Chapter 42 (Psychosocial Disorders)
The nurse is interviewing a 13-year-old girl with depression. During the course of the interview, the girl reveals that her best friend is thinking about committing suicide. Which response by the nurse would be most appropriate?
"Do you know how she is planning to kill herself?"
The nurse is discussing substance abuse with an adolescent. Which statement made by the adolescent should the nurse follow up on first?
"I may drink too much on the weekends but I don't drink during the week."
A nurse taking a health history from an adolescent female would become concerned about anorexia if the adolescent made which statement?
"I've been really tired lately, but I'm afraid that if I rest I will get fatter than I am already."
After teaching the parents of a child with attention deficit hyperactivity disorder about ways to control the child's behavior, the nurse determines a need for additional teaching when the parents state:
"If he misbehaves, we need to punish him instead of reward him."
A 10-year-old girl with ADHD has been on methylphenidate for 6 months. The girl's mother calls and tells the nurse that the medication is ineffective and requests an immediate increase in the child's dosage. What should the nurse say?
"Let's set up an appointment as soon as possible"
The parents of an 18-month-old toddler are concerned that their toddler no longer makes eye contact, does not respond to their smiles or other facial expressions, does not point to toys, and no longer speaks. They said that their toddler used to be able to say "mama" or "dada." The parents started noticing these changes in behavior 3 months ago. Which information can be provided to the parents?
"There are many behaviors that can be thought of as signs of autism spectrum disorders, but only a health care provider can confirm the diagnosis."
Which pediatric client will the nurse point out for the primary health care provider to further assess?
15-year-old client worried that they and their parents will die in a car crash
The nurse is discussing the treatment for a child with attention deficit hyperactivity disorder (ADHD) with a group of school nurses. What would be an appropriate learning setting for a child with ADHD?
A classroom with a plan of study that is followed each day
A nurse in a primary care provider's office is performing a comprehensive assessment on a 16-year-old adolescent diagnosed with anorexia.
Abdomen is concave with hyperactive bowel sounds. Pulses are weak and thready. Vital signs: temperature, 95.9 degrees F (35.5 C); heart rate, 55 beats/min; blood pressure, 88/49 mm Hg Adolescent has a body mass index (BMI) of 15.2. Laboratory values: sodium, 149 mEq/l, potassium, 2.9 mEq/l, hemoglobin, 9 g/dl ; hematocrit, 45%.
A school-age boy is on methylphenidate for ADHD. What negative side effect should the mother be advised to monitor for in the child?
Appetite suppression
The nurse is caring for a hospitalized infant who has been diagnosed with nonorganic failure to thrive (NFTT). Which action would the nurse implement for this client?
Apply lanolin or A+ D ointment to the infant's skin once a shift.
During adolescence, alcohol is connected to what problem frequently seen in this age group?
Automobile accidents
Parents of a school-age child have begun a program of therapy that includes giving the child a token each time the child follows directions. Which theoretical framework provides the background for such a program?
Behavioral theory
What potential side effect of smoking crack should the nurse teach adolescents about to ensure their understanding of the drug's possible impact?
Cardiac arrest
An infant diagnosed with nonorganic failure to thrive (NFTT) is being treated in the hospital. Which intervention would the nurse implement for this child to provide increased nutritional intake?
Document all feedings and the infant's response to the feeding.
Parents are reluctant to accept that their preschooler has attention deficit hyperactivity disorder (ADHD), so the nurse is explaining the commonly seen characteristics of this syndrome. Which characteristics would the nurse include in the explanation? Select all that apply.
Easily distracted Failure to complete tasks before going on to another one Impulsiveness
The football coach notices that one of the players has been more energetic and overly happy lately during practice. The player also got in fight with a teammate last week. The coach contacts the health care provider, concerned that the student is using anabolic steroids. What physical sign would the nurse advise the coach to be on the lookout for that would further validate the illicit drug use?
Gynecomastia
What is the most difficult risk factor for a child to overcome related to substance abuse?
Home environment where there is drug or alcohol abuse
Parents of a school-age child experiencing encopresis are discussing the problem with the child's health care team. Their understanding of this problem is indicated when the parents respond in what manner?
If there is no organic cause for the problem, the family may need to explore counseling for an emotional problem.
The nurse is assessing a child diagnosed with autism spectrum disorder (ASD). Which finding will the nurse expect to assess?
Indifferent attachment to a parent
Which behavior typical of children with autism spectrum disorder (ASD) requires the nurse to maintain special care to keep them safe?
Insensitivity to pain
A mother brings her 6-month-old infant to the clinic for a runny nose and fever. The nurse notices that the child is very underweight, below the 5th percentile, and the child's length is also short for her age. The infant appears unkempt and does not like being held or cuddled. Which family history could be contributory to this infant's problems?
Marital strife between the parents
The nurse is caring for a 10-year-old recently diagnosed with attention deficit hyperactivity disorder (ADHD). The nurse would expect to provide teaching regarding which medication?
Methylphenidate
A 6-month-old infant presents at the pediatric clinic with his/her mother. The child is very thin, less than 5% on the growth chart, irritable, listless, unresponsive to the nurse, and has poor muscle control. The child has no history of serious illness. When the infant begins to cry, the mother is very slow to respond and the child is not comforted by the mother. The nurse is concerned about the infant because these are signs of:
Nonorganic failure to thrive.
When teaching parents of a child with encopresis, what would the nurse stress?
Not punishing the child for encopresis
Which approach to drug education would be most effective for a group of school-age children?
Providing the children with strategies of how to refuse offers of drugs
The nurse is caring for a child prescribed methylphenidate. Which teaching will the nurse reinforce for this client and caregiver?
Record intake and weight.
The nurse is working with a child diagnosed with encopresis. After a complete medical workup has been done, no organic cause has been found for the disorder. What follow-up will the nurse expect?
Referred for counseling
A mother is telling the school nurse about her concerns regarding her 13-year-old daughter, who is experiencing headaches. Her grades have dropped, and she is sleeping late and going to bed early every night. The nurse advises the mother that the first priority should be to:
Schedule an immediate history and physical examination.
With all the warnings on cigarette packages and media coverage of the side effects of tobacco use, why do school-age children and adolescents continue to smoke or chew tobacco?
School-age and adolescent children view the threats to their health as far in the future, and the child feels that he or she can stop at any time.
The school nurse suspects that a girl at her school is experiencing school phobia. She has missed numerous days from school and reports a stomach ache and some vomiting and has a low-grade fever. The symptoms subside when the child is permitted to stay home. What intervention would be appropriate for this child?
Set up a meeting between the parents and school officials to help the child return to school without experiencing her symptoms
A child has been prescribed methylphenidate to take daily. Which nursing instructions are important to provide to the family?
Stress the need for adequate nutrition.
An advance practice mental health nurse is preparing for an individual therapy session with a 14-year-old boy who has normal cognitive abilities but is suffering from depression. Which of the following approaches is most likely to engage the boy and establish a therapeutic alliance?
Talk therapy with the nurse
The nurse has been working for several days with an adolescent who has anorexia nervosa. What is an indication that the adolescent is developing trust in the nurse?
The adolescent telling the nurse purging occurs after each meal.
In collecting data on a 7-year-old child with a possible diagnosis of school phobia, the nurse directs questions related to the following topics. Which would most likely be a cause of the child having school phobia?
The child may have a fear of being separated from the parent.
A 6-year-old client has been diagnosed with an autism spectrum disorder. Which symptom will the nurse expect the client to display?
The client spends time alone in repetitive play activities.
A 15-year-old student has been referred by the homeroom teacher to the school nurse for evaluation. The teacher is concerned that the student may be suffering from major depression. Who should be the primary source of information to investigate the concerns about the student?
The student
To feed lunch to a child with autism spectrum disorder (ASD), which action would be most important for the nurse to take?
Use a repetitive series of movements.
A nurse is conducting a mental status examination with a 5-year-old boy who is playing with trains and blocks of different colors. He repeats the same actions with the trains over and over again throughout the examination. Which of the following questions would be most appropriate?
Why does that red train keep crashing into all of the other trains?
The nurse is reinforcing education about warning signs of suicide to a group of parents. Which sign(s) will the nurse reinforce? Select all that apply.
withdrawal from social activities increased activity level poor concentration noted in school lack of impulse control