Unit 15 & 17 - Care of Family Ch. 22

12. A nurse is educating the parents of a child diagnosed with major depression prescribed a selective serotonin reuptake inhibitor (SSRI). The parents do not want to fill the prescription because they have heard SSRIs increase the risk of suicide in children. Which statement by the nurse is most appropriate? A. "I will convey your concerns to your health-care provider." B. "If you don't want your child to take the medication, don't fill it." C. "SSRIs have been used for many years to treat depression." D. "This information is controversial, so watch your child carefully."

ANS: D Studies result in conflicting information on this topic; the FDA has issued a "black box" warning for increased risk of suicide in youths taking SSRIs, but subsequent studies have shown this class of drug to be effective in reducing suicidal ideation. The parents should be educated and instructed to watch their child carefully, no matter what medication is prescribed.

24. A nurse in the pediatric clinic suspects a patient is the victim of child abuse. What action takes priority? A. Ask a coworker to confirm the suspicions. B. Confront the parents with this information. C. Document the findings in the child's chart. D. Report the suspicions according to state law.

ANS: D All states have mandatory reporting laws for suspected child maltreatment. The nurse's priority action is to report the findings per state law and facility policy. The other actions are not incorrect; they just are not the priority.

29. A nurse is assessing a child who has a large head, an elongated face, and prominent ears. Which discharge instruction is most important? A. "Create a family pedigree so I can assess for Down syndrome." B. "Please make an appointment with a pediatric cardiologist." C. "We will call you regarding a referral for genetic testing." D. "You will need to abstain from alcohol in your next pregnancy."

ANS: C This child has manifestations of fragile X syndrome. The family needs to have genetic testing done for this inherited condition. The other instructions are not necessary.

27. A nurse is making a referral for a family whose teenage daughter has anorexia nervosa. Which referral is the most appropriate? A. Crisis intervention counseling B. Family-oriented therapy C. Multidisciplinary team D. Psychiatrist

ANS: C Eating disorders are difficult to treat, and often the entire family is involved in therapy. The best approach is often a multidisciplinary team with expertise in this topic. The other services may be needed on a case-by-case basis, but overall the best referral is to a treatment center that uses a multidisciplinary team.

5. A nurse is caring for a child with attention deficit-hyperactivity disorder (ADHD). Which medications does the nurse anticipate may be prescribed for this child? (Select all that apply.) A. Adderall (amphetamine salts) B. Haldol (haloperidol) C. Prozac (fluoxetine hydrochloride) D. Ritalin (methylphenidate hydrochloride) E. Strattera (atomoxetine)

ANS: A, D, E Drugs most commonly used for ADHD include stimulants such as Ritalin and Adderall, and Strattera (a nonstimulant). Haldol is an antipsychotic. Prozac is an antidepressant.

21. A community nurse approaches the organization's manager wanting to set up screening for risk factors for Tourette's syndrome in children. Which response by the manager is the most appropriate? A. Allocate funding for a family psychosocial or cognitive condition screening. B. Deny the request because Tourette's syndrome has very little impact. C. Explain that Tourette's syndrome is most likely inherited. D. Facilitate cooperative agreements with a community laboratory facility.

ANS: C Tourette's syndrome is an inherited neuropsychiatric disorder. Children with Tourette's syndrome are often teased or bullied, and the disorder can have a major impact on social functioning and relationships. A family psychosocial or cognitive condition screening and cooperative agreements with local laboratory facilities are not warranted.

26. A nurse has identified substance abuse in an adolescent. In addition to a treatment center referral, what other referral is most important? A. Counseling for parents B. Law enforcement C. Mental health provider D. Social services agencies

ANS: C Untreated psychiatric disorders increase the risk of substance abuse, so the family should be referred to a mental health provider. Many treatment centers include this service, but if not, the nurse needs to facilitate this referral. The other referrals are not necessarily needed.

22. A nurse is assessing families in the community for child maltreatment. Which family would the nurse identify as being at highest risk? A. Children involved in many activities B. Family with multiple children C. Older parents with only children D. Single mother living in poverty

ANS: D Identified risk factors for child maltreatment include: children with disabilities; children of very young parents; children of single mothers who live in poverty; parents who suffer from mental or chronic physical illness; parents who have rigid ideas of discipline, excessive stress, or marital conflict; parental substance abuse; and intergenerational history of abuse.

9. A child diagnosed with depression is given the nursing diagnosis of situational low self-esteem. Which statement by the child indicates that a short-term goal has been met? A. "I have to sleep a lot when I feel sad, sometimes until noon!" B. "I wish I didn't make so many mistakes in my homework." C. "My mom makes me special cookies when I am feeling sad." D. "When I was feeling bad, I remembered my great science project."

ANS: D One important goal for the child with situational low self-esteem is to have the child engage in positive self-talk. Remembering a great project is a good way to highlight the child's abilities in his or her own mind. The other statements do not indicate movement toward resolution of this diagnosis.

31. A child has the possible diagnosis of autism spectrum. While awaiting the results of further testing, which action by the nurse is the most appropriate? A. Continue to monitor the child for late signs of autism. B. Reassure the parents that concerns are probably not valid. C. Refer the child to audiology to rule out a hearing impairment. D. Wait for results before referring the child to early intervention or a local school program.

ANS: C Because children on the autism spectrum have difficulties in communication, a hearing test is in order to rule out any physiological cause contributing to this manifestation. Continued monitoring is always appropriate, but that is not the best option. Parents usually do have concerns that are valid regarding their child. Referrals to school-based or early intervention programs should not wait for a definitive diagnosis.

8. A nurse is teaching a classroom of middle school students sleep hygiene. Which information does the nurse provide? (Select all that apply.) A. Create a healthy environment for sleep in your room. B. Go to bed at the same time every night of the week. C. Only use your bed for sleeping and reading. D. Set your cell phone to vibrate or low volume. E. Turn off your computer 1 hour before bedtime.

ANS: A, B, E Many strategies exist for improving sleep. The nurse should teach the children to create a healthy sleep environment in their rooms, to go to bed at the same time each night, and to turn off technological devices such as computers and cell phones 1 hour before bedtime. The bed should only be used for sleeping.

4. A nurse is providing education to the parents of a child who has anxiety. Using the FRIENDS strategy for managing anxiety, what techniques does the nurse teach? (Select all that apply.) A. Explore plans B. Fight the anxiety C. Inner thoughts D. Reward yourself E. Stay calm

ANS: A, C, D, E FRIENDS is an acronym for feeling worried, relax and feel good, inner thoughts, explore plans, nice work so reward yourself, don't forget to practice, and stay calm...you know how to cope. Fight the anxiety is not part of the acronym.

6. A mother brings her child to the clinic requesting a selective serotonin reuptake inhibitor (SSRI) to help treat her daughter's posttraumatic stress disorder (PTSD). Which rationale will the nurse use when responding to the child's mother? A. Children have too many side effects from SSRIs. B. Research shows that treating specific symptoms is better. C. SSRIs have a long history of successful use in PTSD. D. This classification of drugs has rarely been used in PTSD.

ANS: B Although SSRIs have long been used as first-line treatment for PTSD, there is scant evidence supporting this practice. Research supports treating specific symptoms as they arise.

32. A pregnant woman asks the nurse how much alcohol must be consumed to put her fetus at risk of fetal alcohol spectrum disorder. What answer by the nurse is the most appropriate? A. Any alcohol during the third trimester B. Any amount at any time during the pregnancy C. More than 2 drinks/day in the first trimester D. Three or more drinks/day throughout pregnancy

ANS: B Data show that alcohol intake at any time of pregnancy is harmful. The nurse should educate the woman that drinking any amount of alcohol at any time during her pregnancy can increase the risk of fetal alcohol spectrum disorder.

4. The pediatric nurse is assessing a child who complains of a stomach ache. This is the child's fourth visit to the clinic for the same problem, and there has not been a diagnosis yet. What action by the nurse is best? A. Ask about child's functioning and development. B. Instruct the mother not to keep the child home from school. C. Obtain a thorough family history from the mother. D. Perform an abdominal exam and document findings.

ANS: A Children with anxiety often present with somatic complaints that do not have a physical cause. The nurse should inquire about the symptoms characteristic of all anxiety disorders, including impaired function or development related to anxiety. The nurse should not just instruct the mother to send the child to school, as this is not a helpful strategy in alleviating the problem. A thorough history is important, but most likely would have already been done in prior visits. Performing and documenting an abdominal exam are both important, but again will not provide specific assistance in this situation.

1. A nurse wishes to increase an at-risk child's resilience. What action by the nurse would be most helpful? A. Assist the child in recognizing internal resources. B. Help the child see that others are worse off. C. Instruct the child to "toughen up." D. Teach the child therapeutic communication skills.

ANS: A Resilience is the ability to recognize and use internal or external resources in dealing with adversity. Helping the child see his or her internal resources is a positive step in improving resiliency. Telling the child that others are worse off than he or she is or that he or she should "toughen up" is dismissive and not helpful. Teaching appropriate communication is important, but children do not need therapeutic communication skills.

11. A school nurse is speaking with the parents of a child identified as possibly being at risk of suicide. Which question by the nurse is the priority during the nursing assessment? A. "Do you have any guns in your home?" B. "Does your child have any close friends?" C. "Has your child been hoarding objects?" D. "Is your child ever left alone at home?"

ANS: A The most common methods of committing suicide in children and adolescents are firearms (46%), suffocation (37%), and poisoning (8%). The most important question the nurse can ask in the options listed is whether or not the family has guns in the home. Typically the suicidal youth will distance from friends and give away prized objects. Being left alone may or may not be relevant, but is not as important as assessing if the child has a means to carry out a plan.

28. A nurse is working with the family of a child who is overweight. What action by the nurse is most appropriate? A. Help the family identify fun activities. B. Instruct the child to exercise for an hour each day. C. Place the child on a restricted-calorie diet. D. Set a weight-loss goal for the child.

ANS: A The nurse should encourage the entire family to engage in physically active and fun events. What people like, they will continue to do. The nurse can help the family members identify activities they enjoy or help them discover new ones. Setting rigid and unrealistic exercise goals is likely to fail. Restricted diets are also not recommended for children, as they contribute to eating and weight problems. The nurse should not set goals for the child, but rather plan goals together with the child and family.

19. An advanced practice nurse is working with a child diagnosed with oppositional defiant disorder. What action by the nurse is most appropriate? A. Assess the child's performance at school. B. Facilitate genetic testing for the entire family. C. Screen the child for other psychosocial problems. D. Warn the parents not to leave siblings alone with the child.

ANS: C Children with both oppositional defiant disorder and conduct disorder often have other psychological comorbidities. The nurse should screen the child for other problems. Assessing performance at school may be important in some cases, but is not the most appropriate action. Genetic testing is not done for this disorder. Siblings may be at risk when being left alone with the child, but this would need individual assessment and is not applicable to all children with this disorder.

13. Parents of a teen diagnosed with schizophrenia report being exhausted and overly stressed. Which action by the nurse is most appropriate? A. Ask if the parents are getting enough sleep. B. Assess if the family is still in counseling. C. Refer the family to a support organization. D. Request medication to calm the parents.

ANS: C Families with schizophrenia (along with families dealing with any difficult chronic condition) should be referred to support organizations. The National Alliance for the Mentally Ill (NAMI) is one such organization. Assessing for sleep is a good idea, but not comprehensive enough. The family should remain in counseling, but, again, this option is not comprehensive enough and does not provide the family with an action plan. Requesting medication for the family does not help the family learn coping strategies.

16. A child with attention deficit-hyperactivity disorder (ADHD) is in the clinic with parents, who complain that even though they are following the treatment plan, the child is not improving. What action can the nurse suggest to improve the effectiveness of the plan? A. Consult with the school nurse to follow through with behavior logs. B. Ensure the entire family is continuing to keep counseling appointments. C. Reassure the parents that it takes a long time to see changes in behavior. D. Teach the parents about herbal and diet therapies they can try at home.

ANS: A The school nurse is in an ideal position to work with teachers and create behavior charts so the child's treatment plan is followed throughout the school day. The parents have already said they are compliant with the treatment plan, so there is no need to assess if they are still going to counseling. Although it may take some children a while to make changes in behavior, simply telling the parents this information does not provide them with information they can use to make positive changes. Diet and herbal therapies are not proven treatments for ADHD.

3. The nurse is assessing a child for an anxiety disorder. What manifestations noted by the nurse are common to all anxiety disorders? (Select all that apply.) A. Distress or avoidance of feared situations B. Does not go away or gets worse over time C. Impaired functioning or development D. Leads to avoiding social situations E. Physical symptoms such as palpitations and sweating

ANS: A, B, C General manifestations common to all anxiety disorders include: anxiety that does not go away or gets worse over time, anxiety that pervades more than one aspect of the child's life, significant distress or avoiding of feared situations, and impaired functioning or development as a response to anxiety. Avoiding social situations is specific to social anxiety disorder. Physical symptoms such as palpitations and sweating are specific to panic disorder.

17. A child has been diagnosed with oppositional defiant disorder (ODD). The parents ask the nurse what risk factors the child has for this disorder. Which response by the nurse is the most appropriate? A. "I am not sure; you can ask the doctor during your appointment." B. "It seems to be an inherited problem from a recessive gene." C. "The etiology seems to be complex, with multiple causes." D. "Unfortunately, nobody knows what causes this condition."

ANS: C The etiology of ODD is complex and multifactoral, so it is difficult to identify specific risk factors. The nurse may not know the answer, but should find out and inform the parents directly. ODD is not an inherited recessive condition. Although the exact cause of (and therefore risk factors for) ODD is not known, simply stating this fact does not give the parents any useful information. The nurse should provide whatever information there is regarding this condition.

18. The nurse is working with the family of a child with conduct disorder (CD). The parents are very stressed and fighting a great deal. What action by the nurse is the most appropriate? A. Assess the family for sleep disturbances. B. Question the parents about alcohol intake. C. Refer the family to a weekend respite program. D. Suggest the parents enter couples' counseling.

ANS: C The stress of caring for a child with CD can be overwhelming. The nurse is in an ideal position to encourage the parents to care for their needs, too, to reduce stress. One helpful intervention is to refer the family to a respite care program so the parents can experience some stress-free time without the child. Assessing sleep patterns and substance abuse may or may not be beneficial. Couples' counseling also may or may not be beneficial. Simply being away from the child for short periods of time might be the only intervention needed.

2. The mental health nurse is preparing a presentation for nurses who work with pediatric patients. Which barriers to mental health screening should the nurse include in the presentation? (Select all that apply.) A. Belief that children do not have psychosocial or cognitive conditions B. Family shame related to psychosocial or cognitive conditions C. High level of health literacy regarding psychosocial or cognitive conditions D. Minimizing of psychosocial or cognitive conditions symptoms by health-care providers E. Stigma of psychosocial or cognitive conditions in society

ANS: A, B, D, E There are many barriers to adequate health care for psychosocial or cognitive conditions in children. The belief that childhood is a time free of stress and problems leads to denial that children can indeed have psychosocial or cognitive conditions. Family shame and the stigma of psychosocial or cognitive conditions are both barriers. Health-care providers often minimize parents' concerns about psychosocial or cognitive conditions. Even people who have a high level of health literacy tend to have low levels of literacy related to psychosocial or cognitive conditions.

1. A nurse working with at-risk children recognizes that vulnerability to psychosocial or cognitive disorders depends on which risk factors? (Select all that apply.) A. Environment B. Genetics C. Immunity D. Temperament E. Timing of exposure

ANS: A, B, D, E Vulnerability is defined as those characteristics that may predispose the child to a disorder. Vulnerability is affected by a number of risk factors, including environment, genetics, temperament, and timing of the exposure to the threat to mental health. Immunity is not recognized as a risk factor that affects a child's vulnerability to cognitive or psychosocial disorders.

10. A nurse is working with a family whose child has bipolar disorder. Which item is the most appropriate for the nurse to including in the teaching session for this child and family? A. Ensure the child follows all house rules; do not give in. B. Instruct family that if mania is uncontrollable, hospitalization is required. C. Protect younger children from sexually aggressive behaviors. D. Provide routine and structure and appropriate freedom.

ANS: D In bipolar disorder, structure and routine are important. The child can be allowed freedoms as appropriate and within limits. Prioritizing battles is also important; the nurse should not encourage rigidity in the parents. While hypersexualized behavior can be apparent, patients with bipolar disorder are not necessarily sexually aggressive. Hospitalization may be required briefly in extreme cases.

7. A pediatric nurse is explaining child abuse and neglect to a class of nursing students. Which information does this nurse provide the students during the presentation? (Select all that apply.) A. Children with disabilities are at higher risk. B. Diagnosing physical child abuse is easy and quick. C. Each week, about 5 children die from abuse. D. Neglect is most common, but is difficult to identify. E. Unexplained, recurrent conditions may be caused by abuse.

ANS: A, D, E Children with disabilities have a higher risk of abuse than do nondisabled children. Child neglect is the most common form of child maltreatment but may be difficult to identify. One type of child maltreatment is Munchausen by proxy, in which a parent causes recurrent, unexplained conditions in the child for attention. Diagnosing child abuse may take a long time due to the thorough family and child assessments needed. In fact, more than 5 children die each day as a result of maltreatment.

30. A child with Down's syndrome has been admitted to the hospital with a respiratory condition and is producing thick, tenacious mucus. Which nursing action is the priority? A. Ensuring a patent airway B. Involving child-life therapy C. Preventing nosocomial infection D. Relieving stress at hospitalization

ANS: A All answers are appropriate nursing interventions; however, the child with Down's syndrome has a small oral cavity and small airway, which can be easily occluded. The priority action of the nurse is to maintain the child's airway.

14. A nurse is assessing children for reactive attachment disorder (RAD). Which child would the nurse identify as being at highest risk for this disorder? A. Adopted from foreign orphanage B. Given care by extended family C. Placed in day care at 3 months D. Unmarried, cohabitating parents

ANS: A Children with RAD have not experienced consistent and nurturing parenting. They have often endured abuse, neglect, and abandonment. A child adopted from an orphanage would have the highest risk of RAD.

15. A mother requests information on caring for her child just adopted from a foreign orphanage. The mother has heard of reactive attachment disorder (RAD) and wants to provide an environment that is appropriate for this child. What suggestion by the nurse is the most appropriate? A. Ignore temper tantrums and crying fits. B. Post a schedule of daily activities such as meals. C. Put the child in psychotherapy. D. Teach the child "stranger danger."

ANS: B In creating an environment supportive of a child who is at risk for RAD, the nurse must explain that these children have no concept of what basic needs will be met, if any. Posting a schedule of daily activities (wake up, meals, leave for school, bedtime) is a visual reminder to the child that those needs will be met in this home. Parents of children should respond to crying and temper tantrums with patience; they should not ignore this behavior. Families with a child diagnosed with RAD do need therapy; however, this will not help the mother immediately create a home environment conducive to this child. Children with RAD do have boundary issues; the child should be taught "stranger danger," but this is not the priority.

2. A faculty member is explaining the impact of immigration on mental health to a group of nursing students. What information should the faculty member provide? A. Immigrants have multiple sources for health care, so their needs should be met. B. Meeting basic human needs often outweighs the need for mental health. C. Refugees and immigrants do not often have mental health problems. D. Because immigrants do not speak English, mental health assessment is difficult.

ANS: B New immigrants to this country are often consumed with learning English, getting jobs, and adapting to an entirely different way of life in a new world. Often meeting these basic human needs consumes family energy, leaving family members no resources to identify and seek treatment for psychosocial or cognitive disorders. Immigrants suffer from disparities in health care, and often their health-care needs are unmet. Immigrants and refugees do have mental health problems, especially if they have come from war-torn or violent societies. Not all immigrants are non-English-speaking individuals.

3. When working with immigrant and refugee families, what strategy by the nurse is likely to have the most positive impact? A. Avoid anticipatory guidance and focus on immediate problems. B. Praise the families often for what they are doing well. C. Refer them to social services agencies that work with immigrants. D. Teach them the laws and customs regarding discipline in the United States.

ANS: B Nurses who work with immigrant/refugee families should praise the families for what they are doing well and keep resilience-promoting strategies in mind. Anticipatory guidance can prepare families for handling future problems. Referrals are always an important aspect of care when appropriate, but the nurse needs to provide effective strategies. Newcomers to this country do need to understand laws surrounding discipline if they come from a country in which typical disciplinary measures might be seen as problematic in the United States.

25. A student nurse wants to know what substances adolescents are at highest risk for abusing. Which information is the most appropriate for the pediatric nurse to share with the student? A. It depends on what is popular at the time in their schools. B. Alcohol and prescription drugs, because they are in most homes. C. Substance abuse varies greatly between age groups and level of school. D. There are no reliable data on substances abused most by adolescents.

ANS: B The major factors determining what substances are abused most are availability and cost. Alcohol, tobacco, and prescription drugs are found in most homes, making them readily available and cheap. Substance abuse may depend somewhat on what peers are using and the age of the user, but bigger factors are cost and availability.

20. A father brings his child to the clinic with complaints that the child jumps around, gestures continuously with the hands, and makes grunting noises. He wants to know if the child has attention deficit-hyperactivity disorder (ADHD). What response by the nurse is the most appropriate? A. "Does your child have risks for obsessive-compulsive disorder?" B. "I don't think so; that sounds more like a tic disorder." C. "Possibly; those are some classic symptoms of ADHD." D. "Yes, that definitely sounds like ADHD to me."

ANS: B Tics are sudden, painless, nonrhythmic behaviors that are either motor or vocal and appear out of context. Examples include eye blinking, facial grimacing, hand gestures, jumping, throat clearing, grunting, meaningless changes in volume and pitch of speech, and echolalia. The nurse should explain to the father that these symptoms sound more like tic disorder. The other answers are inappropriate.

23. A nurse is teaching a class to new mothers who are also high school students. What action by the nurse is the most appropriate in order to decrease the risk of child maltreatment? A. Explain the laws regarding child abuse and neglect. B. Provide education on normal childhood development. C. Refer all the young mothers to a social service agency. D. Teach the mothers signs and symptoms of abuse.

ANS: B Young mothers (and fathers) may have unrealistic expectations for their child's behavior based on ignorance of normal growth and development. This can lead to anger, resentment, and harsh discipline, especially if the parent feels the child is acting out deliberately. Teaching normal growth and development along with age-appropriate disciplinary strategies can reduce the incidence of child maltreatment. Simply explaining laws and manifestations will not result in major decreases in child abuse. Not all young mothers need social service intervention; this can be offered based on individual and family assessments.

6. A mother brings a child to the clinic with concerns about attention deficit-hyperactivity disorder (ADHD). Which behavioral assessment findings support this diagnosis? (Select all that apply.) A. Compulsive "collecting" B. Inability to stay in chair for a meal C. Nonstop talking D. Refusal to complete homework E. Sleeping whenever possible

ANS: B, C, D ADHD is characterized by behaviors related to inattention, hyperactivity/impulsivity, or both. The child's inability to sit in a chair for meals, nonstop talking, and refusal to complete homework are all signs of possible ADHD. Compulsive "collecting" could relate to an anxiety disorder such as hoarding. Excessive sleeping could indicate depression.

8. A parent calls the clinic to clarify discharge instructions for his child, who was just diagnosed with major depression. The parent states "I was told to watch for anhedonia. What does that mean?" Which explanation by the nurse is the most appropriate? A. Flat affect and absence of emotions B. Lack of personal hygiene and grooming C. Loss of interest in activities once enjoyed D. Self-mutilation or engaging in self-harm

ANS: C Anhedonia is loss of interest in activities once enjoyed.

5. A nurse is interviewing a mother of two children, ages 5 and 14. They were in a hotel fire a year ago in which their father was killed. The mother is concerned because the younger child has nightmares. The older child does not seem to have any problems. What action by the nurse is the most appropriate? A. Ask the mother about physical injuries to the children. B. Determine if the mother sought counseling after the fire. C. Focus the appointment on the younger child only. D. Inquire if the older child avoids hotels, even on television.

ANS: D The younger child has risk factors for and symptoms of posttraumatic stress disorder (PTSD). Although the mother expresses concerns about only the younger child, the nurse should inquire about the health of the older child too, in order to provide holistic care to this family. There are developmental differences in presenting symptoms, and although nightmares in a younger child might be frequently seen in PTSD, an older child might avoid situations or places that remind him or her of the incident. Information about physical injuries is important to note, but is not the priority 1 year after the fire. PTSD does not appear immediately after an incident, so counseling after the fire may not have prevented the onset of PTSD and certainly would not have identified its presence.

7. A nurse is working with the parents of a child who has the following complaints: fatigue, insomnia, persistent irritable mood, and significant weight loss. Which discharge instruction is the priority? A. Encourage the child to eat more protein. B. Enroll the child in after-school activities. C. Establish a routine bedtime and wake time. D. Ensure the child is safe at all times.

ANS: D This child has symptoms of depression. The priority is ensuring the child's safety.