Chapter 53: Psychosocial Problems in Children and Families My Nursing Test Banks

Chapter 53: Psychosocial Problems in Children and Families

Test Bank

MULTIPLE CHOICE

1. Which sign or symptom is likely to be manifested by an adolescent with a depressive disorder?

a.

Abuse of alcohol

b.

Impulsivity and distractibility

c.

Carelessness and inattention to details

d.

Refusal to leave the house

ANS: A

Feedback

A

Depression often manifests in conjunction with substance abuse, so children who abuse substances should be evaluated for depression as well.

B

Impulsivity and distractibility are manifestations of attention-deficit/hyperactivity disorder (ADHD).

C

A diminished ability to think or concentrate, carelessness, and inattention to details is a clinical manifestation of ADHD.

D

A refusal to leave the house, even to play with friends, is characteristic of separation anxiety disorder.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1453

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

2. Which statement about suicide is correct?

a.

Children younger than 10 years of age do not attempt suicide.

b.

Suicide risk decreases with age.

c.

Suicide is usually an isolated event in a school community.

d.

The prevalence of suicide attempts is higher among males.

ANS: A

Feedback

A

Suicide by children under the age of 10 is uncommon.

B

The risk of suicide increases with age.

C

It is common for suicide to occur in a cluster within a community (e.g., schools).

D

Males have a 4% rate of suicide attempts compared to 8% in females; however, males are more likely to die after a suicide attempt.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1457

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

3. The best response for the nurse to make to an adolescent who states, I am very sad. I wish I was not alive. is

a.

Everyone feels sad once in a while.

b.

You are just trying to escape your problems.

c.

Have you told your parents how you feel?

d.

Have you thought about hurting yourself?

ANS: D

Feedback

A

This is a judgmental response that ignores the adolescents obvious statement indicating a need for professional help.

B

This is a judgmental response that could increase the adolescents sense of isolation and rejection.

C

The parents should be made aware of an adolescents precarious mental state; however, this response does not address the adolescents statement.

D

This response acknowledges the adolescents suicide gesture and further assesses the adolescents condition.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1458 | Box 53-1

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

4. The long-term treatment plan for an adolescent with an eating disorder focuses on

a.

Managing the effects of malnutrition

b.

Establishing sufficient caloric intake

c.

Improving family dynamics

d.

Restructuring perception of body image

ANS: D

Feedback

A

The treatment of eating disorders is initially focused on reestablishing physiologic homeostasis.

B

Once body systems are stabilized, the next goal of treatment for eating disorders is maintaining adequate caloric intake.

C

Although family therapy is indicated when dysfunctional family relationships exist, the primary focus of therapy for eating disorders is to help the adolescent cope with complex issues.

D

The focus of treatment in individual therapy for an eating disorder involves restructuring cognitive perceptions about the individuals body image.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1465

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

5. A parent of a child with an anxiety disorder states, I dont know how my child developed this problem. On what information should the nurse base a response?

a.

Genetic factors, hormonal imbalances, and societal influences all contribute to the development of anxiety disorders in children.

b.

Like many conditions affecting children, the etiology of anxiety disorders is unknown.

c.

The majority of anxiety disorders have a clear pattern of genetic inheritance.

d.

Dysfunctional family patterns are usually identified as the cause of an anxiety disorder.

ANS: A

Feedback

A

Anxiety disorders are responses to stress and may be manifested as disturbances in feeling, body functions, behavior, or performance. Children with a history of verbal, physical, or sexual abuse; frequent separation from or loss of loved ones; drug use, incarceration, or lower socioeconomic status; homosexuality; chronic illness; behavioral disorders; and dysfunctional families are more likely than peers with healthy family patterns to have anxiety disorders.

B

The etiology of many anxiety disorders in children can be identified.

C

Some anxiety disorders are inheritable disorders. Others have been identified as having other origins.

D

Research consistently shows that psychosocial disorders are caused by a combination of predisposing or inherent factors and environmental or interactional factors.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1451

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

6. In counseling an adolescent who is abusing alcohol, the nurse explains that alcohol abuse primarily affects which organ of the body?

a.

Heart

b.

Liver

c.

Brain

d.

Lungs

ANS: C

Feedback

A

Although an excessive amount of a chemical can cause cardiac abnormalities, the brain is the most commonly affected organ.

B

Long-term alcohol use is known to impair the liver; however, brain function is decreased by any amount of alcohol intake.

C

The primary effect of substance abuse is on the brain and residually on the rest of the body. Alcohol affects the entire brain by decreasing its responsiveness.

D

The pulmonary system is not the primary target; however, one commonly abused drug known to cause pulmonary problems is tobacco.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1466

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

7. The outpatient nurse understands that the phase of substance abuse characterized by a 14-year-old child admitting to using marijuana every day with friends after attending school is

a.

Experimentation

b.

Early drug use

c.

True drug addiction

d.

Severe drug addiction

ANS: C

Feedback

A

With experimentation, the individual tries the drug to see what it is like or to satisfy peers.

B

Early drug use is identified as using drugs with some degree of regularity for their desirable effects.

C

True drug addiction is identified as regular use of drugs. Physical dependence may be present. Social functioning has a drug focus.

D

In severe drug addiction, the physical condition of the individual deteriorates and all activities are related to drug use.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1466 | Box 53-2

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

8. The school nurse observes an unkempt child dressed in inappropriate clothing who repeatedly asks for food. About which problem is the nurse concerned?

a.

Physical abuse

b.

Physical neglect

c.

Emotional abuse

d.

Sexual abuse

ANS: B

Feedback

A

There are no physical indicators of actual abuse in this description. Behavioral indicators of physical abuse reflect an impaired relationship with parents and other adults.

B

These physical and behavioral indicators suggest that parental attention is not being given to the childs physical needs. The child is being neglected.

C

Emotional abuse is manifested by developmental problems or maladaptive behaviors.

D

Physical indicators of sexual abuse are focused on the genitourinary system. A variety of behavioral indicators range from bizarre sexual behavior to eating and sleeping disturbances.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1468

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

9. A child who has symptoms of irritable mood, changes in sleep and appetite patterns, decreased self-esteem, and disengagement from family and friends lasting 3 weeks meets the criteria for which depressive disorder?

a.

Major depressive disorder

b.

Dysthymic disorder

c.

Cyclothymic disorder

d.

Panic disorder

ANS: A

Feedback

A

A 2-week (or longer) episode of depressed or irritable mood in addition to disturbances in appetite, sleep, energy, or self-esteem meets the criteria for a major depressive disorder.

B

A dysthymic disorder is associated with a depressed or irritable mood for at least a year.

C

A cyclothymic or bipolar mood disorder is characterized by chronic, fluctuating mood disturbances between depressive lows and highs for a year.

D

A panic disorder is a type of anxiety disorder.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1453

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

10. What is the goal of therapeutic management for a child diagnosed with ADHD?

a.

Administer stimulant medications.

b.

Assess the child for other psychosocial disorders.

c.

Correct nutritional imbalances.

d.

Reduce the frequency and intensity of unsocialized behaviors.

ANS: D

Feedback

A

Although medications are effective in managing behaviors associated with ADHD, all families do not choose to give their child medication. Administering medication is not the primary goal.

B

Children with ADHD may have other psychosocial or learning problems; however, diagnosing these is not the primary goal.

C

Interventions to correct nutritional imbalances are the primary focus of care for eating disorders.

D

The primary goal of therapeutic management for the child with ADHD is to reduce the intensity and frequency of unsocialized behaviors.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1460

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

11. Which behavior demonstrated by an adolescent should alert the school nurse to a problem of substance abuse?

a.

States feelings of worthlessness

b.

Increased desire for social conformity

c.

Does not feel need for peer approval

d.

Deterioration of relationships with family members

ANS: D

Feedback

A

Feelings of worthlessness are suggestive of a depressive disorder. An adolescent with a substance abuse problem may be depressed, but this behavior is not a manifestation of substance abuse.

B

The clinical manifestations of substance abuse are marked by an increase in antisocial behavior as the desire for social conformity decreases and the need for the substance increases.

C

The adolescent with a substance abuse problem may demonstrate an excessive dependence on peer influence.

D

Deterioration of relationships with family members, irregular school attendance, low grades, rebellious or aggressive behavior, and excessive dependence on peer influence are behaviors that may indicate substance abuse.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1466

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

12. Which behavior verbalized by a school-age child should alert the school nurse to a problem of possible obsessive-compulsive disorder (OCD)?

a.

States feelings of worthlessness and sadness everyday

b.

Feels need to ride a bike around the tree in front of the house seven times every day before entering the house

c.

Recurrent episodes of chest pain, heart palpations, and shortness of breath when entering the computer classroom

d.

Deterioration of relationships with family members

ANS: B

Feedback

A

Feelings of worthlessness and sadness are suggestive of a depressive disorder.

B

Obsessive-compulsive disorder (OCD) manifests repetitive unwanted thoughts (obsessions) or ritualistic actions (compulsions) or both.

C

Panic disorders often cause recurrent episodes of chest pain, heart palpations, and shortness of breath. These symptoms may be accompanied by a feeling of impending doom.

D

Deterioration of relationships with family members, irregular school attendance, low grades, rebellious or aggressive behavior, and excessive dependence on peer influence are behaviors that may indicate substance abuse.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1453

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

13. Which finding noted by the nurse on a physical assessment is most suggestive that a child has been sexually abused?

a.

Swelling of the genitalia and pain on urination

b.

Smooth philtrum and thin upper lip

c.

Speech and physical development delays

d.

History of constipation, drowsiness, and constricted pupils

ANS: A

Feedback

A

Physical indicators of sexual abuse may include swelling or itching of the genitalia and pain on urination. Other indicators may include bruises, bleeding, or lacerations of the external genitalia, vagina, or anal area.

B

The infant with fetal alcohol syndrome may have microphthalmia or abnormally small eyes or short palpebral fissures, a thin upper lip, and a poorly developed philtrum.

C

Children who have been emotionally abused may exhibit speech disorders, lags in physical development, failure to thrive, or hyperactive and disruptive behaviors. Although there is a possibility for speech and developmental delays, these are not more suggestive of sexual abuse than swollen genitalia and pain on urination.

D

Opiates can cause detachment and apathy, drowsiness, constricted pupils, constipation, slurred speech, and impaired judgment.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1469

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

14. Which manifestation is atypical of ADHD?

a.

Talking incessantly

b.

Blurting out the answers to questions before the questions have been completed

c.

Acting withdrawn in social situations

d.

Fidgeting with hands or feet

ANS: C

Feedback

A

Talking excessively is a characteristic of impulsivity/hyperactivity.

B

Blurting out the answers to questions before the questions have been completed is an indication of the impulse control that is often lacking in children with ADHD.

C

The child with ADHD tends to be talkative, often interrupting conversations, rather than withdrawn in social situations.

D

Fidgeting is typical of the overactivity that is associated with ADHD.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1459

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

1. The parents of a teen suspect their child is using amphetamines. Manifestations of amphetamine use include (select all that apply)

a.

Weight gain

b.

Excessive talking and activity

c.

Excessive sleeping

d.

Insomnia

e.

Agitation

ANS: B, D, E

Feedback

Correct

Euphoria, hyperactivity, agitation, irritability, insomnia, weight loss, tachycardia, and hypertension are expected behaviors and effects of amphetamine abuse.

Incorrect

The adolescent using amphetamines is likely to have weight loss not weight gain. Excessive sleeping may be associated with alcohol abuse or abuse of barbiturates.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1465 | Table 53-1

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

2. A nurse working on the pediatric unit should be aware that children admitted with which of the following assessment findings are suggestive of physical child abuse? Select all that apply.

a.

Bruises in various stages of healing

b.

Bruises over the shins or bony prominences

c.

Burns on the palms of the hands

d.

A fracture of the right wrist from a sports accident

e.

Rib fractures in an infant

ANS: A, C, E

Feedback

Correct

Bruises in various stages of healing and burns on the palms of the hand may be indicative of physical abuse. Rib fractures in an infant are another indicator of physical abuse.

Incorrect

Bruises over the shins or bony prominences are seen in children beginning to walk. A fracture of the right wrist can occur as the child begins to participate in sports activities.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1468

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

3. The nurse is aware that suicide risk increases if the child displays which characteristics? Select all that apply.

a.

Previous suicide attempt

b.

No previous exposure to violence in the home

c.

Recent loss

d.

Effective social network

e.

History of physical abuse

ANS: A, C, E

Feedback

Correct

The risk of suicide increases if the child has had a previous suicide attempt, a recent loss, or a history of physical abuse.

Incorrect

No previous violence in the home or having an effective social network decreases the risk of suicide.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1457

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

COMPLETION

1. The rapid onset of physical, cognitive, and emotional symptoms that results in chest pain, shortness of breath, and the signs of impending doom is known as ________________.

ANS:

panic disorder

Also referred to as panic attacks. Before considering a diagnosis of panic disorder, organic causes should be ruled out. These may include hyperthyroidism, hyperglycemia, epilepsy, and mitral valve prolapse.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 1452

OBJ: Nursing Process: Assessment

MSC: Client Needs: Physiologic Integrity, Psychological Integrity

TRUE/FALSE

1. Bipolar disorder is characterized by chronic, fluctuating, and extreme mood disturbances. Onset for this disorder occurs most often during the late preschool to early school-age stage of development. Is this statement true or false?

ANS: F

Bipolar disorder occurs most often in late adolescence or early adulthood. Depression and lowered mood, alternate with episodes of the elation and aggression. Impaired social relationships are common.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 1454

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychological Integrity

2. Munchausen syndrome by proxy occurs when a person falsifies illness in their child. The pediatric nurse who is admitting a preschooler with this potential diagnosis understands that this is the most difficult form of child abuse to diagnose. Is this statement true or false?

ANS: T

This is correct. The most common reasons these caretakers give for seeking treatment for the child include: bleeding, seizures, central nervous system depression, apnea, vomiting, diarrhea, fever, and rash. The parents behavior reflects a serious psychiatric disturbance that requires both psychiatric treatment and removal of the child from their care.

PTS: 1 DIF: Cognitive Level: Application REF: p. 1470

OBJ: Nursing Process: Diagnosis

MSC: Client Needs: Psychological Integrity, Physiologic Integrity

 

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