Chapter 32: The Child With an Emotional or Behavioral Condition My Nursing Test Banks

Chapter 32: The Child With an Emotional or Behavioral Condition

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier Inc.

MULTIPLE CHOICE

1. When a parent asks the nurse to describe what is meant by a learning disability, the nurses most helpful response would be:

a.

A child may have difficulty with perception, language, comprehension, or memory.

b.

It is characterized by inattention, impulsiveness, and hyperactivity.

c.

The childs intellectual ability limits his learning.

d.

The child has difficulty learning because of brain damage.

ANS: A

Learning disability is an educational term. Children with learning disabilities may have average to above-average intelligence, but they may experience difficulties in perception, language, comprehension, and conceptualization.

DIF: Cognitive Level: Application REF: 739 OBJ: 2

TOP: Learning Disability KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

2. What would be the appropriate response to an adolescent who states, This has been the worst day of my life?

a.

You should focus your mind on positive thoughts.

b.

Everybody has a bad day now and then.

c.

Youre young. What could be so terrible?

d.

Tell me about the worst day in your life.

ANS: D

The nurse establishes a rapport with the adolescent by acknowledging his or her feelings and giving the adolescent full attention.

DIF: Cognitive Level: Application REF: 735, NCP 32-1

OBJ: 3 TOP: Suicide KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

3. The nurse asks, Do your parents drink every day? The adolescent suddenly shouts, Im not going to talk about that! Its none of your business, anyway! Leave me alone! The nurse recognizes that the outburst was stimulated by the fact that the adolescent is:

a.

Acting out and needs to be brought under control so the conference can continue

b.

Trying to shift the focus of the conference away from himself, and the nurse needs to refocus

c.

Demonstrating that this problem requires the assistance of a psychiatrist

d.

Responding to the discrediting of his parents, which causes anxiety in the child; thus reassurance is needed that blame will not be directed at anyone

ANS: D

Discrediting parents threatens the childs security and creates anxiety.

DIF: Cognitive Level: Comprehension REF: 730 OBJ: 4

TOP: Suicide KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

4. The nurse answering phone calls at a local suicide prevention hotline would recognize the statement indicating the greatest risk of suicide is:

a.

I just needed to talk to someone to keep myself from thinking silly thoughts about killing myself.

b.

My parents arent home and wont be back for 4 hours. That should be enough time for the pills to work. Ive got a hundred of them.

c.

My dad will be home first, so hell find me. So I think Ill use his gun. I hope he didnt lock the cabinet.

d.

My girlfriend is here with me. She told me to call because I was talking crazy about killing myself.

ANS: B

The risk of death increases when there is a definite plan of action, the means are readily available, and the person has few resources for help and support.

DIF: Cognitive Level: Analysis REF: 764 OBJ: 3

TOP: Suicide KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

5. The nurse assesses an early sign of depression in a 15- year-old boy who previously was active in a band, and had saved his money to buy a special guitar when he:

a.

Gives up the band to spend time with his girlfriend

b.

Spends all of his time at the library studying in order to qualify for the honor society

c.

Gives his guitar away and spends his time listening to music in his room

d.

Withdraws all of his money out of the bank to buy an expensive leather jacket

ANS: C

A major depression is characterized by a prolonged behavioral change from baseline that interferes with school, family life, and age-specific activities, frequently signaled by giving prized possessions away.

DIF: Cognitive Level: Analysis REF: 733 OBJ: 3

TOP: Depression KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

6. A mother is concerned because her teenage son is always in trouble for fighting at school and always seems to be angry. She mentions that her husband drinks a bit. The understanding guiding the nurses response is:

a.

The boy is displaying antisocial behavior and should be evaluated for mental illness.

b.

He is displaying one of the typical defense patterns of children of alcoholics and should receive immediate treatment.

c.

The mother is displaying her own anger with her husbands drinking, and she needs immediate intervention.

d.

This boy is only one member of the family affected by alcoholism, and all members should receive immediate intervention.

ANS: D

Early recognition of and intervention for children of alcoholics are paramount. This adolescent is using the coping pattern of acting-out behaviors to deal with the family situation.

DIF: Cognitive Level: Comprehension REF: 738 OBJ: 9

TOP: Substance Abuse KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

7. The school nurse suggests to the classroom teacher that the most appropriate classroom intervention for a child with attention deficit hyperactivity disorder would be:

a.

Seat the child in the back of the room to prevent distractions for other children.

b.

Pair the child with a student buddy to offer reminders to pay attention.

c.

Divide work assignments into shorter periods with breaks in between.

d.

Separate the child from others to increase his focus on schoolwork.

ANS: C

The child with attention deficit hyperactivity disorder needs breaks between periods of work and study.

DIF: Cognitive Level: Application REF: 739, Box 32-2

OBJ: 11 TOP: Attention Deficit Hyperactivity Disorder

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Coordinated Care

8. The nurse explains that the person who is bulimic:

a.

Is severely underweight

b.

Alternates binge eating with purging

c.

Is an introverted perfectionist

d.

Has extremely close family relationships

ANS: B

Bulimia is characterized by alternating binge eating and purge behavior.

DIF: Cognitive Level: Knowledge REF: 740 OBJ: 12

TOP: Bulimia KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

9. A 14-year-old girl with obsessive-compulsive disorder tells the nurse other teens tease her because she washes her hands many times during the school day. The nurse is aware that this disorder puts the adolescent at greater risk for:

a.

Anorexia nervosa

b.

Suicidal behavior

c.

Attention deficit hyperactivity disorder

d.

Learning disability

ANS: B

OCD is related to depression and other psychiatric disorders. Suicidal behavior is a high risk for adolescents with OCD.

DIF: Cognitive Level: Comprehension REF: 732 OBJ: N/A

TOP: Obsessive-Compulsive Disorder KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

10. The statement made by a parent of an adolescent with anorexia nervosa indicating an understanding of this condition is:

a.

There really isnt anything to worry about. Dont they say you can never be too thin?

b.

My daughter just doesnt have much of an appetite.

c.

She is just trying to punish me for divorcing her father.

d.

She seems to see herself as fat, even though her weight is below normal.

ANS: D

Individuals with anorexia nervosa have a disturbed body image, which this parent correctly recognizes.

DIF: Cognitive Level: Application REF: 740, Figure 32-2

OBJ: 12 TOP: Anorexia Nervosa

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

11. An appropriate nursing intervention for a hospitalized child who is autistic would be to:

a.

Place the child in a location where she can watch all of the activity on the unit.

b.

Use the childs chronological age as a guide for communication.

c.

Keep the childs room free of toys or objects that she might want to take home with her.

d.

Organize care to provide as few disruptions to the routine as possible.

ANS: D

During hospitalization, the nurse should provide a highly structured environment with few distractions for a child who is autistic.

DIF: Cognitive Level: Application REF: 732 OBJ: N/A

TOP: Autism KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

12. A nurse planning to speak with a parent support group about childhood autism would include the information:

a.

Significant signs of the disorder manifest by 1 year of age.

b.

The earliest signs of autism are impulsivity and overactivity.

c.

Autism is usually diagnosed when the child goes to elementary school.

d.

Medications can cure childhood autism.

ANS: A

Failure to use eye contact and look at others, poor attention span, and poor orienting to ones name are significant signs of dysfunction by 1 year of age.

DIF: Cognitive Level: Application REF: 732 OBJ: N/A

TOP: Autism KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

13. An adolescent is brought to the emergency department after an automobile accident. When the nurse approaches the adolescent, he becomes combative. The nurse notes his speech is slurred and his gait is ataxic. The nurse suspects the adolescent has used:

a.

Alcohol

b.

Cocaine

c.

Amphetamines

d.

PCP

ANS: A

Behavioral signs of alcohol ingestion include slurred speech, short attention span, drowsiness, combativeness, and violence.

DIF: Cognitive Level: Analysis REF: 736, Table 32-1

OBJ: 7 TOP: Substance Abuse

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

14. When the nurse is collecting a nursing history, an adolescent states that she has tried speed. The nurse recognizes this as the street name for:

a.

Barbiturates

b.

Cocaine

c.

Methamphetamine

d.

Marijuana

ANS: C

Speed is the street name for methamphetamine.

DIF: Cognitive Level: Knowledge REF: 737, Table 32-2

OBJ: 7 TOP: Substance Abuse

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

15. The nurse explains that the member of the child guidance team who is a medical doctor with special training in psychoanalytic theory is the:

a.

Psychiatrist

b.

Psychoanalyst

c.

Psychologist

d.

Counselor

ANS: A

The psychiatrist is a medical doctor; the psychoanalyst may be a medical doctor or a psychologist. The psychologist is not a medical doctor, and neither is the counselor.

DIF: Cognitive Level: Application REF: 731 OBJ: 5

TOP: Psychoanalytic Professional KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

16. Because young children cannot express themselves well, the nurse uses the therapeutic intervention that allows children to act out their feelings, which is:

a.

Art therapy

b.

Play therapy

c.

Music therapy

d.

Bibliotherapy

ANS: B

Play therapy allows a young child to act out with dolls or figures concerns that the child may be unable to adequately express verbally.

DIF: Cognitive Level: Comprehension REF: 731 OBJ: 1

TOP: Play Therapy KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

17. The nurse explains that use of stimulants will decrease hyperactivity in the autistic child, but has the negative aspect of:

a.

Sedating the child

b.

Impairing cognition

c.

Causing hypotension

d.

Creating fluid retention

ANS: B

Stimulants that decrease the hyperactivity in the autistic child also impair cognition and may increase the potential of self-injuring behavior.

DIF: Cognitive Level: Application REF: 732 OBJ: 2

TOP: Autism KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

18. A 9-year-old has been admitted to the hospital after huffing lighter fluid. The nurse should assess for:

a.

Depressed respirations

b.

Severe vomiting

c.

Frightening hallucinations

d.

Elevation of temperature

ANS: A

Inhaling hydrocarbons depresses the central nervous system, including respiratory rate and general sensorium.

DIF: Cognitive Level: Application REF: 735 OBJ: 7

TOP: Substance Abuse KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physical Integrity: Reducing Risk

19. As the pediatric nurse listens to a 9-year-old child read to his 6-year-old roommate, the nurse assesses possible dyslexia when the child:

a.

Becomes hyperactive and ceases to read

b.

Reads the word GOD as DOG

c.

Makes up a story rather than reading the text

d.

Stutters as he reads

ANS: B

Dyslexics often transpose a word as they read; for example, the word is GOD, but it appears to the dyslexic child as the word DOG.

DIF: Cognitive Level: Application REF: 739 OBJ: N/A

TOP: Dyslexia KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection

MULTIPLE RESPONSE

1. The nurse describes the members of a mental health team for child guidance as including a:

Select all that apply.

a.

Psychiatrist

b.

Pediatrician

c.

Psychologist

d.

Dietitian

e.

Social worker

ANS: A, B, C, E

The traditional members of the child guidance team are the psychiatrist, pediatrician, psychologist, and social worker. The dietitian is not usually on the treatment team.

DIF: Cognitive Level: Comprehension REF: 731 OBJ: 5

TOP: Members of the Child Guidance Team

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

2. The school nurse cautions a group of parents about the prevalence of children who get high by inhaling hydrocarbons and fluorocarbons, such as:

Select all that apply.

a.

Glue

b.

Chlorine

c.

Cleaning fluid

d.

Copy machine toner

e.

Aerosol sprays

ANS: A, C, E

Although there are many products that could be inhaled, the most frequently used products are glue, cleaning fluid, aerosol sprays, Freon, shoe polish, and gasoline products.

DIF: Cognitive Level: Application REF: 736, Table 32-1

OBJ: 7 TOP: Inhaling Hydrocarbons

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

3. The nurse takes into consideration in planning the care of an adolescent with anorexia nervosa that the cause of this disorder is:

Select all that apply.

a.

Discomfort relative to emerging sexuality

b.

Fear of intimacy

c.

Pervasive low self-esteem

d.

Egocentricity

e.

Inability to meet developmental needs

ANS: A, B, C, D, E

All options listed are considered to be the cause of anorexia nervosa.

DIF: Cognitive Level: Application REF: 740 OBJ: 12

TOP: Anorexia Nervosa KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

COMPLETION

1. The nurse documents that every time the child is directed to discuss the relationship with her brother, she complains of shortness of breath and begins to have asthma-like symptoms. The nurse assesses this behavior as a ____________________ reaction.

ANS: psychosomatic

DIF: Cognitive Level: Analysis REF: 731 OBJ: 1

TOP: Psychosomatic Reaction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

NOT: Rationale: A psychosomatic reaction is one in which a dysfunction of the body has an emotional or mental cause.

2. The nurse assists with the intervention of ____________________ therapy, which provides a physical and social environment that is stable and therapeutic.

ANS: milieu

DIF: Cognitive Level: Comprehension REF: 731 OBJ: 1

TOP: Milieu Therapy KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care

NOT: Rationale: Milieu therapy is a modality of treatment offered to troubled children in which they are placed in an environment that is stable and therapeutic so that their problems might be better expressed or identified.

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