Chapter 35: Child Psychiatric Nursing My Nursing Test Banks

Chapter 35: Child Psychiatric Nursing

Test Bank

MULTIPLE CHOICE

1. When assisting a 5-year-old child to develop the ability to delay gratification, it is most valuable for the nurse to:

a.

teach parents to assign a point system for expected daily activities.

b.

develop the nurse-patient relationship during unstructured playtime.

c.

encourage the child to express feelings when feeling frustrated.

d.

model the ability to delay gratification.

ANS: A

Nursing interventions that help children learn to delay gratification include a point system to reinforce the behaviors, the use of games with commands such as stop and wait, and other activities and strategies that teach self-control.

DIF: Cognitive Level: Application REF: Text Page: 674

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

2. Which assessment finding most clearly indicates an adolescent has a conduct disorder?

a.

Misses at least one day of school a month

b.

Admits to pulling the dogs ears and tail for fun

c.

Told the teacher that he is usually sad and confused

d.

Consistently awakens during the night and has difficulty falling asleep again

ANS: B

While children with anxiety, depression, and conduct disorders all share school problems, depression, and altered sleeping patterns, demonstrating aggression toward people or animals is unique to conduct disorders.

DIF: Cognitive Level: Application REF: Text Page: 670

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

3. What outcome would be most appropriate for the plan of care for a 7-year-old child with a diagnosis of conduct disorder?

a.

Parents will demonstrate effective parenting skills, thus minimizing conflicts with their child.

b.

The child will be capable of successfully accomplishing the academic work appropriate of a first grader.

c.

Parents will institute verbal reprimands as a primary form of consequence for their childs misbehavior.

d.

The child will verbalize the pathology of his condition within 6 weeks of beginning behavioral modification therapy.

ANS: A

An outcome is something that is measurable and specific to the individual. Since the only information available is the diagnosis, the most specific outcome is the one that is directly related to family factors, such as parental conflict and poor parenting. Although academic performance, verbal reprimands, and verbalization of the pathology all are affected by conduct disorders, the behaviors associated with the disorder are most effectively managed by focused parenting techniques that minimize them and the resulting conflicts.

DIF: Cognitive Level: Application REF: Text Page: 679

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Psychosocial Integrity

4. A parent complains that his child wont tie her shoes even though shes capable of doing it. Which response by a nurse is most therapeutic?

a.

Why is it so important to you that she tie her shoes?

b.

What have you done to try to encourage her to tie her shoes?

c.

Let your daughter go with her shoes untied. Dont you think she will soon tire of tripping over her shoelaces?

d.

It sounds as if your daughter is seeking attention. How much quality time do you typically spend with her each day?

ANS: B

The nurse needs to perform a complete assessment to determine the etiology of the childs problem and the parenting skills of the parent. Determining that the parent has tried to encourage the child to tie her shoes is the initial step in the nursing process.

DIF: Cognitive Level: Analysis REF: Text Page: 672

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

5. Which response by a nurse is most therapeutic in response to parents who are concerned that their child has been drawing sexually explicit pictures?

a.

Are you sure your child fully understood what it was that was being drawn?

b.

What did your child say when asked about why the drawings were made?

c.

Most children experiment with this type of behavior at a certain age.

d.

I will need your permission to speak directly with your child.

ANS: B

The information in the question demonstrates that the childs parents are concerned about the behavior thus indicating their feelings about the drawings. At that point the first thing the nurse would want to know is the childs motivation and response to the incident.

DIF: Cognitive Level: Analysis REF: Text Page: 673

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

6. A child confides to a nurse, My uncle tried to play with meyou know, fondle mewhen he picked me up after school. My parents will be upset if they find out. Theyll blame me because I like it when he tickles me. Which communication by the nurse would be the most therapeutic?

a.

You feel your parents will blame you rather than your uncle?

b.

Id like for you to tell me more specifically what your uncle did to you.

c.

Dont be afraid; Ill be there to talk to your parents about what your uncle did.

d.

Im sure your parents will believe you; they know you wouldnt lie about this.

ANS: B

The most therapeutic nursing intervention is the one that asks the child to discuss the incident more specifically.

DIF: Cognitive Level: Application REF: Text Pages: 671-672

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

7. Nursing care for a child with attention-deficit/hyperactivity disorder (ADHD) usually includes which therapeutic component?

a.

Foster care

b.

Institutionalization

c.

Stimulant drug therapy

d.

Cognitive processing games

ANS: C

Management for children with ADHD includes contingency management, stimulant drug therapy, family therapy for conflict, assigning tasks in small steps to channel energy, behavior therapy, parenting-skills training, home help, environmental modification to reduce distractions, and educational programs for learning disabilities.

DIF: Cognitive Level: Comprehension REF: Text Page: 670 | Text Page: 678

TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. Which statement best indicates that a child diagnosed with attention-deficit disorder (ADD) has difficulty tolerating frustration?

a.

The childs sibling says, He just cant seem to finish anything he starts.

b.

The child says, I guess I understand why it wasnt nice to do what I did.

c.

The childs parent says, He never stands up for himself. Even when he knows hes right, hell give in to someone else.

d.

The childs parent says, He never believes me when I tell him he looks fine for a kid his age. He thinks hes fat and ugly.

ANS: B

Being able to tolerate frustration includes being able to persevere despite challenges and resistance. The remaining options demonstrate aggressive behavior and poor self-esteem.

DIF: Cognitive Level: Application REF: Text Page: 671

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

9. Which observation gives the best indication that an adolescent is able to effectively balance relaxation and work?

a.

After being reminded to clean his bedroom the child goes back to playing computer games.

b.

When found sitting quietly in the living room the child indicates to parents that the behavior is a way to relax.

c.

The child enjoys several group sports and delivers newspapers before school for 25 families in the neighborhood.

d.

The child seems to enjoy participating in activities such as cleaning and learning complicated software on the family computer.

ANS: C

Being able to use ones leisure time and to relax is a skill that must be balanced and learned. Balancing work and play are the challenges that reverberate throughout life for all of us. Too much leisure or daydreaming or excessive use of work as leisure cannot be as adaptive as consistent, balanced activities developed throughout life. The correct option demonstrates both relaxation and work in a healthy manner.

DIF: Cognitive Level: Application REF: Text Page: 670 | Text Page: 678

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

10. A group of 10-year-old children are playing a board game. Which of these patient outcomes would the nurse evaluate as evidence of a favorable response to the frustration of losing?

a.

The child congratulates the winner.

b.

The child walks away to read a book.

c.

The child invites another child to join.

d.

The child wants an immediate rematch.

ANS: A

Being able to lose a game with good sportsmanship is a good indication of social adaptation. Poor concentration and limited attention span can cause the child to interrupt the game or add others to increase distraction. Poor ability to delay gratification would engender demanding behavior and the intolerance of loss.

DIF: Cognitive Level: Application REF: Text Page: 674

TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

11. When assisting a child to learn to express personal feelings verbally without hurting a playmates feeling, the nurse encourages the child to first:

a.

play with imaginary friends.

b.

play the role of the other child.

c.

avoid competitive games like baseball.

d.

use nonverbal mannerisms like frowning.

ANS: B

Role playing is an excellent way to teach a child how to verbalize negative and positive feelings without being aggressive or passive. Assertiveness training uses role playing and role reversal to help patients learn how to be appropriately assertive.

DIF: Cognitive Level: Application REF: Text Pages: 681-682

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

12. Which medication would the nurse expect to include in a care plan for an adolescent with a history of conduct disorder and violent behaviors?

a.

Antianxiety agents

b.

Antipsychotic medications

c.

Antihistamine medications

d.

Antidepressant medications

ANS: B

Antipsychotics are most often used for rage and violent self-directed or other-directed behaviors in adolescents. Antianxiety agents probably would be avoided for this group of patients. Antidepressants and antihistamines are not specific for violent and raging behaviors.

DIF: Cognitive Level: Comprehension REF: Text Page: 679

TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. When attempting to modify unacceptable behaviors exhibited by an aggressive and self-destructive child, which nursing intervention would be most therapeutic while being the least restrictive?

a.

Informing the child that physical restraints will be used to remodel behavior

b.

Requiring the child to interact only with staff when unable to behave

c.

Encouraging the child to engage in only low-stimulation activities

d.

Secluding the patient with a time-out for inappropriate behavior

ANS: D

Less restrictive interventions for aggressive, hostile, and destructive children include time-outs, open-door seclusion, therapeutic holding, and room programs to reduce inappropriate behavior.

DIF: Cognitive Level: Analysis REF: Text Page: 682

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

14. Which nursing intervention would be most effective when assisting a child with attention-deficit/hyperactivity disorder (ADHD) to learn to use good hygiene measures each morning?

a.

Have the child watch parents groom and dress each morning.

b.

Stay with the child while talking them through each activity every morning.

c.

Add a new activity to the morning care routine each time the child masters a task.

d.

Dress the child slowly and encourage him or her to practice redressing again alone.

ANS: C

The child with ADHD will learn best when skills are taught in small steps and when new skills are added only after the child demonstrates mastery and comfort in performing the previous tasks. In addition, it is important to reduce the stimuli in the learning milieu, such as television or radio, to allow the child to concentrate.

DIF: Cognitive Level: Application REF: Text Page: 673

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

15. A child has a history of anxiety disorder. Which statement by the child supports this diagnosis?

a.

I dont need to go to school like some other kids.

b.

School is really boring so I dont like to go there.

c.

My stomach aches in the morning so I cant go to school.

d.

My parents cant make me go to school if I dont want to.

ANS: C

Anxiety disorder in children can be manifested in avoidance of school using the pretense of a stomachache or headache. Other behaviors include pervasive worry and irritability, restlessness and pervasive fearfulness, and restless sleep and nightmares. The other options demonstrate oppositional defiance and avoidance in general.

DIF: Cognitive Level: Application REF: Text Page: 677

TOP: Nursing Process: Diagnosis|Nursing Process: Analysis

MSC: NCLEX: Psychosocial Integrity

16. When a 14-year-old child reports feeling like I just want to blow that persons head off, the school nurses initial reaction is to:

a.

report the statement to parents, police, and school authorities.

b.

say to the child, Tell me what you mean when you say that.

c.

restate, Youre feeling really angry with this person right now, arent you?

d.

confer with other staff by asking, What do you think the child meant by that?

ANS: B

The first step is to perform a complete lethality assessment. The nurse begins by clarifying, asking the child to elaborate on his or her statement. The nurse may need to report the homicidal ideation but not until the lethality level is determined.

DIF: Cognitive Level: Application REF: Text Page: 680

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

17. The parents of a 7-year-old child recently adopted from another country report that their child has frequent headaches, a poor appetite, and isnt doing well in school. The nurse should initially:

a.

draw a family genogram.

b.

talk with the child about the symptoms.

c.

hold an intervention that includes all involved parties.

d.

perform a culturally congruent comprehensive assessment.

ANS: D

The clinical manifestations identified by the parents certainly indicate depression, but the nurse cannot assess these without performing a thorough examination and mental status assessment of the family members. Culture considerations must not be ignored in this situation.

DIF: Cognitive Level: Application REF: Text Page: 672

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

18. When planning care for a school-age child who has been diagnosed with an anxiety disorder, which measure would the nurse include initially in the treatment plan?

a.

Securing the support of the childs teacher

b.

Identifying any mental illness in the family history

c.

Providing the child with individual relaxation training

d.

Exploring the possible admission of the child to a residential facility

ANS: A

Since the stressors affecting the child may be exacerbated by the school environment (e.g., separation and performance anxiety), the support of the childs teacher is vital to identifying and managing the childs anxiety disorder. Parental anxiety disorders, depression, or both have been identified as family factors in childrens anxiety disorders, but this would be in the history, not in the plan. Residential treatment would not be the first option in a plan, and individual relaxation may or may not be part of treatment.

DIF: Cognitive Level: Application REF: Text Pages: 671-672

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

19. Which question would be most appropriate to ask when attempting to determine a 6-year-old childs ability to establish trusting relationships after being diagnosed with an anxiety disorder?

a.

Do you like making new friends?

b.

Is it important to be liked by people?

c.

What would you do if your favorite toy got broken?

d.

How do you feel when you cant have something you want?

ANS: A

Children with the medical diagnosis of generalized anxiety disorder may have difficulty establishing trusting relationships because they are very concerned about their perceived competency. The following questions are used to evaluate this skill: Does the child enjoy making friends? Does the child often feel picked on by other people? Does the child not know what to say when getting to know someone?

DIF: Cognitive Level: Application REF: Text Page: 673

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20. When planning immediate care for a child based on a biopsychosocial assessment, the nurse initially addresses any dysfunction in the:

a.

biological development of the child.

b.

effect of medical illness on the child.

c.

social support systems available to the child.

d.

childs mastery of specific ego competency skills.

ANS: D

When assessing a child via a biopsychosocial approach, attention should focus on the childs biological development; the presence of medical illness; cognitive and personality characteristics; cultural context; and the childs family, school, and social environment. When planning immediate care, however, the nurse would assess ego competency skills first to determine the childs strengths and the extent of mastery of each skill.

DIF: Cognitive Level: Application REF: Text Page: 673

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

21. Which child should be assessed for attention-deficit/hyperactivity disorder (ADHD)?

a.

A second-grade child reads at a first-grade level. The child cries when left by a parent but loves to run races in the schoolyard at recess.

b.

A fourth-grade child loves to daydream during class and regularly entertains the class with original stories. The child does not enjoy reading.

c.

A third-grade child is on detention for the third time this month and is considered the class clown. The child often volunteers to read aloud.

d.

A second-grade child is withdrawn and plays alone most school days. The child can read a third-grade storybook.

ANS: A

A psychiatric illness in children that illustrates the interplay of genetics and environment is ADHD. Children with ADHD usually exhibit excessive activity and have difficulty paying attention. These behaviors are often tolerated by the family. However, when these children begin school, they are identified as problematical because these behaviors interfere with the childs academic performance and peer relationships.

DIF: Cognitive Level: Application REF: Text Page: 670

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

22. Which characteristic best indicates that a child has many resiliency factors?

a.

The ability to throw a ball farther than most other children on the team

b.

A healthy relationship with a Big Brothers volunteer despite having an abusive parent

c.

The ability to win writing awards in school despite a diagnosis of attention-deficit/hyperactivity disorder (ADHD)

d.

A history of physical abuse by a parent and recent placement in a supportive foster home

ANS: B

A childs individual characteristics and early life experiences, as well as protective factors in the social and physical environment, contribute to resilience, the ability to withstand stress. What makes some children more resilient than others? Specific protective or resiliency factors of children have been identified. A sense of autonomy is one resiliency factor. Another factor is adaptive distancing, which occurs when a child is able to distance himself or herself from excessively close involvement with a dysfunctional family, transcend a difficult past, avoid identifying with troubled family members, and select healthy alternatives as they become available.

DIF: Cognitive Level: Analysis REF: Text Pages: 670-671

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

23. Which statement by a child best indicates the child may be experiencing symptoms of depression?

a.

I dont like to play outside. Besides, Ive got so much homework and my parents expect me to be a good student.

b.

I have some friends at school but theres no one my age who lives in my neighborhood. I watch television and play with my video games.

c.

Ive got some friends, but they are older than me. Sometimes we play together but not all the time since they want to do things Im not old enough to do.

d.

I dont know; I dont think about school much. Its just a place I have to go every day. I guess its alright. Some of the kids are nice, and I like the food.

ANS: D

Children with internalizing disorders such as depression are often the best informants about their affective states. Statements relating to the stressors such as so much homework are indicators of internalized stress that may be manifested as depression. The other options lack the cues that the client is experiencing stress.

DIF: Cognitive Level: Analysis REF: Text Pages: 671-672

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

24. A nurse is meeting with an adolescent who appears to be better able to cope with anxiety because of compliance with the treatment plan. Which statement by the adolescent confirms that belief?

a.

I went to the school dance last week. I didnt dance, but I didnt leave either. I stayed until the end. Next time Im going to try to talk with some of the kids.

b.

I went to the ball game last week with my friend. We met a couple of other people from school that were there. It was fun, and I really enjoyed myself.

c.

I wish the other kids in my school would include me in their game of basketball. I would play if I could.

d.

Im going to call one of the kids in my class next week so we can play ball or something.

ANS: B

The child is obviously showing improvement in social skills and is beginning to trust peers. This enjoyment is an indication of lessening anxiety.

DIF: Cognitive Level: Application REF: Text Page: 688

TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

25. A nurse is working with primary school-age children diagnosed with psychiatric disorders. To most therapeutically address low self-esteem issues the nurse should:

a.

give positive feedback for small goal accomplishment.

b.

reward all acceptable behavior with positive feedback.

c.

set major goals so that they can strive for accomplishments.

d.

encourage active participation in a peer self-esteem self-help group.

ANS: A

Accomplishment of a goal, no matter how small, is very rewarding, and incremental goal-setting can be an effective way to provide opportunities for success. Giving frequent positive statements without foundation will not effectively build self-esteem in the child, and making major goals for the child will probably be overwhelming. Children with low self-esteem will not be motivated to participate in a peer self-help group because they usually withdraw and are not motivated to work on goals without guidance and help.

DIF: Cognitive Level: Application REF: Text Pages: 685-686

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

Leave a Reply