Question 1

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?

Accepted Answer

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.

Question 2

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?

Accepted Answer

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.

Question 3

An advanced practice nurse is working with a child diagnosed with oppositional defiant disorder.What action by the nurse is most appropriate?

Accepted Answer

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.

Question 4

A nurse wishes to increase an at-risk child's resilience.What action by the nurse would be most helpful?

Accepted Answer

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.

Question 5

When working with immigrant and refugee families,what strategy by the nurse is likely to have the most positive impact?

Accepted Answer

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.

Question 6

A nurse is assessing children for reactive attachment disorder (RAD).Which child would the nurse identify as being at highest risk for this disorder?

Accepted Answer

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.

Question 7

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?

Accepted Answer

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.

Question 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?

Accepted Answer

Anhedonia is loss of interest in activities once enjoyed.

Question 9

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?

Accepted Answer

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.

Question 10

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?

Accepted Answer

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.

Question 11

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?

Accepted Answer

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.

Question 12

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?

Accepted Answer

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

Question 13

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?

Accepted Answer

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.

Question 14

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?

Accepted Answer

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.

Question 15

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?

Accepted Answer

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.

Question 16

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?

Accepted Answer

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.

Question 17

Parents of a teen diagnosed with schizophrenia report being exhausted and overly stressed.Which action by the nurse is most appropriate?

Accepted Answer

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.

Question 18

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?

Accepted Answer

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.

Question 19

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?

Accepted Answer

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.

Question 20

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?

Accepted Answer

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 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.

Quiz 22: Caring for the Child With a Psychosocial or Condition

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?

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?

An advanced practice nurse is working with a child diagnosed with oppositional defiant disorder.What action by the nurse is most appropriate?

A nurse wishes to increase an at-risk child's resilience.What action by the nurse would be most helpful?

When working with immigrant and refugee families,what strategy by the nurse is likely to have the most positive impact?

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 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 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 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 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 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?