Question 1

The nurse is preparing to interview a 6-year-old client and parent in an outpatient psychiatric setting. To establish a treatment alliance with the child, the nurse should do what?&#10;A) Tell the child, &#34;I watch Sesame Street all the time.&#34;&#10;B) Talk to the child while standing up and looking down.&#10;C) Tell the child that this must be a bit scary.&#10;D) Ask the parent if the child can be interviewed alone.

Accepted Answer

To establish a treatment alliance with the child, the nurse should recognize the child's individuality and show respect and concern for the child. The nurse should demonstrate sensitivity, objectivity, and confidentiality. The statement about it being scary for the child demonstrates sensitivity for the child's situation. Telling the child about watching Sesame Street makes the assumption that the child indeed does so. The nurse needs to be on the child's level. Asking if the child can be interviewed alone would not allow the nurse to observe the child-parent interaction. After talking with the parent and child together, the nurse should ask to speak with the child alone for a while. Young children may fear separating from their parents.

Question 2

A nurse is interviewing a 12-year-old child in an outpatient psychiatric setting. Which statement would be most appropriate for the nurse to say to establish a high degree of credibility?&#10;A) &#34;How would you describe your parents?&#34;&#10;B) &#34;Tell me about your best friend.&#34;&#10;C) &#34;I have several teddy bears; would you like one to hold?&#34;&#10;D) &#34;You'd get along better with your parents if you'd follow their advice.&#34;

Accepted Answer

The nurse can establish a high degree of credibility simply by taking note of, and asking about, things that are obviously important to children (e.g., a sport the child participates in, a rock group displayed on a shirt, a toy the child may have brought in). However, children have an uncanny natural "radar" for phony adult behavior. Attempts to establish rapport work only when the nurse is genuinely interested in the child's life. Asking a child to describe his or her parents would not necessarily reflect something that is important to the child. Instead, the question focuses on the parents and not the child. Asking a 12-year-old child about holding a teddy bear may be interpreted as demeaning to a child of this age. Suggesting that the child follow his parents' advice is nontherapeutic and judgmental.

Question 3

The nurse is providing care to a 10-year-old child who is hospitalized in a psychiatric setting. To establish rapport with the child, which statement by the nurse would be most appropriate?&#10;A) &#34;Let's compare your situation to that of Cinderella's in the fairy tale.&#34;&#10;B) &#34;I'm going to use the DECA tool to measure your self-control and initiative.&#34;&#10;C) &#34;Let's have you draw a picture of yourself.&#34;&#10;D) &#34;Would you like to play a game of checkers with me?&#34;

Accepted Answer

Nurses can establish rapport with school-age children by using competitive board games such as checkers. Comparing the child with Cinderella may be interpreted by a 10-year-old child as demeaning and below his or her level. This technique would be more appropriate for a preschooler. Self-drawings are effective for preschoolers. The DECA tool measures self-control and initiative in children 2 to 5 years of age.

Question 4

The nurse is caring for an adolescent in the outpatient psychiatric setting. To help the adolescent feel more in control of the initial therapy sessions, which statement by the nurse would be most appropriate?

A) "I won't share anything with your parents that you don't want me to share."
B) "Adolescents often feel a distrust of authority figures. Is that true with you?"
C) "Your parents care a great deal about you. That's why you are here."
D) "If something is uncomfortable for you, you don't have to talk about it."

Accepted Answer

To help an adolescent feel more in control, an appropriate statement by the nurse is, "If something is uncomfortable for you, you don't have to talk about it." Adolescents are likely to be defensive in front of their parents and concerned with confidentiality. At the start of the interview, the nurse should clearly convey to the adolescent what information will and will not be shared with the adolescent's parents. Adolescents generally prefer a straightforward, candid approach to the interview because they often distrust those in authority. However, it is not necessary for the nurse to question the adolescent about his view. Telling the adolescent that his parents care a great deal does nothing to support the adolescent's need for control.

Question 5

A child and the child's family visit a psychiatric outpatient setting because the parent is concerned about the child's behavior at school. The child scores 65 on the Global Assessment of Functioning (GAF) scale. The nurse interprets this finding as which of the following?

A) The child requires inpatient therapy.
B) The child is experiencing homicidal thoughts.
C) The child is functioning well in the area of school.
D) The child can be treated effectively as an outpatient.

Accepted Answer

The GAF scale ranges from 0 to 100; the lower the score, the higher the level of impairment, indicated by psychiatric symptoms and level of general functioning. A score on the GAF from 51 to 69 indicates that the child has moderate symptoms in one area, such as school phobia. Children in this category can be treated on an outpatient basis. A score of 30 may indicate that the child is severely homicidal or suicidal and has made previous attempts, that hallucinations or delusions influence the child's behavior, or that the child has serious impairment in communication or judgment. A score of 70 to 100 usually indicates that the child is functioning well in relation to his or her school, peers, family, and community.

Question 6

The nurse is assessing the self-concept of an 8-year-old child. Which question would be least appropriate for the nurse to ask?&#10;A) &#34;If you had three wishes, what would you wish for?&#34;&#10;B) &#34;What would you like to be when you grow up?&#34;&#10;C) &#34;What subjects do you like best in school?&#34;&#10;D) &#34;What did you have for breakfast this morning?&#34;

Accepted Answer

The question about breakfast evaluates the child's recent memory. The questions about what do you would wish for, what would you like to be when you grow up, and what subjects you like best in school reflect self-concept.

Question 7

A nurse in an outpatient clinic is assessing a child, and will interview the child and the child's parents separately. Which of the following comments would the nurse anticipate the child making during the upcoming interview?

A) "I can't get along with my parents."
B) "I yell at my parents a lot."
C) "I'm sad a lot, and I have trouble sleeping."
D) "I refuse to do what my parents tell me to."

Accepted Answer

Generally, children provide better information about internalizing symptoms (e.g., mood, sleep, suicide ideation), and parents provide better information about externalizing symptoms (e.g., behavior disturbances, oppositionality, relationship with parents).

Question 8

A nurse is performing an assessment interview of a 14-year-old client who is being admitted to an adolescent substance abuse unit. The parents are concerned about repeated problems at school that they associate with drug use. The client stalks into the office, abruptly sits down, and says, "Okay, ask your stupid questions, but don't expect me to cooperate!" Which response by the nurse would be most appropriate?

A) "Your attitude is offensive; I can see why your parents brought you here."
B) "Why don't we wait until you've calmed down a bit to start the interview?"
C) "Why are you so angry?"
D) "You seem pretty upset. Tell me about what is upsetting you."

Accepted Answer

The nurse's ability to communicate respect, cooperation, honesty, and genuineness is important. Rejection by the adolescent, even outright hostility, during the first few interactions is common, especially if the teen is having behavior problems at home, at school, or in the community. The nurse should be patient and avoid jumping to conclusions. Hostility or defiance may be a test of how much the teen can trust the nurse, a defense against anxiety, or a transference phenomenon. Thus, the nurse needs to address the adolescent's behavior and statement in a nonjudgmental, accepting manner. Telling the adolescent your attitude is offensive or waiting until the client calms down is nontherapeutic. Asking the adolescent "Why are you so angry" also is inappropriate. The underlying feelings need to be addressed in a therapeutic manner.

Question 9

The nurse is beginning an assessment interview with an 8-year-old child who has been brought in for counseling by parents. When beginning the interview, which question would be most appropriate for the nurse to ask first?

A) "How are you feeling?"
B) "How old are you?"
C) "Has anyone told you about why you are here today?"
D) "Why do you think I'm talking to you alone without your parents here?

Accepted Answer

When assessing a school-aged child, the nurse should begin the interview with a broad opening question that addresses the child's understanding of why he or she is there. This question often helps to identify children's misperceptions that could create barriers to working with him or her. Asking about how the child is feeling or the child's age would occur later in the interview. Asking the child why he or she is being interviewed alone opens the door for misinterpretation and promotes feelings of isolation that could lead to increased anxiety.

Question 10

A nurse is interviewing a 12-year-old client who has been diagnosed with depression. The client's depression was triggered by the father's death 2 years ago. The nurse interprets which comment made by the client as reflecting egocentrism?

A) "If I hadn't yelled at my dad and told him to go away, he never would have died."
B) "I'm still sad because my dad died a couple of years ago."
C) "I think I'm just experiencing normal grieving."
D) "My father was the best friend I ever had; I still can't believe he's gone for good."

Accepted Answer

Egocentrism is a preoccupation with one's own appearance, behavior, thoughts, and feelings. For example, the preteen believes that yelling at the father caused the father's death. The statements about being sad and not believing the father is gone are not examples of egocentrism. It would be unlikely for a preteen to use the term "normal grieving."

Question 11

A nurse is preparing to assess a 9-year-old child who has been sexually abused. Which action would be the priority for the nurse?&#10;A) Find out when the abuse occurred.&#10;B) Document the assessment for use in court.&#10;C) Use anatomically correct dolls to elicit information.&#10;D) Ensure that the environment is safe and supportive.

Accepted Answer

The answer of A nurse is preparing to assess a...

Question 12

A group of nursing students is reviewing information about stress and coping in children. The students demonstrate a need for additional study when they identify which experience as a stressful for a child?

A) Loss
B) Chronic illness
C) Racial discrimination
D) Social support

Accepted Answer

The answer of A group of nursing students is reviewing...

Question 13

A nurse is preparing to interview a 4-year-old child. Which technique would be most effective for the nurse to use for the assessment?&#10;A) Direct, simple questions&#10;B) Play materials such as blocks&#10;C) Pediatric anxiety rating scale&#10;D) Children's Depression Inventory

Accepted Answer

The answer of A nurse is preparing to interview a...

Question 14

A nurse identifies that a child's temperament is happy when the parents are present but more withdrawn when they are not. Which is a likely explanation of this phenomenon about temperament?&#10;A) Temperament is influenced by parental control.&#10;B) Temperament does not have the ability to change during one's life.&#10;C) Temperament is determined by social influence of peers.&#10;D) Temperament is controlled by the child's emotions.

Accepted Answer

The answer of A nurse identifies that a child's temperament...

Question 15

A nurse asks a child, &#34;What do you want to do when you grow up?&#34; With this question, what is the nurse assessing?&#10;A) Self-concept&#10;B) Caregiver influence&#10;C) Ambitions&#10;D) Thought process

Accepted Answer

The answer of A nurse asks a child, &#34;What do...

Question 16

A nurse is preparing an in-service presentation for a group of staff psychiatric nurses who will be providing care to children and adolescents in a new outpatient psychiatric clinic. When describing important issues related to interviewing children, which instruction would the nurse emphasize? Select all that apply.

A) Use simple terms such as sad or nervous instead of depressed or anxious.
B) Individualize the questions based on judgment and discretion.
C) Use questions that lead the child to the response desired.
D) Speak in longer sentences that include a description of what is being asked.
E) Let the child's statements and behaviors guide the interview.

Accepted Answer

The answer of A nurse is preparing an in-service presentation...

Question 17

A group of nurses is reviewing information about temperament and its effect on the child's behavior. The nurses demonstrate understanding of the concept when they identify which characteristic of temperament. Select all that apply.

A) Emotional bonding
B) Sequential growth processes
C) Activity level
D) Adaptability
E) Insecurity

Accepted Answer

The answer of A group of nurses is reviewing information...

Question 18

A nurse is preparing to complete a mental status examination of an adolescent who is experiencing behavioral problems at school. When assessing the adolescent's thought processes, which characteristic would the nurse need to keep in mind about this age group? Select all that apply.

A) Their view of things in a concrete manner
B) Ability to look at things hypothetically
C) Beginning ability to use logic
D) Ability to use abstract thinking
E) Difficulty in putting feelings into words

Accepted Answer

The answer of A nurse is preparing to complete a...

Question 19

After completing the mental status assessment of a 9-year-old boy, which finding would the nurse document as reflecting the child's motor activity? Select all that apply.&#10;A) Favorite story, Huckleberry Finn&#10;B) Short attention span&#10;C) Hyper-alertness&#10;D) &#34;Went to the park last weekend&#34;&#10;E) Nail biting&#10;F) History of temper tantrums

Accepted Answer

The answer of After completing the mental status assessment of...

Question 20

An assessment of a child is different from an assessment of adults. Which components are included in the assessment of children and adolescents? Select all that apply.&#10;A) Language&#10;B) Medical history&#10;C) School grades&#10;D) Emotional skills&#10;E) Social abilities

Accepted Answer

The answer of An assessment of a child is different...

Deck 36: Mental Health Assessment of Children and Adolescents