Question 1

A nurse is considering reporting suspected abuse by a step-father, but she is worried that she might jeopardize a developing relationship with the child's mother. What legal ramifications should she consider?

Accepted Answer

1. Nurses who have any evidence of abuse of a child are mandated by law to contact their state's department of child protective services to report concerns. Any nurse who fails to follow mandatory reporting laws can lose his or her license. Mandated reporters are protected from criminal or civil liability if they report in good faith. Parents are responsible for the child's medical costs.

Question 2

The school nurse recommends that the parents of a student seek help because the student is constantly in trouble and recently has set several small fires on school grounds. What condition is the school nurse suspecting?

Accepted Answer

2. Children with a conduct disorder are more likely to fight, steal, vandalize, or have school problems. These are not signs of depression; however, the child with a conduct disorder may also be depressed. The most distinctive features of attention-deficit/hyperactivity disorder (ADHD) are inattention to the surrounding environment and hyperactivity and/or impulsiveness. The child with an oppositional defiant disorder may exhibit low self-esteem, minimal frustration tolerance, swearing, mood lability, and precocious use of tobacco, alcohol, or illegal drugs.

Question 3

A 14-year-old patient has been raised from infancy in a series of foster homes and has difficulty forming significant and stable emotional connections. This increases the patient's risk for which responses or disorders? Select all that apply.

Accepted Answer

1. Insecure attachments in infancy have been linked with a higher incidence of emotional problems, including anxiety, depression, conduct problems, suicidality, drug use, aggressive and antisocial behaviors, and ADHD in childhood and adolescence. Schizophrenia is a genetically associated vulnerability.
2. Insecure attachments in infancy have been linked with a higher incidence of emotional problems, including anxiety, depression, conduct problems, suicidality, drug use, aggressive and antisocial behaviors, and ADHD in childhood and adolescence. Schizophrenia is a genetically associated vulnerability.
3. Insecure attachments in infancy have been linked with a higher incidence of emotional problems, including anxiety, depression, conduct problems, suicidality, drug use, aggressive and antisocial behaviors, and ADHD in childhood and adolescence. Schizophrenia is a genetically associated vulnerability.
4. Insecure attachments in infancy have been linked with a higher incidence of emotional problems, including anxiety, depression, conduct problems, suicidality, drug use, aggressive and antisocial behaviors, and ADHD in childhood and adolescence. Schizophrenia is a genetically associated vulnerability.

Question 4

A group of nurses were discussing psychological issues related to childhood abuse. Which statement indicates their understanding of these issues?

Accepted Answer

4. The frequency and number of abusive events influences the severity of psychological distress. If the home environment is the source of maltreatment, trauma can result in more significant consequences due to the lack of supports. Children under 10 can have PTSD. Most children do not develop long-term problems secondary to abuse, but some continue to respond to their environment in ways that have a long-lasting impact on their functioning.

Question 5

A nurse is working with a family that demonstrates a high level of conflict. Which intervention would be most appropriate?

Accepted Answer

1. Helping the family members to better advocate and communicate within the family would help to decrease the high emotion at home, improve social support, and provide a backdrop for more effective problem solving in the home. Medication is indicated for serious mental health disorders, not for resolving conflicts. Identifying a family member as causing conflict (identified patient role) is an indication of family dysfunction, not an intervention to resolve it. Collaborative, rather than authoritative, decision making helps resolve conflicts.

Question 6

A 7-year-old patient tells the nurse, "I did bad things today," and the nurse responds, "Tell me about the bad things you did today." What is the nurse doing to connect to the child's experience?

Accepted Answer

2. If a child uses certain language to describe a feeling or experience, the nurse should attempt to use that language in further understanding the child's experience. The point of the nurse's response is not to address the child's "bad behavior," but to discuss whatever subject the child introduced. The nurse's open-ended response allows the child to follow his or her own thoughts rather than provide specific information. The nurse is not simply reflecting the child's experience but stimulating further discussion.

Question 7

A community nurse is concerned about risky adolescent behavior online. What might be an appropriate subject for a parent workshop to help address this issue?

Accepted Answer

3. Helping parents and children navigate the Internet with safety and privacy is an important family intervention that will protect the entire family from potential harm. Knowing how to use social media does not provide protection from possible threatening behavior, victimization, and sexual abuse. Keeping children off the Internet does not provide them with the tools to safely navigate it. Getting access to Internet communications does not teach children how to use the Internet safely.

Question 8

A 7-year-old child recently experienced the death of the family's pet dog. The dog was the child's constant companion. What does the nurse understand the child is at risk for developing as a result of the pet's death?

Accepted Answer

4. Separation anxiety disorder involves a developmentally inappropriate and excessive anxiety over separation from home or from attachment figures and may appear after a stressful life event, such as the death of a pet. This child's dog may be viewed as an attachment figure, thus placing this child at risk for a separation anxiety disorder. Agoraphobia, the fear of being in public places, is not related to this situation. Risk factors for conduct disorder are related to difficulties with parent-child interactions. Children with elimination problems may have psychosocial risk factors. However, the child who experiences a significant family loss is at increased risk for separation anxiety disorder.

Question 9

A nurse is meeting with a 14-year-old girl who reveals that she frequently engages in cutting. Which thought of the nurse's would be most therapeutic?

Accepted Answer

4. Regardless of the trigger, nursing care of the self-injurious child or adolescent is to ensure safety first, and then to help the patient develop new skills for problem solving and managing difficult emotions and interpersonal conflicts. Adolescents who self-injure differ from those with depression. Medication is not necessarily indicated in self-injury. Adolescents who self-injure may evidence delinquent behavior, PTSD symptoms, substance and tobacco use, greater degrees of hopelessness, higher impulsivity, and suicidal ideation.

Question 10

A parent reports that her nine-year-old son experiences nocturnal bed-wetting several times each month. The parent wants to know if this problem will cure itself. Which is the most appropriate response by the nurse?

Accepted Answer

3. Although as many as 10% of seven-year-olds wet the bed at night, there is a high remission rate, with only 1% to 2% of adolescents still experiencing nocturnal enuresis. Although family therapy and support may be indicated in some cases, it is not the only treatment alternative. Medications may be used to temporarily control bed-wetting, but they do not stop it. Most causes of enuresis are not organic.

Question 11

A nurse is working with a 16-year-old tornado survivor who is diagnosed with posttraumatic stress disorder (PTSD). What therapy might she use to emphasize positive outcomes of trauma?

Accepted Answer

2. PTG theory emphasizes the transformative potential of one's experiences with highly stressful events and circumstances, noting that positive growth experiences may be optimal during late adolescence. Somatic experiencing addresses PTSD by focusing on the body's remembered sensations. CBT has been found to be an effective treatment intervention for PTSD, but it does not emphasize the positive growth potential. Eye movement desensitization and reprocessing (EMDR) is a fairly new, nontraditional type of psychotherapy that remains controversial among some health care professionals.

Question 12

A parent tells the nurse that her brother has Tourette syndrome and she is concerned that her five-year-old son may be at risk for the same disorder. Which is the most appropriate reply?

Accepted Answer

2. Genetic associations have been found in Tourette syndrome. The impact of environmental effects, heterogeneity, and other factors complicate what this means for diagnosis and treatment of children with this disorder, and no definite cause-effect relationship has been determined. Advances in genetic technology have implicated genetic associations in Tourette syndrome.

Question 13

The psychiatric nurse is discussing indicators of conduct disorders in children with a group of student nurses. The nurse will be sure to discuss which behavior that children with conduct disorders find challenging?

Accepted Answer

3. The central feature of a conduct disorder is repetitive and persistent behavior that violates the basic rights of others or major age-appropriate societal norms or rules. Behaviors that show aggression toward people and animals, destruction of property, deceitfulness or theft, or serious violations of parental or school rules are indicators of a possible conduct disorder. The inability to eat a balanced diet is not an indicator of an emotionally disturbed child. Children with a conduct disorder tend to find peers with similar issues. Difficulty interpreting internal stimuli or external cues is not related to conduct disorders.

Question 14

A school nurse wants to design an in-school program to help improve the mental health of the students. What topic would be an appropriate choice that would affect the most students?

Accepted Answer

3. Approximately 30% to 40% of children and adolescents are bullied or bully others in their school years. A proactive, collaborative approach appears to have the greatest outcomes on changing bullying behaviors. Weight control, although it may have some self-esteem repercussions, is not a mental health intervention for a significant population. Drug abuse prevention is an important mental health intervention, but it would not affect the most students, as approximately 8% of the adolescent population estimated to use illicit drugs. Effective studying is an academic, not a nursing, intervention.

Question 15

A nurse is working with a 17-year-old girl with bulimia nervosa. What experience in the nurse's own life could interfere most with nurse's objectivity?

Accepted Answer

3. The nurse must be careful to understand and mediate his or her own experiences as a child and as an adult; direct experience with a disorder such as bulimia can have a significant impact on the nurse's objectivity. A poor personal body image is important to acknowledge when treating someone with bulimia, but its impact is not as significant as having suffered from the disorder. Although knowing someone with bulimia can provide additional information about the condition, it is not likely to have a powerful impact on objectivity. Personal experience with a disorder is not a prerequisite to professional treatment of the problem.

Question 16

During a therapy session an 11-year-old patient tells the psychiatric advanced practice nurse that he wants to leave. The nurse wants to understand what created this feeling. How might she respond to the patient's statement?

Accepted Answer

3. Asking about what happened acknowledges the patient's need, and using an open-ended question is more likely to elicit a meaningful response. Asking about where the patient may want to go pins him down and limits his responses. Suggesting that the patient is upset makes an assumption that closes off discussion. Suggesting that the patient stay and talk addresses the nurse's need without addressing the patient's need.

Question 17

A kindergarten teacher refers a student to the school nurse because he appears unable to engage in play with the other children and insists on playing alone with a particular toy. He also shows delayed language development. What disorder might the nurse suspect?

Accepted Answer

2. The core symptoms of ASDs are impairment of social interactions and communication, and restricted, repetitive behaviors and interests. Conduct disorder is defined by a relatively persistent pattern of multiple antisocial behaviors during childhood and adolescence. PTSD is a response to trauma that often involves recurring, distressing dreams related to the event. Although children with PTSD may withdraw from others and disengage from activities, they do not typically exhibit language delays. Core symptoms of ADHD fall into three categories: inattention, hyperactivity, and impulsivity.

Question 18

A 12-year-old patient, who was recently place in foster care after one year in a residential facility, reports recurring nightmares about a violent event in the residence. He also has some difficulty remembering and concentrating. The nurse suspects the patient may be developing which disorder?

Accepted Answer

4. Symptoms of PTSD include recurring, distressing dreams related to the event as well as memory impairment, impaired information processing, and difficulty concentrating. Children who are depressed typically cannot communicate their sadness with words, as in verbal reports of troubling dreams, but instead communicate to others with their withdrawn, sad, and/or irritable mood states. Separation anxiety occurs when a child exhibits great fear and distress when separated from parents or home. Pediatric bipolar disorder (PBD) is characterized by significant mood disturbances, including elated or irritable mood.

Question 19

A nurse is describing the multifactorial perspective of mental health and illness to the parents of a child recently diagnosed with autism spectrum disorder. Which statement would the nurse utilize when describing this approach?

Accepted Answer

3. The best explanation of the multifactorial nature of psychiatric disorders is that genetically determined attributes and life experiences interact to influence mental health outcomes. Discussing the association of exposure to drugs and alcohol to psychiatric disorders partially explains complications occurring during the perinatal period as a cause of some mental illnesses. Discussing the effects of early psychological trauma on brain structure partially explains nervous system responsiveness. Discussing feedback mechanism dysfunction would provide a partial explanation of neuroendocrine reactivity.

Question 20

The school nurse is meeting with a child and his parents. The child was recently diagnosed with autism spectrum disorder (ASD). What is an appropriate goal for this first meeting?

Accepted Answer

1. A first session should include education about symptoms, the impact on functioning, and possible therapies. The first session should not be focused on predetermined behavioral objectives; over the long term, the nurse should focus on how patient needs can be articulated and addressed as specific, realistic, and measurable goals for the patient's care and include the patient in developing them. Theories on the causes of ASD examine various possible etiologies but definitive causes are still not determined. A psychopharmacologist or child psychiatrist should be considered to assess the appropriate medication regimen.

Quiz 30: Disorders of Childhood and Adolescence