Chapter 42: The Child with a Psychosocial Disorder Growth and Development
The nurse is discussing substance abuse with an adolescent. Which statement made by the adolescent should the nurse follow up on first? "My sister is a college freshman and she smokes pot with her friends." "I may drink too much on the weekends but I don't drink during the week." "My mom's brother was in treatment for alcoholism a few years ago." "I broke up with my girlfriend because she said I partied too much."
"I may drink too much on the weekends but I don't drink during the week." Explanation: Frequent use or abuse of substances can lead to addiction or dependence, a compulsive need to use a substance for its satisfying or pleasurable effects.
While interviewing a depressed adolescent, it is revealed that the client has considered hurting oneself. What question is the nurse's priority? "Do your parents know that you want to hurt yourself?" "Tell me why you would want to hurt yourself." "Have you discussed this with anyone else?" "Tell me exactly how you would hurt yourself."
"Tell me exactly how you would hurt yourself." Explanation: It is important for the nurse to find out exactly how the adolescent is envisioning harming oneself. This information will help the nurse to take measures to prevent an attempted suicide. The other questions are important to ask, but are not the priority. They do not elicit the necessary information to prevent an attempt.
What potential side effect of smoking crack should the nurse teach adolescents about to ensure their understanding of the drug's possible impact? a rapid high followed by a slow letdown drop in temperature cardiac arrest a high that lasts hours
cardiac arrest Explanation: Adolescents who smoke crack run the chance of having a cardiac arrest due to the rapid absorption of crack into the blood stream. Cocaine usage and crack makes the body temperature rise, the high lasts a short amount of time, usually 5 minutes, and the rapid high is followed by a rapid crash that resembles depression.
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. discuss the situation with her teacher. ask the school psychologist to do psychometric testing. call for an appointment with a psychologist.
schedule an immediate history and physical examination. Explanation: The first step is to conduct a physical examination to rule out or identify illnesses or physical problems that might cause depression. Once any physical causes have been ruled out, the health care team can determine the most appropriate approach to assess the girl's symptoms.
A mother is suspicious that her adolescent has bulimia because the child seems to be dependent upon laxatives and vomits frequently after eating a meal. What physical finding would be most suggestive of this diagnosis? dental erosions and caries callouses in the palms of her hands weight below the 5th percentile on the growth chart recurrent strep throat
dental erosions and caries Explanation: A client with bulimia will display dental caries and erosions from the chronic exposure to stomach acids from self-induced vomiting. The normal weight of a client with bulimia will be normal or slightly overweight, not below the 5th percentile. Calluses are noted in the back of the hands of a client with bulimia, not the palms, and recurrent strep throat is not associated with bulimia at all
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 extended periods of fatigue fainting headaches
gynecomastia Explanation: Anabolic steroid use can cause periods of euphoria and decreased fatigue, not more fatigue. Gynecomastia is a common side effect of prolonged steroid use, as well as liver damage, hypertension, psychotic episodes, and aggression. Headaches and fainting are not side effects of steroid use.
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? "Why do you think she wants to kill herself?" "Are you the only person who knows?" "Do her parents know she wants to kill herself?" "Do you know how she is planning to kill herself?"
"Do you know how she is planning to kill herself?" Explanation: Because the girl is depressed, the nurse suspects that the girl is indirectly talking about herself, not her best friend. When an adolescent raises the issue of suicide, it is important to find out exactly how he or she is envisioning suicide and take measures to prevent an attempted suicide. Therefore, the nurse should ask how the "friend" is contemplating suicide in order gather this information and open a dialogue to encourage the girl to reveal she is talking about herself. Asking why, asking if the parents know, or asking if the girl is the only one who knows would not elicit the critical information about the method of suicide.
A nurse is explaining the difference between anorexia nervosa and bulimia nervosa. The nurse knows the teaching was effective when the parents make which statement? "Individuals with bulimia have a normal weight or are slightly overweight." "Neither of these disorders is life threatening, only socially unacceptable." "Russell's sign is present in anorexia nervosa." "Anorexia refers to binge eating and purging by vomiting to prevent weight gain."
"Individuals with bulimia have a normal weight or are slightly overweight." Explanation: Individuals with bulimia are often a normal weight or slightly overweight, and therefore the problem may escape notice from friends and family. Bulimia refers to recurrent and episodic binge eating and purging by vomiting, accompanied by awareness that the eating pattern is abnormal, and yet the individual is not able to stop the pattern. Both of these disorders are life threatening. With either type of bulimia, the combination of frequent vomiting and use of laxative or diuretics can result in such serious physical complications, notably electrolyte abnormalities, which can ultimately lead to effects as severe as cardiac arrest. In teens with anorexia, the nurse may observe significant hypotension, hypothermia, and bradycardia. If the process is allowed to continue without therapy, it can lead to starvation, serious health problems, and even death. Laboratory analysis may reveal anemia and leu
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." "What does the teacher say?" "Let's wait a few more weeks before we do anything." "Let me talk to the doctor about this."
"Let's set up an appointment as soon as possible." Explanation: The nurse plays a vital role in administering medicines and observing and reporting responses. A face-to-face appointment with the family and the doctor or advance practice mental health nurse can help uncover client and parental factors that may be preventing success. Once it is established that the family is using the medication properly as well as instituting structure within the home, it can be determined if an increased dosage or alternate medicine would be appropriate. Deferring to the doctor will not elicit any information from the mother, and waiting will not address the current concerns. The teacher can only reveal partial information about the effectiveness of the medication, which can be reviewed once other factors have been addressed in a face-to-face visit with the family and client.
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? "What does the teacher say?" "Let's wait a few more weeks before we do anything." "Let's set up an appointment as soon as possible." "Let me talk to the doctor about this."
"Let's set up an appointment as soon as possible." Explanation: The nurse plays a vital role in administering medicines and observing and reporting responses. A face-to-face appointment with the family and the doctor or advance practice mental health nurse can help uncover client and parental factors that may be preventing success. Once it is established that the family is using the medication properly as well as instituting structure within the home, it can be determined if an increased dosage or alternate medicine would be appropriate. Deferring to the doctor will not elicit any information from the mother, and waiting will not address the current concerns. The teacher can only reveal partial information about the effectiveness of the medication, which can be reviewed once other factors have been addressed in a face-to-face visit with the family and client.
While interviewing a depressed adolescent, it is revealed that the client has considered hurting oneself. What question is the nurse's priority? "Tell me why you would want to hurt yourself." "Have you discussed this with anyone else?" "Do your parents know that you want to hurt yourself?" "Tell me exactly how you would hurt yourself."
"Tell me exactly how you would hurt yourself." Explanation: It is important for the nurse to find out exactly how the adolescent is envisioning harming oneself. This information will help the nurse to take measures to prevent an attempted suicide. The other questions are important to ask, but are not the priority. They do not elicit the necessary information to prevent an attempt.
An adolescent was caught sneaking liquor out of the family liquor cabinet at home. When confronted by the parents, the adolescent admits to have been drinking daily for the last 3 years. When the parents talk to the health care provider about how to intervene for their child, what information would be appropriate to share with them? -Treatment for adolescents is easier than for adults because adolescents are still impressionable. -Alcoholism can be addressed and people respond well regardless
Adolescents who have a family history of alcoholism may be more prone to problems with alcohol. Explanation: Adolescents who receive counseling and treatment for problem drinking are more likely to recover than those who have been problem drinkers for a long time. Experts know that alcoholism tendencies are hereditary for children with a family history of alcoholism. Adolescents are harder to treat because they feel like they are immortal and nothing can hurt them. Additionally, adolescents have a more rapid progression of the disease than adults. The earlier the alcohol problem is addressed, the more likely that person is to recover.
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? Monitor urinary output to ensure that it remains 2 to 3 cc/kg/hr. Apply lanolin or A+ D ointment to the infant's skin once a shift. Instruct the parents that they must meet the infant's needs for cuddling and stimulation. Feed the infant 20-calorie formula every 4 hours while in the hospital.
Apply lanolin or A+ D ointment to the infant's skin once a shift. Explanation: The infant's skin may be very dry due to malnutrition and poor fluid intake, so the nurse needs to apply some type of skin lubricant to prevent irritation. Urinary output should be 0.5 to 1.0 cc per kg per hour. Telling the parents what they are doing wrong will only further harm their self-esteem since many of them feel they are inadequate already. Feeding an infant with 20-calorie formula is not meeting nutritional needs. A minimum 24-calorie formula is needed until the infant begins to gain weight.
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. Feed the infant on demand so the infant will be hungry. Recommend that the parents rock the infant quietly and not talk to the infant. Burp at the end of every feeding and place the infant on the stomach.
Document all feedings and the infant's response to the feeding. Explanation: An NFTT infant requires frequent, scheduled feedings every 2 to 3 hours. The infant also needs to be talked to during the feeding to assist with bonding and development of trust. Always document the volumes the infant took, as well as how the infant fed. The infant is burped several times during the feeding and then placed on the back for sleeping.
The nurse is assessing a child diagnosed with autism spectrum disorder (ASD). Which finding will the nurse expect to assess? Engaging in dangerous activities Indifferent attachment to a parent Frequently losing things Slow motor actions
Indifferent attachment to a parent Explanation: A child with autism spectrum disorder can show a lack of or no attachment to parents. Motor skills are not expected to be slowed or delayed, because a child with ASD tends to spend hours in repetitive play and may display bizarre motor and stereotypic behavior. The child may become completely absorbed in strange repetitive behaviors such as spinning an object, flipping an electrical switch on and off, or walking around the room feeling the walls. Frequently losing things can be associated with attention deficit hyperactivity disorder. Engaging in dangerous activities could be related to a conduct disorder.
Which behavior typical of children with autism spectrum disorder (ASD) requires the nurse to maintain special care to keep them safe? Loss of hearing for high frequencies Insensitivity to pain A craving for salt A fascination with bright colors
Insensitivity to pain Explanation: A number of children with autism spectrum disorder may have a hyposensitivity to pain. Thus, if they hurt themselves, they may not feel the associated pain. It is why one can see these children biting themselves or head banging and not feeling any pain. Having cravings, a fascination with colors, and hearing loss may or may not be associated with a child on the autism spectrum but these manifestations would not be associated with safety.
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? They see their parents or caregivers smoking and do not see the harm it is doing to them. They do not believe the information provided to them through the media. 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.
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. Explanation: Children who smoke or use tobacco cannot conceive of the future effects that tobacco will have on their bodies. They see others smoking around them and, through example, think smoking is OK for them. They do not understand the effect on their long-term health because they are focused on the here and now.
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? Explain to the child that everyone knows she is faking her problems and she has to stop because she is going to school. Meet with her principal to find out why she hates school and d
Set up a meeting between the parents and school officials to help the child return to school without experiencing her symptoms. Explanation: The child should not be kept at home indefinitely for such vague symptoms. Since the symptoms subside when the child is allowed to stay home, school phobia needs to be considered. Setting up a meeting with the principal is not necessary at this point, but the parents need to meet with school officials to determine what is causing the child to be frightened at school. The parents and school officials need to work together to get the child back to school symptom-free. Confronting the child and telling her that no one believes that she is ill will only exacerbate the problem. Reference:
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 be a poor student and be afraid of failing grades. The child may be bored and feels more intellectually stimulated at home. The child may have a fear of being separated from the parent. The child may have a language barrier.
The child may have a fear of being separated from the parent. Explanation: School-phobic children may have a strong attachment to one parent, usually the mother, and they fear separation from that parent, perhaps because of anxiety about losing her or him while away from home. Being a poor student and worrying about grades would be more common in the later school age and adolescence. A child may be anxious about language but that is generally not enough to cause phobias. If the child is bored at school the parents should ask to meet the teacher and define the child's needs. Many children need extra stimulation but that is not the same as having a phobia.
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 be a poor student and be afraid of failing grades. The child may have a fear of being separated from the parent. The child may have a language barrier. The child may be bored and feels more intellectually stimulated at home.
The child may have a fear of being separated from the parent. Explanation: School-phobic children may have a strong attachment to one parent, usually the mother, and they fear separation from that parent, perhaps because of anxiety about losing her or him while away from home. Being a poor student and worrying about grades would be more common in the later school age and adolescence. A child may be anxious about language but that is generally not enough to cause phobias. If the child is bored at school the parents should ask to meet the teacher and define the child's needs. Many children need extra stimulation but that is not the same as having a phobia.
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 be a poor student and be afraid of failing grades. The child may have a language barrier. The child may be bored and feels more intellectually stimulated at home. The child may have a fear of being separated from the parent.
The child may have a fear of being separated from the parent. Explanation: School-phobic children may have a strong attachment to one parent, usually the mother, and they fear separation from that parent, perhaps because of anxiety about losing her or him while away from home. Being a poor student and worrying about grades would be more common in the later school age and adolescence. A child may be anxious about language but that is generally not enough to cause phobias. If the child is bored at school the parents should ask to meet the teacher and define the child's needs. Many children need extra stimulation but that is not the same as having a phobia.
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? Do you like playing with trains and blocks? What year is it? Are you having fun now?
Why does that red train keep crashing into all of the other trains? Explanation: Asking about the red train is an open-ended question that could help the nurse elicit the fantasies and feelings underlying the boy's play. A 5-year-old may not know what year it is. Questions allowing yes or no answers do not open a dialogue.
A nurse in a primary care provider's office is performing a comprehensive assessment on a 16-year-old adolescent diagnosed with anorexia. Click to highlight the findings that will require follow up. Adolescent is awake, alert, and oriented. Lungs are clear, abdomen is concave with hyperactive bowel sounds. Pulses are weak and thready . Vital signs: temperature, 95.9°F (35.5°C); heart rate, 55 beats/min; blood pressure, 88/49 mm Hg ; oxygen saturation, 98% on room air. Adolescent has a body m
abdomen is concave with hyperactive bowel sounds. Pulses are weak and thready temperature, 95.9°F (35.5°C); heart rate, 55 beats/min; blood pressure, 88/49 mm Hg; potassium, 2.9 mEq/l (2.9 mmol/l); hemoglobin, 9 g/dl (90 g/l); hematocrit, 45% (0.45).body mass index (BMI) of 15.2 Explanation: The abdomen should be flat, not concave. This is a common finding in an adolescent with anorexia.Hyperactive bowel sounds are an abnormal finding and should be assessed further.Weak, thready pulses are an abnormal finding and may indicate dehydration.A temperature of 95.9°F (35.5°C) is subnormal (normal: 97.7°F to 98.6°F; 36.5°C to 37.0°C).A heart rate of 55 beats/min indicates bradycardia, which is often seen in an adolescent with anorexia (normal: 60 to 79 beats/min). A blood pressure of 88/49 mm Hg indicates hypotension (normal: 112-128/66-80 mm Hg).A body mass index (BMI) of 15.2 indicates the adolescent is significantly underweight for their height and weight (normal: 18
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 systems theory psychodynamic theory token economy theory
behavioral theory Explanation: Reinforcing behaviors with rewards reflects a basic principle of behavioral therapy. This process reinforces the desired behaviors by replacing inappropriate behaviors with positive behaviors. Psychodynamic theory involves in-depth talk theory based on psychoanalysis. Systems theory is looking at all systems to see how they work together to produce a result. This work involves the study of the mind, body and spirit. A token economy allows for tokens to be accumulated for good behavior and then exchanged for a meaningful object or privilege.
An infant is diagnosed as having organic failure to thrive. What client history finding would be contributory to this diagnosis? inadequate maternal education parental neglect cystic fibrosis parental drug abuse
cystic fibrosis Explanation: Organic failure to thrive incorporates those infants who have a physical reason for their inability to gain weight and grow. This includes heart problems, cystic fibrosis, and gastrointestinal problems. All of these reasons will cause the infant to have inadequate weight gain and being at or less than the 5th percentile on the growth chart.
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 headaches fainting extended periods of fatigue
gynecomastia Explanation: Anabolic steroid use can cause periods of euphoria and decreased fatigue, not more fatigue. Gynecomastia is a common side effect of prolonged steroid use, as well as liver damage, hypertension, psychotic episodes, and aggression. Headaches and fainting are not side effects of steroid use.
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? headaches gynecomastia fainting extended periods of fatigue
gynecomastia Explanation: Anabolic steroid use can cause periods of euphoria and decreased fatigue, not more fatigue. Gynecomastia is a common side effect of prolonged steroid use, as well as liver damage, hypertension, psychotic episodes, and aggression. Headaches and fainting are not side effects of steroid use.
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 maternal age of 20 prematurity gastroesophageal reflux
marital strife between the parents Explanation: A diagnosis of nonorganic failure to thrive (NFTT) is caused from a lack of bonding between the mother and the infant. Often, the mother feels alone and overwhelmed by life's circumstances. Marital strife, stress, lack of knowledge about parenting, and poverty can all contribute to the inability of the mother to bond with her infant and care for the child properly. Prematurity and gastroesophageal reflux would both be organic causes of failure to thrive. Being a young mother does not necessarily mean that the infant will not be cared for properly.
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: anorexia nervosa. organic failure to thrive. nonorganic failu
nonorganic failure to thrive. Explanation: Organic failure to thrive is seen when there are serious physiologic illnesses that cause the child to lose weight. In this situation, the child has not had any serious illness and the mother-child bond is suspect as evidenced by the child not responding to the mother's attempts to comfort. Anorexia nervosa and bulimia are seen in older children.
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: organic failure to thrive. anorexia nervosa. nonorganic fai
nonorganic failure to thrive. Explanation: Organic failure to thrive is seen when there are serious physiologic illnesses that cause the child to lose weight. In this situation, the child has not had any serious illness and the mother-child bond is suspect as evidenced by the child not responding to the mother's attempts to comfort. Anorexia nervosa and bulimia are seen in older children.
Rumination disorder is a poorly understood condition of young children. This refers to: a habit of eating nonfood substances. fear of moving objects. rechewing undigested food. excessive worrying about friendships.
rechewing undigested food. Explanation: Rumination is the rechewing of undigested food. It occurs primarily in infants and is a little-understood process. Pica is the eating of non-food substances such as clay, paint, or sand. It occurs in preschool to school-age children. Since rumination occurs in infants it is doubtful they are concerned about friendships or moving objects.
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? put on a high-calorie, high-protein diet administered antidiarrheal medications started on methylphenidate referred for counseling
referred for counseling Explanation: Encopresis is the repeated involuntary passage of feces of normal or near-normal stool in places not appropriate for that purpose. If no organic causes (e.g., worms, megacolon) exist, encopresis indicates a serious emotional problem and a need for counseling for the child and the family caregivers. Medications such as methylphenidate are used for hyperactivity. The diet needs to be high fiber. Antidiarrheals are contraindicated because they can cause more constipation. Lubricant laxatives should be used.
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 administered antidiarrheal medications put on a high-calorie, high-protein diet started on methylphenidate
referred for counseling Explanation: Encopresis is the repeated involuntary passage of feces of normal or near-normal stool in places not appropriate for that purpose. If no organic causes (e.g., worms, megacolon) exist, encopresis indicates a serious emotional problem and a need for counseling for the child and the family caregivers. Medications such as methylphenidate are used for hyperactivity. The diet needs to be high fiber. Antidiarrheals are contraindicated because they can cause more constipation. Lubricant laxatives should be used.
A mother is concerned about her adolescent daughter's depression. What is the major problem associated with depression that the mother needs to be monitoring her daughter for? anorexia running away suicide promiscuity
suicide Explanation: When an adolescent is depressed, it is most important to be monitoring the child for suicide. Suicide is the leading cause of death in children 10 to 19 years of age. Girls attempt suicide 5 times more often than boys but are less successful. A depressed adolescent may develop anorexia, become promiscuous or run away because they may feel rejected, or do not have strong relationships with others, but these concerns are not as important as monitoring for suicide
The nurse is assessing an adolescent who tells the nurse, "I have been using cocaine for a while now. At first, I would get high after smoking just once. But now I have had to smoke more and more to get the same effect." The nurse interprets the adolescent's statement as reflecting which situation? -withdrawal -tolerance -use disorder -dependence
tolerance Explanation: The adolescent's statements reflect tolerance, which is the ability of body tissues to endure and adapt to continued or increased use of a substance; this dynamic means the drug user requires larger doses of the drug to produce the desired effect. A substance use disorder is the misuse of an addictive substance that changes the user's mental state. Dependence is a compulsive need to use a substance for its satisfying or pleasurable effects. Withdrawal refers to the physical and psychological symptoms that occur when the drug is no longer being used.
