Deck 35: Psychosocial Alterations

Question 1

In individual therapy involving a child or adolescent, who decides what will be shared with caregivers?

A) the child or adolescent
B) the therapist
C) the parents or guardian
D) the therapist and the child

Answer 1

the therapist and the child

Question 2

The focus of family therapy is:

A) the identified problem person
B) solving family problems
C) relationships and communication patterns among family members
D) to resolve crises as well as to decrease anxiety and fears of members

Answer 2

relationships and communication patterns among family members

Question 3

The major focus of play therapy is to:

A) help the child reveal emotions, feelings, and problems
B) get the child to relax and be less anxious and upset
C) teach the child how to play fairly and share toys with others
D) evaluate whether the child has masculine or feminine type of play

Answer 3

help the child reveal emotions, feelings, and problems

Question 4

Which of the following disorders is the most commonly encountered neurobehavioral disorder of childhood?

A) antisocial personality disorder
B) school phobia
C) eating disorders
D) attention-deficit hyperactivity disorder

Question 5

Which of the following is the basic impairment in attention-deficit hyperactivity disorder?

A) inability to complete tasks due to distractibility and forgetting the task at hand
B) too few inhibiting behaviors, causing problems in learning self-regulation behaviors
C) hyperactivity and acting as if motor driven
D) inattention to safety issues with resulting high-risk behavior

Question 6

Attention-deficit hyperactivity disorder (ADHD) is viewed as a disorder that will be present:

A) until the child is in junior high school and then will disappear
B) until the high school years and then be resolved
C) through the high school years and then diminish
D) as a chronic disorder that persists into adulthood

Question 7

The school nurse is working with a child suspected of having attention-deficit hyperactivity disorder (ADHD) by some of his teachers. The nurse is aware that some other conditions can produce behaviors similar to ADHD. Which of the following conditions, in addition to hearing problems and learning disabilities, can be mistaken for ADHD?

A) anxiety or depression, and absence seizures
B) personality disorders and anxiety disorders
C) low self-esteem and efforts to cover it up
D) immaturity and or regression

Question 8

There are three subtypes of attention-deficit hyperactivity disorder; one type is primarily of the inattentive type. Which of the following behaviors by a child would the nurse recognize as matching the diagnostic criteria under inattention?

A) fidgets with hands or feet
B) acts as if motor driven
C) gives answers before questions are completed
D) has difficulty organizing tasks and activities

Question 9

In order for a child to be diagnosed with attention-deficit hyperactivity disorder, a child must meet 6 of 9 diagnostic criteria and these symptoms must be present in two or more settings and have persisted for how long?

A) at least 3 months
B) at least 6 months
C) between 8 and 10 months
D) between 11 and 12 months

Question 10

To be diagnosed with attention-deficit hyperactivity disorder (ADHD), a child must have at least 6 of 9 symptoms of inattention and 6 of 9 symptoms of hyperactivity or impulsivity. Also, the symptoms must have occurred in two or more settings; persisted for 6 or more months; adversely affected functioning in school, work, or social situations; and been present before what age?

A) 4 years
B) 5 years
C) 6 years
D) 7 years

Question 11

Behavioral management of attention-deficit hyperactivity disorder includes which of the following methods?

A) aversive therapy
B) extinction
C) clear definition of acceptable and unacceptable behaviors and accompanying consequences and rewards
D) strict rules and strict punishments for breaking a rule, even the first time, with no warning periods but only enforcement

Question 12

A child diagnosed with attention-deficit hyperactivity disorder has been on methylphenidate (Ritalin) for several months. The physician orders a "drug holiday." Which of the following is the most likely reason for the drug holiday?

A) to give the parents a break from having to administer the medication
B) to determine if the drug is still necessary every day or necessary at all
C) to save money because the drug is very expensive
D) to reverse the adverse side effects of this drug

Question 13

The nurse is working with the caregivers of a child who has attention-deficit hyperactivity disorder. The caregivers ask the nurse to help them figure out how to get their child to pay better attention to instructions because then they tell her to do something, she never seems to recall what they asked her to do or she completes only part of the task. She is having the same problem at school. What is the best intervention the nurse can suggest?

A) Give only one or two instructions at a time, and break new tasks into smaller parts, teaching each part separately.
B) Write all the instructions out in detail, and give the written instructions to the child to use while completing the task.
C) Offer a reward for completing tasks, and have an appropriate punishment for not completing work.
D) Have another child who is organized and completes the tasks to work with and tutor their child.

Question 14

The nurse is working with the parents of a child with attention-deficit hyperactivity disorder. The child is on methylphenidate (Ritalin). Which of the following actions by the nurse would be most helpful in getting the parents to comply with the medication regimen?

A) Talk to the parents about the benefits of the medication more than the side effects associated with the medication.
B) Talk with the parents about several children who have been helped by taking Ritalin.
C) Explore the parents' feelings and concerns about the medication.
D) Contract with the parents to try the child on Ritalin for a month and reevaluate at that time.

Question 15

The nurse is working with a child who has a diagnosis of attention-deficit hyperactivity disorder and is taking a stimulant medication. The child has lost weight and is short for his age group. The nurse will talk with the parents about this weight loss and the lag in growth attainment. The nurse will most likely explain this to the parents in which of the following ways?

A) The weight loss and growth lag are due to the energy that a hyperactive child burns, and this will eventually be corrected by the stimulant.
B) Children on stimulants often lose weight and have a lag in growth, so we need to talk with the pediatrician about how to minimize these side effects.
C) The child is at an age there weight loss is normal, and the child may soon have a growth spurt.
D) Some children are just slender and short for their age group and this may be a genetically caused phenomenon.

Question 16

The nurse working with children who have a major depressive disorder (MDD) will notice that these children, compared to adults with major depressive disorder, are:

A) less depressed and more closely resemble an adult with dysthymic disorder
B) unlikely to exhibit any of the signs of depression that adults exhibit
C) easier to treat and they have a sort of depression that responds readily to medication
D) more irritable, express more anxiety, and verbalize more about somatic complaints

Question 17

The nurse assessing a child or adolescent with a diagnosis of dysthymic disorder (DD) will find which of the following symptoms?

A) a depressed or irritable mood for most of the day, on most days, for 2 or more years, and low energy or fatigue
B) severe shaking of the hands then trying to hold a glass of water or other object
C) a depression that is deeper, more acute, and more likely to lead to suicide than major depressive disorder
D) labile mood and hyperactive thyroid with an increase in circulating thyroid hormones and associated symptoms

Question 18

The school nurse is working with children from various cultures. The nurse notices that one of the foreign-born students seems to be silent and avoids eye contact with the principal, teachers, and other adults. The nurse decides to do further assessment before reaching a conclusion about the cause of this behavior. Which of the following is the most likely cause of the silence and avoiding eye contact?

A) one of the depressive disorders
B) low self-esteem
C) poor English language skills
D) cultural norms

Question 19

The school nurse working with a group of adolescents with mood disorders is aware that the third leading cause of death in 10- to 19-year-olds is which of the following?

A) automobile accidents
B) drug overdose
C) suicide
D) disease

Question 20

The school nurse notices that one of the adolescents who is in a peer support group is talking about not being around long and is giving away some belongings. The nurse suspects this adolescent may be thinking about suicide. Which of the following interventions would be best?

A) Ask the adolescent: "Have you ever thought about killing yourself or wishing you were dead?"
B) Report the suspicions to the principal, the vice principal, and adolescent's teachers.
C) Talk with the family of the adolescent, and ask them if they have any idea about what is going on with their child.
D) Talk with the peers of the adolescent, and ask them to watch this adolescent and find out what is going on.

Question 21

An adolescent hospitalized after a suicide attempt is due to be discharged after a weeklong stay in the psychiatric unit. The nurse assessing this adolescent notices that the child has a dramatic lifting of the depression and seems cheerful. The nurse's best course of action is to do which of the following?

A) Talk with the parents about the positive change in mood.
B) Call the psychiatrist immediately to notify her of the mood change, and ask that the psychiatrist assess this adolescent prior to discharge.
C) Wait until the parents come, do discharge teaching, and release the adolescent to go home.
D) Watch the adolescent closely to see if this is a sign that the depression is truly resolved or if the adolescent is going into mania.

Question 22

The nurse working with children and adolescents who talk about suicide intentions is aware that those at highest risk of completing the suicide are those who:

A) have a single caregiver who psychologically abuses them
B) suffer from depression or some mood disorder
C) describe a plan to use a firearm and have access to a firearm and ammunition
D) are talking about saving up some of their pills and taking them all at once

Question 23

Which of the following things must the nurse teach caregivers of children and adolescents as a primary prevention of suicide?

A) what to say to their child then the child is suicidal
B) how to manage the medication of an adolescent who is suicidal
C) to work with the treatment team then the adolescent is hospitalized
D) to identify risk factors for suicide and signs of depression

Question 24

Nurses on the unit have been working with an adolescent who was discharged a couple of days ago. The nurses receive word that this adolescent has just been found dead from a self-inflicted gunshot wound. Which of the following things would most help these nurses?

A) a debriefing session with an opportunity to work through their own feelings of self-blame, grief, or guilt
B) details of how the adolescent planned and went about the work of killing himself
C) a visit to the funeral home to view the adolescent and talk with his family and friends
D) talking with the caregivers or parents of the adolescent who committed suicide

Question 25

The essential feature of separation anxiety disorder (SAD) is marked anxiety about separation from major attachment figures, home, or familiar surroundings, which:

A) is repeated every time the child is in similar circumstances
B) lasts at least 2 weeks and is repeated several times a year
C) is beyond that expected for the child's developmental level
D) cannot be resolved with the usual distraction or ignoring

Question 26

The nurse assessing a child suspected of having school phobia is aware that which of the following contributes to caregivers' ineffectiveness in helping the child with school phobia or with refusing to return to school?

A) wanting to discipline or disciplining the child
B) ambivalent feelings by the caregiver
C) lack of information about school phobia
D) being busy with work and other involvements

Question 27

Children with generalized anxiety disorder (GAD) can best be described as:

A) excessive worriers who worry even then school and social successes indicate they have nothing to worry about
B) worried about nothing in particular but feeling worried all the time even if no cause can be found
C) worried about everything, every waking minute, and being unable to accomplish any work
D) having a low level of worry but being consistently at this same level of worry

Question 28

The nurse assessing a school-aged child with separation anxiety disorder (SAD) will most likely find that the child has been exhibiting which of the following behaviors?

A) aggression toward other children and especially any siblings
B) refusing to eat in what seems to be an effort to get attention
C) exhibiting complaints of stomachaches, headaches, nausea, vomiting, and low-grade fevers without any physiological cause
D) refusing to leave home and sometimes even refusing to leave the bedroom and familiar belongings for days or even weeks at a time

Question 29

The school nurse observes an adolescent who always brings his lunch and eats in isolation from others. In class and groups this young man looks uncomfortable then called on to speak and has taken some teasing from peers for blushing and sweating then interacting in a group. The school nurse will do further assessment with the adolescent and his caregivers because these symptoms are most consistent with those found in which of the following conditions?

A) social isolation disorder
B) schizoid disorder
C) social phobia disorder
D) separation anxiety disorder

Question 30

Which of the following outcomes would the nurse evaluate as a goal met for a child who has been given a nursing diagnosis of "Fear related to separation from caregiver":

A) Child stayed overnight with a peer.
B) Child stated he or she will go to camp for a week.
C) Parent has devised a reward system for the child staying 1 hour or more without the parent present.
D) Caregiver reports the child seems less nervous then talking about separation.

Question 31

The parents of a child with failure to thrive have questioned how many calories their infant will need. The nurse is aware that children with failure to thrive need to receive ____________________% of their recommended daily caloric intake.

Question 32

Which of the following are appropriate goals in working with a child or adolescent with a diagnosis of anorexia nervosa? Select all that apply.

A) weight gain to within 5% of ideal body weight within 1 week's time frame
B) weight gain to within 10% of ideal body weight at a gain of 1-2 pounds per week
C) eat 100% of a 2,500-calorie diet each day
D) eat a balanced diet with sufficient calories to allow weight gain