Deck 36: Adolescent Psychiatric Nursing

Question 1

Which intervention by the nurse would be the most therapeutic when a student reports witnessing a depressed teenager put a gun into a locker?

A) Call the principal and request a locker search without breaching confidentiality.
B) Accompany the witness to the principal's office to further discuss what was seen.
C) Call the police immediately and report that there is a student in school with a gun.
D) Call the parents of the depressed teen and ask them to come and talk with their child.

Answer 1

Accompany the witness to the principal's office to further discuss what was seen.

Question 2

A parent calls the school nurse to say,"My teenager got a forearm tattoo without my permission and won't be returning to school.We will educate our child at home,away from all the evil influences at your institution." Which is the most appropriate initial action for a school nurse to take?

A) Report the parent's comments to the school guidance counselor.
B) Invite the parent to meet with the nurse and guidance counselor.
C) Educate the parent that to some people a tattoo is considered "body art."
D) Share with the parent that many students get tattoos as a sign of independence.

Answer 2

Invite the parent to meet with the nurse and guidance counselor.

Question 3

An adult states,"When I was young,I would never have even thought of being disrespectful or being disobedient to my parents." The nurse gains insight that supports the theory that this adult was probably raised in a home with which parenting style?

A) Authoritarian
B) Traditional
C) Democratic
D) Permissive

Answer 3

Authoritarian

Question 4

An adolescent currently being treated for aggressive behavior says,"I need to tell you something very important,but first you have to promise not to tell anyone else." Which communication by the nurse would be most therapeutic?

A) "As you know nurses are obligated to document patient conversations, but I can be trusted not to tell anyone else but staff what you share with me."
B) "A nurse has a sacred responsibility to advocate for our patients, and I have taken an oath to maintain the confidentiality of all my patients."
C) "I am very discrete when it comes to issues my patients discuss with me when they consider the topics to be serious or important."
D) "I will always maintain your confidence except when I think that what you tell me might place you or others in danger."

Question 5

Which response by an adolescent during the termination of outpatient substance abuse therapy indicates the need to reevaluate the treatment plan? The adolescent:

A) says, "I'm ready to get started, but I'm just a little worried."
B) becomes tearful, and the voice quivers while saying, "goodbye."
C) says, "I never thought I'd be sorry to stop coming here!"
D) writes a note sharing fears of relapsing once independent.

Question 6

A teacher shows a nurse an adolescent's textbook that has been defaced with sexually explicit drawings and asks,"Do you think that this student is being molested at home?" The nurse responds most therapeutically by:

A) identifying for the teacher that this is fairly normal adolescent behavior but encouraging the teacher to continue to monitor the child.
B) seeing the adolescent immediately to discuss the drawings and calling social services to report the situation.
C) asking the teacher what the adolescent said about the drawings and then giving direct attention to the behavior and its implications.
D) instructing the teacher to call the parents and have them come to the school immediately so the situation can be discussed with the principal.

Question 7

A father drags his adolescent to the nurse's office at school and says,"I caught him trying to run away from school again." The nurse should initially:

A) ask the child why he feels a need to keep running away.
B) inform the parent that these actions could be considered physical abuse.
C) refer both the adolescent and the parent to the local juvenile justice authorities.
D) encourage the parent and child to talk with the nurse about the current problems.

Question 8

When a teacher reports that an adolescent has begun failing in class and is isolated from friends during laboratory sessions,the nurse responds most therapeutically by stating:

A) "Let's discuss this. The symptoms of adolescent depression can look very different from those of adult depression."
B) "Have you set limits on the student's behavior and called for an immediate family intervention?"
C) "I'll call the student's parents and see if I can get their permission to assess for possible depression."
D) "Have you noticed whether others have been bullying the student in your class?"

Question 9

An adolescent refuses to go to gym class after classmates jokingly called two freckles under his nipples extra breasts.Which intervention would be most therapeutic for this adolescent?

A) Reassure him that they are freckles not extra breasts, and send the student back to the gym to play basketball.
B) Acknowledge the student's self-consciousness while reflecting the reality that the statement was made as an insensitive joke.
C) Call the principal and explain the situation and the possibility that the school may be experiencing a bullying problem that focuses on anatomy jokes.
D) Inform his parents of their child's concerns, and suggest they have a discussion about hurtful joking and age appropriate anatomy to deal with the issue.

Question 10

A parent reports,"My adolescent sometimes acts like an adult and at other times like a child." The nurse reassures the parent,explaining that this represents an expected attempt to cope with changes in which developmental area?

A) Sexual behavior
B) Peer pressure
C) Social role
D) Identity

Question 11

A parent shares with a nurse a concern that an adolescent "constantly reads about Hitler and watches history television programs that show concentration camp footage." Which statement would be the most therapeutic response?

A) "Are there any other behavior changes that concern you?"
B) "Being interested in Hitler isn't necessarily something to be worried about."
C) "Have you ever talked with your child about how this interest in Hitler concerns you?"
D) "I'll be happy to talk with your child, but anything I learn is considered confidential."

Question 12

Which intervention would be the most therapeutic for the school nurse on the 1-year anniversary of a shooting that killed three of the school's adolescent students?

A) Plan a convocation for students, family, and teachers to revisit the deaths and loss.
B) Recommend that the principal cancel school for private observances around the town.
C) Plan a forum of commemoration for faculty, students, and family with grief counselors and experts on violence prevention.
D) Suggest to the principal that no specific acknowledgement be made in order to avoid reinforcing attention to the violence that occurred.

Question 13

A nurse would be most concerned about the risk of suicide in which adolescent?

A) A 13-year-old girl with poor school performance
B) A 14-year-old male exhibiting hostile behavior
C) A 17-year-old female with alcohol abuse issues
D) An 18-year-old male with relationship problems

Question 14

Since the divorce of parents 6 months ago,an adolescent has been absent from school nearly every Friday and gives vague complaints of various illnesses.Which nursing intervention would be most therapeutic in this situation?

A) Ask the student to discuss what is happening on Fridays.
B) Call the student's parents to determine their view concerning the behavior.
C) Request that the school counselor invite the student's parents for a family meeting.
D) Arrange for an examination including diagnostic testing to rule out any medical illnesses.

Question 15

Which behavior would indicate to the nurse that an adolescent has entered the third stage of substance abuse? The adolescent:

A) is abusing alcohol on the weekends.
B) has been caught smoking hash in the school bathroom.
C) admits to being curious about the alcohol in the family liquor cabinet.
D) has begun selling drugs at school to support a serious drug addiction.

Question 16

Which nursing intervention would be most effective when assisting an adolescent whose best friend recently committed suicide?

A) Arrange for crisis intervention therapy for the adolescent lasting at least 1 year.
B) Establish a trusting relationship while periodically assessing the adolescent for depression.
C) Encourage the adolescent to meet weekly for lunch and discussion regarding the feelings of loss.
D) Perform an ongoing mental status and lethality assessment every month for a period of no less than 6 months.

Question 17

Which statement would be the most therapeutic initially when interviewing an adolescent who attempted suicide in the school bathroom?

A) "Can you tell me what you were thinking that caused you to attempt suicide?"
B) "It appears that you were really interested in letting your classmates know you were angry."
C) "If you are willing to discuss the reasons you wanted to die, I'm certainly willing to listen to you."
D) "How do you feel I can help you, since most suicide attempts are really cries for help?"

Question 18

Which nursing intervention would be most effective when assisting an adolescent who is in stage three of substance abuse?

A) Recommend a drug-free self-help group and family therapy.
B) Provide drug education and drug-free activities for the adolescent.
C) Recommend hospitalization at a drug abuse center to facilitate withdrawal.
D) Provide anticipatory guidance to help the adolescent develop healthy coping skills.

Question 19

An adolescent relates a mutual masturbatory experience to a nurse and says,"I think I'm a homosexual." Which statement by the nurse with respect to the patient's development stage is most appropriate?

A) "Adolescence is the common time for sexual experimentation."
B) "It's important to be happy with your sexuality, whatever it may be."
C) "You might be bisexual. Tell me about your sexual behavior in detail."
D) "It's believed that many homosexual people begin to experiment at your age."

Question 20

An adolescent says,"What am I supposed to do? My parents are so strict.They never let me do anything or go anywhere with my friends." Which nursing intervention would be most effective?

A) To determine the extent of the countertransference, ask the adolescent, "Why do you think a nurse could help?"
B) Maintain a balanced stance with the adolescent, but plan to teach the parents to gradually allow for independence.
C) To establish trust, tell the adolescent that the nurse will strongly encourage the parents to allow more opportunities for independence.
D) In order to encourage dialogue, ask the adolescent to provide specific examples and situations in which the parents acted strictly.

Question 21

When asked to manage the care of an intoxicated adolescent who was found drinking alcohol in the school bathroom,the school nurse should: (Select all that apply.)

A) arrange for the adolescent to sleep in a safe place.
B) report the adolescent's drinking to the local police.
C) inform the parents that the child will be suspended.
D) call the parents to notify them of the situation.
E) notify the school's alcohol counselor.

Question 22

An adolescent is just beginning individual therapy.The nurse suspects the adolescent is demonstrating resistance when stating:

A) "There isn't anything so wonderful about this kind of therapy."
B) "I'm really busy and may miss some of our meetings because of things I have to do."
C) "I don't really need to be here. It's my parents who have the real problems, not me."
D) "It is so embarrassing to have to come here and talk with someone I hardly know about my problems."

Question 23

An adolescent self-mutilates by cutting.Which strategy would best support the child in eliminating these urges initially?

A) Encourage the adolescent to identify and verbalize feelings rather than acting them out.
B) Encourage the adolescent to select individuals to call when the urge to self-mutilate occurs.
C) Teach the adolescent stress management techniques to reduce impulsivity, such as counting to 10.
D) Teach the adolescent to use distraction techniques, such as snapping a rubber band, when destructive urges arise.