Chapter 42: The Child with a Psychosocial Disorder - ML5

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? What year is it? Do you like playing with trains and blocks? Why does that red train keep crashing into all of the other trains? Are you having fun now?

Correct response: 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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, AUTISM SPECTRUM DISORDER, p. 908. Chapter 42: The Child with a Psychosocial Disorder - Page 908

During a routine well-child check the caregiver of a 10-year-old tells the nurse that her child has recently starting passing stool into his underwear. This behavior indicates a symptom of which disorder? echolalia encopresis encephalopathy enuresis

Correct response: encopresis Explanation: Encopresis is chronic involuntary fecal soiling beyond the age when control is expected (about 3 years of age). Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, ENURESIS AND ENCOPRESIS, p. 910. Chapter 42: The Child with a Psychosocial Disorder - Page 910

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? "Anorexia refers to binge eating and purging by vomiting to prevent weight gain." "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."

Correct response: "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 leukopenia, an elevated BUN and creatinine levels, hypercholesterolemia, and elevated liver enzymes; endocrine studies may reveal a low T3 and T4 while reverse T3 levels may be elevated. An electrocardiogram commonly demonstrates bradycardia and may include arrhythmias or a prolonged QTc interval. Adolescents with purging may develop severe erosion of their teeth because of the constant exposure to acidic gastrointestinal juices from vomiting. Russell sign (scars or calluses on the dorsal side of the hand from repeated contact of the teeth while inducing vomiting) might be present in those who engage in purging behavior. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, EATING DISORDERS, pp. 917-918.

What is the most difficult risk factor for a child to overcome related to substance abuse? peer pressure home environment where there is drug or alcohol abuse a diagnosis of ADD a dysfunctional family situation

Correct response: home environment where there is drug or alcohol abuse Explanation: Children who are exposed to family members who abuse alcohol or drugs are the least influenced by educational programs promoting abstinence from drugs. Their home environment has a great impact on how they view substance abuse. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, SUBSTANCE ABUSE, p. 913. Chapter 42: The Child with a Psychosocial Disorder - Page 913

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 the school nurse the student's parents the homeroom teacher

Correct response: the student Explanation: The student is the primary historian, and the nurse should first elicit the student's perspective on the problem to establish a therapeutic alliance. The school nurse might have some input, but his or her contact with the student may have been minimal. The student's parents can provide insight and assistance, but they may not be willing to do so because of cultural differences. The teacher will provide a valuable timeline and observations as the individual who referred this case; however, the student is still the primary historian. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, DEPRESSION AND SUICIDE, p. 911. Chapter 42: The Child with a Psychosocial Disorder - Page 911

A nurse is assessing a child with suspected drug use. Which characteristics are related to an increased risk of substance use? Select all that apply. being a member of a family that has had another member who uses drugs being a member of an only-child family being a member of an abusive family having behavioral problems being a slow learner

Correct response: being a member of a family that has had another member who uses drugs being a member of an abusive family having behavioral problems being a slow learner Explanation: Being a member of an only-child family has not been identified as a risk factor for substance use. Being a member of a family that has had another member who uses drugs or of an abusive family have been shown to increase one's risk for substance use, as has being a slow learner and exhibiting behavioral problems. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, SUBSTANCE ABUSE, p. 913. Chapter 42: The Child with a Psychosocial Disorder - Page 913

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 starts to act out, we'll have him do a time-out to help him refocus." "We can use a reward system when he behaves appropriately." "If he misbehaves, we need to punish him instead of reward him." "We need to help him set realistic goals that he can achieve."

Correct response: "If he misbehaves, we need to punish him instead of reward him." Explanation: Punishment for misbehaving would be inappropriate because it would lead to negative feelings and further decrease self-esteem. Appropriate behavior management strategies include time-outs, positive reinforcement, reward or privilege withdrawal, or a token system. Setting realistic goals also is helpful to foster self-esteem and independence. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, ATTENTION DEFICIT HYPERACTIVITY DISORDER, p. 909. Chapter 42: The Child with a Psychosocial Disorder - Page 909

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? weight below the 5th percentile on the growth chart dental erosions and caries recurrent strep throat callouses in the palms of her hands

Correct response: 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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, EATING DISORDERS, p. 918. Chapter 42: The Child with a Psychosocial Disorder - Page 918

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?" "Why do you think she wants to kill herself?" "Do her parents know she wants to kill herself?" "Are you the only person who knows?"

Correct response: "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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, DEPRESSION AND SUICIDE, p. 911. Chapter 42: The Child with a Psychosocial Disorder - Page 911

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." "My sister is a college freshman and she smokes pot with her friends." "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."

Correct response: "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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, SUBSTANCE ABUSE, p. 913. Chapter 42: The Child with a Psychosocial Disorder - Page 913

A nurse taking a health history from an adolescent female would become concerned about anorexia if the adolescent made which statement? "I try to eat three meals each day but don't always have enough time to sit down for each meal." "My monthly cycle is not always regular. Sometimes, I may skip a month or two between my cycles." "I exercise every day by running one mile in the late afternoon — or mornings on days that are really hot." "I've been really tired lately, but I'm afraid that if I rest I will get fatter than I am already."

Correct response: "I've been really tired lately, but I'm afraid that if I rest I will get fatter than I am already." Explanation: Clients with anorexia view themselves as fat even though they are emaciated and have a skeleton-like appearance. Stating that she is tired, another symptom of anorexia, along with the feeling that she is already fat both are warning signs for anorexia nervosa. If the adolescent's weight is also very low, this would also concern the health care provider. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, EATING DISORDERS, pp. 917-918. Chapter 42: The Child with a Psychosocial Disorder - Page 917-918

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 me talk to the doctor about this." "Let's wait a few more weeks before we do anything." "What does the teacher say?" "Let's set up an appointment as soon as possible."

Correct response: "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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, ATTENTION DEFICIT HYPERACTIVITY DISORDER, p. 909. Chapter 42: The Child with a Psychosocial Disorder - Page 909

The nurse is performing an assessment on an adolescent after the parents report concern about a risk for suicide. Which statement by the adolescent is of greatest concern? "Sometimes I just wish I would not wake up." "School is difficult for me." "I do not have many friends." "I feel like I do not fit in." "I think that I am ugly."

Correct response: "Sometimes I just wish I would not wake up." Explanation: Each of the statements listed indicates some degree of a depression and a saddened mood. One of the greatest risk factors for suicide is the verbalization of a wish to die or cease being. Thus, while each statement made does warrant investigation, the others are not of the highest concern. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, DEPRESSION AND SUICIDE, p. 911. Chapter 42: The Child with a Psychosocial Disorder - Page 911

While interviewing a depressed adolescent, it is revealed that the client has considered hurting oneself. What question is the nurse's priority? "Tell me exactly how you would hurt yourself." "Tell me why you would want to hurt yourself." "Do your parents know that you want to hurt yourself?" "Have you discussed this with anyone else?"

Correct response: "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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, DEPRESSION AND SUICIDE, pp. 911-912. Chapter 42: The Child with a Psychosocial Disorder - Page 911-912

Which pediatric client will the nurse point out for the primary health care provider to further assess? 5-month-old client who is startled by loud noises and bright lights 2-year-old client who cries each time the parents leave the room 3-year-old client stating a monster may be under the bed in the room 15-year-old client worried that they and their parents will die in a car crash

Correct response: 15-year-old client worried that they and their parents will die in a car crash Explanation: The nurse will point out the 15-year-old client for further assessment. At this age, the client should be worried about social acceptance and success in school, not death. The client is experiencing symptoms of anxiety. The 5-month-old client startled by loud noises and bright lights is normal and expected. Separation anxiety is normal in a 2-year-old client. If this persists beyond toddler age or the client could not be consoled, further assessment would be needed. "Seeing" or "hearing" imaginary people or animals (monsters, wizards, etc) is normal behavior for the 3-year-old client. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, Anxiety disorders, p. 910. Chapter 42: The Child with a Psychosocial Disorder - Page 910

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? Adolescents who receive counseling and treatment are less likely to recover from problem drinking than adults. Adolescents who have a family history of alcoholism may be more prone to problems with alcohol. Treatment for adolescents is easier than for adults because adolescents are still impressionable. Alcoholism can be addressed and people respond well regardless of how long a person has been drinking when the problem is identified.

Correct response: 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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, Alcohol Abuse, p. 914. Chapter 42: The Child with a Psychosocial Disorder - Page 914

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? 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. Document all feedings and the infant's response to the feeding. Burp at the end of every feeding and place the infant on the stomach.

Correct response: 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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, EATING DISORDERS, p. 917. Chapter 42: The Child with a Psychosocial Disorder - Page 917

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? They can help the child by trying to control his stooling pattern with medications. He needs to be allowed to make his own decisions or choices about his life. If there is no organic cause for the problem, the family may need to explore counseling for an emotional problem. Encopresis always indicates that the child is constipated and needs nutritional counseling.

Correct response: If there is no organic cause for the problem, the family may need to explore counseling for an emotional problem. Explanation: If a child is experiencing encopresis and there is no organic problem found such as constipation, inadequate fiber in the child's diet, or not drinking enough liquids to soften the stool, the child and family may need counseling for an emotional problem. It is thought that either over-controlling or under-controlling the child's life may be a contributory factor, along with emotional stressors in the child's life. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, ENURESIS AND ENCOPRESIS, p. 910. Chapter 42: The Child with a Psychosocial Disorder - Page 910

The nurse is assessing a child diagnosed with autism spectrum disorder (ASD). Which finding will the nurse expect to assess? Slow motor actions Frequently losing things Engaging in dangerous activities Indifferent attachment to a parent

Correct response: 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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, AUTISM SPECTRUM DISORDER, p. 908. Chapter 42: The Child with a Psychosocial Disorder - Page 908

When teaching parents of a child with encopresis, what would the nurse stress? Not punishing the child for encopresis Importance of cleaning the child immediately after an accident occurs Necessity for giving 4 to 6 tablespoons of bismuth subsalicylate per day Need for keeping the child close to bathroom facilities at all times

Correct response: Not punishing the child for encopresis Explanation: Encopresis (inappropriate soiling of stool) is a symptom of an underlying stress or disease. It can be the manifestation of how the child expresses the trauma or depression that is occurring. The child needs therapy to determine the cause and to treat the problem. If a child is scolded or punished for encopresis or if more than normal attention is paid to the problem, the problem will worsen. Giving medications will not prevent the encopresis. The proximity of the bathroom will not impact the situation, because with encopresis the child soils the underwear and does not go to the bathroom. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, ENURESIS AND ENCOPRESIS, p. 910. Chapter 42: The Child with a Psychosocial Disorder - Page 910

The nurse is caring for a child prescribed methylphenidate. Which teaching will the nurse reinforce for this client and caregiver? Provide three large meals each day. Give medications to assist the child to sleep. Administer the medication at bedtime. Record intake and weight.

Correct response: Record intake and weight. Explanation: The nurse will reinforce to the caregiver to keep a record of the child's daily food intake (food diary) and body weight. Common side effects of methylphenidate include anorexia, weight loss, nervousness, and sleep disturbances. Consuming frequent, small meals helps maintain adequate intake because children taking methylphenidate often do not eat large portions. Methylphenidate is a stimulant and should be given in the morning to limit sleep disturbances. There is no need to discuss medications to facilitate sleep. If the child's sleeping becomes disrupted, further investigation would occur. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, Attention deficit hyperactivity disorder, p. 909. Chapter 42: The Child with a Psychosocial Disorder - Page 909

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 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. They believe that smokeless tobacco does not have the health concerns of regular tobacco in cigarettes. They see their parents or caregivers smoking and do not see the harm it is doing to them.

Correct response: 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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, SUBSTANCE ABUSE, p. 915. Chapter 42: The Child with a Psychosocial Disorder - Page 915

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? Continue to allow her to stay home if she appears ill and is complaining of illness. Meet with her principal to find out why she hates school and doesn't want to go. Set up a meeting between the parents and school officials to help the child return to school without experiencing her symptoms. Explain to the child that everyone knows she is faking her problems and she has to stop because she is going to school.

Correct response: 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: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, ANXIETY DISORDERS, Phobias, p. 911. Chapter 42: The Child with a Psychosocial Disorder - Page 911

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 stating "You're the best nurse on the unit." The adolescent telling the nurse purging occurs after each meal. The adolescent stating the desire to eat again. Saying which nurse's orders the adolescent will follow.

Correct response: The adolescent telling the nurse purging occurs after each meal. Explanation: The adolescent with anorexia tends to have many fears and a high need for acceptance. Therefore, trust is difficult for this adolescent. Trust has to be gained from an adult before the adolescent can share confidences. Purging after every meal with anorexia is common and one of the goals of therapy is to stop the purging. It is often done in secret. When the adolescent has gained trust in the nurse then the adolescent will begin to share the number of times purging has been happening. When the adolescent is making statements such as liking one nurse more than another or following one nurse's instructions and not the others, this is manipulation. It is not healthy. The adolescent stating a desire to eat again could be interpreted two ways. The adolescent could be getting healthier with therapy or it could also be seen as manipulation and a way to purge more often. Either way, it is not a sign that trust has developed. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, Anorexia Nervosa, pp. 917-918. Chapter 42: The Child with a Psychosocial Disorder - Page 917-918

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. 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.

Correct response: 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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, ANXIETY DISORDERS, p. 911. Chapter 42: The Child with a Psychosocial Disorder - Page 911

To feed lunch to a child with autism spectrum disorder (ASD), which action would be most important for the nurse to take? Allow the child to ask questions about the procedure. Use an authoritarian manner to gain control. Do not allow the child to see the spoon approach the mouth. Use a repetitive series of movements.

Correct response: Use a repetitive series of movements. Explanation: Children with an autism spectrum disorder have an array of symptoms. No two children may present with exactly the same ones. Many children on the spectrum spend many hours in the day in repetitive movement. If this is the case then repetitive movement would be the most beneficial way to feed the child. The child on the spectrum may be nonverbal, so allowing the child to ask questions is not a viable situation. Many of these children are hyperactive and they do not respond to authoritarian control. This form of control usually makes the situation worse. It would be very difficult to feed a child without the child seeing the utensil in front of the face. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, AUTISM SPECTRUM DISORDER, p. 908. Chapter 42: The Child with a Psychosocial Disorder - Page 908

During adolescence, alcohol is connected to what problem frequently seen in this age group? teen suicide violence automobile accidents drug usage

Correct response: automobile accidents Explanation: Adolescents who drink and drive do not realize the impact of the alcohol in their reflexes and judgment. Fine motor control and judgment are affected even at lower levels of alcohol consumption. Driving is considered another adult behavior. There are no prying adult eyes on the adolescent drivers, so they think they are invincible and can drink and drive. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, Alcohol Abuse, p. 914. Chapter 42: The Child with a Psychosocial Disorder - Page 914

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? psychodynamic theory systems theory behavioral theory token economy theory

Correct response: 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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, ATTENTION DEFICIT HYPERACTIVITY DISORDER, p. 909. Chapter 42: The Child with a Psychosocial Disorder - Page 909

The nurse observes an adolescent who appears to be persistently sad, has angry outbursts, has a decreased appetite and complains of headache frequently. Additionally, the mother reports that the teen is somewhat defiant and has been missing her curfews. The nurse recognizes that these are all signs of what problem? substance abuse depression alcohol abuse striving for independence

Correct response: depression Explanation: Common symptoms of depression seen in adolescents are persistent sadness that interferes with their daily activities. They appear angry, have poor appetite, are defiant, have worsening grades in school, and are spending more time alone instead of with friends. Depression may lead to substance or alcohol abuse but the depression comes first. These behaviors go far beyond the normal adolescent desire for independence. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, DEPRESSION AND SUICIDE, p. 911. Chapter 42: The Child with a Psychosocial Disorder - Page 911

The nurse is caring for an adolescent girl with anorexia nervosa. What findings would indicate to the nurse that the girl requires hospitalization? weight gain of one-half pound per week food refusal body mass index of 18 soft, sparse body hair and dry, sallow skin

Correct response: food refusal Explanation: Food refusal, severe weight loss, unstable vital signs, arrested pubertal development, and the need for enteral nutrition warrant hospitalization. Soft, sparse body hair and dry, sallow skin are signs of anorexia, but do not warrant hospitalization. A weight gain of one-half pound per week indicates progress toward therapeutic goals. A body mass index of 18 is on the low end of the normal range of body mass. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, EATING DISORDERS, pp. 917-918. Chapter 42: The Child with a Psychosocial Disorder - Page 917-918

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

Correct response: 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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, Other Abused Drugs, p. 916. Chapter 42: The Child with a Psychosocial Disorder - Page 916

A parent brings a child to the pediatric clinic, stating that the child was diagnosed with attention deficit hyperactivity disorder (ADHD). Which symptoms does the nurse anticipate finding with this child? inattention, impulsive, and hyperactivity hyperactivity, defiant, and disruptive excess motor activity, learning disability, and depression visual impairment, hyperactivity, oppositional defiant

Correct response: inattention, impulsive, and hyperactivity Explanation: Attention deficit hyperactivity disorder (ADHD) is characterized by three major behaviors: inattention, impulsiveness, and hyperactivity. Defiance may be present in some children, but not all, and many times ADHD causes disruption in multiple environments. Excess motor activity is present with hyperactivity, but learning disability and depression may occur as a result of having ADHD. Visual impairment must be ruled out with ADHD as sometimes children with visual impairment appear inattentive due to being unable to read the board. Hyperactivity is a part of ADHD, but not visual impairment. Oppositional defiant disorder may also present in children with ADHD, but it is not considered part of ADHD. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, ATTENTION DEFICIT HYPERACTIVITY DISORDER, p. 909. Chapter 42: The Child with a Psychosocial Disorder - Page 909

Which approach to drug education would be most effective for a group of school-age children? telling the children how expensive drugs can be to buy providing the children with strategies of how to refuse offers of drugs recommending the students tell the police when they see someone using drugs reporting the statistics of HIV exposure when sharing needles for drug injections

Correct response: providing the children with strategies of how to refuse offers of drugs Explanation: By fostering self-esteem and empowering children to stand up against drugs and providing them with strategies to avoid drugs when offered to them, parents and health care providers can make an impact on children's behavior and positively influence them to resist drugs when offered to them. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, SUBSTANCE ABUSE, p. 913. Chapter 42: The Child with a Psychosocial Disorder - Page 913

The nurse is caring for an adolescent diagnosed with anorexia nervosa. Which education will the nurse include in the client's discharge teaching? appropriate exercise routines methods for desensitization referrals to counseling services proper administration of phenelzine

Correct response: referrals to counseling services Explanation: Adolescents with eating disorders need to increase self-esteem or a feeling that they have control over their life. This can be achieved through extensive counseling services, which should be scheduled for this client prior to discharge. The client needs to be nutritionally stable before participating in exercise activities. Desensitization is not a method of treatment used for anorexia. It is used to diminish emotional responsiveness to a stimulus through repeated exposure. Phenelzine, a monoamine oxidase inhibitor (MAOI), is not used to treat anorexia. It is used to treat depression. Selective serotonin reuptake inhibitors (SSRIs) and antipsychotics are typically used to treat clients with anorexia nervosa. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, EATING DISORDERS, p. 917. Chapter 42: The Child with a Psychosocial Disorder - Page 917

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 started on methylphenidate administered antidiarrheal medications put on a high-calorie, high-protein diet

Correct response: 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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, ENURESIS AND ENCOPRESIS, p. 910. Chapter 42: The Child with a Psychosocial Disorder - Page 910

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: discuss the situation with her teacher. schedule an immediate history and physical examination. ask the school psychologist to do psychometric testing. call for an appointment with a psychologist.

Correct response: 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. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, DEPRESSION AND SUICIDE, pp. 911-912. Chapter 42: The Child with a Psychosocial Disorder - Page 911-912

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? play therapy with the nurse activity therapy with paint talk therapy with the nurse activity therapy with games

Correct response: talk therapy with the nurse Explanation: Talk therapy is the preferred approach for adolescents and is most likely to lead to an open dialogue and build a therapeutic alliance. The nature of the therapeutic session is determined by the client's age and developmental status. The boy has normal cognitive skills; the other approaches would be more appropriate for younger children. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, DEPRESSION AND SUICIDE, pp. 911-912. Chapter 42: The Child with a Psychosocial Disorder - Page 911-912

A school nurse is working with a group of adolescents. Which assessment findings might prompt the nurse to screen for eating disorders? Select all that apply. weight fluctuation erosion of teeth menstrual irregularity absence of hunger frequent nurse visits

Correct response: weight fluctuation erosion of teeth menstrual irregularity Explanation: Screening for eating disorders may be routine for a particular client population in some clinical settings or may be cued by clinical manifestations, such as weight fluctuation, teeth erosion, disruption of menstruation, chronic constipation, dehydration, gastric reflux, syncope, and others. Frequent nurse visits do not necessarily mean there is an eating disorder. Those with eating disorders still experience hunger but ignore it as well as signs of physical weakness and fatigue. Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment, EATING DISORDERS, pp. 917-918. Chapter 1: The Nurse's Role in a Changing Maternal-Child Health Care Environment - Page 917-918

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 refusing to give personal items away lack of impulse control

Correct response: withdrawal from social activities increased activity level poor concentration noted in school lack of impulse control Explanation: The nurse will reinforce warning signs, which include withdrawal from social activities (depression), increased or decreased activity (could indicate drug usage), poor concentration (depression), lack of impulse control (depression or other mental disorder), and giving personal items away (no longer needed when dead). Reference: Hatfield, N. T., & Kincheloe, C., Introductory Maternity and Pediatric Nursing, 5th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 42: The Child with a Psychosocial Disorder, Depression and Suicide, p. 912. Chapter 42: The Child with a Psychosocial Disorder - Page 912