriate when describing how to address the topic of death with preschoolers? a) "Tell them honestly that the person has died and won't be coming back" b) "Use words like sleep or heaven to explain the loss" c) "Keep the questions from the child about the death to a minimum" d) "Tell the child once and then let the topic fade away"

d) Resilience Pg. 243 Resilience is the phenomenon by which some children at risk for psychopathology, because of genetic or experiential circumstances, attain good mental health, maintain hope, and achieve healthy outcomes. Bibliotherapy is an expressive therapy using relationships to the content of of books or poetry and other written words. Normalization refers to processes through which ideas and actions come to be seen as normal. Developmental delays are when a child does not reach a developmental milestone at the expected time.

40. Assessment of a client at risk for psychopathology is able to attain good mental health, maintain hope, and achieve healthy outcomes. The nurse interprets this as demonstrating which of the following? a) Normalization b) Bibliotherapy c) Developmental delay d) Resilience

d) Observing the parental fights and wanting to be loyal to both parents Pg. 247-248 Conflict between parents leads to anger and anxiety in children because they want to be loyal to and please both parents. This feeling of being "caught in the middle" leads to depression, anxiety, and deviant behavior. Children exposed to a continuing demonstration of hostility demonstrate higher levels of aggressive behavior. The less postdivorce conflict between parents there is, the greater is the children's well-being.

41. The parents of a 12-year-old are hostile to each other, fight frequently, and plan to divorce. The child will move with the mother to another part of town. Which of the following factors will likely have the most negative effect on the child? a) Coping with developmental issues as well as the divorce b) Going to a different school c) Traveling on weekends to be with the father d) Observing the parental fights and wanting to be loyal to both parents

a) "I've been getting support from my friends" Pg. 245 Adolescents are able to understand death as an abstract concept and that it is permanent. They mourn by talking about the loss, but they may withdraw or seek comfort through peer groups. Children are more likely to keep questioning about death or experiment with ideas about death such as killing insects. Young children view death as reversible, with statements that the person will be coming back.

42. A male client with advanced heart failure was being cared for by his 15-year-old son and his family. The person recently died and the home health care nurse is making a home visit to the family to assess how the family is coping with the death. When interviewing the 15-year-old family member, which statement would the nurse most likely expect to hear? a) "I've been getting support from my friends" b) "I like to play with killing insects outside" c) "I know my grandfather will be coming back" d) "I keep asking questions about the death"

d) Egocentric thinking Pg. 245 The invincibility fable is an aspect of egocentric thinking in adolescence that causes teens to view themselves as immune to dangerous situations, such as unprotected sex, fast driving, and drug abuse. It is not related to identity or independence. Formal operations is characterized by the adolescent's ability to use abstract reasoning to conceptualize and solve problems.

43. When explaining the invincibility fable phenomenon to the parents of an adolescent, the nurse describes it as reflective of which concept of adolescent development? a) Independence b) Identity c) Formal operations d) Egocentric thinking

a) Relational aggression Pg. 249 Girls are more likely to use relational aggression, which involves disrupting peer relationships by excluding or manipulating others and spreading rumors. When bullying, boys are more likely to use physical aggression, and bigger boys usually pick on smaller, weaker ones.

44. Girls who bully are more likely to use which of the following? a) Relational aggression b) Sexual aggression c) Nonverbal aggression d) Physical aggression

b) Formal operations Pg. 245 The final stage of cognitive development includes the ability for abstract thought. This is termed the "formal operations stage."

45. According to Piaget, adolescents who have reached the final stage of cognitive development are in a stage termed... a) Concrete b) Formal operations c) Sensorimotor d) Preoperational

a) Perform in school Pg. 252 Children whose parents are dependent on alcohol live in an unpredictable family environment, coping with stress that may disrupt their ability to perform in school and lead to other emotional problems.

46. A psychiatric-mental health nurse is assessing the children whose parents are dependent on alcohol. The assessment reveals that the children are living in an unpredictable family environment and are experiencing difficulties in coping with stress. The nurse integrates knowledge of this information, being alert to problems focusing primarily on the children's ability in which area? a) Perform in school b) Interact with peers c) Sustain a relationship d) Develop attachments

a) Functional Pg. 245 The functioning level of the surviving parent is the best predictor of a child's adjustment to the loss.

47. Following the death of a parent, which of the following levels of the surviving parent is the best predictor of a child's adjustment to the loss? a) Functional b) Developmental c) Physical d) Social

a) Parents Pg. 252 To minimize damaging the nurse-family relationship, experts recommend that nurses report abuse in the presence of the parents, preferably with the parent initiating the telephone call.

48. To avoid damaging the nurse-family relationship, experts recommend that nurses report abuse in the presence of which of the following? a) Parents b) Siblings c) Clergy d) Physician

b) Scapegoat Pg. The literature on children of parents who have alcoholism has described several typical roles that children assume, including the "hero" (overly responsible children who may ignore their own needs to take care of parents and other children), "scapegoat" (problem children who divert attention away from the parent with alcoholism), "mascot" (family clowns who relieve tension and mask feelings through joking), and "lost child" (children who suffer in silence but may exhibit difficulties at school or in later life).

49. A nurse is reviewing the history of a family in which a parent has a history of alcoholism. One of the children has been exhibiting behavior problems requiring a focus on interventions to address the child's problems. The nurse identifies this child as assuming which role in the family? a) Lost child b) Scapegoat c) Hero d) Mascot

c) Personality Pg. 248 A growing body of research shows that sibling relationships significantly influence personality development. Positive sibling relationships can be protective factors against the development of psychopathology, particularly in troubled families in which the parents are emotionally unavailable.

50. A psychiatric-mental health nurse is reading a journal article describing research about sibling relationships. The nurse demonstrates understanding of the article by identifying that sibling relationships significantly influence which type of development? a) Language b) Motor c) Personality d) Physical

b) Feelings of being connected to school e) Presence of a caring adult or parent Pg. 255 Protective factors associated with mental health promotion include the presence of a caring adult or parent and feelings of school connectedness. Intense sibling rivalry, parental conflict associated with divorce and parental substance abuse are risk factors associated with the development of mental health problems.

6. A psychiatric-mental health nurse is conducting a program for a local community group about factors that help protect children from mental health problems. Which factor would the nurse most likely include? Select all that apply. a) Substance abuse by parent b) Feelings of being connected to school c) Parental conflict with divorce d) Intense sibling rivalry e) Presence of a caring adult or parent

b) Nurses are legally responsible for reporting suspected abuse Pg. 252 Nurses are legally mandated to report any reasonable suspicion of abuse and neglect to the appropriate state authorities. Mandated reporting laws allow the state to investigate the possibility of abuse, provide protection to children, and link families with the support and services. Nurses are immune from liability for reporting suspected abuse, but they may be held legally accountable for not reporting it. To minimize damaging the nurse-family relationship, experts recommend that nurses report abuse in the presence of the parents, preferably with the parent initiating the telephone call.

7. Which is accurate regarding the reporting of physical and sexual abuse of children? a) Nurses should not report the abuse in front of the parents b) Nurses are legally responsible for reporting suspected abuse c) Nurses are not immune from liability of the report d) Nurses are not qualified for reporting abuse

a) "Grandma has died and is not coming back, but we will always remember her" Pg. 245 Parents should tell a child honestly that a person has died and is not coming back. They need to answer the child's questions and repeat the process as the child gradually begins to grasp the reality. A child may interpret the other options literally and begin to fear going to sleep or focus anger on an irrational idea that a person deliberately has not returned.

8. A preschooler appears frightened after the death of his grandmother. Which of the following statements by the parent would be most helpful in reassuring the child at this time? a) "Grandma has died and is not coming back, but we will always remember her" b) "Jesus took grandma to be with him" c) "It's going to be OK" d) "Grandma went to sleep with Jesus"

d) Encouraging positive statements about the other parent Pg. 247-248 Evidence shows that it is not the divorce itself but rather the continuing conflict between the parents that is most damaging to children. Parents manage divorce better if they can remember that children naturally idealize and identify with both parents and need to view both of them positively. Therefore, it is helpful for parents to guard against making negative statements about each other and focus on evidence of their former partner's love and respect for the child. In addition, a structured home and school environment with reasonable and consistent limit setting are important protective factors against emotional problems in children. Moreover, regular and predictable visitation is important.

9. A psychiatric-mental health nurse is working with a couple who are divorcing. The couple has three children. Which aspect would the nurse likely emphasize to the couple as being most important to promote the children's adjustment to the divorce? a) Allowing visitation on an as-needed basis b) Establishing an unstructured environment in the home c) Providing an open, limit-free setting d) Encouraging positive statements about the other parent