Behavioral/Mental Health Conditions Flashcards
1. Identify assessments for the child with behavioral and mental health conditions. 2. Identify interventions for the child with behavioral and mental health conditions. 3. Discuss principles of safety for children with behavioral and mental health conditions.
Which of the following is accurate concerning adverse childhood experiences (ACES)?
a. The greater the number of ACES, the greater the risk of negative outcomes.
b. ACES that begin during the adolescent eyars have the greatest impact on health.
c. There is no difference in the experience of ACES among different ethnicities.
d. Although no physical health alterations have been associated with experiencing multiple ACES, many psychosocial effects have been linked.
a
The greater the number of ACES, the greater the risk of negative outcomes. ACES experienced chronically throughout childhood lead to toxic stress that can have a negative impact on physical as well as psychologicla health. Children of different races and ethnicities do not experience ACES equally.
Which ACES are most common among all races and ethnicities?
a. Emotional and physical abuse
b. Emotional and physical neglect
c. Parental separation and economic hardship
d. Substance misuse and metal illess
c
Parental separation and economic hardship are the most commonly experienced ACES.
Which of the following is accurate concerning human trafficking?
a. Women and children of both sexes are the primary victims.
b. Victims are more commonly from rural areas with limited access to urban resources.
c. The majority of victims have limited interaction with healthcare professionals.
d. It is one of the fastest growing industries in the world.
d
Human trafficking is one of the fastest growing industries in the world as it is highly profitable. Females in all age groups comprise most victims. Victims are commonly from urban areas with access to highways and waterways. Most victims have sought care from healthcare professionals while being trafficked.
A 14-year-old female has been brought into the emergency department after experiencing syncopal episodes. The child does not speak English but is accompanied by an adult claiming to be the guardian who is fluent in the child’s langugage and English. Which of the following is the best approach in caring for this child?
a. Have the guardian serve as an interpreter.
b. Use an interpreter to interview the child away from the guardian.
c. Use an interpreter to interview the child and guardian.
d. Speak slowly to the child to determine the child’s language abilities.
b
A child who does not speak English but is accompanied by an adult of different ethnicity who communicates for the child, may be a victim of human trafficking. Using an interpreter to interview the child away from the adult may result in the child sharing more information.
Which of the following raises the most concern for human trafficking?
a. A 16-year-old child with a tattoo of a current musical artist.
b. A 14-year-old child carrying her passport in her backpack.
c. A child accompanied by an adult who is inattentive and sleeping on the day bed.
d. A 17-year-old child with monogrammed initials tattooed on the ankle.
d
Although all factors need to be considered, having initials tattooed can be a form of branding and should be a red flag. Children who are victims of abuse often do not have access to items of identificationsuch as passports. Adults accompanying the vitims are usually attentive and do not leave the child alone.
A nurse providing information on trauma informed care begins the educational program by listing the principles of the approach. Which of the following is a principle to include?
a. Resuscitation
b. Safety
c. Paternalism
d. Prevention
b
Trauma informed care promotes a culture of safety, empowerment, and healing. Safety is one of the principles of the approach.
Which of the following children has the highest likelihood of developing resilience after exposure to trauma?
a. A child who attends a community youth group for children whose parents are incarcerated.
b. A child who is living in extreme poverty, who just earned an academic award.
c. A child who identifies as having a nurturing relationship with her father after her mother died from an intentional overdose of opioids.
d. A child who is leading a support group after witnessing a school shooting.
c
The presence of a nurturing adult is the strongest protective factor associated with developing resilience to childhood trauma.
What is resilience?
The presence of a nurturing adult is the strongest protective factor associated with developing resilience to childhood trauma.
The single most common protective experience seen in children that develop resilience is at least one stable and committed relationship with a parent, caregiver or other adult.
1. Focus on strengths/assets rather than deficits and risks of negative outcomes; try to succeed in the face of adversity.
2. Reduce risk factors while promoting protective factors.
Protective Factors
Are conditions that make one or more or less likely to engage in high-risk behaviors and deal with stressful conditions. These include:
* feeling connected to parents, peers, the school and community
* participating in extracurricular activities
* academic success
* self-confidence
* a sense or humor
* having respect for oneself, for others, and for the property of others
* coping and problem solving skills
A pediatric community health nurse is gathering data concerning violence by youth. Which of the following is accurate?
a. Self-inflicted injuries are included in the category of violence by youth.
b. Heterosexual youths are more likely to experience multiple forms of violence in comparison to sexual minority adolescents.
c. Children who are injured from fighting without the use of weapons are not included under the category of violence by youth.
d. Although youth violence is common, it rarely leads to death.
a
Self-inflicted injuries are included in the category of violence by youth. Sexual minority youth are more likely to experience violence. Fighting with or without weapons is categorized as violence by youth. Violence is a leading cause of death for youth.
A 3-year-old is admitted with a burn injury. Which of the following is typically associated with accidental burns?
a. A doughnut shaped burn to the buttocks.
b. A burn to one extremity with splash marks extending from distal to proximal.
c. A cigarette burn to the inner thigh.
d. A burn resembling a glove or a sock.
b
A burn that is isolated to one extremity with splash marks is typically associated with an accidental burn. Burn findings that include a glove, sock, or doughnut shaped markings are usually due to being forcibly held in hot water. While a cigarette burn may be accidental, one that is located to the inner thigh is suspicious of abuse.
A child is admitted with suspected Factitious Disorder Imposed on Another. To confirm the diagnosis, the nurse anticipates that the child’s diagnositc workup will include:
a. Coagulation factor analysis
b. CT of the head
c. Urine and blood toxicology screening
d. Skeletal survey
c
Factitious Disorder by Proxy involves fabricating or creating manifestations of illness in a child. A toxicology screen can potentially identify toxins administered to the child.
The pediatric nurse is caring for a child with suspected Factitious Disorder Imposed on Another. What characteristics are commonly displayed by the abusing parent?
a. Very demanding and uncooperative
b. Indifferent and uninvolved with the child
c. Nurturing to the child and cooperative with the staff
d. Friendly with the staff, but rarely present
c
In situations where Factitious Disorder by Proxy is present, the responsible parent typically appears nurturing and cooperative with the staff. The parent rarely leaves the child.
Which of the following is most often noted in a school aged child with anxiety?
a. Complains of a headache and stomachache.
b. Increased school performance due to social isolation.
c. Increaseed focus on one specific activity at the cost of other activities such as school.
d. Excessive time spent sleeping.
a
Children with anxiety often have somatic complaints such as headaches and stomachaches. Self-esteem and performance in school and other activities are usually decreased.
A 10-year-old female has been diagnosed with generalized anxiety disorder. The nurse recognizes that this will most likely be managed with:
a. Anti-anxiety medication
b. Cognitive therapy and anti-anxiety medication if needed
c. Allowing the child time to outgrow the behavior and reevaluating after puberty
d. Encouraging attendance at gorup therapy to promote the development of empathy toward peers
b
Generalized anxiety is managed with cognitive therapy by promoting self-esteem and teachingrelaxation techniques. Anti-anxiety medication is used, when necessary, in conjunction with cognitive therapy.
Which of the following is accurate concerning childhood depression?
a. Most cases of depression resolve with maturation.
b. A cause-and-effect relationship with stressors and manifestations of depression is more commonly seen in younger children.
c. Depressed children tend to blame others for negative events.
d. Manifestations of childhood depression are very similar to that seen in adult depression.
b
Young children commonly display a cause-and-effect relationship between stressors and manifestations of depression. Manifestations of depression in children are often different from those seen in adults and do not usually resolve with maturation. Depressed children tend to exhibit self-blame for negative events.
A care conference has been arranged for an 8-year-old child with depression. The child is not considered to be a suicide risk. The best management plan for this child is:
a. Individualized one on one outpatient counseling
b. Group counseling with children of various ages
c. Admission to the pediatric behavioral unit for in-patient counseling
d. Admission to the pediatric unit with a consult to the mental health team
a
The child with depression is best managed with individualized outpatient therapy. It is best to avoid removing the child from the home unless needed for safety.
Which of the following is true concerning non-suicidal self-injury?
a. There is an increased risk of completed suicides.
b. It is typically the result of a failed suicide attempt.
c. The behavior usually begins during early adolescence and increases throughout adulthood.
d. Injuries are usually in locations that are easily visible.
a
Children who participate in non-suicidal self-injury are at an increased risk of completed suicide. There is no intent of suicide associated with non-suicidal self-injury. The behavior begins during early adolescence but typically decreases during the adult years. Injuries such as cuts and burns are usually located in hidden but easily accessed areas.
Which of the following is the most common method of completed suicides among both male and female adolescents?
a. overdose of legal drugs
b. overdose of illegal drugs
c. firearms
d. strangulation
c
Firearms are the most common method of completed suicides in both sexes.
An adolescent has been receiving therapy for suicide ideation. Which of the following is reassuring?
a. The child appears to have sudden cheerfulness after depression.
b. The child talks about saving money for a concert that he wishes to attend the following year.
c. The child’s parents describe him as argumentative.
d. The child gave his ddrum set to a younger sibling.
b
Saving money for an event in the future shows that the child has hope for the future. Although cheerfulness may seem to be a positive sign, it is often seen when a child has decided to attempt suicide as there is a solution to the sense of hopelessness. Giving items away and being argumentative are associated with suicide.
The nurse is teaching a class about keeping children safe. One of the parents asks a question about teen suicide. Which of the following is accurate concerning suicide?
a. Girls are more likely to die from suicide than boys.
b. Boys are more likely to attempt suicide than girls.
c. Suicide is either the 2nd or 3rd leading cause of death among adolescents depending on race.
d. There are rarely warning signs.
c
Suicide is the second leading cause of death among Caucasian adolescents and the third leading cause of death among African American adolescents. Boys are more likely to die from suicide because they use more violent methods. Girls are more likely to make uncompleted attempts at suicide becuase they typically use less violent methods. There are usually many warning signs before a teen attempts to take his life. These include signs of depression and withdrawal.
A child is admitted for treatment of bulimia nervosa. When developing the plan of care, the nurse anticipates including interventions that address which metabolic disorder?
a. Hypoglycemia
b. Metabolic alkalosis
c. Metabolic acidosis
d. Hyperkalemia
b
The child with bulimia nervosa typically exhibits habits of binging and purging. Frequent induction of vomiting is a source of metabolic alkalosis as the acidic contents of the stomach are purged. So, one of the interventions for the child with bulimia nervosa is correction of fluid and electrolyte disturbances, particularly metabolic alkalosis.
The nurse is performing an assessment on an 11-year-old being evaluated for an eating disorder. She has lost a significant amount of weight and currently weighs less than 85% of her expected body weight. Which of the following would be expected in an eating disorder?
a. Tachycardia, hypotension, vague abdominal complaints, and diarrhea
b. Bradycardia, hypotension, vague abdominal complaints, and diarrhea
c. Bradycardia, hypotension, vague abdominal complaints, and constipation
d. Tachycardia, hypotension, vague abdominal complaints, and constipation
c
The child with an eating disorder enters a state of starvation where the body responds by slowing itself. Constipation with vague abdominal pain often results. The circulatory system responds with bradycardia and hypotension.
The nurse is caring for Kenny, a 17-year-old with severe bulimia. The nurse analyzes Kenny’s labs and is not surprised to find which of the following?
a. Metabolic acidosis, hyperkalemia
b. Metabolic alkalosis, hyperkalemia
c. Metabolic acidosis, hypokalemia
d. Metabolic alkalosis, hypokalemia
d
The child with bulimia loses excessive acid and potassium when he vomits causing metabolic alkalosis with hypokalemia.
Bobby is a 3-year-old being evaluated for autism. Which of the following would the nurse expect his mother to report?
a. Bobby likes to play with children who are much younger than him.
b. Bobby often rocks back and forth.
c. Bobby likes to stay busy and doesn’t do well with a rigid routine.
d. Bobby has periods of extreme lethargy.
b
Children with autism often comfort themselves with self-stimulating behavior such as rocking. They often prefer to play alone and do best with very structured routines. They usually experience extreme hyperactivity instead of lethargy.
A nurse needs to assess a 5-year-old child with autism. The child is playing with a toy car that he is holding and intently looking at. How should the nurse proceed with the assessment?
a. Tap him on the shoulder and say his name.
b. Take the car away and tell the child it will be returned at the end of the assessment.
c. Pick him up and put him in the nure’s lap for the assessment.
d. Sit three feet away from him on the floor and begin talking to him in a quiet voice.
d
The child with autism has difficulty engaging in interpersonal interactions. The best way to begin the assessment and establish therapeutic interaction is for the nurse to be present and attentive in his environment, while maintaining a physical distance.
